Federal officials are issuing grants of between $1.4 million and $2 million to 29 community health centers across 14 states and Puerto Rico to help them expand their virtual care and digital health footprints.
The federal government delivered a much-needed valentine to 29 health centers on Monday with the release of nearly $55 million to support virtual care services for underserved populations.
The money, announced by the Health and Human Services Department through the Health Resources and Services Administration (HRSA), supports an ongoing effort by the government to help federally qualified and community health centers and rural health clinics use innovative new technologies, such as digital health tools and telehealth and remote patient monitoring platforms, to address access issues caused in part by the pandemic.
“Virtual care has been a game-changer for patients, especially during the pandemic,” HHS Secretary Xavier Becerra said in a press release. “This funding will help health centers leverage the latest technology and innovations to expand access to quality primary care for underserved communities. Today’s announcement reflects the Biden-Harris Administration’s commitment to advancing health equity and putting essential health care within reach for all Americans.”
“Today’s awards will help ensure that new ways to deliver primary care are reaching the communities that need it most,” added HRSA Administrator Carole Johnson. “Our funding will help health centers continue to expand their virtual work while maintaining their vital in-person services in communities across the country.”
Through the American Rescue Plan and efforts like the Federal Communications Commission’s COVID-19 Telehealth Program and Connected Care Pilot Program, federal officials are looking to build momentum for virtual care services, which were mired in a low adoption rate prior to the pandemic but have seen a surge over the past two years.
Health centers have been especially busy, reported a 6,000% increase in virtual visits and a 130% percent increase in centers using digital health from 2019 to 2020. There are more than 1,400 of them scattered across the country, serving some 29 million people a year, the majority of which are living at or below 200% of the federal poverty line and faced with financial, societal and physical barriers to accessing care.
While this increase in the use of virtual care is good, it may also be unsustainable. Much of the growth is tied to emergency federal and state waivers issued during the public health emergency to expand access to and payer coverage of virtual care during the pandemic. Some states have made improved their virtual care guidelines since then, but many of those waivers will end when the PHE does, forcing care providers to drop services that are no longer sustainable.
Support has been growing to pressure Congress to make many, if not all, of those waivers permanent. In January some 336 organizations, led by the American Telemedicine Association (ATA), Healthcare Information and Management Systems Society (HIMSS), College of Healthcare Information Management Executives (CHIME), Consumer Technology Association (CTA), Alliance for Connected Care and others, sent a letter urging Congress to enact permanent telehealth reform.
Researchers at the University of Miami School of Medicine have launched an NIH-funded study to create a 'digital twin,' which would stand in for the patient on any tests or new treatments to determine whether they're effective.
Researchers at the University of Miami Miller School of Medicine are creating a “digital twin” that would replace the patient during tests and treatments.
Called the MLBox, it would use digital health wearables and smart devices in the home to collect biological, clinical, behavioral and environmental data on a patient, then create a model that could be used to test out new treatments before they’re tried on the actual patient.
The project is being spearheaded by the Miller School’s Media and Innovation Lab (TheMIL), along with Amazon Web Services and the Open Health Network, and will initially focus on treatments for sleep issues, such as sleep apnea, and their link to serious health concerns like dementia and heart disease.
“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.”
Seixas will be working on the project, which is funded by the National Institutes of Health, with Girardin Jean-Louis, PhD, director of the Translational Sleep and Circadian Sciences Program and professor of psychiatry and behavioral sciences.
Through the use of sensors and digital health devices, the MILBox will develop and analyze a patient’s sleep patterns, weight, environmental pressures and stress levels. The data will be gathered over seven consecutive days to create a biological health algorithm, which would act as a patient’s digital twin.
The idea is to create a model that will stand in for the patient, allowing care providers to study how a certain drug or treatment works without putting the patient through any stress or danger. For example, it would allow doctors to identify and design a treatment for a specific type of allergy without needing to run the patient through a battery of tests to identify to what the patient is allergic.
“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,” the press release stated. “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.”
