Digital health aims at some of the biggest healthcare challenges, including lowering costs, fostering engagement and improving health outcomes. However, before achieving these goals, it must win over providers and payers to secure physician buy-in and reimbursement.
The first step is defining the digital therapeutics (DTx) landscape. There are so many new technologies hitting the healthcare scene that it can be hard to tease apart the differences.
Here’s what providers and patients need to know about digital therapeutics and how they can start holistically integrating the breakthroughs into the services they provide.
Digital therapeutics vs. digital health vs. telehealth
Nowadays, you often hear these terms used interchangeably. Indeed, there is a lot of overlap between them, but it is important to distinguish between them.
In a recent digital therapeutics services report , the health experts at Star Global defined the differences as the following. Digital health is the broadest category and refers to the use of digital technologies, including online platforms, wearable technologies, connectivity and sensors to enhance healthcare delivery efficiency. It’s focused on driving personalization and on-demand care.
Digital therapeutics are a subset of digital health. Digital therapeutics deliver evidence-based therapeutic interventions and refers to a broad swathe of products and services designed to address stakeholder needs across the healthcare ecosystem.
Most DTx products are patient-centric, but there are some like the AI virtual assistant and diagnostic toolkit Suki. By smoothing out the provider workflow, it creates more time and interaction for providers to have with patients.
By Jerry Rankin, strategy director of healthcare interoperability, Infor.
Jerry Rankin
The unrelenting if unpredictable movement of continental plates builds new mountain ranges and reshapes continents, but for the most part, we do not notice their progress. Such a shift has come to healthcare.
This spring two US Federal agencies, ONC and CMS, announced complimentary Final Rules, signaling tectonic movement in healthcare interoperability. These rules are very consequential for the industry, but while no one can claim that they went unnoticed, the industry has been understandably instead fixated on responding to the COVID-19 pandemic. In response, the federal agencies involved have pushed the implementation timelines back by roughly six months.
The Final Rules
On May 1, 2020, the ONC published a Final Rule implementing provisions of the 2016 21st Century Cures Act. Known in the industry as the “Information Blocking and Health IT Certification” Final Rule, the Provider and EHR focused rule requires developers of Certified Health Information Technology (e.g. EHRs) to make standard APIs available for the delivery of individual and population records, as well as defines the data set and transaction standards of the APIs to be United States Core Data Set for interoperability (USCDI) and FHIR, respectively.
In a parallel action, the CMS issued a ruling implementing provisions of the Cures Act, known as the “Interoperability and Patient Access Rule,” leveraging “Conditions of Participation” in Federal Health programs. The finalized rule requires payers to provide a Patient Access API which gives patients access to certain health data including personal data.
These rules represent an important federal nudge to the industry to move in the next few years to implement and adopt standard, digital friendly APIs for the exchange of key patient information, eliminate policies and practices of health IT vendors, providers and other data holders that constrain the free flow of healthcare data, and, importantly, bring payers and consumers into the interoperability discussion, enabling data to flow across the healthcare ecosystem.
These rules are just the tip of the iceberg, though. The industry has been hard at work for years developing the FHIR API standard, and there are abundant examples of voluntary industry led collaborations working to improve and streamline healthcare leveraging FHIR. For example, the HL7 Da Vinci Project sponsors collaboration among payers, providers and HIT vendors working to define standards-based implementations to improve some of the more costly workflows in the industry. In addition to adoption by traditional HIT vendors, even IT “gorillas” are adopting FHIR. We recently saw this with the launch of Microsoft Cloud for Healthcare which extensively leverages FHIR APIs and data standards.
What to expect for payers and providers?
Payers and providers and their health IT vendors have a great deal of work to do on a tight timeline to meet the requirements put in place and to simply keep up with the pace of change in the industry. Given the massive investment in and footprint of legacy systems, there is a vast amount of work to do to connect systems and data to the emerging FHIR API ecosystem.
Every day, all over the world, countless people put their lives in the hands of doctors, nurses, surgeons, psychiatrists, and other medical professionals, hoping and expecting to receive the care and attention they need to deal with a wide range of medical ailments and complaints.
In the vast majority of cases, these medical professionals are able to meet the needs of their patients to the best of their abilities, but in some cases, the errors of human nature occur, leading to an inaccurate diagnosis, an incorrect prescription, or even a serious surgical error.
Studies and statistics show that more than 250,000 deaths occur every year in the US because of medical errors. It’s a frightening statistic, reminding everyone that even doctors don’t always get things right, while also reminding medical professionals of the incredible weight of responsibility that sits on their shoulders every time they talk to a patient or prescribe a treatment.
