This quarter, hospitals and clinics continued to integrate digital health into their practice, using it to engage and treat patients, as well as improve hospital workflows. Telehealth continues to be a growing field. More healthcare providers have expressed interest in expanding their telehealth offerings, according to the Foley survey. Hospitals have also started to integrate augmented and virtual reality programs into their models to help the patient experience, particularly for their youngest patients. Both the US and UK government continue to show interest in expanding their digital health offerings. Read on for a roundup of notable Q4 provider stories.
Once you are finished reading, check out our Q1, Q2 and Q3 roundups.
Telemedicine
Telemedicine continued to rise into the mainstream this quarter as more states created regulations around the practice and professionals begin to discuss the possibility of making it a new speciality.
As new telemedicine players sprout from the woodwork and employers more frequently offer telehealth options to their employees, a new breed of doctors may be needed to match the technology’s growing popularity. In an editorial published in JAMA, NewYork-Presbyterian physicians argued that adoption of a new multidisciplinary medical specialty focused on virtual care would best prepare practitioners to the unique challenges of telehealth.
Historically, new specialities have been adopted by the development of new medical technologies and knowledge in care delivery, the authors explained. As medical teams begin to integrate these advancements into a more structured approach, recognition and refinement of the budding discipline grows alongside wider adoption.
The field seems to be rapidly growing and more hospitals are interested in expanding the telemedicine program. The Foley Telemedicine and Digital Health Survey revealed more interest and use of telemedicine amongst health organizations.
In 2014, 87 percent of survey respondents reported that they did not expect most of their patients to be using telemedicine by 2017. However, this year three-quarters of respondents reported that their organization either offers telemedicine options now or plan to offer telemedicine services. Of those, 53 percent said they were looking to expand.
In November the American Health Information Management Association announced the Telemedicine Toolkit. AHIMA said that hospitals and practices can use the new toolkit to assess potential opportunities relating to their particular needs and to analyze documentation, legal, and reimbursement practicalities ahead of establishing a telehealth program.
This quarter also saw the introduction of a new way for clinicians to find jobs working in telemedicine. Nomad Health’s online freelance marketplace for healthcare professional staffing now includes postings for telehealth positions alongside traditional healthcare roles. With the updated service, doctors interested in telehealth practice will be able to view and apply to open position listings from several telehealth service providers, including American Well and First Stop Health.
Not only does telemedicine seem to be expanding, it is also being bouyed by continued improvements in state regulations. A slew of states are rolling out or modifying their laws to better define regulatory frameworks specifically affecting remote delivery of care. In fact, every state but Connecticut and Massachusetts has made substantive legal changes to how telehealth is delivered in the past year, with some taking specific actions to better define the path of mental health-focused treatment, according to recent data on telemental regulations released by healthcare and life sciences firm Epstein Becker Green.
AI, VR and more
Virtual reality, artificial intelligence, and augmented reality are quickly becoming common tools used for healthcare providers to treat and engage patients.
AR is now available to some of the youngest patients at Alder Hey Children’s Hospital in Liverpool, UK. The hospital recently launched a new augmented reality tablet app to entertain, educate and distract the hospital’s young children. Children can choose an animated avatar who will appear on the app as they visit different parts of the hospital and offer them entertainment, information, and support as well as challenges they can complete to unlock new content.
Using augmented and virtual realities seem to be a trend in pediatric medicine. Los Angeles Children’s Hospital hosted a study that was aimed at using VR to help kids feel less anxious in a hospital. The study published in October, gave kids VR headsets as their blood was being drawn. Researchers found that using VR significantly reduced acute procedural pain and anxiety in patients compared to using the standard of care. The study also found that patients who reported being more fearful of physiological sensations related to anxiety benefited more from the VR treatment.
But it isn’t just kids who may see the benefits of virtual experiences. Service members unwilling to open up about their PTSD in person may be more likely to speak with computer-generated virtual interviewers, research published this quarter suggests. Due to their anonymity and rapport-building capabilities, these virtual interviewers could be uniquely positioned to break through soldiers’ fears of discrimination and career-affecting stigma and improve mental health care.
