Researchers have found that telehealth performed better than in-person care in 11 of 16 HEDIS quality performance measures, but that doesn't mean virtual care is superior to the office visit.
New research published in the Journal of the American Medical Association (JAMA) finds that telehealth was superior to in-person care in 11 of 16 quality performance measures for primary care.
The study, conducted by researchers at the Robert Graham Center in Washington DC and Pennsylvania-based Wellspan Health, focused on more than 526,000 patients receiving healthcare services at roughly 200 Wellspan Health outpatient sites between March 1, 2020, and November 30, 2021, and used HEDIS (Healthcare Effectiveness Data and Information Set) measurements.
The researchers, led by Derek Baughman, MD, of the Robert Graham Center and Wellspan Good Samaritan Hospital in Lebanon, Pennsylvania, and Yalda Jabbarpour, MD, and John Westfall, MD, MPH, both of the Robert Graham Center, said the results don't mean that health systems should close their clinics and focus on virtual care. Rather, they should offer telehealth as a part of the overall care plan, particularly for those who face barriers to accessing in-person care.
The study noted that in-person care showed better results for all medication-based measures, while telehealth offered better results in testing and counselling measures, such as vaccinations, chronic disease testing, and cancer and depression screenings.
"Notwithstanding the statistical significance, the clinical relevance of these findings is perhaps more meaningful at the population health level for evaluating the outcomes of adding telemedicine as a care venue," Baughman and his colleagues noted. "Moreover, telemedicine exposure (especially blended office and telemedicine care) likely simulates a likely real-life scenario for the health consumer."
"Practically, these findings provide reassurance for health entities seeking to add telemedicine to their care capacity without reducing quality of care," they added. "And as we found, embracing telemedicine for enhancing certain aspects of care might be an avenue for enhancing quality performance in primary care."
Baughman and his team said it wasn't clear why telehealth outperformed in-person care, though they noted that a telehealth platform offers better opportunities for care providers to reach out multiple times to patients to "engage in quality measure-promoting intervention." They also noted that some treatments, such as the initiation of a lifelong or life-changing medication program, are best begun in person, and perhaps shifted to virtual platforms for follow-up.
"Future studies could provide more granularity on optimizing the specific role of telemedicine in clinical scenarios, eg, understanding whether there is an association between stages of hypertension and effect modification attributable to the management venue or an association between venue and number of blood pressure medications," they wrote. "This would provide insight on where to invest in health care infrastructure and what clinical venue would be most valuable. This could also guide venue selection for patients initiating antihypertensive therapy vs patients requiring a third antihypertensive. Such insight would promote win-win environments to increase value: improved health outcomes for patients and incentive for clinicians and health systems operating in value-based care models."
The Jacksonville health system is deploying two life-sized (and selfie-capable) robots designed to perform tasks for staff and care providers that would otherwise take them away from the bedside.
Jacksonville, Florida-based Baptist Health is using a robot to improve clinical workflows and give patients and visitors 'someone' to snap selfies with.
Baptist Medical Center Jacksonville and Wolfson Children's Hospital have deployed Moxi, developed by Austin, Texas-based Diligent Robotics, to help staff and care providers with tasks that might otherwise take up time away from patients, such as transporting equipment and lab samples and even picking up items left for patients at the front desk.
“Today, our team members spend time retrieving and gathering supplies, medicine and patient items,” Tammy Daniel, DNP, Baptist Health's senior vice president and chief nursing officer, said in a press release. “Moxi’s support will allow them to focus on people as opposed to tasks, and on what they do best: patient care.”
The adult-sized robot, equipped with a gripper at the end of an arm, uses AI technology and an array of sensors to navigate busy hallways without bumping into objects or people, can maneuver through doors and elevators, and learns as it goes. Hospital officials also describe it as "intelligent, dedicated to its job, has expressive eyes, and is happy to pose for selfies."
“We are continually looking for innovative ways to support our team in caring for our patients, which is why I am so pleased to see this project begin,” Michael A. Mayo, DHA, FACHE, the health system's president and CEO, said in the release. “Artificial intelligence combined with robotic process automation in a tool like Moxi provides a way to improve hospital functions – giving our team members time back in their day to work where they are most needed.”
Once called COWs (Computers On Wheels), robots have been used for years for various functions within the hospital setting, ranging from manual pickup and delivery to providing audio-visual communication between patients and care providers in other locations. As the form factor and technology have improved, they've been assigned other duties, and are even being used in remote locations like health clinics, assisted living communities and homes.
