With its ability to extend care into the home for all patients, including high-risk and high-acuity patients, and provide a data-first approach to healthcare, this next generation of RPM holds the key to reshaping the health care system into one that will work better for patients and providers alike.

Remote patient monitoring (RPM) is not new. In fact, products like HomMed (now owned by HoneyWell) and Cardiocom (now owned by Medtronic) are over a decade old. While Covid-19 has created new buzz around virtual care, many health systems have been doing some form of remote health monitoring for many years.

However, in recent years, RPM has fundamentally evolved, enabling more sophisticated clinical monitoring. Legacy vendors known for their medical devices now struggle to horizontally integrate software, hardware, and user experience together into a single platform while newer companies have taken advantage of advances in IoT, artificial intelligence, and cloud computing to expand the possible clinical use cases for RPM. Moreover, changes to Medicare reimbursement and the introduction of value-based payment models, such as the Quality Payment Program (QPP) and the Hospital Readmissions Reduction Program (HRRP), have created greater financial incentives for RPM. And of course, COVID-19 has further reduced financial barriers to adoption and proven the value and demand for managing care within the home.

In the same way the internet went through a seismic shift in the early 2000’s as it went from Web 1.0 to 2.0, RPM is experiencing a similar evolution that is poised to transform care delivery as we know it.

So, what does this next generation of RPM – RPM 2.0 – look like?

Home-based care for chronic disease

Many of the resource issues in the US and UK can be attributed to our management—or lack of management—of chronic disease. According to the CDC, 90% of the $3.5 trillion dollars spent on healthcare annually is spent on those with chronic health conditions. Today, with healthcare being primarily delivered within the four walls of the hospital, our system is structured to deal with acute needs far better than long-term management of disease.

For chronically ill patients, the next generation of RPM can allow healthcare to be extended into the home and, for the first time, allow safe preventive and proactive management of higher-risk patients, while also dramatically reducing healthcare costs. RPM 2.0 can be used to help post-acute transitions of care for high-risk patients to accelerate discharge home, improve recovery and reduce readmissions. Today, between 15-25% of people discharged from a hospital will be readmitted within 30 days, largely because patients are not able to identify signs of deterioration until it’s too late. With RPM 2.0, providers can offer continued surveillance post-discharge that allows them to intervene or adjust a care plan based on real-time, continuous patient vitals from home. By offering hospital-grade monitoring at home, RPM can also eliminate the need for high-risk patients to be admitted into a hospital in the first place. With 24/7 insight into patient vitals and the ability to identify early signs of deterioration, hospitals can provide acute hospital care within the home, freeing up hospital capacity and enabling a better care experience for patients.

Data-first remote monitoring

One of the greatest challenges to delivering remote care to higher-risk, higher-acuity patients, such as those with COPD, cancer, or diabetes, is obtaining high-quality, clinical-grade data. For these patients, health deterioration can happen quickly and with significant consequences. While intermittent monitoring may be appropriate for lower-risk populations, safely managing sick and higher-risk patients at home requires more than a daily blood pressure reading.

The winners in RPM will be those who do not see themselves as device companies, but rather, as data companies. Monitoring devices are simply a means to capture a patient’s health data. It is making sense of that data that truly adds value to providers so that they can understand patient health at home. Gaining insight that can meaningfully impact care decisions requires deeper tracking of human health at home, particularly with continuous data.

Actionable insights

One of the reasons that intermittent blood pressure and weight measurements have been the mainstay of RPM for decades is because they are easy to operationalize and clinically manage. For many within healthcare, the thought of continuous health data may seem excessive, especially since legacy products set an expectation that every data point requires clinical attention to review.

But data should be seen as simply a raw input rather than the final product. Providers should not have to review individual data points, but instead, they should be given actionable insights. The next generation of RPM platforms should serve as a call to action when a patient’s health is deteriorating, or better yet, if there is a probability of deterioration in future that warrants proactive treatment.

While capturing a deep picture of patient health is critical to managing chronically ill patients, it’s the sophisticated monitoring capabilities that allow providers to do this at scale. By looking beyond a single data point to sustained trends across multiple vital signs, clinical monitoring is what separates the signal from the noise and can allow more efficient use of providers’ time, ultimately improving patient outcomes and cost of care.

Integrated intervention

Ultimately, the ability of RPM to improve healthcare delivery is contingent on the intervention. It is not enough to identify health deterioration if there is not a quick or easy way to intervene. While this aspect of RPM receives the least focus, it is the most important. An intervention doesn’t need to be complicated. In fact, it can be as simple as scheduling a same day telehealth visit. However, even when it does become more complicated, involving additional services such as pharmacy delivery or in-home emergency care, better outcomes require integrated and coordinated services to allow for rapid intervention.

With its ability to extend care into the home for all patients, including high-risk and high-acuity patients, and provide a data-first approach to healthcare, this next generation of RPM holds the key to reshaping the health care system into one that will work better for patients and providers alike. As health systems continue to search for ways to improve their care delivery model, RPM will continue to evolve to meaningfully shift care outside the hospital and move healthcare from a reactive to a proactive model.

Source: MedCityNews

Data analytics strategy represents a сomprehensive approach to handle massive data sets with specific technologies. The data analytics process is quickly permeating many industries, especially the healthcare industry.

In the healthcare industry, data analytics yields almost immediate benefits with measurable results and actionable insights. The benefits of data analytics in healthcare are majorly divided in two categories; reducing the cost of treatment and improving patient outcomes.

By analyzing available data, doctors can quickly learn about their patients’ medical history, allergies, and illnesses they have suffered at different points in their lives, providing insights into the patient’s current health status.

Doctors’ can also see the earliest warning signs of diseases and tackle such illnesses at their first stages, thus improving treatments.

With healthcare analytics, doctors can make accurate predictions, track risks for chronic diseases, monitor a patient’s response to treatment more efficiently, manage staffing and inventory, and generally improve patient care. Below are some of the ways in which data analytics in healthcare works to improve healthcare delivery.

Improving patient outcomes

By providing real-time data to bolster medical evidence, analytics can quickly provide relevant insights on health data related to patient wellness for making better decisions and improving the quality of treatment and patient safety. Custom healthcare software development helps collect and transform data into actionable insights, improving patient care and medical support. Physicians can identify high-risk patients and possible complications, helping them to intervene faster and more efficiently.

In the United States, over 90% of hospitals ensure the seamless transfer of patient data across all medical facilities using Electronic Health Records (EHRs). Each patient has a digital and adjustable health record that captures every useful piece of information that can help healthcare providers form accurate opinions about a patient’s health status.

This completely eliminates needless paperwork, decreases office visits, eliminates repetitive lab tests, streamlines the process, and generally improves outcomes.

Bolstering patient engagement

Healthcare analytics also improve patient engagement by actively involving them in their healthcare. There are certain situations where patients are asked to wear smart health devices that track changing vital signs such as heart rates, blood pressure, blood sugar level, etc.

With these smart devices, patients can monitor changes in their physical conditions and update their digital record with real-time data which their physician can access and give them feedback even without a hospital visit. This significantly cuts back unnecessary hospital visits, so healthcare providers focus on more important cases. The more patients are actively involved in their healthcare, the better they are motivated to live healthier lives.

Predicting risk of chronic diseases

Chronic disease treatment is known to be one of the most expensive in the healthcare industry. The majority of factors that affect health conditions are hidden in patients’ daily lifestyle choices and health habits. Therefore delivering the best possible medical care will mean considering these factors and developing an encompassing analytics model for predicting the risk of certain diseases.

Capturing the relevant metrics data analytics can predict which patients are at higher risks of certain chronic disease development or recognize the earliest warning signs and move quickly to address such disease at the initial stage. Predictive analytics is a big part of data analytics, as it can help doctors circumvent preventable illnesses and tackle chronic diseases before they get out of hand.

Source: Analytics Insight

Extracting household patient EHR data proved to be as effective at tracking transmission as COVID-19 contact tracing, according to a research letter published in JAMA Network Open.

Because COVID-19 is primarily transferred by person-to-person contact through respiratory droplets in households, researchers aimed to find out if healthcare professionals could leverage EHR home address data to identify COVID-19 risk factors and estimate transmission risk.

Researchers analyzed EHR COVID-19 data between exposed children and adults from Mass General Brigham between March and May 2020. Researchers compiled data from all patients registered at the addresses of index cases but excluded patients who did not have at least one health system visit within the last 60 months.

Overall, researchers evaluated 7,762 index cases between 17,917 at-risk individuals. Using EHR data, researchers found a 10.1 percent overall household infection risk, or 1,809 COVID diagnoses. This transmission risk percentage was consistent with traditional contact tracing, the study authors wrote.

“Independent factors significantly associated with higher transmission risk included age greater than 18 years and multiple comorbid conditions,” the study authors wrote. “In sensitivity analyses limiting the maximum size of the household to as small as 2 persons, the calculated transmission risk increased to only 13.8%.”

Although EHRs proved to be useful to track COVID-19 patients, relying on home address EHR data was also a major limitation, wrote the research team. The study authors said leveraging home address data could lead to undercounting and overcounting household members.

There currently isn’t a great fix for that issue, but nevertheless, the researchers contended the EHR-based strategy was effective.

“Although we acknowledge that contact investigations are the standard approach for estimating household transmission risk, we believe that the consistency of our results with these approaches suggests that our approach may provide a more efficient method for risk estimation and household contact identification,” the study authors explained. “Moreover, our sensitivity analysis indicated that the results were qualitatively similar when restricted to smaller households.”

Overall, EHR data could support COVID-19 control efforts, so as long as adequate infrastructure is in place to put this to scale.

Developing, implementing, and assessing a plan for EHR systems and public health information systems require a boost in health IT, governance, and overall strategy, according to a separate study published in The Journal of the American Medical Informatics Association (JAMIA).

COVID-19 response efforts have included the collection and analysis of individual and community EHR data from healthcare organizations, public health departments, and socioeconomic indicators. But those resources haven’t been deployed the same way in all healthcare organizations, the researchers stated.

An analysis of COVID-19 response efforts from 15 healthcare organizations that saw delays in correctly understanding, predicting, and mitigating the COVID-19 spread highlighted some pitfalls.

The research team determined a number of steps that could help organizations in the current and future steps to mitigate the pandemic. The researchers’ recommendations may also help in future public health crises.

Health IT infrastructure needs to support public health that leverages EHR systems and associated patient data, but it cannot be developed and implemented right away, the researchers wrote.

Additionally, having better control of the timeliness of data analysis will be essential. Because analytic methods do not always give real-time results, it is easy to overlook or underuse EHR data.

Researchers also found public health information infrastructure does not currently support larger-scale integration. Due to this issue, health organizations have been largely unable to gather information during the pandemic because it requires multiple data submissions to a number of agencies.

Source: EHR Intelligence

A group of health IT developers and stakeholders, including Epic and Cerner, formed a digital COVID-19 vaccine coalition to support patients with secure access to vaccine records.

Several health IT vendors, organizations, and stakeholders, including Epic and Cerner, announced the formation of the Vaccination Credential Initiative (VCI), which aims to give individuals digital access to their COVID-19 vaccination records.

The VCI is made up of CARIN Alliance, Cerner, Change Healthcare, The Commons Project Foundation, Epic Systems, Evernorth, Mayo Clinic, Microsoft, MITRE, Oracle, Safe Health, and Salesforce.

The group is currently developing a standard model for health organizations administering the COVID-19 vaccine. The effort is designed to make the results available to individuals in an interoperable and accessible digital format.

Currently, the current digitized vaccination record system does not streamline the control, distribution, or access to vaccination records.

“A secure, convenient solution to verify COVID-19 vaccination will play an important role in accelerating a healthy and safe return to work, school and life in general,” Joan Harvey, president of care solutions at Evernorth, Cigna’s health services business, said in a statement.

To achieve this goal of digitalization, VCI members are utilizing open, interoperable SMART Health Cards specification, based on W3C Verifiable Credential and HL7 FHIR standards, the coalition explained. The goal is to store this patient immunization data in digital wallets.

Individuals without smartphones would be able to obtain a printed paper with QR codes to obtain credentials, according to the coalition.

To David Bradshaw, senior vice president of Consumer and Employer Solutions at Cerner, the initiative will help improve data exchange standards, while supporting patients the ability to easily access and share “verified vaccination information via their mobile device in situations where proof-of-vaccine is necessary.”

The coalition is working together to develop a safe and secure way for individuals to access their COVID-19 vaccination records. Digitalizing these documents can enhance patient matching and expedite the time it will take for individuals to return to work, school, traveling, and extracurricular activities.

“As we explore the many use cases for the vaccination credential, we are working to ensure that underserved populations have access to this verification,” said Brian Anderson, MD, chief digital health physician at MITRE, in a statement. “Just as COVID-19 does not discriminate based on socio-economic status, we must ensure that convenient access to records crosses the digital divide.”

