info@ehidc.org

 202-624-3270

Digital Care

Hide On Website: 
No

With Rural Health Care Stretched Thin, More Patients Turn To Telehealth

July 07, 2019

 With Rural Health Care Stretched Thin, More Patients Turn To Telehealth

A recent NPR poll of rural Americans found that nearly a quarter have used some kind of telehealth service within the past few years; 14% say they received a diagnosis or treatment from a doctor or other health care professional using email, text messaging, live text chat, a mobile app, or a live video like FaceTime or Skype. And 15% say they have received a diagnosis or treatment from a doctor or other health professional over the phone.

The full NPR article can be viewed at this link

Name: 
Anna

The medium, the message and the measure: a theory-driven review on the value of telehealth as a patient-facing digital health innovation

July 07, 2019

The medium, the message and the measure: a theory-driven review on the value of telehealth as a patient-facing digital health innovation

By what measure should a policy maker choose between two mediums that deliver the same or similar message or service? Between, say, video consultation or a remote patient monitoring application (i.e. patient-facing digital health innovations) and in-person consultation? To answer this question, we sought to identify measures which are used in randomised controlled trials. But first we used two theories to frame the effects of patient-facing digital health innovations on – 1) transaction costs (i.e. the effort, time and costs required to complete a clinical interaction); and 2) process outcomes and clinical outcomes along the care cascade or information value chain, such that the ‘value of information’ (VoI) is different at each point in the care cascade or value chain. From the trials, we identified three categories of measures: outcome (process or clinical), satisfaction, and cost. We found that although patient-facing digital health innovations tend to confer much of their value by altering process outcomes, satisfaction, and transaction costs, these measures are inconsistently assessed. Efforts to determine the relative value of and choose between mediums of service delivery should adopt a metric (i.e. mathematical combination of measures) that capture all dimensions of value. We argue that ‘value of information’ (VoI) is such a metric – it is calculated as the difference between the ‘expected utility’ (EU) of alternative options. But for patient-facing digital health innovations, ‘expected utility’ (EU) should incorporate the probability of achieving not only a clinical outcome, but also process outcomes (depending on the innovation under consideration); and the measures of utility should include satisfaction and transaction costs; and also changes in population access to services, and health system capacity to deliver more services, which may result from reduction in transaction costs.

The full article can be downloaded below.  

Name: 
Anna

Integrating Telemedicine Into Training: Adding Value to Graduate Medical Education Through Electronic Consultations

June 22, 2019

Integrating Telemedicine Into Training: Adding Value to Graduate Medical Education Through Electronic Consultations

Lack of timely access to high-quality specialty care in the United States remains an enormous challenge, especially for uninsured and rural populations. Over 70% of federally qualified health centers reported barriers to specialty care for their patients, leading to diagnostic delays and poor health outcomes. A recent study found that 86% of referral coordinators in a community health center cited patient insurance as the most important driver of poor access to specialty care. The increasing pressure for primary care clinicians to manage complex patients in shorter visits may also incentivize over-referrals: The US referral rates doubled from 1999 to 2009. These trends, as well as an ongoing national emphasis on cost savings in health care, have led to a recent increase in the use of telemedicine. Learning how to utilize telemedicine has become more relevant for trainees preparing to enter the physician workforce. Integrating telemedicine into graduate medical education (GME) curricula provides an important mechanism for improving trainee education on value-based care and increasing access to specialty care.

The full article can be downloaded below.  

Name: 
Anna

Approaches for Departments, Schools, and Health Systems to Better Implement Technologies Used for Clinical Care and Education: Best Practices

June 16, 2019

Approaches for Departments, Schools, and Health Systems to Better Implement Technologies Used for Clinical Care and Education: Best Practices

New technologies create opportunities and challenges that significantly impact education, health care, and business. Leaders in academic health centers and departments of psychiatry already exploring TP (telepsychiatry) or TBH (telebehavioral health) must also consider integrating social media, mobile health, apps, and other emerging technologies related to clinical care, training, faculty development, and administrative missions. Successful implementation of technology requires hands-on leadership, needs assessments, participation by all levels of the organization, and continuous quality/performance improvement to support a positive e-culture. Additional research is needed to develop consensus regarding priorities, prototypes, standardization, and best implementation strategies.

