The American Telemedicine Association kicked off ATA2022 this week with an examination of the challenges faced by care providers, and a plea that telehealth could be the avenue by which providers reconnect with their patients and understand the patient experience.
Telehealth, as everyone likes to say these days, is here to stay. But the really exciting thing is what it can do to bring humanity back to healthcare.
That was the big take-away from the first day of the American Telemedicine Association’s first in-person conference in three years, taking place this week in Boston. With a theme focused on “What now?”, the several hundred attendees milling about the convention center were told that empathy and connection are the keys to continuing virtual care in a post-pandemic world.
“It’s really about how we care for people,” said Adrienne Boissy, the former chief experience officer of the Cleveland Clinic who became chief medical officer of digital health company Qualtrics in 2021, in an opening keynote that focused on the idea of agility.
ATA CEO Ann Mond Johnson kicked off the three-day event Sunday morning with a call for attendees to recognize that the pandemic may have brought telehealth to the forefront and proven its value, but it also exposed long-standing challenges, ranging from policy and regulation to licensing and addressing social determinants of health.
“There is more than broadband and interactive access that we have to deal with,” she said.
This includes the idea that the business of healthcare has gotten away from the simple, basic act of helping people with their health. While the nation may be moving toward ideas like value-based and patient-centered care, much of what’s still taking place these days is episodic, centered on the healthcare provider or site, and plagued by a reliance on payment. That, compounded by the perils of COVID-19, is why so many healthcare providers are stressed out and either gone or ready to go.
And that’s where telehealth can and should help.
Joe Kvedar, the Harvard Medical School professor and longtime digital health expert, pointed out that consumers “have always been enthusiastic” about telehealth because it helps them access care when and where they want it, while payers are still ambivalent but leaning in the right direction. Providers, he said, “are our biggest challenge.”
Hospitals may lose revenue on telehealth, he said, and “there’s a lot of holding back” in embracing virtual care because of the uncertainty surrounding reimbursement and, in some cases, clinical value. But the healthcare industry has to understand that telehealth checks some of the boxes that in-person care can’t, and it’s what consumers want.
More importantly, said Boissy, it gives providers and consumers and opportunity to connect in ways they haven’t before.
“This should be a wake-up for us,” she said.
Boissy pointed out that we’ve gotten to the point where consumers are fed up with their healthcare options, and will seek out providers who give them what they want. And it’s up to healthcare to give them what they want. Telehealth gives them that opportunity to meet the consumer, and to establish a connection that goes beyond occasional office visits. It gives them an opportunity to collaborate with patients on their health and wellness.
Furthermore, Boissy said telehealth gives providers an opportunity to engage with patients and enrich the patient experience – to which she quickly added that the patient experience isn’t just “any question on a survey.”
“It starts with communication,” she said.
Boissy said the healthcare industry, for the most part, may have forgotten how to communicate with consumers, or it may not understand what communication means. Providers, she said, tend to say “I understand” too quickly, or far too often, driving a wedge between them and patients who don’t think their doctors are listening to them.
And one of the biggest issues that consumers have with healthcare is access. It may take days to schedule a visit to the doctor, and hours to travel to the doctor’s office, yet the doctor may spend only a few minutes with the patient for an issue that could have been handled with a simple video visit.
Healthcare providers are reluctant to embrace those video visits because they aren’t getting reimbursed for them as well as for the in-person visit, but consumers want that access, and they’re willing to switch providers – or even ditch the tradition primary care provider model for a platform supported by their health plan or a retail site like Amazon, Google or Walmart – to get what they want.
“Who’s going to win the battle for primary care?” Kvedar pointed out.
As he, Boissy and the other speakers on day one of the ATA conference emphasized, telehealth can be the platform by which healthcare providers re-engage with consumers and understand the value of the patient experience.
The state is one of 10 and Washington DC that allow patients with a terminal illness to request help in dying from a healthcare provider, but had been the only one that didn't specifically allow that request to be made via a video visit.
Vermont’s governor has signed into law a bill amending the state’s assisted suicide statute to include telemedicine.
S.74, passed by the state House and Senate after an almost two-year process and signed by Gov. Phil Scott on April 27, amends the state’s medical aid in dying law, which was passed in 2013, allows a patient who meets specific criteria to request a prescription to aid in dying through telemedicine, eliminating the need for two in-person consults and a 48-hour waiting period. The bill also establishes legal immunity for licensed healthcare providers, including pharmacists.
The bill defines telemedicine for these purposes as an interactive audio-video platform that complies with the requirements of the Health Insurance Portability and Accountability Act (HIPAA).