“As the world begins to recover from the pandemic, having electronic access to vaccination, testing, and other medical records will be vital to resuming travel and more,” said Mike Sicilia, executive vice president of Oracle’s Global Business Units, in a statement. “This process needs to be as easy as online banking. We are committed to working collectively with the technology and medical communities, as well as global governments, to ensure people will have secure access to this information where and when they need it.”

The initiative comes on the heels of several EHR vendor collaborations, including Cerner and MEDITECH, which recently developed an EHR-integrated COVID-19 vaccination solution for their respective customers.

Truman Medical Centers and University Health in Missouri integrated Cerner’s solution last month. Truman was one of the first 150 hospitals across the country to receive and successfully deploy the vaccine and the health system had to successfully optimize its EHR workflow to send its test results to the state’s reporting program.

“We looked to Cerner as a partner because they had a playbook for mass vaccination that was previously utilized at a couple of test sites,” Heather Gleason, senior director IT applications at Truman Medical, said in an interview with EHRIntelligence. “We wanted to integrate ‘smart technology’ to make sure that we can get people quickly in and out of the vaccination process.”

Source: EHR Intelligence

St Mary’s hospital was slated for a £1bn redevelopment before the pandemic struck, with work due to start in 2027. The main emergency and specialist hospital serving north-west London will still get its upgrade, but it might look quite different now. “Covid-19 has dramatically changed things,” says James Kinross, a surgeon who works at St Mary’s and sits on its redevelopment planning committee.

Before the pandemic, Kinross says, the committee’s goal was to improve the efficiency of existing care pathways; now it’s to rethink those pathways entirely. St Mary’s is a test case, but the shape of healthcare is being reconsidered everywhere and that has major implications for the way hospitals will look in future.

George Mann, an architect and pioneer of evidence-based hospital design at Texas A&M University in College Station, compares the coming transformation to that of commercial airports in the past. The first airports resembled train stations, because it took people time to realise that transport would never be the same again. “I don’t think we totally understand that we’re in the middle of a paradigm shift,” he says.

That might sound like hyperbole, given the eternally cash-strapped state of many healthcare systems and the anticipated economic downturn due to Covid-19, but think of the changes the pandemic has already forced through. The Chinese built a hospital in 10 days, while in many countries medical consultations shifted online. Meanwhile, existing hospitals – even and perhaps especially in the wealthy global north – buckled under the sudden, immense strain.

Pictures flashed around the world of Covid-19 patients sitting in their cars outside a hospital in Naples, breathing oxygen from tanks. Non-Covid patients have seen their potentially life-saving treatments postponed indefinitely, while hospitals have themselves seeded Covid clusters.

None of this is surprising, says hospital architect Thomas Schinko of Vasconi Architectes in Paris, because the world’s richest countries have all but eliminated the concept of contagion from their hospitals, infectious diseases no longer being the biggest killer there. “We’ve lost that reflex of protecting personnel from patients or patients from other patients,” says Schinko. Result? “Our health systems are completely unadapted to this kind of disease.”

The pandemic has accelerated some trends, such as the one to a “hospital without walls” – the hospital conceived as a digitally connected community rather than a circumscribed physical space. The twin pillars of digital health are electronic health records (EHRs), which allow patient information to be shared across health systems, and telehealth, which allows patients and physicians to communicate at distance.

“Almost overnight we’ve gone from face-to-face consultations to the vast majority being by phone, text or online.”

Many countries had been moving towards both since the 1990s, but at different speeds and with different degrees of success. In the UK, for example, most GP surgeries now use EHRs, but hospitals are further behind. There are genuine obstacles to embracing digital health provision, says Saira Ghafur, a respiratory physician and the lead for digital health policy at Imperial College London’s Institute of Global Health Innovation. These obstacles include inequality of access to IT and concerns about cybersecurity.

The risk of cybersecurity breaches was dramatically highlighted in 2017, with the WannaCry hack of the NHS, while in the last year US hospitals have seen a wave of them. Such breaches can happen in any tech-enabled industry or domain, but the case in September of a patient who died during a cyber-attack on a German hospital served as a reminder that the stakes when it comes to healthcare are the highest.

Nevertheless, Ghafur says, since Covid, during which we have experienced the benefits of receiving care in the comfort of our own homes, such obstacles seem surmountable. “Almost overnight we’ve gone from face-to-face consultations to the vast majority being what we’d call digital-first – by phone, text, video call or online,” she says. “That has fundamentally changed the way that we deliver care.”

And she thinks those changes are here to stay. The results of a survey of nearly 10,000 patients in London, which her group will publish soon, suggest that in general they want more, not less, digital healthcare. Though it certainly doesn’t suit everyone, in future people will have more choice in how they access healthcare – being able to mix and match channels.

With the move to digital, Schinko says, we’ll see medicine becoming more preventive, as well as more personalised and precise. Patients with asthma and diabetes are already used to monitoring their peak flow and blood sugar (respectively) through dedicated apps, for example. And the adoption of a more “salutogenic” approach, which emphasises health rather than disease, is visible in China and the US, which have invested heavily in digitisation.

In China, for example, the care pipeline for infectious disease starts at the airport, with routine temperature checks (even outside a pandemic), while the Children’s Hospital of Philadelphia, considered one of the most technologically advanced in the US, offers services through its web portal and in 2019 launched a pilot telehealth programme in schools. The goal, in each case, is to prioritise surveillance and early intervention.

This is the hospital without walls – the hospital that is everywhere, embedded in our lives. And since some medicine will always require patients and medical personnel to meet, it will inevitably shape the places where that happens, too. Kinross says that before the pandemic, the St Mary’s planning committee was considering shifting resources from inpatients to outpatients. Now they’re thinking more boldly. “Maybe we can just do away with some aspects of outpatients and deliver all of this care outside the hospital,” he says. “Maybe we can leverage digital in a radical new way.”

Kinross envisages primary- care physicians or GPs taking on more responsibility (aided by decision-support technology), secondary care or specialist doctors spending more time in the community and an expansion of social care. Hospitals as physical entities will become specialist hubs, he says, with each specialism concentrated at one or a few hubs within a region, rather than replicated across many generalist hospitals.

Such a health system might have been better equipped to manage this pandemic, and reduce its impact, but it’s unlikely to have prevented it. Since future pandemics are inevitable, and since we don’t know when or where they will emerge, how should healthcare systems prepare? “What we can’t afford to have is lots of empty beds in hospitals doing nothing, waiting for a once-in-a-century surge,” says Kinross.

Hospitals plan for all kinds of mass casualty events. But as John Mazziotta, who runs the University of California, Los Angeles (UCLA) healthcare system, said in a recent podcast, planning is easier when these events involve a sudden influx of patients whose numbers then taper off. “This [pandemic] is a mass casualty event that evolves in slow motion in the other direction and keeps getting worse until it peaks, and it was harder to plan for,” he said.

Several solutions have been proposed. All patient rooms at the Ronald Reagan hospital, which was opened on the UCLA campus in 2008, can be converted into intensive care rooms and all of them can be switched to negative pressure, which stops airborne germs from escaping the room. Similarly, after the Asian epidemic of severe acute respiratory syndrome (Sars) in 2003, Singapore and Hong Kong adapted their hospitals, equipping them and developing protocols so that they could be transformed quickly in the event of an epidemic.

The disadvantage of this approach is that the disease may erupt far from the hospital, so an alternative solution is to rapidly build a facility dedicated to the detection and treatment of epidemic patients where it is needed, as the Chinese did during Sars, completing the Xiaotangshan hospital in Beijing in just seven days. They replicated that feat several times this year, building Wuhan’s Huoshenshan hospital in 10 days, for example. Made out of prefabricated units, Huoshenshan incorporated testing and research labs and accommodation for personnel.

Other countries built fast too, in response to Covid-19. Surge hospitals went up all over the US last spring, while the UK constructed the temporary Nightingale hospitals. But many of these were underused or not used at all, sometimes because they were understaffed. Architect Huang Xiqiu of the China IPPR International Engineering Corporation in Beijing, who designed both Xiaotangshan and Huoshenshan hospitals, says that the facility alone is not enough: “A systematic approach should be followed.”

That involves conceiving of the temporary hospital as part of a larger city- or area-wide disaster prevention plan, organising on-site stores of medical and protective equipment, maintaining a roster of available, qualified staff and setting up an emergency command centre to oversee the execution of the disaster plan. It helped, in China, that the state assumed all the costs of the Covid-19 response.

Annmarie Adams, a historian of hospital architecture at McGill University in Montreal, says that it’s no coincidence the UK’s temporary Covid-19 hospitals are named for nursing pioneer Florence Nightingale. Architecturally, they mark a return to the “pavilion plan” favoured in the 19th century, when infectious diseases were still the biggest killer globally and ventilation was considered key. The original Nightingale ward had a barracks-like arrangement of bed-window-bed-window embedded, usually, in plenty of green space. After the advent of antibiotics, the pavilion gave way to the “hospital-as-office-tower” model, which bundled the specialties together in the name of efficiency and relied on those very antibiotics, along with hygiene, to keep infection at bay. Not surprisingly, this model has proved the least well adapted to a novel viral disease. “We became addicted to antibiotics,” says Mann.

If the hospital of the future is a specialist hub, digitally embedded in the community, those that specialise in infectious disease must also be capable of responding to an epidemic, meaning that they must have built-in flexibility. Luca Aldrighi, a hospital architect with RMJM Prague in the Czech Republic, envisages a pavilion-monoblock hybrid. “In my opinion, the future of the hospital is to take the best of these two layouts,” he says.

There are different ways of achieving that, but one way he could imagine is to have pavilions surrounded by gardens or piazzas and connected underground. In the event of a surge, the pavilions could be expanded into the surrounding space through the addition of modular units.

Hospitals don’t just reflect the evolution of medicine, Adams says. They are also shaped by wider cultural influences. Hospitals that once looked public, resembling prisons and other reform institutions, now look more like hotels, shopping malls or airports, reflecting a more consumerist culture. Nevertheless, she agrees that adaptability will be the watchword in the post-Covid-19 world, which has learned that it is still vulnerable to infectious disease. As she said recently: “I suspect hospital architects will focus on preparing for the unexpected.”

Source: The Guardian

Allscripts, athenahealth, Cerner, DrChrono, Epic, Greenway Health, Meditech and NextGen offer an up-to-the-minute look at how they’re enabling complex immunization recordkeeping for their health system customers.

Never in the history of electronic health records has there been a more important public health recordkeeping task than the one that is at hand at this very moment in the nation’s history: tracking COVID-19 vaccinations.

As a result of this all-important development, EHR vendors from across the industry have been preparing their products and their healthcare provider organization users to make sure that when a patient receives this critical vaccination, it is recorded correctly, pushed to the necessary parties, and is accessible now and in the future by all the appropriate caregivers.

Healthcare IT News discussed this huge issue with top executives at Allscripts, athenahealth, Cerner, DrChrono, Epic, Greenway Health, Meditech and NextGen Healthcare.

They offered insights into preparations that began earlier this year, described the changes they’ve made to their EHR systems and discussed how they’ve been rolling out – and helping train for – these new design and workflow changes.

Preparations and initial thoughts on the vaccines and EHRs

Meditech has had its Coronavirus Task Force up and running this year, assisting clients through all stages of their pandemic response.

“As word of a vaccine started to circulate, we were already working with customer advisory boards to determine what steps would be needed for preparation, looking to our Immunization Registry and patient registries as solutions for tracking and reporting on vaccine administration,” said Helen Waters, executive vice president at Meditech. “We are fully vested in ensuring our customers are well-positioned to hit the ground running.”

The EHR maker said of course its work required guidance from the CDC, HHS, public health officials and industry organizations. These efforts ramped up on Oct. 29, when the company attended the CDC Operation Warp Speed Town Hall.

"The CDC informed us of the vaccine codes that would be available and urged vendors to build these codes into their system ASAP." - Helen Waters, Meditech

“Here, the CDC informed us of the vaccine codes that would be available and urged vendors to build these codes into their system ASAP,” Waters explained. “Since the codes were released on Nov. 12, we have updated our customers by sharing these codes along with vaccine guidance. Also, we immediately began working with our interoperability team to review the CDC’s HL7 draft specifications.”

Meditech continues to attend weekly EHRA/CDC breakout meetings to monitor evolving updates provided by the CDC. In addition, it is collaborating with its Meditech User Group, MUSE, and soliciting feedback from its customer base through email surveys.

“Providing the solutions and guidance to support our customers through this critical venture and bring an end to this pandemic remains Meditech’s top priority, with all divisions fully invested in these efforts,” Waters said.

Getting provider clients up to speed

Cerner began preparing for potential COVID-19 vaccines back in April as cases were rising in the U.S. It then ramped up efforts by mid-summer to make sure its solutions and clients were ready.

At that time, Cerner recognized that some of its clients would play a community-wide vaccination role and would need a patient-first strategy that included tools outside of the company’s core EHR workflow.

“When it became clearer in October that an approved vaccine was likely in early 2021, we engaged with the CDC and some of its information technology suppliers in order to successfully interoperate with federal and state registries,” said Dr. David Nill, vice president and chief medical officer at Cerner. “We needed to make sure that our clients were ready on the IT front to handle such a monumental and important task.”

