A remote patient monitoring program launched by Penn Medicine to treat COVID-19 patients at home is working fine and proving its value. Adding technology didn't make it any better.
New technology doesn’t always add value to a good remote patient monitoring program.
That’s the take-away from a study of a COVID-19 RPM program managed by Penn Medicine and recently published in the New England Journal of Medicine. The study of more than 2,000 patients enrolled in the health system’s COVID Watch program in 2020 and 2021 found that patients who used a pulse oximeter at home didn’t have better outcomes than patients who simply contacted their care providers when they had breathing problems.
“Compared to remotely monitoring shortness of breath with simple automated check-ins, we showed that the addition of pulse oximetry did not save more lives or keep more people out of the hospital,” Anna Morgan, MD, medical director of the COVID Watch program, an assistant professor of General Internal Medicine and the study’s co-author, said in a Penn Medicine press release. “And having a pulse oximeter didn’t even make patients feel less anxious.”
To be sure, the program – which has treated more than 28,500 patients - still proves that an RPM platform can be an important tool in monitoring patients outside the hospital, reducing hospital traffic, and improving clinical outcomes.
“The program made it easy to identify the sickest patients who needed the hospital, and keep the others at home safely,” David Asch, MD, executive director of the Center for Health Care Innovation and a professor of Medicine, Medical Ethics and Health Policy, said in the press release. “The program was associated with a 68 percent reduction in mortality, saving a life approximately every three days during peak enrollment early in the pandemic.”
But that doesn’t mean it needs more technology.
Launched in March 2020, the program uses a text messaging platform to keep track of patients diagnosed with COVID-19 who were well enough to stay at home. The automated system sends text messages to those patients twice a day for two weeks, asking how they feel and if they’re having difficulty breathing. If patients indicate they are having problems, a nurse will call them and either suggest continued monitoring, schedule an urgent telemedicine appointment or direct the patient to the hospital’s Emergency Department.
Penn Medicine then decided to see if more technology would make the program better. Acting on research from the Perelman School of Medicine that patients might not notice when their blood oxygen levels are dropping to dangerous levels, the RPM program sent some patients home with a pulse oximeter.
“Several health systems, and even states like Vermont and countries like the United Kingdom, have integrated pulse oximetry into the routine home management of patients with COVID-19, but there’s been scant evidence to show this strategy makes a difference,” M. Kit Delgado, MD, an assistant professor of Emergency Medicine and Epidemiology and the research project’s principal investigator, said in the press release.
With support from the Patient-Centered Outcomes Research Institute (PCORI), Delgado and her colleagues then studied outcomes from roughly 2,000 patients enrolled between March 2020 and February 2021, randomly divided between those using pulse oximeters and those not using the device. And they found no difference in outcomes.
“Overall, these findings suggest that a low-tech approach for remote monitoring systems based on symptoms is just as good as a more expensive one using additional devices,” Krisda Chaiyachati, MD, an assistant professor of Internal Medicine and the research project’s co-principal investigator, said in the press release. “Automated text messaging is a great way for health systems to enable a small team of on-call nurses to manage large populations of patients with COVID-19,”
The study offers a lesson for any health system looking to launch a new technology platform or use an new tool: Don’t just assume it will make things better.
“There are a lot of other medical conditions where the same kind of approach might really help,” he added.
The Medical University of South Carolina and The Citadel have agreed to a partnership that will allow cadets at the Charleston military college to access healthcare services, including via virtual care, through the health system
Virtual care is coming to The Citadel
The famed military college in Charleston has forged a partnership with the Medical University of South Carolina (MUSC) to provide healthcare services for its roughly 3,300 cadets.
The multi-phased program includes access to MUSC’s 24/7 Virtual Urgent Care program, which enables staff at the college’s infirmary to connect with healthcare providers at MUSC through a telemedicine platform. Students will also be able to manage their healthcare interaction through the health system’s digital health portal.
“Some of the many benefits this affiliation provides include integrated health care access for cadets who can use the MUSC digital medical records portal to manage their care, prescriptions and appointments, and will now have 24-hour access to their medical records and appointments as well as continuing to have 24-hour access to medical care,” Charles Cansler, vice president for finance and business at The Citadel, said in a press release. “Additionally, cadets will be treated with the latest medical technology both on campus and at other MUSC facilities as needed. And over time, upgrades will be made to the infirmary equipment, processes and the building itself.”