The argument follows a familiar path around the use of telemedicine for controversial healthcare services, such as abortion. Supporters say patients should be able to use virtual care to access the services they need but can’t get to in person, because of physical, geographical, or social barriers or a lack of available providers. Opponents argue that some healthcare services shouldn’t be allowed through virtual channels because a patient should be in front of a care provider, in the same room, to talk through what may be a difficult decision.
Ten states and the District of Columbia currently allow medical aid in dying, also called assisted suicide and death with dignity, with all but Vermont including the use of telemedicine in their guidelines.
Vermont’s bill was hotly debated, and included the rejection of an amendment in the House that would have mandated at least one in-person meeting between the patient and a healthcare provider during the process. Adding to the emotion surrounding the issue, the bill was supported by former Vermont House Majority Leader Willem Jewett, who gave an interview with the VTDigger online news service just a few days before dying in January.
“It’s the fundamental authority of the individual over the most fundamental decision they’ll make in their life,” Jewett, 58, who died of mucosal melanoma, said in the interview. “It becomes simple if you accept that premise.”
The original law, which Jewett helped to pass, enables patients with a terminal illness and a prognosis of six months or less to make two in-person requests, at least 15 days apart, to a prescribing physician for drugs to assist in one’s death. That patient must also see another consulting physician in person and make a written request, and wait at least 48 hours after receiving the prescription to use it.
State Senator Dick McCormack, who sponsored S.74, and others, including Patient Choices Vermont, said that process can take months, sometimes longer than the time the patient have left, robbing those patients of their choice in the matter.
“These improvements will really help alleviate suffering toward the end of life, and make the process of medical aid in dying more compassionate,” Betsy Walkerman, president of Patient Choices Vermont, told VTDigger on April 27, following Governor Scott’s signature making the bill a law.
As amended by the bill, Vermont’s law allows patients to request medications to assist in dying from a healthcare provider, either in person or via telemedicine if the physician determines that a video visit is clinically appropriate. The patient must make the request twice, at least 15 days apart, and the clinician must determine that the patient is suffering from a terminal illness, is capable of making that decision and has been informed about the process to access and use those drugs. It allows the physicians to prescribe and the pharmacist to fulfill that prescription and eliminates the 48-hour period between when the patient receives the drugs and uses them.
Finally, it states that “no physician, nurse, pharmacist or other person licensed, certified, or otherwise authorized by law to deliver health care services in this State shall be subject to civil or criminal liability or professional disciplinary action for acting in good faith compliance with the provisions of this chapter.”
A recent survey of 100 health system executives finds that most say a strong digital health strategy is essential, yet less than a quarter are confident in the one they have.
More than 90% of health systems surveyed recently say a strong digital health strategy is essential to improving clinical outcomes, boosting clinician satisfaction rates and increasing productivity, yet less than half actually have a strategy in place. And less than a quarter are “very confident” that they have the right strategy.
That’s the troubling take-away from a survey of 100 health system executives conducted this past February by Sage Growth Partners. The survey, contained in Panda Health’s Hospital Digital Health Technology Report: 2022, offers a glimpse of the chaotic digital health market that healthcare leaders are facing these days, and offers a few guidelines to establishing a path forward.
"This report shows that hospitals are struggling in their efforts to improve efficiency, patient care, and outcomes as a result of challenging and time-consuming technology procurements," David Harvey, CEO of Panda Health, a digital health marketplace launched in 2020 through a partnership of CentraCare, the Gunderson health System and ThedaCare, said in a press release. "It can take hospitals up to one year or longer to find and contract for new solutions, and even after implementing them, many question if they selected the best technology for their unique needs. Healthcare organizations need a more streamlined process, so they can confidently move faster and drive better outcomes."
Digital health was seen as a “nice to have” strategy just a few years ago, but the pandemic pushed things into overdrive. Many healthcare organizations embraced virtual care platforms and digital health tools and programs to reduce traffic at overcrowded hospitals and replace in-person treatment at a time when the risk for spreading the virus was high.
Now, with COVID-19 easing into the background and consumers expressing their desire to continue using digital health, health systems are looking to make those emergency measures more permanent and trying to develop long-term strategies.
Identifying the Path Forward
“Many organizations are turning to digital health solutions, which tend to integrate with and complement EHRs and other systems of record, to build patient loyalty, improve the bottom line, and support staff members and clinicians,” the Panda Health report says. “These technologies span a multitude of use cases and solution categories, including patient engagement platforms, financial clearance and price estimation tools, digital care navigators, and more.”
