Are Wearables Decentralizing Medicine?

It’s no secret that increasing healthcare costs and an aging population are taxing the U.S. healthcare industry and exacerbating a skills gap within the medical industry. While automation and IoT are helping to alleviate the manufacturing skills gap, some companies are working on similar technologies to aid the medical industry. The following presents trends and products OEMs and doctors are hoping will lighten the workload of an aging population.

The full Machine Design article can be viewed at this link.  

Record-Breaking FDA Approvals Mean Hope for Patients but Challenges for Healthcare Access, Delivery and Affordability

Last year, the U.S. Food and Drug Administration (FDA) approved a record-breaking 59 new medicines that will advance healthcare for patients with chronic and rare diseases.

This is great news, because it shows that our scientific understanding of the mechanisms that change the course of disease is leading to pharmaceutical breakthroughs. And the evolution of regulatory requirements like Therapy Breakthrough designation is shortening approval times and getting new treatments to patients faster.

However, this same progress presents significant challenges for the healthcare industry. While recent and anticipated scientific innovation marks much-needed progress for patients, in many cases, the systems designed to promote patient access to these new treatments have not kept pace.

This disparity will undoubtedly impact many areas of healthcare. Payers, distributors and pharmacies will have to address the challenges that come with how a new generation of medicines is covered, reimbursed, distributed and dispensed—in addition to creating the need for effective care strategies that optimize outcomes.

The full Surescripts article can be viewed at this link.  

Using Clinical Decision Support Tools To Facilitate Decision-Making In Precision Medicine

To fulfill its promise precision medicine requires accurate decision support tools, especially to streamline biomarker testing so that the appropriate targeted therapies are prescribed. Even in oncology, where precision medicine has advanced the farthest compared to other therapeutic categories, clinical decision tools are needed to sort through and analyze reams of clinical and molecular data for the purpose of optimizing treatment algorithms.

The full Forbes article can be viewed at this link. 

Public Concern About Monitoring Twitter Users and Their Conversations to Recruit for Clinical Trials: Survey Study

Social networks such as Twitter offer the clinical research community a novel opportunity for engaging potential study participants based on user activity data. However, the availability of public social media data has led to new ethical challenges about respecting user privacy and the appropriateness of monitoring social media for clinical trial recruitment. Researchers have voiced the need for involving users’ perspectives in the development of ethical norms and regulations.

This study examined the attitudes and level of concern among Twitter users and nonusers about using Twitter for monitoring social media users and their conversations to recruit potential clinical trial participants.

We used two online methods for recruiting study participants: the open survey was (1) advertised on Twitter between May 23 and June 8, 2017, and (2) deployed on TurkPrime, a crowdsourcing data acquisition platform, between May 23 and June 8, 2017. Eligible participants were adults, 18 years of age or older, who lived in the United States. People with and without Twitter accounts were included in the study.

While nearly half the respondents—on Twitter (94/603, 15.6%) and on TurkPrime (509/603, 84.4%)—indicated agreement that social media monitoring constitutes a form of eavesdropping that invades their privacy, over one-third disagreed and nearly 1 in 5 had no opinion. A chi-square test revealed a positive relationship between respondents’ general privacy concern and their average concern about Internet research (P<.005). We found associations between respondents’ Twitter literacy and their concerns about the ability for researchers to monitor their Twitter activity for clinical trial recruitment (P=.001) and whether they consider Twitter monitoring for clinical trial recruitment as eavesdropping (P<.001) and an invasion of privacy (P=.003). As Twitter literacy increased, so did people’s concerns about researchers monitoring Twitter activity. Our data support the previously suggested use of the nonexceptionalist methodology for assessing social media in research, insofar as social media-based recruitment does not need to be considered exceptional and, for most, it is considered preferable to traditional in-person interventions at physical clinics. The expressed attitudes were highly contextual, depending on factors such as the type of disease or health topic (eg, HIV/AIDS vs obesity vs smoking), the entity or person monitoring users on Twitter, and the monitored information.

The data and findings from this study contribute to the critical dialogue with the public about the use of social media in clinical research. The findings suggest that most users do not think that monitoring Twitter for clinical trial recruitment constitutes inappropriate surveillance or a violation of privacy. However, researchers should remain mindful that some participants might find social media monitoring problematic when connected with certain conditions or health topics. Further research should isolate factors that influence the level of concern among social media users across platforms and populations and inform the development of more clear and consistent guidelines.

The full article can be downloaded below.  

Closing the Gap: Identifying Rates and Reasons for Nonadherence in a Specialty Population

Adherence to specialty and nonspecialty medications is often calculated using pharmacy claims data. However, specialty medication regimens are complex and may require periods of intentional gaps in therapy. Common adherence calculations are insufficient in identifying reasons for gaps in therapy. Because adherence reporting is a growing measure of quality care for specialty pharmacy accreditation and payer and manufacturer contracts, a better understanding of the rates and reasons for nonadherence within a specialty population is needed.

The objective was to identify rates and reasons for misidentified and true nonadherence in patients who are prescribed specialty medications.

A single center, retrospective cohort study was conducted using pharmacy claims data between March 2017 and February 2018. Medication adherence was calculated using proportion of days covered (PDC). Electronic medical records of a random 10% sample of nonadherent patients (PDC<80%) were manually reviewed to identify reasons for nonadherence. Patients were then classified as either (a) misidentified as nonadherent (i.e., a provider-directed discontinuation or disruption of treatment that varies from the prescribed administration schedule or transfer of the prescription to an external pharmacy) or (b) truly nonadherent (discontinuation or disruption of treatment that varies from the prescribed administration instruction that is not directed or recommended by the provider or health care team).

