Learn about the history of health IT policy in the US, and how the national infrastructure being built today via the 21st Century Cures Act, is paving the way for a digitally native healthcare ecosystem in the years ahead.
{"title":"The Evolution and Promise of Digital Health","authors":"Stephen Konya","doi":"10.30953/thmt.v8.394","DOIUrl":"https://doi.org/10.30953/thmt.v8.394","url":null,"abstract":"Learn about the history of health IT policy in the US, and how the national infrastructure being built today via the 21st Century Cures Act, is paving the way for a digitally native healthcare ecosystem in the years ahead.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126821293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The capabilities of and interest in artificial intelligence (AI) in healthcare, and more specifically, population health, has grown exponentially over the past decade. The vast volume of digital data or “big data” in the form of images generated by an aging population, with an ever-increasing demand for imaging, amassed by radiology departments, provides ample opportunity for AI application and has allowed radiology to become a service line leader of AI in the medical field. The screening and detection capabilities of AI make it a valuable tool in population health management, as organizations work to shift their services to early identification and intervention, especially as it relates to chronic disease. In this paper, the clinical, technological, and operational workflows that were developed and integrated within each other to support the adoption of AI algorithms aimed at detecting subclinical osteoporosis and coronary artery disease are described. The benefits of AI are reviewed and weighed against potential drawbacks within the context of population health management and risk contract arrangements. Mitigation tactics are discussed, as well as the anticipated outcomes in terms of cost-avoidance, physician use of evidence-based clinical pathways, and reduction in major patient events (e.g., stroke, hip fracture). The plan for data collection and analysis is also described for program evaluation.
{"title":"Closing the Look in AI, EMR and Provider Partnerships: The Key to Improved Population Health Management?","authors":"A. Kurek, D. Langholz, Aiesha Ahmed","doi":"10.30953/thmt.v7.370","DOIUrl":"https://doi.org/10.30953/thmt.v7.370","url":null,"abstract":"The capabilities of and interest in artificial intelligence (AI) in healthcare, and more specifically, population health, has grown exponentially over the past decade. The vast volume of digital data or “big data” in the form of images generated by an aging population, with an ever-increasing demand for imaging, amassed by radiology departments, provides ample opportunity for AI application and has allowed radiology to become a service line leader of AI in the medical field. The screening and detection capabilities of AI make it a valuable tool in population health management, as organizations work to shift their services to early identification and intervention, especially as it relates to chronic disease. In this paper, the clinical, technological, and operational workflows that were developed and integrated within each other to support the adoption of AI algorithms aimed at detecting subclinical osteoporosis and coronary artery disease are described. The benefits of AI are reviewed and weighed against potential drawbacks within the context of population health management and risk contract arrangements. Mitigation tactics are discussed, as well as the anticipated outcomes in terms of cost-avoidance, physician use of evidence-based clinical pathways, and reduction in major patient events (e.g., stroke, hip fracture). The plan for data collection and analysis is also described for program evaluation.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"146 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115992409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew Sakumoto, Jiancheng Ye, R. Kalu, Kathryn L. Jackson, S. Rittner, Timothy Long, M. Goel, T. Walunas
Introduction Patient portals are the “front door” to telehealth - online scheduling, video visit links, and digital after visit summaries are often conveyed via the patient portal. Patient portal tools often require similar patient skills and attitudes as telehealth adoption. Analyzing patients’ perceptions and beliefs around this digital patient engagement tool may lead to insights regarding telehealth, particularly in historically underrepresented patient populations. Methods Participants from a Federally Qualified Health Center (FQHC) in Chicago, IL were surveyed on general technology use, healthcare-specific technology use, and barriers and facilitators to patient portal use. Results The 149 respondents (81% response rate) represented a unique population base with 96% African American, 74% with educational attainment of some college or less, and 48% with at least one chronic medical condition. Technology access and use were high with 78% computer ownership, 98% mobile phone ownership (with 75% smartphone ownership). In terms of patient portal perception, 75% rated Perceived Usefulness (U) as high. Perceived Ease