According to the survey:
68% want digital care coordination/care journey orchestration tools;
63% of the health systems are looking to implement digital reputation management tools within the next three years;
61% are looking for digital care navigators or website chatbots;
47% are looking for financial clearance and price explanation tools;
43% are looking for self-service patient scheduling solutions;
41% want patient engagement tools;
39% are interested in remote patient monitoring services; and
38% are eyeing self-service payments and estimates services.
(Interestingly, of the health systems surveyed, 91% say they already have a telemedicine platform in place, with the remaining 9% planning on adopting one within three years.)
But creating a strategy to address those needs is not that easy.
According to the survey, only 6% of the health systems surveyed have a “fully developed” digital health plan, while 46% feel their plan is “moderately developed.” Conversely, 16% said they haven’t developed any plan, and 31% say it’s “slightly developed.”
When asked to identify the biggest barrier to establishing a strategy, 38% citing the integration vetting process, 34% identified vetting solutions for functionality, 15% focused on cybersecurity vetting, and 10% identified technical standards vetting.
Part of the problem is tied to the crowded digital health market, fueled by a dramatic increase in venture funding from $14 billion in 2020 to $26.5 billion in 2021. According to the survey, 66% of health systems say it’s moderately or extremely challenging to find the right solutions to consider, while 71% say it’s moderately or extremely challenging to align internal stakeholders to a digital health strategy.
Alongside that, more than half of the health systems surveyed said they get more than 10 e-mails or phone calls every week from digital health vendors, with 3% saying they field more than 100 a week, yet 95% surveyed said those vendor contacts result in business deals less than 2% of the time.
To tackle these challenges, the report makes three recommendations:
Establish a deliberate and actionable strategy;
Find new ways to quickly narrow the field; and
Conduct a more efficient evaluation and contracting process.
That may include seeking outside help. Some 56% of the health systems surveyed said it would be very or extremely valuable to partner with another organization to evaluate and implement a digital health strategy.
The recommendation may seem simplistic, but the value of a good digital health plan is clear. Some 83% of the health systems surveyed say digital health adoption will increase over the next three years, and 65% say their budgets will increase as a result. In other words, if they’re spending money on the issue, they’d better know what they’re spending it on.
The Iowa health system has launched a subscription-based program, with help from Fitbit, to not only encourage people to improve their health and wellness, but share that information with the care providers.
Healthcare organizations are looking to the consumer wearables space to promote health and wellness, with the goal of improving patient engagement and clinical outcomes.
The latest to do so is MercyOne, which has launched a subscription-based wellness platform aimed at helping consumers improve their lifestyles through digital health.
The Iowa-based health system is making its Circle+ powered by MercyOne platform available to anyone, whether or not they’re a patient. Participants can sign up and complete an assessment to gain access to a suite of virtual resources and mHealth apps, at a charge of $19.99 per month.
The program, unveiled this past March, combines the benefits of the consumer-facing digital health market with the support of a healthcare organization, which can curate and recommend specific resources and products. Surveys have shown that consumers will embrace health and wellness ideas more readily if they’re supported or recommended by a healthcare provider.
The health system is partnering with Fitbit on the program, which gives members a free Inspire 2 fitness tracker or preferred pricing on a more expensive wearable, as well as a Fitbit Premium membership. Other benefits include access to apps like Navigate Wellbeing, Total Brain, and Fringe.
“MercyOne has embraced consumer-facing digital health overall including remote patient monitoring, virtual nursing, [and] virtual triage, as well as virtual visits for primary and specialty care and more,” MercyOne President and CEO Bob Ritz said in an e-mail interview with HealthLeaders. “This partnership with Fitbit is just one of the ways we are continuing to offer care anywhere and connect with consumers in new ways.”
“Our mission calls us to transform the health of our communities, and our vision is to set the standard for a personalized and radically convenient system of health services,” he added. “Ultimately with Circle+ powered by MercyOne, we want to connect with people before they are sick to keep them well. We develop comprehensive business plans to support our innovation initiatives, which include return on investment assessments.”
Officials say the program will not only drive interest in preventative care, but support the health system’s clinical services as well. They want people in the program to not only pay more attention to their health, but share that data with their care providers, who in turn can guide them and improve care management.