Much of the work will be done on the PatientSphere 2.0 platform developed by the Mountain View, CA-based Open Health Network. Officials say the platform will be device-agnostic and scalable, so that more sensors and devices can be added and more data collected to address other health concerns.
“You will be able to add and subtract different devices based on the use case,” Seixas said in the press release. “We’ve designed this to be future-proof and support our larger mission of creating a new kind of personalized health care.”
The program enrolled its first participants in late 2021, and officials hope to have as many as 1,500 participants this year.
A new survey conducted by the University of Michigan and supported by the AARP finds that less than one in every three seniors is using an mHealth app, andf those numbers are even lower for seniors who should be using them.
Senior care advocates say mHealth apps could do a world of good for people over 50 who want to live healthy lives and stay in their own homes, but a new survey finds that less than a third actually use that resource.
According to an online and phone survey of some 2110 seniors ages 50-80 taken in August 2021 by the National Poll on Healthy Aging, based at the University of Michigan Institute for Healthcare Policy and Innovation and supported by the AARP, only 44% have ever used an mHealth app, and only 28% are using one now. That’s stunning news considering the emphasis being put on virtual care these past two years to deal with the pandemic.
“Now that most older adults have at least one mobile device, health-related apps can provide an opportunity to support their health-related behaviors, manage their conditions and improve health outcomes,” Pearl Lee, MD, MS, a geriatrician at Michigan Medicine who worked on the poll report, said in a press release.
Indeed, not only do most seniors either have a smartphone, laptop, tablet or computer, but there are more than 350,000 mHealth apps to choose from, offering help with and resources on chronic care management, cognitive and behavioral health, diet and exercise, even on-demand access to primary and specialty care services.
Yet 56 percent of the seniors surveyed said they’d never used an app. And those who are in poor health, or with lower levels of income or education (often part of a population that faces barriers to accessing the care they need), are far less likely to have used or be using apps.
For example, only 14% of seniors surveyed who live with diabetes are using an app to manage their medications, and just 28% are using an app to manage their blood sugar levels. When asked specifically if they used continuous glucose monitors, which are wearable and allow people to track and manage their blood glucose numbers in real time, just 11 percent said they use the devices, and yet 68 percent said they’d heard of the devices and more than half expressed an interest in trying them.
The AARP, which has long been an advocate of the use of digital health tools to help older Americans live longer and better lives, sees that interest as a good sign.
“AARP’s research has found a sharp increase in older adults purchasing and using technology during the pandemic, and many are interested in using technology to track health measures,” Indira Venkat, the organization’s vice president of consumer insights, said in the press rleease. “With more people 50+ owning and using technology, we may start to see an increase in older adults using apps to monitor their health.”
Of those seniors who are taking advantage of this resource, 34% are using apps to track exercise and 22% are monitoring nutrition. About 20% are using apps to manage their weight, 17 percent are tracking sleep, 9 percent are monitoring their blood pressure, 8 percent are using them for meditation, and just 5 percent are using apps to access mental health or stress management resources.
Among the seniors surveyed who aren’t using mHealth apps, roughly half said they aren’t interested (a better word might be ‘motivated’), 32% said hadn’t thought about using apps, 20 percent weren’t sure if they would be helpful and 14 percent said they are uncomfortable with the technology.
These results aren’t earth-shattering – many surveys have reported low adoption of mHealth resources among the senior population over the past decade. But the results once again point a finger at the healthcare industry for not emphasizing the value of mHealth apps to seniors.
Advocates say more health systems should make digital health education and access an integral part of senior care management and coordination strategies, and care providers should take the time and effort to help seniors understand where to access and how to use the technology.
Privacy and security concerns may play a part as well. According to those surveyed, just 23 percent were very confident that their personal health information is sure on mHealth apps, while 58 percent were somewhat confident and 20 percent had no confidence in mHealth app security.
That includes putting more effort into targeting mHealth resources at seniors who could really use them. Only 15 percent of seniors with annual incomes less than $30,000 use mHealth apps (compared to 43 percent of seniors with incomes greater than $100,000), and those with college degrees are more than twice as likely to use apps as are those who hadn’t completed their high school education. In addition, seniors who reported being in good, very good, or excellent health were more likely to use apps than those saying they’re in poor or fair health (29% to 21%).
