Humana deploys testing app in a single month that would have taken months under previous agile hand-coding methods.
The treacherous world of application development has swallowed many IT budgets, inside and outside of healthcare. For decades, as modern applications evolved, IT shops were restrained by the abilities of teams of developers hand-coding applications, until a new term emerged—"technical debt"—described as the ever-widening gap between software requirements, and the ability of IT shops to fulfill those requirements.
An application development executive at health insurer Humana thinks the payer has discovered a better way, one that draws down the technical debt in the process.
Using a relatively new form of self-documenting visual application development, Humana has been able to reduce application development time, as well as decrease time needed to update those applications, says Bruce Buttles, digital channels director at Humana.
Technical debt doesn't just refer to legacy applications. It can be compounded by previous agile-based software development methods, which place a value of speed of development, but not necessarily documentation or reuse, Buttles says.
Pictured: Bruce Buttles is the digital channels director at Humana. Photo courtesy of Bruce Buttles.
Buttles joined Humana three and a half years ago, having already been a user of one such visual programming system, provided by OutSystems, for two and a half years.
He had been skeptical about the capabilities of visual application development, compared to traditional hand-coding of applications. And yet, when he compared OutSystems to those methods six years ago, it was able to produce the same level of optimized code as hand coders—if not better.
"When I took this job at Humana, I said, 'If you guys are open to this idea, then I would continue to be a consideration for candidacy,' " he said. " 'If you're not open to this idea, tell me now, because I'm not interested.' That's the course of my career. I will never take another job that isn't completely willing to embrace the idea of automated software engineering like this. I just can't do it. I can't go back."
At Humana, Buttles hit the ground running, "The very first solution we built we literally did over a weekend, and launched it," he says. The application replaced an unruly spreadsheet that Humana call centers were using to refer callers to locations offering tests to Humana members. From there, Buttles and his team were able to quickly build master/detail query screens in the app, allowing Humana call center staff to search for testing locations using basic search on a web browser.
The team kept evolving the application, so that after a month of work, it also included a map interface —similar to Google searches—accessible by the general public, as well as Humana staff. "At the height, we had around 12,000 testing locations being tracked and updated," Buttles says.
Traditional development would have taken months
Buttles estimates that a sharp team of hand-programmers would have taken at least three months to deliver the same application—or, more likely, four to six months.
The visual programming system outputs the standard sort of code found in enterprise applications today—Microsoft C# code for the application tier, running on the .Net Framework, as well as standard SQL code. On the front end, it generates standard HTML, CSS, and JavaScript.
Code reuse is also more feasible with the self-documenting system, "especially if you abide by the OutSystems best practice, which is the four-layer canvas. This four-layer canvas breaks things down into four tiers. That makes it very logical," Buttles says.
Recently, OutSystems conducted a survey about technical debt among 521 IT decision-makers spanning enterprises (companies with more than $2.5 billion in revenue), commercial companies (with $1 billion to $2.5 billion in revenue), and small-to-medium businesses (with $50 million to under $1 billion in revenue), inside and outside of the healthcare industry.
On average, responding businesses devote more than a quarter (28%) of IT budgets to addressing technical debt, compared to about a third (33%) to innovating and building new capabilities, and just shy of 40% to running status quo operations, the OutSystems report found.
Buttles says this method of application development also makes much more predictable estimates of how long applications will take to build.
"As a business and technical executive, the hardest part of my job is trying to predict how long is it going to take, how much is it going to cost, are we going to be on time and on budget," he says. "Even the best agile teams in the world deliver every two weeks. On a good day, they're 80% accurate." With the visual system, developers often work fast enough to get ahead of application requirements creation.
Traditional application development also works off of requirements documents that quickly become out of date, as code gets rapidly built and revised. With a self-documenting system, the requirements document is an integral part of the self-documenting whole, Buttles says.
Also feeding the visual development trend is the increasing availability of application programming interfaces (API) in use throughout enterprises, including healthcare, which products such as OutSystems support.
"Some of the best apps we see our customers build come from the use of a couple of different [enterprise] platforms to create a new kind of experience for an end user," says Robson Grieve, chief marketing officer at OutSystems.
One example in healthcare is applications that onboard new employees while provisioning their addition to many different systems in use by the healthcare organization, Grieve says.
Pediatrix Medical Group, part of MEDNAX, used OutSystems to develop BabySteps Cloud, a cloud-based clinical documentation app for material, newborn, and pediatric services, Grieve says. By modernizing the app, MEDNAX was able to push new features every two weeks, rather than years apart, which led to research and best practices that saved the lives of an estimated 100,000 babies, he adds.
Study pulls in social determinants of health signals to highlight patients at risk.
Social determinants of health data are now being used to risk stratify cancer patients according to, among many other things, their purchasing habits.
The new study describing this work, published in June in Future Oncology, found that the patients whom an artificial intelligence software tool predicted to be at high risk of dying in the next 30 days were 7.4 times more likely to die within 30 days than those predicted to be at low-risk.
The algorithm was trained on clinical and socioeconomic data to predict mortality. The algorithm can help drive earlier interventions for patients at risk, or direct patients to palliative care services to ease their end-of-life suffering.
Sibel Blau, MD, Medical Director, Northwest Medical Specialties. Photo courtesy of Northwest Medical Specialties.