“We plan to evolve our … program to support clinical pathways,” Janell Pittman, MercyOne’s chief marketing and digital strategy officer, said in the e-mail exchange. “MercyOne has long been a believer in the impact social influencers of health have on health outcomes and has employed community health workers, health coaches and more to impact health outcomes by addressing loneliness, transportation, prescription access and food security to name just a few. We will continue to transform the health of our communities by supplementing analog approaches with digital with expanded use of remote patient monitoring, expanded connections to patients via asynchronous and synchronous care, hospital at home and more.”
“We do encourage members to download critical pieces of [the program] to share with their provider,” added Try Cook, the health system’s division director of business solutions. “These items include the results of wearable tracking, health risk assessment summary, health coaching goals, and other results-oriented metrics. Each member is provided specific instructions on how to download and provide this info to their providers. Our providers and care managers will use this data and member input to provide personalized care.”
The Children's Community Health Plan is using a digital therapeutic to improve patient engagement and give members dealing with panic disorder an alternative to medication or emergency in-person treatment.
Healthcare providers and payers often look for alternatives to medication in treating chronic conditions, especially those experienced by children. One increasingly popular example is digital therapeutics, which can be delivered virtually, though an mHealth app, when and where needed.
The Children's Community Health Plan (CCHP) is seeing success with one such treatment for members dealing with PTSD and panic disorder. The Milwaukee-based health management organization, an affiliate of Children's Wisconsin, recently made a digital health platform developed by Freespira available for free to its 150,000 members, roughly 60% of which are children, and saw success in roughly 70% of the people who used the platform.
"We've been pleasantly surprised by the number of members who have engaged in treatment," says Mark Rakowski, the health plan's president.
The key word is "engaged," and it's one that healthcare organizations like CCHP have long struggled with in chronic care management. People often have a difficult time sticking with a treatment over a lengthy period of time—and with chronic conditions that time might be a lifetime. Patients get tired, lose interest, the treatments fall off, and the chances of negative health outcomes shoot upward.
A Digital Health Alternative to Drugs
Digital therapeutics, defined by the Digital Therapeutics Alliance as "medical interventions delivered directly to patients through evidence-based, clinically evaluated software," takes aim at the patient engagement dilemma. Advocates say these treatments, delivered via mHealth apps, devices, even video games, have the potential to hold patients' attention longer and make them more inclined to manage their healthcare.
With CCHP, the motivation to use this treatment stems from a statistic from the Centers for Disease Control and Prevention (CDC) that nearly 3 million children have been diagnosed with a serious emotional or behavioral health condition during the pandemic, and that roughly 6% of children ages 6–17 now experience those health issues.
Children's Community Health Plan President Mark Rakowski. Photo courtesy CCHP.
"We needed another tool in our toolbelt," says Rakowski. "This is an alternative treatment to traditional psychotherapy or pharmacology, which can sometimes have side effects. This gives us a chance to try something new."
The Freespira platform addresses panic disorder through breathing, based on the theory that the underlying physiological cause is tied to breathing irregularities and a hypersensitivity to carbon dioxide. Through a breathing sensor, tablet, and customized app, users undergo two 17-minute treatments a day to normalize breathing patterns for a 28-day period.
After one year of use, CCHP officials reported that 68% of the nearly 250 people who used the digital therapeutic experienced "clinically significant" reductions in symptoms associated with PTSD and panic disorder.
This, in turn, means less of a reliance on prescription medications, fewer visits to the doctor's office or the hospital to treat emergencies like panic attacks, and an improvement in quality of life, which carries with it a number of downhill benefits. For payers, the ROI is seen in reduced healthcare costs and better clinical outcomes.
Finding a Path to Sustainability
Rakowski says CCHP reviewed the data before agreeing to support the Freespira platform, "and that was really the key." But the health plan is going to need its own data to scale up and sustain the program.
While CCHP is initially providing the Freespira digital therapeutic free of charge, that won't last forever. Because a large percentage of the health plan's member base is on Medicaid, they'd like the Centers for Medicare & Medicaid Services (CMS) to offer reimbursement. That, in turn, would convince more care providers to either prescribe or recommend the treatment to their patients.
"We can cover the cost for now because we are seeing ROI," Rakowski points out. "But will that remain over time? Our future payments are based on claim utilization … and we're going to need longitudinal data to prove that."
And long-term sustainability, he says, will be tied to patient engagement.
An important aspect of this treatment is provider buy-in. Having a doctor prescribe or recommend this treatment (as opposed to having a health plan suggest or recommend it) goes a long way toward improved patient engagement. Patients trust their doctors and will listen to them, Rakowski says, and they'll be more inclined to stay in touch with their doctors about the treatment.
