The executive vice president and chief innovation officer for the Pennsylvania-based health system is helping to create new programs and pathways, all while focusing on the path to value-based care.
Innovation in healthcare doesn't just mean finding a new way to do something. It's a "fundamentally different approach to solving a problem that has quantifiable outcomes."
That's the mantra for Karen Murphy, MD, executive vice president and chief innovation officer for Geisinger and founding director of the Pennsylvania-based healthcare organization's four-year-old Steele Institute for Health Innovation. As such, she's leading the way in one of the most competitive healthcare markets in the country to research and develop new technologies and strategies to take healthcare into the value-based care era.
She has her hands full. The pandemic may have propelled telehealth and digital health innovation forward by roughly a decade, but it has also exposed barriers in using technology to connect with underserved populations, as well as causing a surge in stress, depression and anxiety, and exacerbating the burnout rate and workforce shortages in healthcare. While giving Murphy and her colleagues good targets at which to direct innovation, these barriers can also be landmines, capable of derailing an innovative platform or concept if not addressed.
Karen Murphy, executive vice president and chief innovation officer at Geisinger. Photo courtesy Geisinger.
One more caveat: healthcare innovation isn't occurring in a vacuum. Healthcare organizations are expected to simultaneously evolve and continue to deliver healthcare.
"We are caring for patients each and every day, and it's very, very difficult to innovate and operate at the same time," Murphy says. "We are not a healthcare store. We need to integrate innovation" into the ongoing care platform.
That's why innovation needs to show value, and have measurable results that can be used to prove sustainability, especially on a timeline.
The idea that innovation is meaningful' "is really hard," she adds. "We constantly expect short-term results from long-term strategies."
One strong example is the Fresh Food Farmacy, a program developed out of the Steele Institute that addresses a key challenge to care management for people living with diabetes: diet. People living with diabetes need to carefully manage what foods they eat, including when and how much they eat. This is a social determinant of health, a factor not usually included in clinical care, but which affects a patient's health and wellness as dramatically as medication.
Through the program, patients are screened in a primary care setting for food insecurity, and if they have those concerns and an A1C level of greater than 8.0 (an indicator that the patient isn't managing his or her diabetes well), they're given a "prescription" or a referral for the Fresh Food Farmacy, which gives them and their household the ingredients for 10 nutritious meals a week.
To date, the program, which also operates in satellite locations in Kingston and on the Jersey Shore, has provided almost 2 million pounds of food, or roughly 1.5 million meals, to about 1,500 patients. Internal data suggests that has helped patients reduce their A1C levels as much as 2.4 points. Geisinger is now looking to expand the program and is partnering with digital health company Season Health to integrate the program later this year into the Geisinger Health Plan.
Murphy says the program demonstrates two key facets of innovation:
It rethinks how care providers collaborate with patients to improve clinical outcomes
It's not all about the technology.
"Digital allows us to communicate with patients more effectively," she says. "And it allows us to intervene for [preventive health and wellness] in a much more cost-effective way than in the past. It gives us the tools we need to engage with patients … but we still need to learn how to engage."
"I'm thrilled for the disruption that we're seeing in healthcare," Murphy adds. "It's forcing us to rethink how we engage with patients. It's not the same as 20 years ago."
In this case, Geisinger can use technology—e-mails, text messages, and virtual care—to connect with patients at the time and place of their choosing, and through these connections the health system can collaborate to improve not only care, but health and wellness. This shifts from the philosophy that delivers healthcare in episodes, to address immediate needs to a continuous model that manages care over the long term. With chronic care patients, such as those living with diabetes, that would include not only access to food but also meetings with dietitians to help manage diet and lifestyle.
"With value-based care, providers are reimbursed based on outcomes, rather than volume," Murphy says. "And we are gathering evidence, over the past 10 years, that we've [created] positive outcomes with quality measurements."
Murphy says those measurements and that data are also needed to attract payers and to reconfigure payment methodologies that, as of now, aren't in sync with value-based care. If innovation can be proven to transform care, payers and providers will need to agree on how these programs are covered and sustained, so that the incentives will be there to continue them.
That's where innovation is headed, into platforms and programs that enhance the connection between patient (or consumer) and care provider (or team), particularly outside the hospital, doctor's office or clinic, and in-between the scheduled appointments and treatments.
Murphy sees several areas in which innovation will play a part in the healthcare ecosystem. She sees AI and machine learning playing a part in the back end, automating processes, analyzing data, and reducing workflow stresses that plague today's doctors and nurses. Those concepts will also be brought to bear on the front end, helping to manage chronic care and other treatments while giving providers more face-to-face time with their patients.