The individuals in the study group were geolocated, based upon their home addresses, to pull in the characteristics of their neighborhoods, says John Showalter, MD, MSIS, chief product offer at Jvion, whose artificial intelligence software was used to identify the at-risk data set of cancer patients.
"We also go out and purchase individual data typically used for marketing," Showalter says.
According to the study, purchasing data originated with third-party data vendors such as Acxiom, Experian, and Transunion. Individual behavioral data included elements such as history of internet searches on health conditions, purchasing channels, and life stage. All purchased data are indexes indicating preferences and no transactional-level data was used, according to the study.
Other data comes from government sources such as the U.S. Census Bureau, U.S. Department of Agriculture, and the National Oceanic and Atmospheric Association (NOAA), can correlate patients’ whereabouts with information including local sources of high air and water pollution, Showalter says.
Studied patients were scored weekly, and researchers assessed algorithm performance using dates of death in patients’ electronic health records.
The study concluded that for patients scored as highest risk for 30-day mortality, the event rate was 4.9% (vs 0.7% in patients scored as low risk; a 7.4-times greater risk). Additionally, it concluded that development and validation of a decision tool to accurately identify patients with cancer who are at risk for short-term mortality was feasible.
One of the study authors, Sibel Blau MD, is medical director and owner of Northwest Medical Specialties, PLLC, a cancer treatment center and oncology clinic located in the Pacific Northwest.
Blau, who also leads the national Quality Cancer Care Alliance(QCCA), says the data gathers the kind of social determinants of health information that physicians and oncologists are usually unable to glean, in part because they tend to be weak signals of information. Other QCCA clinics throughout the country are now using the new AI tool as well, she says.
"Sometimes patients pop up in that list that we know they're at the end of their life," Blau says. "They are appropriate patients and we already are taking care of them."
Other patients appear on the list whose risk comes as a surprise to clinicians. "No matter how great you are, the best doctor in the world, you don't know every second of what's going on with the patient," Blau says. "This tool allows us to get those sick people into the clinic earlier."
If the patient is unexpectedly on the AI-predicted 30-day mortality list, then clinicians call those patients into an acute care clinic developed specially to treat these at-risk patients, Blau adds.
"We do tell patients, we have this tool, which tells us that you might be at risk of being sick and dying from this disease," Blau says.
Within two years, the tool helped double palliative care referrals, while hospice referrals jumped 12-fold.
Northwest Medical Specialties is a participant in the CMS’ Oncology Care Model (OCM), an innovative, multi-payer model focused on providing higher quality, more coordinated oncology care. "We get paid on an episodic payment basis, rather than fee-for-service," Blau says.
"Our practice has gone through a lot of transformation," she says. "One of our weakest areas was the end of life. I had to put a lot of support into not just Jvion, but other things as well."
Jvion’s analytics added a layer of just-in-time information that prompted the clinic to open the acute care clinics as well as weekend clinics. Through these actions, Northwest Medical Specialties has been able to improve its OCM end-of-life measures from minus 36% in July 2016 to minus 3% today, Blau says.
"We’re still not the best or the greatest, but we closed that gap significantly," Blau says.
Among the actions that the new clinics and a new patient care coordination team have taken, are better treatment of patients’ depression, pain control, hospice referrals, and palliative care, Blau adds.
The tool has also led to more meaningful end-of-life conversations with terminal patients, giving them agency over their final days.
The Jvion tool highlighted the clinic’s need to increase the number of mid-level and advanced practice providers interested in end-of-life discussions, palliative care, acute care, and goals of care, Blau says.
Former Allscripts CEO and Livongo founder now heads Transcarent, touted as a comprehensive platform for employees of self-insured employers.
Glen Tullman is a serial entrepreneur in the digital healthcare business.
After leaving the CEO's position at Allscripts in 2012, he founded Livongo, a diabetes monitoring and remote monitoring company acquired last year by Teladoc for $18.5 billion.
Now, Tullman is on to the next startup, Transcarent, which uses technology to improve how consumers engage with top healthcare providers. The platform is focused on employees of self-insured employers.
Tullman recently responded to HealthLeaders' questions about how his latest startup intends to help self-insured employers navigate the virtual-care-dominated world of the COVID-19 pandemic.
HealthLeaders: What is consumer-directed healthcare, and how does it differ from healthcare as practiced in the U.S. today (other than concierge care)?
Glen Tullman: Consumer-directed care is a completely different way of experiencing health and care than what we’re currently used to. Despite the massive amount of innovation that’s happened over the last few years, and especially over the last 18 months or so, health care is still more confusing, more complex, and more costly than ever before. When’s the last time you heard someone say they loved their healthcare experience? It doesn’t happen often, and it’s a shame because there are hundreds of companies, providers, payers, and PBMs working within the ecosystem to solve healthcare’s challenges, but no one’s cracked the code on genuinely improving the patient experience. At Transcarent, we want to correct that by creating a new and different kind of health and care experience that puts people back in control of their healthcare decisions and makes it easier to stay healthy.
The consumer-directed model is actually a lot closer to how we approach other experiences in our lives, like booking a trip or purchasing a new pair of running shoes. Right now, if I were to go on a site like Amazon and type in the kind of shoe I’m looking for, I would get information about all kinds of shoes from all sorts of brands. Some would be more expensive, some might be specific to the type of exercise I want to do, but I would have all the information right there in front of me to choose the right pair for my needs – I am in control.