Cerner was able to put in place many of its model recommendations for the fall flu campaign, gaining insights to modify the workflow based on recommendations for COVID-19 vaccine administration, he added.

At NextGen Healthcare, preparations for vaccine administration and reporting began several months ago. Dr. Robert Murry, chief medical information officer, said the EHR vendor initially focused on the four areas most important to its ambulatory clients:

How to equip the EHR to be able to document vaccine administration (with new CPT/CVX codes, inventory control, VIS sheet, etc.) for large numbers of people, both in the context where the patients are current patients and where they may not be.

How to equip the EHR to be able to report to appropriate agencies the vaccines that the practice administers, for example, a state immunization registry.

How to equip the EHR to be able to do electronic case reporting of COVID-19 (and eventually immunizations, a kind of alternate reporting mechanism).

How to equip the EHR, if needed, to be able to report any adverse outcomes from vaccine administration.

From Jan. 29 to today

EHR company athenahealth has been focused on rapidly responding to the COVID-19 pandemic and supporting its customers all year.

“We made the first COVID-driven changes available to all our practices back on Jan. 29 when there were only a handful of confirmed cases in the U.S.,” said Paul Brient, chief product officer at athenahealth. “We deployed COVID screening questions, diagnostic test orders and direct links to the latest CDC recommendations to all our providers overnight.”

"We engaged with the CDC and some of its information technology suppliers in order to successfully interoperate with federal and state registries." - Dr. David Nill, Cerner

The vendor is fortunate to have a cloud-based, single-instance EHR that enables changes to be made quickly and immediately available to all provider clients, he added.

“Since then, we have pushed out approximately 150 updates ranging from updated assessment content to align to initial CDC travel and exposure guidance, to updated code sets for COVID-19, to patient testing and risk dashboards for our practices to monitor their panels, to workflow enhancements for remote and in-car check in – all delivered immediately in the cloud to the entire athenahealth network,” he explained.

The company’s preparedness for a COVID-19 vaccine began in spring 2020. It kicked off a research effort to understand how its practices were managing their patient populations with risk stratification, patient outreach and testing protocols. It also spent time learning what it could from experience with past flu vaccination efforts. All these learnings are foundational to identifying and engaging patients as COVID-19 vaccines become available, Brient said.

“As more details of vaccines emerge, we have a team of subject matter experts working to understand the requirements and distribution guidelines defined by the federal government and states in order to provide best practice workflow recommendations and support to our practices,” he said.

“This includes staying abreast of registry updates, partnering with clients that are participating in early vaccination efforts, and making updates to our global compendiums and code libraries as soon as they are available.”

Talking with HHS, the CDC and Warp Speed

Allscripts has been participating in conversations with HHS, the CDC and Operation Warp Speed through the course of the pandemic, most recently meeting weekly to address the need to track and report vaccine administration.

“The good news is that there are no changes yet from a federal perspective that require EHR development because we have met the existing ONC certification requirements associated with connectivity to immunization registries,” said Leigh Burchell, vice president of government affairs at Allscripts.

“The only area in which we are finding ourselves having to do new development specific to tracking the COVID-19 vaccines is where some states are requesting the transmission of unique data elements. We certainly favor a more consistent approach rather than the state-by-state adjustments to what is necessary to be reported.”

"All of the workflows, safeguards, handoffs, inventory controls, billing mechanisms, automated reporting, etc., that are currently well-known will be utilized for COVID-19 vaccines as well." - Dr. Robert Murry, NextGen Healthcare

At Greenway Health, the primary concern is ensuring its healthcare organization clients have what they need to properly document immunizations and communicate with patients and government bodies seamlessly without any workflow disruptions.

“As pharmaceutical companies began their efforts to develop COVID-19 vaccines in earnest with Operation Warp Speed, Greenway Health simultaneously initiated a cross-company initiative to ensure our two EHR solutions were enhanced to support our ambulatory care providers as they began to administer the vaccines,” said Dr. Michael Blackman, chief medical officer.

In parallel, Greenway Health participated alongside other EHR vendors in Electronic Health Records Association-led discussions with the CDC, HHS and the state immunization registries to stay abreast of the fast-moving events related to the rollout of the vaccine. As an industry, it’s vital that EHR vendors all fully understand and meet the government’s data requirements that are required by providers to fulfill, Blackman said.

Creating custom fields

Daniel Kivatinos, COO and co-founder of DrChrono, said his company’s product is a flexible software platform.

“The platform has an electronic medical records app with powerful technology that enables a medical practice to build a practice in a bespoke way,” he said. “With different options for tracking fields, a practice for example can select a ‘custom field’ creating a field tied to the medical record for ‘COVID-19 vaccines’ allowing data points and record keeping.”

DrChrono also offers other fields that can be created in the custom note, along with tailored tagging. Depending on the practice, a care team can configure the EHR to best suit their needs, he added.

How current efforts are coming along

At EHR giant Epic, the company recently released software updates specific to the COVID-19 vaccine. Dr. Nichole Quick, who works on the clinical informatics team at Epic, explained that these updates include:

• Automatic scheduling of follow-up appointments. Patients are reminded through MyChart to come back for their second dose at the right time based on which manufacturer’s vaccine they received. For example, Pfizer’s vaccine requires a second dose 21 days after the first, while Moderna’s vaccine requires a second dose 28 days after the first.

• Decision support tools. New reminders ensure that patients receive the correct vaccine when they return for a second dose.

• Additional support for mobile workflows in mass vaccination settings. Updates to Epic’s mobile app, Rover, are designed to make it simple to track vaccine administrations in mass vaccination and drive-through sites.

• COVID-19 vaccine analytics. Epic created specific metrics to help healthcare organizations keep track of things like how many people have been vaccinated and who still needs to come in.

• Vaccination status in MyChart. Patients can complete pre- and post-vaccination questionnaires and share their immunization status with their healthcare providers, employers, schools and others.

The vendor is adding these updates to an array of tools, Quick said, that customers already use to facilitate and track tens of millions of annual vaccine administrations:

• Vaccine prioritization. Health systems can identify priority patient populations for vaccination based on criteria such as age, risk factors and occupation.

• Patient outreach. Healthcare organizations can use MyChart to send targeted notifications and communications to patients. Patients can use MyChart to schedule their immunizations and receive reminders to come in for both their first and second doses.

• Coordination of immunization across healthcare organizations. Using standards-based interoperability, Epic can share vaccine administration data with other healthcare organizations. For example, patients may receive their first and second vaccine doses in different locations – getting their first dose in a pharmacy and their second dose in a clinic.

• Efficient mass vaccination. The software is designed to support mass immunization efforts, such as flu shots and pediatric immunizations, in traditional and non-traditional care settings.

• Post-vaccination surveillance. Providers can use Epic to communicate with patients and track potential side effects and safety indicators. The software can collect adverse event data for submission to the CDC’s Vaccine Adverse Event Reporting System, or VAERS. It can also identify affected patients if a vaccine is later recalled.

• Public health reporting. Epic helps healthcare organizations share vaccine administration data electronically, in near real time, with state and local Immunization Information Systems, public health agencies and tribal health departments.

A holistic approach to vaccines and EHRs

Meditech said it views vaccine distribution holistically, taking into account the importance of patient safety, the speed with which this has to happen, the volume of individuals who are going to need to be vaccinated, and the timeframe and sequence of the vaccine requirements.

“Our approach is to remain agile, as there are a number of factors to consider, including the different vaccine manufacturers, eligibility phases by state, whether the patient is known or unknown to a facility, whether the patient has comorbidities and risk factors, and where the vaccine will be administered,” said Waters of Meditech. “Vaccine distribution requires careful collaboration across all venues of care, as well as across all distribution sites across the community.”

"We have a team of subject matter experts working to understand the requirements and distribution guidelines defined by the federal government and states in order to provide best practice workflow recommendations and support to our practices." - Paul Brient, athenahealth

To guide its clients, Meditech is providing best practice guidance and scenarios for vaccine administration across each of its integrated care areas (for example, practice, acute, ED, LTC and clinics) to ensure the best possible outcome, Waters added.

“We understand that vaccine administration is not a one-size-fits-all approach, so we’re preparing our customers for a variety of scenarios,” she said. “As frontline workers will be among the first vaccinated, we’re tracking them in our EHR. Registries will be available to identify other eligible patients for vaccine distribution according to phase-based guidelines and FDA and CDC recommendations.”

For those patients known to an organization, clinicians benefit from embedded clinical decision support, which helps identify patients who are high-risk or immunocompromised, including those with severe allergies or pre-existing conditions and women who are pregnant, she said. Clinicians can view comprehensive EHR data, including allergies and medications, to identify potential risks or conflicts based on FDA guidelines, she added.

A mobile system to gather vaccine info from anywhere

“In addition, they can see if a patient is under treatment for other conditions,” Waters explained. “We are also providing a short form, web-based mobile solution that supports the capture of the COVID-19 immunization quickly from any venue – such as a drive-up site – without an appointment and medical record on file. This is particularly important for high-volume vaccination sites, where the patient is not always known to the health system.”

Since the vaccine will be distributed in two doses, it is equally important to accurately track and share which dose was given and when. Meditech is enabling its clients to track vaccine distribution across its EHR and communicate important distribution details with state, federal and third-party sources, including distribution date, dose and manufacturer, Waters said.

“Per CDC guidelines, our system will produce a certificate as proof of the individual’s vaccination to present as required,” she said. “We also offer a bidirectional immunization registry to report vaccine administrations to the state, and to verify whether a patient has received a first dose elsewhere and which pharmaceutical company manufactured that dose.”

"We certainly favor a more consistent approach rather than the state-by-state adjustments to what is necessary to be reported." - Leigh Burchell, Allscripts

But the safest way to ensure a patient receives the correct second dose is by having that patient return to the same location, Waters contended. To encourage this, Meditech’s scheduling solution includes inherent decision support to drive the vaccine appointment sequence, with proactive confirmation and reminders shared with the patient, she explained.

“Finally, we are making it easy for our customers to seek appropriate reimbursement from a program or plan that covers related COVID-19 vaccine fees by patient, without charging the patient,” she said. “Our emphasis is on achieving these goals as efficiently as possible. This will be a large-scale endeavor, and creating solutions that work for a variety of scenarios is imperative. We are approaching this challenge as an opportunity to support our customer needs in an agile manner.”

Model workflow recommendations

Cerner is preparing end-to-end model workflow recommendations for U.S. and non-U.S. healthcare organization clients that incorporate patient outreach, scheduling opportunities, clinician administration best practices, billing, and reporting and analytics tracking after administration.

Reminder outreach is essential because some COVID-19 vaccines require two doses for full efficacy, said Nill of Cerner.

“The recommendations also can include an optional mass vaccination solution at no cost to our clients, helping to supplement rapid vaccination without sacrificing safety checks or administration documentation,” he explained. “Mass vaccination procedures help make it quick to register patients, identify vaccines needed and document administration of vaccines at a large scale.

“For example, Boston Children’s Hospital has successfully used Mass Vaccination this fall to expand its flu vaccination efforts to its parking garage and additional non-office based clinics.”

The EHR maker has reached out to clients big and small, urban and rural, to understand their plans and best support and prepare their EHR domains appropriately ahead of receiving the vaccine, Nill added.

“In addition, we have offered several webinars, office hours and client workflow discussions to prepare the ideal socially distanced workflow, including drive-through vaccination,” he said.

Working on some of the very first vaccinations

Athenahealth has healthcare organization clients participating in some of the first vaccinations. Even before the emergency use authorizations were approved, and as NDC, CVX and MVX assignments were being finalized, the EHR maker updated its drug compendium to include available COVID-19 vaccine orderables. Brient said the company has been working to understand how best to support these early sites and respond in near-real time to make sure they are successful.

“We will continue to stay very close to the evolving guidance and protocols from CMS,” he said. “In addition, we are examining our entire vaccine and patient management workflow so that we can best support our clients in this very important and unique effort. Both the transition to high numbers of telehealth visits and the high volume of COVID testing have necessitated important changes to our software.”

"As pharmaceutical companies began their efforts to develop COVID-19 vaccines in earnest with Operation Warp Speed, Greenway Health simultaneously initiated a cross-company initiative to ensure our two EHR solutions were enhanced to support our ambulatory care providers as they began to administer the vaccines." - Dr. Michael Blackman, Greenway Health

The high volumes of vaccines (and unique requirements such as two-dose vaccines) similarly require changes to the core athenaOne workflows to allow practices to operate optimally, Brient added.

“We have a cross-divisional working group that is considering all our clients’ diverse needs and is spearheading enhancements and workflow guidance across a myriad of use cases,” he noted. “This includes identifying patients, or healthcare workers, who are high priority for a vaccine; engaging patients around COVID vaccination; managing the coordination and scheduling of patients across the two vaccine doses; properly documenting vaccinations according to guidelines; and reporting across clinical measure, registry and billing needs.”

All enhancements will be deployed immediately to all clients as soon as they are available, he added.