of Use (E) domains similarly had 70% or higher agreement from patients, and potential barriers and facilitators in the Attitudes Toward Use (A) section included a preference to calling their doctor, and minority of patients viewing the portal as unsafe way to communication, too complicated to use, or taking too much time. Additional stratification analysis by demographic variables (age, gender, educational attainment, and number of chronic conditions) revealed differences in portal perception across the Usefulness, Ease of Use, and Attitudes domains. Discussion Insights from barriers, attitudes, and capacity to use patient portal tools deliver important insight into overall adoption of other digital health modalities, including telehealth. In an urban historically underserved patient population, technology access and use is quite high, and mobile phones access was nearly ubiquitous with a large majority using the internet function on their mobile device. Different age groups, genders, levels of educational attainment, or degree of multi-morbidity have different values and needs. Therefore, each subpopulation needs targeted messaging of different portal benefits. Conclusion Our research provides initial insights into patient-level factors influencing patient portal attitudes, with implications toward telehealth adoption. Demographic differences have a significant impact on attitudes toward technology adoption. Equitable uptake of portal and telehealth services will require tailored messaging, training, and multiple modes of communication, including web-based and mobile.
{"title":"Patient Portal Perceptions in an Urban Community Health Center Setting: Insights for Telehealth","authors":"Matthew Sakumoto, Jiancheng Ye, R. Kalu, Kathryn L. Jackson, S. Rittner, Timothy Long, M. Goel, T. Walunas","doi":"10.30953/thmt.v7.373","DOIUrl":"https://doi.org/10.30953/thmt.v7.373","url":null,"abstract":"Introduction \u0000Patient portals are the “front door” to telehealth - online scheduling, video visit links, and digital after visit summaries are often conveyed via the patient portal. Patient portal tools often require similar patient skills and attitudes as telehealth adoption. Analyzing patients’ perceptions and beliefs around this digital patient engagement tool may lead to insights regarding telehealth, particularly in historically underrepresented patient populations. \u0000 \u0000Methods \u0000Participants from a Federally Qualified Health Center (FQHC) in Chicago, IL were surveyed on general technology use, healthcare-specific technology use, and barriers and facilitators to patient portal use. \u0000 \u0000Results \u0000The 149 respondents (81% response rate) represented a unique population base with 96% African American, 74% with educational attainment of some college or less, and 48% with at least one chronic medical condition. Technology access and use were high with 78% computer ownership, 98% mobile phone ownership (with 75% smartphone ownership). In terms of patient portal perception, 75% rated Perceived Usefulness (U) as high. Perceived Ease of Use (E) domains similarly had 70% or higher agreement from patients, and potential barriers and facilitators in the Attitudes Toward Use (A) section included a preference to calling their doctor, and minority of patients viewing the portal as unsafe way to communication, too complicated to use, or taking too much time. Additional stratification analysis by demographic variables (age, gender, educational attainment, and number of chronic conditions) revealed differences in portal perception across the Usefulness, Ease of Use, and Attitudes domains. \u0000 \u0000Discussion \u0000Insights from barriers, attitudes, and capacity to use patient portal tools deliver important insight into overall adoption of other digital health modalities, including telehealth. In an urban historically underserved patient population, technology access and use is quite high, and mobile phones access was nearly ubiquitous with a large majority using the internet function on their mobile device. Different age groups, genders, levels of educational attainment, or degree of multi-morbidity have different values and needs. Therefore, each subpopulation needs targeted messaging of different portal benefits. \u0000 \u0000Conclusion \u0000Our research provides initial insights into patient-level factors influencing patient portal attitudes, with implications toward telehealth adoption. Demographic differences have a significant impact on attitudes toward technology adoption. Equitable uptake of portal and telehealth services will require tailored messaging, training, and multiple modes of communication, including web-based and mobile.