The agency will meet in September with interested parties to discuss a long-debated proposed registration for providers wishing to prescribe controlled substances via telemedicine without first conducting an in-person exam.
The US Drug Enforcement Administration may finally be open to giving healthcare providers more freedom to prescribe controlled substances via telemedicine.
The DEA has scheduled two public listening sessions, to take place on September 12 and 13, to discuss creating a special registration for providers who want to prescribe controlled substances without first conducting an in-person evaluation.
The notice marks a change in tone for the agency, which has long resisted creating that registration process even though it was mandated by Congress in 2008 through the Ryan Haight Online Pharmacy Consumer Protection Act. Telehealth advocates have long argued that providers should be able to prescribe certain medications without first needing an in-person exam as a way of expanding access to and treatment for mental health and substance abuse issues. Several members of Congress and the American Hospital Association have also chimed in, urging the DEA to take action.
Relaxed rules for prescribing controlled substances via telemedicine were included in waivers put in place during the COVID-19 Public Health Emergency, but the PHE ended in May. The DEA proposed a new set of rules set to take place after the PHE, then backtracked and extended the waiver for six months after those new rules drew strong criticism.
"Among the 38,369 comments submitted in response to the [proposed new rules] a significant majority expressed concern, with respect to at least some controlled substances, that the proposed regulations placed limitations on the supply of controlled substances that could be prescribed via telemedicine prior to an in-person medical evaluation," the DEA said in its meeting notice. "In addition, several hundred comments specifically raised the possibility of a separate Special Registration for those practitioners who seek to prescribe controlled substances without conducting an in-person medical evaluation of patients at all."
"DEA is open to considering—for some controlled substances—implementation of a separate Special Registration for telemedicine prescribing for patients without requiring the patient to ever have had an in-person medical evaluation at all," the agency continued. "DEA also observes that making permanent some telemedicine flexibilities on a routine and large-scale basis would potentially create a new framework for medicine that fundamentally expands access to controlled substances in a way that warrants a new framework for accountability based, in part, on increased data collection and visibility into prescription practices in order to ensure patient safety and prevent diversion in near-real-time."
With that in mind, the agency is asking those attending the upcoming meetings to consider the following questions:
If telemedicine prescribing of schedule III-V medications were permitted in the absence of an in-person medical evaluation, what framework, including safeguards and data, with respect to telemedicine prescribing of schedule III-V medications do you recommend to help the agency ensure patient safety and prevent diversion of controlled substances?
Should telemedicine prescribing of schedule II medications never be permitted in the absence of an in-person medical evaluation? Are there any circumstances in which telemedicine prescribing of schedule II medications should be permitted in the absence of an in-person medical evaluation? If it were permitted, what safeguards with respect to telemedicine prescribing of schedule II medications specifically would you recommend to help the agency ensure patient safety and prevent diversion of controlled substances?
If practitioners are required to collect, maintain, and/or report telemedicine prescription data to DEA, what pieces of data should be included or excluded? What data is already reported to federal and state authorities, insurance companies, and other third parties?
If pharmacies are required to collect, maintain, and/or report telemedicine prescription data to DEA, what pieces of data should be included or excluded? What data is already reported to federal and state authorities, insurance companies, and other third parties?
The head of innovation and product discusses why healthcare shouldn't mimic either Amazon or the banking industry, but it should harmonize with the music industry's transformation.
The path to healthcare transformation isn't an easy one, and there are many examples of how to do things wrong. A health system has to invest in leadership that knows how to plan innovation strategy and develop the technologies and services that show true value and improvement.
HealthLeaders recently sat down (virtually) with Brian Mullen, head of innovation and product at The Clinic by Cleveland Clinic, to get his take on how healthcare should be evolving and where healthcare providers should look for inspiration.
Q: How do you define innovation within healthcare?
Mullen: Innovation in healthcare is simply about moving the field forward to improve quality of life outcomes.
If you’re involved in digital transformation at a healthcare organization, one of the first assumptions you need to abandon is the view that healthcare isn’t innovative. Healthcare is by far the most innovative industry in the world today. Considering the different stakes involved in healthcare and other technology delineates this point quite clearly: The challenges in healthcare aren’t often simply a matter of incremental improvement but more likely involve earth-shattering paradigm change like curing cancer, replacing a heart, or developing and deploying a vaccine to millions of people in a matter of mere months.