Following what works

At NextGen Healthcare, the vaccine administration workflow will be identical in the NextGen Enterprise EHR to other vaccines.

“As an ambulatory EHR vendor, we have thousands of practices administering a variety of vaccines currently, with some practices administering hundreds of vaccines a day now – for example, large pediatric practices,” said Murry of NextGen Healthcare. “So all of the workflows, safeguards, handoffs, inventory controls, billing mechanisms, automated reporting, etc., that are currently well-known will be utilized for COVID-19 vaccines as well.”

The EHR and population health tools enable providers to document the particular vaccine provided to each patient. Once the reporting requirements at the state and federal level become available, the mode of transfer of this data and the specific data elements can be determined, he said.

The most important thing is that – at least at this point – there should not be major changes to EHR workflow, said Blackman of Greenway Health.

“Clinicians should be able to administer vaccines the way they always do, and our products can transmit this information to state immunization registries,” he said. “There are certain new optional data elements the CDC is requiring from registries, such as identifying demographic priority groups. The registries may, in turn, require these additional elements from providers.”

"Most of the changes we’ve made to the software that are specific to the COVID-19 vaccine are turned on automatically, so there’s very little manual setup involved – allowing our customers to focus on adjustments that are specific to their organization." - Dr. Nichole Quick, Epic

The vendor said it continues to monitor the situation closely as this aspect is still in flux.

“From a product development standpoint, we are making sure that the clinical terminology sets our products rely on include the necessary drug and procedure codes to support the COVID-19 vaccines, and that our interoperability connections with state registries continue to facilitate immunization reporting,” he noted.

Rolling out changes, training, looking ahead

Over the past several weeks, Epic healthcare provider organization clients have joined webinars led by Epic experts who have walked through system setup and recommended operational workflows.

“Most of the changes we’ve made to the software that are specific to the COVID-19 vaccine are turned on automatically, so there’s very little manual setup involved – allowing our customers to focus on adjustments that are specific to their organization,” Quick explained. “We’ve also published written guidance that ranges from high-level, executive-facing recommendations to detailed technical instructions.”

Most of the development for the COVID-19 vaccine already is complete, and the final updates will be finished and available to clients worldwide by the end of December, she added.

Training is the key to success

Meditech’s most important concern has been determining how to record the vaccine data and leverage the depth of an integrated EHR as efficiently as possible.

“We’ve supplied customers with build guidelines for new vaccine codes and easy access to frequently asked questions to make them aware of preparations they can make today to be ready to administer these vaccines as they become available,” said Waters of Meditech. “Training is the key to success. Our customer service team works with customers daily on training and preparedness to ensure content has been updated and modified to reflect this guidance.”

Key guidance includes how to enter data quickly into the system and how to create appointment reminders to assist with COVID-19 vaccination preparation. Meditech also is training clients on its new mobile offering for high-volume vaccine administration locations for individuals who are not patients of a health system.

“One of the benefits of our EHR is its flexibility,” Waters contended. “As updated guidelines become available, we will continue to proactively communicate with our customers through a variety of channels.”

Training and coaching

Right now, athenahealth is working jointly with its clients that are participating in early vaccine distribution to understand their needs and support them as those needs evolve, Brient said.

“A key element of this work is to formally document our learnings so we can provide training and coaching for clients as we roll out enhancements and workflow recommendations,” he said. “This training is provided in informative best practices guides within our software. As we did in the early days of the COVID-19 pandemic, we will make these enhancements immediately available to all our clients across our cloud-based EHR as soon as they are ready.”

The goal is that most users will be able to adopt these changes without training, but for users who need training or have unique workflows, the company has named customer success managers who can provide any additional support clients need to begin successfully administering, managing and recording vaccines, he added.

Since DrChrono has a cloud-based EHR, it is able to roll out new features and enhancements every week; it trains users on new features weekly via ongoing webinars, posting information to its YouTube channel and putting updated content in its knowledge base.

“We have a dedicated account management team that works to keep our user base informed,” Kivatinos said. “We are accustomed to making changes fast; for example, when COVID-19 hit the United States, the DrChrono team created a large effort quickly to roll out a telehealth solution, creating a telehealth offering within a short window and training our user base on the telehealth offering.”

Coding, tracking, transmitting

Murry of NextGen Healthcare said most users do not need additional training since the workflow is similar to what they already use for vaccination management and reporting.

“The key difference will be new specific COVID-19 coding,” he explained. “Tracking would need to be improved to strip out, document and record only COVID-19 vaccination information for transmission to the CDC. We are working toward making the first system changes that allow documentation of vaccine administration with the new CPT/CVX codes available to our clients as soon as possible.”

Communication with clients will be more critical than the training aspect because each state’s circumstances are different, he said.

“We are meeting with all constituents by specialty and market to help them prioritize a plan for their specific situation.”

Source: Healthcare IT News

A computerised system that advises doctors on the best treatment to give a patient is among the artificial intelligence projects that have been awarded £20m by the British government.

The money will be shared between 15 AI projects being run at UK universities.

It's been done as part of the Turing fellowship scheme, named after maths genius and AI pioneer Alan Turing.

The projects help the UK meet some of today's most pressing challenges.

These include developing more effective ways of treating cancer and supporting efforts to tackle climate change.

AI describes software systems that make decisions usually requiring human expertise.

It has the potential to transform the way we live, allowing tasks to be performed faster and more accurately than they are by people.

The doctor's assistant, or clinical colleague, is a project being led by Professor Aldo Faisal, of Imperial College London. It would be able to recommend medical interventions such as prescribing drugs or changing doses in a way that is understandable to decision makers, such as doctors.

This could help them make the best final decision on a course of action for a patient. This technology will use "reinforcement learning", a form of machine learning that trains AI to make decisions.

The aim is to relieve the pressures and workload on doctors and clinicians. But similar systems could be used in sectors such as aerospace or energy, where there is a need for decision-making support.

Another of the projects will aim to use AI to spot cancer before it can develop and spread in the body. It's being led by Prof Christopher Yau at the University of Manchester.

Prof Yau said it would involve using the vast amounts of information produced by genomic sequencing - the ability to sequence the full complement of DNA contained in the nuclei of human cells, including cancer cells.

If successful, it will enable medical experts to track cancer more accurately and help them decide at an earlier stage what treatments patients require. This would increase the chances of saving lives as treatment is usually more successful when given earlier.

Another project, led by Dr Antonio Hurtado, from the University of Strathclyde, aims to meet the growing demand across the UK economy to process large volumes of data fast and efficiently - while minimising the energy required to do so.

His AI system will use laser light, similar to technology used in supermarket checkouts, to perform complex tasks at ultra-fast speeds. It could be used in areas such as weather forecasting and processing images for medical diagnostics.

Being able to perform these tasks at lightning speed, with minimal energy consumption, could help to transform industries such as energy, healthcare and finance, improving efficiency, while helping the UK to meet its net zero ambitions by 2050.

Science Minister Amanda Solloway said: "The UK is the birthplace of artificial intelligence and we have a duty to equip the next generation of Alan Turings with the tools that will keep the UK at the forefront of this remarkable technological innovation.

"The inspirational fellows we are backing today will use AI to tackle some of our greatest challenges head on, transforming how people live, work and communicate, cementing the UK's status as a world leader in AI and data."

Source: BBC News

Using a remotely-delivered, algorithm-driven program for disease management, patients experienced significant improvement in cholesterol and blood pressure levels, according to late-breaking research presented today at the American Heart Association's Scientific Sessions 2020. The virtual meeting is Friday, November 13-Tuesday, November 17, 2020, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care. The manuscript of this study is simultaneously published today in Circulation, the American Heart Association's flagship journal.

Failure to appropriately treat hypercholesterolemia (high cholesterol) and hypertension (high blood pressure) remains an ongoing clinical challenge that increases the risk of heart attacks, stroke and cardiovascular death. Using digital tools, clinicians at Brigham and Women's Hospital in Boston, Massachusetts, initiated and continue to conduct a remote, algorithmically driven, hypercholesterolemia and hypertension management program.

Between January of 2018 and May of 2020, researchers screened 18,810 patients and enrolled 5,000 patients into either the cholesterol program, the hypertension program -- or both. Among the 3,939 patients enrolled in the cholesterol program, 35% had established atherosclerotic cardiovascular disease (ASCVD); 25% had diabetes but no ASCVD; and 31% had a low-density lipoprotein cholesterol (LDL-C) >190 mg/dL. Doctors, pharmacists and support specialists helped design these management programs to initiate and adjust the medication doses, also known as titration, to achieve maximum benefits for patients while minimizing clinically important side effects.

"To better control cholesterol and blood pressure, both of which are major cardiovascular risk factors, we need new end-to-end treatment solutions that improve patient identification, data collection, education and care delivery, including standardizing medication regimens. We are redefining treatment pathways to address persistent gaps in health care, overcome clinical inertia and address the problems of limited access to physicians by expanding remotely-delivered care," says the study's lead author Benjamin M. Scirica, M.D., M.P.H., a cardiologist at Brigham and Women's Hospital and associate professor of medicine at the Harvard School of Medicine, both in Boston.

Using electronic health records and doctor referrals, the program identified people with uncontrolled LDL-C and/or high blood pressure. Patients received digitally connected blood pressure cuffs for use at home, and pharmacists and support staff used the clinical algorithms to initiate and titrate medications at preset intervals until treatment goals were achieved.

Results of the study include:

• An overall LDL-C reduction of 52 mg/dl (42%) occurred in patients who completed the titration phase of the program.

• Significant LDL-C reductions were achieved in patients who met one of four cholesterol-risk categories -- established atherosclerotic cardiovascular disease, diabetes, severe hypercholesterolemia (LDL >190 mg/dL) or high-risk primary prevention.

• The average reduction in blood pressure was 14 mmHg systolic and 6 mmHg diastolic reduction.

• An overall LDL-C reduction of 24 mg/dl (18%) was achieved in all patients enrolled.

"This is an effective and efficient strategy to care for high-risk yet undertreated patients and to optimize guideline-directed therapy. Specialized out-of-office treatment for cholesterol and blood pressure control reduces the need for in-person visits and allows for collaborative decision-making in-patient care. The results of our study provide a model for expanding remote health care delivery to increase access to care, to help reduce health inequities and to improve health care quality," said Scirica.

Source: Science Daily

RWD(Real World Data, 실제임상자료)를 활용해 도출한 RWE(Real-World Evidence, 실제임상근거)의 다양한 활용가능성이 최근 주목되는 가운데, CDM(Common Data Model, 공통데이터모델)을 활용해 국내 대표적 RWD인 심평원 자료의 활용이 더욱 극대화 될 것이라는 분석이 제기됐다.

이 같은 내용은 건강보험심사평가원의 HIRA 빅데이터 브리프 제4권 2호 ‘임상시험의 효율적 디자인 시뮬레이션, 사전 예측을 위한 HIRA빅데이터 활용 가능성(저자 이형기 서울대학교 융합과학기술대학원 교수)으로부터 나왔다.

RWD는 임상시험이 아닌 비중재적(non-interventional) 또는 관찰 방법을 사용해, 주로 연구

이외의 목적으로 수집한 자료를 말한다. 대표적인 RWD에는 전자의무기록(electronic medical record, 이하 EMR) 자료ㆍ급여청구(health claims) 자료ㆍ질병 레지스트리 자료ㆍ라이프로그 자료가 있다. 적절한 방법을 사용해 다양한 RWD를 잘 가공하고 분석하면 의약품이 사용되는 실제 임상 환경에서 질병의 진단 및 치료가 어떤 식으로 이루어지는지, 의약품의 진정한 효과는 어느 정도인지 실용적인 통찰을 얻을 수 있다. 이러한 통찰을 총칭해 RWE라고 부른다.

의약품 시험 및 허가에서 RWD/RWE 활용은 더욱 확대되고 있다. 최근 미국•유럽•일본의 의약품규제기관들은 의약품의 허가, 적응증 확대, 임상시험 설계 및 시판 후 약물감시(pharmacovigilance)에 필요한 근거 자료를 생성하는 데 ‘실제임상자료(Real-World Data, 이하 RWD)’와 ‘실제임상근거 (Real-World Evidence, 이하 RWE)’의 활용 가능성을 긍정적으로 받아들이기 시작했다. 기존 제도의 틀은 유지하면서도 RWD/RWE에 근거해 의약품을 허가하는 방식을 제도권 내로 끌어들이려는 새로운 시도이다.

국내에서도 RWD/RWE를 의약품 허가 심사에 활용할 수 있는 다양한 방안을 모색 중이다.

이 중 심평원과 건보공단 두 기관이 보유한 빅데이터는 2019년 5월 기준 6조 4000억 건에 달하며, 특히 의료기관에서 심평원에 제출하는 급여청구자료는 전 국민을 포괄하므로 이는 국내에서 활용할 수 있는 대표적인 RWD로 꼽힌다.