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122422663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective Well-child visits and immunizations among children in the U.S. declined at the pandemic’s onset and vulnerable populations have been disproportionately affected. This pilot projects tested an innovative mechanism to use chatbots to engage caregivers in evidence-based preventive care for children. Design We used artificial intelligence (AI)-enabled chatbots to personalize messages and facilitate appointment scheduling over a five-month period. Chatbots introduced a novel way to connect vulnerable populations to care and challenged traditional convention of provider-patient engagement. Setting The pilot study was conducted at a Community Health Center in Chicago, Illinois that serves roughly 10,500 children, and 82% of patients are racial and/or ethnic minorities. Participants We targeted outreach to 200 English and Spanish-speaking families with children 0-17 years of age for proactive outreach using chatbots promoting well-child visit completion and up-to-date immunization status; moreover, a special emphasis was placed on the 0-2 age group as the first two years represent a critical time for primary prevention of vaccine-preventable diseases. InterventionsThe intervention focused on pre-visit engagement by launching an AI-enabled chatbot to deliver personalized messages and facilitate appointment scheduling via mobile devices. CHEC-UP also provided evidence-based anticipatory guidance prior to an appointment. Coaching in preparation for the visit with trusted information has the potential to educate, improve confidence and promote shared decisions between the parent and provider. Patient experience was measured via surveys deployed via the chatbot. Main Outcome Measures & Results Chatbots facilitated a relative increase in well-child visits and immunizations by 27% in the intervention group. Well-child visits and immunizations in the intervention group increased 13% compared to the control group. Survey results and patient interviews indicated a high level of patient satisfaction using the chatbot. In addition to a favorable perception of the chatbots, patients also identified future use cases for chatbots. Conclusions Engaging patients with chatbots improved vaccination and well-child uptake. Patients were highly satisfied with chatbot engagement. By engaging patients and caregivers, chatbots present the potential to proactively engage patients in care and optimize vaccination uptake and realize one of societies’ greatest public health achievements: decreasing the spread of communicable diseases.
{"title":"CHEC-UP: A Digital Intervention to Reduce Disparities in Well-Child and Immunization Completion in Community Health ","authors":"N. Mohanty","doi":"10.30953/thmt.v7.375","DOIUrl":"https://doi.org/10.30953/thmt.v7.375","url":null,"abstract":"Objective \u0000Well-child visits and immunizations among children in the U.S. declined at the pandemic’s onset and vulnerable populations have been disproportionately affected. This pilot projects tested an innovative mechanism to use chatbots to engage caregivers in evidence-based preventive care for children. \u0000Design \u0000We used artificial intelligence (AI)-enabled chatbots to personalize messages and facilitate appointment scheduling over a five-month period. Chatbots introduced a novel way to connect vulnerable populations to care and challenged traditional convention of provider-patient engagement. \u0000Setting \u0000The pilot study was conducted at a Community Health Center in Chicago, Illinois that serves roughly 10,500 children, and 82% of patients are racial and/or ethnic minorities. \u0000Participants \u0000We targeted outreach to 200 English and Spanish-speaking families with children 0-17 years of age for proactive outreach using chatbots promoting well-child visit completion and up-to-date immunization status; moreover, a special emphasis was placed on the 0-2 age group as the first two years represent a critical time for primary prevention of vaccine-preventable diseases. \u0000InterventionsThe intervention focused on pre-visit engagement by launching an AI-enabled chatbot to deliver personalized messages and facilitate appointment scheduling via mobile devices. CHEC-UP also provided evidence-based anticipatory guidance prior to an appointment. Coaching in preparation for the visit with trusted information has the potential to educate, improve confidence and promote shared decisions between the parent and provider. Patient experience was measured via surveys deployed via the chatbot. \u0000Main Outcome Measures & Results \u0000Chatbots facilitated a relative increase in well-child visits and immunizations by 27% in the intervention group. Well-child visits and immunizations in the intervention group increased 13% compared to the control group. Survey results and patient interviews indicated a high level of patient satisfaction using the chatbot. In addition to a favorable perception of the chatbots, patients also identified future use cases for chatbots. \u0000Conclusions Engaging patients with chatbots improved vaccination and well-child uptake. Patients were highly satisfied with chatbot engagement. By engaging patients and caregivers, chatbots present the potential to proactively engage patients in care and optimize vaccination uptake and realize one of societies’ greatest public health achievements: decreasing the spread of communicable diseases.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124135670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This narative challenges readers to discuss a diagnosis of a suspicious lesion during a telemedicine consultation in the era of COVID-19.
