What Adoption of Remote Patient Monitoring will mean for Healthcare Delivery

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Millions of people are growing sicker and older at an accelerating rate. The World Health Organization (WHO) estimates that between 2015 and 2050, the number of individuals over 60 years will nearly double from 12% to 22%.[i] Inevitably, an increasing number of older people will require more medical needs and caregiving, which will ultimately place more and more pressure on an already stressed healthcare system. Therefore, finding ways to leverage technology to manage the health of populations efficiently and cost effectively, will be the key in providing the best quality of care.

[i] Retrieved from http://www.who.int/mediacentre/factsheets/fs404/en/

Remote Patient Monitoring: A Cost-Effective Solution to Improving Health Outcomes

Patient care is holistic, which means that it should continue even if the patient is discharged from the hospital and is recovering at home. Therefore, healthcare providers must have access to innovative, state-of-the-art medical equipment that allows them to reach more patients so that proper guidance and monitoring can be performed. This in turn allows the clinical team to identify at-risk patients, and monitor strict compliance to diet, medications and other home instructions, thus, ensuring the continuity of quality care. In fact, one study has shown that home monitoring of patients with congestive heart failure leads to lower hospitalization rates and improved mortality.[i]

Fortunately, starting this 2018, The Centers for Medicare and Medicaid Services (CMS) has made a great move and will support and reimburse healthcare providers using remote monitoring technologies. Specifically, CMS has decided to unbundle and activate CPT code 99091 (collection and interpretation of physiologic data), which allows providers to be reimbursed for time spent collecting and analyzing patient-generated health data.

To receive patient adjustments, healthcare providers must document the work related to your care using a coding system of the Current Procedural Terminology (CPT) Editorial Panel. This coding system has been used for decades to bill insurers, who then pays for the provider according to a contracted fee schedule. In order to get credit, CMS requires providers to:

  1. Use digital tools to help them monitor and provide guidance to patients outside of the hospital or clinic. Within this guideline, they must collect and use patient-generated health data to allow them to provide quality assessment and ongoing care.
  2. Use health technology platforms and devices that provides real-time patient-generated health data to the healthcare team (active feedback loop).
  3. Use platforms or devices that are endorsed and offered clinically by healthcare teams to patients.
  4. Only use platforms or devices that collect and transmit patient-generated health data in real-time. Platforms or devices that collect but do not transmit these data are not eligible technology.

Adoption of remote patient monitoring using appropriate health technology platforms and devices will play a bigger role in healthcare delivery as the population ages. Remote patient monitoring can make an enormous difference in terms of health outcomes by reducing complications, improving access, and significantly reducing costs. With CMS supporting the reimbursement for healthcare providers who will use remote monitoring technologies, more and more healthcare organizations will start adopting this innovative and cost-effective technology to deliver the best quality of care.

[i] Bhimaraj A. Remote Monitoring of Heart Failure Patients. Methodist DeBakey Cardiovascular Journal. 2013;9(1):26-31.

Digital Health Research: A Guide

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Digital health research & Shift in Perspectives | Patients Are the Focus of Research

Digital health research plays a crucial role in telemedicine and e-health, which can be defined as medical treatment and research delivered by technology.

Digital health research is much more than data collection, remote observation, and increased mobility. In fact, digital health research empowers patients, provide personalized care, and benefit connected care pathways (“mHealth… What Does It Really Mean?” 2014). It isn’t only about apps and technology solutions. Digital health research represents a whole shift in ideas: patients become active participants in research and practice.

  • Patients are active participants and decide along with practitioners. Note that decisions can be made outside the hospital.
  • Information, data, and treatment become personalized. Therefore, leaflets with general health information and impersonal medical checks are no longer of interest.
  • Communication and information access is transparent and safe (Kayyali et al., 2017). Software and cloud platforms guarantee secure data exchange.

With the implementation of digital health research solutions, research institutions and stakeholders have started to adopt patient-centered care to catch up with today’s healthcare demands. In fact, numerous studies reveal the perceived potential of digital health research and mHealth. For instance, an international study conducted across the USA, China, Brazil, and India (Kayyali et al., 2017) showed that 89% of healthcare practitioners, 75% of patients, and 73% of users, believe that digital health research and mHealth can improve real-life outcomes.

Digital health research & Smartphones | Research Has Never Been So Accessible

Digital health research is popular among users as it involves the usage of mobile devices. As mHealth is supported by the wide use of mobile tools, researchers also benefit from technology. The impressive computing and communication capabilities, such as text messages and GPS, facilitate data collection, management, analysis, and communication. Not surprisingly, mobile devices have replaced personal digital assistants (PDAs) and pagers. With their advanced features, such as maps, high-resolution screens, powerful operating systems, and compact sizes, mobile devices and smartphones, in particular, are more user-friendly, accessible, and effective (Ventola, 2014).