At Transcarent, we are redefining the relationship that people have with the health care system by giving them the same kind of unbiased, transparent information about the care options available to them, providing trusted guidance where they know we will never choose what’s best for us over them, as happens today, and then letting them make the decision that’s best for themselves and their families. It’s an approach that puts employees and their families back in control of their own health, and we know that given the right information, people will make choices that lead to better health outcomes. We trust people.
(Glen Tullman is CEO of Transcarent. Photo: Courtesy of Transcarent)
HealthLeaders: Ultimately, do you have more faith in private enterprise's role to fix healthcare than you do in government regulation and oversight?
Tullman: I’ve said it often, but given the current state of affairs, I believe that employers will play a key role in driving real change within the healthcare ecosystem. We’ve already seen evidence of this. Three of the nation’s largest employers —JPMorgan Chase, Berkshire Hathaway, and Amazon — launched Haven in 2018 as a joint venture to lower costs and improve the quality of care for employees. They did that because they concluded that payers would never be aligned with their interests. When they spend more, payers make more.
We know now that Haven ultimately didn’t succeed, but I believe it was a wake-up call for the industry. Think about it. In any other industry, if your customer was so disappointed in the way you were doing business that they developed their own solution, you’d have a real problem. Self-insured employers have watched costs rise year over year, with no real correlation in the quality of care their employees are getting or alignment from a cost standpoint. On top of this, they’re being inundated with dozens of fragmented digital health solutions, each promising to address a specific part of care because the current systems don’t work well.
They’re desperate for change, and that’s why Transcarent was created. In fact, we were approached by several employers that had seen the success of Livongo in creating a health experience that people not only liked but loved, that measurably improved clinical outcomes (they were healthier) and that actually cost less. And these were people dealing with challenging chronic conditions. These large self-insured employers asked that we do the same thing for their employees, but across the full span of health care needs.
HealthLeaders: Despite much talk about healthcare becoming digital-first, many in the public are still not able to access their care digitally. What must be done to correct this?
Tullman: The digital-first push has been happening for a few years, but I would argue that maybe our scope of what we mean when we say "digital-first" has been too narrow. The place that I think we want to get to as an industry and as a society is putting the consumer first. To be clear, there are still real access issues when it comes to ensuring that people have the digital tools necessary for virtual care options, remote monitoring, and the like. But as providers, we also need to be willing to meet people on their own terms.
If it's the middle of the night and a mom doesn't want to bring her sick child into the urgent care center, she can connect with a provider through Transcarent in an average of 60 seconds. If a person is on the go and prefers to text a doctor about their symptoms, rather than taking time to do a video call or go into an actual doctor's office, they can do that as well. The increased utilization of virtual care has been paramount during the pandemic, but digital tools don't mean anything if an individual doesn't want to use them in the long term. The future of healthcare has to be focused on providing multiple avenues for consumers to access care on their own terms.
HealthLeaders: Much of what ails healthcare is cost. What is the ultimate tonic for high costs: true competition, price controls, care rationing, or something else?
Tullman: To drive down healthcare costs, we must provide consumers with three things: broad unbiased choice (like Amazon does); trusted expert guidance (like Travelocity does), and high-value care (already provided by many of our health systems but we have no way to differentiate). Transcarent’s surgical solution is a prime example of this. When a Member comes to Transcarent in need of surgery, our first step is to immediately get them an expert second opinion. Oftentimes it turns out that surgery may not even be medically necessary, and we’ve saved a person from having surgery that they didn’t really need. Most importantly, that’s a safer option for the person. A better option. And it saves them and their employer money.
Let’s say, though, that they do end up needing the surgery. Transcarent will ensure that the member has the option to receives the surgery at the highest quality and most appropriate site of care, and we’ll even fly them there to get it if necessary. In the past, the CEO would go to the best place. The janitor was told where to go. Now they both get access to the same exact, high-quality choices and without co-pays or co-insurance. That’s kind of magical and it happens to be much more equitable. Everyone gets high-quality care they can afford. Again, this kind of access to high-quality providers and Centers of Excellence has traditionally been reserved for those that could afford it or people with influence, but it’s open to everyone with Transcarent. And on an overall basis, because it eliminates unnecessary surgeries and medical errors by going to top-quality health systems, it results in an average savings of 25-50% per procedure. For back surgeries, which are historically very ineffective and very expensive, it’s even greater.
HealthLeaders: Are there superior business models that have yet to be tried, or to be implemented successfully, and how can we get there?
Tullman: At Transcarent, we’ve taken on a full-risk model, meaning we’re fully aligned with the employers and completely focused on making the health and care experience easier for their employees and their families. Our success is based on whether or not we improve the health and care experience for our Members and their families, measurably improve clinical outcomes, and lower overall costs for the Member (no-copays or co-insurance) and their employer. This concept is very different than the traditional navigator models deployed by companies like Accolade, Grand Rounds, or Castlight Health, where employers pay upfront for access to the solution. Ultimately, the full-risk model ensures alignment among stakeholders, a necessity if we’re going to fix the current system and have better alignment with the employer and health consumer (all of us). We don’t want to “navigate” a broken system . . . we want to fix it.