She's also bullish on remote patient monitoring, a fast-growing and evolving strategy that took off during the pandemic. She sees traditional care pathways enhanced with RPM platforms that use sensors and AI to monitor and manage care at home through wearables, smart technology, and other tools.
"There will be other factors that we don't even know about today," she says. "That's what's exciting."
Advocate Aurora Enterprises, the innovation subsidiary of Milwaukee-based Advocate Aurora Health, is building a portfolio of companies and programs aimed at helping seniors live longer, healthier lives at home.
The fastest-growing population in the US are seniors, and they're very much interested in staying healthy longer and staying at home. With that in mind, healthcare organizations are developing care management programs that allow seniors to age independently, and they're researching and investing in programs that improve home-based care, including telehealth and digital health.
As vice president of strategy and analytics, Sheetal Sobti leads the aging independently category for Advocate Aurora Enterprises, a subsidiary of Milwaukee-based Advocate Aurora Health that advances innovative solutions to address people’s broader health needs. In her role, she is responsible for building a portfolio of health and wellness companies that enables seniors to thrive independently, comfortably and affordably in their homes.
She recently sat down with HealthLeaders to talk about how Advocate Aurora Enterprises selects companies to add to its portfolio, and how those companies complement a strategy of helping older adults age independently.
HealthLeaders: How can innovative new technology or services be used to help seniors stay at home, rather than moving into a senior living facility?
Sheetal Sobti: We’ve found that most seniors want to stay in a familiar environment—oftentimes it’s where they raised their families, and where they have friends and family in the community. For many older adults, having the comforts of home prevents social isolation, which can negatively impact physical and mental health. There’s also a financial benefit to aging in place, since senior living facilities can be expensive.
However, many older adults end up having to live with family or move into a senior living facility because an adverse event happens in the home—they fall, or they just can’t get their needs met. If we can help keep them safe, that ensures they can stay home longer and be more comfortable.
Sheetal Sobti, vice president of strategy and analytics, Advocate Aurora Enterprises. Photo courtesy Advocate Aurora Enterprises.
That’s why Advocate Aurora Enterprises invested in Senior Helpers, which connects seniors to caregivers who help with activities of daily living like getting in and out of the shower or up and down the stairs. Now, with the addition of MobileHelp, we’re infusing our service portfolio with technology to provide an additional layer of safety and security to offer seniors and their family members greater peace of mind.
Q: How does Advocate Aurora Enterprises evaluate technology or services to support? What do you look for and, perhaps, what do you look to avoid?
Sobti: Our goal is to continue assembling a portfolio of innovative health and wellness solutions that help people live well at every stage of life, while also diversifying our revenue. When it comes to the aging independently [landscape], we look at the types of solutions that seniors and their family caregivers are purchasing. We ask, how can we make their lives easier?
Then we leverage our clinical expertise, which includes connecting such solutions to the broader continuum of care. We look at what’s happening when seniors are sick, in addition to what’s happening when they’re well. We complete the picture by connecting traditional home healthcare offerings, as well as our expertise in managing utilization and risk, with technology and services that compliment clinical care.
As far as what we would avoid, that might include anything that falls within Advocate Aurora Health’s core clinical purview.
Q.How are healthcare providers addressed with these products or companies? Do you look for technology or services that integrate with the primary care provider or the local health system?
Sobti: We really like the idea of using technology to connect medical professionals with services that could benefit their patients.
Last year we invested in Xealth, a platform that connects providers with an array of solutions to help patients reach their health and wellness goals. In a way, Xealth is a key enabler of our portfolio, helping achieve synergies between solutions and providers. For example, in the future if a clinician is discharging a patient who says they don’t have someone at home to help with their medication or prepare meals, that clinician could use a platform like Xealth to identify a temporary need for caregiving services like those provided by Senior Helpers.
Q.What are the challenges or barriers to adopting innovative new technology or strategies?
Sobti: It’s a big change—not just for consumers but also for health systems. But there’s a greater readiness in the post-COVID world.
Health systems today are competing in the same space as fast-moving technology companies that have far more capital, wider consumer bases and, frankly, more in-depth knowledge of consumers and their purchasing power. On the flip side, health systems have clinical expertise and trusting relationships with consumers. Things are constantly evolving and there’s a need to meet consumers where they’re at.
Q.How does Advocate Aurora Enterprises help the Advocate Aurora health system? Does the health system identify healthcare trends to pursue or test out promising new technologies or services?
Sobti: We’ve done a lot of research on market trends and solutions that complement clinical care to advance whole person health. That’s how Advocate Aurora Enterprises identified its three key areas of focus: aging independently, family development and support, and personal wellness.