One population that is seeing the benefits of AI is seniors. This quarter multiple companies have developed AI products for seniors living with loneliness.
For example, Accenture completed a pilot program in the UK, which uses its artificial intelligence platform to help seniors manage their care and daily lives. The technology was developed by Accenture Liquid Studio in London and is tailored for older people living independently. It can learn users’ behaviors and preferences and suggest activities to support their physical and mental health.
The platform runs on the Amazon Web Services cloud and includes a portal that lets family members and caregivers check on the individual’s daily activities. The platform can also help spot abnormalities in the user’s behavior, such as a missed medication, then alerts family and friends.
AI is also being used to help monitor seniors at risk of falls or other safety issues. CarePredict — a Fort Lauderdale, Florida-based company that sells a senior monitoring platform comprised of networked wearables and data-driven diagnosis prediction — has announced that will be deploying its system in LifeWell Senior Living’s newly established aging and memory care facility in Santa Fe, New Mexico, The Legacy. This will be the third LifeWell facility in which the CarePredict Tempo system will be used to track residents’ behaviors and alert caretakers to potential declines or emergencies.
Care coordination
Purpose built messaging devices were a hot topic at the Healthcare Messaging Conference and Exhibition at Harvard Medical School in November. In recent years pagers have gone out of vogue as more and more hospitals have adopted smartphone messaging systems to communicate. But while "bring your own device" (BYOD) was once the trend, hospitals are increasingly moving toward hospital-owned, purpose-built smartphones.
One of the adopters of purpose built messaging was the medical team at Asheville, NorthCarolina-based Mission Health. The system reported a significant increase in the ability to locate staff across fields after a hospital messaging system was implemented. Before the pilot study, only 31 percent of caregivers reported that they were satisfied with being able to locate an RN. That number increased to 79 percent after the study was deployed. Similar results were found in satisfaction with locating CNAs, which increased from 25 percent to 78 percent satisfaction. Now Mission Health now plans on expanding the system to the rest of the enterprise.
Hospitals across the country have expressed interest in using staff members time more efficiently. Using wearable sensors, researchers at the University of Missouri have developed a new method for tracking how nurses in the intensive care unit (ICU) spend their shifts.
The method uses a Near Field Electromagnetic Ranging (NFER) system, where nurses wear nonintrusive sensors during their shift. Routers placed around the unit track the devices worn by the nurses so researchers can see what nurses are doing in real-time.
But it isn’t just about improving workflow; many of the new coordination products are expected to directly impact patients. For example, Argentinian ambulance doctors are using WhatsApp to fast track their patients’ care. Study data presented at the Argentine Congress of Cardiology’s 2017 conference suggests that using the free messaging app to send diagnostic electrocardiograms (ECGs) directly to a hospital’s catheterization lab allowed heart attack patients to bypass the emergency department and reduce mortality.
Innovation
Several hospitals and accelerators have designed their own schemes to further digital health.
Pulse@MassChallenge, the pre-series B digital health startup accelerator that launched last year with the backing of the Commonwealth of Massachusetts and a number of industry supporters, announced the 32 startups in its second class in December. Pulse works a little differently than many other accelerators. It takes no equity in the startups and doesn't accept startups unless a major healthcare stakeholder wants to work with them as a "champion" in a relationship that's half mentorship, half pilot program.
Director Nick Dougherty said the biggest difference between the inaugural year and this year is that not only are champions working with startups, but that also some of them are working with each other on projects, including a collaboration between Boston Children's Hospital and Cerner as well as another between Campbell's and AARP. This years class includes a number of startups focusing on the opioid epidemic, senior health and diabetes management.
Cedars-Sinai Medical Center’s has also been expanding its accelerator program. In December the third accelerator class held its demo day as the 10 companies announced a slew of pilots, deployments, and other deals. Nine out of the 10 companies has a pilot or commercial deal with Cedars-Sinai itself, but a number of companies also have deals with other hospitals, payers, or pharma companies. One, Tasso, has a $6 million grant contract with the Department of Defense. Tasso’s Hemolink is a wearable, minimally invasive device that lets patients collect blood samples at home. Other startups include CancerAid, an app for cancer patients and Aiva’s Amazon Alexa skill for hospital-bond patients.