HealthLeaders: What are you hearing from leading health systems relating to digital health, and more specifically, what specifically about the rise of digital health reminds you of the early days of hospitals and doctors' offices adopting EHRs?
Tullman: While many health systems are embracing digital health, the explosion of new services that both helps and sometimes competes with them definitely has them overwhelmed, at times. It’s not too dissimilar to the plight of self-insured employers who are also overwhelmed with countless digital health services pitching them every day, something I discussed with The Wall Street Journal. However, they understand that if they are going to compete with tech-savvy upstarts and other industry giants, they’re going to have to drive adoption really quickly and offer a new and different consumer experience.
There are a few parallels to the adoption of EHRs years ago – namely the challenge of driving adoption and usage internally. The clinical staff is already under tremendous stress, and every time you add new technology, it can be met with resistance because it seemingly adds more work. That’s why it’s up to digital health vendors to do a better job making the experiences seamless, but also working together to create integrations that are aligned and drive ROI at scale both clinically and financially. That friction is something that plagues the EHR community still to this day. This is not easy but it’s doable with the right leadership and the right focus, which brings us front and center to where we started . . . putting the health consumer back in charge or, said another way, consumer-directed care.
An all-Epic study spanned 349 health systems, and found pediatricians receive considerably fewer messages regarding patients, prescriptions, team activities, and results.
Pediatricians spend significantly less time actively using electronic health record (EHR) software than general medicine and family medicine clinicians, according to a study recently published in JAMA Network Open.
Some differences are due to the less medically complex health of pediatric patients, but the study authors, led by Lisa S. Rotenstein, MD, MBA, assistant medical director, population health and faculty wellbeing at Brigham and Women's Hospital, suggest that the burden of EHR documentation may be due to other factors.
The authors suggest that the burden of documenting adult patients can be lessened by making messaging more efficient, and by streamlining documentation requirements.
The study authors analyzed 349 health systems, all using Epic EHR software. The study was exempt from informed consent requirements because the data was deidentified first, the study authors stated.
Clinicians in these systems had a mean 12.9 encounters per day among general pediatrics clinicians, 11.5 encounters per day among general internal medicine clinicians, and 12.8 encounters per day among family medicine clinicians.
Mean daily total active EHR time ranged from 94.7 minutes among general pediatrics clinicians, 121.5 minutes among general internal medicine clinicians, and 127.8 minutes among family medicine clinicians.
Family medicine clinicians spent twice as long (18 minutes) on in-basket messages as did pediatric clinicians (9.4 minutes). General medicine clinicians spent similar amounts of time (18.4 minutes) as family medicine clinicians, according to the study.
Pediatric clinicians spent two-thirds as much time on clinical review and orders than their general and family medicine counterparts, the study stated. Compared with general medicine and family medicine clinicians, pediatric clinicians received one-fifth as many prescription messages, one-third as many patient messages, one-half as many team messages, and fewer than one-half as many results messages.
HIE event notification shows promise in solving healthcare challenges.
Primary care physicians recognize the need for better coordination and welcome health information exchange (HIE) event notifications as a way to improve patient care, according to a new study from U.S. Department of Veterans Affairs (VA), Regenstrief Institute, IUPUI, and Icahn School of Medicine at Mount Sinai researchers.
The study, "Perceptions of event notification following discharge to improve geriatric care: qualitative interviews of care team members from a 2-site cluster randomized trial," appeared online ahead of print in the Journal of the American Medical Informatics Association (JAMIA).
In a healthcare system where individuals often receive medical care from more than one system, care coordination among providers after discharge from an emergency department or hospital in one system, while the patient's primary care physician resides in another, poses many challenges and often fails to happen, according to the study. This incomplete sharing of clinical information can adversely affect health outcomes.
"While our study focused on patients whose primary care was provided in the VA system, this is an issue faced by patients and their providers in many, if not most, healthcare systems in the United States," said study senior author Brian Dixon, PhD, MPA, the Regenstrief Institute and Indiana University Richard M. Fairbanks School of Public Health at IUPUI director of public health informatics. Dixon is also a research scientist at Regenstrief and an associate professor of epidemiology at the Fairbanks School, as well as an affiliate scientist at the VA Health Services Research and Development Center for Health Information and Communication, located at the Richard L. Roudebush VA Medical Center.
Primary care doctors in the VA system typically have not been notified when their patients were seen at a non-VA emergency department, or hospitalized at a non-VA facility, the study reported. Thus, physicians can be unaware of the need for follow up, and only learn of the event months later from patients themselves. During these intervening months, patients typically are not receiving care from physicians primarily responsible for overseeing overall health.
"The majority of Americans rely on their primary care physician to coordinate care of medical specialists and hospitalizations," Dixon said in the announcement of the study's release. "They expect their doctor to know about their care, but most of the time that's not happening. Our study is unique because we investigated primary care teams' perspectives on utilization of an electronic foundation—health information exchange—to enable automatic notifications—for example, a primary care physician's patient has been hospitalized for a heart attack—to remediate this problem and found positive reception."
The study authors interviewed primary care team members, who considered electronic alerts (such as news that a patient was seen in the ED for chest pains and sent home when it was determined not to be a cardiac event) as both necessary and effective to support timely follow-up care, particularly for older adults at increased risk of such medical episodes.