"We don't want to get in the way of that relationship," he says.
And like CMS, doctors need to see the proof that a digital therapeutic will work for their patients before supporting it. And that value can work both ways.
"They want to make sure that the technology itself has that level of scrutiny," Rakowski says.
Rakowski says these home-based treatments—CCHP also works with Propeller Health, a digital health company focused on breathing problems like asthma and COPD—offer benefits to care providers as well, in that they can manage their patients more easily on a digital health platform. Doctors not only gain a link to the patient's life between scheduled visits to the office, but they get data that helps them see how the patient is doing, how the current treatment plan is or isn't working, and what daily events or stressors might be bringing on panic attacks and other worrisome outcomes.
That's especially important in dealing with a behavioral health concern. Rakowski says that patients living with these health issues are still stigmatized and are less inclined to visit a doctor when they need one. They may also have difficulties opening up to a doctor about their mental health or describing what they're feeling or how they're acting.
"Just getting people to pick up their phone [and call] is a challenge," Rakowski says.
A digital therapeutic must not only be functional, but easy and attractive enough that someone will want to use it and continue using it when needed. A treatment like Freespira's fits that bill, while also helping patients become more comfortable with managing their health.
Rakowski says CCHP has plans to boost the number of members using the Freespira platform, and he's hoping the numbers continue to look good. They've had good and bad luck with digital health so far, but the success of both Freespira and Propeller Health is giving administrators ideas on what other treatments to try. They'd love to find an mHealth app, he says, that will help new and expectant mothers with maternity care.
"Implementation is time-consuming," he says, "but for us as a health plan, we see what we've done with this so far and the difference we're making. We're changing people's lives."
ATA2022, taking place next week in Boston, will give the organization an opportunity to plan the evolution of telehealth beyond the pandemic, and to talk about bringing virtual care to an 'inspirational level.'
Healthcare organizations are experimenting with new and innovative technologies and services as they move away from the pandemic and closer to value-based care, and a lot of those cool new ideas will be front at center at next week’s ATA2022 American Telemedicine Association conference in Boston.
Meeting in person for the first time in more then two years, telehealth advocates will have the chance to chat up what some are calling “Healthcare 3.0.” It describes an ecosystem based on lessons learned from the rapid uptake of virtual care during the COVID-19 emergency, the fast-moving field of consumer healthcare, and new advances in mobile technologies, including smart devices, sensors, and wearables.
This year’s theme is “Now what? Creating an Opportunity in a Time of Uncertainty.”
“It’s more than all of us asking, ‘What do we do now?’” says ATA CEO Ann Mond Johnson. “People want to make sure that telehealth wasn’t just a pandemic-only tool.”
Indeed, as ATA2022 convenes next Sunday through Tuesday at the Boston Convention Center in the city’s trendy Seaport District, much of the talk is still centered on how to continue the momentum beyond COVID-19. The public health emergency caused by the pandemic is expected to end before the close of 2022, putting an end to many federal and state measures enacted during the PHE to improve access to and coverage of telehealth services. The ATA is among many organizations lobbying the federal government to extend or even make permanent those measures, but in the meanwhile providers and payers are uncertain as to how to chart a long-term telehealth strategy.
Johnson says the shift from in-person to virtual care during the pandemic – and the gradual shift back to a hybrid platform that combines the two – has proven that telehealth is viable, either as a supplement to improve in-person care or an alternative when barriers exist. Providers, she says, are now learning to “bake it into the process,” or integrate virtual and in-person services.
That’s especially apparent in the growth of remote patient monitoring programs that allow providers to monitor and communicate with patients at home, and in hospital-at-home concepts that allow hospitals to shift some acute care and ICU services to the home by combining RPM platforms and tools with in-person care.
More than one panel will discuss the RPM and Hospital at Home concept, with one focusing on the payer perspective and another on innovations in delivery and strategy. Other hot-button topics include telemental health, VC support for innovative start-ups, virtual care strategies for critical and emergency care, senior and pediatric care programs and policy issues such as cross-state licensing.
The ATA will also shine the spotlight on start-ups with its Telehealth Innovators Challenge, which enables nine “virtual care visionaries” in three categories – in-patient care solutions, the patient experience, and tools that deliver care – to showcase their ideas before a panel of judges.
Mond hopes the conference continues the evolution of telehealth. What once was considered a nice idea worthy of a pilot project is now a standard of care in many places, existing alongside or integrated with in-person care. Now, she says, the industry needs to bring it to an “inspirational level,” taking on the social determinants of health and addressing disparities in care.