As part of the agreement, MUSC Health will bill insurers for care provided at the college and the college will cover co-pays for cadets.
“Health care is undergoing a major transformation right now – from digitization and automation of certain services to how and when individuals access in-person care,” Eugene Hong, MD, MUSC Health’s chief physician executive, said in the release. “As the needs of the community change with the times, we look forward to doing our part to help The Citadel ensure the health and well-being of the Corps.”
One of six senior military colleges in the US, The Citadel was founded in 1842, 18 years after MUSC, also in Charleston, was opened. Its students are called the South Carolina Corps of Cadets, and come from 45 states and 23 other countries.
Penn State researchers have developed an mHealth app that allows care providers and pharmacists to identify drug-drug interactions at the point of care for patients using marijuana or CBD
Penn State is taking aim at the growing popularity (and legalization) of marijuana and cannabidiol (CBD) products with an mHealth app designed to help providers identify how those products might interact with other medications.
The CANNabinoid Drug Interaction Review (CANN-DIR) app is a free web-based resource targeted at healthcare providers and pharmacists. Developed by researchers at the Penn State College of Medicine, it allows users to select the cannabinoid product that a patient is taking and provide information on how it reacts to over-the-counter and prescription medications.
“Some drugs can affect the way others are broken down by the body, which can be problematic in the case of medications with a narrow therapeutic index,” Kent Vrana, the project leader and Eliot S. Veseli Professor and Chair of the Department of Pharmacology, said in a press release. “People may not realize that THC (delta-9-tetrahydrocannabinoil) and CBD products have the ability to change the way other drugs are metabolized, and it’s an important conversation for patients and health care providers to have with each other. CANN-DIR can help facilitate those conversations and provide useful information for health care providers when prescribing medications to their patients.”
The app is an ideal example of how clinical decision support is going digital, through online resources that can be accessed on laptops, tablets and other mobile devices at the point of care.
“The goal of CANN-DIR is to provide health care providers an additional resource to improve patient safety by reducing unintended drug-drug interactions,” added Paul Kocis, a clinical pharmacist at the Penn State Health Milton S. Hershey Medical Center who created the database with Vrana. “We hope this resource will also focus attention on how cannabinoids can affect the metabolism of other medications.”
According to the National Conference of State Legislatures, 18 states, as well as Washington DC and Guam, have legalized the recreational use of marijuana, while 37 states, Washington DC, Guam, Puerto Rico and the US Virgin Islands have approved the medical use of marijuana. And just this month, the US House of Representatives voted to decriminalize marijuana, though a similar bill now before the Senate isn’t expected to pass.
The pandemic created a surge in virtual care as state and federal lawmakers relaxed the rules to expand telehealth access and coverage, but now some states are looking to tighten the regulations
With COVID-19 slowly moving into the rear-view mirror, some states are dialing back the telehealth freedoms that healthcare providers enjoyed during the pandemic.
In Alabama, Senate Bill 272 and House Bill 423 aim to mandate in-person visits for certain virtual care services, with supporters arguing that a visit to the doctor's office is needed to maintain the physician-patient relationship and to ensure quality care.
Specifically, the Alabama bills would mandate:
At least one in-person visit every 12 months for physicians who meet with a patient four or more times a year via telehealth (current language allows for in-person care when necessary to meet the standard of care); and
An in-person visit whenever a physician prescribes a controlled substance (current language allows for prescription of controlled substances via telehealth if that service meets state and federal regulations and telehealth is consistent with the standard of care).
The debate over a telehealth visit meeting the requirements of the doctor-patient relationship is long-standing, but was pushed aside during the pandemic in the rush to adopt telehealth, when the federal government and every state relaxed guidelines on access and coverage to encourage more virtual care.
Now, with the federal public health emergency scheduled to expire later this year, some state governments are debating whether to make those emergency measures permanent. And some are pushing to crack down on what they see as an excessive use of telehealth.
“Today, telehealth is being done, but there are no guidelines, there is no foundation in the state of Alabama,” Alabama Rep. Paul Lee, a Republican who sponsored the House bill, told the House Health Committee he chairs, according to the Alabama Daily News. “It’s basically the wild, wild west.”