这篇叙述挑战读者讨论在COVID-19时代远程医疗会诊期间可疑病变的诊断。
{"title":"COVID-19 Era: Diagnosis of a Suspicious Lesion in a Telemedicine Consultation","authors":"Ofira Zloto, Nicola Dunlop","doi":"10.30953/thmt.v7.372","DOIUrl":"https://doi.org/10.30953/thmt.v7.372","url":null,"abstract":"This narative challenges readers to discuss a diagnosis of a suspicious lesion during a telemedicine consultation in the era of COVID-19.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124432873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher March, BS, Kimberly Gandy, MD, PhD, Jos Domen, PhD, Sayyed Hamidi, MD, MBA, MPH, Ryan Chen, BS, Paul Barach, MD, MPH, Anthony Szema, MD
Background: Digital health tools to bridge gaps in managing infectious pandemics was a proposition grounded until recently more in the hypothetical than in reality. The last two years have exposed the extraordinary global need for robust digital solutions. Objective: The objective of this study was to determine the ability of remote patient monitoring (RPM) during the COVID-19 pandemic to improve clinical outcomes and assure continuity of care in patients with asthma. Methods and Findings: Design: The intervention combined health coaching telephone calls and remote telemonitoring. Participants: 102 patients with asthma were enrolled in a telemonitoring protocol at the beginning of the COVID-19 pandemic in the United States. Setting: A private, university affiliated, outpatient clinical adult and pediatric allergy/immunology and pulmonary practice. Intervention: Patients were enrolled with the primary rationale of maintaining continuity of care in the face of uncertain clinical care options. Enrollment and data collection proceeded in a fashion to allow detailed retrospective analysis. Telemonitoring included a pulse oximeter linked to a smart phone using the software platform Plan-it Med (PIM)®. A healthcare professional monitored data daily, and patients were contacted by providers due to vital sign abnormalities and treatment plan alterations. Patients were encouraged to remain on the platform daily during the first three months of the pandemic. After respiratory and or clinical stability was achieved and clinic visit opportunities were resumed, patients were encouraged to maintain engagement with the platform but were not expected to use the platform daily. Main Outcome measures: Asthma Control Test (ACT) scores were recorded before and after 6 months. Paired Wilcoxon signed-rank tests (dependent groups, before vs. after) and Wilcoxon rank-sum (Mann-Whitney) tests were performed for unpaired results (independent groups, RPM vs. Control). Results: 19 of 102 patients had physiological abnormalities detected (18.6%). Eight of these 19 patients had actionable changes in prescription regimens based on RPM findings (42.1%). In patients utilizing RPM, there was a reported decrease in shortness of breath episodes and a decreased need for rescue inhalers/nebulizer medications (P=0.005). Daily engagement in the first three months of the protocol was 61%. In a subset analysis, 48 study participants (47.1%) chose to continue to actively use the program for at least 14 months. 54 RPM patients were 99.1% compliant with RPM after 110 patient months. Of the patients that chose to discontinue the RPM program the reasons included: (1) symptom alleviation (41.7%); (2) out-of-pocket costs to patients (38.9%), and (3) difficulty using the RPM program (16.7%). Conclusions: A novel RPM technology positively impacted continuity of care, asthma outcomes, quality of life, and self-care.