Baptist Health is using two Moxi robots, one in Wolfson Children's Hospital and the second in the adjoining J. Wayne and Delores Barr Weaver Tower at Baptist Jacksonville, and officials expect to evaluation their performance in six to eight months. The project is supported by the Reid Endowment for Technology at Baptist Health, established in 2008, and the Miller Electric Technology Endowment at Baptist Health, established in 2014.
With Sutter Health Chief Design and Innovation Officer Chris Waugh leading the way, health system executives attending the HealthLeaders Innovation Exchange learned how to bring compassion and empathy back into healthcare.
Healthcare providers may be able to bring care to the patient, but do they really care for the patient?
Roughly two dozen chief information officers and other health system executives charged with setting innovation strategy gathered in Boston recently for the HealthLeaders Innovation Exchange, where they were told that the industry often lacks empathy for the people it's supposed to treat. And that connection to the patient will be vital as the industry shifts to value-based care.
"What's happening in healthcare is we peg patients by condition and we have absolutely no idea who they are," said Chris Waugh, vice president and chief design and innovation officer for California-based Sutter Health. "We know that precision medicine will be amazing [and] we know about precision genetics, but what about precision care?"
An expert in human-centered design, Waugh was vice president of design at the San Francisco-based One Medical Group and held an entrepreneurial leadership role at IDEO, a Bay Area design and innovation firm, before joining Sutter Health. His accomplishments there include the development and launch of Tera, the health system's virtual visit platform.
At the Innovation Exchange, he gave the attendees a Master Class on human-centered design, which focuses on thinking about the person you're treating as you plan the treatment. While in other businesses it's designed to make the customer happy and support return engagement, in healthcare the strategy is vital to not only boost engagement but improve clinical outcomes.
As an example, he detailed how Sutter Health creates baby books for new mothers that detail the baby's journey from the hospital to the home. Those books include interviews conducted by Sutter Health staff with the new mother on everything from Mom's emotions to the weather, and are given to the mother 30 days after discharge—at a time when family and friends usually drift away to leave the new family alone, post-discharge care plans with the hospital or doctor tail away, and post-partum issues like stress and depression creep in.
The book, Waugh said, not only gives new mothers an emotional link to the hospital, it helps to reconnect them with the hospital to seek additional care, a strategy to tackle high rates of depression and improve outcomes for both mother and child over the long run.
Waugh then split the audience into groups, gave them a profile of a patient or care provider, and asked them to develop a care management plan (or, in the case of the provider, a workflow) that would meet their needs and boost engagement.
The purpose of the exercise was to encourage healthcare executives to look beyond traditional care management pathways and identify other ways to deliver care, including using digital health tools that allow patients and providers to access more resources. In doing so, they were compelled to look at care delivery from the patient's point of view, identifying the gaps and challenges that affect patients and their families, that might be overlooked by providers.
James McElligott, MD, MSCR, executive medical director for telehealth and an associate professor at the Medical University of South Carolina's Children's Hospital, pointed out that the delivery of healthcare may be a business to clinicians, but it's personal to their patients, and clinicians need to find or reinforce that emotional connection.
The concept isn't new. The American Telemedicine Association focused on the idea of bringing humanity back to healthcare at their annual conference this past May in Boston. But as the pandemic eases and healthcare organizations redirect their energies to the shift from episodic care to value-based care, those in charge of innovation need to focus their investment on new technologies and strategies that highlight the value in care delivery.
That focus will also help health systems as they deal with post-pandemic challenges ranging from workforce shortages, stress and burnout, and pressure from non-traditional healthcare resources that include telehealth providers, payers and health plans with their own provider services, and retail giants like Amazon, Walmart, CVS, and Google.
With those pressures, Waugh and others noted, health system leaders will need to be innovative to keep their patients engaged and attract consumers to their brand. That will include incorporating services that address the social determinants of health, such as ride-sharing, nutrition and exercise, and housing and financial assistance. It might also include childcare services or coupons for a night out for new parents or stressed-out staff.
And that, attendees at the Innovation Exchange learned, is what makes healthcare intriguing right now.
"I'm excited about building the foundation of better [healthcare]," noted Saad Chaudhry, MSc, MPH, CHCIO, CDH-E, chief information officer at Maryland's Luminis Health.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Follow the community on LinkedIn. To inquire about attending a HealthLeaders Exchange, email us at exchange@healthleadersmedia.com.