Brian Mullen, head of innovation and product at The Clinic by Cleveland Clinic. Photo courtesy The Clinic by Cleveland Clinic.
An app, which is the sort of innovation we’re seeing in many other industries, doesn’t cure anything, nor does it change a terminal illness to a chronic condition yet. Digitalizing and automating existing processes and interaction is impactful but not the only way to innovate.
Q: You've said that the future of healthcare will look more like the music industry rather than banking. What do you mean by that?
Mullen: We’ve heard people for years say that 'Healthcare needs to be like the financial industry.' But do you really love your bank? Why in God’s name do we want healthcare to look like banking?
Frankly, the analogy has gotten us incremental change. We may have an app now that can remind us of an appointment or allow us to pay an outstanding bill, but that doesn’t move the needle on an individual or population’s health. Chronic care programs essentially just remind people to do things, which is helpful but limited. Healthcare has focused so much on automating transactions the same way that banks do, but it hasn’t transformed into true impact to patients like we see in other areas of healthcare innovation like biotech, medtech, etc.
The reason I think the future of healthcare may and should look more like the music industry is because of the advances we’ve seen in music in both alignment that serves the interest of all key stakeholders and personalized services for the consumer.
For instance, years ago you had to buy a whole CD for $15 to get the one song you wanted. Napster and others created ways for customers to get the music they wanted when they wanted it, but free music didn’t work for the labels or the artists. Apple found a way to offer songs for $1 that made customers happy and worked for the labels and artist. It was a solution that benefited everyone.
The next generation of the music industry aims to deliver more personalized experiences. Both Apple and Spotify, as well as other services like Pandora or Deezer, are leveraging historical data and predictive algorithms to anticipate the sort of music you might like and recommend it.
In healthcare, finding solutions that provide value to all parties—patient, provider, and payer—are positioned to deliver better patient outcomes, higher customer satisfaction, and more efficient business models for everyone involved. Once the alignment happens across parties, will we be able to offer customized personalized services to patients that will support and enable them to improve their care.
Q: What are the biggest challenges or barriers you see to healthcare innovation?
Mullen: Better regulatory structures are critical, especially when it comes to patient access. Other than healthcare, I can’t think of any other major industry where you can’t access services across state lines.
The good news is healthcare has already shown its ability to adapt and change radically. During the COVID-19 pandemic, for instance, the number of telehealth appointments in the nation grew close to 800%, according to the National Institutes of Health, and telemedicine is now a permanent part of our healthcare landscape.
That’s important. I live in Boston, where within 10-15 miles I have top-class medical specialists of every sort easily available to me. But for most of the world it's not like that, and I expect the growth of telehealth to be a key enabler in breaking down access to care.
Overcoming this lack of access is core to our mission at The Clinic. Our mission is to increase access to the world's best clinicians anywhere in the world. It shouldn’t just be limited to those lucky enough to live in a few select geographic locations like Boston and Cleveland.
Q: How should traditional healthcare organizations react to the emergence of new, direct-to-consumer participants in the healthcare space like Amazon, Google, Walgreens, and others?
Mullen: The call for healthcare delivery to 'be more like Amazon' is getting louder. But as someone who is deeply entrenched in digital health, I can tell you the 'Amazonification' of healthcare might not be what we want.
Amazon is a master of distribution. It delivers but doesn’t exercise much control on the quality and services provided through its marketplace. In healthcare, the platform to use for care delivery is only as good as the care itself. A great digital platform with sub-par providers is still a sub-par solution. Digital transformation to increase access isn't enough.
Trust is critical in healthcare. Patients need to trust they are getting the best advice and aren't being upsold. We work every day at The Clinic to make sure we are increasing access to the world’s best, but we're also delivering quality and building trust with our customers. If the patient has trust in the quality, then they can have the confidence and peace of mind they are seeking when getting a second opinion.
Healthcare institutions are increasingly realizing that preserving brand quality plays an essential role in successful digital transformation. Healthcare’s future relies on change that will come from collaborations with tech companies and key players in the healthcare system. Just like what transformed the music industry: When tech companies like Napster made changes without the rest of the industry following suit, it failed, but when Apple aligned their tech with the broader music industry there was a paradigm change where the customer won.
Q: The Clinic by Cleveland Clinic was launched via an intriguing partnership between the Cleveland Clinic and Amwell. How has this partnership helped the health system?
