Alexandros Giannakis and Fabian Gautschi
There are key aspects digital health solutions must meet to positively impact health and quality of life
COVID-19 has fundamentally changed how patients receive medical care. With an almost mandatory need to engage with practitioners through physical distance, a reported 44 percent of cellphone users globally have used their mobile device for a diagnosis or treatment. Precautionary mandates imposed on routine activities have forcefully shifted doctor and patient connections to digital platforms. In response, the rollout of digital health solutions, such as health tracking and management apps, has surged as care providers and patients adopt and adapt to digital engagement services with unprecedented fervor.
Now, while digital health solutions such as health tracking apps are not new ideas, the wide adoption of these tools by practitioners to directly interact with patients alongside quantified holistic management of the patient’s health is. This poses a new opportunity for physicians and health specialists to guide their patients through major health management areas – general health, activity, biomechanics, sleep, nutrition, mental health and omics – and impact quality of life, health status and treatment outcomes.
As new digital health solutions are developed by both healthcare industry insiders and new digital natives, there has been a huge focus on the experience aspect of such offerings. Aiming to reach the standards of consumer goods and retail industry solutions, these digital health tools have achieved progress with user-friendliness, engagement and seamless connectivity. However, a great experience is a founding block to delivering value but remains insufficient to achieve health outcomes. The digital health solutions that positively impact health and quality of life will reflect the following key aspects:
1. Design treatment based on a holistic view of the patient.
One recent study correlates 80-90 percent of health to social determinants (i.e., health behaviors that result from social conditions). Tracking patients’ lifestyle and behavior, together with relevant health factors of general health, activity, biomechanics, sleep, nutrition, mental health and omics are imperative to coaching a patient towards wellness. Consider a diabetes patient who is using a digital diary shared with their physician to track diet. Although the diary will afford the physician line of sight into key treatment factors, such as sugar intake, it leaves room for other disease enablers to fall through the cracks. For example, if physical activity and sleep – two high-risk factors in patients with diabetes that influence energy and dietary uptake – are not similarly monitored, there is a significant risk of treating the patient with a sub-optimal nutritional and insulin treatment regime. Similar applies to monitoring mental health, which is a key determinant of the patient’s willingness and ability to adhere to a disciplined treatment and a balanced lifestyle, both key determinants of long-term health as a diabetic.
These selected examples reflect how digital health solutions must consider the patient’s holistic health to properly contextualize both the disease and the most effective treatment. Every therapeutic area has its own set of relevant factors. Therefore, digital health solutions must be tailor-made in order to capture and analyze the information that is relevant to each therapeutic area and its specific application within individual treatments. As a first step, organizations pursuing digital health solution offerings must define their data strategy by clearly outlining the data required to obtain objective and holistic information about the patient. Only by leveraging the right data, can decisions informed by digital health solutions lead to improved outcomes and better quality of life for patients.
2. Access and analyze data from multiple sources to enable a holistic view of the patient.
While digital health solutions have already increased access to care, their biggest value-add will be unlocked when they can access and analyze patient-related data stored at disparate databases. Expect that these databases will belong to multiple parties including the patients themselves, health insurances, healthcare providers, wearables’ companies, etc. To ensure all this data can be leveraged for the development of meaningful and personalized insights, without having to go through time-consuming, costly, and often restrictive legal technical transformations, digital health solutions must be able to leverage information in situ – where it is located – instead of having to pull it into a centralized location. Practically, this works by enabling analytics across distributed databases without having to overcome limitations like data privacy/ownership, as the raw data is being leveraged without being disclosed or seen by third parties. Going back to our example of a digital diary that tracks a diabetes patient’s diet, this would enable synchronization with the patient’s medical record that includes information on past hyperglycemic events. Using this data can help define which levels of blood glucose can be considered safe by providing health experts a higher level of accuracy of the type of nutrition that will be most effective for the patient.
3. Let the results speak for themselves.
Possessing a holistic view of the patient through the aggregation of data from multiple sources, physicians will be able to put disease treatment into the full context of the patient with whom they are working. Having the right data will allow the care that practitioners provide to be hyper-personalized in a way that cannot be achieved through traditional drug treatments. Leveraging data and insights to guide the body’s natural health defense systems into action will help improve health and treatment outcomes. The improved outcomes should be highlighted throughout the patient’s journey in order to further encourage engagement with the digital health solution and sustain the positive impact.