“People who describe their health as fair or poor – the people who might be most in need of the kind of tracking, support and information a good health app can give – were significantly less likely to use such apps than those who say they’re in excellent, very good or good health,” Preeti Malani, MD, an infectious disease physician with training in geriatrics at Michigan Medicine who directed the poll, said in the press release. “Health providers should consider discussing the use of health apps with their patients, because one-third said they had never thought about using one.”
A new program sweeping across Canada enables healthcare providers to prescribe a year-long pass to the country's national parks for patients dealing with mental and physical health concerns.
Healthcare providers in four Canadian provinces are taking a unique approach to addressing soaring rates of depression and anxiety: they’re prescribing nature.
Doctors, nurses and other providers are prescribing year-long Parks Canada Discovery Passes, worth roughly $70, to patients struggling with mental and physical health issues through a national program called PaRx, or A Prescription for Nature. The prescription offers unlimited admission to more than 80 national parks, national historic sites and national marine conservation areas.
“I can’t think of a better way to kick off 2022 than being able to give the gift of nature to my patients,” Melissa Lem, MD, a family physician and Director of PaRx, said in a blog by the BC Parks Foundation, which launched the program in November 2020. “There's a strong body of evidence on the health benefits of nature time, from better immune function and life expectancy to reduced risk of heart disease, depression and anxiety, and I’m excited to see those benefits increase through this new collaboration.”
The program was started in British Columbia and has since been adopted in Ontario, Saskatchewan and Manitoba, with more than 1,000 healthcare providers registered. It won a prestigious Joule Innovation prize from the Canadian Medical Association and was recognized by the World Health Organization in its recent COP26 Special Report on Climate Change and Health.
Lem and other others supporting the program say it encourages people with stressful health concerns, particularly behavioral health issues like depression and anxiety, to get out and enjoy nature, and that studies have proven the beneficial effects of being outdoors.
“We see health benefits in all sorts of different spheres,” Angie Woodbury, a student at the Max Rady College of Medicine, part of the University of Manitoba, and an active participant in and researchers for the PaRx program, said in a January 2022 story published by the university. “In cardiac health, in stress and anxiety, in pain, energy and mood, things like that. We know that spending two hours … in nature reduces your levels of the stress hormone cortisol.”
“A lot of people are under the assumption [that] you’re healthy if you take your medications and exercise, or go to the doctor,” Woodbury added. “But [roughly] 80% of your health has to do more with social determinants of health, the built environment that you live in — your level of income, whether you’re able to afford medications or healthy foods. Social prescribing is trying to address those other things that impact your health.”
And they’re not stopping there. Lem recently told the Canadian news service TriCity News that the program is looking to partner with transit organizations to provide free transportation to parks for new Canadians and inner-city residents.
“We need to reduce barriers to nature,” she said, adding that she hopes the entire country will participate in the program by the end of this year. The park pass prescription “makes the message even more powerful and easier to follow. It is a big deal.”
The state of Michigan is funding a one-year study at the Children's Healing Center, which is expanding its programs to include play and recreation therapy, social and emotional support programs and caregiver resources, many of which aren't covered by Medicaid.
The state of Michigan is funding a study that will analyze how play and recreation therapy, social and emotional support programs and caregiver services can improve life for children with complex medical conditions and their families.
State officials have budgeted $900,000 for the Children’s Healing Center, which opened in Grand Rapids in 2015. The grant will support a 12-month program launched in October 2021 by the center and Priority Health, a Michigan-based health plan, to offer expanded services for 100 children and their families and study the value of caregiver-focused resources and play therapy, which are not traditionally covered by Medicaid and thus often out of reach for many families.
“This new pilot will make a huge difference to families in our community who have kids with complex medical conditions,” Children’s Healing Center CEO Amanda Barbour said in a press release. “Clinical studies consistently reinforce the healing power of play, yet access to play is not always easy for our families. By providing hospital-grade facilities that focus on cleanliness, we make play safe and fun – and that translates into fewer inpatient hospital stays and other improved outcomes.”