Mullen: What’s been fantastic about our partnership is how fully it’s helped both patients and providers. The Cleveland Clinic has a vast team of world-class providers in almost every specialty you can imagine. The Amwell platform enables us to deliver a connected digital care experience to the patient and providers
Patients love it because they now have a chance to get a second opinion consult by one of the world’s best specialists or subspecialists from the comfort of their home without traveling, which wasn’t possible just a few years ago. Providers like it, and consistently give us high scores, because they feel empowered and engaged, and they know they are having an impact on people who don’t have access to the highest quality of care.
Q: What new technologies or strategies are you hoping to use in the future? What's on the horizon for healthcare innovation?
Mullen: I am particularly excited about the use of AI and data analysis. I think we’ll soon see solutions that will support doctors in offering patients highly personalized and accurate diagnoses, treatments, and medications. I also think AI has a huge opportunity to improve safety in healthcare by helping to detect things like negative drug interactions at an individual level.
A challenge for healthcare—and an opportunity—that comes with assimilating and analyzing the huge amount of data we have available today is streamlining the presentation of it in personalized ways to provide better dashboards, portals, and medical device interfaces that offer patients fast, understandable updates on their condition. In addition, how do we ensure that historical bias isn’t further amplified in the AI tools that we build?
Q: What has surprised you about healthcare innovation to date, good or bad?
Mullen: There is so much good. I’m fascinated by it. Today we have things many of us couldn’t imagine as kids: artificial hearts and kidneys. Face transplants. More medications to help turn potentially fatal ailments into chronic diseases, the number of cancers we can now cure, and a whole set of more proactive and personalized ways to treat chronic disease.
Most strikingly in recent history has been the almost overnight ramp-up of telehealth to serve populations everywhere during the pandemic. We’re no longer tethered geographically to the medical experts within just a few miles of where we live.
The downside, perhaps, is that with the proliferation of modern information we’ve had so many innovators, and we now have thousands of apps out there for each different condition. I’d like to see us get to a place where a patient who has, say, diabetes and heart problems will have a single app to manage both and have information presented to them in a way that’s easy to understand, helpful, and motivating. We’ve made a lot of improvements in providing a better patient experience, but I think we have a lot of room for improvement, too.
Q: How do you see The Clinic by Cleveland Clinic evolving?
Mullen: I am tremendously excited to see faster development of both our national regulatory structure and our national insurance payer models, which I know will facilitate the simpler, faster, more affordable, and more widespread use of telehealth.
The tools we have today in telehealth can provide expert access at the right time to people in need to provide both peace of mind and the best care available, but we’ve only begun to make that promise available nationally and internationally. I think we have some very exciting years ahead that will make both patients and providers much more satisfied with our healthcare system.
The two organizations, members of the Coalition for Health AI, have forged a five-year partnership built around the new Duke Health AI Innovation Lab and Center of Excellence.
Duke Health and Microsoft are aiming to get ahead of the AI wave with the launch of an AI Innovation Lab and Center of Excellence.
The two organizations announced a five-year partnership this week "aimed at responsibly and ethically harnessing the potential of generative artificial intelligence (AI) and cloud technology to redefine the healthcare landscape."
The news comes as healthcare organizations across the globe are experimenting with AI and as federal and state governments, tech firms, and health systems grapple with how to oversee the technology. Just last month, the White House and the heads of several major tech companies—including Microsoft—announced a non-binding commitment to responsibly govern how AI is developed and used.
The Duke-Microsoft collaboration aims to give the healthcare industry a place to forge those standards.
"The partnership is a milestone in the evolution of digital healthcare," Jeffrey Ferranti, MD, senior vice president and chief digital officer of Duke Health, said in a press release. "Our unrivaled expertise in data science, patient care, and technology innovation synergizes perfectly with Microsoft's healthcare solutions and AI technology. Together, we are poised to propel Duke into the forefront of digitally focused health systems, while simultaneously studying the reliability and safety of generative AI in healthcare."
Through the partnership, Duke Health will use Microsoft's Azure cloud platform to develop AI-based programs to support healthcare services, both administrative and clinical.
“Microsoft is excited to collaborate with Duke Health to operationalize responsible AI principles, helping to ensure that AI is deployed safely, effectively, and in an unbiased and transparent manner,” David Rhew, MD, Microsoft's global chief medical officer and vice president of healthcare, said in the press release. “Together we will apply the latest Microsoft technologies to expedite and scale Duke Health’s nationally recognized model of AI governance. By sharing best practices and lessons learned, we hope other organizations will benefit from our experience.”