And in that she hopes the industry will lead by example.
“This boils down to change management,” she says. “It’s time to take that next step.”
Researchers at the Medical University of South Carolina are using mice models to design better treatments for babies born with low birthweight who suffer a germinal matrix hemorrhage (GMH).
Thousands of children are born with very low birthweight in the US every year, and many are at high risk of suffering a brain hemorrhage, called a germinal matrix hemorrhage (GMH), shortly after birth, causing severe long-term health effects or death.
Researchers at the Medical University of South Carolina (MUSC) are turning to mice to develop new strategies for diagnosing and treating the condition, an effort that could greatly improve the birth rate and reduce the number of birth defects.
“We were just having to wait for bad things to happen,” Ramin Eskandari, MD, a pediatric neurosurgeon at MUSC Children’s Health, said in a recent press release. “And then we had to react to them. We have no treatment for the actual hemorrhage or for preventing the stroke or hydrocephalus that comes after.”
Eskandari said he came upon research by Stephen Tomlinson, PhD, vice chair of the Department of Microbiology and Immunology at MUSC, who was focusing on a part of the immune system called the complement system. Thinking that work could have applications for infants, the two collaborated with Mohammed Alshareef, MD, a senior neurosurgery resident at MUSC, to create a mouse model to stand in for premature infants with very low birthweight.
In a study recently published in the International Journal of Molecular Sciences, the team found that they could inhibit the complement system in the brain immediately after a hemorrhage, reducing and possibly even preventing temporary and permanent damage that accompany these types of strokes. By using a complement inhibitor called CR2Cry, they found improve not only survival but weight gain, reduce brain injury and incidents of hydrocephalus, an improve motor and cognitive performance in adolescence.
The new treatment could have a profound effect on the survival rate and long-term health for babies born with very low birthweight, who made up about 1% of infants born in the US in 2020, or roughly 48,500 births. And those numbers are rising as healthcare providers use new technology and treatments to treat newborns.
“We’re seeing younger and younger babies viable,” Eskandari said in the press release. “I remember when a 23-week-old baby wasn’t viable, and even in the last eight years since my residency, we’re now seeing babies at 20 weeks not only be viable but live full lives and attend school.”
The process that Eskandari and his colleagues developed is unique in the more than 100 clinical trials currently running, because it targets a specific part of the brain. But focusing on the point where the pathology begins, they can avoid affecting the complement system for the entire body, thus reducing the chance of infection and other immune disorders.
Eskandari and his colleagues say their research will not only help infants born with brain hemorrhages, but those dealing with other types of brain injury as well.
“These babies are a really good overall model of how all brain injury could potentially be helped,” he said, adding that he hopes to launch a clinical trial soon at MUSC. “Having a hemorrhage that leads to stroke and hydrocephalus checks a lot of boxes that we see in many patients.”
The vulnerabilities were found in the Aethon TUG smart autonomous robot, which is used by hundreds of health systems to ferry medications and other supplies throughout the hospital.
An autonomous robot commonly used in hospitals to transport medication and other supplies from room to room could be hacked and used to spy on patients and staff, according to a New York-based healthcare IoT security company.
Cynerio announced earlier this month that its researchers had discovered five vulnerabilities in the innards of the Aethon TUG smart autonomous robot, which is sued in hundreds of healthcare sites around the world.
Robots like the Aethon TUG are used by hospitals to do light housekeeping and ferry items from one place to another, relying on radio waves, sensors and other technology to open doors, take elevators and maneuver through hallways without hitting anything. More advanced telepresence robots are being used to connect care providers in other locations with patients in their rooms or the Emergency Department and even perform some guided surgeries.
Collectively called the JekyllBot:5, the malware was found in the TUG Homebase Server’s JavaScript and API platforms, as well as a WebSocket that is used to relay commands from the server to the robot. According to a Cynerio press release, these vulnerabilities could:
Disrupt or impede the timely delivery of medications and lab samples;
Shut down or obstruct hospital elevators and door locking systems;
Monitor or even take videos and pictures of patients, staff, and hospital interiors, as well as sensitive patient medical records;
Control the robots to allow them to access restricted areas, interact with patients or crash into staff, visitors, and equipment; and
Hijack administrative user sessions in the robots’ online portal and inject malware through their browser to enable future cyberattacks on IT and security team members at healthcare facilities.
Cynerio has reportedly been working closely with Aethon to send patches to its customers to apply to the robots and has updated firewalls at some hospitals so that their IP addresses can’t be used to access the robots.