Part of the reason we exist is to help broaden Advocate Aurora Health’s business portfolio at a time when health systems across the country are navigating broad industry challenges, from stagnant reimbursement rates to increased competition. And we share a purpose of helping people live well. So there likely will be times when the health system chooses to offer the proven solutions that Advocate Aurora Enterprises invests in or acquires.
Q. What new technologies or strategies are you looking at now? What’s on the horizon for healthcare innovation?
Sobti: On the heels of our MobileHelp acquisition, our focus is on integration and identifying synergies that make it even easier for seniors to age in place. We’re excited about the opportunity to bundle Senior Helpers’ in-home personal care services with MobileHelp’s personal emergency response systems and remote patient monitoring capabilities.
We’ll continue looking at solutions that keep people safely in their homes, while also alleviating the burden on family caregivers. And we’ll stay focused on broadening the continuum of care to help people live well at every stage of life.
The Digital Twin Consortium has created a framework for the use of digital twin technology, which is just now being adopted in healthcare to help providers improve care management.
The Digital Twin Consortium has unveiled a document designed to help healthcare organizations using the innovative digital health platform to improve clinical care.
Reality Capture: A Digital Twin Foundation lays out the groundwork for using the technology, which essentially uses sensors and AI to create a digital twin of an object, room, building or landscape, for use in planning and design. In healthcare, the strategy focuses on developing a digital twin of a patient, which can then be used to test the effectiveness of treatments before they're tried on the patient.
“Reality capture technologies play an important role in providing context and, depending on the scenario, delivering real, on-time decision support for situational awareness," Dan Isaacs, chief technical officer of the Boston-based organization, said in a press release. "This in turn enriches digital twin predictive accuracy and outcomes. Situational awareness serves to augment event intelligence for timely, high confidence, data driven, and evidence-based decision making."
While other industries have used digital twin technology for close to two decades, only recently has it been adapted to healthcare.
This past February, the University of Miami Miller School of Medicine announced a partnership with Amazon Web Services and the Open Health Network to create the MLBox, which would use digital health tools, including wearables and smart devices, to collect biological, clinical, behavioral, and environment data on a patient to create a digital twin. The project is supported by the National Institutes of Health.
“We want to demonstrate that this kind of individualized data capture can spur a new line of research and personalization in healthcare,” Azizi Seixas, PhD, founding director of TheMI, an associate director for the Translational Sleep and Circadian Sciences Program at the Miller School of Medicine, and one of the nation’s leading experts on sleep health, said in a press release. “With the capacity to discover everything we can about the individual, we can change the relationship between people and their health.”
“Eventually, such digital twins could comprise sufficient detail about an individual so that a computer could test different treatment or wellness options against that model to predict which are most likely to produce the best outcomes for that person,” officials said in a press release. “Instead of prescribing treatments based on a statistical model of outcomes across a large population, this new approach would provide each patient with a personalized recommendation calculated to produce the best outcome for them.”
With its new document, the Digital Twin Consortium aims to lay the foundation for guidelines and standards of digital twin technology.
“For digital twins to play a growing role in the industry for simulations, remote control or metaverse experiences, they must accurately reflect built reality,” Dominique Pouliquen, CEO of Cintoo, which has been using the technology in construction projects, said in the press release. “Various technologies are available to capture these conditions, ranging from passive cameras to active laser scanners, but navigating the reality-capture landscape is not easy. There isn’t a single scanning device that meets the criteria for all possible use cases and workflows. Today’s white paper provides information organizations can use to make the right investment decisions.”
Roughly 30 community pharmacies across the country will have access to a digital health platform that enables patrons to take a 10-minute, self-administered cognitive performance screening to detect early signs of Alzheimer's disease.
As many as 30 pharmacies across the country will soon have access to a digital health platform that will allow patrons to test themselves for early signs of Alzheimer's disease.
The Community Pharmacy Enhanced Services Network (CPESN) will select the pharmacies to receive Cognivue Clarity, a self-administered, 10-minute cognitive performance screening tool developed by digital health company Cognivue. The project will include training and onboarding services to help pharmacy employees use the tool to screen patrons and evaluate the results.
“The pandemic highlighted the need for trusted and accessible testing, screening, and referrals for large swaths of the population, but in particular for those living in underserved neighborhoods or with cognitive limitations," CPESN USA Executive Director Troy Trygstad, PharmD, MBA, PhD, said in a press release. "Community pharmacies are likely to play an essential role in early identification, education, and warm handoffs for those at risk or in cognitive decline.”
More than 6 million people in the US currently live with Alzheimer's, according to the Alzheimer's Association, with that number projected to triple by 2060. While there is no known cure, early detection of symptoms can help healthcare providers develop care management plans for brain health that could delay the progression of the disease and improve quality of life.