Best Practices

  • Assessing Readiness for Change - Institutions have to assess readiness to change at the participant, program, and organizational levels.  Programs need good communication, collaboration, and teamwork.
  • Create/Hardwire the Culture - For health care, technology use requires clinical skills, technical support, and team workflow adjustment—so planning and evaluation must cover these landscapes.
  • Write Policies and Procedures - The overall administrative approach should attend to process, procedures, policy, and evaluation in order to plan, implement, and manage a program. Input from all levels of the organization—including clinician, manager, and technology stakeholders—should help ensure fidelity to the plan, reduce uncertainty, and improve effectiveness.
  • Establish the Curriculum and Competencies - Clinical and administrative-based issues related to care include documentation, EHR, medico-legal, billing, cultural, confidentiality, and privacy.  Implementing an e-culture and teaching associated competencies successfully will likely require a mixture of methods to increase learners’ skill level over time.
  • Train Learners and Faculty - All programs will best serve their trainees’ professional development needs by identifying faculty thought leaders or champions of these increasingly important modalities. They can link to others through national educational organizations.
  • Evaluate/Manage Change - Change requires leadership and management approaches for technology across multiple clinical, academic, and administrative missions. Change may be facilitated by use of opinion-leader visits and discussions, survey instruments, focus groups, site visits, in-person and on-line courses, and external consultants. Inevitable, foreseen, and unforeseen negative consequences of such disruptions require skillful management.

The full article can be downloaded below.  

Name: 
Anna

Factors Determining Patients’ Choice Between Mobile Health and Telemedicine: Predictive Analytics Assessment

June 16, 2019

Factors Determining Patients’ Choice Between Mobile Health and Telemedicine: Predictive Analytics Assessment

The solution to the growing problem of rural residents lacking health care access may be found in the use of telemedicine and mobile health (mHealth). Using mHealth or telemedicine allows patients from rural or remote areas to have better access to health care.

The objective of this study was to understand factors influencing the choice of communication medium for receiving care, through the analysis of mHealth versus telemedicine encounters with a virtual urgent clinic.

We conducted a postdeployment evaluation of a new virtual health care service, Virtual Urgent Clinic, which uses mHealth and telemedicine modalities to provide patient care. We used a multinomial logistic model to test the significance and predictive power of a set of features in determining patients’ preferred method of telecare encounters—a nominal outcome variable of two levels (mHealth and telemedicine).

Postdeployment, 1403 encounters were recorded, of which 1228 (87.53%) were completed with mHealth and 175 (12.47%) were telemedicine encounters. Patients’ sex (P=.004) and setting (P<.001) were the most predictive determinants of their preferred method of telecare delivery, with significantly small P values of less than .01. Pearson chi-square test returned a strong indication of dependency between chief concern and encounter mediums, with an extremely small P<.001. Of the 169 mHealth patients who responded to the survey, 154 (91.1%) were satisfied by their encounter, compared with 31 of 35 (89%) telemedicine patients.

We studied factors influencing patients’ choice of communication medium, either mHealth or telemedicine, for a virtual care clinic. Sex and geographic location, as well as their chief concern, were strong predictors of patients’ choice of communication medium for their urgent care needs. This study suggests providing the option of mHealth or telemedicine to patients, and suggesting which medium would be a better fit for the patient based on their characteristics.

The full article can be downloaded below.  

Name: 
Anna

Care Team Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: Qualitative Study

June 16, 2019

Care Team Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: Qualitative Study

Novel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs.

The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to increase the reach of HBPC to more homebound patients.

We collected qualitative data from HBPC staff (ie, physicians, registered nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York metropolitan area through 16 semistructured interviews and three focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (ie, relatedness, competence, and autonomy) as an analytical lens.

Four broad themes—pros and cons of scaling, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship—and multiple second-level themes emerged from the analysis. Staff acknowledged the need to scale the program without diminishing effective patient-centered care. Participants perceived alerts generated from patients and caregivers using telehealth as potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. However, they also noted that telehealth could increase efficiency and enable more informed care provision. Telehealth could enhance the patient-provider relationship by enabling caregivers to be an integral part of the patient’s care team. Staff members raised the concern that patients or caregivers might unnecessarily overutilize the technology, and that some home visits are more appropriate in person rather than via telehealth.