“These zero-day vulnerabilities required a very low skill set for exploitation, no special privileges, and no user interaction to be successfully leveraged in an attack,“ Asher Brass, Cynerio’s lead researcher on the JekyllBot:5 vulnerabilities and head of cyber network analysis, said in the press release. “If attackers were able to exploit JekyllBot:5, they could have completely taken over system control, gained access to real-time camera feeds and device data, and wreaked havoc and destruction at hospitals using the robots.”
And the concerns aren’t limited to accessing sensitive and valuable data through web portals or e-mail scams. Robots and smart devices both within the hospital setting and outside the campus that can remotely access healthcare operations are at risk of being accessed and controlled. Experts have warned that these vulnerabilities can not only expose data but put lives at risk.
“Hospitals need solutions that go beyond mere healthcare IoT device inventory checks to proactively mitigate risks and apply immediate remediation for any detected attacks or malicious activity,” Cynerio founder and CEO Leon Lerman said in the press release. “Any less is a disservice to patients and the devices they depend on for optimal healthcare outcomes.”
Researchers at the University of Michigan have developed algorithms that allow them to track the progress of the virus through a smartwatch, and hope to expand that platform to monitor other health concerns.
Researchers at the University of Michigan have created a protocol for tracking COVID-19 symptoms through a smartwatch, and say the process could eventually be used to detect other health issues, such as the flu.
In a study recently published in Cell Reports Medicine, the research team traced six factors derived from heart rate data collected by a smartwatch that determine when a user is infected by the virus and how sick they become. They found that those living with the virus experienced an increase in their heart rate per step once the symptoms were detected, and those dealing with a cough experienced a much higher heart rate per step than those who didn’t have a cough.
“We found that COVID dampened biological timekeeping signals, changed how your heart rate responds to activity, altered basal heart rate and caused stress signals,” Daniel Forger, a professor of mathematics and research professor of computational medicine and bioinformatics at the University of Michigan and part of the research team, said in a press release issued by the university. “What we realized was knowledge of physiology, how the body works and mathematics can help us get more information from these wearables.”
The research adds to the growing body of evidence that mHealth wearables can be used to detect and monitor COVID-19 in patients at home, enabling healthcare organizations to treat them through remote patient monitoring programs rather than putting them in a hospital.
It also expands the opportunities for RPM programs to track and treat other health concerns at home instead of the hospital, clinic or doctor’s office. In time, wearables and sensor-embedded clothing could be used to detect and monitor a wide range of health concerns, from viruses like the flu to chronic conditions like diabetes, asthma, cardiac failure and cancer.
In Michigan, researchers focused on data from patients in the Intern Health Study, a multi-site study that followed physicians in several locations across their first year of residency, as well as the Roadmap College Student Data Set, which tracked student health during the 2020-21 school year through Fitbit wearables, self-reported COVID-19 diagnoses and symptom information and publicly available data. In all, they tracked the health of 43 medical interns and 72 students.
Using an algorithm developed to estimate daily circadian phase from heart rate and step data taken from a wearable, they found that:
Heart rate increase per step, a measure of cardiopulmonary dysfunction, increased after symptom onset.
Heart rate per step was significantly higher in participants who reported a cough.
Circadian phase uncertainty, the body’s inability to time daily events, increased around COVID symptom onset. Because this measure relates to the strength and consistency of the circadian component of the heart rate rhythm, this uncertainty may correspond to early signs of infection.
Daily basal heart rate tended to increase on or before symptom onset. The researchers hypothesize this was because of fever or heightened anxiety.
Heart rate tended to be more correlated around symptom onset, which could indicate the effects of the stress-related hormone adenosine.
The research team said they were able to create new algorithms that can be used to study how an illness impacts heart rate physiology – and which could be used to expand the use of wearables in healthcare.
“There’s been some previous work on understanding disease through wearable heart rate data, but I think we really take a different approach by focusing on decomposing the heart rate signal into multiple different components to take a multidimensional view of heart rate,” Caleb Mayer, a doctoral student in mathematics, said in the press release. “All of these components are based on different physiological systems. This really gives us additional information about disease progression and understanding how disease impacts these different physiological systems over time.”
Healthcare organizations are using digital patient questionnaires to gather real-time data from patients, allowing clinicians to adjust care management when and where needed.
Healthcare organizations are using digital health tools to gather more data about their patients, but the challenge has always been how to use that information.
At Ascension Illinois, care providers are using Measurement-Based Care (MBC) to improve outcomes in behavioral health treatment. The strategy is based on collecting information throughout treatment to assess outcomes, then modifying care management plans to improve treatment.