Finally, in October the Thrive Innovation Center in Louisville, Kentucky opened. The Center is a nonprofit dedicated to showcasing new aging in place technologies in partnership with tech companies like Samsung, CDW Healthcare, Lenovo, and Aruba, as well as a number of aging tech startups. Louisville is a hub for senior care and home care companies, including Humana, Kindred Healthcare, Signature Healthcare, and Atria Senior Living. The Thrive Center will serve as a sort of show room for new aging in place technologies for those caregivers.
Training tools
A number of new products targeted at training new doctors or helping seasoned clinicians polish their skills were introduced this quarter.
A new video game aims to help emergency room doctors figure out the level of care needed for different patients. Doctors who played the video game were less likely to under-triage patients than their peers who were given traditional didactic educational tools, according to a new trial led by the University of Pittsburgh School of Medicine. The study, published in the British Medical Journal, found that doctors who played the video game under-triaged 53 percent of the time, compared to didactically trained physicians who under-triaged 64 percent of the time.
In November the FDA cleared EndoVantages’ SurgicalPreview, a cloud-based computer modeling platform that lets surgeons upload individual patient’s CT scans and then creates a 3D model of the brain with anatomical measurements. The new tool is expected to help doctors chose the precise size of the device for a patient’s artery and how to place it correctly. The tool enables clinicians to view stent strategies, calculate aneurysmal volume and neck size and view stent delivery and placement.
Digital tools are also helping medical and healthcare students. A study of a new web-based tool called Learning Moment, which helps medical students track their learning experiences while on rotation, revealed that the most student learning happens in patients’ rooms. The tool was developed by clinicians at Boston Medical Center (BMC) and BU School of Medicine to help students reflect on their experiences and share their learning with peers.
Additionally, Johnson & Johnson subsidiary Ethicon and Touch Surgery launched a Virtual Residency Program for surgery students, a new use case for the simulated surgery app launched last fall. The program pre-launched in April and currently has 75 organizations enrolled.
The iOS app takes users through a variety of more than 150 simulated surgical procedures. With realistic 3D rendering, the user can cut, stitch, implant and anything else required, with instructions popping up as they go. The idea is to increase surgical skills globally, especially in areas where access to surgical procedures is poor. For medical students in places even with robust medical schools and training, the app allows for them to practice a complicated surgery or get a preview of what a particular surgery will look like before they actually see it in person.
But it isn’t just medical students benefiting from the new digital tools. Researchers at the University of Massachusetts Lowell are currently developing a “virtual child” for professionals and students working with kids living with autism spectrum disorder. The learning tool will allow these caregivers an opportunity to practice behavioral interventions outside of a real-world situation.
US and UK news
This quarter the UK continued to jump into the digital health game, this time in the North of England. In November the National Health Service Trusts located in England’s North East region announced a partnership focused on broadened implementation of digital health strategies. NHS Health Call was initially established by the County Durham and Darlington NHS Foundation Trust, and relied on technologies developed by Harrogate, England-based remote patient monitoring company Inhealthcare. The Trust has now awarded shares in Health Call to five neighboring NHS acute trusts located in the North East in return for active participation in the digital health initiative.
Also in the UK, a new pilot program aims to use telemedicine to improve care during long ambulance rides. In rural Scotland ambulance rides can take as long as four or five hours. Those hours spent in the ambulance are critical, said Neil Fraser, director of space and communications at ViaSat UK.
Global broadband service and technology company ViaSat, announced that it will be partnering with The University of Aberdeen’s Centre for Rural Health, NHS Highland, and the Scottish Ambulance Service to pilot a program called SatCare which allows paramedics to send high-resolution videos and ultrasound images from ambulance to hospital based medical experts before the patient arrives.
Meanwhile, the US government seems to be focusing on giving digital health tools to their veteran and military population.