背景:利用数字卫生工具弥合传染性大流行管理方面的差距，直到最近这一主张更多是基于假设而非现实。过去两年暴露了全球对强大的数字解决方案的巨大需求。目的:本研究的目的是确定在COVID-19大流行期间远程患者监测(RPM)改善哮喘患者临床结局和确保护理连续性的能力。方法与发现:设计:采用电话健康指导和远程监护相结合的干预方法。参与者:在美国COVID-19大流行开始时，102名哮喘患者参加了远程监测方案。环境:私立，大学附属，门诊临床成人和儿童过敏/免疫学和肺部实践。干预:患者入组的主要目的是在面对不确定的临床护理选择时保持护理的连续性。登记和数据收集以一种方式进行，以便进行详细的回顾性分析。远程监测包括使用Plan-it Med (PIM)®软件平台连接到智能手机的脉搏血氧仪。医疗保健专业人员每天监测数据，并且由于生命体征异常和治疗计划更改，提供者与患者联系。在大流行的头三个月，鼓励患者每天留在平台上。在达到呼吸和/或临床稳定并恢复门诊就诊机会后，鼓励患者继续使用该平台，但不期望患者每天使用该平台。主要观察指标:6个月前后分别记录哮喘控制测试(ACT)评分。配对Wilcoxon符号秩检验(依赖组，前后)和配对Wilcoxon秩和(Mann-Whitney)检验(独立组，RPM与对照)。结果:102例患者中检出生理异常19例(18.6%)。这19名患者中有8名(42.1%)根据RPM结果对处方方案进行了可操作的改变。在使用RPM的患者中，据报道呼吸短促发作减少，对吸入器/雾化器药物的需求减少(P=0.005)。在该协议实施的前三个月，每日参与度为61%。在一个子集分析中，48名研究参与者(47.1%)选择继续积极使用该计划至少14个月。54例RPM患者110个月后，RPM依从性为99.1%。在选择停止RPM计划的患者中，原因包括:(1)症状缓解(41.7%);(2)患者自付费用(38.9%)，(3)使用RPM程序困难(16.7%)。结论:一种新的RPM技术对护理的连续性、哮喘结局、生活质量和自我护理有积极的影响。
{"title":"Remote Patient Monitoring Effectively Assures Continuity of Care in Asthma Patients During the COVID-19 Pandemic","authors":"Christopher March, BS, Kimberly Gandy, MD, PhD, Jos Domen, PhD, Sayyed Hamidi, MD, MBA, MPH, Ryan Chen, BS, Paul Barach, MD, MPH, Anthony Szema, MD","doi":"10.30953/thmt.v7.374","DOIUrl":"https://doi.org/10.30953/thmt.v7.374","url":null,"abstract":"Background: Digital health tools to bridge gaps in managing infectious pandemics was a proposition grounded until recently more in the hypothetical than in reality. The last two years have exposed the extraordinary global need for robust digital solutions. \u0000Objective: The objective of this study was to determine the ability of remote patient monitoring (RPM) during the COVID-19 pandemic to improve clinical outcomes and assure continuity of care in patients with asthma. \u0000Methods and Findings: \u0000Design: The intervention combined health coaching telephone calls and remote telemonitoring. \u0000Participants: 102 patients with asthma were enrolled in a telemonitoring protocol at the beginning of the COVID-19 pandemic in the United States. \u0000Setting: A private, university affiliated, outpatient clinical adult and pediatric allergy/immunology and pulmonary practice. \u0000Intervention: Patients were enrolled with the primary rationale of maintaining continuity of care in the face of uncertain clinical care options. Enrollment and data collection proceeded in a fashion to allow detailed retrospective analysis. Telemonitoring included a pulse oximeter linked to a smart phone using the software platform Plan-it Med (PIM)®. A healthcare professional monitored data daily, and patients were contacted by providers due to vital sign abnormalities and treatment plan alterations. Patients were encouraged to remain on the platform daily during the first three months of the pandemic. After respiratory and or clinical stability was achieved and clinic visit opportunities were resumed, patients were encouraged to maintain engagement with the platform but were not expected to use the platform daily. \u0000Main Outcome measures: Asthma Control Test (ACT) scores were recorded before and after 6 months. Paired Wilcoxon signed-rank tests (dependent groups, before vs. after) and Wilcoxon rank-sum (Mann-Whitney) tests were performed for unpaired results (independent groups, RPM vs. Control). \u0000Results: 19 of 102 patients had physiological abnormalities detected (18.6%). Eight of these 19 patients had actionable changes in prescription regimens based on RPM findings (42.1%). In patients utilizing RPM, there was a reported decrease in shortness of breath episodes and a decreased need for rescue inhalers/nebulizer medications (P=0.005). Daily engagement in the first three months of the protocol was 61%. In a subset analysis, 48 study participants (47.1%) chose to continue to actively use the program for at least 14 months. 54 RPM patients were 99.1% compliant with RPM after 110 patient months. Of the patients that chose to discontinue the RPM program the reasons included: (1) symptom alleviation (41.7%); (2) out-of-pocket costs to patients (38.9%), and (3) difficulty using the RPM program (16.7%). \u0000Conclusions: A novel RPM technology positively impacted continuity of care, asthma outcomes, quality of life, and self-care.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131093474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amar Gupta, J. Halamka, Lauren Park, Naomi Kim, Veda Donthireddy, Mariam Dogar, Dinesh Patel