“We are thrilled to work alongside the team at the Children’s Healing Center to help provide critical and transformative emotional and social care to our most vulnerable populations here in West Michigan,” said Priority Health President Praveen Thadani, whose organization is helping to identify and enroll the 100 children and their families and will be responsible for data collection and identifying benchmarks. “Our goal is to help individuals live healthier lives, and that is why we work closely with our provider partners to implement value-based arrangements that result in better patient outcomes and lower overall cost of care. This pilot program is a launch pad for future innovations that rethink the way in which care is delivered.
The center will submit a report in September that will analyze the program’s value, utilization trends and health outcomes associated with isolation and loneliness, mental health concerns, emergency department visits and hospitalizations. That study will help state officials in deciding whether to support similar programs for Medicaid recipients in the future.
The 7,200-square-foot center is designed as a germ-free environment, and id divided into four zones: active fitness, art and learning, exploratory play, and technology. Programming is available for children up to age 26 and their caregivers.
The Hudson Headwaters Health Network is seeing significant interest in its new mobile health unit, a specially designed vehicle to take healthcare right to the people.
A network of community health centers in upstate New York has started using a mobile medical unit to help remote patients—including students at a small college campus—access care. And officials say the fledgling program could eventually lead to a mobile health fleet.
The Hudson Headwaters Health Network, based in Queensbury, rolled out its first van shortly before winter, with scheduled stops in three small communities (a fourth stop, at the SUNY Adirondack campus, has since been added). The 40-year-old network of 21 community health centers used a $1 million grant and added close to $2 million in fundraising to support the service.
The mobile unit addresses a growing problem in rural areas like northern New York, where healthcare providers are scarce and health insurance is often a luxury. FQHCs and rural health clinics (RHC) are often the only resource for residents' basic healthcare needs if they can the time and make the effort to travel to a clinic.
But a clinic that can travel to these small towns makes a big difference.
Jessica Rubin, vice president of philanthropy and communications at the Hudson Headwaters Health Network. Photo courtesy HHHN.
"The idea was to do what we do best," says Jessica Rubin, HHHN's vice president of philanthropy and communications. "We provide primary care, and when you can't build any more brick-and-mortar [locations], mobile is the best way to reach people."
The idea of putting healthcare on wheels isn't necessarily new, dating back to the first house call. But the advent of digital health technology and an emphasis on taking healthcare to people who normally can't or don't access care is giving these programs added value.
According to research published in 2020, there are roughly 2,000 mobile health clinics operating in the U.S., providing an average of almost 3,500 annual visits. Slightly less than half are federally funded, and about 30% are affiliated with a health system (about a third are independent and 24% are affiliated with a university). They focus on primary care and prevention, and serve an equal mix of insured and uninsured patients.
Nowadays mobile health units can be seen in many large cities, offering everything from primary care to specialty services like behavioral health, substance abuse care, and sexual health information in underserved neighborhoods. And they're starting to show up in small towns and rural areas where providers are scarce and travel to the nearest clinic or hospital can be tough.
These vehicles are often repurposed or specially designed RVs to replicate the clinic or doctor's office, and containing the technology necessary to conduct exams and some tests, connect virtually with healthcare providers, and link with the electronic medical record.
Rubin says HHHN worked with a company that manufactures food vans—an industry that faces similar regulations regarding delivery vehicles—to design the mobile health unit. It includes two exam rooms, an area set aside for tests, some telehealth capabilities, and a refrigerator for storing medications.
John Dudla, CIO of the Hudson Headwaters Health Network. Photo courtesy HHHN.
"It operates pretty much as if we were in a brick-and-mortar building," says John Dudla, the health system's chief information officer. "Although when you take something on the road, there are a bunch of challenges to think about."
For example, HHHN must work with each community it visits to find a good location to park the van for the day, allowing visibility and easy access for patients. In Salem, New York, it's parked at the courthouse, while in Lake Luzerne the van sits outside town hall. In Whitehall, it is parked next to the town's recreation center. The vehicle can't be parked overnight, at least during the winter, when low temperatures might damage the medications stored inside. That's why HHHN chose its first sites within an hour of the home base.