그러나 국내에 기 구축된 RWD를 바로 임상연구 자료로 활용하기에는 한계가 있다고 이형기 교수는 지적한다. 자료 자체는 가치가 있을지 몰라도 측정 방식이나 대상이 표준화돼 있지 않고, 서로 연결되지 않은 독립 개체, 기관, 단체가 자료를 생성하기 때문이다.

예를 들어, EMR의 경우 각 의료기관이 독립적으로 각자의 EMR을 기록하지만, 외부로 반출할 수 없기 때문에 다기관에 걸쳐 개인 환자의 건강 상태를 연속적으로 추적하는 것은 불가능하다. 또한, 급여청구자료의 경우 개인 환자의 구체적인 임상 정보와 검사 결과가 포함되지 않은 경우가 대부분이고, 전 국민 약 3% 정도에 해당하는 자료만 임상연구에 활용할 수 있다.

따라서 이러한 분절된 RWD만으로는 이들을 연계하지 않는 이상 의미 있고 활용도가 큰 RWE를 만들어 내기 어렵다는 게 이형기 교수의 설명이다.

이에 식품의약품안전처(이하 식약처)는 시판 후 약물감시에 급여청구자료와 EMR 등의 RWD/RWE 활용 방안과 관련된 가이드라인 마련을 추진하고 있다.

뿐만 아니라 보건복지부는 보건의료 빅데이터 시범사업의 하나로 2019년 국내 최초로 건보공단ㆍ심평원ㆍ질병관리본부ㆍ국림암센터와 같은 4개 공공기관이 보유한 보건의료 빅데이터를 개인 단위로 연계한 ‘보건의료 빅데이터 플랫폼’을 마련했다.

이형기 교수는 특히 데이터의 이질적 특성을 고려했을 때 분산연구망 방식을 활용한 공통데이터모델(CDM)을 주목했다.

CDM은 기관별로 상이한 데이터 용어와 구조를 표준화한 모델로, 물리적 통합 없이도 분석 코드를 수행한 결과(통계)값만 공유한다. 이러한 방식으로 다기관 공동 연구 수행이 가능하며, 각 의료기관에서 보유한 환자 개인의 원본 데이터는 데이터 보유기관 밖으로 유출되지 않는다.

최근 심평원은 CDM을 활용한 코로나19 검사 및 진료 청구자료를 분석할 수 있도록 처음으로

임상데이터를 대규모 오픈 소스 형식으로 공개하였다. 심평원은 연구자가 제출한 분석 코드 결과 값만 제공하게 된다.

이형기 교수는 “이러한 방식은 향후 CDM을 기반으로 심평원 청구자료와 병원 청구자료를 연결(link)할 수 있는 토대를 마련할 것으로 기대된다”면서 “더 나아가서 심평원이 보유한 RWD를 개인 환자의 구체적인 임상 정보와 검사 결과가 들어 있는 EMR까지 연결한다면 국내 RWD 활용 범위를 더욱 넓힐 수 있을 것”이라고 봤다.

한편, 이형기 교수는 심평원이 보유하고 있는 RWD와 이로부터 생성될 RWE를 활용함으로써 국내 의약품 개발 및 신약 허가를 가속화ㆍ효율화할 수 있는 실제적인 방안도 제시했다.

이 교수는 “심평원이 보유한 RWD는 소아ㆍ노인ㆍ임산부와 같이 치료적 고아 집단(therapeutic orphan)에서 허가초과사용(off-label) 의약품의 처방 및 허가 근거를 제공하는 데 유용하다”면서 “아울러 심평원의 RWD에는 전 국민의 건강보험 급여 자료가 포함돼 있기 때문에 완결성이 떨어지는 자발적 희귀질환 등록 레지스트리를 보완하거나 대치함으로써 희귀질환 치료제 개발 과정을 조력할 수 있다”고 밝혔다.

이어 그는 “더 나아가 정밀의학(precision medicine) 구현을 위한 국가연구코호트의 원형으로 심평원의 RWD를 활용함으로써 새로운 타깃의 혁신적 신약 개발 과정을 앞당기는 것도 가능하다”고 덧붙였다.

출처: 의학신문

제이브이엠은 유럽 노르웨이의 자회사 N 조제 공장형 약국이 NSP를 도입해 운영한 결과, 추가 인력 절감 효과 등 다양한 장점을 확인됐다.

대부분의 해외 조제 공장형 약국은 접수 받은 처방의약품을 대량 조제해 전국 각지로 배송하고 있다. NPS를 추가로 도입하면서 업무 효율성을 크게 높일 수 있게 됐다.

이번에 입점한 NSP는 기존 전자동 의약품 분류•포장 시스템인 'ATDPS'와 자동 포장 검수 시스템 'VIZEN'을 결합한 제이브이엠의 주력 제품이다. NSP에는 잘못 조제된 의약품을 발견하는 즉시 자동으로 다시 조제하는 ARDTM기술이 적용됐다.

ARDTM은 의사의 처방과 다른 의약품이 발견되면, 자동 폐기되는 동시에 올바른 의약품이 투입되는 혁신 기술이다. 조제된 의약품이 포장되기 직전까지 고성능 카메라가 자동으로 검수해 의사 처방에 따른 완벽한 조제약이 환자에게 전달된다.

NSP는 의약품 분배통이 6가지 색상 LED로 구분돼 약사가 약품 투입 위치를 쉽게 파악할 수 있다. 의약품 부피와 수량 등에 따라 포장지 사이즈를 다양하게 선택할 수 있고, 포장지 역시 기존의 2배 용량인 600m 점보 롤이 적용돼 교체 주기를 대폭 줄였다.

한편 제이브엠은 한미약품그룹의 계열사다.

출처: 아시아타임즈

Physicians have faced a number of key technical challenges during the COVID-19 pandemic, including the inability to send and receive patient data, as well as issues related to electronic health record (EHR) interface and failure to effectively extract EHR data. Interoperability and patient data exchange are critical for physicians, hospitals, health systems and payers alike to minimize the spread of the coronavirus, as is overcoming reliance upon data silos and ensuring that care gaps are quickly resolved with a single source of reliable information.

Unfortunately, 40% of hospitals report that public health agencies are unable to effectively receive patient data, which impacts the way COVID-19 is reported and treated.

With the economy reopening and people returning to work/education obligations and social activities, the spread of COVID-19 is expected to surge. Enhanced interoperability will be important to monitor the spread of the virus and perform contact tracing. Interoperability offers other benefits for physicians as well, such as streamlining care, fostering patient-centered care and lowering healthcare costs by an estimated$30 billion. The right patient care program can enable physicians to rapidly access, extract and electronically export patient data.

Given today’s enormous healthcare challenges, a growing number of physicians recognize the value of seamless, automated patient health data exchange and its contribution to overcoming issues related to transparency and communication.

Enhanced Clinical Decision-Making

Optimal point-of-care solutions offer innovative capabilities as a one-source, payer-agnostic platform that enables physicians to rapidly access, extract and electronically export patient data from a meaningful use-certified EHR to a continuity of care document (CCD).

Physician practices should look for an innovative approach that enhances workflows and clinical decision-making. This can virtually eliminate human transmission errors which can result from faxing and uploading documentation for supplemental data.Most importantly, this automated approach closes quality care gaps in near real-time. Ideally, the solution should also offer secure, electronic transmission of a patient’s vital medical information, which is especially critical during the COVID-19 pandemic.

This is an opportunity to regularly extract data created in a physician’s EHR and provide a patient’s full clinical history, including actionable insights on diagnoses, open care gaps, inpatient/outpatient visits and prescriptions at the point of care. Effective CCD file extraction eliminates the 30-60-day lag from claims systems to close care gaps, creates action plans and drives bi-directional communication between the payer and physician.

CCDs also assist in Transitions of Care management. Typically, when patients switch health plans, claims history does not follow. CCDs improve referral and authorization time and provide a patient’s history, all of which helps to reduce patient and provider abrasion/burden and leads to faster care.

Furthermore, when it comes to risk adjustment, the CCD process helps to support revalidation, suspicion of new conditions and documentation of medical diagnosis that were missed simply because a clearinghouse failed to clear the diagnosis when it was billed.

With this in mind, a point-of-care solution that also offers real-time data insights captured from disparate sources, allowing 360-degree visibility into the patient’s health status based on information from EHRs, health information exchanges (HIEs), claims, labs, pharmacy and hospital sources can reduce the need for multiple platforms. Through the aggregation of data from these sources, users gain real-time data transparency and patient-level drill-down dashboards. These dynamic dashboards also provide collaboration opportunities to break down departmental silos.

Thinking Ahead to Value-Based Care

The COVID-19 pandemic has been shining a light on the challenges of quality measurement. Implementing the recommendations for improvement will require a higher level of planning and coordination because the risks of failing to do so are significant.

Physicians who want their practices to remain sustainable are moving toward value-based models and embracing the tools that provide the most efficient high-touch care, generate improved outcomes and enable them to improve financial performance.

Quality improvement programs are a critical part of value-based care because they systematically collect information from physicians or patients with the aim of assessing the quality of care provided and improving treatment outcome or efficiency. During the shift to value-based care, it’s important for physicians to move carefully and thoughtfully, choosing a system that encompasses benchmarks and risk-adjustment rules. A value-based model with high-touch, prevention-focused care is about providing more care that is holistic and patient-centered at the present time to prevent the need for far more expensive care later. The result: better outcomes for patients and better fiscal positioning for physicians.

Now more than ever, physicians across the country need this level of innovative technology solution to drive data interoperability, optimize care quality, reduce administrative burden, enhance value-based care initiatives and improve financial performance and communication.

Source: Medical Economics

The United Arab Emirates’ Dubai Health Authority (DHA) has become the first healthcare authority in the country to integrate Wolters Kluwer’s clinical decision support (CDS) resource, UpToDate with an electronic medical record (EMR), it has been announced.

In a statement released by the US-headquartered information services and solutions company, the UpToDate integration allows doctors, nurses and pharmacists from 18 DHA sites to access it via the authority’s Salama EMR to “make evidence-based clinical decisions for their patients and keep their medical knowledge up to date in a more seamless way.”

As well as being accredited by the DHA, UpToDate also enables clinicians to gain Continuing Medical Education (CME) credits while applying their learnings from searches during clinical practice.

THE LARGER CONTEXT

According to Wolters Kluwer, UpToDate – reportedly used by over 1.9 million clinicians around the world – is the “only clinical decision support resource associated with improved patient outcomes and hospital performance.”

It continued in a statement: “Over 100 independent studies evidence the benefit to patients, clinical teams and healthcare systems in terms of improving length of stay, efficiency and patient outcomes, and reducing error rates and healthcare costs.”

In 2018, a study published in the International Journal of Medical Informatics found a “significant association” between use of UpToDate CDS and reduced diagnostic errors, with physicians using UpToDate encountering a “significantly lower rate of diagnostic errors compared with a control group without UpToDate”.

Denise Basow, managing director, president and CEO for Clinical Effectiveness at Wolters Kluwer – Health stated: “We are delighted to support DHA in their vision to provide world class healthcare across Dubai.

“Providing evidence-based clinical decision support in the clinical workflow is critical for driving consistent, standardised and high-quality care throughout a patient’s care journey.”

ON THE RECORD

Meanwhile, on his part, Younis Kazim, Dubai Healthcare Corporation CEO of DHA said: “Patient Safety is DHA’s number one priority and our goal is to be at the forefront of healthcare innovation that delivers significant benefits to patients.

“Making UpToDate accessible through the Salama EMR will support busy clinicians at the point of care to drive consistently high-quality care, minimise errors and improve hospital efficiency. We are pleased to partner with Wolters Kluwer on this mission.”

DHA’s Medical Education and Research Department Director, Wadeia Sharief added: “As a resource for medical education and daily practices, UpToDate at the point of care for all DHA healthcare professionals can be accessed through the library platform and smart devices.

“Integrating UpToDate into Salama showed light after great efforts from the library and Salama team to obtain and gain return on investment in patient care.”

Source: Healthcare IT News

A computerized clinical decision support tool safely improved Clostridioides difficile test stewardship at two facilities in Seattle, according to a study in Open Forum Infectious Diseases.

“We recognized that there was significant opportunity for improved diagnostic stewardship as it relates to C. difficile testing at our institution,” Catherine Liu, MD, associate professor of medicine at the University of Washington School of Medicine, told Healio. “We were interested in assessing whether a clinical decision support tool embedded in the [electronic health record] could improve appropriateness of C. difficile testing.”

Liu and colleagues compared C. difficile PCR test utilization, hospital-onset C. difficile infection (CDI) rates and clinical outcomes before and after the implementation of a computerized clinical decision support (CCDS) order at the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC).

According to the study, providers were automatically directed to use the electronic order set, which included guidelines that preferentially recommended testing patients with new-onset hospital-associated diarrhea in the absence of laxative use for C. difficile and prompted providers to order a multiplex enteric pathogen panel only for those presenting with community-onset diarrhea.