The increased amount of virtual care during the COVID-19 pandemic has exacerbated the challenge of providing appropriate medical board oversight to ensure proper quality of care delivery and safety of patients. This is partly due to the conventional model of each state medical board (SMB) holding responsibility for medical standards and oversight only within the jurisdiction of that state board and partly due to regulatory waivers and reduced enforcement of privacy policies. Even with a revoked license in one state, significant number of physicians have continued to practice by obtaining a medical license in a different state. Individualized requests were sent to 63 medical boards with questions related to practice of telemedicine and digital health by debarred or penalized medical doctors. The responses revealed major deficiencies and the urgent need to adopt a nationwide framework and to create an anchor point to serve as the coordinator of all relevant information related to incidents of improper medical practice. The ability to cause damage to large number of patients is significantly more now. Federal and state agencies urgently need to provide more attention and funding to issues related to quality of care and patient care in the changing ecosystem that includes medical specialists at a distance and the use of evolving digital health services and products. The creation, maintenance, and use of an integrated information system at national and multinational levels is increasingly important.
{"title":"Medical Boards: Impact of Growing Virtual Care and Need for Integrated Approach to Enhance Quality and Safety","authors":"Amar Gupta, J. Halamka, Lauren Park, Naomi Kim, Veda Donthireddy, Mariam Dogar, Dinesh Patel","doi":"10.30953/tmt.v7.363","DOIUrl":"https://doi.org/10.30953/tmt.v7.363","url":null,"abstract":"The increased amount of virtual care during the COVID-19 pandemic has exacerbated the challenge of providing appropriate medical board oversight to ensure proper quality of care delivery and safety of patients. This is partly due to the conventional model of each state medical board (SMB) holding responsibility for medical standards and oversight only within the jurisdiction of that state board and partly due to regulatory waivers and reduced enforcement of privacy policies. Even with a revoked license in one state, significant number of physicians have continued to practice by obtaining a medical license in a different state. Individualized requests were sent to 63 medical boards with questions related to practice of telemedicine and digital health by debarred or penalized medical doctors. The responses revealed major deficiencies and the urgent need to adopt a nationwide framework and to create an anchor point to serve as the coordinator of all relevant information related to incidents of improper medical practice. The ability to cause damage to large number of patients is significantly more now. Federal and state agencies urgently need to provide more attention and funding to issues related to quality of care and patient care in the changing ecosystem that includes medical specialists at a distance and the use of evolving digital health services and products. The creation, maintenance, and use of an integrated information system at national and multinational levels is increasingly important.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115601628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Remote Patient / Physiologic Monitoring (RPM), as a tool helps in eliminating or reducing the cost of care in Nigeria and West Africa, and hence has contributed to the advancement of telemedicine. As a result, telemedicine conserves time and improves cost factors of care delivery by achieving efficiencies through technology while demonstrating quality and outcomes in new and novel ways. This paper looks into the growth and application of RPM in Nigeria. Management of diseases using RPM, measures, and regulations taken to incorporate RPM in Nigeria, and their connectivity to remote and rural areas are all highlighted within the context of this paper. This paper identifies effective utilization of RPM technology as a solution to address problems of poor health care delivery and outcomes in Nigeria by identifying the prevailing limitations mitigating the incorporation and growth of RPM in the country’s healthcare delivery system.