The authors, in addition to Dixon, are Emily Franzosa, Morgan Traylor, Kimberly Judon, Vivian Guerrero Aquino, Ashley L. Schwartzkopf, and Kenneth S. Boockvar, all of the VA. Dr. Boockvar is also with Icahn School of Medicine at Mount Sinai.
Now that this qualitative study has demonstrated the perceived benefits and acceptability of electronic event notification by primary care physicians and their teams, Dixon and colleagues said they are working on a quantitative analysis, measuring the actual impact of these notifications on follow-up care, as well as preventing repeat emergency department visits and rehospitalizations.
This work was supported by U.S. Department of Veterans Affairs Health Services Research and Development Service (grants IIR-10- 146 and I01 HX001563; principal investigator K. Boockvar).
About Richard L. Roudebush Veterans Affairs (VA) Medical Center
Established in 1932, the Richard L. Roudebush VA Medical Center serves Veterans from across Indiana and western Illinois. The Roudebush VAMC is one of the largest and most complex medical centers in the Department of Veterans Affairs, and provides acute inpatient medical, surgical, psychiatric, rehabilitation, and neurological care to more than 60,000 Veterans annually. Some of the many services available to Veterans include emergency medicine, primary care, cardiac care, radiation oncology, audiology, community-based extended care and community VA clinics.
About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.
Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute's research mission.
A new Lumeon survey lists improving patient access, team coordination, and improving care quality as top wishes, but inadequate budgets, data silos, and inflexible EHRs remain as barriers.
While the COVID-19 pandemic highlighted how huge a role technology can play in making the care process more efficient and convenient, simply revving up patient engagement tactics fall short of satisfying newly empowered patients, according to a recently released survey.
Research by digital health company Lumeon identified top digital transformation priorities, as picked by C‑suite leaders at U.S. hospitals. The list includes short- and long-term goals to make care more positive and efficient.
The report reveals that as the U.S. emerges from the pandemic, and hospitals' key aims continue to be increasing patient volumes and revenue, digital transformation will continue to be ever more important in achieving those aims.
Among the findings in this research, conducted by Sage Growth Partners on behalf of Lumeon:
Improving patient access is the top digital transformation goal for 59% of providers.
94% of leaders report that care team coordination is key for successful digital transformation.
43% of providers said improving care quality continues to be a key priority.
Among other findings, eight out of 10 providers say waste reduction has been a focus during the pandemic.
Growth in new brick-and-mortar hospital services will be more selective than before, the survey found.
Providers expect good digital patient experiences will translate into more word-of-mouth recommendations.
In the next 12 months, 88% of providers say digital transformation is moderately or very important, the survey found. That number rises to 93% when the time frame reaches out to the next three years.
Major barriers to digital transformation were also reported out by the survey.
Despite two-thirds of providers stating their IT budget had increased or stayed the same as during 2020, almost half of respondents said that their IT budget might still be insufficient to achieve their transformation objectives.
Other barriers identified by respondents included low adoption by patients, technology silos, inability to demonstrate return on investment, and limited EHR customizability.
Consumer demand and new tech supply are driving growth, says trade group.
Jumping 7.5% in a single year, retail revenue for U.S. tech will reach an all-time high of $487 billion in 2021, driven by surging consumer demand for tech related to work, school, and lifestyles, according to a report released by the Consumer Technology Association (CTA)®.
"The pandemic strengthened consumers' relationship with technology forever," says Gary Shapiro, president and CEO at CTA. "From working to learning, staying connected with loved ones and taking care of our health, tech played a crucial role in improving our lives. Tech has proved time and again that innovation makes our country resilient in the face of crises. Even though the U.S. still deals with supply chain shortages, labor gaps, vaccination rollouts and looming inflation, tech will help us keep pushing forward."
The CTA U.S. Consumer Technology One-Year Industry Forecast, released two times annually, represents U.S. manufacturer shipments in more than 100 consumer tech product categories, as well as associated software and services.
CTA expects more than 106 million 5G smartphones to ship in 2021, up 530% from 2020. This increase will generate $61 billion in revenue, a 404% increase. Shipments of smartphones overall will increase 10% to 154 million units, earning $73 billion in revenue, up 15%.
Spurred by Americans' continued working from home, laptops shipments will reach 76 million units (up 9%), earning $45 billion in revenue (up 11%).
CTA's report now includes connected exercise equipment such as stationary bikes, rowers, and treadmills. With demand for products such as Peloton and MYX Fitness soaring, approximately 1.5 million units were shipped in 2020, and in 2021 the devices will cross 2 million (a 43% rise) and earn $3.9 billion (a 40% increase).
Shipments of health monitoring devices connected to the internet, such as smart thermometers, pulse oximeters, and blood pressure monitors, will grow to 13 million units (up 23%) and earn $740 million in revenue (a 17% increase). Total revenue of health and fitness tech will reach $13 billion in 2021, representing a 12% growth over last year. Smart watches will grow 8% in unit shipments.
Personal mobility, which CTA defines as including battery-powered bicycles and scooters, is one of the fastest growing categories in the CTA forecast. CTA estimates a total of 1.2 million e-bikes will ship in 2021 (up 15%), earning $1.9 billion in revenue (a 3% jump).