In December Potentia Lab, a behavior changing technology platform, announced that it had won a contract with the Department of Veterans Affairs' Center for Innovation to develop its e-learning platform for veterans living with PTSD. The company's approach to treating PTSD uses positive psychology. Many veterans go to therapy once but don’t go back, said David Milner, cofounder of the company. That is where Potentia Labs comes in. The platform teaches users how to build up skills like resilience and optimism, which have been associated with wellbeing.
Additionally, in November the VA announced that Veterans struggling with speech or cognitive disorders will now be able to access therapy through Constant Therapy, a mobile app that provides supplemental coaching and motivation to patients. Veterans eligible for speech or cognitive therapy through the US Department of Veterans Affairs will now be able to use the app for free.
The app is part of the Newton, Massachusetts-based company The Learning Corp. It was developed in 2012 by Boston University Professor Swathi Kiran, who is a specialist in aphasia. She came up with the idea for the app when working with patients and noticed that they could use a tool that combined technology with communication therapy. The app itself launched in 2014 and uses a tool called the NeuroPerformance Engine to gauge a person’s strengths and weaknesses.
Research
Researchers at the Mayo Clinic found that using emojis instead of the traditional emotional scales helped assess patients’ physical emotional and overall quality of life. The abstract, which was presented at the American Society of Hematology, also found that patients preferred using iPhones and Apple Watches to track outcomes and activity, and that technology was key in collecting study data accurately.
Encouraging patients to help write and add notes to their personal medical charts -- a task typically handled only by medical professionals -- may help patients feel more involved with their own care and improve relationships with their doctors, another study found. In research published in the Annals of Internal Medicine, doctors at UCLA Health and Beth Israel Deaconess Medical Center found that patients could benefit if they are invited to co-produce medical notes, called "OurNotes," with their doctors, rather than merely reading them. The practice may also benefit doctors by reducing time spent on documentation.
Finally, voice recognition technology employed by Google Assistant, Google Home, and Google Translate could soon become a transcription tool for documenting patient-doctor conversations. In a recent proof of concept study, Google researchers described their experiences developing two automatic speech recognition (ASR) methodologies for multi-speaker medical conversations, and concluded that both models could be used to streamline practitioners’ workflows.
Wearables
The Apple Heart Study, an Apple Watch-based ResearchKit study using the heart rate sensor to look at potential arrhythmias, launched in November, the Cupertino tech giant told MobiHealthNews. Apple Chief Operations Officer Jeff Williams announced the study, which is being conducted in collaboration with Stanford University and with assistance from American Well, at Apple’s iOS 8 launch event in September.
The Apple Watch may also soon help patients with major depressive disorder (MDD) record their symptoms easily and accurately. Results from a Cognition Kit study presented at the CNS Summit Meeting in Boca Raton, Florida, suggest that brief cognitive and mood tests administered through the devices obtained results similar to those collected through standard testing and patient assessments.
Using Fitbits to track patients’ activity after cancer surgery could be key to predicting readmission rates, according to new study published in Annals of Behavioral Medicine. Researchers found that patients who were more active during inpatient recovery had a lower risk of 30-day and 60-day readmission after surgery for metastatic peritoneal cancer.
The study went on to say that using Fitbit and other wearable monitoring devices could help clinicians improve postoperative care.
Finally, Fitbit’s wearables are at the heart of recent announcements from diabetes self-management platform One Drop and the City of Santa Monica’s Office of Civic Wellbeing. The first reveals an upcoming integration that will allow users to view Fitbit device data from within the One Drop Mobile app, while the latter describes a public health initiative that will provide residents of the city with Fitbit’s Alta device.
One Drop will allow users to sync Fitbit data with their diabetes management app to easily view physical activity, sleep, and heart rate metrics. The data will also be incorporated into One Drop reports, offering physicians and owners of the service’s “Expert” and “Professional” versions another view of their personalized data. Further, the One Drop will begin to integrate these data into its own analytics, a move that the company says could pay off with new insights into physical activity and its impact on blood glucose levels.