“I think there’s no substitute for in-person contact, for face-to-face contact, for actually talking to the patient, actually examining the patient,” Republican State Senator Larry Stutts said during a hearing on the Senate bill, as reported by the Alabama Political Reporter. “I don’t think there’s any replacement for actually seeing the patient, examining the patient.”
Across the country, the debate is especially contentious with abortion rights, with some states moving to make telemedicine abortions illegal while supporters argue the platform is safe and should be available for women who can’t easily access a care provider in person.
Another point of contention is the telephone, also called audio-only telehealth. While the rules were relaxed during the pandemic to allow providers to conduct some services by phone with patients, critics say the phone isn’t adequate enough to meet the requirements for a doctor-patient relationship.
In Alaska, a proposed bill would have required an in-person visit before any telehealth service. The bill was voted down in committee.
Supporters say the legislation would protect Alaska providers by curbing virtual care services from providers based in other states.
“I made a promise years ago working on a telehealth bill to Alaska physicians that I would never undercut them,” Republican State Senator Lora Reinbold told State of Reform. “This amendment keeps the promise that I made years ago. I truly believe that if we have all these doctors moving [services] up here, and they want to treat Alaskans, and we’re doing telemedicine, you miss so much. It is so important.”
Opponents, meanwhile, say the bill would reduce negatively affect healthcare access and quality.
“I actually want to introduce competition,” Republican State Senator Shelley Hughes said. “I don’t want to inhibit that. I love our in-state providers, but I do believe the health care cost situation has become so severe that we should not be trying to stop Alaskans from seeking more affordable care.”
Telehealth supporters argue that the provider should establish when in-person care is necessary, and that these bills would create barriers to access for underserved and rural patients who can’t easily get to the doctor’s office.
Many have petitioned both Congress and the Centers for Medicare & Medicaid Services to make those pandemic telehealth freedoms permanent, saying those services have been proven to boost access to care and, in some cases, improve clinical outcomes and provider workflows. They also argue that an abrupt end to those freedoms, as would happen when the public health emergency ends, would force health systems to shut down programs and patients to lose access to important services.
"One acknowledged bright spot resulting from COVID-19 has been the extraordinary use of telehealth that has allowed patients to access quality care from the convenience of their homes," Kyle Zebley, vice president of public policy for the American Telemedicine Association, said in a press release accompanying a letter signed by more than 430 organizations, including health systems, urging Congress to make those freedoms permanent.
"However, there is now much uncertainty around the future of telehealth, creating chaos and concern for patients and healthcare providers alike, as the 'telehealth cliff' threatens to abruptly cut off access to care, especially for our underserved and rural populations," he said.
Sri Bharadwaj, vice president of digital innovation and applications at Franciscan Health, is part of a new wave of healthcare executives focused on advancing a culture of virtual (and value-based) care
With virtual health becoming a mainstay in the healthcare landscape, more health systems are including innovation in their leadership structure. The management of new tools and technologies, as well as new strategies that aim to improve clinical care and fine-tune clinician workloads, often now falls to the chief innovation officer, the chief technology innovation officer, or the vice president of digital innovation.
Sri Bharadwaj leads that charge at Franciscan Health, a 12-hospital, 400-site health system based in Indiana. As vice president of digital innovation and applications since February of 2020, he’s been guiding the health system through an intense period of change, precipitated by the pandemic, along with what he says is the journey to value-based care.
“Central to this is change management,” he says. “It’s a critical component of how we operate, and how we will become a virtual hospital of the future.”
The operative word there is ‘change,’ and it’s a key component of the role that Bharadwaj and others like him play in transitioning healthcare to value-based care. He notes that among the biggest challenges to a health system’s acceptance of change is “relationship barriers,” or a reluctance within the organization to embrace new strategies.
“We have to rethink the status quo,” he says. COVID-19 “created an urgency to change and gave us a good look at what we have to do from now on to succeed, and we all have to play a part.”
It’s not an easy role. Just a few years ago, a Health Affairs study looked at the “relatively new” phenomena of the chief innovation officer, and concluded that they often face pushback from upper-level management in fostering innovation.