Microsoft is also looking to get a handle on telehealth applications. Last month, the company announced a partnership with Teladoc to use AI to help streamline administrative challenges and documentation in virtual care.
The Maryland-based health system's vice president and chief innovation officer says healthcare must create platforms that connect patients to the resources they want and need.
To William Sheahan, the future of healthcare lies in connected care.
That's not exactly a new idea, says the vice president and chief innovation officer of MedStar Health, a 10-hospital, 300-plus-site health system centered in the Baltimore-Washington D.C. area, and executive director of the MedStar Institute for Innovation. But it is rooted in change management and focused on the redesign of traditional healthcare practices.
And that's a lot to swallow for an industry that hasn't quite caught on to consumer-based care.
"We have a lot to learn from other industries," he says. "I think we need to do a lot more to … improve the patient experience."
William Sheahan, vice president and chief innovation officer at MedStar Health and executive director of the MedStar Institute for Innovation. Photo courtesy MedStar Health.
For connected care to work, Sheahan says, healthcare organizations need to understand where and why those connections are necessary. Healthcare is moving away from the idea of having the patient go to the care provider and toward "the distribution of expertise using technology," whereby the provider connects with the patient, either in person or through virtual channels.
"We need to meet patients where they are," he says.
Sheahan, whose career includes time spent as a paramedic, educator, and chief officer of an emergency services organization, joined MedStar Health in 2013 as executive director of the MedStar Health Simulation Training & Education Lab (SiTEL), then took over the MedStar Telehealth Innovation Center in 2017, just in time to guide that group's exponential growth during the pandemic.
He's part of a wave of innovation and transformation leaders at healthcare organizations across the country who are taking lessons learned from the COVID-19 crisis to advocate for systemic change in a struggling industry.
"We have to look at each service line … [and] deconstruct and reconstruct it with digital care" as one of the core components, he says.
That's because consumers are demanding more convenient access to care, he says, through channels that allow them to see information (including their health data) and care providers when and where they want. If a health system or hospital is reluctant to offer those services, he says, those consumers will shop around for other care providers.
And that marketplace is growing. Retail giants like Amazon and Walmart, health plans, telehealth companies with their own cadre of doctors, and others are staking a claim in the healthcare sandbox, offering convenience and lower costs.
Sheahan says MedStar Health, like all other health systems, is faced with a "transformation imperative" that goes beyond consumerism. Operating margins are razor-thin, healthcare costs are too high, and the workforce is struggling with stress and burnout and shrinking. Health systems from the top down need to be aligned to address those issues with new ideas and technologies, including drawing ideas that have worked in banking, retail, travel, and hospitality.
"Why can't we have an experience like a Marriott or a Hilton?" he asks.
That's where efforts like the MedStar Institute for Innovation come into play. Sheahan says the center helps create a culture of innovation within the health system, creating an environment for unique ideas to improve both business workflows and clinical outcomes; which are both integral to establishing a new healthcare paradigm. Novel ideas and technologies that improve business processes and reduce stress and workflow issues for staff will, in turn, improve the patient experience and boost clinical outcomes.
"There is a lot of opportunity for automation and efficiency," he says, noting the integration of AI and analytics tools at the back end and the slow-and-gradual development of generative AI.
To address workflow shortages, particularly in the nursing ranks, Sheahan says MedStar Health needs to rethink how technology is used in the hospital setting. Concepts like interactive TV sets in patient rooms, virtual nursing (also known as telesitting), and wireless sensors that drive the "hospital room of the future" not only improve patient engagement and satisfaction but help nurses and other staff improve their outcomes and outlook.
That's not to say every innovation finds a place in the healthcare setting. Health systems like MedStar Health don’t have endless amounts of money to spend on bright new ideas.
"Investments have to be well rationalized," Sheahan says. The "burden of technology on the workforce" means that new tools must prove their value before being embraced.
Sheahan says MedStar Health can be a national leader in connected care, and points to an ongoing collaboration with Intermountain Health and Stanford Medicine as evidence. The three health systems, supported by the Agency for Healthcare Research and Quality (AHRQ), have formed the Connected CARE (Care Access, Research, Equity) & Safety Consortium to dig deeper into how healthcare organizations can use technology to connect patient and providers.
"There's a focus on building technology with our partners that will really drive this transformation," he says.
And that, he says, is how healthcare can and should evolve.