These findings suggest the importance of considering the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program will hopefully facilitate the optimal integration of telehealth innovations.

The full article can be downloaded below.  

Name: 
Anna

Transforming healthcare experiences: Exploring the impact of digital health technology on healthcare professionals and patients

June 12, 2019

Transforming healthcare experiences: Exploring the impact of digital health technology on healthcare professionals and patients

The 2019 Future Health Index is based on primary research conducted across 15 countries. The research explores the experiences of healthcare professionals and individuals – which includes both current and previous patients – in their health systems through two pillars of the Quadruple Aim: improved patient experience and improved staff experience.

Evolution and developments in digital health technology, such as digital health records (DHRs), telehealth and artificial intelligence (AI), offer benefits that could lead to better health outcomes and reduced costs, paving the way toward achieving the Quadruple Aim.

This year’s research sets out to understand knowledge and appetite for using digital health technologies and how they affect experiences of healthcare. DHRs, telehealth and AI were selected due to their growing levels of adoption, as well as their potential to transform healthcare experiences.

The full 2019 Future Health Index from Philips can be downloaded below.  

Name: 
Anna

An Overview of Mobile Cloud Computing for Pervasive Healthcare

June 08, 2019

An Overview of Mobile Cloud Computing for Pervasive Healthcare

Mobile devices, along with wearable sensors, allow patients to access healthcare services from anywhere at any time. The longstanding constraints of computational capability and storage space on mobile devices can be alleviated by outsourcing computation- or data-intensive tasks to remote cloud centers. Thus, mobile cloud computing (MCC) has been recognized as a promising approach to provide pervasive healthcare services to people in their daily life. As the development and adoption of MCC techniques in healthcare, new optimization strategies have been explored and studied to help mobile cloud healthcare services to be deployed in a more effective and efficient manner. In this survey, we demonstrate how MCC techniques have been extensively deployed in various healthcare applications and, specifically, describe the general architecture and design considerations one should take into account while designing an MCC for healthcare scenarios. Given a large number of factors that may affect the performance of the MCC and even result in catastrophic consequences in healthcare, this paper presents the state-of-the-art optimization methods on the MCC for meeting the diverse priorities and achieving the optimal tradeoff among multiple objectives. Finally, the security and privacy issues of the MCC in healthcare are also discussed.

The full article can be downloaded below.  

Name: 
Anna

Telehealth, Children, and Pediatrics: Should the Doctor Make House Calls Again, Digitally?

June 07, 2019

Telehealth, Children, and Pediatrics: Should the Doctor Make House Calls Again, Digitally?

This Article explores the different challenges that arise in incorporating telehealth into pediatrics, especially for entrepreneurs. First, this Article explains how telehealth has been applied, specifically in pediatrics. Next, the Article explores the various legal barriers involving telehealth with particular attention to these issues as they relate to pediatric care, including: Physician-patient relationship, standard of care, informed consent, liability/liability insurance, equipment, and security. This Article then examines the benefits and disadvantages that have been raised in the use of telehealth in relation to pediatric care. Finally, this Article concludes by offering recommendations to those entrepreneurs who hope to have an influence on the future development of telehealth in pediatrics.

The full article can be downloaded below.  

Name: 
Anna

Analysis: Why Alexa’s Bedside Manner Is Bad For Health Care

June 05, 2019

Analysis: Why Alexa’s Bedside Manner Is Bad For Health Care

Virtual communications have streamlined life and transformed many of our relationships for the better. There is little need anymore to sit across the desk from a tax accountant or travel agent or to stand in a queue for a bank teller. And there is certainly room for disruptive digital innovation in our confusing and overpriced health care system.

But it remains an open question whether virtual medicine will prove a valuable, convenient adjunct to health care. Or, instead, will it be a way for the U.S. profit-driven health care system to make big bucks by outsourcing core duties — while providing a paler version of actual medical treatment?

The full Kaiser Health News article can be found at this link.  

Name: 
Anna