“If the goal of the chief innovation officer role is to truly catalyze transformation into new business models, organizations will need to be more ambitious in developing innovation structures, providing access to key stakeholders, and resourcing appropriately,” the report concluded.
And in a 2018 survey conducted by Kevin Schulman, a professor of medicine at the Clinical Excellence Research Center at Stanford University, and several colleagues from the Harvard Business School, roughly one-fifth of the health systems surveyed don’t have a chief innovation officer or appropriate position. With the rest, the position is seen as a strategic role, but often there’s a disconnect between appointing someone to the role and making an impact.
“The innovation literature has a growing focus on the role of organizational structure as a key enabling approach for organizations to consider, particularly for business transformation,” Schulman and his colleagues wrote. “Yet, in our study, only 20% of respondents reported that innovation included a novel organizational form. This result stands in contrast to an aspiration for transformative innovation in organizations, such as a shift to value-based payment models in health care. This result may limit the impact of these innovation efforts: ‘When innovators stop short of business model innovation, hoping that a new technology will achieve transformative results without a corresponding disruptive business model and without embedding it in a new disruptive value network or ecosystem, fundamental change rarely occurs.’ ”
Those challenges aside, the chief innovation officer role is gaining attention in healthcare circles. Chief innovation officers even have their own professional group. In 2018, the Healthcare Innovators Professional Society (HIPS) launched, with 36 executives from some of the most forward-thinking health systems in the country.
“I believed that the pace of innovation could go faster if these executives had access to a non-competitive network of peers with whom they could informally share thoughts and ideas, and work collectively to create solutions,” Toby Hamilton, MD, the group’s founder and executive director said in interview with HealthLeaders.
Sri Bharadwaj, vice president of digital innovation and applications at Franciscan Health. Photo courtesy Franciscan Health.
Bharadwaj says executives like him are starting to prove their value, in part, because COVID-19 emphasized the importance of telehealth and digital health innovation. Those health systems with innovation officers already in place were able to adapt to virtual care more easily at a time when that may have been all that stood between a hospital and complete chaos or closure, while others struggled to embrace not only the technology but the management structure behind it.
As we move beyond the pandemic, health system leaders are now focused on a future that combines virtual and in-person care in a hybrid platform, using new technologies and strategies that focus on remote data capture and care management.
“We’re affecting the entire continuum of care,” Bharadwaj says. “And we need to look around us and see how other industries are doing this. They’re all moving to a digital model.”
He says this digital transformation in healthcare is fueled in part by the shift to consumer-focused care. As consumers gain more control of their healthcare, including deciding how and where they access care, they’re putting pressure on care providers to offer options, such as telehealth visits and digital access to healthcare records, resources, and scheduling. If care providers aren’t willing to make changes, there’s a fast-growing network of new care providers, from retail clinics to telehealth vendors, willing to meet consumers' requests.
A health system’s innovation leader creates an atmosphere by which those changes can be made, Bharadwaj says. It starts with collaboration, in the form of discussions between management, clinicians, and others within the healthcare settings that identify gaps in care or barriers to effective care delivery. How those challenges can be addressed is not only with new technology but with strategies that consider cost, workflow management, and patient engagement. Innovation won’t succeed unless there’s proof in hand that it makes healthcare better.
And that’s where data comes into play.
“Data is the cornerstone to care,” Bharadwaj says. “That’s one of the things we’ve struggled with in the hospital system. We now have the ability to capture so much data, both inside and outside the [hospital], but how do we use it meaningfully?”
How a health system collects and uses data may be the key to whether an innovative new program like remote patient monitoring (RPM) catches on and becomes sustainable and scalable. Bharadwaj says that the data coming into the hospital can be used to paint a more complete and accurate picture of the patient, offering not only more opportunities for improved care management but new insights into preventive health and wellness that affect long-term patient engagement and outcomes.
“In the end, we’re not talking about a patient, but about a person,” he says.
Bharadwaj says the health system of the future won’t be confined to a hospital, clinic, or doctor’s office; he cites recent research by Gartner that predicts at least 40% of a hospital’s business will shift to the home by 2025.
In that landscape, a health system must lay the groundwork for more RPM programs, even the more ambitious hospital at home concept that sees some intensive care services shifted to the home, and it must have a strategy in place for vetting mHealth apps and other digital therapeutics prescribed by doctors, and wearables and telehealth services preferred by consumers.