The program is coordinated by the Avant Institute, a Charlotte, NC-based organization that offers training for pharmacists, pharmacy technicians and pharmacy students on the knowledge and practical application of clinical pharmacy services. It's being funded by a grant from the Switzerland-based Davos Alzheimer's Collaborative, which recently issued $4.5 million in grants to organizations in eight countries to "advance how healthcare systems worldwide detect, diagnose, treat, and care for people with or at risk for Alzheimer’s."
The global project aims to improve healthcare access by connecting with people outside the hospital, clinic or doctor's office and meeting them where they are. Retail sites like pharmacies have often been seen as ideal locations to connect with people, especially underserved populations who can't or won’t see primary care providers on a regular basis.
"This grant provides an opportunity to address a significant need to fill the gaps in conducting standardized cognitive assessments for patients, and pharmacies provide an access point to reach underserved and rural communities," Amina Abubakar, PharmD, president of the Avant Institute and CEO of the Avant Pharmacy and Wellness Center, said in the press release.
Research by the University of North Carolina finds that patient-reported outcomes collected through a digital health platform can help healthcare providers monitor their patients living with cancer at home, improving engagement, quality of life and outcomes.
A new study finds that patient-reported outcomes (PROs) delivered by phone as well as online helped health systems improve care management for people living with advanced cancer.
The study, conducted by the University of North Carolina and recently published in the Journal of the American Medical Association (JAMA), sheds light on the value of an automated survey platform that allows care providers to track patient symptoms at home. The platform reduces stressful travel to and from a doctor's office or clinic and allows providers to monitor patients weekly and intervene when they detect a health concern.
“We had very high engagement with patients and their care teams in this study, with patients completing more than 90% of their symptom surveys, and nurses frequently reaching out to patients when severe or worsening symptoms were electronically reported,” Ethan Basch, MD, MSc, a researcher at UNC's Lineberger Comprehensive Cancer Center and the paper’s lead author, said in a press release. “This likely reflects how accustomed many patients and providers have become to telehealth and electronic communications.”
Supported by the Patient Centered Outcomes Research Institute (PCORI), the PRO-TECT (Patient Reported Outcomes To Enhance Cancer Treatment) trial tracked 1,191 patients receiving care at 52 community cancer clinics between October 2017 and March 2020. Roughly half of the patients were asked to complete a weekly survey, offered online as well as by phone, for as long as a year, while the rest received traditional care, often in he form of scheduled visits to the clinic or doctor's office.
The project enabled participants to report typical symptoms of cancer treatment, including fatigue, nausea, insomnia, appetite loss, diarrhea, pain, difficulty breathing, and constipation. If those symptoms appeared to be worsening or increasing, the digital health platform sent an alert to the patient's care team to follow up immediately.
According to the study, those using the online or phone survey platform experienced roughly 35% better physical function that their counterparts who reported their symptoms during office visits, and they also reported more than 16% better control over their symptoms and more than 40% better health-related quality of life.
The research adds to a growing library of data that virtual care can stand in for in-person care in certain circumstances, and can even help providers improve clinical outcomes. The platform saw increased use during the pandemic, when many health systems turned to telehealth to substitute for in-person care at a time when the risk of infection was high.
The platform also offers crucial value to people living with cancer, with studies suggesting half of cancer-related symptoms are undetected and unreported. Healthcare providers fear that people are skipping appointments or check-ups, in part because of COVID-19 fears, so they aren't keeping their doctors up to date on symptoms.
"Symptom monitoring using electronic systems that facilitate patient-reported outcome (PRO) surveys via the internet, mobile applications, or automated telephone interfaces have been shown to be feasible for identifying symptoms that can be treated by clinicians," Basch and his colleagues wrote in the study. "Prior studies have reported improved outcomes for physical function, symptom control, health-related quality of life (HRQOL), hospitalizations, and survival when such electronic systems are used by patients receiving cancer treatment. Integrating symptom monitoring into routine treatment of cancer may improve outcomes with an opportunity for reimbursement by payers."
The study also proves the value of offering multiple ways of accessing the survey, to take into account barriers that some patients may face in accessing the Internet. Roughly one-third of the participants in the study reported their symptoms via telephone.
It also points out that launching a digital health program comes with challenges.
"Despite prior evidence of the benefits and feasibility of electronic symptom monitoring with PROs, there has not been widespread adoption in treatment for cancer," the study noted. "Implementation requires technology, patient engagement, staff effort, and modification of information flow. A prior analysis of user feedback from this trial found high levels of enthusiasm from patients and clinicians. However, nurses reported that alerts could be burdensome unless there is dedicated time to address the alerts. Despite cost savings associated with PRO monitoring for insurance companies, currently funding is not available to sustain additional costs to clinics of technology and staffing in the US."