An ONC data brief finds that most hospitals are collecting data on social determinants of health, and many are using technology to gather that information, but a lot fewer are collecting that data regularly.
More than 80% of hospitals recently surveyed by the American Hospital Association are collecting data on social determinants of health (SDOH), many through their EHR platform and health information exchanges. Yet only half of those hospitals are collecting data regularly.
Social determinants (or drivers) of health are non-clinical factors that can affect one's health and wellness, including family and housing issues, employment, transportation, food insecurity, and cultural and societal pressures.
"If left unaddressed, the social needs experienced by an individual may lead to poor health outcomes and more time spent in hospitals and interacting with the healthcare system," ONC staffers Wei Chang, Chelsea Richwine, and Samantha Meklir wrote in a recent blog post accompanying the ONC data brief. "Hospitals, therefore, are uniquely situated to help address social needs and mitigate social risk factors by screening for social needs, assisting with transitions of care, and making connections to social service organizations."
According to the AHA survey, administered in 2022, some 83% of hospitals are doing just that, with nearly 75% using a structured screening tool to collect that information, 36% using free-text notes, almost 30% using diagnosis codes, and 20% using non-electronic methods.
Some 60% of hospitals collecting SDOH data are getting some of that information from external sources, the survey found. Those sources include HIEs (46%), other healthcare organizations (28%), social service or community-based referral platforms (22%), and community/social service organizations (18%).
As for how they're using the data, 72% of hospitals collecting SDOH are using the information to inform discharge planning, while 67% cited clinical decision-making, and 65% cited referrals to social service groups. In addition, 48% of the hospitals are using the data for population health analytics, 46% to inform community needs assessments or other equity issues, and 42% for quality management purposes.
These tools and tactics are crucial to improving access to care and clinical outcomes among underserved populations, yet the survey finds that healthcare providers serving those populations aren't necessarily addressing SDOH.
According to the survey, 54% of hospitals collecting SDOH data are doing so on a regular basis, yet lower-resourced providers, such as small, critical access, rural, and independent hospitals, were "significantly less likely" to regularly collect data.
In their blog, Chang, Richwine, and Meklir note that the Centers for Medicare & Medicaid Services (CMS) recently added two SDOH data elements to the Inpatient Quality Reporting (IQP) program. That's one step in the right direction toward compelling providers to collect and use that data.
"While much attention has been devoted to screening—a critical first step to understanding patients’ health-related social needs—additional focus is needed on effective usage of data collected through screening since not all patients who screen positive for social needs are successfully connected to the resources they need," they wrote. "This may be attributable to a number of challenges providers face in using social needs data, including a lack of standardized referral processes and sustainable financial resources, which speaks to a need for building partnerships with community-based partners and increasing their capacity to respond at the community level, and tracking changes in health outcomes following the identification of social needs."
"Looking ahead, more work is needed to capture social needs data in an actionable way so that this information can be used to support shared decision making and address social needs, with the ultimate goal of improving individual and population health," they concluded.
A new study finds that a third of providers surveyed are using digital health to treat OUD and substance abuse, yet the tools aren't being used to expand treatment or reach those who need help.
Digital health tools are increasingly becoming the weapon of choice for healthcare providers treating patients living with opioid use disorder (OUD), according to new research from several New England healthcare organizations.
But that weapon isn't being used as well as it could be.
More than a third of health systems with accountable care organization contracts are using at least one type of technology, including remote patient monitoring and on-demand support tools, says a study recently published in JAMA Network Open. Oftentimes those tools are used alongside the traditional treatment path of in-person care, suggesting that those using the technology are doing so because they can, rather than because they need to.
"Our results suggest that digital health technologies for OUD are more likely to be deployed by organizations with relatively robust traditional SUD treatment resources," the study, conducted by researchers from Harvard, Yale, Dartmouth, UnitedHealthcare and Beth Israel Deaconess Medical Center, concluded. "As such, the technology appears to complement existing SUD treatment resources rather than substitute for unavailable SUD treatment resources."
OUD and substance abuse combine to form one of the nation's most devastating health concerns, one that has been increasing in the wake of the pandemic. The issue is complicated by the fact that many patients conceal their problems or avoid medical treatment, as well as the fact that many are also living with behavioral health issues in need of treatment.