“The hospital of the future will be high-acuity,” he says. “We have to be ready for this, and we have to make sure the home is ready as well. By 2025 or 2030, the patient will have the technology at home to accept virtual care, and we have to be ready to provide it.”
The Pennsylvania health system is partnering with a digital health company to test the value of the Passive Digital Marker is detecting early symptoms that may lead to dementia
The Geisinger health system is launching a study on the effectiveness of an AI tool in identifying cognitive impairment that could lead to dementia.
The Pennsylvania health system is teaming up with New Jersey-based Eisai on the project, which will study the value of the Passive Digital Marker on a set of de-identified data to identify which individuals are dealing with cognitive impairment. The algorithm was designed by researchers at Purdue University and Indiana University.
"As we continue to develop new treatments to prevent and slow the progression of Alzheimer's and related dementias, early detection is becoming even more important," Glen Finney, MD, director of Geisinger's Memory and Cognition Program and a board member of the Greater PA Chapter of the Alzheimer's Association, said in a press release. "Early and accurate diagnosis and treatment of these conditions can drastically improve outcomes and quality of life for both patients and caregivers."
More than 55 million people worldwide are living with dementia, and experts predict that number will rise to 78 million by 2030. In addition, some 40-60% of adults with probable dementia are undiagnosed.
Early detection and treatment can help patients improve their quality of life and potentially reduce healthcare costs and poor clinical outcomes later on, especially if the condition isn’t diagnosed. The technology could also help researchers better understand the root causes of dementia and other neurological conditions and aid in better treatments, perhaps even a cure.
"AI technology has the potential to transform medicine," Yasser El-Manzalawy, PhD, a principal investigator in the project and an assistant professor of translational data science and Informatics at Geisinger, said in the press release. "AI-based tools can efficiently scan massive amounts of healthcare data and identify hidden patterns. These patterns can be used to detect diseases, like cancer and dementia, at an early stage. Our data science research team is uniquely positioned to leverage this innovative technology to develop and validate tools to identify patients with unrecognized dementia or patients at high risk of developing dementia in the future."
The Hospital and Healthsystem Association of Pennsylvania has named the top three winners in a contest recognizing innovative programs launched to address care needs during the pandemic.
Three Pennsylvania health systems are being recognized for innovations they made during the pandemic to improve patient care.
The Hospital and Healthsystem Association of Pennsylvania (HAP), an organization of more than 240 healthcare organizations and other stakeholders in the Keystone State, announced the three winners – comprising four programs – in a contest in which more than 80 entries were judged.
“Pennsylvania hospitals have not only protected the health of their communities during this pandemic but have also been leaders in finding innovative solutions to the unprecedented challenges caused by COVID-19,” HAP President and CEO Andy Carter said in a press release. “These awards recognize the exceptional health care teams that developed creative strategies to meet their communities’ needs and address issues such as vaccine access, racial disparities in vaccination, and medical supply chain disruptions.”
The top three award-winners are:
The Children’s Hospital of Philadelphia, which led a partnership to facilitate early access to COVID-19 vaccines for school and childcare employees with a focus on enabling schools and childcare providers to resume in-person operations while helping to protect the health and safety of students and staff.
The Allegheny Health Network, which was selected for two projects. One addressed shortages of N-95 respirators by developing a strategy for equipping staff with industrial respirators that could be sterilized and reused. The other was a campaign to stage mass vaccination events across the greater Pittsburgh region with a commitment to ensuring access for marginalized and historically underserved communities.
Penn Medicine and Trinity Health Mid-Atlantic, which partnered on a project to address racial inequities in vaccine access by establishing rotating community vaccine clinics throughout the greater Philadelphia region that addressed environmental, socio-economic, and technology-related barriers to vaccine access.
The other health systems placing in the top 10 are Evangelical Community Hospital, Guthrie Healthcare, Jefferson Health, the Lehigh Valley Health Network, Main Line Health, and WellSpan Health.
The health system is using a $100,000 grant from Intel to purchase 70 new cameras and microphones, which will be placed in rooms in hospitals throughout Utah and allow care providers in Salt Lake City to monitor and communicate with patients.