People who live in rural areas of the United States are more likely than those in urban communities to die prematurely from all five of the leading causes of death, per the Center for Disease Control. Remote-based care and telehealth-based visits can help people reduce or manage these conditions. However, rural medical and dental practices must ensure constant internet connectivity.
Telehealth is an excellent resource for caregivers to monitor their patients’ chronic conditions, is an excellent way to deliver care quickly in an emergency, such as a stroke, and virtual visits offered through the technology can reduce barriers to care.
But the most obvious challenge with offering telehealth services to patients is maintaining consistent internet connectivity without encountering dropped connections caused by a single internet connection network. Traditionally, most networks use single line connectivity to maintain the entire network, but doing so can prove to be costly and harmful to practice and patient health.
However, the best rural internet and bonded internet can eliminate these challenges while delivering a continuous internet connection, especially important to small medical and dental practices.
Bonded internet vs. standard single connection
A traditional standard, single connection internet network can likely meet the most basic business demands of medical and dental practices—however, those that require continuous, dependable, fast internet benefit from bonded internet connectivity.
In simple terms, bonded internet combines multiple connections (unlike a single connection network) to ensure stable connectivity. Bonded internet secures an always-on connection by continuously monitoring the network for the best connection. With bonded internet, all network traffic passes through an aggregator, which divides the data stream, and routes it through an individual internet connection.
By Kevin Ruthen, chief technology officer, Support.com.
Kevin Ruthen
Customer support plays a critical role in healthcare. In fact, a report from McKinsey and Company on healthcare consumerism found that “customer service ranked second behind only coverage — and ahead of cost and access — when survey participants were asked what features would make a healthcare company most appealing.”
Historically, customer care for the healthcare industry has been delivered by agents housed in brick-and-mortar call center facilities due to the complex security and compliance requirements. As a result, when the pandemic first struck, many call centers were forced to shut down, ultimately to re-open with physical distancing measures that reduced overall capacity. Others sent agents to work remotely, although they were quickly met with a myriad of challenges associated with managing and securing a remote workforce.
Brick-and-mortar centers traditionally use physical controls and in-person monitoring protocols to ensure security, and many were not prepared to adapt these security measures to a virtual environment. Traditional providers ran into issues verifying an agent’s true identity and confirming whether the agent was operating in a secure and private work environment.
Additionally, providers faced challenges securing an agent’s network and hardware from malicious software (i.e. viruses, malware), that could then spread to the rest of the contact center. Without these security measures and verifications in place, these work-from-home agents were at risk of violating HIPAA security and compliance requirements.
Can customer support for healthcare be provided outside the four walls of a call center? Can secure, HIPAA-compliant customer support be delivered by a remote workforce at scale?
Success with WFH support agents – what does this look like?
Homesourcing is a model that enables outsourced work to be delivered by employees working from home, while maintaining or even improving productivity. Homesourcing requires that all of a company’s processes, platforms, tools, security protocols, and culture are redesigned to support home-based employees. The model requires recruiting full-time (W2) employees who have the traits, work ethic, and time management skills to be successful in a remote environment and enables providers to screen for specific skills or industry experience.
For homesourcing to be a viable model for the healthcare industry, it must address three core areas related to customer data – privacy, control, and access.
FPGA development boards have applications to a whole host of different industries. They are the most popular devices in precision weaponry and even in the cloud. However, FPGA boards are now used in the medical industry, as they offer tremendous benefits over traditional semiconductors. These boards have taken the industry by storm, and we slowly see them being used for many different types of medical tasks.
What Is An FPGA
An FPGA is called a field-programmable gate array. It is essentially a semiconductor with a blank slate. Your microprocessor can execute instructions, but it can only do that if the instructions are something it understands. Similarly, your graphics processing unit only knows how to do calculations and render an image on the screen. They come from the factory fixed to do a specific task.
However, an FPGA comes from the factory as a blank semiconductor chip that you need to program to do something. While an FPGA may contain a green chip that is PCB, it is certainly different from a PCBA. You could potentially program your board to operate exactly as your microprocessor or graphics processing unit. However, these devices are mostly used in industries where they don’t have dedicated processors for specific tasks. It is easy to program, and you don’t need to spend a lot of money manufacturing dedicated silicon. You can also change the programming as you learn more information, making these devices very flexible.