While HHHN looks for sites with Wi-Fi access, the vehicle does have a mobile hotspot for backup and makes use of cellular services when it can. Internet connectivity must be worked out well in advance, as many small towns don't have reliable broadband capability, and the mobile crew can't just pull into the parking lot of a Starbucks or McDonald's and tap into their Wi-Fi.
Rubin says it's important to meet with the community prior to setting up shop—not just to sign all the necessary paperwork, but to push the narrative that a mobile health unit is just the thing for people who can't or don't want to go to the doctor's office.
"We'll be asked, 'Who is this for?' It's for anyone and everyone," she says. "It's important to get that word out so that [people] know we're here and what we do."
What the mobile unit doesn't have is a waiting room, which is not a big problem during the warmer months, but can be a hassle during winter. Dudla says HHHN is encouraging people to schedule appointments through its mobile devices. Using the devices, people can register and submit needed information on-site through a digital health platform developed by Florida-based Qure4u.
The services offered through the mobile medical unit focus on primary care: family and internal medicine, pediatrics, well child services, gynecological care, screenings and immunizations, voluntary family planning, care management and health education, along with some scheduled lab tests.
The van has become an important resource during the pandemic, giving these small upstate New York communities access to both testing and some vaccinations. It was especially helpful last autumn, Dudla says, in providing testing services for several apple orchards, where Jamaican immigrants are often employed during harvest season.
Rubin says the mobile health program's future offers lots of options and opportunities, provided the program can secure long-term funding. And by the growing number of patients HHHN is seeing at each of the four locations, she knows the need is there.
"In one word, it's all about access," she says, adding that HHHN is fielding calls all the time from other communities interested in hosting the mobile unit. "It's the next generation of access in healthcare. It literally drives our mission. And I feel like every day we're learning something new about it."
"Primary care is shifting all the time," adds Dudla, who's crunching the numbers to see what services and locations are generating demand. "We can use this to fill in the gaps."
A study conducted by Stanford Medical found that hypertension patients who shifted from in-person care to virtual visits during the height of the pandemic were better able to manage their blood pressure.
More than three-quarters of hypertension patients who accessed a virtual care platform during the height of the pandemic saw an improvement in blood pressure management, according to a study recently published in a Mayo Clinic journal.
The study, conducted by Stanford Medicine’s Shriram Nallamshetty, MD, and researchers from San Francisco-based Included Health, focused on roughly 570 patients who switched from in-person visits to video visits offered by Included Health between March 2020 and February 2021. It found that 438 patients, or 77% of the group, saw improvements in their blood pressure readings, with a majority seeing improvements of more than 10%.
“With recent reports that rates of adequately controlling hypertension in the US have declined over the last decade, virtual care has demonstrated to be an effective model to provide improved hypertension care,” Nallamshetty, who co-authored the study, published in this month’s Mayo Clinic Proceedings: Innovations, Quality & Outcomes, said in a press release. “For chronic conditions like hypertension, we must consider the impact of the virtual care model in raising the standards of care for all patients.”
According to the Centers for Disease Control and Prevention, roughly 47 percent of American adults are diagnosed with hypertension, and yet only one in four have their blood pressure under control. Both of those numbers have risen significantly during the pandemic, which has kept patients from accessing in-person care and caused more to become less vigilant in managing their blood pressure.
Healthcare organizations and digital health advocates are pointing to studies like the Stanford research that indicate virtual care can take the place of in-person care when needed, and can even improve care management by allowing patients and their care providers to connect and collaborate more frequently and conveniently.
Through a virtual platform, patients can also access other care management resources, and providers can support treatment by emphasizing the value of diet and exercise in hypertension management.
“The results of this study suggest that a holistic approach to hypertension management, attending to lifestyle changes and appropriate medications, is effective through virtual video primary care visits nationwide,” the study concluded. “We did not find notable differences between patients in terms of rural or metro location, sex, ethnicity, or other factors, other than adherence to therapy.”