{"title":"Systematic Overview of Remote Patient Monitoring in Nigeria (West Africa)","authors":"U. Idris, Latifah O. Abdulkarim, B. Arkwright","doi":"10.30953/tmt.v7.359","DOIUrl":"https://doi.org/10.30953/tmt.v7.359","url":null,"abstract":"Remote Patient / Physiologic Monitoring (RPM), as a tool helps in eliminating or reducing the cost of care in Nigeria and West Africa, and hence has contributed to the advancement of telemedicine. As a result, telemedicine conserves time and improves cost factors of care delivery by achieving efficiencies through technology while demonstrating quality and outcomes in new and novel ways. This paper looks into the growth and application of RPM in Nigeria. Management of diseases using RPM, measures, and regulations taken to incorporate RPM in Nigeria, and their connectivity to remote and rural areas are all highlighted within the context of this paper. This paper identifies effective utilization of RPM technology as a solution to address problems of poor health care delivery and outcomes in Nigeria by identifying the prevailing limitations mitigating the incorporation and growth of RPM in the country’s healthcare delivery system.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132225293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Kuppuswami, Suresh Subramanian, R. Ravichandran
Background: India accounts for nearly one in six maternal deaths and over the last two decades, maternal mortality in India has decreased rapidly and faster than the global rate. However, the rate of decline has been slowing and further progress calls for new interventions and improvements in existing programs and the care-delivery process. Objective(s): We developed and tested a telehealth solution that included an early warning system and a clinical decision support tool for timely detection of clinical deterioration and appropriate management of women in labor at a large general hospital in India. The pilot study with 15,184 patients was associated with a significant decrease in maternal mortality and in-hospital eclampsia. The results were published earlier this year. Here we examine and analyze the maternal deaths that occurred during that study period and discuss reasons why preventable deaths occurred despite the telehealth early warning system and recommend possible approaches to further reduce the maternal mortality rate. Study Design: We carefully reviewed medical records of all maternal deaths during the two-year pilot from admission until death or transfer of these patients to a tertiary care center. We deconstructed the events leading to the adverse outcome and evaluated each based on the three delay modules for maternal deaths, namely seeking care, reaching the facility, and receiving care after reaching the facility. Results: Twelve maternal deaths occurred during the period of the study, six deaths occurred at the study sites and six deaths occurred after transport to a tertiary institution. Nine deaths were determined to be preventable. In five cases although multiple alerts were created indicating a clinical deterioration of the patients’ condition, lack of adequate knowledge and insufficient training on the part of the staff contributed to delays in initiating treatment and/or delays in timely transport. In all cases where the deaths occurred after the patient was transported, the warning system had identified the acute risk appropriately prior to the initiation of the transport. Considering all cases, the telehealth early warning system generated red alerts in every case, indicating an acute emergency (66.7%) and/or yellow alerts requiring continued observation (33.3%). Conclusion(s): Telehealth solutions incorporating early warning capability for identifying clinical deterioration among patients can play a crucial role in resource-constrained settings. Telehealth early warning systems have the potential to accelerate the care-delivery process and expose gaps in an organization’s operating procedures as well as in the knowledge base of providers. Successful implementation of such telehealth systems requires strong referral networks and appropriate protocols to take advantage of the system’s early warning capabilities. In addition, it may be necessary that the early warning system be implemented in all referring and receiv