Chris Novak, vice president and chief operating officer for Ascension Illinois' behavioral medicine service line, says the process of gathering data to support treatment benefits not only the provider but also the patient. The health system uses a digital health platform developed by Owl to create a baseline assessment for each patient, then uses ongoing virtual questionnaires to demonstrate patient progress, giving providers the evidence they need to measure and then improve treatment.
The digital platform is important. It has allowed health systems like Ascension Illinois to move from paper-based questionnaires and subjective observations during visits to data collection at the point of care, saving valuable clinician time. It allows the provider to gain a better idea of what the patient is experiencing, and to collaborate with the patient on care management.
Chris Novak, vice president and chief operating officer for Ascension Illinois' behavioral medicine service line. Photo courtesy Ascension Illinois.
"It helps us to demonstrate to our patients in real time the improvements that we're seeing," he says. And in doing so, it allows clinicians to personalize patient care.
Data is often considered the cornerstone to improving clinical care, and innovations like digital health and telehealth have proven both beneficial and problematic. They allow healthcare providers to collect much more data than before, about patients as well as their home environment and daily habits, but that data must be sorted and analyzed. Without processing tools, providers are overwhelmed by data, unable to determine what information they can use.
"The field is evolving," says Novak, who sees home-based digital health platforms and wearables as the next evolution of MBC. The information contained in those platforms, he says, can greatly affect care management if used correctly. A care provider who can see into a patient's daily lifestyle can pinpoint activities or habits that affect health, and design care plans that reinforce good habits and steer the patient away from bad ones.
With the MBC platform used by Ascension Illinois, Novak and his colleagues gain insights from clinically validated assessments, offering objective data on a patient's care plan. The patient answers questionnaires electronically and submits the information to the care provider. For patients living with thought disorders or who might have problems answering questionnaires, the provider can administer those questionnaires with the patient during a session.
Those assessments give care providers the real-time information they need to improve care, and thus become the basis for value-based care.
"Across a wide range of treatment settings, there is a substantial gap between the outcomes achieved in randomized controlled trials and in routine mental health care," the study noted. "One of the main contributors to enhanced outcomes in randomized controlled trials is that treatment protocols include systematic measurement of symptom severity, followed by algorithm-based treatment adjustments when patients are not responding to care."
"Although there are numerous brief, validated symptom rating scales that reliably measure change in severity of symptoms over time, only 17.9% of psychiatrists and 11.1% of psychologists in the United States routinely administer symptom rating scales to their patients," the researchers continued. "On the basis of clinical judgment alone, mental health providers detect deterioration for only 21.4% of their patients who experience increased symptom severity. Detection rates are even worse for patients whose symptoms are not deteriorating but who also are not improving as expected. The failure to detect patients who are not responding to treatment contributes to clinical inertia (defined as not changing the treatment plan despite a lack of substantial improvement in symptom severity.) The use of symptom rating scales to monitor outcomes helps prompt clinicians to overcome treatment inertia and change the treatment plan when patients are not responding to treatment."
That study concluded that because behavioral healthcare providers weren't demonstrating the value of their treatments, payers weren't supporting the programs, leading to "chronic underfunding of mental health services." It argued that MBC could prove that value.
Then came the pandemic.
Novak says MBC proved its mettle during the pandemic, when most health systems shifted from an in-person model of care to a virtual platform to reduce the spread of the virus and enable care providers to treat patients in their homes. Through the platform, providers were not only defining the effectiveness of their treatments but also comparing the value of an in-person treatment program against a virtual program, or one that combines both virtual and in-person care.
It also allowed them to gain support from payers, who typically want to see proof that a new service will reduce costs and/or improve outcomes before they reimburse providers.
"Our discussions with payers have been positive," Novak says. MBC "quantitatively [demonstrates] that improvements are being made in a virtual setting, which is on par with in-person care."
The challenge, of course, lies in synching the data to the electronic health record (EHR), a process often complicated, if not hindered, by different platforms that store data in silos. Novak notes his health system currently works with four different EHRs, so it's easier right now to keep that data separate and integrate it later, when they move to one EHR.
That's where he sees this platform evolving. As the technology improves and systemwide integration is made easier, MBC will become a standard of care, with automated and adaptive testing that allows care providers to see the results in real time, adjust care management on the fly, and modify future assessments and tests to be more personalized.
"Behavioral health horizontally intersects all areas of medicine," he says, "and demonstrating the impact of effective care is critical."