Healthcare organizations are using augmented and virtual reality technology to give doctors and nurses better insight on challenging treatments.
While augmented and virtual reality is seeing success as a clinical treatment for issues like pain management, some healthcare organizations are using the technology to improve training and education for doctors and nurses.
The technology gives providers an immersive experience, allowing them to see and even act in typical—and not so typical—situations, learning how to act under normal circumstances as well as in an emergency. According to one study profiled in the Harvard Business Review, providers using a VR platform to train on a surgical procedure saw a 230% improvement on the Global Assessment Five-Point Rating Scale when compared to providers receiving traditional training.
"Today’s rapidly evolving surgical landscape requires new ways to provide access to experiential surgical education," Gideon Blumstein, an orthopedic surgery resident at UCLA's David Geffen School of Medicine and the author of the HBR story, concluded. "In addition, we must formalize our approach to technical assessment in order to more objectively measure surgeons’ capabilities to ensure a consistent level of quality and standardized skill set of our surgical workforce."
At the Johns Hopkins University School of Medicine, AR and VR are used to give future clinicians a better idea of what they'll be facing when they begin their healthcare career.
"As part of our resident education curriculum, virtual reality, used in conjunction with physical models, provides our junior residents an immersive training environment to learn a variety of procedures," says Dawn Laporte, MD, vice chairman of education and a professor of orthopedic surgery. "Our residents can practice and assess their learnings both collaboratively and independently."
"From a residency program perspective, reporting and analysis from surgical VR platforms can be an outstanding tool to benchmark individual performance, proficiency and progression of residents across various programs, and can also detect areas of weakness or improvement in the curriculum," she adds. "Any time you can decrease the learning curve and increase the opportunity for residents and fellows to learn, train, and repeatedly practice outside of the operating room, will lead to improved procedural competence and performance–translating directly to better care quality and outcomes."
Laporte says the technology platform is quite different from the traditional routine of working with cadavers or Sawbones simulation training models.
"There was a learning curve for those unfamiliar with the technology," she says. "As with the integration of any new technology there are going to be challenges, so apart from the unexpected technical issues, [there were a few problems with] encouraging utilization of VR and making sure there are enough headsets available."
"It’s important to note that virtual reality is not a replacement for hands-on training, but rather an enhancement," Laporte adds. "Particularly, VR gives nuanced and aspiring surgeons the unique ability to practice both independently and repeatedly, for continuous skills training, with minimal utilization of risk or resources."
She says Johns Hopkins will be analyzing how the platform compares to other training methods in ease of use, comfortability, and performance, as well as confidence in a simulated VR environment.
"As we continue to integrate more VR training modules into the curriculum, we’ll explore offering tailor-made courses that meet the individual and residency program requirements," she adds. "We also look forward to the ability to introduce variability through VR modules to see how residents think on their feet or adapt when faced with unexpected events to develop the skills to anticipate and react to intraoperative complications.
At Texas A&M University's College of Nursing in Corpus Christi, administrators are using a combination of VR and patient simulation technology developed by Gaumard to help nursing students learns the nuances of assisting in childbirth and post-partum care.
"It's very difficult for students to visualize what's happening," says Lisa Snell, the school's nursing simulation laboratory supervisor. Students use a VR headset and holograms to not only virtually experience the delivery of care, but to also see what goes on inside a woman's body when she gives birth.
"Textbooks are flat, one-dimensional and often revised," says Catherine Harrel, an assistant clinical professor at the school. "This gives [students] an opportunity to see what actually happens in a normal birth as well as in an emergency. They learn how to think and respond quickly [to emergencies] they might not see that often" but which might save lives.
Snell says the program has proven its value in preparing nursing students for the real world and will soon be used in local hospitals to help nurses there improve their capabilities and stay up to date on the latest treatments.
"Teaching tends to be technical, and that can lead to some bad habits," Harrel adds. Nursing students "not only learn how to deal with different types of situations [through VR], they also learn how to communicate with patients. Sometimes that's the hardest thing to do when you walk into a [patient's] room."
The three health systems are expanding their study on telehealth use for primary care during the pandemic to examine how connected health platforms can address the access needs of people with chronic conditions and other vulnerable populations.
Three major health systems are expanding an ongoing digital health partnership to create a patient safety learning laboratory aimed at improving telehealth access for those with chronic care needs and other vulnerable populations.