To sum up, the use of mobile devices gives researchers access to:

  • A wide variety of computing and connectivity abilities
  • Millions of potential participants
  • Cost-effective techniques

Digital health research & Health Apps | Just Pick a Topic

Mobile devices support the increase in popularity and effectiveness of digital health research. So do apps. Health apps are medical software programs designed to run on a mobile device and accomplish a certain goal (Ventola, 2014).

From studying diabetes to fitness, health apps offer an interactive way to reach participants and provide a systematized approach to data management. The only thing people need to do is download an app. On top of that, cloud computing offers numerous data storage options, which guarantees safety. Note that consent forms are also being integrated into app-based research. Thus, researchers can forget about time-consuming paperwork, medical records, and additional output, and participants can be sure that their data is safe and confidential.

Digital health research & Health Apps | Just Pick a Topic

Mobile devices support the increase in popularity and effectiveness of digital health research. So do apps. Health apps are medical software programs designed to run on a mobile device and accomplish a certain goal (Ventola, 2014).

From studying diabetes to fitness, health apps offer an interactive way to reach participants and provide a systematized approach to data management. The only thing people need to do is download an app. On top of that, cloud computing offers numerous data storage options, which guarantees safety. Note that consent forms are also being integrated into app-based research. Thus, researchers can forget about time-consuming paperwork, medical records, and additional output, and participants can be sure that their data is safe and confidential.

Digital health Research| Utility

Achieving meaningful results to improve patient’s lives has always been the main objective of the research. In fact, patients’ well-being is the main reason why digital health research solutions broaden research and benefit medical findings. Neurological, cognitive, biological and even environmental studies can only gain from technology. Not surprisingly, researchers use apps as they have realized the advantages of mobile devices and applications. By implementing technology into healthcare, medical professionals, programmers and patients work together towards the future of medicine.

Digital health Research| Utility

Digital health research & Clinical Trials

As clinical trials play a crucial role in research, digital health research can only benefit studies (“Software-enabled clinical trials,” 2017). More and more companies implement technology into practice and move to digital data. Virtual trials (conducted outside of the hospital) and digital biomarkers (sensors and wearables) are popular among experts. With tech and interoperability innovations, digital health research leads to effective recruitment, cost-effective methods, rich data, and meaningful analyses.

Digital health research: The Practical Side

Digital health research is powerful. However, researchers need to consider some vital aspects when initiating app-based research and digital clinical trials:

Design: Designing research is a long process and developing an app adds some additional demands to the study. Data shows that the average time for creating an app is about 18 weeks. Note that user testing with real end-users is crucial. Testing includes usability testing, and usability inquires. Usually, usability testing evaluates interfaces and protocols. On the other hand, usability inquiries include surveys and interviews to assess users’ experiences and needs.

Usability: When designing an app, researchers and sponsors need to focus on design and usability. Having more usable applications will foster engagement and motivation (Zapata, 2015). Research shows that to be successful, apps must be easy to use. In fact, usability is defined as the facility people can use a technological tool to perform a task and achieve a goal. Usability can determine research success. According to the ISO/IEC9126–1 quality model usability involves understandability, learnability, operability, and attractiveness. These aspects aim to achieve efficiency, effectiveness, and satisfaction. For instance, users report that the color black and small letters are not attractive. Experts need to consider the fact that elderly users are not interested in gaming apps and younger adults perform online tasks faster. Programmers need to understand that a monotonous interface and too much text decrease learnability and efficiency. Difficulty in scrolling and navigating menus also need to be considered.

Reminders: In fact, talking about designs and usability, it’s been proven that push notifications facilitate clinical trials, research, and treatment. By integrating reminders in an app, experts can engage users and help them manage their drug intake better, for example. Of course, reminders should not be invasive.

Relevance: Creating a health app might be exciting, but programmers, patients, and medical professionals need to work together to create a relevant app. Users should not be presented with confusing apps, experts should not be overwhelmed with complex analytics, and healthcare providers should not experience technology fatigue in their already stressful working environment. In other words, additional administrative and technology burden should be avoided.

Mobility: When it comes to digital health research, experts need to take advantage of the mobility aspect related to digital health research. Smartphones take patients away from clinics and labs. What’s more, technology can connect devices, solutions, and institutions and improve practices (“mHealth…What does it really mean?” 2014).

Time & Costs: The development of a health app needs to be relevant and effective. That means that technology should reduce doctor’s visits, interventions, and readmissions. Data should be used effectively to reduce costs. In fact, when it comes to digital recruiting, data shows that virtual trials can cost half as much compared to a traditional on-site study (“Software-enabled clinical trials,” 2017).

Safety: Technology connects systems, scenarios, and institutions. As technology solutions provide real-time updates from a wide range of inputs, safety needs to be considered. Note that stakeholders also need to have access to information, which should be confidential and secure. Data exchange needs to be supported by protocols, consent forms, and safe cloud platforms.

Personal Characteristics: Most of all, healthcare technologies should focus on patients. Personal characteristics, such as age and education, need to be considered. It’s interesting to mention that a study on diabetes showed that people felt the need of social interactions, chat rooms, and forums (Kayyali et al., 2017). What’s more, each topic of research requires different study methods and approach, so apps need to be personalized and efficient.