Intermountain Healthcare is using a $100,000 grant from Intel to expand a remote patient monitoring program inside its hospitals.
The Salt Lake City-based health system is using the money to purchase 70 camera and microphone units, which will be posted in in-patient rooms in Intermountain hospitals throughout the state. The video feed is monitored by clinical staff in Salt Lake City, giving those smaller, rural hospital an extra set of eyes and ears and an on-demand link to providers in an emergency.
The Patient Safety Monitoring (PSM) program was launched in 2017, with a goal of remotely monitoring patients and helping smaller hospitals facing staffing issues. The program has helped the health system monitor more than 9,500 patients for more than 1.4 million hours.
Aside from monitoring for falls and other emergencies, the program enables patients to communicate with care providers on-demand. It proved especially useful during the pandemic, allowing providers to monitor patients in isolation and reducing room visits. The platform allows one clinical staff member to monitor a dozen rooms at the same time.
“While this pandemic has been taxing on both parties, it is gratifying that there are ways to help alleviate the burdens of the pandemic one way or another to these populations,” Andrew Davis, project lead for Patient Safety Monitoring at Intermountain Healthcare, said in a press release. “We are always strategizing and finding ways to improve safety and this grant helps fulfill that.”
While some healthcare organizations were using RPM and telemedicine technology prior to the pandemic, COVID-19 created a surge of intertest in in-patient virtual care platforms, including audio-visual communications and digital health devices that capture patient information and send it to care providers in another location, such as the nurses’ station.
Healthcare leaders are now looking to adapt those platforms for use after the pandemic, with new tools and technology that increase monitoring and communications capabilities and allow providers to keep a better eye on patients in the hospital.
The Fayetteville, NC healthcare provider recently opened the Dorothea Dix Care for Adolescents to improve access to care and expand treatment to include the whole family.
With one in four children experiencing depression and one in five struggling with anxiety as a result of the pandemic, healthcare organizations are scrambling to develop new ways of addressing the mental health crisis. And they’re finding that treatment works best if it extends to the family.
Cape Fear Valley Health in Fayetteville, NC, recently opened the new Dorothea Dix Care Unit for Adolescents with that strategy in mind. The new facility also addresses an acute need for access in the Fayetteville-Cumberland County area, where families either have to visit the local hospital ER or drive more than an hour for mental healthcare services.
HealthLeaders recently chatted by e-mail with John Bigger, Cape Fear Valley Health’s corporate director of clinical services, about this new facility, and how it improves upon traditional healthcare services for children and adolescents.
Q.What services will the Dorothea Dix Care Unit for Adolescents offer?
JB: The Dorothea Dix Care Unit (DDC Unit) at Cape Fear Valley Health System (CFVH) will be designed specifically to provide help to adolescents from ages 12-17 and their families during periods of acutely exacerbated psychiatric illness in the CFVH system service area. During their short-term stay, youth will participate in individual, group, and/or family counseling with a focus on evidence based adaptive skill building as a foundation for successful reintegration into the community. An individualized treatment plan is developed with the youth and their family that will address and problem-solve around the issue(s) that may have contributed to the current crisis.
A secondary goal of the DDC Unit is to assist the youth and/or their families with accessing support services that will continue to help the adolescent in improving overall functioning within their home or community setting. Having this unit in Cumberland County, NC allows this for a much easier transition for the youth. This unit will likely serve adolescents that utilize resources at a higher level than most when seeking services.
Q.Will you be featuring any digital health tools or platforms? How does digital health figure into your treatment strategy, both now and in the future?
JB: Digital health tools will be utilized to provide psychoeducation through streaming programs related to self-care, education regarding mental illness, and so on. In addition, video components will be utilized to provide opportunities for role playing healthy activities and communication strategies.
In the future, we see digital health as increasing in both capacity and content, which will be utilized to assist patients in adaptive coping skills and learning. As technology improves, digital health will have a positive impact on helping with emotional regulation, biofeedback, access to telecare, and so on.
Q. How do mental health services for adolescents differ from services for adults?
JB: Adolescents are in a unique phase of life where they are trying to establish psychosocially independent functioning through distancing from parents and integration into various peer groups. This presents significant challenges as the adolescent navigates through emotional connection to the family and the push-pull relationships. In addition, the emotional and physical maturity of adulthood has not been established yet, causing significant challenges as well. Mental health services for adolescents need to be delivered through consideration of these unique life challenges and programming will need to be developed which incorporates these elements into the daily treatment.
