Requiring smartphone ownership for mHealth interventions: who could be left out?

Mobile health (mHealth) interventions have the potential to improve health through patient education and provider engagement while increasing efficiency and lowering costs. This raises the question of whether disparities in access to mobile technology could accentuate disparities in mHealth mediated care. This study addresses whether programs planning to implement mHealth interventions risk creating or perpetuating health disparities based on inequalities in smartphone ownership.

Video Directly Observed Therapy (VDOT) is an mHealth intervention for monitoring tuberculosis (TB) treatment adherence through videos sent by patients to their healthcare provider using smartphones. We conducted secondary analyses of data from a single-arm trial of VDOT for TB treatment monitoring by San Diego, San Francisco, and New York City health departments. Baseline and follow-up treatment interviews were used to assess participant smartphone ownership, sociodemographics and TB treatment perceptions. Univariate and multivariable logistic regression analyses were used to identify correlates of smartphone ownership.

Of the 151 participants enrolled, mean age was 41 years (range: 18–87 years) and 41.1% were female. Participants mostly identified as Asian (45.0%) or Hispanic/Latino (29.8%); 57.8% had at most a high school education. At baseline, 30.4% did not own a smartphone, which was similar across sites. Older participants (adjusted odds ratio [AOR] = 1.09 per year, 95% confidence interval [CI]: 1.05–1.12), males (AOR = 2.86, 95% CI: 1.04–7.86), participants having at most a high school education (AOR = 4.48, 95% CI: 1.57–12.80), and those with an annual income below $10,000 (AOR = 3.06, 95% CI: 1.19, 7.89) had higher odds of not owning a smartphone.

Approximately one-third of TB patients in three large United States of America (USA) cities lacked smartphones prior to the study. Patients who were older, male, less educated, or had lower annual income were less likely to own smartphones and could be denied access to mHealth interventions if personal smartphone ownership is required.

The full article can be downloaded below.  

Scaling Blockchains to Support Electronic Health Records for Hospital Systems

Electronic Health Records (EHRs) have improved many aspects of healthcare and allowed for easier patient management for medical providers. Blockchains have been proposed as a promising solution for supporting Electronic Health Records (EHRs), but have also been linked to scalability concerns about supporting real-world healthcare systems. This paper quantifies the scalability issues and bottlenecks related to current blockchains and puts into perspective the limitations blockchains have with supporting healthcare systems. Particularly we show that well known blockchains such as Bitcoin, Ethereum, and IOTA cannot support transactions of a large scale hospital system such as the University of Kentucky HealthCare system and leave over 7.5M unsealed transactions per day. We then discuss how bottlenecks of blockchains can be relieved with sidechains, enabling well-known blockchains to support even larger hospital systems of over 30M transactions per day. We then introduce the Patient-Healthchain architecture to provide future direction on how scaling blockchains for EHR systems with sidechains can be achieved.

The full article can be downloaded below.  

The Real Epidemic: Not Burnout But 'Moral Injury' Of Doctors Unable To Do Right By Patients

During the course of my husband’s two months of outpatient care, and four days in the local ICU, I realized that the physicians were shockingly absent, and the nurses only a little less so. They had withdrawn into the recesses of the system, remote from patients and families, working at the top of their billing capacity, but walled off from those they were caring for by phone trees and receptionists playing a potentially deadly game of “operator.”

Blaming the medical staff in this situation would be easy, but misplaced. It is the system, designed and overseen largely by non-clinicians, that is to blame.

The full WBUR article can be viewed at this link.  

Why Pharmacies Are About To Be Hit Hard By Disruption

Pharmaceutical distribution vary from country to country, but all of them are subject factors that make genuine competition in the sale of prescription drugs a complex matter. The need to verify that the patient requesting a given medicine has obtained the corresponding prescription from a doctor, as well as other aspects related to how the medicine is acquired (totally or partially subsidized, by public or private bodies, etc.), along with other issues reflect a business fabric that can vary enormously from the large US drugstore chains to the traditional pharmacies in many European countries, owned by a qualified pharmacist, with their regulated margins, and which until a few years ago, sold only pharmaceutical or related products.

Recent moves by Amazon seem to presage disruption in the pharmaceutical sector. In June 2018, the e-commerce giant acquired PillPack for just under $1 billion, precipitating sharp falls in the share value of companies such as CVS, Walgreens, Boots or Rite Aid: PillPack, which also traded with Walmart and was simply a little-known startup as far as the general public was concerned, had obtained a license to sell prescription drugs in all US states, and furthermore, was a service designed from scratch to be digital, a situation very few of its competitors could contemplate.

The full Forbes article can be viewed at this link.  

Patients can’t afford for doctors to misunderstand the healthcare business

Patients are often dismayed or surprised that their doctor cannot earnestly explain the cost-benefits of different treatments. A 2013 survey by the Journal of the American Medical Association found that 87% of graduating doctors felt uncomfortable with their knowledge of the business of medicine and 81% felt they lacked an understanding of healthcare legislation.  As surgeons, we have slowly let ourselves become exclusively technicians. Just like Aristotle and Plato said.

By turning our noses up at the business of medicine, we have lost ownership over our patients, and the agency to advocate for them. As Osler said, “The good physician treats the disease. The great physician treats the patient who has the disease.”

We as physicians and surgeons need to recover our identity and learn the business skills that our teachers have forgotten, but our forefathers stood up for.

The full Quartz article can be viewed at this link.  

