A new survey finds that both patients and providers see value in telehealth visits as a complement to in-person care but not a replacement. And they don't like distractions.
A survey of patient and provider attitudes toward telehealth find that both see the virtual visit as a complementary to the in-person visit, but not as a replacement. And they both certainly know when a virtual visit isn't working.
Compiled by the New York-based telehealth scheduling company Zocdoc, the survey, taken separately of patients and care providers between May 2020 and May 2022 and combined with an analysis of appointment bookings, charts the increase in telehealth visits during the pandemic and a decrease in recent months as the COVID-19 crisis has waned. It found that roughly one-third of all visits were virtual in 2020, as the pandemic peaked, and that number dropped to 17% as of May 2022.
The one exception is in mental health services. Some 74% of mental health appointments were for virtual services in May 2020, and that number rose to 85% in May 2021 and has increased to 87% in May 2020. The numbers show that both patients and providers are finding a comfort zone in telehealth for mental and behavioral health services.
Perhaps more intriguing are the challenges that come with a virtual visit. According to the survey, providers noted the following distractions:
A patient plucking their eyebrows during the appointment, not realizing the video was on;
Patients taking video calls while using the bathroom;
A cat jumping on a client's head during hypnosis;
A patient rollerblading on the beach during an appointment; and
Children interacting while their parents were meeting virtually with a care provider, either with the parent (playing peek-a-boo) or talking to the provider.
And patients weren't the only transgressors. According to the survey, patients noted the following issues with their care providers:
A provider with a frozen video screen, which the patient mistook for an "impressively focused, intense gaze;"
An unmade bed in the background;
A provider conducting the virtual visit from his car;
A provider's cat grooming itself for 45 minutes in the background; and
Meeting a provider's "really cute!" pet parrot.
Those observations point to the value of educating both patients and providers on how to conduct a virtual visit. Health systems should be training their care providers on how to present themselves during a virtual visit, and they should also be communicating to their patients how those visits should be handled on that end.
That said, telehealth can give the care provider an opportunity to see the patient's home environment and routines, which can factor into both diagnosis and treatment. According to the survey of providers, 36% reported seeing a patient's pet, 31% saw a family member or roommate, and 42% saw a patient outside of the house.
Healthcare providers have often said that a telehealth visit with the patient in his or her home can offer insights into habits and lifestyle that aren't seen or talked about in in-person visits, and which can affect healthcare delivery and outcomes. For example, a mental healthcare provider might be able to see certain stressors in the home that affect a patient's mental health, while a doctor treating a patient living with diabetes might gain better insight into how that patient eats and exercises each day.
Aside from pointing out the benefits and challenges of seeing patients and care providers via video, the Zocdoc study highlights the importance of treating telehealth as a part of the healthcare process, not as a replacement for in-person care. The platform offers certain advantages, with patients reporting that it's convenient and can eliminate the burden of taking time off from work or school, hopping in the car or taking a bus and travelling to a doctor's office.
But it's not always the right mode of care, with providers opining that it doesn't allow them to fully examine a patient. According to the survey, 58 percent of providers said it was more difficult or much more difficult to examine patients, and a quarter said it wasn't possible to provide the type of care patients expect via telehealth. Some 37% of providers said it was more difficult or much more difficult to build a relationship with patients via telehealth, and only 7% said it was easier (interestingly, 31% or patients felt it was easier to build a relationship with a provider via telehealth, saying the decreased level of formality in a virtual visit enabled them to be more comfortable).
The path for health system executives going forward is to highlight the benefits of telehealth and present that as an option to in-person care when appropriate, and to point out that telehealth can support in-person care but doesn't have to replace it.
Compelled by consumers who don't always want to schedule a video visit or drive to the doctor's office or ER, health systems are finding new value in asynchronous, or store-and-forward, telehealth.
Not every telehealth encounter has to include video, or even be a real-time conversation. Many healthcare organizations are finding that an asynchronous – also called store-and-forward – platform works better for certain services.
"It can be a very simple, efficient format for what we want to do," says Brett Oliver, MD, chief medical information officer for Baptist Health, an eight-hospital, 400-site health system based in Louisville, Kentucky serving parts of Illinois, Indiana, and Tennessee. "And that's what our patients really want."
