Eric Gantwerker, MD, MMSc (MedEd), FACS, a practicing pediatric otolaryngologist and medical director for Level Ex, explains how healthcare organizations can use video games and gamification as an educational tool for clinicians.
Healthcare organizations are finding uses for video games that go far beyond entertainment. They're being used to help patients – particularly younger ones – understand healthcare concepts, from chronic disease management to medication adherence, while care providers are using games to track patient outcomes in cases ranging from autism to concussion treatment.
More recently, health systems are using them as educational resources, with the idea that a game can work better than a book or classroom event.
HealthLeaders recently sat down (virtually) with Eric Gantwerker, MD, MMSc (MedEd), FACS, a practicing pediatric otolaryngologist at Northwell Health's Cohen Children's Medical Center and medical director for Level Ex, a video game studio that has designed games for continuing medical education (CME). Gantwerker, who holds degrees from Harvard Medical School and Georgetown University and was recently inducted as an associate member of the American College of Surgeons' Academy of Master Surgeon Educators, shares his thoughts on how the power that practicing through play can improve a clinician's ability to learn and adopt new skills.
Q: What are the benefits to using video games for continuing medical education (CME)?
Gantwerker: While video games are inherently built for entertainment, at their core, they are built on deep knowledge and understanding of how to activate and stimulate the brain to induce learning.
For hundreds of thousands of years, humans have learned through play. Whether playing pretend, turning over a snow globe, or knocking over a maze of dominoes, our minds are constantly developing new mental models to understand the world around us. Expert game designers are well-versed in sociology, psychology, and the cognitive sciences that underlie motivation and behavior. They know how to achieve the perfect balance between challenge and mastery and they develop games deliberately to build reward-driven experiences that capture the attention of billions of people. Games are also intentionally designed to quickly and easily onboard players to the rules and progress swiftly to developing strategy by simply playing the game.
Eric Gantwerker, MD, MMSc (MedEd), FACS, a pediatric otolaryngologist at Northwell Health's Cohen Medical Center and medical director for Level Ex. Photo courtesy Northwell Health.
Because video games are built for entertainment, they create an intrinsically motivated environment for players where they play for the sheer pleasure of playing. Traditional medical learning and CME are a requirement of medical practice, creating an extrinsically motivated environment for physicians, but they are not fun by design. Lectures, webinars, and thick textbooks are a passive form of learning that often require more time to learn from, but don’t always translate into strong knowledge retention. When games and medicine collide, healthcare professionals are thrust into an entertaining environment that they actively want to engage with - the material just happens to be something they are very familiar with and can learn from. If done well, games can be an extremely powerful tool.
Q: How are these games introduced or incorporated into an education regimen?
Gantwerker: Oftentimes, the best way to integrate them is to augment formal learning for both knowledge and skills. Games are not intended to replace entire curricula, nor should they. Medical education that is rooted in facts, such as learning the bones in the body, can be easily learned through passive activities like reading or simple matching exercises. For more challenging, experience-based interactions in medicine, such as performing a knee replacement operation or diagnosing a skin disease, the power of video games to create mental models and build 3D spatial skills helps physicians actively make sense of the complexity through play. Imagine the physics that is learned through playing Angry Birds. Players understand mass, velocity, inertia, and all of Newton’s three laws of motion just by playing a game.
Q: What are the drawbacks or challenges to using video games for CME?
Gantwerker: Perception is the major challenge facing video games for CME. There are 2.6 billion video game players in the world and their average age is 36, yet people still associate games with child-like and brain-numbing entertainment and there continues to be a lack of understanding by educators and faculty that video games aren’t just for kids. In fact, they are a powerful educational tool and often better than reading an article or chapter or sitting in a lecture.
Another challenge is that there are a lot of applications of game elements or 'gamification' that don’t work that well. This gives a bad connotation to game-based learning as the effectiveness studies done may conflate games that are developed with the deep-design principles and psychology of video games and those that just add leaderboards and quizzes to educational contexts. This leads both the public and discerning educators to believe that games aren’t as powerful as traditional learning methods, which is not true.
Additionally, the technologies that are used to create medical video games are tremendously powerful, but they require expert game designers and engineers to realize their full potential. Because of this, we are now seeing more digital health startups hiring from the ranks of triple-A game studios to advance their work in this area.
Q: How does a video game improve a healthcare provider's skills that traditional education doesn't?