The study, drawn from a 2021-22 survey of 505 ACOs, of which 276 responded, finds that 33.5% of those responding are using some type of technology, such as virtual mental health therapy and tracking, virtual peer recovery support, and digital recovery support for adjuvant cognitive behavioral therapy (CBT). Just as important, that percentage increased among providers with a dedicated addiction medicine specialist or a registry to track mental health.
That's an important distinction. Digital health has long been considered an import platform to reach patients who either can't or won’t access healthcare providers for treatment. This means providers can and should be using these tools to connect with people who they might otherwise not treat or who would skip treatment. The study suggests that providers are using the technology to bolster care for patients they're already treating, and that providers who already focus on OUD and substance abuse care are using the tools.
"Organizations with substantial resources may have the ability to effectively integrate digital services," the study reported. "On one hand, organizations can extend treatment provided by their clinicians through mobile tools to track mental health symptoms remotely. On the other hand, technologies could substitute for insufficient SUD resources to meet clinical demand for patients with OUD. If technologies are primarily available in organizations with robust SUD treatment resources, then they are not yet reaching their full potential to advance access to care for patients with unmet needs in organizations without traditional treatment alternatives."
Therefore, for digital health to really have an impact on OUD and substance abuse treatment, it has to be used to reach those not receiving treatment. As well, this technology has to be made available to more healthcare providers who haven't traditionally treated patients with OUD or substance abuse issues but who can, including primary care providers and rural and community health clinics.
The study offers suggestions for expanding use of the technology to more organizations, as well as addressing health equity concerns.
"Our findings suggest a mismatch between need and deployment," researchers pointed out. "Organizations with fewer SUD treatment resources were less likely to adopt emerging technologies. To address this mismatch, policy initiatives could focus efforts on overcoming barriers to technology implementation in high-need, resource-limited healthcare settings. For example, policy makers and payers might test policies and reimbursement schemes that support health care organizations without local SUD treatment resources to integrate digital health technologies for OUD into their practices and workflow."
"Initiatives to advance the uptake of technologies may address costs, knowledge, user engagement, organizational culture, leadership, interoperability, and data security concerns," the study continued. "Training and education for patients and clinicians may be a productive avenue to increase adoption. For example, Kaiser Permanente used both clinician referrals and direct-to-patient approaches to drive service use during a large-scale integration of digital mental health technologies. Future efforts may require investing in trained staff, such as digital navigators, to support patients and clinicians to overcome technological, workflow, and digital literacy constraints. Digital navigators offer an opportunity to overcome both patient- and staff-level barriers to technology use even in low-resource settings."
The implication is that while digital health is being used to address the substance abuse crisis, it could be used much more effectively, not only as a complement to existing programs but as a platform for more providers to reach more people in need of help.
The Oakland-based payer with about 4.8 million members has announced a partnership with Microsoft to build an integrated data hub, called the Blue Shield Experience Cube, on Microsoft's Azure cloud platform. Officials say the hub will enable payers, providers, and other parties to access usable data more quickly and efficiently to streamline and improve care management for members.
“Our goal is to create high-tech, high-touch experiences for our members that are holistic and personalized by removing longstanding silos and bringing together data in the cloud,” Lisa Davis, BSC's executive vice president and chief information officer, said in a press release. “Microsoft’s cloud technology can help Blue Shield better coordinate with providers to open up greater access to care and services for our members. When data is available in near real-time, it enables shared decision-making among members and providers to improve health outcomes and reduce the cost of care.”
The news follows an announcement in May of a collaboration between BSC and Google Cloud to pilot an AI program aimed at expediting the prior authorization process.
“We want to help ease the administrative burden on our healthcare providers so they have more time to deliver the best care possible," Davis said at that time "Leveraging Google Cloud technologies and artificial intelligence, we are working to ensure our members get timely access to clinically necessary care and services."
With Microsoft, BCS is now turning its attention to improving the care journey for its members. The first project to be launched through the Blue Shield Experience Cub will be the development of an integrated digital health record, which will include a member's health information, medications, labs, ER visits, healthcare utilization, plan coverage, and other data.
"The information brought together by the Experience Cube will facilitate more data-driven care coordination to recommend actions that help members through transitions of care or prompt Blue Shield care managers to create programs that connect members to resources that address social determinants of health," officials said in the press release.
BCS has already moved some of its services into Azure, reportedly enabling the health plan to process billions of transactions in weeks instead of months. Future plans include expanding the capabilities of the Experience Cube to integrate more data, including costs of healthcare services, and incorporate AI tools.