Ultimately, as more patients successfully improve health and treatment outcomes using digital health solutions and technologies, these offerings will further evolve into delivering an increasing number of standalone treatments, known also as digital therapeutics. To get there, offering great experience can draw patients in, but technically designing these solutions to access and analyze the right holistic data no matter where it is located and to whom it belongs is what will unlock better health outcomes. Care delivery has changed significantly with incredible speed, ensuring these emerging solutions are tailor-made to each therapeutic area and patient will be the impetus for successful treatment.
During the Precision Medicine World Conference, informaticians describe the rapid progress they made harnessing EHR data as well as their hopes for improved public health infrastructure
Informatics executives are making a valuable contribution to the pandemic response through the collection, dissemination and analysis of EHR and clinical registry data. During a recent panel discussion, leaders from several health systems also described the challenges and shortcomings they faced and a wish list for the future.
The June 15 Precision Medicine World Conference panel was hosted by Atul Butte, M.D., Ph.D., director of UCSF’s Institute for Computational Health Sciences. He asked his panelists to describe some of their accomplishments during the COVID era, and each respondent described significant changes their teams were able to make in short order.
For instance, Melissa Haendel, Ph.D., chief research informatics officer at the University of Colorado, who leads the National Center for Data to Health, described the number of people who came together to harmonize and aggregate data and create the National COVID Cohort Collaborative (N3C), which aims to take EHR data and harmonize it and bring it together and make it broadly accessible. “One of the overarching goals of this initiative was to create a fully transparent, reproducible, and broadly accessible electronic health record data repository of COVID patients and matched controls being drawn from a variety of different clinical institutions,” she said. “We're up to almost 90 institutions now that have signed on to the initiative. We now have over 2,000 people working on it. It demonstrates the sort of commitment and partnership between the community members, the research networks from the different common data models, the government centers for translational science award sites, and commercial entities all working collectively together in a rather unprecedented governance structure to enable the creation of this limited data set, which to our knowledge is now the largest publicly available, limited data set in U.S. history.”
Philip Payne, founding director of the Institute for Informatics at Washington University in St. Louis, also works on N3C. He described his organization’s work with partners at BJC Healthcare. “The real lesson learned for us was all about how we realign our priorities — how do we harness our capabilities in the informatics and data science research arena, and use them to tackle what was largely an operational problem? These included activities, such as bringing together all of the data across our regional health systems and brokering that data such that it would be available for broad use for hospital capacity planning, response planning, and then later in the pandemic, to help manage our public vaccine campaigns, all while at the same time making sure that we're able to do our core work of research around the pandemic and make that data quickly available to our investigators.”
Payne added that this wasn't just about providing data, but also about pilot funding. “We launched a series of just-in-time pilot funding mechanisms to bring together different disciplinary teams that could tackle fundamental problems such as one project that led to a predictive model to identify patients coming into our emergency departments that would benefit from palliative care as opposed to admission to the ICU, especially for those with multiple comorbid conditions and a high probability of mortality.”
In addition, Chris Longhurst, CIO at UC San Diego Health, and Jessie Tenenbaum, Ph.D., chief data officer for the North Carolina Department of Health and Human Services, described some of the challenges they overcame in tracking and reporting on COVID cases and vaccination rates.
Despite all the impressive work described, Butte asked the panelists what tools they wish they had and how we could best prepare for future challenges, including the next pandemic.
Longhurst noted that UCSD has all its students and employees on the same electronic health record that it uses for its patients. “That really helped to support us during the pandemic, because we had all that data about our testing and our vaccine administration in one place. However, I'd say that the vaccine data on our populations has been a real challenge. The State of California said if you're going to administer COVID vaccines, you need to report it to the registry. But, of course, these registries were built primarily for pediatric immunizations — low volume, and in many cases, not bidirectional interfaces. We really stressed those systems, and the public health infrastructure broke when we stressed them. So there was a period of time for a month or more when they were unable to send us that bidirectional data, and we couldn't integrate that, to understand the first- and second-dose gaps and things of that nature.”