Gantwerker: Motivation and engagement are some of the biggest challenges named by medical educators today, but they also happen to be the major advantages of playing games. When players are both motivated and engaged they enter a state of mind called the 'flow state.' A well known psychologist named Mihaly Csikszentmihalyi coined this term to describe elite athletes and musicians. This period of intense concentration denotes a maximally efficient period of learning and contributes to better knowledge retention and skill development. The flow state creates a game environment where fun and entertainment are prioritized and education becomes the unintended consequence – it’s why people can lose track of time while playing.
Q: How does one convince a health system's executive leadership to embrace video games for CME?
Gantwerker: It all comes back to perception. There is ample evidence proving the power of games when learning technical and knowledge-based skills. Even consumer games have shown effects on learners with several studies showing that those who played action video games at a young age had better visuospatial skills and performed better on laparoscopic surgery-based tasks than those that did not.
The other critical component in gaining executive leadership’s support is helping them understand the difference between 'gamification' and true video game design. Gamification takes elements devoid of deeper learning and connection to gameplay and applies it to a separate context like leaderboards and badges. You can easily turn a learning activity like watching webinars into a game by slapping a leaderboard on to the video platform so users can see where they fall amongst their peers. It may be motivating at the start, but it does not contribute to a stronger understanding of the skills being taught.
My advice to leadership is to always give games a chance -- the risk is low and the reward can be quite high. Put a well-designed game head-to-head with any other learning modality and you’ll see the advantages of time, enjoyment, and depth of understanding.
Q: How do healthcare-related video games differ from typical video games?
Gantwerker: This is all about context. Typical video games that use healthcare as the context are often a parody of medical practice. But if you respect the field, design games for entertainment and create a game environment that requires healthcare professionals to apply applicable knowledge to a situation, they are surreptitiously learning something medically relevant. That’s the secret sauce to creating an effective medical video game.
However, healthcare-related video games do have a lot in common with typical video games as they are both built on fundamental core gameplay loops -- the main set of actions undertaken by a player that define the game -- that have been trialed billions of times. These game mechanics and styles are ubiquitous and can easily be applied in healthcare games. They include things like match 3, collection mechanics, puzzle mechanics, first-person shooter, real-time strategy, set and play mechanics, experience points, virtual currency, etc.
Q: How will this field evolve? What new technologies or strategies do you see on the horizon that might improve video games for CME or make the C-suite more receptive to using them?
Gantwerker: I think perceptions are finally changing and people are realizing the power of game design and technology. As I noted earlier, we are seeing a huge influx of game designers from big name studios coming into the healthcare technology startup world to advance the design of medical video games. We also see the morphing of digital entertainment and the movie industry that is pushing the boundaries of what computers and AI can do in the games industry. This will bleed over into healthcare in meaningful ways, creating much more realistic virtual patients, more natural virtual patient interactions, and more visually appealing virtual healthcare environments.
The metaverse is another concept that comes up a lot when talking about the future of gaming, but it’s important to note that the metaverse is just a platform. It’s software-based, and can be viewed through different hardware, such as a VR headset, but it is still just a platform. Many health tech companies have put their stake down on one platform, say VR or AR, but in doing so have limited themselves to that single platform. Medical video games, however, are platform-agnostic given their software-based modality and can be played on a phone, through a web browser or with the use of external hardware like a VR headset, making them much more accessible. We also see a lot of extended reality (XR) being applied in healthcare and games and this hardware will continue to get better, faster, less bulky and intrusive, and hopefully more intuitive to use as well.
I hope that the studies done on medical video games continue to evolve and not lump games like Jeopardy in with action-adventure games, when trying to draw conclusions about efficacy. Authors in this space need to be better about discerning based on educational levels and outcomes, educational context and game-type, and software vs hardware solutions. Once we have a better understanding and definition of true medical video games, we can start speaking the same language and see the widespread application of these tools in the healthcare space.
The South Dakota-based health system has broken gound on a 60,000 square-foot virtual care center, part of a $350 million initiative launched in 2021 to extend telehealth and digital health services across the Upper Midwest. The program will include five 'satellite clinics' located in rural and underserved communities.
Sanford Health is going all-in on telehealth and digital health, with a new virtual care center and five "satellite clinics" aimed at expanding access to care and resources across the Midwest.
The Sioux Falls, SD-based health system, billed as the largest rural health system in the country, covers roughly 250,000 square miles across several states with a network of 47 medical centers, 224 clinics, 158 skilled and nursing rehab facilities and hundreds of other healthcare sites. Officials announced the ground-breaking for the Sanford Virtual Care Center during this week's "Future of Rural Healthcare" conference.