Finally, parent and family involvement tend to be at a higher level of investment for adolescents so that family therapy is more enhanced.
Q. It sounds as if family and/or caregivers figure prominently in treatment plans. How will this new facility address family and/or caregivers?
JB: Family and caregivers are essential in adolescent care. Oftentimes, mental illness has impacted the entire family, not just the adolescent receiving care. Our psychotherapists in Fayetteville will meet with family members to not only assess functioning within the family dynamic, but to also focus on developing strong aftercare plans, which incorporate ongoing care of the family and the adolescent. This can be achieved through family therapy during aftercare in conjunction with individual and/or group therapy for the adolescent.
Q. The pandemic has certainly brought the need for these services into the spotlight. What lessons have you learned during the pandemic that will affect how you treat adolescents or how you designed this new facility?
JB: The pandemic has presented significant challenges with adolescent mental health care across the country. Social distancing has impacted the ability to identify and establish appropriate social integration and social groups. School isolation and limited extracurricular activities have limited the ability for people to interact. In addition, social media has become a social norm, and this is fraught with its own challenges in relation to fitting in, social bullying, and so on.
The lessons we have learned play a key role in how we approach treatment. We will have more face-to-face sessions while at the same time utilizing the digital learning platforms listed earlier to help guide adolescents through establishing appropriate interactions with others, both interpersonally and through social media platforms. We will also work with the adolescents to focus on challenges they face through the pandemic and how we can help to address them on an individual basis.
Q. What are the biggest challenges you face in providing mental health care for adolescents?
JB: The biggest challenges we face are related to simply finding the right resources for adolescents upon discharge from our facility. Simply put, we need more outpatient providers that support adolescents through evidence-based practices. We do not have enough in our community, and the need is there. In addition, challenges remain regarding how to navigate the journey into adulthood while dealing with the pressures of peer groups, social media, and the like.
Having a strong support group/system becomes critical for adolescents facing the stage of life. The Dorothea Dix Care Unit is a step in the right direction for the Fayetteville-Cumberland County region, allowing patients to work with board certified psychiatrists, and for local families to be more involved in the treatment process. The unit opens the doors for better access, meaning children in crisis can get immediate care, rather than waiting for a bed elsewhere while spending longer periods of time in the Emergency Department.
Q. What new technology or services would you to use in the future? What’s out there that you’re excited about trying out?
JB: As mentioned earlier, digital technology development will have a dramatic impact in the future, where adolescents will be able to reach out for help through various platforms. It would be great for an adolescent to be able to use an app so they can check in with a therapist, access breathing techniques, have biometric information on their phones they can utilize to provide biofeedback, and so on. Other future things involve checking medication levels remotely, utilizing technology to learn about one’s body, and so on.
Q. How will these services or this facility evolve?
JB: I think research leads this area. While there are a tremendous number of ideas regarding technology, there needs to be development into functional realms prior to implementation. Then, once the functionality of an idea is developed, it needs to be researched through evidence-based research to ensure that it works, and works the way it’s supposed to.
Finally, parameters need to be put into place to ensure the new technology is not able to be used in a harmful way. As an academic/teaching hospital we’ll be able to establish cutting edge techniques to help our patients.
Health systems like Magnolia Regional Health Center are boosting patient engagement and reducing wasted prescriptions with new services at the point of care.
Medication adherence is a significant pain point for healthcare providers, contributing to wasteful expenses, physician stress, and reduced clinical outcomes. Some health systems are turning to digital health technology not only to help patients take prescribed medications, but to make sure those drugs are the most appropriate and economical.
At Magnolia Regional Health Center in Corinth, Mississippi, clinicians are using a digital tool developed by DrFirst within their Meditech EHR to identify prescription benefits and therapeutic alternatives (ranging from other treatments to lower-priced generic medications) with patients at the point of care. The myBenefitCheck tool enables clinicians to reduce the chances of a patient deciding not to fill a prescription or follow dosing instructions.
"We've had some challenges over the years," says Brian Davis, CHCIO, the hospital's chief information officer.