Of the 7,488 included prescription records from 18 specialty areas, 1,059 met criteria for nonadherence. 105 prescription records (representing 105 unique patients) were manually reviewed; most of these patients (58%) were truly nonadherent, driven by inability to contact patients for refills (59%). However, 40% were misidentified as nonadherent, most due to provider-directed medication holding (69%). Two percent of patients were nonadherent for unknown reasons.

Many patients classified as nonadherent based on pharmacy claims experienced gaps in therapy due to medically appropriate reasons. Methods to better measure and identify true nonadherence are needed to efficiently and adequately affect specialty medication adherence behavior.

The full article can be downloaded below.  

Reaching People With Disabilities in Underserved Areas Through Digital Interventions: Systematic Review

People with disabilities need rehabilitation interventions to improve their physical functioning, mental status, and quality of life. Many rehabilitation interventions can be delivered digitally via telehealth systems. For people with disabilities in underserved areas, digitally delivered rehabilitation interventions may be the only feasible service available for them.

The objective of this study was to evaluate the current status of digital intervention for people with disabilities in remote and underserved areas.

A systematic review was conducted on this topic. Keyword searches in multiple databases (PubMed, CINAHL, and Inspec) were performed to collect articles published in this field. The obtained articles were selected based on our selection criteria. Of the 198 identified articles, 16 duplicates were removed. After a review of the titles and abstracts of the remaining articles, 165 were determined to be irrelevant to this study and were therefore removed. The full texts of the remaining 17 articles were reviewed, and 6 of these articles were removed as being irrelevant to this study. The 11 articles remaining were discussed and summarized by 2 reviewers.

These 11 studies cover a few types of disabilities, such as developmental disabilities and mobility impairments as well as several types of disability-causing disorders such as stroke, multiple sclerosis, traumatic brain injury, and facio-scapulo-humeral muscular dystrophy. Most of these studies were small-scale case studies and relatively larger-scale cohort studies; the project evaluation methods were mainly pre-post comparison, questionnaires, and interviews. A few studies also performed objective assessment of functional improvement. The intervention technology was mainly videoconferencing. Moreover, 10 of these studies were for people with disabilities in rural areas and 1 was for people in urban communities.

A small number of small-scale studies have been conducted on digital interventions for people with disabilities in underserved areas. Although the results reported in these studies were mostly positive, they are not sufficient to prove the effectiveness of telehealth-based digital intervention in improving the situation among people with disabilities because of the small sample sizes and lack of randomized controlled trials.

The full article can be downloaded below.  

Long-term integrity protection of genomic data

Genomic data is crucial in the understanding of many diseases and for the guidance of medical treatments. Pharmacogenomics and cancer genomics are just two areas in precision medicine of rapidly growing utilization. At the same time, whole-genome sequencing costs are plummeting below $ 1000, meaning that a rapid growth in full-genome data storage requirements is foreseeable. While privacy protection of genomic data is receiving growing attention, integrity protection of this long-lived and highly sensitive data much less so. We consider a scenario inspired by future pharmacogenomics, in which a patient’s genome data is stored over a long time period while random parts of it are periodically accessed by authorized parties such as doctors and clinicians. A protection scheme is described that preserves integrity of the genomic data in that scenario over a time horizon of 100 years. During such a long time period, cryptographic schemes will potentially break and therefore our scheme allows to update the integrity protection. Furthermore, integrity of parts of the genomic data can be verified without compromising the privacy of the remaining data. Finally, a performance evaluation and cost projection shows that privacy-preserving long-term integrity protection of genomic data is resource demanding, but in reach of current and future hardware technology and has negligible costs of storage.

The full article can be downloaded below.  

Cost-effectiveness of precision medicine: a scoping review

Precision medicine (PM) aims to improve patient outcomes by stratifying or individualizing diagnosis and treatment decisions. Previous reviews found inconclusive evidence as to the cost-effectiveness of PM. The purpose of this scoping review was to describe current research findings on the cost-effectiveness of PM and to identify characteristics of cost-effective interventions.

We searched PubMed with a combination of terms related to PM and economic evaluations and included studies published between 2014 and 2017.

A total of 83 articles were included, of which two-thirds were published in Europe and the USA. The majority of studies concluded that the PM intervention was at least cost-effective compared to usual care. However, the willingness-to-pay thresholds varied widely. Key factors influencing cost-effectiveness included the prevalence of the genetic condition in the target population, costs of genetic testing and companion treatment and the probability of complications or mortality.

This review may help inform decisions about reimbursement, research and development of PM interventions.

The full article can be downloaded below.  

How patient satisfaction scores are changing medicine

Healthcare organizations have been using patient satisfaction scores since the late 1980s to improve care delivery and calculate physician and staff bonuses, among other purposes. Now, in the shift toward value-based care, such scoring is playing an even greater role in determining physician reimbursement and helping patients choose a physician.

But is it also changing the way physicians practice medicine?

Physicians, frustrated with feelings of powerlessness over how the scores are determined, fear that they give patients too much influence. Experts say the scores are here to stay, and offer suggestions for ways to approach them in the future.

The full Medical Economics article can be viewed at this link.  

AI Policies Are Setting Stage To Transform Healthcare But More Is Needed

White House and federal leaders have been working behind the scenes to lay the groundwork to use technology for dramatic improvements in healthcare. Since the announcement of the Artificial Intelligence (AI) Initiative earlier this year there has been increased funding and agency proposals that will lead to more accurate diagnoses, earlier treatments and ultimately empower patients be in control of their own health. But even more attention is needed to keep America competitive on the global AI front. 

The full Forbes article can be found at this link.