Smart speakers and home robot products will drive 100 million smart home devices to ship in 2021 (up 11%), holding flat on revenue, with $15 billion, CTA reports.
Growth also continues in audio services, video streaming, gaming consoles, televisions, virtual reality and augmented technology, and electronic toys, CTA adds.
Jason Szczuka tackles new role at Bon Secours Mercy Health.
The newly named chief digital officer (CDO) of Bon Secours Mercy Health is no stranger to the title, having held it previously at Cigna for two years. Jason Szczuka took Bon Secours' first such defined role on July 8, helming the digital efforts of the 50-hospital, seven-state system headquartered in Cincinnati. "A chief digital officer is something different to every company, based on the existing vision of that company's top executive leadership, as well as the underlying culture and capabilities of that organization," Szczuka says. Digital innovation and services are a common thread, however. Szczuka reports to chief executive officer John Starcher, Jr. and took time to answer questions from HealthLeaders.
Jason Szczuka is the chief digital officer at Bon Secours Mercy Health. Photo courtesy of Bon Secours Mercy Health.
This transcript has been edited for clarity and brevity.
HealthLeaders: To what extent did the ongoing transition from pandemic-focused care to post-pandemic hybrid care, some in person, some remote, define your new position and your new responsibilities?
Jason Szczuka: Those are two very different things. Because not every organization is doing that. The reality is, though, that there's too much emerging whitespace to say that my role has an actual definition or set of responsibilities today. What I will say is, we have an obligation to extend quality care into more convenient, connected, and consistent forums, so that we can optimize a patient's health and wellness, whether they are in person, online, or a combination of both at home.
HL: There's a digital divide in healthcare that the pandemic seems to have highlighted. People who have mobile phones or a good idea how to use your website were taken care of pretty well, compared to other people who maybe aren't as digitally savvy. Wouldn't a chief digital officer address that divide?
Szczuka: It's a real problem. And it's becoming a bigger problem, which the pandemic highlighted. We always use the term health equity. We've got to be more direct and think about the poor and underserved markets that are most at risk on the wrong side of this digital divide. Just because an individual doesn't have the latest iPhone in their pocket or wearable on their wrist does not mean that advanced technologies cannot help them out. The digital divide is not an excuse to not work for those populations.
HL: What does the term digital transformation mean to you?
Szczuka: When I think of transformation, it's more culture, it's fluid, and it's evergreen. You've never transformed. You're always transforming. And if you're always transforming, then it becomes much easier to figure out what are the offline or antiquated services that we can digitize, and then secondly, where can we innovate to create something new today that was not there yesterday. Only by accepting what transformation is do I think you'll ever have meaningful success in those other areas.
HL: Large healthcare systems continue to wrestle with mandates to implement data interoperability with each other, public health institutions, payers, and the government. Does the chief digital officer have a role to play in this, since one aspect of interoperability is intuitive design, or lack thereof? It's one thing to say, we can connect this to this, but if the patient experience is terrible, what have you accomplished?
Szczuka: You're hitting on an important part of interoperability that nobody's truly talking about in these big health institutions yet. There's phase one that everybody goes through: let's comply. And then phase two: now let's productize. No CDO has to be there for the compliance phase. But if you're ever going to just scratch the surface of accomplishing what interoperability is intended to do, the CDO not only has a role to play, they have a leading role to play. Because if the input of that interoperability never makes its way into the solutions, and therefore, the decision-making of the stakeholders that it's pointed to is all for naught, it's just going to be data happening out there in the forest. And nobody's going to ever make a decision they otherwise wouldn't have because of it. That, to me, is the critical part of interoperability, that we're not there yet. I'm not saying it's been consciously ignored. There is so much work to get to compliance, and that doesn't even begin to address the garbage-in, garbage-out of interoperability between different institutions right now.
HL: So much is assumed these days that the data is in good enough shape to do all sorts of marvelous things with it, such as the analytics, the machine learning, and the AI. But if you're basing that on data that isn't clean, you're building on a house of cards.
Szczuka: Interoperability is the ultimate onus of collaboration, in that, you've got to know what you're putting into the pipes of our system is reliable enough for somebody else to use blindly. Let's just rip the band aid off and call it what it is. There is no organization, with maybe the exception of the newest, app-based, very shallow, very small-scope data set, that somebody might have where they actually know it's pretty clean. Nobody's there yet. So, as we develop things at Bon Secours Mercy Health, we're going to develop them from a mindset that they will be used by all participants in our industry, including those that you would think of as our competitor. I love the fact that the government is doing this, because it's forcing all of us to get serious quickly about our data. And so, I have seen dramatic improvements in payers, I've seen dramatic improvements in providers, and I've seen greater capabilities by patient/consumer-focused players as well.
HL: What's your game plan? How are you going to execute? What are you going to measure? What are the goals you're setting for yourself?
Szczuka: At Bon Secours, I am now able to put a digital extension on a foundation of what has historically been recognized as phenomenal care. What we don't have yet is an actual understanding of the KPIs of a digital health business that that care is being extended through. So first and foremost, I'm going to establish where we actually are today. What do these KPIs look like? Everything from patient engagement to clinical outcomes, to cost savings, to the consumer and their plan sponsor as a whole. Only by measuring it is how we are going to improve it, so that I can figure out what are the digital solutions and connections that will improve those KPIs, [and] have a disciplined road map that we operate and execute off of.