A 2017 study estimated that 69% of patients with at least $250 in annual medication costs are abandoning their medications, a percentage that had risen steadily due to rising out-of-pocket costs, and undoubtedly has gotten worse because of the pandemic. Health systems like Magnolia are now using new tools to address that issue at the point of care.
Where clinical decision support tools originally allowed care providers to research symptoms and identify treatments, new technology taps into the EHR and other databases to expand that palette. Providers can now access the entire patient record, including claims data, to better understand how a specific patient might react to a specific treatment (including whether a patient can afford that treatment) and collaborate with the patient on treatments that would work.
To study the tool's effectiveness, Magnolia Regional analyzed medication adherence and prescription fill rates for 417 patients living with congestive heart failure (CHF) between July 2020 and September 2021. They found that first-fill prescription abandonment rates for expensive antithrombotics was higher for patients readmitted to the hospital (50%) than for patients who didn't have to return (35%), while there was little difference between the two groups when less expensive anticoagulants were prescribed. The evidence indicated that patients were not filling their prescriptions or not following doctor's orders when cost was a factor.
Brian Davis, chief information officer for Magnolia Regional Health Center. Photo courtesy MRHC.
Davis says these tools allow doctors to talk with patients at their most vulnerable moment—when they're being diagnosed and given a course of treatment. That's when clinicians may have the best chance of ensuring long-term care management.
"If providers had access … at the point of care, they could have better conversations," he says. "This allows our care providers to get in front of medication adherence."
Magnolia Regional's experience is one example of how innovative technologies and strategies are being used to improve medication management. Some providers use digital pill boxes, telehealth platforms, or mHealth apps to track medication adherence at home, while others are deploying technology to give clinicians the resources to discuss adherence with patients as they're being treated.
The advances extend to eprescribing as well. At the recent HIMSS22 conference in Orlando, First Databank (FDB) unveiled FDB Vela, a cloud-based platform that integrates with the EHR and, according to its makers, "enables the seamless flow of critical medication prescription information, benefits verification, and clinical decision support between prescribers, payers, pharmacies, and other constituents."
"Drug information needs to be integrated into the EHR" to give clinicians tools at the point of care, says Robert Katter, FDB's president.
Katter says much of the innovation these days is tied to patient-centered care. Consumers are asking for that information, he says, when they meet with care providers, so that they can make informed decisions about their care.
The new technology and strategies address several concerns in care management. Aside from aiming to reduce the amount of wasted or unused prescriptions, care providers want to know whether the treatments they're prescribing are working, and that only happens if the patient is following doctor's orders. Pharmaceutical companies would also like to know that information, which they could use to design more effective medications.
Then there are the clinical outcomes. If a patient doesn't follow treatment, the condition might worsen, perhaps leading to more treatments and even hospitalization. The same outcomes might be seen in a patient that is taking the wrong medications, or not taking the right doses.
Davis says that care providers have the opportunity to talk with patients not only about the different types of treatments available, but the varying degrees of effectiveness. One drug may be more expensive than a generic alternative, but it's more likely that the first drug is more effective, while the generic drug may get the job done but over more time. The doctor might also find more information in the patient's medical record on the potential for side effects.
Branded, higher-cost medications "do tend to show better outcomes," says Davis. But that doesn't mean a generic medication isn't effective. And if a patient can afford only the less expensive drug, there's a much better chance that he or she will fill the prescription and follow doctor's orders.
"It has led to several changes in medications," he says.
These tools also affect patient engagement, or activation. A clinician who has more specific information at the point of care stands a better chance of having a meaningful conversation with the patient, one that gets the patient involved in his or her care. A more engaged patient would then most likely follow the care management plan, or be more inclined to work with the clinician to make sure the course of treatment is effective.
Davis sees these new tools and strategies as the first step in a more comprehensive care management program, particularly for patients with chronic conditions. And they point to the need for a robust EHR that includes a patient's complete medication history and integration with both the health plan and the pharmacy.
Beyond that, there's an opportunity on these platforms to identify social determinants of health, such as why a specific patient won't take certain medications or can't afford them. A clinician who has insight into a patient's home and family life, financial concerns, and other pressures would then be able to design an appropriate care management plan that offers a better chance of being followed.
"There's some work there in balancing these things out," he says.