How Do They Work
An FPGA works very similarly at a transistor level, but the abstraction above makes all the difference. While it uses transistors like every other semiconductor, it also has reprogrammable gates that act as memory. It is essentially memory that you can reprogram to execute instructions. The basic unit of an FPGA is called a logical element. These logical elements can be connected to each other to form execution units. This ability to reconfigure themselves to changes in programming is what makes all the difference.
Primarily, hospitals are used to guiding and supporting patients by making personal phone calls, sending letters or text messaging. However, many hospitals report that reaching patients, especially the patients at working age, can be difficult as patients are hesitant to pick up unknown numbers or are occupied during the regular hospital working hours.
Also, when posting letters, hospitals won’t get notified if a patient has actually received, opened, and understood the content.
However, it’s now 2020 and things are starting to change. An increasing number of patients use smartphones and the internet several times a day. As a matter of fact, Statista, has reported that the smartphone penetration rate in the United States has continuously risen over the past ten to fifteen years to more than 80% today.
Patients are looking for more and more medical information online and they are willing to participate more in their own care than in the past. Patients also want transparency of their care processes. Telemedicine and digital patient engagement platforms not only offer improvement to a patient’s communication but it also enables vast opportunities for hospitals to streamline care processes, interact with patients remotely, and automate care coordination or data collection.
Digital patient engagement enables automated care processes
Digital patient engagement has already increased the reach and type of interactions patients and nurses have with their patients now, but it will be even more prominent in the future. Hospitals can use, for example, mobile telemedicine applications, portals, care coordination or patient engagement software, video meeting software, or remote patient monitoring tools to connect with patients. New technological tools can offer transparent care pathways to patients and help hospitals and clinics engage, educate, and collect data from the patients.
Automated education keeps patients on track
With digital tools and platforms, patients can be educated and supported through mobile phones, tablets, and computers. Patients can access and read care-related information or instructions and submit forms or questionnaires when it is most convenient to them. Care teams can also determine when they want patients with specific procedures or treatments to receive education and task reminders, and digital tools will send the information automatically at the most optimal time.
We’ve all experienced crises in our lives. They may be personal in nature (e.g., involving our interpersonal relationships), organizational (e.g., relating to our employment or retirement income) or nature-made (e.g., floods, tornados, or the COVID-19 pandemic). When crises hit our communities, the impacts can be widespread and far-reaching.
Healthcare providers and community-based organizations (CBOs) are called upon to provide more rapid and extensive care and support to the community than is otherwise the norm. A well-established and highly functioning Connected Community of Care (CCC), as is the case here in Dallas, Texas, can provide a tremendous strategic and tactical advantage over non-connected peers.
Since 2014, the Parkland Center for Clinical Innovation (PCCI) has led an effort to bring together several large healthcare systems and a number of regional social-service organizations such as food banks, homeless assistance associations, and transportation service vendors, along with over 100 smaller CBOs (i.e., neighborhood food pantries, crisis centers, utility assistance centers) and area faith-based organizations to form the Dallas CCC.
Over time, civic organizations, such as the Community Council of Greater Dallas, Dallas County Health and Human Services (DCHHS), and select academic institutions have begun to participate in various community-wide projects under the Dallas CCC umbrella. Central to the success of the Dallas CCC are the partnerships that have been formed between the CBOs and a number of local healthcare systems (Parkland Health & Hospital System [Parkland], Baylor Scott & White Health, Children’s Medical Center, Methodist Health System, and Metrocare Services), clinical practices, and other ancillary healthcare providers serving the Dallas metroplex. These partnerships have proved essential in building a truly comprehensive and functional network aimed at improving both the health and well-being of Dallas residents.
Connecting these various entities and forming a two-way communication pathway is an electronic information exchange platform termed Pieces Connect, which allows for real-time, two-way sharing of information pertaining to an individual’s social and healthcare needs, history, and preferences.
The information exchange platform is the glue that holds the physical network together and provides one of the mechanisms to disseminate information from public health and healthcare entities to social service providers in the community. It allows the individual community resident, via the CBO, to become better informed about important health issues, such as routine vaccinations or preventive care, such as social distancing and proper mask usage during a pandemic.
Until recently, the primary mission of the Dallas CCC focused on addressing residents’ social determinants of health (SDOH) issues through providing community resources (e.g., food assistance, housing, transportation) to improve the lives of Dallas County residents. While this mission has become even more critical during the COVID-19 pandemic, the work of the Dallas CCC has also evolved to include identifying COVID-19 sites within the County and directing community outreach efforts to help stem the rapid spread of the virus.