"The Centers for Medicare & Medicaid Services has suggested including PROs in a proposed oncology payment model," Basch and his colleagues wrote. "Expansion of current billing codes for remote monitoring to include PROs in oncology would facilitate greater use of the intervention. Future work could delineate the relationship of PRO monitoring with patient navigation. Work is needed to refine algorithms for communicating alerts to assess whether the number of notifications can be safely reduced."
Basch says the project now needs to be expanded, to improve efficiency and determine the best models for widespread use.
“PRO-TECT is a way to bring patients together with their care team and aids in identifying those who are at greatest risk,” he said in the press release. “And because we had equal success at all 52 practices in 25 states, it shows that there’s a wide acceptance for this kind of intervention.”
PedsGuide, an mHealth app developed by Children's Mercy Kansas City, is an on-demand clinical decision support platform designed to assist rural and remote healthcare providers who are treating children.
One of the benefits of digital health is that it allows healthcare providers to collaborate and share their expertise with others who don't have that background. Children's Mercy Kansas City is following that path with a new mHealth app designed to give providers a clinical decision support tool for pediatric care.
"Many ERs see children because they have to," says Brandan Kennedy, MD, a pediatric hospitalist and clinical informaticist and associate director of inpatient health informatics at the Kansas City, Missouri-based hospital. "Less than 10% of their ER traffic is kids, so it's not their comfort zone … but that doesn't mean they can’t treat them."
To address that concern, Kennedy and his colleagues created PedsGuide, an app that gives users on-demand clinical decision support (CDS) resources for a wide range (and growing) of pediatric care concerns, from burn treatment to diabetic ketoacidosis. The free app can be accessed via desktop, laptop or mobile device, and even includes a quick-call feature to connect with emergency medicine physicians or the Children's Mercy medical transport team.
"We wanted to create something that can help physicians make decisions at the front line of care," he says.
Brandan Kennedy, MD, associate director of inpatient health informatics, Children's Mercy Kansas City. Photo courtesy Children's Mercy Kansas City.
CDS tools for frontline healthcare providers have evolved significantly during the past few decades, thanks in large part to the advent of online resources and mobile devices. What once had to be looked up in a reference book, dictionary or magazine can now be accessed via computer or smartphone.
The challenge, as always, is in finding the right resource, an effort made all the more difficult by the growing numbers of CDS providers.
At Children's Mercy Kansas City, the belief is that healthcare providers treating children should be getting their guidance from pediatric specialists.
Sallie Guezuraga, who manages the Innovations Center at Children's Mercy's Center for Pediatric Innovation, says ER physicians first came up with the idea to develop a resource that would help frontline care works in emergency situations. They soon realized the information they wanted to include was changing often, thanks to new research and innovations. The onset of the pandemic added to the volumes of information—and the urgency to get that information out there.
"We couldn't update it quickly enough," she says. "We had to digitize it."
Armed with a research grant, the Innovations Center team created a simple mHealth app designed to help clinicians in treating children under 3 years old who presented with a fever. From there, they created new modules for infant care, then asthma treatment, then resuscitation workflows. The topics and ideas just kept coming in.
"The build became very ambitious," says Kennedy, who joined Children's Mercy several months into the program.
The current app platform has seen roughly 70,000 uploads, and Kennedy and Guezuraga say they're nowhere close to being done mapping out the infrastructure.
Sallie Guezuraga, Innovations Center manager, Children's Mercy Kansas City Center for Pediatric Innovation. Photo courtesy Children's Mercy Kansas City.
As part of the process, he says, the research team studied human factors engineering, including concepts like usability testing and think-aloud feedback, to understand how people interact in these situations with others and with technology. They wanted to know how clinicians might need and access information in different situations, such as an emergency or operating room or clinic. They also travelled with EMS responders in ambulance to see how an app might be used in an emergency situation in a rural location.
"In our current state in medicine, we have information overload," says Kennedy, noting there are more than 33 million articles of clinical literature in PubMed alone. "We have to make sure that we are translating that research into practice … in such a way that it can be used" by healthcare providers needing quick and accurate answers to their questions.
"We want to understand how and when people are using [PedsGuide] and what they are using it for," he adds.
To get a module ready for use could take as little as 18 months, says Guezuraga, or it could take a few years. And the infrastructure has to be in place so that Children's Mercy can research and update that information often.
To keep that information relevant, Children's Mercy Kansas City allows the research team the time they need to update the platform. And Guezuraga says the team is working with other organizations, such as the American Academy of Pediatrics, to make sure the information is reliable and valid.