Mainstay Life Services, which offers support for people with intellectual and/or developmental disabilities in Pennsylvania, reduced ER and urgent care clinic visits and improved clinical outcomes through virtual care.
A Pennsylvania-based support provider serving people with intellectual and/or developmental disabilities (I/DD) has reportedly saved almost $100,000 in emergency care costs over the past two years through telehealth.
Pittsburgh-based Mainstay Life Services, which currently supports roughly 400 people and their families across 42 sites, has partnered with New Jersey-based StationMD, which offers specialized telehealth services for people with I/DD in 21 states. Through that collaboration, StationMD has facilitated 245 telehealth visits over that two-year span.
According to a press release issued by StationMD, 92% of those visits were resolved without need of a medical transport, and 27% of those visits (67 visits) would have resulted in transport to an ER or urgent care clinic had telehealth not been available. This resulted in a savings of $98,758 in reduced hospital and emergency care costs.
“People with I/DD often have complex medical issues in addition to their underlying disability diagnosis," Maulik Trivedi, MD, FACEP, co-founder and chief strategy officer for StationMD, said in the press release. "Our clinicians are able to address and resolve over 90% of the medical concerns via our telehealth solution. We’re providing a backbone of care and serving as a critical medical resource 24/7 for individuals, families, and support staff.”
The savings point to the value of virtual care for a specific population that faces extra challenges in accessing healthcare. Whether living at home or in a structured setting, people with I/DD often need specialized care and aren't able to easily visit a doctor's office or clinic.
"Research shows that organizations have increased their use of telehealth technologies to better serve individuals with I/DD," the brief states. "Some reported benefits of telemedicine for people with I/DD include lower cost of care, lower transportation costs, improved medication reconciliation communication, and less exposure to communicable diseases especially during the [COVID-19 Public Health Emergency]. By assessing the impact of telehealth on individuals with I/DD, healthcare providers can continue to adapt and innovate ways to better serve people with I/DD through the use of various telehealth modalities."
According to a separate RIC brief, a 12-month pilot partnership in 2018 between StationMD and New York's Partners Health Plan resulted in 679 telehealth visits, of which 90% were resolved without need for further medical care. That, in turn, saved Partners $2.2 million in ED and hospitalization costs, $20,800 in transportation costs and $1,900 per member in medical costs.
Mainstay, which has increased its use of telehealth services by 288% since January 2022, plans on expanding its relationship with StationMD. They also plan to talk about the partnership at the 2023 Rehabilitation & Community Providers Association (RCPA) conference this October in Hershey, Pennsylvania.
“StationMD has helped the people we support to connect immediately from the comfort of home with doctors who understand them best," Kim Sonafelt, Mainstay's chief executive officer, said in the press release. "We’re seeing better health outcomes. Their team is happier, and the cost-savings allow us to offer better services.”
The hospital has created a high-tech command center to monitor patient progress through the hospital and address any pain points and potential care concerns.
As healthcare organizations across the country embrace telemedicine and digital health platforms within the hospital, they're creating high-tech command centers to manage all those new connections and capabilities.
One of the latest is Children's Mercy Kansas City, which partnered with GE HealthCare to craft a NASA-inspired Patient Progression Hub, a 6,000-foot "mission control center" that allows care providers to track a wide range of services, from patient care and supply chain to weather and traffic beyond the hospital's walls.
"It gives us a complete look at the patient as well as the surrounding community," says Stephanie Meyer, the health system's senior vice president and chief nursing officer. "We're looking at the entire patient flow instead of just a piece of it."
The hub brings together many of the new technologies that comprise healthcare innovation strategy these days, including remote monitoring, audio-visual telemedicine, predictive analytics and AI, and technologies built into the EMR platform that allow administrators to monitor a patient's progress through the hospital from admission to discharge.
The strategy is an expansion of the central nurse's station on a patient floor, where nurses could keep an eye on many patient rooms through connected devices and audio-visual telemedicine feeds. That idea gained value during the pandemic, when health systems looked to monitor contagious patients without sending nurses or other staff into each room.
Today's command centers are much larger, monitoring more than one wing, even entire hospitals. Some are located in large rooms built for that purpose, while other health systems are carving out empty space left over from previous expansions or even in nearby office buildings or warehouses. The development of wireless monitors, expanded connectivity, and more sophisticated telemedicine platforms gives health systems more opportunities to gather data and track patients and staff from a distance.