Faced with a surge in virtual visits and a growing population of limited English proficiency (LEP) patients, clinicians at Massachusetts General Hospital developed a three-pronged approach to tackling the language barrier and improving access to care for underserved populations.
Healthcare organizations may see virtual care as the key to helping underserved populations access care, but things don’t work so well if those patients have problems understanding English.
With a surge in virtual care caused by the pandemic and a growing population of limited English proficiency (LEP) patients, clinicians at Massachusetts General Hospital launched new protocols to make sure the Boston-based health center was reaching people who needed to be reached. The developed three specific strategies aimed at tackling what could be a considerable barrier to care.
“With an increased reliance on virtual care for health care during the pandemic, it’s important to make sure we are not increasing disparities for patients who have language barriers,” Aswita Tan-McGrory, MBA, MSPH, director of the Disparities Solutions Center and administrative director of the Mongan Institute at MGH, said in a press release. “Also, addressing challenges with these three strategies will actually increase care and access for all patients.”
“We really had to put ourselves in the patient’s shoes and walk through all workflows to make sure language and health literacy needs were being addressed,” added Esteban A. Barreto, PhD, MA, director of Evaluation of Equity and Community Health at MGH. “Our findings suggest that as health systems continue to address such needs, patients with limited English proficiency should be able to have an active role in managing their own health which, in turn, may positively impact their health.”
First, the team identified the five top languages spoken by MGH’s patient population and launched a targeted campaign in multiple languages aimed at reaching people with limited technology and health literacy. The campaign was designed to extol the benefits of MGH’s digital health channels and giving them an easy pathway to enrollment.
In addition, the health system made 43 Amazon Fire tablets available through an affiliated community health center to patients with LEP and technology barriers, and paired participants with a bilingual students intern to learn how to use the tablet to access healthcare resources.
“We have successfully enrolled our first cohort of patients, and the pilot is still ongoing and will provide insights and recommendations for engaging patients with LEP in accessing virtual visits,” Tan-McGrory and her colleagues said in the article. “Our feasibility pilot highlighted that creative solutions may need to include a partnership with payers, community-based organizations, and faith-based organizations to provide broadband hotspots that patients can use to access virtual care.”
Second, to address privacy concerns from patients, MGH created a script that described how the health system protects information through the Health Insurance Portability and Accountability Act (HIPAA), and under what circumstances patient information can be shared. They also created cards in multiple languages outlining he rights and protection of immigrants under the US Constitution. Finally, the team identified a need to educate clinicians about whether and how to ask patients and family members about their immigration status.
“They also should avoid documentation of such status on a patient’s medical record to reduce stigma or unnecessary risk should immigration enforcement officers obtain access to the medical record,” Tan-McGrory and her team pointed out.
Third, MGH partnered with Doximity to develop a browser-based platform, one that doesn’t require the user to download an app, that can be used to create customized text messages in different languages and initiate a video visit. That platform can also be used to link in medical interpreters, either in advance or on demand. Finally, the health system customized its EHR platform to allow virtual visits that include interpreters, including third-party interpreters if none are available in-house.
“Healthcare organizations will undoubtedly rely heavily on virtual visits to provide patient care in the future,” the team concluded in its article. “As such, they will need to take all these challenges into consideration if they are to provide high-quality care and address disparities for patients with LEP.”
“Unfortunately, virtual visit platforms and systems are by default built for the technology-literate, English-speaking patient who has a smartphone, tablet, and/or computer,” they added. “Given the likelihood that payment reimbursement for audio-only visits will be reduced or discontinued after the public health emergency ends, healthcare organizations and policy makers should consider the impact on access to virtual care for those without broadband or technology. Ideally, systems, workflows, and platforms must be reviewed by staff who have the lived experience of low digital literacy, language barriers, and lack of access to technology or broadband. We have recently partnered with CRICO, our medical malpractice insurer, to develop best practices for the conduct of virtual visits.”
Along with Tan-McGrory, the lead author for the report, and Barreto, the senior author, the team included Lee H. Schwamm, MD, Christopher Kirwan, PhD, and Joseph R. Betancourt, MD, MPH.