Unlike synchronous telehealth, which basically consists of a two-way, real-time audio-video feed between patient and care provider, asynchronous telehealth doesn't involve real-time communication, and most often doesn't include video. Consumers enter information into an online platform at their own time and convenience, usually through a questionnaire, and a care provider accesses that data on the other end then responds with a diagnosis and treatment plan. It can be done by phone or computer and include images and even video, but the key factor is that both patient and provider can access the platform at the time and place of their choosing.
Asynchronous telehealth has proven popular in direct-to-consumer programs and for services that don't rely on immediacy or direct communication. It's often used for acute care concerns for someone who might visit the doctor's office, an emergency care clinic, or the emergency room for, but which aren’t critical enough to merit hands-on care, such as infections, rashes, colds, and viruses. In fact, numerous health systems dealing with crowded ERs have used asynchronous telehealth platforms to reduce ER traffic and give patients an easier way to seek care at home.
Moving Beyond the Pandemic
At Baptist Health, Oliver said the health system leaned on its asynchronous eVisit platform during the pandemic, when ER traffic was heavy, hospitals were struggling with both capacity and workforce issues, and there was a strong need to separate infected patients from uninfected patients and staff.
"It was a real eye-opener for us," he says.
Brett Oliver, MD, chief medical information officer for Baptist Health. Photo courtesy Baptist Health.
With the pandemic fading, the health system has seen steady interest in the platform, an indication that asynchronous telehealth has a place in Baptist Health's roster of services, alongside both in-person and video visits.
"Our patients want this," Oliver says. "And if we don't have it, they'll go elsewhere."
Baptist Health isn't a unique case. Asynchronous telehealth had been enjoying some success prior to COVID-19, especially in populous areas where the market for non-urgent walk-in care was intense. But many health systems were hesitant to adopt a service that didn't include video, and federal and state regulations were much more restrictive, and in some cases prohibited use of the technology altogether. The pandemic changed that, as state and federal regulators relaxed the rules to increase coverage of and access to telehealth and health systems willing to give it a try.
Oliver says Baptist Health had created a centralized hub for nurse practitioners to handle asynchronous telehealth visits, building the platform out of an old retail clinic program that hadn't worked. They built the program on their Epic EHR infrastructure, partnering with telemedicine vendor Bright.md.
Prior to the pandemic, he says, the asynchronous service saw limited use, but COVID-19 changed the public's perception on how it wanted healthcare access. Primary care had always been somewhat of a challenge for Baptist Health and its patients, many of whom live in rural areas, but a platform that allowed them to connect with a care provider at their own convenience, rather than driving somewhere or finding the time to sit down in front of a computer for a video visit, hit the mark.
Oliver says many people are more comfortable talking about their health in this format, rather than through a video or even in person. They're less self-conscious, and usually focused on getting quick and easy treatment for a nagging health concern that isn't serious enough to merit a traditional healthcare visit. A post-visit survey of patients found that one in every four or five would have gone to an ER had they not been able to use an eVisit, he says.
"A lot of people didn't know about asynchronous," he says, noting they handle about 100 cases per week, down from a high of 300 during the height of the pandemic. "Now they don't want to go without it. They feel this is personalized care even though it doesn't have video."
The process is fairly simple. Consumers fill out a questionnaire, which takes roughly 12-15 minutes, which is screened by an NP and forwarded to a clinician. The clinician reviews the information within the EHR, then submits a diagnosis and care plan where appropriate. The health system promises a response within two hours, but usually gets back in touch within 15 minutes.
Oliver says the encounter can be ramped up at any time to include a video visit or a recommendation that the patient visit a doctor. The questions in the questionnaire are also fine-tuned to make it easier for the NPs to refer cases to the right clinician, and the health system is setting aside time to update and add questions to enable them to treat more health concerns.
According to Oliver, almost 90% of the patients seen and treated via the platform don’t seek additional care within 30 days, which means they're getting the care they need. The health system is also reporting a patient satisfaction rate well above 90%.
That information will be important to track and collect, he says, to convince payers that asynchronous telehealth should be a covered service. Like so many other health systems, Baptist Health isn't being reimbursed for these services, and instead charges users a flat fee, which may hinder adoption by the Medicare and Medicaid populations.