“This flagship center will be the premier training ground to prepare medical students, residents and nurses for the next generation of care delivery,” Brad Schipper, the health system's president of virtual care, said in a press release. “The innovation that takes place in this building will help us deliver on our promise to patients by leveraging the best of technology to provide high-quality, safe care with an emphasis on convenience and affordability.”
The 60,000 square-foot facility, expected to open in 2024, will house clinician workspaces equipped with telemedicine and digital health technology and feature services that include on-demand virtual primary, behavioral health and urgent care. It will also house "innovation, education, and research initiatives to advance digital healthcare and workforce solutions for the future."
The announcement is the latest step in a $350 million virtual care initiative launched in 2021 and aimed at improving access to care for rural and underserved populations, which comprise a considerable part of Sanford Health's coverage area. The program will include the development of five clinics, also equipped with the latest in virtual care technology, in locations where in-person healthcare services "are otherwise unavailable or diminishing."
The program aims to make the Upper Midwest a hotbed for telehealth and digital health innovation and outreach. Avera Health, a multi-state healthcare organization also based in Sioux Falls, launched its own telehealth education center in 2019, alongside a national telehealth certificate program, and then sold its Avera eCare telehealth business last year to a private capital firm, which has renamed the business as Avel eCare.
Another big player in the region is Salt Lake City-based Intermountain Healthcare, which has an extensive telehealth and digital health network. Sanford Health and Intermountain had discussed joining forces in a merger in 2020, but ended those talks that same year.
The Louisville-based health system is working with Cadence to establish the platform in 18 community hospitals in 12 states, with plans to expand the service to all of its 79 hospitals in 25 states.
ScionHealth is launching a remote patient monitoring program to provide chronic care management services to ambulatory patients in 18 community hospitals across 12 states.
The Louisville-based health system, created in 2021 by Kindred Healthcare and LifePoint Health, is partnering with Cadence on the RPM platform, and plans to eventually scale the program out to its 61 specialty hospitals and long-term acute care populations in 25 states. The program will support patients living with heart failure, diabetes, hypertension, and chronic obstructive pulmonary disease (COPD).
"We are committed to advancing innovative healthcare solutions in order to serve patients where and when they need care,” Rob Jay, the health system's Chief Executive Officer, said in a press release. “Our partnership with Cadence will allow us to seamlessly extend care from our community-based hospitals and our long-term acute care hospitals to patients at home, both expanding access and improving the quality of care for patients managing chronic conditions.”
RPM programs are gaining momentum across the country as a means of improving care management for patients at home, in between (and sometimes replacing) visits to the doctor's office or clinic. Many programs use digital health tools to collect data from patients weekly or even daily, enabling patients and their care teams to communicate and adjust care plans when needed.
“Our partnership with Cadence offers consistent, proactive monitoring outside of the clinic, enabling early interventions if and when necessary to improve a patient’s overall health and wellbeing,” Dean French, MD, the health system's Chief Medical Officer, added in the press release. “We believe that remote patient monitoring and responsive virtual care will become the standard of care for treating chronic conditions and we are excited to be a first mover in bringing these capabilities to our communities.”
Hub-and-spoke telemedicine networks can extend specialty services and education into rural areas and improve clinical outcomes and provider efficiencies. But providers have to do their homework before jumping online.
Telemedicine is designed not only to improve patients' access to care, but to extend the reach of healthcare providers beyond the hospital, clinic, or doctor's office. That's especially true for specialty care providers, who are fewer in number but in high demand throughout the country.
The Cardiovascular Institute of the South (CIS), based in Houma, Louisiana, specializes in cardiovascular care in a part of the country where those resources are limited and a higher percentage of people are living with at least one chronic condition. With that in mind, the institute has leveraged a hub-and-spoke telemedicine platform, with CIS at the center, to help rural patients in Louisiana and surrounding states access care.
"It gives us many more opportunities to treat patients," says Craig Walker, MD, who founded CIS as a solo practice in 1983 and now serves as president of an operation encompassing almost 90 cardiologists and more than 60 nurse practitioners. "We can be in places where we couldn't be before, providing better care for our patients and helping physicians in rural areas."