Meyer and Jennifer Watts, MD, an emergency medicine physician and Children's Mercy Kansas City's chief patient progression medical officer, says the hub took several years to design and build and involved input from many different departments and people, from IT staff to nurses.
While some parts of the hub were tested out over the past half-year, the hub officially opened in April. And it comes at a perfect time, as healthcare leaders look to virtual care technology to reduce stress and burnout among staff and create more engaging workflows.
"For a long time people were just fixated on what was right in front of their faces," Watts says of the hard times caused in no small part by the pandemic. "We wanted to get all of our [employees and staff] to look up and see things from an enterprise level. The processes we could make easier, the workflows we could affect. We wanted to make things meaningful again."
The hub features a video wall containing customized apps, or tiles, to monitor the flow of patients through the health system. Those working in the hub can drill down and follow specific patients, look at staff schedules and scheduled services like labs and tests, even manage open beds and identify bottlenecks. Data analytics and AI tools on the back end track not only current activity but plan out future tasks, identifying surges and problems before they affect staff or patient care.
"Prior to implementation, the organization relied on manual processes and often retrospective data to understand patient census and anticipate discharges," Jodi Coombs, MBA, BSN, RN, Children's Mercy's executive vice president and chief operating officer, said in an April press release announcing the hub's opening. "Now we have visibility into operations across the entire system to make faster and smarter complex decisions as soon as vital workflows change. The Patient Progression Hub journey enables endless possibilities for using real-time data to drive actions that deliver excellent patient care and supports our team members."
Watts and Meyer say the NASA-inspired command center can be intimidating at first because of the high-tech look and feel, and that caused some trepidation among nurses and staff members who would be working there. Many of those people were brought into the planning stages early on to add input on how the technology and layout could be designed to be less intimidating.
"This is a very complex, multi-faceted technology," Meyer says. "It involved a lot of buy-in and training on how to interact with everything."
The benefits, meanwhile, are numerous—and discovered on an almost daily basis. Patient care is coordinated and streamlined right up through an expedited and more efficient discharge process, which reduces stress for staff as well as patients and their families. If a patient is showing signs of distress or his or her data is trending in the wrong direction, a nurse in the hub can identify that concern and take action before it becomes an emergency. Even external issues like dangerous storms, accidents, and traffic jams are monitored so that the hospital can prepare for new patients.
"We're looking at the future of pediatric care," says Meyer. "And it gives [staff and employees] a renewed hope in the future of healthcare."
Meyer says Children's Mercy Kansas City will add new technologies and capabilities in time, including more AI and predictive analytics tools, remote patient monitoring programs that extend from the hospital to the home, and wearables and other digital health tools.
We're going to do things that we haven't even thought of yet," says Watts. "We're just starting on this journey."
The Virginia hospital will use an analytics platform integrated with its EHR to track patient feeding metrics, identify pain points, and offer best practices to improve staff workflows and clinical outcomes.
A children's hospital in Virginia is integrating digital health technology into its neonatal intensive care unit to improve care management for preterm babies and infants with acute medical conditions.
The partnership between Roanoke-based Carilion Children's Hospital and Astarte Medical will enable NICU staff to access the latter's NICUtrition platform, which analyzes patient feeding practices and outcomes to identify feeding protocol effectiveness, patient risk factors, and best practices that can positively impact patient outcomes.
The technology, which will be integrated with the hospital Epic electronic health record platform, is critical to a 60-bed hospital that typically operates at or close to capacity.
NICUtrition "is able to reflect both longitudinal and real-time patient feeding and growth metrics that help our care teams make evidence-based decisions," Dena Goldberg, PhD, RDN, a clinical dietitian and neonatal specialist at Carilion Children's Hospital, said in an e-mail to HealthLeaders. "Because the platform streamlines data-gathering, we no longer have to collect nutrition and growth outcome data by hand and then use statistical software to analyze it. It's not replacing any jobs but augmenting our teams and reducing the burden placed on resources."
The fast-paced, stressful environment of an NICU often puts high demands on staff who are monitoring frail babies and tracking key vital signs and metrics every hour, if not more often. Digital health tools that can accessed through the EHR can help with that data gathering and analysis, offering crucial clinical decision support when and where needed.
Goldberg said the technology will be evaluated over the next 3-6 months to see how it affects daily workflows as well as clinical outcomes. That research may be used to help expand the platform to other areas of pediatric care, including cardiac care and cerebral palsy.