According to Liu, the study showed that the implementation of the CCDS reduced C. difficile PCR test utilization, specifically inappropriate testing in the setting of recent laxative use (HMC: –60.8%; 95% CI, –74.3%, –40.1%; UWMC: –37.3%; 95% CI, –58.2%, –5.9%). Compared with the 20-month preintervention period, the study showed that during a 12-month postimplementation period, there was an “immediate and sustained reduction” in PCR test utilization at both hospitals (HMC: –28.2%; 95% CI, –43.0%, –9.4%; UWMC: –27.4%; 95% CI, –37.5%, –15.6%), according to the study.

Researchers said the intervention was associated with an increase in the C. difficile test positivity rate at HMC (P = .01), although there were no significant differences in hospital-onset CDI rates or in the number of patients with hospital-onset CDI who developed severe CDI or CDI-associated complications.

“Computerized clinical decision support tools can be effective in directing clinicians toward appropriate C. difficile testing,” Liu concluded. “Although we did not observe any harm associated with more restrictive testing, we suggest that institutions adopting such tools also consider assessing for unintended adverse consequences.”

Source: Healio

Over the last few months, the COVID-19 pandemic has thrown the world into an unprecedented situation. It even gave birth to new concepts such as social-distancing and prioritized technologies like cloud, internet of things (IoT) services, and artificial intelligence. Likewise, IoT and the internet of medical things (IoMT) have witnessed a number of innovative revolutions to address the coronavirus crisis. These technologies in healthcare and retail may have a long-lasting impact in the upcoming future.

IoT has predominantly become one of the frequent expressions across the technological domain nowadays, with the potential to significantly enhance the way we interact with the contemporary world. From high-level healthcare devices to common household gadgets, IoT technology is getting more intelligent and connected to the internet, facilitating seamless communication between networks and devices.

Why medical connectivity matters?

The coronavirus outbreak has led IoT healthcare companies to promptly provide solutions for combatting the increasing requirement for high-quality medical services. Medical connectivity is the sole extinguisher to the fast-spreading COVID-19 that has taken over the entire healthcare ecosystem from vaccine developing labs, pharmaceutical companies, hospitals, and health insurers. Applications such as telemedicine include remote patient monitoring, and interactive medicine can help in social distancing with inpatient monitoring that is expected to achieve traction during this time.

The current advancements in technology, for any industry, indicates secure communication, enhanced storage and transfer of massive data, and numerous benefits that prevent industries from backtracking. Most of these advantages are being capitalized on by the healthcare sector, as it perhaps has the utmost gain from these rapid progressions.

The growing role of IoT in medical connectivity

Quarantine tracking

One of the most significant measures to curb the spread of coronavirus is the effective quarantine of infected or perceived-to-be-infected people. From connected drone monitoring to thermal heat scanners, IoT devices are being utilized to collect data and pass on this information to Governments or healthcare sectors.

There are several wireless communication and GPS technologies, such as connected drones, cellular positioning systems, etc. that can be implemented to monitor people at gatherings or even at offices.

Medical automation and healthcare connectivity

The COVID-19 pandemic is proving to be a catalyst for 5G innovation, particularly in healthcare automation and medical connectivity. The revolution in innovation such as 5G enabled medical robots can instantly and accurately scan human temperature, deliver drugs, and disinfect hospitals wards, therefore reducing the exposure of humans to the virus. These humanoid robots can also overcome the deficiency of personal protective equipment required for doctors and nurses. Countries like China were able to make use of 5G-enabled healthcare automation by introducing a 5G+ remote consultation arrangement across its multiple hospitals; where the medical personal could consult patients as well as interconnect and learn from various healthcare professionals.

AI-based medical robots and chatbots

As COVID-19 cases spiked all around, the number of calls to healthcare sectors regarding symptoms queries and precaution strategies was overwhelming. According to Partner Healthcare, Boston, the average delay time on their hotline topped almost up to 30 minutes, creating more panic and unawareness.

To eradicate this dilemma, software enterprises collaborated with hospitals and healthcare centers to set up AI-based chatbots on their website and mobile apps. These chatbots were capable of asking a series of questions to screen visitors as well as provide safety measures according to the severity of their health.

Also, smart hospitals were set-up in Wuhan, China, to assist healthcare professionals, these hospitals were the ideal example of AIoT, a combination of the internet of things and artificial intelligence. From scanning body temperatures and monitoring heart-rate to cleaning and disinfecting the premise, these AI-based robots performed remarkably well for their responsibility.

The growing role of IoT in other sectors

E-learning and online classrooms

Across the world, schools and educational institutes have been closed for months, and it has forced the institutions to take the classes online as social distancing standards continue. However, e-learning with advanced technologies can be a comparatively better alternative than traditional offline classrooms. In the future, there can also be device-based augmented reality classrooms, where students get the entire privilege of being at a school within their own houses.

Essential business automation

One of the most significant concerns during the pandemic is the availability of groceries, consumer supplies, and retail. The more autonomous and innovative retail environment with the electronic shelf label (ESL) technology helps mitigate the hand-operated, in-person workload by implementing IoT devices to monitor and track commodities on the shelves. The IoT smart shelves can facilitate an effective shopping experience and improve safety with social distancing and less human interaction.

IoT technology has enabled more efficient and innovative services across a wide range of industries ranging from healthcare to manufacturing. Mobile network operators (MNOs) are in the ideal setting to facilitate these types of time-critical services due to their capability to leverage advanced 5G networks systematically and cost-effectively.

IoT services and technology may be the most prominent innovation that has been making impressions in the healthcare industry. It has provided us with many opportunities to innovate, all we need to do is stay committed to innovation and quality production of this remarkable connected technology.

Source: Thenextweb

The pandemic has led to huge spikes in digital technology adoption as doctors and patients have complied with social distancing guidelines. In fact, according to the Royal College of General Practitioners, 71% of routine consultations were remote in the four weeks leading up to April 12th, compared to 25% in the same period last year. This is a tremendous shift.

COVID-19 has sharpened the mind. We all understood the need for social distancing and minimising footfall to our GP surgeries and hospitals as lockdown came into effect in March, in order to manage infection rates effectively and ensure healthcare systems were not overwhelmed. Having the technological capability to offer remote consultations, where appropriate, is beneficial for general practice, the wider NHS and patients alike. However, although adopting a remote monitoring system to complement usual care may improve user satisfaction and potentially have some benefits on outcome, it doesn’t necessarily reduce demand on the healthcare system – in fact, often, quite the reverse.

As we move into phase three of controlling the virus and start easing lockdown measures across the country, we need to learn how to continue to support our healthcare system moving forward to manage an ever-increasing demand.

There is a real imperative for remote patient monitoring (RPM) and management to support patients and help healthcare systems become more efficient. RPM has allowed us to take more control of our own health whilst reducing footfall to our healthcare facilities, allowing resources to be focused on where it is needed most. As demand for healthcare continues to grow, RPM can, when implemented intelligently, play a key role in assisting healthcare staff manage increasing demand without over-stretching already strained clinic and staff resources.

Key challenges of RPM adoption

While we’re well aware of the benefits of RPM, the implementation of these technologies does not come without its challenges.

Firstly, a thorough understanding of how a remote patient monitoring system is anticipated to support, for example, earlier interventions or improve operational efficiency, are essential to any implementation. And indeed, the anticipated benefits need to be clearly identified and measured before and after implementation.

Secondly, prior to the pandemic, Deloitte’s ‘Shaping the future of UK healthcare: Closing the digital gap’ report found that many digital health innovations failed as clinicians were reluctant to engage with them. Key reasons included the amount of change required to familiar processes, the time taken to implement, and a lack of education and training. Therefore, it is imperative that a proper change management process is followed. This is preferable, and likely to be much more impactful, than the lazy alternative of adding the technology to existing care-pathways.

Third, but of equal importance, is ease-of-use. New technologies must be simple and intuitive for both clinicians and patients if they are to bridge, rather than reinforce, the digital divide.

Finally, digital health technology providers need to understand the regulatory and technical environment the technology will inhabit. It is very likely that the technology may be deployed in hardware that is not high spec; therefore, what is developed in a high-tech company might not work seamlessly in an NHS hospital with older, less powerful infrastructure.

The role of RPM in easing lockdown

As strict lockdown measures were introduced in March 2020, the government, Public Health England and the NHS, encouraged those with milder COVID-19 symptoms to use applications to help self-manage their health and help manage the strain on local healthcare services. This allowed clinicians to focus more time on the patients that need emergency care. The result was a tremendous rise in deployment and use of digital health technologies in just days and weeks instead of months and years.

RPM also has the power to improve access to healthcare services for vulnerable groups advised to shield during the COVID pandemic. For example, Sensyne’s GDm-Health digital therapeutic app helps pregnant women and their care teams proactively monitor and manage diabetes remotely. The risks to mother and child associated with this condition are significant if not treated, and include an increased rate of caesarean section, pre-eclampsia and premature birth. Clinicians use the system to remotely monitor blood glucose levels, and prioritise care to women needing it most. Mums-to-be upload their blood glucose readings from home, and communicate with their care teams through the app. The need for face-to-face appointments is reduced, administrative time is saved, and quality of care is improved. GDm-Health is an exemplar of how RPM can enhance the existing care pathway, improve operational efficiency and help deliver better outcomes for patients.

Despite lockdown measures easing, the threat from COVID-19 is far from over and it’s important that we continue to look after vulnerable patient groups. RPM can help us achieve this, by giving providers the option to deliver care to patients in their homes, reducing the risk of infection spread and freeing up capacity for those who need it the most. It may even allow some patients to be discharged earlier because follow-up care can be delivered remotely. If a patient's condition deteriorates, RPM software can alert clinicians in real-time, enabling them to take the appropriate course of action quicker than might otherwise be the case.

Equipping scientists with data for drug discovery

The fundamental role of RPM is to improve the quality of data and information flow to deliver timely, effective and safe care. Data from RPM applications can be uploaded to Electronic Patient Records (EPR), which can be used to provide a complete medical history and real-time information resource. Furthermore, this data can be anonymised, aggregated and used to analyse patterns within a disease and inform clinical research aimed at drug discovery and disease prevention. Gaining insights from anonymised patient data may, for example, allow for faster vaccine development and new treatments, not just for COVID-19, but also for other diseases.

As we continue to fight coronavirus, we must recognise the great potential of technology to help us. It is important that RPM solutions are implemented swiftly but with a clear pathway to deliver operational efficiency and improved clinical care in a tightly controlled ethical, information governance and regulatory framework. The hope is that by doing so, healthcare providers can manage future peaks, continue to improve health outcomes, free up time for clinicians to treat more patients and drive scientific research into disease prevention and treatment.

COVID-19 may have provided the motivation for both patients and clinicians to embrace new technologies - something that was difficult to achieve before – and this change is likely to be a common feature of routine clinical practice going forward. Demand on our healthcare systems will continue to rise, yet this demand can be better managed with technology that is aimed at earlier detection and intervention, preventing more costly treatments and providing the catalyst for transformative change in medical practice, helping to move from reactive to preventative models of care.

Source: Med-technews

Lee Health, a health system based in Fort Myers, Florida, has had inpatient telemedicine infrastructure in place since 2014, ambulatory telemedicine since 2015 and a direct-to-consumer system since 2019.

THE PROBLEM

But the health system needed to rapidly ramp up ambulatory support to address challenges brought on by the COVID-19 health crisis. It immediately recognized a need for virtual employee-health-screening to clear staff for work each day and minimize spread of the coronavirus.

It was equally important for Lee Health to identify a scalable platform that could be quickly implemented to support the clear and immediate need for broader virtual care offerings. The health system needed a platform to remotely connect clinicians, patients, families and community partners, within the inpatient setting and from home.

Patient visitation restrictions brought on by the pandemic prevented families from being with their newborns in the Neonatal Intensive Care Unit. It kept COVID patients in isolation. The health system needed a new mechanism to help these patients engage with loved ones. It needed a means to connect its physician network with non-emergent patients at home. It also needed an alternative avenue to support behavioral health and emergency department patients without putting clinician or individual health further at risk.

PROPOSAL

Lee Health’s goal was to find a telemedicine system that could traverse its different verticals and that was scalable. If Lee were going to spend the money, it wanted to do it right.

“We developed a short list of telehealth solutions that could support the full spectrum of our needs – ambulatory, inpatient and direct-to-consumer,” said Jon Witenko, system director, virtual health and telemedicine, at Lee Health.

"Our administrative team first focused on employee health, conducting daily staff health screenings via telehealth. This gave clinical staff an opportunity to get familiar with the technology." - Jon Witenko, Lee Health

“The Caregility UHE platform would allow us to immediately integrate telehealth into our Epic EHR platform and quickly roll out virtual visits to clinicians and patients. The cloud-based, mobile-enabled solution meant we could use existing resources and keep implementation hurdles to a minimum.”

The scalable telehealth system would lay the groundwork for “the new normal” in healthcare delivery without Lee Health having to juggle a multitude of vendors or constantly reevaluate licensing needs, Witenko added. The UHE system would allow Lee Health to immediately extend virtual care to support employee health and ambulatory patients.