The hub and spoke telemedicine model exists in many forms around the country, and is perhaps most popular in rural areas. It places a large, often academic hospital or health system (or in this case a specialty clinic) at the center, on a telemedicine platform that connects to smaller hospitals, clinics, and other healthcare sites. Specialists at the hub connect virtually with these spoke sites to treat patients, assist remote care providers, or even provide mentoring or clinical education services.
Forming a Bond With Patients
CIS launched its telehealth program in 2017, in a partnership with InTouch Health, and has continued that relationship through Teladoc's acquisition of InTouch in 2020. Alongside teleneurology and stroke care, cardiovascular disease is seen as an ideal form factor for hub-and-spoke telemedicine, as it affects roughly one in four people, drives some $320 billion in annual healthcare spending, and accounts for about one-third of Medicare costs.
Craig Walker, MD, founder and president of the Cardiovascular Institute of the South. Photo courtesy CIS.
"Telemedicine has the ability to transform the way cardiology care is delivered, through expanding access across rural areas, managing bed capacity, easing travel burden on sub-specialties, improving collaboration between sub-specialties, and expanding our own coverage internationally," Walker said in a 2017 press release announcing the CIS collaboration with InTouch.
Today, Walker says CIS is conducting more than 200,000 virtual visits a year. The clinic reports a response time of less than 30 minutes and a 99% patient satisfaction rate, with some 86% of patients able to stay in their community to access care rather than travelling to a distant location.
"We're forming a bond with [our patients]," Walker says. "It tells a patient that we're interested in them, so we're reaching out to them."
With this model of care, CIS specialists can help treat patients in rural and remote locations who either can't get to CIS or another hospital or who would have difficulty making that trip. The specialists use the virtual platform (typically a telemedicine robot or audio-visual link through a computer) to meet with patients and help care providers in those spoke sites, whether it be a hospital, clinic, or managed care site. With that platform, rural providers know they have a specialist helping them—not only guiding them, but giving them the skills and confidence to improve their own care management.
As health systems struggle to fill vacant positions, and in the case of rural hospitals, stay open, telemedicine models like the hub and spoke offer important opportunities to improve care and keep more patients in-house. A small hospital in a remote location can, for instance, create virtual channels with larger, distant health systems to provide everything from backup ICU care to behavioral health services.
"Any time a hospital has to refer a patient out, they lose," Walker points out, noting that he's been surprised at how well this platform can eliminate hospitalizations and transfers. "They need those patients to stay [in the hospital and get the care they need, which is closer to home."
The Project ECHO Model of Care
These platforms can also be used to educate and train care providers in rural areas on chronic care management, public health, and other issues, enabling them to provide better care for their patients rather than sending them to specialists. The model is known as Project ECHO (Extension for Community Health Outcomes), and was developed in 2003 by Sanjeev Arora, MD, at the University of Mexico, as a means of teaching rural provider how to care for patients living with hepatitis C. Similar to a clinical care model, it places an academic hospital at the center and enables specialists to use telemedicine to conduct virtual education sessions for rural providers.
"Community providers, particularly community-based health centers, provide coordinated, patient-centered care in facilities proximate to their patients," Arora and his colleagues wrote in a 2011 article in the New England Journal of Medicine outlining the Project ECHO model. "Patients are likely to have greater trust in local providers, who tend to be culturally competent with respect to their specific communities. This may enhance patients' adherence to treatment and allow for greater direct contact with the clinician, including more frequent visits."
"As a result, local providers may be better able to comply with best-practice protocols, ensure close assessment of the results of laboratory tests, offer education tailored to the patient, and provide better and more timely management of side effects," the study concluded. "In addition, the fact that the primary care of the patient and the management of Hepatitis are provided by the same clinician ensures better coordination of care and fewer communication challenges."
There are now hundreds of Project ECHO programs across the country in almost every state, offering education on topics such as pediatric care, substance abuse treatment, behavioral health, diabetes care management, cancer care, senior care, HIV/AIDS care, and more recently, COVID-19 and infectious disease treatments.
Balancing Patient and Provider Workflows
At CIS the focus is on clinical care and improving outcomes not only for the patient but the care provider.
Walker points out that the telemedicine platform gives his staff the ability to care for more patients, but not at the expense of their own health and wellness. Specialists are able to factor virtual care into their workloads, creating schedules that are comfortable. While those video visits comprised about half of their work week during the height of the pandemic, when in-person care was reduced to emergencies, they now factor out to around 10% of the workload.
"This reduces a lot of stress that leads to burnout," he says.
With telemedicine part of the model of care now, even integrated into the electronic medical record platform, CIS is hiring staff specifically for virtual care, and has created a 6,000-foot facility for those visits.