Whether you’re a payer, provider or government entity, social determinants are a critical component of healthcare and pharmaceuticals in the twenty-first century. Social determinants of health—or the social, economic and environmental factors of where we live and work such as social isolation, economic inequality, pollution and food deserts—are preventing too many people across the globe from living healthy lives.

In this webcast a panel of health experts will examine insights from PwC’s recent report: Action required: The urgency of addressing social determinants of health. The report leverages research and fieldwork, including a global survey of more than 7,900 people across 8 countries, interviews with healthcare organization leaders, analysis of more than 25 case studies, and input from our own health industries subject matter experts. All of this culminates into a PwC-perspective on how to succeed with a social determinants of health strategy.​

Agenda:

• How to lead in social determinants of health: Five steps for bold action
• A deeper dive: Applying technology and data analytics to tackle social determinants of health
• Case study: Quantifying the health impact and ROI of Meals on Wheels - how Visiting Nurse Association (VNA) of Texas applied technology to quantify their program's impact

Speakers: 

Benjamin Isgur - Health Research Institute Leader, PwC

Ben leads PwC's Health Research Institute. In this role, he oversees thought leadership and research initiatives for the firm and clients. He also consults with healthcare systems, trade associations, and policy groups on strategic planning, and industry intelligence and trends. Ben is a published writer and his research is often cited by health leaders across the industry. In addition, he frequently speaks on a range of topics, including physician-hospital alignment, government policy, medical cost trends, consumerism, academic medicine and digital health. Ben received a master's degree from the LBJ School of Public Affairs at the University of Texas at Austin where he was a US Department of Defense fellow.

Chris Culak - Vice President, Chief of Strategy and Development, VNA Meals on Wheels

Chris Culak joined VNA in October 2014, bringing with him more than 22 years of experience in fundraising and non-profit management. He came to VNA after implementing and managing programs for Dallas Children’s Advocacy Center, the National Audubon Society, Planned Parenthood, North Texas Food Bank and the American Heart Association. Chris holds a Bachelor of Science degree in Health Care Administration with a minor in Psychology from Texas State University in San Marcos. He and his wife Nichole live in the Oak Cliff area of Dallas with their daughter, Zoë, and son, Anders.​

Translational research: turning research into advocacy

The social determinants of health are increasingly being recognized within the trauma community. These determinants are major drivers of health and have a huge impact on access to surgery and surgical disparities. As trauma surgeons, we continue to struggle with optimizing care for our patients with many social needs and struggle with trauma as a chronic disease. As we are now using public health approaches to combat complex issues such as gun violence, it is ideal to view our work in a wider context which includes addressing the root causes of trauma and advocating for our patients and our communities. In addition, we need to teach and mentor this broader approach for our students and residents.

The full opinion article can be downloaded below.  

LiveWell RERC State of the Science Conference Report on ICT Access to Support Community Living, Health and Function for People with Disabilities

This article summarizes the proceedings of the three session State of the Science (SOS) Conference that was conducted by the Rehabilitation Engineering Research Center for Community Living, Health and Function (LiveWell RERC) in June 2019 in Toronto, Canada. RERCs customarily convene an SOS conference toward the end of their five-year funding cycle in order to assess the current state and identify potential future research, development, and knowledge translation efforts needed to advance their field. The first two sessions focused on the current and future state of information and communication technology (ICT) for mobile health (mHealth) and mobile rehabilitation (mRehab). The third session was a wide-ranging discussion of pressing needs for future research and development in the field. Several “big ideas” resulted from the discussion among participants in the SOS Conference that should inform the structure and operation of future efforts, including: (1) identifying active ingredients of interventions, (2) incorporating effective behavior-change techniques into all interventions, (3) including measures of social determinants of health in evaluation studies, (4) incorporating user-customizable features into technology solutions, and (5) ensuring “discoverability” of research and development outputs by stakeholders via structured and continuous outreach, education and training. Substantive areas of work include gaming and esports, the gamification of interventions for health and fitness, the cultivation of community supports, and continuous outreach and education wherever a person with a disability may live.

The full article can be viewed at this link.  

Nine Experts On The Trends That Changed Healthtech In The Last Decade, And The Innovations To Expect By 2030

As we enter 2020, it seems like a good moment to reflect on how technology has reshaped the way we think about, and deliver, healthcare in the last 10 years, and to look forward to the innovations that might transform our sector in the decade ahead. 

I asked some of my peers to share their views on the biggest developments in digital health during the 2010s, and their predictions for what the 2020s will bring.

The full Forbes article can be viewed at this link.  

Toward a Person-Centred Learning Health System: Understanding Value from the Perspectives of Patients and Caregivers

What matters most to people who use healthcare?  What matters to their caregivers?  How do we use this information to support ongoing quality improvement in the healthcare system?  In this paper, we explore three concepts from the current healthcare discourse, intended to drive health system improvements: person-centred care, value-based healthcare and learning health systems.  We propose that key tenets from each of these concepts should be combined to create a person-centred learning health system (PC-LHS).  We highlight two key points: First, in achieving a PC-LHS, the experiences, priorities and values of patients and their caregivers should be continually collected and fed into data systems to monitor ongoing quality improvement and performance benchmarking.  Second, the information collected in determining value must include important contextual factors-- including the social determinants of health-- as patient health and well-being outcomes will ultimately be shaped by these factors, in addition to health system and disease factors.  In summary, improving value for patients and caregivers, by capturing the things that matter most to them, within their life contexts, needs to be part of the continuous quality improvement cycle that lies at the heart of a learning health system.  

The full article can be downloaded below.