The system is designed for flexibility and future growth, he said. One goal was to extend the telehealth system to community partners that do not have a telehealth system in place to further support population health efforts.

MARKETPLACE

There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News recently compiled a comprehensive list of these vendors with detailed descriptions. To read this special report, click here.

MEETING THE CHALLENGE

Roughly one week after signing the contract, Lee Health began rolling out new telehealth programs.

“Our administrative team first focused on employee health, conducting daily staff health screenings via telehealth,” Witenko explained. “This gave clinical staff an opportunity to get familiar with the technology. We then ramped up our inventory of hardware cameras and rolled out virtual visits to our ambulatory providers – family practice and specialist physicians alike – for engagement with patients at home. Clinicians placed in mandatory quarantine due to exposure were able to continue to engage with patients remotely using the platform.”

Integration with Lee Health’s Epic EHR MyChart patient portal made it simple for clinicians to launch telemedicine sessions from within the patient record. Patients receive secure, one-time text or email invitations to join sessions without having to download an application.

“It’s as seamless as possible for patients and clinicians,” Witenko stated. “Our inpatients were given telehealth-equipped smart devices with one-click functionality that allows them to dial out to clinicians or loved ones. We dramatically increased the number of mobile telehealth carts to triage ED patients, limit exposure and perform rounding, specialty consultations and urgent assessments in our acute facilities and skilled nursing facilities.”

The health system extended access to its telehealth platform for both internal physicians and community physicians to provide care to patients in the hospital. Outside of the hospital, access to quick “drive-through” behavioral telehealth visits also have been made available to those without smart devices.

RESULTS

Lee Health fielded 200 employee health visits in a single clinic on day one and continue to use virtual visits to clear clinicians for work and monitor those in quarantine.

Lee Health’s 600 ambulatory physicians were systematically turned on to start virtual patient-appointments within the EHR. The platform was rapidly expanded to dietitians; physical, speech and occupational therapists; home health nurses; lactation; patient outreach; educators; and other ancillary services. In one week, virtual visits soared to 1,200 sessions per day with capacity supporting 200 concurrent calls.

“We performed 500 visits in the first five days of virtual health,” Witenko recalled. “We performed almost 50,000 in April and May. Our virtual visits are taking place from any private patient location to any secured clinician location where there is an internet connection. Both clinicians and patients have reported that virtual sessions tend to be shorter and more focused than traditional care visits, improving patient experience and staff productivity.”

ADVICE FOR OTHERS

“As social distancing continues and the nation lays out tentative plans to reopen businesses and schools, telehealth will continue to play a key role,” Witenko said. “Lee Health views virtual care as a permanent fixture in care delivery and plans to continue expansion. With that in mind, I’d recommend identifying a platform that can grow with your organization.”

Lee Health quickly learned it needed a robust support plan as this was a new experience for both patients and most of its providers. Its support team grew from one person to a team of 20 members fielding calls and guiding participants through the process.

The calls were often time-intensive as patients were anxious and not very comfortable with technology. The Lee Health team walked them through the process, performed test visits with them, and ultimately reassured them this was a new experience for everyone, but the provider organization was there to help them.

“Device-agnostic, cloud-supported platforms reduce implementation and support burdens,” Witenko advised. “Offer engagement tips to staff and patients to get parties comfortable with the solution. Build a strategy that allows you to work with what you already have and minimizes resource redundancies. Get creative. Perfection is the enemy of the good. If we had waited for everything to be ironed out, we would have never gotten started.”

Nothing is future-proof, he added.

“Seek out a solution and more specifically a vendor that continues to adjust as workflows and technology evolve,” he concluded. “Look for technology that is versatile not only for current state, but can be incorporated into multiple permutations, otherwise you’ll have dozens of disparate programs.”

Source: HealthITNews

In an effort to ease the strain on critical care resources and healthcare staff during this pandemic, Mayo Clinic has just partnered with Diagnostic Robotics to automate their patient triage system – allowing Mayo Clinic to make quicker, smarter decisions for patients when limited medical resources are available.

Medical-Grade AI Triage and Clinical-Predictions Platform

The automated predictive patient triage system uses artificial intelligence and a simple, intuitive questionnaire to perform clinical intake of patients visiting emergency rooms, urgent care clinics, and even patients from home. The clinical staff can review the self-reported condition, suggested differential diagnoses, and a hospitalization risk score for the patient in order to supplement the physician decision making process in real-time. Diagnostic Robotics’ triage platform has been trained on millions of EHR data, and billions of data points from the US and Israel.

Reduce Physician Burden, Optimize Emergency Room Visits

The platform, supported by Mayo Clinic’s emergency medicine department will help reduce physician burden and optimize emergency room visits for patients and for the entire medical team. By using predictive analytics, Mayo Clinic’s new AI system will help navigate patients to the most appropriate site of care, potentially reducing costs by as much as 47%.

“Our mission at Diagnostic Robotics is to improve patients’ experience and support healthcare providers by creating seamless, data-driven interactions that reduce administrative burdens and curb the costs of care,” said Yonatan Amir, co-founder and CEO of Diagnostic Robotics. “We are excited to collaborate with Mayo Clinic and implement our triage platform, this collaboration reflects the synergy between our technological vision and Mayo Clinic’s cutting-edge medical expertise.”

Diagnostic Robotics has recently adapted its technology to develop a separate COVID-19 risk assessment and monitoring tool, partnering with the Rhode Island Department of Health to roll out the platform to all Rhode Island’s residents, as well as an establishing a partnership with Salesforce and Deloitte to make the platform available to governments and healthcare systems globally.

Diagnostic Robotics Background

Diagnostic Robotics has brought together leading artificial intelligence researchers to create a powerful AI solution trained on data from more than 27 million patient visits and currently in use at more than 75% of HMOs in Israel. Anchored in Tel Aviv and New York City, the company’s 90+ doctors, AI experts, and software engineers are collaborating with a growing number of payer and provider partners in the United States and around the world to deliver actionable insights to the point of care.

Source: HIT Consultant

DrFirst, a Rockville, MD-based provider of e-prescribing, patient medication management, and price transparency solutions, today announced the release of the next generation of its SmartSig technology, which uses patented artificial intelligence (AI) to improve the quality of patient medication history when it is imported into hospitals’ and health systems’ electronic health record (EHR) systems. Clinicians use the imported information for medication reconciliation, which is recommended every time a patient is admitted, transferred, or discharged from a healthcare facility. Accurate medication reconciliation is a National Patient Safety Goal of The Joint Commission.

How Gaps in Prescription Histories Complicate The Medication Reconciliation Process

Simple prescription instructions, called “sigs,” can have hundreds of variations or be missing entirely from patients’ medication histories when they are imported into hospitals’ EHRs. The missing instructions add to the risk of medication errors and take time for staff to reconcile during the medication reconciliation process. In addition, the wide variability of sig terminology presents a more significant challenge than most people might imagine for translating and structuring the data, said G. Cameron Deemer, president of DrFirst. “Even a simple prescription instruction, such as ‘take one tablet by mouth once daily,’ can have hundreds of text variations,” he explained. These gaps in prescription histories complicate the medication reconciliation process, often requiring clinicians and staff to spend hours conferring with pharmacies and other providers to gather missing sig details and then manually enter them

A recent study by the University of Michigan reveals that quality issues due to free-text sigs also negatively impact pharmacy workflow and endangers patients, requiring pharmacists to manually edit 84% of electronic prescriptions to create accurate patient labels, which can still introduce human errors. The study, published in May by BMJ Quality & Safety, concludes that “development of tools and techniques such as a comprehensive set of structured direction components or machine learning-based natural language processing techniques may help produce clear directions.”

How SmartSig 2.0 Works

DrFirst’s SmartSig is incorporated into the company’s MedHx solution, which provides a more complete, clean, and consumable patient medication history for the medication reconciliation process. When medications are imported into EHRs, sigs associated with them typically arrive as unstructured free text, often with missing pieces of information and using a variety of terms for the same instructions (e.g., “by mouth” vs. “orally”) which makes the process of entering the medications labor-intensive and increases the risk of adverse drug events (ADEs).

SmartSig AI addresses these challenges by producing accurate, structured, real-time translations. The technology converts free text elements of medication sigs into a health system’s standard terminology and processes the data into appropriate fields so that it becomes functional within the EHR. With better and actionable data, health systems’ EHRs can more accurately trigger critical safety checks, such as drug interactions and allergy alerts.

SmartSig 2.0 accurately translates nearly 93% of incoming prescription information, called sigs, helping avoid medication errors and saving up to 30 seconds of work for each drug entered during the medication reconciliation process.

Initial Results/Outcomes for Providers

This time savings can add up to several thousands of hours in a month, depending on the size of the hospital or health system. For a mid- to large-size hospital reconciling more than 2 million patient medications in a month, this could save more than 200,000 work hours per year.

In an initial study with six health systems, SmartSig 2.0 further enhanced the quality of structured and codified sigs over the previous version. Sig translations from free text increased by an average of 11% with the next-generation technology, compared to SmartSig 1.0, which already improved translation and inference by up to 82%. The early adopters include Covenant HealthCare (Saginaw, Mich.), King’s Daughters Medical Center (Brookhaven, Miss.), Lafayette General Health (Lafayette, La.), Maimonides Medical Center (Brooklyn, N.Y.), and St. Claire HealthCare (Morehead, Ky.).

SmartSig’s patented AI is a game-changing solution that nearly perfects the quality of converted free-text sigs and drastically reduces the amount of time staff must spend verifying and reconciling medication histories,” he added. “More importantly, SmartSig has the potential to reduce adverse drug events, which are blamed for more than 100,000 deaths per year,” said Deemer.

Source: HIT Consultant

What is it?

By definition, Smart hospitals are those that optimize, redesign or build new clinical processes, management systems and potentially even infrastructure, enabled by underlying digitized networking infrastructure of interconnected assets, to provide a valuable service or insight which was not possible or available earlier, to achieve better patient care, experience and operational efficiency.

The most important component for smart hospitals is the ability to provide a valuable service of insight, which was simply not possible or available earlier. This is what makes a hospital a step further from being just digital, making it truly smart. Simply digitizing, or making the hospital paperless (although a great achievement) is not sufficient. We see current implementations of digital solutions in hospitals as steps in their journey to become smart. From exploratory implementations to an intermediate stage, to finally becoming smart where hospitals have a complete alignment of clinical processes and management systems.

The smart hospital framework involves three integral layers – data, insight and access. Data is being collected even today, although not necessarily from all systems in a hospital, but is not integrated together to derive ‘smart’ insight, which can be done by feeding it in to analytics or machine learning software. This insight must be accessible to the user – a doctor, a nurse, facilities personnel or any other stakeholder, through an interface including a desktop or a smartphone or similar handheld device, to empower them to make critical decisions faster, improving their efficiency.

There are three areas that smart hospitals address – operations, clinical tasks and patient centricity. Operational efficiency can be achieved by employing building automation systems and smart asset maintenance and management solutions, along with improving internal logistics of mobile assets, pharmaceutical, medical device, supplies and consumables inventory as well as control over people flow (staff, patients and visitors). Not only do these solutions reduce operational costs such as energy requirements, but also reduce the need for capital expenditures on mobile assets for example, by improving utilization rates of existing equipment. Patient flow bottlenecks, when addressed, improve efficiency, allowing more patients to be ‘processed’ through the system, allowing for more revenue opportunities at lower costs.

Trends driving smart hospitals:

Shift from disease treatment to health management - A major change in recent years is the shift in focus from disease treatment to health management, a term that encompasses wellness, healthy living, disease prevention, and rehabilitation. The change is being driven both by patients, who want longer, healthier lives, and by payers, which are facing budgetary pressures (and, in some cases, financial losses). The shift to health management is occurring in many countries around the world. For instance, the Singapore government has established an organization called the Health Promotion Board that encourages residents to adopt healthy living habits through the dissemination of evidence-based information and disease prevention programs at homes, workplaces, and schools. All residents in Singapore are urged to pay attention to their diet, exercise regularly, and undergo preventive screening, all of which helps reduce the likelihood of disease development (or progression) and need for hospital care. The Health Promotion Board also places greater focus on the nonhospital segments of the overall patient care pathway—and gives residents a tangible push to stay out of, and get out of, hospitals.

Quest for clinical outcomes and quality - Shocking as it may sound, diagnostic and treatment errors are common in healthcare. Research in the United States, for instance, has shown that five per cent of outpatient diagnoses are incorrect, diagnostic errors contribute to about ten per cent of patient deaths,3 and approximately 20 per cent of orthopaedic surgeons will conduct a wrong-site surgery at some point in their career.4 News reports in developing countries suggest that the misdiagnosis rates there could be even higher. The World Health Organization estimates that even in developed countries, seven out of every 100 hospitalized patients develop a healthcare-related infection each year.5 In the United States alone, more than US $210 billion is wasted annually on “unnecessary services.”6 These statistics make it clear that the concept of hospitals as the major site of care delivery needs a fundamental transformation to improve the quality of care. AI, robotics, and other new technologies can improve treatment precision and dramatically decrease the probability of error.