Although they have done a lot of hardening of the system in California, they still have significant infrastructure issues. “For example, here in San Diego County, we have our own county registry that then reports data to the state,” Longhurst said. “And, of course, they use different identifiers so it's very hard to reconcile that. The one perhaps provocative suggestion I might make is that we shouldn't be doing anything at the county level. I don't think that our county IT colleagues really have the wherewithal from a security standpoint or data expertise standpoint. And I think that if we can harden that and centralize it at the state level, at least, that's going to make it easier to get the right data to the county public health leaders, but also make it easier for the health systems, which in most cases, span multiple counties.”
After describing some of the efforts the State of North Carolina has made to automate aspects of public health data reporting on COVID, Tenenbaum noted that although they now have all this data, they have a lot of trouble with linking it. “We have huge efforts right now at creating a master patient index. We don't have one identifier for vaccination data versus case data. And so for breakthrough cases, we're having to do a pretty manual matching probabilistic process. We're working with our state HIE, which is really good at this, to get that master patient index.”
Payne noted that his organization operates a health system that spans multiple states, about a 300-mile catchment area. “We see an extreme degree of variability in the vaccine registries and the ways in which vaccination information is being documented in EHRs, in the occupational health context or in student health contexts relative to our universities, not to mention what happens when we have large public vaccination events run either by the National Guard or various public health departments.” They work with five different public health departments within just the St. Louis metropolitan area.
“The timeliness of that data is very challenging based upon how it's collected and how it's submitted,” Payne stressed. “The way in which we can query it from the registries is highly variable. That leads to some very challenging situations where we're trying to understand what is our real state of vaccination, and in particular, in communities that are highly underserved or at risk. We are a microcosm of the U.S. healthcare system, where we have a lot of access, a lot of equity and a lot of disparity issues to navigate, particularly amplified in this campaign. We can't get to that data quickly enough. And I think it speaks volumes to the lack of a real interoperable healthcare data fabric at a regional or national level, which we all knew was the case. And we've just sort of amplified our understanding of that.”
Haendel closed by noting that a few of the themes that were mentioned included centralization and identifiers. “It's all about being able to harmonize information for asking important questions. In the face of a new disease, we really want to take advantage of all the different data that we can about an individual and a population. In healthcare i we take data that is about a patient. Now we have EHR data, we have imaging data, we have viral sequencing data, we have survey data. We ship those data to different places, never to be reconnected again. And so my hope in the future is that we have a system where we can put the patient back together again — my very technical term — to do the multimodal analytics, get the imaging machine learning working together with the clinical data at the scale of the whole nation. And that really does take that management of centralization into the state or the national level, and really good identifier management for security as well as for data analytics.”
A northeast Indiana health system has joined the statewide HIE to support public health efforts that lean on interoperability and data exchange.
Parkview Health, a 10-hospital health system in northeast Indiana, has joined the Indiana Health Information Exchange (IHIE) to support statewide, data-driven public health efforts powered by interoperability.
IHIE is the non-profit organization that operates the Indiana Network for Patient Care (INPC), the largest inter-organizational clinical data source in the country. INPC has data on more than 17 million patients from over 117 hospitals, 18,000 practices, and 50,000 providers.
“As Indiana’s statewide health information exchange, IHIE believes it has a responsibility to securely gather, analyze, and communicate information in the best interest of public health, and specifically, in support of the Indiana Department of Health,” John Kansky, chief executive officer of IHIE, said in a press release.
IHIE consolidated with Michiana Health Information Network (MHIN) in 2020 to form a statewide HIE, providing healthcare stakeholders with a comprehensive source of connected patient information.
The consolidation has allowed IHIE to accrue clinical data to improve patient care and support public and population health initiatives, the HIE noted.
Now, the HIE’s clinical database will grow even larger with Parkview as a new partner.
“I believe Parkview’s participation will have a significant positive impact, and we greatly appreciate their participation,” Kansky continued.
Ron Double, chief information officer of Parkview Health, noted that COVID-19 has highlighted the importance of secure data exchange for collaboration and innovation.
“We understand the power of data and its impact on the health of our community,” said Ron Double, chief information officer of Parkview Health. “The pandemic demonstrated the importance of securely sharing information and collaborating with agencies across the state. Parkview is looking forward to seeing the impact of this partnership, especially in research and innovation.”
Parkview’s participation will enhance the statewide asset by increasing interoperability for care coordination and public health research efforts, the organizations said.
“Data are essential to us in our work to protect the health and safety of Hoosiers,” said Kristina Box, MD, FACOG, state health commissioner. “Adding Parkview Health to IHIE will greatly enhance our ability to make data-driven, evidence-based decisions for the whole state.”
