Through a mix of studies, pilots, and deployments, the first quarter of 2018 saw a lot of providers moving deeper into digital health. At the same time, more moves by Apple and a lot of action from the federal government continued to create new possibilities for the space.
Apple moves in 2018
Apple’s healthcare move that generated the most talk in 2018 was the launch of a Health Records feature in its consumer-facing Health app, first in a 12-health system pilot, and then in a full launch with 39 health systems.
The feature uses HL7's FHIR (Fast Healthcare Interoperability Resources) specification. Users will be able to see things like allergies, medications, conditions, and immunizations, as well as the sort of things they might check an EHR patient portal for, such as lab results. They can be notified when the hospital updates their data. The data will be encrypted, and users will need to enter a password to view it.
Apple also began data collection for its Stanford Heart Study this quarter, and tipped its hand a little in the informed consent document for the study. This document is the first confirmation from the tech giant that the study data will be used — or at least could be used — in the development and approval of an FDA-cleared product. The product in question is not a new hardware product (for instance, a competitor to AliveCor's KardiaBand). Instead, the investigational device referenced is the study app itself, including, presumably, the algorithms for detecting irregular heart rhythms using the Apple Watch's sensors.
The quarter also saw a new CareKit app and a new ResearchKit app. San Diego-based Sharp HealthCare used Apple’s CareKit, an open source toolkit for hospitals and health systems, to develop its mobile offering, the Sharp Health Companion app. The software is designed to help people navigate their surgery experience, including pre-surgery care, interventions, and post-surgery care. In a pilot focused on cataract surgery patients, Sharp reported that patients achieved an average medication adherence rate of 78.2 percent using the app. The Sharp research team also reported zero surgery cancellations, zero post-surgery complications, and zero readmissions.
At a HIMSS pre-conference event Dr. Lee Hartsell, assistant professor of neurology at Duke University Medical Center, spoke about a new ResearchKit study focused on multiple sclerosis. MS Mosaic, named because its goal is to create a comprehensive picture of the disease from fragmented patient reports, is an Apple ResearchKit app that launched in September. The app includes a number of tracking tools for people with MS to report their daily symptoms, activities, and experiences. In return, they get various features that help them understand trends in their disease.
Telemedicine
At HIMSS 2018 and during the months leading up to it, providers highlighted new forays into telemedicine, among other trends.
Methodist Family Health Centers, a part of Methodist Medical Group and an affiliate of Methodist Health System, in January unveiled Methodist NOW, an online diagnosis and treatment service that enables patients to receive easy access to care by connecting them virtually with their Methodist Family Health Center providers. Methodist NOW, powered by telemedicine vendor Zipnosis, facilitates care delivery through evidence-based online interviews paired with real-time chat functionality that enables patients and providers to exchange messages when additional information is needed for a diagnosis.
Telehealth platform InTouch Health teamed up with North Carolina-based Mission Health and Pennsylvania-based Jefferson Health to develop new telehealth tools aimed at improving patient access and reducing cost. Once developed, the products will be tested at Mission and Jefferson Health facilities. Mission Health primarily serves rural and suburban residents, where as, Jefferson Health cares for many patients living in urban areas. By testing the products at various locations the team aims to create platforms that are applicable across geographies and markets.
And Kaiser Permanente Colorado reported success with Chat with a Doctor, an asynchronous telemedicine service. Chat with a Doctor works like this: When patients go to Kaiser’s main website or to book an appointment, they have the option to use the chat service instead. If they do, they’re connected directly to a Kaiser doctor who is chatting with a maximum of three other patients. The doctor can assess simple things and prescribe some medications. If the condition is more complicated, they connect the patient to a staffer who will schedule an appointment.
Other telemedicine deals:
Through a collaboration with telemedicine company SnapMD, Valley’s Snyder Center for Comprehensive Atrial Fibrillation began offering online consultations. These visits will be designed for prospective patients living in New Jersey and New York interested in learning more about the center’s AFib treatment model.
Consumer-focused telehealth company PlushCare will began offering Thermo Fisher allergy tests. After video consult with PlushCare’s physicians, undiagnosed patients can schedule the test at a local lab and then review the results with the telehealth physician.
The University of Mississippi Medical Center's National Center for Telehealth announced a partnership with SnapMD, deploying the latter's Virtual Care Management software to power UMMC's telehealth platform.
A new collaboration between the Mayo Clinic and Corindus Vascular Robotics may pave the way for off-site coronary procedures. The partnership, backed by a recent grant awarded to the clinic, will take the form of a multi-phase preclinical investigation of the feasibility of telestenting — robotic percutaneous coronary intervention (PCI) procedures conducted remotely. The technology could provide a means to better manage coronary artery disease among rural or other underserved populations worldwide.
Patient engagement
While telemedicine initiatives helped hospitals connect to patients outside the hospital, patient engagement, coaching, and chronic condition management programs helped them to enhance the experience of patients inside the hospital and, in some cases, improve outcomes and reduce readmissions.
Newton-Wellesley Hospital in Massachusetts launched a new app-based initiative to try to keep patients from coming back to the hospital’s cardiology department. The hospital teamed up with Twine Health — prior to its acquisition by Fitbit — to launch a program that virtually connects patients with a health coach who helps them stick to their goals. For the past six months, Newton-Wellesley has been enrolling any eligible patient that wants to participate in the program. Patients download the app during an office visit and meet their health coach in person in the office. They set health goals that the app then helps them track once they go home.