“Retailization” of health services - The old model of hospitals as stand-alone facilities that provide all services to all people is disappearing rapidly. Increasingly, hospitals are becoming just one component of larger, interdependent ecosystems that include multiple other facilities (e.g., primary care providers, clinics, pharmacies, rehabilitation centres). Already, many types of care are being shifted out of hospitals (Exhibit 1). In the United States, for instance, some leading retail companies offer patients a number of routine tests and treatments through clinics located within retail stores. In China, medical resources have traditionally been concentrated in tertiary hospitals, but the government is now shifting the focus toward primary care through a massive effort to build a family physician network and community clinics. New technologies are a key component of the move toward outpatient care since they make it possible to establish strong integration among the various entities, which improves the quality of care.

출처: Healthcare

Chinese researchers from The Trauma Center of Peking University People's Hospital and National Institute of Health Data Science at Peking University are using big data to help identify trauma patients who could experience potential adverse health events in the emergency department through the aid of a clinical decision support system. It was developed using a novel real-world evidence mining and evidence-based inference method, driven by improved information storage and electronic medical records.

The researchers published their results online on February 7 in IEEE Transactions on Systems, Man, and Cybernetics: Systems, a journal of the Institute of Electrical and Electronics Engineers. This is the first clinical decision support systems developed using evidential reasoning in an emergency department setting.

“Appropriate use of information technologies, particularly clinical decision support systems, may aid clinicians to make better clinical decisions and reduce the rate of medical errors. By inputting clinical data of a patient, combined with available historical data, our proposed clinical decision support system outputs a predicted belief degree of severe trauma, including ICU admission and in-hospital death."

Prof. Baoguo Jiang, corresponding author, Director of The Trauma Center of Peking University People's Hospital and China's National Center for Trauma Medicine

"The clinical variable signs and symptoms may be interrelated and lead to a clinical outcome. For example, a patient may have low level of consciousness because of the location of the injury, or it might be related to the high body temperature". In developing their clinical decision support system, the researchers used a trauma dataset from the emergency department at Kailuan Hospital in China, a hospital that has a close research collaboration with The Trauma Center of Peking University People's Hospital. Through the dataset, the researchers obtained the data of 1,299 trauma patients. The degree of interdependence between clinical signs and symptoms can be calculated from historical patient data. In the proposed clinical decision support system, the emergency room physician supplies information about the patient, including blood pressure, pulse rate, respiration rate, consciousness level, body temperature, age, comorbidities, mechanism and location of injury. These clinical signs and symptoms are then processed using an evidential reasoning rule, which compares each piece against the evidence mined from real-world data to predict the probability of adverse events and to optimally manage trauma patients and help them achieve ideal outcomes, trauma patients with a high probability of being admitted to the intensive care unit or dying in hospital need to be identified quickly and accurately upon their arrival at a hospital.

The team found that not only did their model prove especially useful in cases without prior expert knowledge or clinical experiences, but that the clinical decision support system also allowed for more accurate identification of trauma patients with adverse events compared to other systems with traditional machine learning models. Furthermore, the clinical decision support system works in a real-time fashion. From a physician's input of a patient's data to generating appropriate advices, the system works almost without any delay, which in turn helps buy trauma patients valuable time.

Next, the researchers plan to finetune their system and to generalize it for use in other clinical areas and non-emergent department settings.

출처: News Medical

The more we learn about the novel coronavirus (COVID-19), the more unknowns seem to arise. These ever-emerging mysteries highlight the desperate need for more data to help researchers and physicians better understand — and treat — the extremely contagious and deadly disease.

Researchers at Northwestern University and Shirley Ryan AbilityLab in Chicago have developed a novel wearable device and are creating a set of data algorithms specifically tailored to catch early signs and symptoms associated with COVID-19 and to monitor patients as the illness progresses.

Capable of being worn 24/7, the device produces continuous streams of data and uses artificial intelligence to uncover subtle, but potentially life-saving, insights. Filling a vital data gap, it continuously measures and interprets coughing and respiratory activity in ways that are impossible with traditional monitoring systems.

Developed in an engineering laboratory at Northwestern and using custom algorithms being created by Shirley Ryan AbilityLab scientists, the devices are currently being used in a study at Shirley Ryan AbilityLab by COVID-19 patients and the healthcare workers who treat them. About 25 affected individuals began using the devices two weeks ago. They are being monitored both in the clinic and at home, totaling more than 1,500 cumulative hours and generating more than one terabyte of data.

About the size of a postage stamp, the soft, flexible, wireless, thin device sits just below the suprasternal notch — the visible dip at the base of the throat. From this location, the device monitors coughing intensity and patterns, chest wall movements (which indicate labored or irregular breathing), respiratory sounds, heart rate and body temperature, including fever. From there, it wirelessly transmits data to a HIPAA-protected cloud, where automated algorithms produce graphical summaries tailored to facilitate rapid, remote monitoring.

“The most recent studies published in the Journal of the American Medical Association suggest that the earliest signs of a COVID-19 infection are fever, coughing and difficulty in breathing. Our device sits at the perfect location on the body — the suprasternal notch — to measure respiratory rate, sounds and activity because that’s where airflow occurs near the surface of the skin,” said Northwestern’s John A. Rogers, who led the technology development. “We developed customized devices, data algorithms, user interfaces and cloud-based data systems in direct response to specific needs brought to us by frontline healthcare workers. We’re fully engaged in contributing our expertise in bioelectronic engineering to help address the pandemic, using technologies that we are able to deploy now, for immediate use on actual patients and other affected individuals. The measurement capabilities are unique to this device platform — they cannot be accomplished using traditional watch or ring-style wearables that mount on the wrist or the finger.”

“We anticipate that the advanced algorithms we are developing will extract COVID-like signs and symptoms from the raw data insights and symptoms even before individuals may perceive them,” said Arun Jayaraman, a research scientist at Shirley Ryan AbilityLab, who is leading the algorithm development. “These sensors have the potential to unlock information that will protect frontline medical workers and patients alike — informing interventions in a timely manner to reduce the risk of transmission and increase the likelihood of better outcomes.”

Continuous monitoring from hospital to home

The mysterious ways that COVID-19 affects the body seem to get stranger and stranger. Many patients’ symptoms fully disappear before they suddenly and unexpectedly begin deteriorating — sometimes within a matter of hours. Other patients have recovered and tested “negative” but later test “positive” again.

The unknowns underscore the need for continuous patient monitoring to ensure that physicians can intervene at the slightest sign of trouble. The Northwestern and Shirley Ryan AbilityLab teams’ device provides around-the-clock monitoring for COVID-19 patients and those exposed to them.

“Having the ability to monitor ourselves and our patients — and being alerted to changing conditions in real time — will give clinicians a new and important tool in the fight against COVID-19,” said Dr. Mark Huang, a physician at Shirley Ryan AbilityLab, who has worn the sensor. “The sensor also will offer clinicians and patients peace of mind as it monitors COVID-like symptoms, potentially prompting earlier intervention and treatment.”

The device can monitor hospitalized patients and then be taken home to continue 24/7 supervision. The real-time data streaming from patients gives insights into their health and outcomes that is currently not being captured or analyzed by traditional monitoring systems.

“Nobody has ever collected this type of data before,” Rogers said. “Earlier detection is always better and our devices provide important and unique capabilities in that context. For patients who have contracted the disease, the value is even more clear, as the data represent quantitative information on respiratory behavior, as a mechanism to track the progression and/or the effects of treatments.”

“This opens up new telemedicine strategies as we won’t have to bring in patients for monitoring,” Jayaraman said. “Physicians can potentially review the patients’ data for hours, days or weeks, immediately through a customized graphical user interface to a cloud data management system that is being set up for this purpose, to see an overall image of how the patient is doing.”

Although the wearable device is currently unable to measure blood oxygenation levels, which is an important component of lung health, the team plans to incorporate this capability in its next round of devices. The Rogers lab has already successfully incorporated this capability in its previous work to produce clinical grade-monitoring devices for intensive care units. Rogers believes they can easily apply that research to the COVID-tailored devices.

Warning system for the most at-risk

Not only can the device monitor the progress of COVID-19 patients, it could also provide early warning signals to the frontline workers who are most at risk for catching this remarkably infectious disease. The device offers the potential to identify symptoms and to pick up trends before the workers notice them, thereby providing an opportunity to engage in appropriate precautionary measures and to seek further testing as quickly as possible.

“People with obvious, severe symptoms are going to the hospital, being tested or being told to self-isolate,” Jayaraman said. “For those who have symptoms they perceive as mild or seasonal allergies, there is no warning system. They could be in contact with others and unknowingly spread infection.”

Assessing efficacy of new therapeutics

As researchers rush for a COVID-19 cure, physicians have been trying exploratory, sometimes unproven, treatments to help their patients. This is another area where Rogers’ and Jayaraman’s device can play a role.

“Early reports of certain proposed treatments suggest that they can eliminate coughing symptoms more quickly than a placebo,” Rogers said. “Nobody, however, is quantifying certain key symptoms, such as coughing — duration, frequency, amplitude, sounds, etc. Our device allows for precision measurement of this essential, yet currently unquantified, aspect of the disease.”

In the future, this sensor package could help researchers and physicians quantify which therapeutics are working best.

“At the simplest level, our systems allow assessments based on data, in a quantitative way, without relying on human judgment of whether a patient is coughing more or less,” Rogers said.

Device initially conceived for stroke patients

The new device builds on recent research from a collaboration between Rogers’ and Jayaraman’s labs, first published on the cover of the February 2020 issue of Nature Biomedical Engineering, with a focus on monitoring swallowing and speech disorders in patients recovering from stroke. These sensors work by precisely measuring vibratory signatures from the throat and chest. By measuring vibrations rather than acoustics, the team avoids noise from background sounds and it bypasses privacy issues.

In response to requests and inquiries from the medical community, Rogers and Jayaraman realized they could use this technology to measure the vibratory signatures of COVID-like symptoms, including chest wall movements and cough.

Jayaraman’s team is developing custom signal processing and machine-learning algorithms to train the device how to recognize coughs in the data.

“As the algorithm becomes smarter, our hope is that it will begin to discriminate among which coughs are COVID-like and which are from something more benign,” Jayaraman said. “The most basic approach, already deployed on COVID-19 patients and health care workers, simply counts coughs and their intensity.”

More advanced analytics packages will be available within the next few weeks.

Bypassing already-stressed supply chains

Thanks to a generous gift from Northwestern University trustees Kimberly K. Querrey (’24 P) and Louis A. Simpson (’58, ’96 P), Rogers and his team are able to respond quickly to requests for devices. Leveraging a set of manufacturing tools available in the new Simpson Querrey Biomedical Research Building in Chicago, the team is already producing dozens of devices per week. Rogers estimates that his team could produce up to hundreds of devices per week — all in house, largely bypassing the need for external vendors and complex supply chains.

“Quickly developing new technologies internally has never been more crucial,” Querrey said. “This work proves the power of STEM and why it’s so critical to the University and beyond to have world-class researchers like John. I am so proud of John and his team, while working remotely, for thinking outside the box and using their collaborations to help protect our healthcare workers. We are excited to be able to develop these devices within the University and get them in the hands of those needing them most. The ability to measure vibratory signatures could really help with early detection of COVID-19.”

“This crucial philanthropic support has allowed us to develop and deploy the devices and an associated software infrastructure almost immediately, within days, after we started receiving requests from the medical community — without waiting for external vendors, most of which are mostly shut down with the stay-at-home orders,” Rogers said. “In this way, we avoid already-stressed supply chains. We just do it ourselves.”

Comfortable and easy to use

In mid-March, Kelly McKenzie felt foggy and developed a low-grade headache. Having recently returned from a work-related trip overseas, she assumed it was jetlag. But as her symptoms progressed to include cough and congestion, she started to worry. Although her symptoms were not severe enough to seek COVID-19 testing, she knew she should self-isolate.

“Between my international travel and the symptoms, my director and I decided it was best for me to stay home from work, so I wasn’t bringing anything contagious into the hospital,” said McKenzie, who is a research physical therapist at Shirley Ryan AbilityLab.

McKenzie joined the pilot study to test the device and train the algorithm with her symptoms. After wearing the sensor around the clock for a week, she was amazed by the comfort of the soft silicone material and ease of use. Wearers simply charge the device, put it on and it immediately begins to work — streaming real-time data to a smartphone or tablet.

“When you first put it on, you can feel it just because it’s new and different,” McKenzie said. “But after you have worn it for a while, you don’t even notice it.”

Because it is fully encased without wires, electrodes, charge ports or removable batteries, the device can be worn while exercising or in the shower. It turns out this also is important for sterilization and reuse.

“This is absolutely critical for use in the context of this extremely contagious disease,” Rogers said. “Because it is fully sealed in a soft biocompatible silicone material, it can be completely immersed in alcohol, and then exposed to a gas-based system for rigorous sterilization. If there were exposed regions, or plugs or ports or other physical interfaces, the device would not be relevant for this application.”

출처: Northwestern