HL: We've often heard what a great day it will be when we turn off the fax machines. One wonders if that's realistic. Maybe, somehow, they're just going to adapt like everything else, and we won't lose the fax machine. We just won't recognize it.
Szczuka: We will never lose the fax machine, for good reasons. The ones taking risk in healthcare are, ironically, very risk adverse. They're always going to have a fax machine sitting there as a fail-safe. But where it will go away is when nobody else owns them. But the need for the certainty of a fax machine is always going to be there. So, you don't get to shut it off as a channel until it is equally or greater replaced by something else. And we are a long way away from that.
Wearables will track patients as remote home care optimizes hospital resources.
Next month, UMass Memorial Health, a nonprofit health system in Central Massachusetts with more than 14,000 employees and 1,700 physicians, plans to begin offering patients more opportunities to receive care outside of the hospital, using innovative wearable medical devices, as well as other home devices, to increase hospital capacity, and provide better experiences and outcomes for all patients.
"COVID-19 illuminated capacity issues at hospitals worldwide—ours included," says Eric Dickson, MD, president and chief executive officer of UMass Memorial Health. "Our team's ability to quickly build out a field hospital to care for patients during the height of the pandemic has inspired us to think differently about how we can deliver care outside our hospital walls. We see an opportunity to pioneer a new care delivery model that not only addresses hospital resource constraints, but also enables more preventive care and improved patient experiences and outcomes at scale. This is why we're so excited to launch our Hospital at Home program with Current Health."
Eric Alper, MD, is the chief quality officer, chief clinical informatics officer, and vice president at UMass Memorial Health. Photo courtesy of UMass Memorial Health.
Current Health, which makes the remote care management platform offering, will assist UMass Memorial Health in monitoring the patients.
The technology backbone of UMass Memorial Health's Hospital at Home program, provided by Current Health, will provide real-time insight into patient health and coordinating in-home clinical care and services. Current Health will enroll UMass Memorial Health patients eligible for the program through Current Health's platform and configure everything patients need to remotely engage with their care teams, including monitoring equipment, in-home connectivity, and a tablet for chat and video communication.
UMass Memorial Health will use the Current Health platform to:
Quickly detect signs of patients whose conditions are deteriorating, in order to foster early, preventive, and life-saving intervention and treatment
Identify patients needing immediate or in-person care to optimize limited hospital resources
Centrally coordinate in-home visits from UMass Memorial Health clinicians or in-home services
Current Health's platform is also integrating with UMass Memorial Health's Epic EHR to ensure a seamless experience for patients and providers alike.
The initial hospital-at-home enrollment will start with five patients, growing to 10 by September or October, says Eric Alper, MD, chief quality officer, chief clinical informatics officer, and vice president at UMass Memorial Health. In the next year, the program may double to 20, depending on patient demand, and limiting factors such as hiring adequate staff to do home and telehealth visits, he says.
Executives at UMass Memorial Health had been talking about implementing a hospital-at-home program for some time before CMS' waiver allowing remote care of patients kicked in at the beginning of the COVID-19 pandemic in 2020, Alper says.
Being able to generate revenue from the program "definitely sealed the deal for us," Alper says. But executives also thought the program would create value for some of the 50,000 patients in UMass Memorial Health's accountable care organization, primarily Medicare, but expanding into Medicare Advantage and some Medicaid patients, he adds. UMass Memorial Health currently has about 800,000 patients in its overall active patient database, he says.
The concept of hospital-at-home in healthcare is not new. "People have been doing this for probably 15 years, in smaller amounts," Alper says. More than 80 studies have examined the concept and results consistently show that hospital-at-home can improve quality of care, he adds.
Even though CMS has granted about 150 waivers for other hospitals and programs to do this kind of care at home, "we do feel like a pioneer," he says. "No one else is doing this right around us."
Some of the lessons learned so far involve getting medications to home-based patients, defining the requirements around getting infusion nurses into the home, and ensuring the safety of patients and staff alike, Alper says.
Time will tell to what extent such programs can be an alternative to expanding the number of rooms in the hospital itself, Alper says.
"If this goes really well, we could create lots of capacity," Alper says. "That would potentially reduce the need for us to build new beds."
Among the devices employed by Current Health in its remote care management platform is an FDA-approved wearable with flexible armband worn on the upper arm, says Adam Wolfberg, chief medical officer at Current Health. The wearable streams core vital signs up to Current Health's web-based platform via Wi-Fi to a cellular-enabled home hub provided by Current Health. Patients do not need to install their own Internet connection or to download an app to their mobile or desktop devices, Wolfberg says.
The wearable must be recharged for 15 minutes every two days, and if needed, may be left on the patient's arm while recharging, Wolfberg says.
Besides this continuously streamed data, the Current Health platform also integrates with wireless blood pressure cuffs, spirometers, skin temperature sensors, weight scales, and continuous glucose monitors, Wolfberg adds.
Editor's note: This story was updated on July 15, 2021.
An app guides patients from door to destination and uses location services of mobile platforms.
The COVID-19 pandemic spawned a plethora of "digital front door" strategies, but few have pushed technology as broadly in the service of enhancing the patient experience as a mobile application deployed in the greater San Antonio/Bexar County region of Texas by University Health.