MedStar Health, Stanford Medicine, and Intermountain Healthcare are launching the program with support from the Agency for Healthcare Research and Quality (AHRQ), and will continue to work under the Connected CARE (Care Access Research Equity) & Safety Consortium, expanding the initial focus on primary care.
The announcement comes on the heels of a study recently published in npj Digital Medicine, in which the three health systems used an AHRQ grant to analyze how telehealth was used during the pandemic to improve primary care access and use.
“Our initial research demonstrates that telehealth is delivering on its promise to provide accessible and effective care,” Raj Ratwani, PhD, vice president of scientific affairs for the MedStar Health Research Institute, director of the MedStar Health National Center for Human Factors in Healthcare, and co-principal investigator for both grants, said in a press release. “Thanks to the continued support of AHRQ, we will advance patient safety nationally by studying and scaling telehealth as a proactive safety tool while also enhancing its safe use within the diverse communities served by connected care.”
That study drew on data from more than 4.1 million in-person and digital health adult primary care visits at the three health systems in 2019-2021, as well as data from payers.
“While we expected to see variability in telehealth use in primary care, we were interested to learn that those patients with chronic illness and frequent primary care needs consistently replaced one to two visits per year with a telehealth visit,” Ethan Booker, MD, MedStar Health's chief medical officer of telehealth, the study co-author, and co-principal investigator for both grants, said in the press release. “This finding underscores our entry into a new era of chronic care, as telehealth helps providers increase access and care continuity for patients who need it most. Given the evidence that telehealth has expanded our care capabilities, we believe federal and state legislation and regulations should continue to protect telehealth access.”
The new project will focus on four insights gleaned from the earlier program:
Proactive opportunities to advance safety and health through telehealth are powerful;
Process optimization remains as essential to safety as technology enhancements;
Personalization of telehealth technology use serves as a key to both safety and health equity; and
Provider wellbeing is an urgent priority for patient safety as care becomes more connected.
"They will study the care continuum tied to outpatient settings more holistically, with special attention to chronic care and health equity," the press release noted. "To consider safety solution design, development, and implementation, they will also collaborate with experts at Microsoft Research and virtual care platform-as-a-service provider Bluestream Health, and with health equity and patient and family advisors."
CIOs and other healthcare executives gathered in Boston this week for the HealthLeaders Innovation Exchange, where they talked about moving past the pandemic and into a new era of connected health.
As the healthcare industry seeks to regain its footing after the pandemic, those in charge of innovation strategy are looking to balance lessons learned from COVID-19 with the need to be on solid financial ground.
That's a challenging task, say health system CIOs and other executives attending the HealthLeaders Innovation Exchange this week in Boston. In many cases, health systems have adopted telehealth and digital health out of necessity, to deal with COVID-19, but they haven't really put the work into shaping a long-term strategy.
"For the better part of the last decade we've been paying lip service to digital transformation," said Saad Chaudhry, MSc, MPH, CHCIO, CDH-E, chief information officer at Annapolis, Maryland-based Luminis Health. The pandemic "was a splash of water in everyone's faces."
Chaudhry was one of about two-dozen healthcare executives attending this year's Innovation Exchange, an annual event designed to bring CIOs and others together to discuss innovation strategy. Today's event included a master class in human-centered design by Chris Waugh, vice president and chief innovation officer at San Francisco-based Sutter Health, along with round-table sessions aimed at defining innovation and discussing barriers and best practices.
In a poll conducted by HealthLeaders at the beginning of the event, about 70% said restoring their health system's operating margins was one of the top two priorities for the coming year, while advancing digital transformation followed right behind at about 64%.
Those results reflected a desire to move past the pandemic—in fact, only 18% listed as a priority coping with the fallout from COVID-19—and to apply lessons learned in the shift to virtual care to reimagine how healthcare is delivered. And they reinforced that digital transformation is at the top of the to-do list, as innovation was only listed among the top 2 priorities by 23% and strengthening cybersecurity—always a hot topic—didn't even get a vote.
"We should have done this a long time ago," Chaudhry pointed out.
When asked "who champions your causes most at the organization," 55% selected the CEO, indicating an emphasis on top-down support for innovation (10% selected the CMO or CNO, and 25% went with "someone else." But this question and the discussion around it highlighted the fact that innovation isn't necessarily channeled through one C-suite position or based in one department, and can and should be found in all areas and levels of the healthcare system.