They also want to keep the app free of charge. The idea is that healthcare providers need a resource that they can trust.
"This is an app developed by those who are in the field," Guezuraga says. "We have the experience, and we can say, 'Yes, this is what the protocol might say, but this is what actually happens.' We've been there and we know."
Kennedy points out that the app platform isn't seen as a marketable product or competitive advantage, but a tool that healthcare providers should be able to access freely and on demand. It affects all downhill care, he says, because children treated in a rural ambulance, doctor's office, clinic, ER or OR will be treated better and more effectively if the provider has access to the right information, and that in turn helps organizations like Children's Mercy Kansas City to focus on patients who need specialized care.
"We are leveraging the entire health system" to help frontline and primary care physicians improve their actions, Guezuraga says. "This ultimately helps the kids, which is our goal."
Researchers at Washington State University have added digital health sensors to a pacifier in an effort to help pediatric care providers, such as NICUs, monitor and treat infants for dehydration.
Researchers at Washington State University have developed a pacifier fitted with digital health sensors that's designed to help care providers continuously monitor sodium and potassium ion levels, two key indicators of dehydration in infants.
“We know that premature babies have a better chance of survival if they get a high quality of care in the first month of birth,” Jong-Hoon Kim, an associate professor at the Washington State University School of Engineering and Computer Science and a co-corresponding author on the study, said in a press release issued by WSU. “Normally, in a hospital environment, they draw blood from the baby twice a day, so they just get two data points. This device is a non-invasive way to provide real-time monitoring of the electrolyte concentration of babies.”
The pacifiers contain sensors that measure sodium and potassium in saliva, relaying that data through the cloud via a Bluetooth connection to an app on the caregiver's phone, tablet or laptop.
Aside from the challenges of drawing blood samples from infants, especially those born prematurely, the smart pacifier offers care providers an opportunity to view continuous data, rather than relying on information gathered once or twice a day. And the platform could eventually be expanded to include more sensors tracking more biometric data points.
The technology holds promise for neonatal intensive care units, where care providers are charged with treating some of the most fragile patients in the hospital system.
“You often see NICU pictures where babies are hooked up to a bunch of wires to check their health conditions such as their heart rate, the respiratory rate, body temperature, and blood pressure,” Kim said. “We want to get rid of those wires.”
Beyond that setting, the smart pacifier could be used in pediatric clinics, medical offices, even in remote patient monitoring programs that allow healthcare providers to track their young patients' progress at home.
Researchers say the next step is to reduce the cost of the smart pacifier by using more affordable and recyclable materials, and to expand the study to more health systems to establish efficacy.
A new C-Suite survey by West Monroe finds that health system leaders looking to establish a digital health strategy are challenged most by attracting and keeping IT talent and understanding how to define digital health.
Workforce shortages in the healthcare industry aren't limited to clinical care. A new survey finds that more than a third of health system leaders are worried about how to staff and maintain their IT departments.
The Q2 C-Suite Healthcare Poll, issued this month by West Monroe, finds that health systems are faced with unique challenges in expanding their digital health footprint, beginning with increased competition and including a difference of opinion on definitions.
According to the survey, some 34% of C-Suite executives said their biggest challenge when activating digital strategies was in attracting and retaining talent for digital health. And when asked for the biggest impacts from inflation, 68 percent picked wages and another 59 percent selected talent recruiting or retention.
This comes at a time when the healthcare industry is expanding, largely due to the advent of digital health and telehealth platforms that are attracting new players to the sandbox. Health systems now have to contend with competitors using virtual health to attract new business, as well as stand-alone clinics, retail giants like Amazon, Google and CVS Health, and telehealth companies with their own ranks of providers.
The topic came up at the recent American Telemedicine Association conference in Boston, during which Joseph Kvedar, a Harvard Medical School professor and longtime digital health expert, pointed out that there’s an ongoing “battle for primary care.”
Some experts say that healthcare will struggle to attract and keep IT talent because health systems don’t have the budgets to pay those people at the same rate as Amazon, Google or even many healthcare IT companies.
Aside from staffing the IT department to handle digital health initiatives, some 32 percent of executives surveyed by West Monroe said their biggest challenge is a lack of industry consensus on the definition of digital health. This points to a long-standing challenge facing the healthcare industry: The many names and phrases associated with innovative technology, including telehealth, telemedicine, mHealth, digital health, connected health, virtual care, telecare, i-health, and mobile health. Add to that the nuances of remote patient monitoring, remote physiological monitoring and remote therapeutic monitoring, as well as telemental health, telebehavioral health, and so many other tele-services, and the list grows.