Securing Provider Support
Another key benefit to this platform is that it improves efficiency for the provider. But it took some time for the providers to realize that.
"It really was a learning curve for us," Oliver says of the effort to secure provider buy-in. "A lot of them hadn't used this before, and so their first thought was, 'Are you taking something away from me?' They're used to seeing patients because that's how they're paid."
But just as it's more convenient for patients, this platform also fits nicely into the clinician workflow. They can sit down, review all the data on hand, research any nagging questions, and send the patient a diagnosis and care plan in less time than it would take to schedule and complete a video or in-person appointment, and they can bump the encounter up to a video visit or in-person treatment if one is needed.
"About 95% of the diagnoses can be done right after reviewing the patient's information," Oliver says. This tells him not only that the health system is seeing the right patients on that platform, but that it's choosing the right conditions to treat on that platform, and not funneling patients there who end up needing more complex or advanced care.
Aside from adding more health concerns that can be covered in an asynchronous visit, Oliver sees more room for expansion on the platform. He'd like to include chronic care management to enable patients and their care providers to keep in contact between scheduled appointments, as well as wellness visits and follow-ups after inpatient services. In that sense, the platform could be used as a remote patient monitoring program.
"It allows us more touchpoints with our patients," he says. "We need to think about and be able to use different modes of care delivery."
A three-year study in rural Alaska has shown that a telehealth program can help children access specialist services for hearing issues much better than the traditional in-person referral process.
A telehealth program in Alaska that enabled rural children to access hearing specialists is proof that the platform can reduce rural disparities in access to care, according to supporters.
The Hearing Norton Sound study, conducted in 15 rural Alaskan communities from 2017-20, allowed children to connect with specialists for diagnosis and treatment of hearing problems. Roughly 1,500 children in the Bering Strait School District in the northwest part of the state participated in the study, and those using telehealth were treated to follow-up care 17.6% faster than those receiving standard primary care referrals.
According to the study, participating students were split into two groups, with one group accessing specialists via telehealth and the other group being referred for in-person follow-ups. Almost 70% of those using virtual care were able to meet with specialists, researchers said, while only 30% in the other group were able to get follow-up care.
“Childhood hearing loss has well known, profound implications for language development, school achievement and future employment opportunities,” the study reported. “Some populations experience a disproportionately high burden of childhood hearing loss, including rural Alaska Native children, among whom there is a prevalence of up to 31% compared with 1.7-5% in the general US population.”
Emmett, an associate professor in the UAMS College of Medicine Department of Otolaryngology-Head and Neck Surgery and the Fay W. Boozman College of Public Health Department of Epidemiology, partnered with Samantha Kleindienst Robler, PhD, AuD, the Center for Hearing Health Equity's associate director and an assistant professor in the UAMS College of Medicine Department of Otolaryngology-Head and Neck Surgery, on the study. Robler is also a population health researcher at the Norton Sound Health Corporation, a tribally owned and operated independent not-for-profit organization that served as the tribal health partner for the study.
The study targets a common barrier to care in rural parts of the country: a lack of specialists, many of which are clustered around urban areas and cities. To address this imbalance, health systems are setting up telemedicine platforms that allow them to connect with rural providers, such as health clinics and primary care providers, and provide specialists for virtual visits.
Emmett said the study, which was recently published in The Lancet, has implications for any rural part of the country, if not the world, where access to specialists is infrequent and challenging.
“Even if children are identified with hearing loss at school, they often never receive the care that they need," she said. "This loss to follow-up from school screening programs, as well as a dearth of specialists in rural areas, exacerbate barriers to care for rural children."
“The purpose of this study was to test whether telemedicine can address this challenge, providing a way for rural children to promptly enter the health care system to receive the specialty care they need,” she added.
The Los Angeles-based health system is using a $7 million federal grant to expand a digital health program that will develop AI tools to help providers analyze a patient's risk of heart attack and other cardiac concerns.
Cedars-Sinai researchers have received a federal grant to study how AI can be used to help predict heart attacks and other cardiac concerns.