James McElligott, MD, MSCR, executive medical director of telehealth and an associate professor at the Medical University of South Carolina's Children's Hospital in Charleston, echoed several comments in pointing out that innovation is best supported when many departments (and department heads) share in the process, and can be fostered as easily by one doctor with a unique idea or strategy as the head of a hospital.
That can also be a hindrance. When asked "who blocks your causes most at the organization," 25% selected the CFO, highlighting the challenge that innovation faces in securing financial backing, and 55% selected someone else, over the CEO (10%), the CMO (5%), and the CNO (5%).
This, and the discussion that followed, indicates innovative project face a wide array of challenges, including politics. A new technology or program might look great in a pilot, but it might run aground when several departments seek to take control and turn it into a political issue, or it might falter because no one wants to champion the project.
Bradley Crotty, MD, MPH, vice president and chief digital engagement officer at the Froedtert & Medical College of Wisconsin Health Network, as well as chief medical officer and chief product officer at Inception Health and an associate professor at the Medical College of Wisconsin, pointed out that the pandemic did give health systems a process that everyone followed to "get things done." That attention to one common goal worked, he noted, and showed healthcare organizations how to cut through the barriers to achieve a goal.
That should be a model for innovation, he and other said.
Finally, executives were asked where their organization stands in its digital journey. The results, as with the healthcare industry, were across the board. Some 44% were building out the technology and a process roadmap, while 33% were in the execution stage, 11% were conducting a needs assessment, almost 6% were either ensuring ongoing services and support or at the baseline.
The results speak to the various stages of digital health transformation, and point to the fact that each health system will travel its own path. But that doesn't mean they can't share advice on how to make that trip.
The Patient Voices for Telehealth Coalition, launched by the American Telemedicine Association's ATA Action, aims to add the patient and patient advocates to the effort to make pandemic telehealth waivers permanent.
The American Telemedicine Association is enlisting patients in its effort to make pandemic telehealth waivers permanent and expand coverage for and access to virtual care.
ATA Action, the organization's lobbying arm, has announced the launch of the Patient Voices for Telehealth Coalition (PVTC), a collection of state, regional and national groups that represent or advocate for the patient in healthcare.
“To secure access to virtual care, the patient voice must be front and center in the debate for telehealth permanency,” Kyle Zebley, ATA Action's executive director and the ATA's senior vice president of public policy, said in a press release. “We are launching the Patient Voices for Telehealth Coalition to ensure patients continue to play a central role in shaping a future of healthcare that provides all Americans with safe, quality care where and when they need it.”
Supporters have long argued that the patient's perspective is missing in healthcare policy, and that healthcare leaders should pay more attention to what their patients have to say as they develop the health system of the future.
For telehealth advocates, the focus is on waivers enacted by the Centers for Medicare & Medicaid Services during the pandemic to expand Medicare coverage of telehealth and give more providers the freedom to use the technology. Many have reported improved access and clinical outcomes as a result of those waivers.
Initial members of the PVTC are:
Allergy and Asthma Network
ALS Association
American Foundation for Suicide Prevention
Cancer Support Community
Cystic Fibrosis Foundation
EveryLife Foundation
Faces & Voices of Recovery
Immune Deficiency Foundation
National Hemophilia Foundation
National Organization for Rare Disorders
National Psoriasis Foundation
Parent Project Muscular Dystrophy
Telehealth Equity Coalition
The Michael J. Fox Foundation for Parkinson’s Research.
According to the ATA, PVTC members will "attend regular policy meetings with ATA Action members, government relations teams and ATA Action staff to cross-share challenges, opportunities, strategies and solutions to advance telehealth policy, and have access to a growing network of partners to collaborate with on specific advocacy actions at the state and national levels."
Researchers at the University of Missouri have found that health systems who meet CMS meaningful use guidelines for EHRs are improving clinical care and reducing patient mortality rates.
A new study has found that health systems meeting meaningful use requirements established by the Centers for Medicare & Medicaid Services for electronic health records have been able to improve clinical care and reduce patient mortality rates.
The study, conducted by researchers at the University of Missouri, published in the Journal for Healthcare Quality, and focused on more than 5 million patient experiences in 300 US hospitals, reinforces the idea that hospitals should be making the effort to integrate EHRs into clinician workflows – and that the government should promote programs that support interoperability.