"[It has] all the technology we need and a lot of TVs," Walker says. "It looks like a sports bar. And yes, we probably will need more space."
But there's value in expanding. While the program initially cost CIS more than the hospital could bring in, they're now seeing a 180% return on value (according to the Teladoc case study). Walker says they're "getting a lot of referrals" as healthcare providers in surrounding areas and states see the value of connecting with specialists, and payers—especially Medicare and Medicaid—are starting to reimburse for those services.
Walker says more services can be handled on a telemedicine platform, including check-ins and check-ups, remote patient monitoring services, and education sessions for patients on how to manage their own care.
But they can't—and shouldn't—replace in-person care.
"There's a lot you can do with technology now, and it's getting better," he says, "but the physical exam" is still an integral part of the care pathway that can't be completely done via video. Any program that incorporates telemedicine has to factor in-person care into the routine, at a frequency that meets the needs of both patient and provider.
That's part of the checklist that Walker says any healthcare organization should fill out before launching a telemedicine program, either as a hub or as a spoke.
"Do your homework first," he says. "Visit programs that are established. Understand what telemedicine can do, but also what it can't. … And make sure you have everything in place before starting."
That includes not only the technology, but staff and patient buy-in, and a full understanding of workflows.
"It's often the programs that are least ready that need this the most," he says. "So, it's important that you know what you’re getting into. And then you'll see what it can do."
Four health systems will receive $23 million to launch research programs into how telehealth can be used to improve cancer treatment and care management.
The National Institutes of Health's National Cancer Institute (NCI) has designated four health systems as national centers for excellence for their work in using telehealth to improve cancer treatment and care management.
“These centers will address important gaps in telehealth and cancer-related care delivery,” Robin C. Vanderpool, DrPH, chief of the Health Communication and Informatics Research Branch at the NCI's Division of Cancer Control and Population Sciences (DCCPS), said in a press release. “We need to establish an evidence base for using this technology to deliver healthcare in oncology and make it part of routine care. In addition, these centers will explore opportunities for scalability and dissemination of their cancer-related telehealth interventions beyond their own health systems.”
The use of telehealth and digital health skyrocketed during the pandemic, as healthcare organizations sought to reduce the spread of the virus by shifting in-person services to virtual platforms. This shift was especially valuable to cancer care programs, whose patients are at risk of serious complications if they become infected.
The Scalable Telehealth Cancer Care (STELLAR) Center. Located at Northwestern University outside Chicago, this program will focus on using telehealth to extend health services to cancer survivors aimed at reducing risk behaviors such as smoking and physical inactivity.
The University of Pennsylvania Telehealth Research Center of Excellence (Penn TRACE). Located at the University of Pennsylvania in Philadelphia, Penn TRACE will apply communication science and behavioral economics to study the value of several telehealth strategies on shared decision-making for lung cancer screening and to improve timely access to comprehensive molecular testing for advanced lung cancer.
“These centers will be at the cutting edge of some amazing breakthroughs by creating sustainable and effective telehealth options tailored specifically for cancer care,” Roxanne E. Jensen, PhD, a program director in the Outcomes Research Branch in DCCPS who is overseeing the TRACE initiative with Vanderpool, said in the press release. “This work will pave the way for having healthcare delivery look a lot different for cancer patients over the next five to 10 years, and that's really exciting and in alignment with the goals of the Cancer Moonshot initiative.”
Bicycle Health is teaming up with Tele911 to give 911 dispatchers and first responders an on-demand connection to substance abuse counselors and resources, enabling them to offer alternatives to expensive and often unnecessary ER transports.
A new digital health partnership aims to reduce 911 transports to crowded ERs by giving emergency personnel on-demand access to substance abuse resources.
Bicycle Health, a San Francisco-based provider of virtual opioid addiction treatments, in joining forces with Tele911 to develop a platform that helps first responders direct patients with substance abuse issues to the appropriate resources. The service is designed to replace the standard practice of transporting those patients to the hospital for treatment.
“Opioid use disorder impacts millions of Americans each year, yet 80% of them go without treatment,” Ankit Gupta, Bicycle Health's CEO and founder, said in a press release. “Working closely with Tele911 will allow us to reach individuals struggling through emergency health crises, redirect their care, and welcome them to our evidence-backed virtual care model – ultimately putting them on the path to recovery.”