Digital health research: Conclusion

The topic of digital health research is gaining more and more popularity. Telemedicine and mHealth are becoming an everyday practice for trials, research, and treatment. Digital health research solutions are widely used, and the number of companies and institutions that implement technology into practice is increasing (“Software-enabled clinical trials,” 2017). That’s not surprising. Smartphones and apps are popular among users – with fitness and nutrition apps being on the rise. To answer users’ demands, interactive designs should follow the main principle of usability. Therefore, visual functions, such as graphs, videos, and games, need to be incorporated without decreasing the levels of learnability and understanding.

To sum up, the main purpose of digital health research in research is improving patients’ well-being. Technology makes businesses more competitive – all with a focus on consumers. Patients are active participants who have access to information and who use personal and sophisticated tools to manage their conditions. Most of all, digital health research aims to make healthcare accessible and affordable – regardless of age, background and location (“mHealth…What does it really mean?” 2014).

Digital health research is not a futuristic theme in a sci-fi film: it’s a real shift in medical practices worldwide. Digital health research has created a whole new ecosystem; an ecosystem where stakeholders, researchers, healthcare experts, and patients work together to improve people’s health and well-being.

References

Kayyali, R., Peletidi, A., Ismail, M., Hashim, Z., Bandeira, P., & Bonnah, J. (2017). Awareness and Use of mHealth Apps: A Study from England. Pharmacy (Basel), 5 (2).

mHealth… What Does It Really Mean? (2014). The Journal of mHealth, 1 (2).

Software-Enabled Clinical Trials (September 4, 2017). Retrieved from https://blog.andreacoravos.com/software-enabled-clinical-trials-8da53f4cd271

Ventola, C. (2014). Mobile Devices and Apps for Health Care Professionals: Uses and Benefits. Pharmacy & Therapeutics, 39 (5).

Zapata, B., Fernandez-Aleman, J., Idri, A., & Toval (2015). Empirical Studies on Usability of mHealth Apps: A Systematic Literature Review. Journal of Medical Systems, 39 (2).

NBC News

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2:35 onward, NBC talking about QOLTY being used in a Sickle Cell trial. Exciting to see our work and customers being featured on the news!

Impact of Exercise on Progression of Neurodegenerative Disease (UCLA)

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Overview

Impact of Exercise on Progression of Neurodegenerative Disease

UCLA partnered with HexCare to utilize wearable technology to assess the impact of exercise on Alzheimer’s disease. Patients with Alzheimer’s disease were enrolled to determine the impact of activity level on functional brain imaging studies.

Challenges Overcome

1. Lack of established standard for exercise capacity in neurodegenearative disease
2. Poor smartphone penetration

Project

Exercise + Neurodegeneration

Technology

FHIR Standards

Fitbit Flex

Medical

Steps as Proxy for activity.

EMR integration for patient record analysis

CHLA

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Overview

Children’s Hospital Los Angeles partnered with Qolty, utilizing a multimodal approach to encourage and monitor weight loss in an obese pediatric population. 120 children are enrolled in this trial to identify activity patterns critical to meaningful weight loss.

Challenges Overcome

1. Low-income patient population
2. Poor internet access
3. Lack of mobile phone penetration

Project

Obesity in the pediatric population with CHLA

Technology

Fitbit Flex

EHR Data

Medical

120 patients in the pediatric population

EASI PRO

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Overview

USC is collaborating with Qolty to integrate patient-reporated outcomes into Cerner. Qolty will provide patients with a smartphone app where they can take PROs from home. The responses will be securely sent into Cerner, where clinicians can view the data and make decisions that will improve patient care and improve outcomes.

Qolty is a subcontractor for EHR Access to Seamless Integration of PROMIS (EASI-PRO), which will make it easier for researchers and clinicians to collect patient reported outcomes information and use it to improve clinical care and research. By only asking the most relevant questions, PROMIS has the potential to make the surveys up to 10 times shorter, so it is less of a burden on those taking it.

Patient Reported Outcomes Measurement Information System (PROMIS) are a set of NIH sponsored computerized survey tools that changes depending on the patient’s answers, and will be integrated into the Electronic health records of 10 universities across the United States.

Project

EASI-PRO

Technology

Navigation of interoperability FHIR Standards

Secure integration of patient reporrted data

Medical

Integration of over 200 PROMIS Assessments 

How it Works

Streamline survey delivery to your patients

Stay organized with the Qolty platfoirm, and setup administrator or member roles. Everyone on your team has the ability to create and invite patient collaborators to help your team stay aligned visually.

Multiple Data Capture Options

  • Organizational or departmental patient portal enrollment
  • Easy registration
  • In-clinic data collection option
  • Home assessments
  • See if assessment due and/or not started

Contextualized Data

  • NIH PROMIS data in context and contextualized.
  • Patient portal to self track data and visualize their own inputs

Network

Key Partners