A team from the Los Angeles health system's Smidt Heart Institute and Division of Artificial Intelligence in Medicine is using a $7 million grant from the National Institutes of Health's National Heart, Lung and Blood Institute to set up the new program, which will use data from positron emission tomography and CT scans to analyze a patient's risk of cardiac issues.
“Advanced imaging data could help predict patients’ risk of serious cardiac events, but is so complex that clinicians aren’t always able to use it,” Piotr Slomka, PhD, director of Innovation in Imaging and professor of Cardiology and Medicine in the Division of Artificial Intelligence in Medicine at Cedars-Sinai and the lead researcher in the project, said in a press release. “This grant will allow us to create artificial intelligence tools that help physicians everywhere identify high-risk patients who would benefit from targeted therapy.”
According to the American Heart Association, more than 18 million people died of cardiovascular disease in 2019. Many healthcare organizations are looking to digital health to develop new ways to detect cardiac problems early enough for care providers to intervene before they become serious, even deadly.
Cedars-Sinai has long been at the forefront of digital health innovation, working with tools like virtual reality, wearables and AI to improve treatments and clinical outcomes. This past March, researchers in the quantitative image analysis lab at the Biomedical Research Institute announced the development of an AI tool that analyzes the amount and composition of plaque in arteries that supply blood to the heart to determine heart attack risk within five years.
“A deep learning system that rapidly and accurately quantifies coronary artery stenosis has the potential for integration into routine CCTA (coronary CT angiography) workflow, where it could function as a second reader and clinical decision support tool,” the research team reported in a study published in The Lancet. “By providing automated and objective results, deep learning could reduce interobserver variability and interpretative error among physicians. Deep learning-based plaque volume measurements have independent prognostic value for future cardiac events, and could enhance risk stratification in patients with stable chest pain who are undergoing CCTA.”
With this latest program, Slomka and his team plan on expanding the platform.
“This particular grant allows us to build a program—not just a project—which will expedite our innovative plans,” he said in the press release. “In AI, things are changing all the time, and sometimes we find that we could make much more impact if we change direction. The beauty of this grant is that it makes that easy to do.”
Nanotechnology is moving from fiction to reality, with at least two universities studying the use of miniature robots inside the body to treat diseases and address other health concerns.
Fans of Fantastic Voyage take heart: The innovative nanotechnology featured in the 1966 movie about miniaturized doctors entering a human body may actually be coming true—sort of.
Researchers at both Stanford University and Purdue University have recently published studies on the use of miniaturized robots inserted into the body to treat certain health concerns. The robots could be used to delivered timed doses of medicine, chart the course of a tumor or disease, or even remove obstructions such as blood clots.
While nanotechnology has long been a popular topic in fiction, from Michael Crichton's 2003 novel Prey to the most recent James Bond movie No Time to Die, it's starting to show up in the real world. Several programs over the past few years have focused on the development of pills fitted with digital health sensors that are ingested and used to deliver timed doses of medicine and/or track vital signs and medication results, though the digital health company best known for developing that technology, Proteus, filed for bankruptcy in 2020.
Now some researchers are trying a new delivery method.
At Purdue, "microbots" developed by Hyowon "Hugh" Lee, an associate professor from the Weldon School of Biomedical Engineering, have been used to remove blood accumulating around the brain after a stroke. Working with neurosurgeons Timothy Bentley, MD, of Purdue's College of Veterinary Medicine, and Albert Lee, MD, from Goodman Campbell Brain and Spine in Carmel, Indiana, he successfully removed pooled blood in six of seven animals.
"This innovation is a real advance in the care of strokes, which are notoriously difficult to treat," Lee, whose work was recently profiled in Nature Communications, said in a press release. "Patients with brain hemorrhages have a mortality rate of up to 50%. Currently there is no great therapeutic solution for intraventricular hemorrhage. The only other option is blood clot-dissolving drugs that have undesirable risks."
At Stanford, meanwhile, Renee Zhao, an assistant professor of mechanical engineering, is working on "millirobots," or fingertip-sized biomedical robots that move through the body on magnetic fields. As noted in a study in Science Advances, her "spinning-enabled wireless amphibious origami millibot" is designed to "crawl, spin or swim" through the body until it reaches its target, then release a high-concentration drug.