The service is designed for EMS and ambulance companies and other first responders, many of whom are seeing high volumes of 911 calls that end in unnecessary and expensive hospital transports. Several programs now in use across the country use telehealth and digital health technology to screen those emergencies at the scene (or before emergency personnel arrive) and determine if the hospital is the best care plan, with alternatives that can include taking the patient home or to another care site or scheduling a healthcare visit at a more appropriate time.
Health systems and hospitals are also interested in the platform as a means of reducing crowded Emergency Department waiting rooms and unnecessary treatments and improving care coordination.
The Bicycle Health-Tele911 partnership enables first responders to connect with an emergency physician through the Tele911 platform who can evaluate the patient and establish a care plan that may include telehealth and/or home-based visits, MAT treatment and other services through Bicycle Health.
“Many patients who call 911 can safely be treated in place, avoiding costly and medically unnecessary ambulance transports to crowded ERs," Marc Eckstein, CEO and co-founder of Tele911, said in the press release. "This innovative partnership with Bicycle Health will allow us to take that in-home treatment to the next level by allowing us to connect these stable, vulnerable patients to immediate care tailored to their specific needs, ultimately transforming the EMS system and improving OUD care.”
The program will give students in 20 elementary schools access to primary care services, while students in 10 middle and high schools will be able to access telemental health services.
Atrium Health is turning a $10 million gift from Bank of America into an ambitious telehealth program aimed at improving access to healthcare services in schools and other sites.
The Charlotte, NC-based health system is launching its Meaningful Medicine program in 20 elementary schools and 10 middle and high schools in the Charlotte-Mecklenburg Schools (CMS) district during the upcoming school year, and plans to expand the program to 50 schools within three years. The elementary schools will receive school-based virtual care, while middle and high schools will receive telemental health services.
"By improving the wellbeing of our students across Charlotte, we are not only investing in their health, but in our collective future," Eugene A. Woods, Atrium Health's president and CEO, said in a press release. “These young girls and boys will be the future doctors and nurses that will serve the needs of our growing community in the decades to come – and Atrium Health is proud to help model for the nation how health systems, businesses, schools and public officials can work together to have a meaningful impact in historically underserved communities."
“Affordable, accessible medical care is key to the health and well-being of our students,” added Hugh Hattabaugh, CMS' interim superintendent. “The Meaningful Medicine program provides another option for parents to meet their children’s healthcare needs and keep them in the classroom where they can reach their highest academic potential.”
Armed with the latest in digital health technology, school districts across the country are developing virtual care programs that turn the nurse's office – or any room in a school – into a clinic, giving both students and staff access to primary and specialty care services at a moment's notice. The platform helps schools improve access to basic care for staff and underserved students, gives older students and on-demand connection to behavioral health specialists, and reduces time lost to sick days.
The programs also aim to reduce chronic diseases and other negative health outcomes by reducing the barriers to care caused by social determinants of health and supporting health and wellness services.
Atrium Health is also partnering with Central Piedmont Community College and the YMCA of Greater Charlotte on the program, with plans to extend virtual health services to those sites as well.
School-based telehealth services will be provided by providers from Atrium Health's Levine Children's Hospital, working with nurses at each school employed by Mecklenburg County Public Health.
The Baltimore-based health system is applying lessons learned during the pandemic and working with digital health company Get Well on a platform to track those infected with monkeypox and manage their care.
With monkeypox now a public health emergency in the US, LifeBridge Health has launched a digital health platform designed to help patients and their care teams track infections and develop a care management plan.
The Baltimore-based health system is applying lessons learned from the COVID-19 pandemic and working with digital health company Get Well on the platform, which creates a 21-day care plan around those infected with the virus. The platform offers information on symptoms and transmission, allows patients and care providers to track symptoms (including fever, rash, pain and swollen lymph nodes), offers guidance on isolation protocols, and allows care providers to monitor the progress of the virus.
Many healthcare organizations are keeping a wary eye on monkeypox and looking at how they deployed telehealth and digital health tools and strategies during the pandemic to fashion a response to this latest health concern.
"We worked with Get Well to implement digital care plans quickly for COVID-19 in 2020, and we are now seeing heightened interest around monkeypox, given the increasing number of cases," Adam Beck, the health system's director of digital health," said in a press release. "We are hopeful that having ready access to information and monitoring can provide reassurance and reduce anxiety around monkeypox."