It also highlights the challenges that many healthcare organizations have faced in installing EHRs and getting them to work as expected. To date, the federal government has invested more than $30 billion in programs aimed to support EHR adoption, and yet few healthcare leaders will agree that the process has been smooth or fruitful.
EHRs "have the potential to be very helpful, but in practice they tend to be very disruptive because it's time-consuming to train personnel how to use them," Kate Trout, an assistant professor in the MU School of Health Professions and lead author of the study, said in a press release. "They're expensive, and there's always new complicated updates and new forms that come out, and there is often a lack of interoperability for the data to be shared among different healthcare organizations."
Using data from EHRs, the American Hospital Association, and CMS, Trout and her colleagues grouped health systems into three categories: Those who successfully met CMS meaningful use guidelines, those who are using EHRs but not in a way the meets meaningful use guidelines, and those who haven't yet implemented EHRs or who are still integrating the platform.
They found that health systems in the first category were more successful in providing quality care and reducing patient mortality than those in the other two categories.
"This research highlights the importance of using electronic health records in a way that promotes interoperability to streamline processes, speed up decision-making, reduce wasted time, and ultimately improve patient health outcomes," Trout said in the press release. "Ideally the United States could implement one standardized electronic health records system for everyone to ensure compatibility so policy makers can hopefully benefit from this research."
She also pointed to the value of innovation in EHR adoption and use.
"Are there alerts we can put in after a surgery to ensure we follow up at critical points in time?" she asked. "Are there certain patient populations that we can use the data to catch them earlier and make sure we give them extra care and not just put them through the same routine protocols as everyone else? That is how we move away from focusing on implementing the technology and progress toward encouraging innovative ideas that ultimately improve patient health outcomes."
Chris Belmont, vice president and chief information officer for Mississippi's Memorial Health System, says any new program should begin small and focus on the patient.
To Chris Belmont, innovation isn't just a strategy. It's a commitment to improving patient care.
"It's not something you have, but actually something you do," says the veteran healthcare executive who now serves as vice president and chief information officer for the Memorial Health System, a two-hospital network based in Gulfport, Mississippi.
And for innovation to really work, he says, it has to lead back to the patient.
"We're great at creating things, and technology, and processes … but are we really paying as much attention to the patient as we should?" he says.
Belmont has more than 35 years of experience in executive leadership, business development, and consulting, the last two of which have been spent at Memorial Hospital at Gulfport. In the past he's served as vice president and CIO at the University of Texas MD Anderson Cancer Center in Houston and system vice president and CIO for the Ochsner Health System in New Orleans, leading EMR transformation projects at both health systems while helping to revamp their Information Services departments.
At Memorial Health, his strategy for trying out new programs and technologies is to start small, with very specific outcomes, goals, and participants.
"Don't launch these big initiatives," he says. "If we had done that, we would have slowed things down and missed some opportunities."
Chris Belmont, vice president and chief information officer of the Memorial Health System in Gulfport, Mississippi. Photo courtesy Memorial Health System.
In some cases, that might mean starting in a clinical department, rather than IT, to give a program a chance to establish roots before marrying it to a specific technology. Once that base is established, data is gathered, and results are proven, he says. Then, a health system can scale a program out, adding more departments and serving more populations.
"We start with an idea, and we put a program together than can be part of our portfolio," Belmont says. "Once it's in our portfolio, we have the opportunity to put it onto a platform and ask, what can this platform do?"
By taking a tiered approach to innovation, he says, a health system can focus on patient interactions and care. A large project tends to overlook small details, but those details may be what the patient looks at or experiences. As a result, a big program might look good and meet the goals set forth by the health system, but it doesn't necessarily address what the patient wants.
"Don't let the bureaucracy get in the way," he says.
As an example, Memorial Hospital has been working with Emmi digital health technology developed by Wolters Kluwer for patient engagement efforts, with a goal of reducing avoidable ED visits and hospitalizations and improving follow-ups. The hospital had launched a handful of small, concentrated programs and wanted to combine them on one digital health platform.
"It was at a time when we were all distracted by COVID," Belmont says. "Our nurses were busy with screenings and vaccinations, and we wanted to help them. This wasn't a robocall project; we wanted comfortable interactive technology that could improve the experience."
Using interactive voice response calling and multimedia videos to reinforce discharge or care instructions, monitor adherence to care management plans, and remind patients about follow-up appointments, Memorial Health developed a rapport with patients, encouraging them to take a more active role in their care.