Many of the engagement programs we wrote about this quarter focused on children’s hospitals and pediatric health.
In January, MedStar Health announced that it will begin offering expectant mothers a “Mommy Kit” containing an iPhone app, wireless weight scale, and wireless blood pressure cuff. The not-for-profit health system in Maryland and the Washington, DC area, said it joined forces with startup Babyscripts. The kit can be used to generate patient data that, in turn, is captured and transmitted automatically to both the user and the clinic. The Babyscripts app also delivers evidence-based guidelines approved by the patient’s obstetrician in the form of daily nutritional, medical, and lifestyle action items.
Boston Children’s Hospital teamed up with Klick Health in March to bring pediatric patients HealthVoyager, a medication education and patient experience platform that uses VR to show patients their individual medical findings in an immersive 3D environment. The initiative will be part of a validation study to gauge the technology's effect on patient and family understanding and engagement. The trial will focus on pediatric gastrointestinal patients. It will let the children take a peak into their GI track and see exactly what doctors are doing during a procedure. The goal is to make it easier for doctors to explain what is happening during a procedure and in turn increase patient engagement
And healthcare management and communication platform Oneview has recently announced that it will be deploying its new app, Oneview Connect, at Sydney Children’s Hospital Network, which is the largest network of hospitals and services for children in Australia. The app is designed to help patients and their caregivers not just while the patient is in the hospital, but also when the patient is at home. The app was first deployed in a trial run at the Sydney Children’s Hospital Network but will now be available to all patients at Children's Hospital at Westmead.
We also profiled two children’s hospitals overall strategies for patient entertainment and engagement: University of Iowa Stead Family Children's Hospital, which is working with Oneview Healthcare, and Phoenix Children’s Hospital, which is using a comprehensive system of iPads for patient education and entertainment.
Pain management
The quarter saw a larger-than-usual amount of news about chronic pain, which seems to be a hot area of focus for digital health.
Toronto-based startup, ManagingLife, announced that its chronic pain symptom tracking app has been deployed in four Ontario chronic pain sites. The technology will be deployed to the four centers for 24-months and is funded through the Government of Ontario Office of the Chief Health Innovation Strategist's Health Technologies Fund.
The app was first created in 2011, and at the time focused primarily on the users experience. But it has since expanded. Now there are three components to the platform. The first part is the original patient facing app which lets users record how they are feeling on a regular basis. The app summarizes these reports for patients so they can see trends. The second part of the app aims to help facilitate the doctor and patient conversation. Physicians can print out the pain report and have it on hand when the patient comes for a visit.
In February, Evidation Health just announced the launch of a 10,000 person chronic pain study, called the DisCover Project. The research aims to quantify chronic pain and develop digital biomarkers for chronic pain severity, flare ups and quality of life by using activity trackers, health apps, and other more traditional data points.
The study will examine data points including activity behavior data from wearables, the patients’ demographics, medical histories, pain diaries, quality of life measures, voice and speech data, and sleep. Participants are expected to bring their own wearable. The study is expected to include data from Apple Watches, Garmins and Android Watches. Researchers will then use machine learning to identify digital signals tied to health outcomes. The longitudinal case-control observational study will look at data from 4,000 participants in the control group who do not suffer from chronic pain and data from 6,000 patients in the case group that live with chronic pain.
Finally, at HIMSS, Samsung announced a partnership with Travelers Insurance, Cedars-Sinai Medical Center, Bayer, and AppliedVR around using virtual reality for pain management. Samsung and Travelers will fund a 16-month study of between 90 and 140 patients, conducted at Cedars, using technology from Samsung, Bayer, and AppliedVR. Patients in the trial will use therapeutic VR — delivered via a Samsung Gear VR headset paired with a TENS nerve stimulation device from Bayer and a GearFit 2 tracker, also from Samsung. Participants will track day-to-day functional status, work productivity, and their use of pain medications.
Other provider news
This quarter, surgeons from the University of Texas Health Science Center at Houston and Memorial Hermann-Texas Medical Center became the first in the country to use AR during a minimally invasive sinus procedure. Surgeons used Stryker’s Scopis Target Guided Surgery technology to plan a pathway and view critical structures in preoperative medical scanning. This mapping was then overlaid onto the surgeon’s endoscopic views of the surgical area, helping the surgeon follow the defined path and avoid critical structures.
The Mayo Clinic released the results of a new study, which show an 80 percent increase in enrollment of clinical trials for breast cancer when using IBM’s Watson for Clinical Trial matching system. The Watson system uses artificial intelligence to analyze unstructured information and pull out insights from the data. In addition to the uptake in participants, the trial showed that the technology could significantly reduce the time it takes to screen an individual patient for clinical trial matches.
WoundCare, an app developed by researchers from the Wisconsin Institute of Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, was created this quarter with the goal of earlier detection of surgical site infections and prevention of hospital readmissions. Due to the prevalence off surgical sire infections, the WiSOR research team decided to see if postoperative wound monitoring could be effectively achieved by having patients upload photos through the WoundCare app and answer a few brief questions to gather information not easily captured through images. During the study of 40 patients, seven wound complications were detected and one false negative was found.
Finally, a meta analysis published in the inaugural issue of Nature's Digital Medicine in January found that remote patient monitoring had no statistically significant impact on six reported clinical outcomes that the research studied including BMI, weight, waist circumference, percentage of body fat, systolic blood pressure, or diastolic blood pressure. Researchers combed through 4,348 articles that were published on PubMed from January 2000 to October 2016.