The problem isn’t just with semantics. Payers (including the Centers for Medicare & Medicaid Services) often have specific definitions for the services they will or won’t cover, and a healthcare provider who defines digital health or telehealth differently risks losing out on reimbursement. Likewise, how a certain service is defined may affect how it’s managed, staffed and budgeted.
Aside from those two issues, the third challenges identified by healthcare executives in activating digital strategies is a lack of alignment of business and technical priorities, cited by 18% of those surveyed. This number may rise as more healthcare organizations adopt value-based care and struggle with how to identify the value of the digital health program.
Beyond that, according to the survey, 6% identified technology debt and 5% cited identifying, building, and governing uses cases.
“Taken together, an entire 84% of respondents indicated that the industry is facing fundamental misalignments when it comes to digital health,” the West Monroe survey states. “This dramatically underscores the need we see for redirecting some of the attention away from fancy technologies and focusing on conceptual and operational readiness to bring those technologies in the healthcare fold. Only in this way will those technologies make the impacts they’re designed to make—and make them continuously over time.”
Bon Secours Mercy Health is launching a new program for roughly 8,000 patients in Ohio living with chronic kidney disease or end-stage kidney disease that uses technology and multidisciplinary teams to improve chronic care management.
Bon Secours Mercy Health is launching a new program aimed at improving care management and coordination for an estimated 8,000 patients in Ohio who are living with chronic kidney disease (CKD) and end-stage kidney disease (ESKD).
In a partnership with Denver-based Strive Health, the Cincinnati-based health system, which includes 50 hospitals across several states, will use a technology platform and “Kidney Heroes” interdisciplinary care teams composed of nurse practitioners, dietitians, pharmacists, care coordinators and licensed clinical social workers to create a personalized care plan for patients. Among other things, the platform will allow care providers to chart the progression of the disease and the patient’s risk for hospitalization.
The program brings new technologies and strategies to bear on chronic care management, and builds on the idea of extending care outside the hospital, clinic or doctor’s office and into the home, where the patient and care team can collaborate on services. This includes using AI-enhanced technology to design a holistic profile of the patient and identify care needs and gaps.
In an e-mail Q&A with HealthLeaders, Chief Population and Community Health Officer Jean Haynes explains how the program will work.
Q. How will clinical care be delivered under the new model of care?
JH: Strive will deliver additional, specialized clinical services to Mercy Health’s kidney disease patients as an extension of the care already provided by the Mercy Health care team and physicians. The goal is to move upstream in the kidney disease journey and help patients better understand and manage their conditions to slow progression of disease. Chronic Kidney Disease (CKD) affects more than one in seven American adults and 90% do not know they have kidney disease. One in three adults is at risk for developing CKD, making early diagnosis and treatment intervention critical to helping patients stay healthier longer.
Q. How is this different from the "old" model of care?
JH: Technology-enabled data insights allow us to identify and intervene earlier in a patient’s kidney disease journey. … We will be able to identify patients needing earlier outreach and support services including nutrition education, social work services, complex medical coordination, and more.
Q. How will this improve clinical outcomes?
JH: [The} care model combines technology-enabled earlier identification coupled with robust clinical support services to address each patient’s individual, whole-person care needs. By helping to educate patients about their kidney disease and the care options available to them, we can address barriers to medical access that often go unmet, resulting in both an unplanned and unnecessary hospitalization. By reaching patients sooner, we can slow progression of disease, help patients navigate transplant programs, help patients select renal replacement therapies at the right time and increase home dialysis utilization, while helping them to manage other medical conditions. {The] care team is available 24/7 and can meet with patients in their preferred setting (in-person, virtual, telephonic).
Q. What does this mean for the health system? How does it help your doctors and nurses (i.e. workflow changes)?
JH: Bon Secours Mercy Health has been focused on value-based care for many years, and our relationship with Strive helps us elevate our ability to reach patients in their communities and homes to continue delivering care at the right place and the right time. Mercy Health’s physicians and clinical care team coordinate and deliver care through a seamless continuum for their patients, working closely with Strive’s Kidney Hero care team. Strive adds both scale and specialized focus to our already strong primary care network capabilities.
Q. Will new technology (digital health, telehealth, RPM) play a part in this new model of care?
JH: Wherever possible, we will implement technology to be more efficient and provide care in a setting that meets patients’ needs. Bon Secours Mercy Health has been investing in digital strategies for years, and the pandemic highlighted the need to bring them to our patients as quickly as possible. We’ve been using telehealth, digital health, and remote patient monitoring, and we would expect to utilize these tools with our kidney disease patients wherever it is appropriate and desired.