Using mobile-phone push notifications to simplify scheduling, University Health has been able to complete 476,000 vaccinations since the beginning of 2021, and used the app's ability to maintain a full vaccination schedule, enabling the health system to use almost all its vaccine supply, as opposed to numerous systems that experienced waste, due to the vaccine's propensity to expire if not delivered within a few hours of being readied for use.
The system worked, in part, by taking a lightweight, self-service approach to patient engagement, deliberately eschewing the need for a login and password typical of hospital-run mobile patient interaction sessions, or massive staff involvement in scheduling appointments. It also cast a much wider net among the greater San Antonio community than such applications typically reach.
"We spread the word in the community that if you download this application, you would receive notification of when vaccine supplies were available," says Leni Kirkman, executive vice president, chief marketing communications and corporate affairs officer at University Health.
By doing so, University Health saw "an incredible spike in the number of users" of its University Health Go app, available in the Apple App Store and Google Play app stores at no charge, built and powered by technology provider Gozio.
"Having a fully featured mobile app in place has proved instrumental to both our pandemic response and vaccine distribution strategy," says Selene Mejia, University Health digital marketing manager. "The ability to communicate in real-time gives our patients peace of mind as we navigate a fluid COVID-19 care environment. It has allowed University Health to establish a direct relational link with the community, advance vaccine administration in our region, and target vulnerable and underserved populations."
Gozio's technology allows patients to self-schedule appointments, then applies patented turn-by-turn digital wayfinding to direct patients to those appointments.
As preparation for the rapid administration of vaccines at the start of 2021, University Health was able to initially reach 80,000 people who had downloaded the application, as well as others who had signed up for notifications by email, when vaccines became available.
Due to the rapid nature of this notification system, University Health found itself reaching out to many out-of-state members of the public eager for vaccines, including residents as far away as California and even some foreign countries, Kirkman says.
University Health continually reevaluated how best to reach its larger community to accelerate the vaccination program. "The partnerships we did with nonprofits across the community, with schools, with churches, with elected officials" made a big difference, Kirkman says.
In fact, fewer than half of those vaccinated were existing patients of University Health. "When more people in our community are vaccinated, there's less chance of our patients and our employees getting COVID-19," Kirkman says. University Health even provided vaccine for another health provider, when that provider did not get an allocation of vaccine, she says.
"We looked at this as something this community needed to make us safer, to get our kids back in school, to make it safe to go to a restaurant," Kirkman says. "So, we did outreach to our most vulnerable patients, and through those partnerships and outreach, tried to get those folks in as part of those guiding principles. We were here to serve this whole community and even people from other states. We're all in this together. There's no border for COVID."
The wayfinding component was essential to directing patients appropriately. The massive size of University Health's facilities—2 million square feet, expanding to 2.5 million—makes it too easy for disoriented patients, or even the newest group of resident physicians, to get lost. "Having it right there on your phone [makes it] easy to navigate," Kirkman says.
The software's content management system also made it a handy tool to deploy to the mobile devices of University Health staff, to disseminate ever-changing COVID-19 directives and protocols to staff, she adds. "We wanted it to be in the doctor's pocket," she says. "We were promoting it as 'all things information.' "
The digital front-door nature of the software allows health systems such as University Health to integrate other mobile apps, such as Epic MyChart, into a seamlessly connected mobile experience. Popular telehealth apps can also be integrated into the software, if a health system requests it, according to Gozio.
Also helping University Health's success was its July 2020 go-live on Epic. "Epic had already developed a module for vaccine distribution," Kirkman says. "We were one of the first to implement it" so that patients could select a time for their vaccination, without requiring them to make appointments through traditional ways such as phone or email.
The Epic go-live yielded one other benefit. To complete staff training on Epic, University Health had leased space in Wonderland of the Americas, a struggling shopping mall that happened to be centrally located in San Antonio, both geographically and by population distribution.
When the arrival of vaccines was imminent, University Health was able to make this leased space its public vaccination hub, without jamming its existing offices with patients seeking vaccinations, Kirkman says. When vaccination slots opened on December 31, 2020, the public filled 9,000 such slots in a mere three hours, she added.
Part of the software's appeal is the ability of Gozio to rapidly deploy it, says founder and CEO Joshua Titus.
"When we walked into [University Health], they had no app whatsoever," Titus says. "Four weeks later, they had an app in their hands ready to go to the [app] stores."
Titus describes the software not as a replacement for other mobile hospital apps, but as "somewhat of an aggregator of what's already in the system. If they have patient portals, we can tuck those in."
Bluetooth beacon technology lies at the heart of Gozio's wayfinding capability. Within hours, the company can map out precise locations of all of a hospital's facilities, reaching where GPS cannot, as GPS is blocked by the concrete contained within buildings, Titus says. The app even keeps track of where patients have parked their cars, he adds.
By using Bluetooth and not instead requiring Wi-Fi access, this location technology allows app users to navigate to their destinations without requiring access control or the involvement of the hospital's IT staff.
Although mobile device makers have talked for years about mapping indoor spaces, little progress has been made on mobile devices in general, although Gozio will take advantage of some indoor location-services features of the new version 5.2 of Bluetooth, Titus says.
Editor's note: This story was updated on July 9, 2021.