The platform, developed in France and used now in Europe and Canada, will enable health systems in the US to conduct ultrasounds via telemedicine, expanding the reach to remote and rural patients and improving diagnoses and clinical outcomes.
A New Jersey health system will be the first in the country to offer digital health-enabled ultrasound technology developed in France.
Officials at the Robert Wood Johnson University Hospital (RWJUH), part of the RWJBarnabas Health health system, and Rutgers Robert Wood Johnson Medical School (RWJMS) say the MELODY platform enables providers to conduct imaging through a telemedicine platform, enabling patients to access the service in more locations and providers to improve clinical outcomes.
“Imagine that a patient comes to an Emergency Department in the middle of the night and there are no sonographers present to perform the imaging exam that he or she needs,” Partho Sengupta, MD, FACC, Chief of Cardiology at RWJUH and the Henry Rutgers Professor of Cardiology and Chief of the Division of Cardiology at RWJMS, said in a press release. “In the very near future, we can connect with a sonographer at another hospital or from their home to perform a cardiac ultrasound exam that could be lifesaving.”
The platform, approved for clinical use by the US Food and Drug Administration and already being used in Europe and Canada, consists of a robotic arm, the ultrasound machine and video conferencing technology that allows clinicians at different locations to communicate with the patient. It was developed by AdEcho Tech, based in Naveil, France.
By incorporating digital health capabilities, executives say the platform not only allows smaller, rural and remote health systems to conduct ultrasounds, but also allows them to connect virtually with specialists who can facilitate more and better diagnoses.
Sengupta said integrating AI technology into the platform could improve the service even more, giving providers a more robust clinical decision support tool.
“Many cardiovascular diseases remain undetected for a long time and can be silent killers,” Sengupta said. “Combining robotic tele-ultrasound technology with new and existing AI capabilities will provide us with a tremendous opportunity for early detection and treatment of cardiovascular disease in our communities and help us save lives.”
Executive say the platform also helps to address the chronic shortage of ultrasound technologists and sonographers in the country, reduces injuries and strain caused by repetitive movements in manual ultrasounds, and could reduce exposure to infectious diseases like COVID-19 and radiation.
Clinicians at the two hospitals tested the platform in January, and are working to make the service available to patients later this year.
Baptist Health in Arkansas is adapting digital health tools and platforms to improve inpatient care, a pathway that may change how hospitals of the future do their business.
Virtual care technology is giving health system administrators new ideas on how to deliver care inside the hospital.
Baptist Health is one of many health systems using digital health to improve its ICU services and connect care providers throughout the Arkansas-based 11-hospital network, improving care at the bedside and enabling small, rural hospitals to reduce transfers and care for more patients. Executives say the platform, which has been in use for roughly 14 years, allows them to coordinate care from the main hospitals in Little Rock and give outlying hospitals with fewer resources the support they need.
"We're improving care at the bedside," says Kourtney Matlock, corporate vice president of population health. "We can expand our specialists' reach beyond our Little Rock locations and help [rural sites] keep more of their patients."
That's especially important as the health system deals with the pandemic, which has filled up hospital beds and strained workloads. And it will be important beyond COVID-19, as hospitals look to move services onto virtual platforms and reconfigure inpatient care so that those occupying hospital beds are the ones who really need hospital-based care.
"This isn't just about how we use technology," says Danny Kennedy, the health system's IS field services manager. "It's about how we use our hospitals."
Kourtney Matlock, corporate vice president of population health, Baptist Health. Photo courtesy Baptist Health.
As the healthcare industry moves toward the concept of hospitalizing the sickest patients, it's turning the concept of remote patient monitoring around. Telemedicine platforms and digital health tools are being deployed within the hospital setting to capture more patient data and send it directly to who most needs it, no matter where that care team member is located. That may be the nurse down the hall at a central station who's keeping track of all the patients in a specific area, the hospitalist in Little Rock assigned to watch patients in a small hospital a few hundred miles away, or the specialist who's keeping an eye on a patient with complex care needs at another hospital.