“Early messaging around monkeypox and how has it spreads raised some unfortunate stigmas, as the illness initially affected gay men at a higher rate," added Pothik Chatterjee, assistant vice president of innovation for LifeBridge Health. "However, everyone is susceptible and there are many ways it can spread, so we were pleased to work with Get Well on a proactive approach to share accurate and timely information.”
With an emphasis on mobility and innovation, mobile health clinics are helping to tackle care gaps, reach underserved populations, and give hospitals a new access point.
Healthcare organizations are realizing that some services need to be brought to the consumer, rather than waiting for that person to visit a doctor. And they're using mobile health clinics to make that connection.
Mobile health clinics come in many shapes and sizes, from fully equipped, customized RVs or trailers offering a range of primary and specialty care services, to small vans with the supplies and resources needed to address one particular goal, such as sexual health education, mammography screenings, or vaccinations. They're designed to go into communities that lack brick-and-mortar healthcare resources or have populations that won't or can't access healthcare services.
"They are becoming more prevalent, in part because of the pandemic," says Mollie Williams, DrPH, MPH, a lecturer on global health and social medicine at Harvard Medical School and executive director of The Family Van and the Mobile Health Map, a resource for mobile health clinics with more than 700 members.
Mollie Williams, DrPH, MPH, executive director of The Family Van and the Mobile Health Map and a lecturer on global health and social medicine at Harvard Medical School. Photo courtesy of Harvard Medical School.
"One of the benefits of mobile health clinics is their adaptability," adds Elizabeth Wallace, executive director of the Mobile Healthcare Association (MHA), the leading membership organization for mobile health professionals in the US and Canada. "They're designed to turn the traditional healthcare relationship on its head … and create a new model of care."
Williams and Wallace were part of a team that put together The Case for Mobile, a report recently released by the Mobile Health Map and the MHA that examines how mobile health clinics support the business objectives of health systems and impact community health and health equity initiatives.
A surge in popularity as healthcare goes mobile
Williams estimates a few hundred mobile health clinics were in operation prior to the pandemic, and that number has increased to about 2,000 as healthcare organizations look at new ways to deliver care that meets consumers where they are. In addition, they're as popular in urban areas, such as inner cities, as in rural regions.
"The pandemic has sparked innovation in healthcare, including greater interest in mobile programs," the Case for Mobile report states. "Healthcare providers have adopted or scaled up other innovations, including telemedicine, drive-through testing and vaccination sites, and 'pop-up' clinics. It is very likely that innovations sparked by the pandemic will continue in various forms long after the crisis has ended. For example, many mobile clinics that began as a way to expand access to COVID testing or vaccinations are planning to continue operating and adjusting their service offerings to meet other community needs."
"Because of the pandemic, everyone had to think creatively," says Williams. "Now [healthcare executives] are thinking about new ways to use mobile clinics. Some are using them to expand business lines, while others want to expand capacity or reach new communities."
And while some have classified mobile health clinics as "alternatives" to healthcare models, a 2017 study published in the National Library of Medicine and authored by researchers at Harvard Medical School indicates these vehicles can also serve as entry points to a health system, helping consumers navigate the complexities of healthcare access, and paving the way for future in-person and virtual connections.
"In many contexts, [mobile health clinics] can and do play an integral part in a healthcare system, providing accessible and sustainable care with quality that matches traditional healthcare settings," that study concluded.
These mobile access points "can identify pressures that a hospital is facing and address them in a different way," Wallace says. They can be located next to a retail center, like a mall or supermarket, or alongside a library or town offices, even next to a theater, park, beach, or motel, attracting people who might need care but are wary of going to a crowded ER or urgent care clinic.
Finding the right use case for a mobile health clinic
Williams says a common misperception about mobile health clinics is that they have to be expensive or filled with the latest in digital health technology. A health system can spend as little as $150,000 or $200,000 in startup costs for a mobile health program and see success, as long as the program reaches and engages its target population with services that meet a gap in care.
"Those costs don't have to be substantial compared to what you're probably spending" to address the care needs of that population, she says.
And they can be flexible. If one approach or one location isn't working, pull up stakes and move, or redesign the mobile clinic to address a different healthcare concern.
Wallace says healthcare organizations looking to launch a mobile health program should first conduct a community needs assessment. This gives the organization an opportunity to talk to the community about what it wants and needs, as well as identifying partners in the project. That may include health systems and local doctors, charitable groups, civic organizations, and even local government. The idea is to create a group of stakeholders who can help guide the program as it launches and evolves and identify any issues it may have to address.