"A lot of times [patients] don’t remember what was said [in visits with their doctor]," Belmont says. "We created a more effective messaging platform that engaged with them. It was more comfortable for them than the traditional automated reminders. I was surprised at how quickly patients reacted to the new platform."
According to data supplied by Wolters Kluwer, the program reduced unnecessary ED visits by 26%, which, in turn, reduced ED costs by about $89,000 over 1,000 patient discharges. The 30-day readmission rate also dropped between 27% and 65%, depending on patient adherence to prescribed programs. In addition, patients were 50% more likely to attend follow-up care appointments with their provider within 21 days of discharge.
"This was so much more effective than anything we'd done before in getting patients to [follow their care plan]," Belmont says.
The key to establishing that relationship, he says, is in listening to and understanding what the patient wants, rather than creating some shiny new toy or program and asking the patient to accept it.
"We have to look at this from the patient's point of view," he says. "Just think what would happen if we did too much of this. Would the patient be overwhelmed if we communicate too much? How do we make sure that we're not contacting them [to the point that] they're turning away?"
Belmont calls this a conundrum that every health system will face as it adopts more technology and programs that create more connections with patients outside the health system. All these channels will be great for collaborating on care management and passing information back and forth, but when will it be too much? How do healthcare providers create a conversation with the patient that meets the demands and expectations of both parties?
"Feedback is vital," he says, "both direct and indirect." Aside from asking patients how they want to interact with their care teams, providers need to gather data on how often patients communicate, on what channels, and whether those communications make an impact.
"My metric is if they keep coming back for more," Belmont says. "My role in this is the platform manager. I'm here to connect all the points, to make sure they're secure, and especially to make sure that they are reliable, and that the data we're getting is making a difference."
As Belmont looks to broaden those platforms with new programs and technology, he's focused on creating services that continue, rather than one-time interactions. He wants patients to look at this platform as an ongoing relationship with their care team, as well as a library of resources that they can access whenever they need help.
"We as a health system have to make sure we're taking advantage of all the tools in the toolbox," he says.
Researchers from Stanford, USC, Georgia Tech, and the University of Tokyo have developed a battery-powered digital health wearable that attaches to the skin and can measure tumor size continuously and in real time, offering hope for advancements in both cancer research and treatment.
Researchers has developed a wearable digital health sensors that can track the size of a tumor, a vital factor in determining the effectiveness of cancer drugs.
The Flexible Autonomous Sensor measuring Tumors (FAST) device, a battery-powered patch that adheres to the skin, measures the strain on the membrane surrounding the tumor in real-time and transmits the data to a smartphone app. It has the potential to replace the traditional method of tracking tumors via caliper and bioluminescence, allowing care providers to understand a drug's effectiveness in days instead of weeks.
“This work is a prime example of how wearable electronics can further precision health technologies — we can monitor the growth of a tumor with tens of micron resolution using just a sensor and a cell phone app," Yasser Khan, an assistant professor of electrical and computer engineering at the University of Southern California, said in a press release. "We can observe the progression 24/7, unlike any of the existing imaging techniques, and precisely tell if a drug is working on not in treating the tumor."
Researchers from Stanford University, USC's Viterbi School of Engineering, Georgia Tech, and the University of Tokyo teamed up to develop the wearable, which could significantly improve cancer research and treatment.
“It is a deceptively simple design,” Alex Abramson, an assistant professor of chemical and biomolecular engineering at Georgia Tech and first author of the study, said in the press release. “But these inherent advantages should be very interesting to the pharmaceutical and oncological communities. FAST could significantly expedite, automate and lower the cost of the process of screening cancer therapies.”
Armed with newer, more refined technology, researchers across the globe have been developing digital health wearables for clinical treatment and research. Some have redesigned commercial smartwatches and fitness bands or added technology, while others have worked with smartglasses, jewelry, hearing aids, and clothing. Still others are developing ingestibles, bandages, patches, and tattoos that can track and gather data from the body and transmit that information through digital health apps to care teams or researchers.
In this case, researchers say the FAST device has three advantages over traditional care:
It provides continuous, real-time monitoring;
The sensor attached to the patch is sensitive to one-hundredth of a millimeter, enabling researchers to track miniscule changes to a tumor that might not be detected by other methods; and
The device is non-invasive, attaching to the skin like a bandage, and reusable.