Matlock says Baptist Health had been using a physician group in Israel to remotely monitor its ICU patients up until 2019, when it shifted to a model that kept its care providers within the health system. That's been part of a long-term strategy, she says, to develop inpatient virtual care that makes the best use of staff and allows clinicians to practice at the top of our license.
"We've had a lot of these conversations for years," she says. "We want to be able to utilize our staff differently" and create workflows that benefit them.
Both Matlock and Kennedy say Baptist Health has had many physician champions for virtual care, but there were also a lot of clinicians who didn't want to move in that direction.
Danny Kennedy, IS field services manager, Baptist Health. Photo courtesy Baptist Health.
"A lot of physicians were skeptical at first," Kennedy says. "We could just never get them on board prior to COVID. Now they're coming to us."
The pandemic changed that, bringing not only clinicians but entire health systems into the digital health ecosystem and cramming five to 10 years of innovation into two years. And while technology was trained on caring for infected patients and reducing the chances of exposure for care teams, forward-thinking health systems were eyeing strategies that took them beyond the pandemic, where digital health would be used inside the hospital to refine and direct care to where it would be most needed.
That requires a different way of thinking, and one that is challenging health system leaders to recognize that tomorrow's hospital will be considerably different. It will involve more integration, as services are coordinated through digital health channels, and an understanding of how nurses and doctors can be redeployed to improve care management.
Remote patient monitoring will play a significant part in the reimagined hospital of the future, where patients receive more care at home. But that's still a ways off. Matlock notes that Baptist Health had been using an RPM program since 2003, but dropped it roughly two years ago because reimbursement wasn't there to support the service.
"It'll be back," she says. "I see it as one big offering."
It may also include the hospital-at-home concept being shepherded by the Centers for Medicare & Medicaid Services, which combines RPM, telehealth, and in-person services to care for patients at home who might otherwise be in the ICU. That could help hospitals relieve stress on inpatient services and give more patients an opportunity to recover at home, where studies have shown they tend to have more positive clinical outcomes.
Matlock expects that Baptist Health will use some of the technology and strategies they're now using in their ICUs to transition into a hospital-at-home program.
For now, the health system is focusing on the inpatient network. This includes coordinating care with the smaller, more remote hospitals in their network, where ICUs are either small or nonexistent and a patient transfer to a larger hospital might take dozens of phone calls. Linking to the larger hospitals in and around Little Rock enables those small hospitals to expand their ICU capabilities, even create ICU beds where they didn't have any, and care for more patients, keeping them closer to home and their families instead of shipping them off somewhere distant.
In some cases, Baptist Health is using telemedicine carts to manage care, and many rooms are being equipped with tablets that synch with a virtual care platform developed by New Jersey-based Caregility and the health system's Epic EHR, allowing not only providers to connect with the patient record but giving patients a means of connecting with friends and family, or for those who need interpreters.
"That was a big satisfier for us," says Kennedy.
He also notes that some clinicians were hesitant to embrace monitoring and caring for patients in other hospitals, fearing it would add to their workloads and be unreliable. But many were convinced as they used the technology, he says, and worked with clinicians in those other hospitals to coordinate care.
"Everyone is a lot more receptive to the concept now that they've used it," he says.
The platform has also allowed Baptist Health to expand the reach of its specialists, giving those smaller hospitals access to pulmonologists, infectious disease and wound care experts, and lactation consultants—neurology consults are being handled through a third party—with more services on the way. This once again allows those smaller hospitals to provide more and better care for the people in their surrounding communities, an important factor at a time when many small hospitals are struggling to stay afloat.
Matlock says Baptist Health has been contacted by other healthcare systems about those services, but currently doesn't have the staff or the bandwidth to expand. She says the health system might someday fine-tune its platform to a point where it can market those services through a new business line.
All that is in the future, of course. But it's tucked into a long-term strategy that mirrors the direction of the healthcare industry. Health systems need to reimagine how care is delivered, expanding the platform to cover patients no matter where they need that care, and offering services that interact with the communities they serve. The hospital may sit at the geographical center of that platform, but it will no longer be where everyone goes to get care.