Q. What are the challenges you're addressing in implementing this model?
JH: Early identification of patients with CKD: Technology-enabled data insights allow us to identify and intervene earlier in a patient’s kidney disease journey. … We will be able to identify patients needing earlier outreach and support services including nutrition education, social work services, complex medical coordination, and more.
Preventing crash starts for dialysis: Unfortunately, across the country, over 50% of dialysis starts are unplanned. The majority of ESRD patients receive dialysis treatments in a dialysis center. Our goal is to ensure that every patient who has the desire and meets the criteria for home dialysis is provided that opportunity.
Q. How will this platform evolve?
JH: Our initial focus is with the Medicare population, with the intention to expand.
Q. Do you anticipate using this model or applying this strategy to other chronic care populations?
JH: Yes, we currently do this today. We support eight ACOs/CINs across four states. Each of these CINs provides whole person care for populations which include commercial, Medicaid and Medicare. Focusing on whole person care has provided great outcomes and experience for the patients we serve.
Q. What one piece of advice (non-vendor-specific) would you give to other health systems considering this model of care?
JH: Health systems can and should play a critical role in the redesign of how care is provided for patients with kidney disease. [The Centers for Medicare & Medicaid Services] has been very clear that kidney care as a specialty will be a focus area for the Innovation Center moving forward, as evidenced by programs like CKCC (Kidney Care Choices) and ETC (ESRD Treatment Choices). Second, we believe there is a great opportunity to partner to quickly build and scale these new clinical capabilities.
The University of Missouri is partnering with Cognoa on a Project ECHO telemedicine program that will help train rural and remote primary care providers to use digital health technology to diagnose autism spectrum disorder (ASD).
The University of Missouri is launching a telemedicine program aimed at helping rural and remote primary care providers use digital health to diagnose children living with autism.
The university’s ECHO Autism Communities Research Team is partnering with pediatric digital health company Cognoa on the project, which will train remote PCPs on a Project ECHO telemedicine platform to use Cognoa’s Canvas Dx in the diagnosis of autism spectrum disorder (ASD).
“We are excited to incorporate Cognoa’s Canvas Dx within our existing diagnostic model in hopes of expanding primary care physicians’ tools to reliably identify and diagnose children with autism,” Kristin Sohl, MD, executive director of ECHO Autism Communities and a pediatrician who specializes in autism at University of Missouri Health Care, said in a press release. “We are continuously exploring how innovations like Canvas Dx may help streamline the pathway to care, make more efficient use of specialty centers, and drive down wait times in a way that overcomes geographic and socio-economic barriers.”
The project aims to help PCPs who may not have easy access to resources to coordinate and manage care for their patients living with autism, and it may help prove the value of virtual care and digital health tools in treating this population.
And it’s a significant population. Studies estimate as many as one in every four children is at risk for a developmental delay, while one in 44 are affected by ASD. Autism can be diagnosed in children as early as 18 months, yet many aren’t diagnosed until they’re 4 years old. Earlier interventions, especially prior to age 3, can significantly improve lifelong outcomes.
Telehealth advocates say those interventions can be improved by giving primary care providers access to more resources through digital health and telehealth channels, enabling those providers to connect with families in their homes or community health clinics instead of making them drive to a distant clinic or specialist.
The study, conducted by the University of Missouri’s ECHO Autism Communities Research Team, will connect as many as 15 primary care providers in both rural and suburban areas of the state and involve as many as 100 children in their care who are at risk of ASD or developmental delay.
The Project ECHO (Extension for Community Health Outcomes) platform, developed in 2003 at the University of New Mexico, enables experts at a large health system or teaching hospital to mentor and train rural care providers on a specific topic through a hub-and-spoke telemedicine model.
Classified as software-as-a-medical device (SaMD), Canvas Dx uses AI technology to help clinicians identify signs of autism in children between the ages of 18 and 72 months who are at risk of developmental delay. It includes a questionnaire for the parent/caregiver, a separate questionnaire completed by a video analyst who reviews two videos of the child recorded by the parent/caregiver, and an HCP questionnaire completed by the PCP who meets with the child and parent/caregiver, with the data gathered through a telehealth portal.
“We are excited to collaborate with the ECHO Autism team to evaluate how Canvas Dx can support physicians to diagnose or rule out autism in the primary care setting,” Sharief Taraman, MD, Cognoa’s chief medical officer, said in the press release. “The demand for diagnosing children at risk of developmental delay far exceeds the ability of prevalent processes to provide timely diagnosis. ECHO Autism is an exemplary model to increase the capacity of care for children with neurodevelopmental conditions. Through this study, we hope to learn that the combination of Cognoa’s … technology, along with improvements in clinician knowledge, clinical expertise and longitudinal care that is the basis of ECHO Autism, can improve the quality of care for children and families.”