IHIE has not only supported statewide interoperability efforts, but national ones, too.
Earlier this year, IHIE and five other major health information exchanges (HIEs) formed the Consortium for State and Regional Interoperability (CSRI).
CSRI aims to boost nationwide patient data exchange by progressing patient data exchange initiatives across the country and promoting state-to-state interoperability for providers, health plans, Medicaid programs, and public health departments.
Additionally, CSRI will form data-driven healthcare insights for federal agencies to advise critical policy decisions and increase health IT innovation.
The consortium is made up of IHIE, Chesapeake Regional Information System for our Patients (CRISP), which covers Maryland, District of Columbia, and West Virginia; CyncHealth in Nebraska and Iowa; Health Current of Arizona; Manifest MedEx of California; and Colorado Regional Health Information Organization (CORHIO).
“CSRI is well-positioned to leverage economies of scale on projects that have the potential to move the interoperability needle in a big way,” Morgan Honea, CEO of CORHIO, told EHRIntelligence.com in a February interview. “I am incredibly excited to be a part of this innovative group and look forward to developing and delivering HIT that can help solve significant data problems.”
In the fight against COVID-19, the six HIEs partnered with their local public health departments to enhance data exchange. The HIEs supported test ordering and scheduling with state and county clinics, as well as the development of dashboards for COVID-19 test results, mortality, and hospitalizations. The HIEs also supported contact tracing efforts, COVID-19 alerts, and predictive analytics to identify high-risk patients.
To recover from COVID-19’s financial downturn and improve patient outcomes, healthcare organizations are prioritizing health IT and EHR optimization.
Healthcare organizations are investing in health IT resources and EHR optimization after a year of COVID-19 financial turbulence, according to the 9th annual Health IT Industry Outlook survey conducted by Stoltenberg Consulting Inc.
The survey collected insights from chief information officers (CIOs) or IT directors at a variety of healthcare facilities.
According to the results, EHR optimization is a big-ticket item for most CIOs in 2021. More than half of respondents (59 percent) said that "getting the most out of existing IT purchases, like the EHR system" is their healthcare organization’s biggest financial goal post-COVID-19.
“In a rapidly evolving environment, technology must adapt to the changing needs of healthcare and the changing preferences of consumers more directly involved in their own care journeys,” the researchers wrote.
Approximately one in three CIOs (31 percent) reported that EHR new version upgrades are the top IT spending priority for their healthcare organizations, while one in four industry leaders reported investment in cybersecurity measures as the top spending priority for 2021.
However, despite CIOs reporting greater investment in EHR upgrades, 33 percent of respondents said cybersecurity was their organization’s top mission-critical priority compared to 30 percent who reported EHR upgrades as the top mission-critical priority. This is likely due to the uptick in healthcare cybersecurity events in 2021, the report authors noted.
Additionally, after a pause in early 2020, healthcare mergers and acquisitions (M&A) are growing in popularity once again, prompting CIO interest in health IT system integration, the survey authors explained. Approximately 20 percent of CIOs reported that IT integration after system consolidation is a mission-critical priority, indicating the need for high-quality IT support.
However, more than half of respondents (55 percent) reported that as they face decreased revenues from COVID-19, budgeting for qualified IT resources is their organization’s most significant operational burden for the second consecutive year.
The researchers said that enabling a mix of flexible and properly skilled staff is key as CIOs seek to lessen administrative burden and control costs.
When IT support teams are well-versed in both the EHR system and the healthcare organization’s cross-organizational workflow and communication practices, they can better tailor processes to maximize efficiency and system utilization, the researchers explained.
“At a time when the digital experience has become a competitive differentiator for hospitals and health systems, many internally operated help desks cannot handle the crush of inquiries coming their way,” the researchers wrote. “Utilizing IT support resources who can easily flex in and out of project area needs is pivotal for nimble response that better optimizes IT spending without draining resource costs or adding on ramp up and training time.”
Additionally, the researchers called for CIOs to apply analytics to end-user support. By doing so, organizations can determine where further investment is needed. For instance, help desk incident analysis helps underscore large-scale workflow or system education difficulties, the researchers said.
“As a clear view into organization-wide EHR use, this is especially helpful during mission critical events, like crisis management, new system go lives or EHR upgrades to detect areas of concern,” the report authors wrote.