Elizabeth Wallace, executive director of the Mobile Healthcare Association. Photo courtesy of the MHA.
"It shouldn't be thought of as a pilot project," she adds. That evokes images of a test, or something that's being tried out and can be cancelled at any moment. This, instead, is a program that aims to stay in the community and foster a lasting relationship.
In addition, mobile health clinics don’t have to be dependent on technology to be effective.
"Technology and mobile healthcare, they're not in the same universe," Williams says. "I would say they can complement each other and stimulate each other … but they don’t have to both be there."
"We've found, in some cases, that technology doesn't resonate with them," she says of the typical mobile health clinic visitor. "They don't seek out [healthcare services] like you or I. They are coming to a mobile clinic, in many cases, for that personal touch."
This, in turn, can help a health system connect with its surrounding communities. That point was made by a health clinic operator interviewed for the MHA/Mobile Health Map report.
"For communities that have been disinvested or marginalized by our healthcare system through generations, being able to go to them, make the effort to get right where they are-say here I am," the clinic operator said. "I’m here to respond to you. It’s a good way to be able to bring them into a healthcare system that maybe they are distrustful of."
Sowing the seeds for sustainability
The challenge for many mobile health programs lies in finding a means of continuing past the loan, grant, or award used to get the program up and running.
"The launch is just the beginning," says Williams. "You need to establish a plan for getting support, especially from payers."
The key, as with any new healthcare program, is to gather evidence that the program works. That may be in reduced ER visits, which help a hospital's bottom line and lessens the pressure on 911, ambulance and EMS services, or an improvement in screenings, public health education, chronic care management, and other services that boost clinical outcomes down the line. The unmeasured effect, meanwhile, lies in an improved community.
The drawbacks? It's hard to find any.
"We worked really hard to find people who would disagree with us," Williams chuckles. "We tried really hard to find people to tell us that mobile clinics were a bad idea, and that just didn't play out."
The New York health system is looking for 1 million patients to participate in a program aimed at developing genetics-based precision medicine treatments and new therapies.
The five-year project, launched in a partnership with Regeneron, aims to provide researchers with data that will help in the development of genetics-based precision medicine treatments and new therapies.
“For decades, we have hoped that genetics would offer doctors the blueprints to each patient’s unique health care needs," Alexander W. Charney, MD, PhD, an associate professor of psychiatry, genetics, and genomic sciences at the Icahn School and project leader, said in a press release. "While genetics has proved to be a powerful tool for understanding rare disorders, we still do not have enough data to know how effective it may be in helping to treat and diagnose most patients. A big reason for this is that most gene sequencing studies are not designed for this.”
“For this project, we found several key ways to provide researchers with the massive, clinically focused, real-world data that are needed to truly determine the effectiveness of precision medicine and hopefully improve patient care,” he added.
The Mount Sinai Million Health Discoveries Program, developed on a digital health platform created by Vibrent Health, will be led by Charney; Girish N. Nadkarni, MD, MPH, the Irene and Dr. Arthur M. Fishberg Professor of Medicine; Dara Meyer, MS, PMP, director of operations and project management; and Rachelle Weisman, MPH, associate director of clinical operations, all of whom are based at the Icahn School. Charney and Nadkarni are co-directors of The Charles Bronfman Institute for Personalized Medicine at Icahn Mount Sinai, which will over see the program.
Patient recruited by the health system who give their consent will have their DNA sequenced and analyzed, after which a de-identified version of the electronic medical record profile will be sent to researchers. At the Regeneron Genetics Center, researchers will perform exome screening and whole-genome genotyping.
“At Mount Sinai, precision medicine rests on a three-legged stool of gene sequencing, advanced electronic medical records, and cutting-edge algorithmic data analysis techniques," Eric J. Nestler, MD, PhD, the Nash Family Professor of Neuroscience, director of The Friedman Brain Institute, Dean for Academic Affairs at Icahn Mount Sinai, and chief scientific officer of the Mount Sinai Health System, said in the press release. "This project exemplifies that highly promising approach. We expect that the unprecedented size and diversity of this study will provide researchers with clinically actionable information to deliver better care for patients.”
"Almost all the information we need for this study is already embedded in the electronic medical records," added Nadkarni. "This means that we can greatly shorten the interview process, which in the past has reduced the chances a patient would consent to being enrolled in a study. In general, we believe that by re-evaluating each detailed step of the enrollment process, we can raise the participant levels we need to produce meaningful data that will one day help patients’ lives.”