{"title":"Maternal Deaths During a Pilot Study Using Digitized Maternal Early Warning System","authors":"N. Kuppuswami, Suresh Subramanian, R. Ravichandran","doi":"10.30953/tmt.v7.316","DOIUrl":"https://doi.org/10.30953/tmt.v7.316","url":null,"abstract":"Background:\u0000India accounts for nearly one in six maternal deaths and over the last two decades, maternal mortality in India has decreased rapidly and faster than the global rate. However, the rate of decline has been slowing and further progress calls for new interventions and improvements in existing programs and the care-delivery process.\u0000Objective(s): \u0000We developed and tested a telehealth solution that included an early warning system and a clinical decision support tool for timely detection of clinical deterioration and appropriate management of women in labor at a large general hospital in India. The pilot study with 15,184 patients was associated with a significant decrease in maternal mortality and in-hospital eclampsia. The results were published earlier this year. Here we examine and analyze the maternal deaths that occurred during that study period and discuss reasons why preventable deaths occurred despite the telehealth early warning system and recommend possible approaches to further reduce the maternal mortality rate.\u0000Study Design: \u0000We carefully reviewed medical records of all maternal deaths during the two-year pilot from admission until death or transfer of these patients to a tertiary care center. We deconstructed the events leading to the adverse outcome and evaluated each based on the three delay modules for maternal deaths, namely seeking care, reaching the facility, and receiving care after reaching the facility.\u0000Results: \u0000Twelve maternal deaths occurred during the period of the study, six deaths occurred at the study sites and six deaths occurred after transport to a tertiary institution. Nine deaths were determined to be preventable. In five cases although multiple alerts were created indicating a clinical deterioration of the patients’ condition, lack of adequate knowledge and insufficient training on the part of the staff contributed to delays in initiating treatment and/or delays in timely transport. In all cases where the deaths occurred after the patient was transported, the warning system had identified the acute risk appropriately prior to the initiation of the transport. Considering all cases, the telehealth early warning system generated red alerts in every case, indicating an acute emergency (66.7%) and/or yellow alerts requiring continued observation (33.3%).\u0000Conclusion(s): \u0000Telehealth solutions incorporating early warning capability for identifying clinical deterioration among patients can play a crucial role in resource-constrained settings. Telehealth early warning systems have the potential to accelerate the care-delivery process and expose gaps in an organization’s operating procedures as well as in the knowledge base of providers. Successful implementation of such telehealth systems requires strong referral networks and appropriate protocols to take advantage of the system’s early warning capabilities. In addition, it may be necessary that the early warning system be implemented in all referring and receiv","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121610740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Topics addressed include: How does the "primary care" model consumers want virtually play out in the home? What is required for success? What are the best scenarios for virtual primary care, and what are the limitations? Can we create a solution with all the benefits of virtual and overcome perceived limitations, too?
{"title":"Home-based “Virtual” Primary Care - Opportunities and Challenges","authors":"Sean Mehra, Marcus Osborne","doi":"10.30953/tmt.v7.368","DOIUrl":"https://doi.org/10.30953/tmt.v7.368","url":null,"abstract":"Topics addressed include: \u0000 \u0000How does the \"primary care\" model consumers want virtually play out in the home? \u0000What is required for success? \u0000What are the best scenarios for virtual primary care, and what are the limitations? \u0000Can we create a solution with all the benefits of virtual and overcome perceived limitations, too? \u0000","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"375 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115295295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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