In a news story issued by Stanford, Zhao and her team say the technology "won’t just provide a handy way to effectively dispense medicine but could also be used to carry instruments or cameras into the body, changing how doctors examine patients."
"While we won’t see millirobots like Zhao’s in real healthcare settings until more is known about optimal design and imaging best practices, the lab’s first-of-its-kind swimmer … is among their robots that are furthest along," the press release continues. "It’s currently in the trial stages that come before any live animal testing that proceeds human clinical trials."
Boise State University and the University of Utah are collaborating on a new program that will use virtual reality to help medical students identify and address social determinants of health.
A new project being launched at Boise State University and the University of Utah aims to use virtual reality to train medical students how to talk to their patients about social determinants of health.
Boise State School of Nursing Associate Professor Kate Doyon and co-investigators Nancy Allen and Julie Gee, associate professors at the University of Utah’s College of Nursing, will be working with the Spencer S. Eccles Health Sciences Library and Therapeutic Games & Applications Lab to create VR platforms that will teach future doctors, nurses, dentists and social workers how to talk to patients about non-clinical barriers that may affect their ability to access care or follow care plans.
“As providers, we have to know what the barriers and facilitators are to get [patients] on a plan of care,” Doyon said in a press release issued by Boise State. “It should be routine to ask the patient about their world.”
“At the end of the day a plan must be patient-centered,” she said, she added.
Social determinants of health can have a profound effect on clinical outcomes by hindering or even preventing consumers from getting the healthcare services they need. These barriers include family and job support, socio-economic and cultural norms, language issues, physical and geographical obstacles and digital literacy.
Supported by a $100,000 grant from the University of Utah's VR4 Health Sciences Education program, the project will create VR scenarios that allow students to see how these barriers, such as lack of access to a pharmacy or a home life that isn't conducive to post-discharge recovery, affect care management and coordination.
“The more realistic we can make the [virtual reality simulation], the more of an impact we can have,” said Doyon, who plans on seeking funding from the National Institutes of Health.
Healthcare experts say that by identifying the social determinants of health, providers can develop more comprehensive care coordination and management plans that overcome those barriers to care and boost health and wellness. That might include helping consumers understand how to use telehealth and digital health, arranging transportation to and from medical appointments or offering resources to address food insecurity, exercise, legal and family issues, even budgeting and housing concerns.
The Health and Human Services Department's Office for Civil Rights has released guidelines on how healthcare providers can use audio-only telehealth platforms, including the phone, that meet requirements set forth by the Health Insurance Portability and Accountability Act.
Federal officials are cracking down on healthcare organizations using audio-only telehealth platforms – such as the telephone – to deliver healthcare services.
The Health and Human Services Department's Office for Civil Rights (OCR) has released guidance on how providers can use "remote communication technologies to provide audio-only telehealth services" without running afoul of the Health Insurance Portability and Accountability Act (HIPAA), which focuses on how sensitive health information is disclosed over various communications channels.
“Audio telehealth is an important tool to reach patients in rural communities, individuals with disabilities, and others seeking the convenience of remote options," OCR Director Lisa J. Pino said in a press release. "This guidance explains how the HIPAA Rules permit health care providers and plans to offer audio telehealth while protecting the privacy and security of individuals’ health information.”
Audio-only telehealth platforms have been heavily regulated in the past, and in many cases healthcare providers aren't permitted to conduct healthcare via that technology. But during the pandemic, which forced providers to move away from in-person services and conduct more business via telehealth, the federal government issued a series of waivers, including one on HIPAA enforcement, aimed at expanding telehealth use and coverage.
Telehealth advocates have noted that the pandemic has proven the value of audio-only telehealth, particularly in rural and remote areas and for people who don't have access to audio-visual telemedicine platforms or rely on the telephone as their only means of communication. While the federal waivers are scheduled to end with the public health emergency (PHE), some states have already taken action to permit the use of audio-only telehealth for certain services, and several bills before Congress aim to make those freedoms permanent and nationwide.
The OCR guidance serves to remind healthcare organizations that they need to be careful how they use audio-only telehealth during the public health emergency, and that those rules will tighten when the PHE ends.
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.”
