Internal Memo: Amazon Care to shut down, ‘not a complete enough offering’ for corporate customers

Excerpt – Amazon will stop offering its Amazon Care primary health-care services at the end of this year, according to an internal memo, after determining that it wasn’t “the right long-term solution for our enterprise customers.” The surprise move Wednesday is a major course correction in Amazon’s broader foray into healthcare. Amazon says the decision impacts only Amazon Care, and not its other health-care initiatives. “This decision wasn’t made lightly and only became clear after many months of careful consideration,” said Neil Lindsay, Amazon Health Services senior vice president, in the email to Amazon Health Services employees. “Although our enrolled … Read More

Smartphone apps promised to help combat the pandemic. How well did they work?

“A new review paper, published Monday in Nature Biotechnology, explores the wide range of apps rolled out to combat the pandemic [..]. Here are four questions that still need to be answered about how apps can combat Covid. [1] How do you get broad swaths of the public to adopt an app? “Contact tracing had a lot of problems,” said [physician and Director of Digital Medicine at Scripps Research Translational Institute and a co-author of the new paper Jay] Pandit. [..] The initial goal for the U.K. National Health Service’s Covid-19 app was to reach a 60% adoption rate. [..] … Read More

Intravenous Fluids—A Test Case for Learning Health Systems

“Explanatory trials evaluating the efficacy and safety of adding a new drug or device to current clinical care (A vs A-plus) are traditionally powered to detect the smallest difference in clinical outcomes that would justify incorporating the new treatment into care, considering its added risks, costs, and burdens. For example, the median minimal clinically important difference in mortality targeted by acute care trials has been approximately 8%, implying that smaller differences in mortality might not justify incorporation of the new treatments into care. These types of trials ask, “is this new treatment better than current care by enough to offset … Read More

The Telehealth Era is Just Beginning: More gains in quality, affordability, and accessibility are on the way

“Having analyzed health outcomes data from the independent National Committee for Quality Assurance, health plan member satisfaction surveys from J.D. Power, and internal data from our own organizations, we are confident that full implementation of five opportunities would improve clinical quality nationwide by 20%, increase access to care by 20%, and reduce health care spending by 15% to 20%. Reduce Expensive and Unnecessary Trips to the ER Reverse America’s Chronic-Disease Crisis – For members of large multispecialty medical groups such as Kaiser Permanente [KP], high blood pressure is a much more manageable problem [outside of KP, control rates hover around … Read More

Developing a shared sepsis data infrastructure: a systematic review and concept map to FHIR

“There is an urgent need to improve diagnostic excellence in sepsis1. One potential solution is the development of a flexible, scalable, and interoperable data infrastructure to screen and identify sepsis patients across health systems using real-time, granular clinical data available within electronic health records (EHRs). Despite clinical data for millions of sepsis or pre-sepsis patients routinely collected in EHRs, the healthcare enterprise has accessed only a small fraction of these data to improve the clinical understanding of sepsis. The development of a sepsis data backbone could be extended to meet diverse needs, including sepsis translational research, clinical care delivery, machine … Read More

Preventing Delayed and Missed Care by Applying Artificial Intelligence to Trigger Radiology Imaging Follow-up

“[..] artificial intelligence (AI) is well suited to the detection and reporting of follow-up recommendations because of the large volume of imaging studies requiring screening and the relatively standardized language employed by radiologists in preparing reports. Natural language processing (NLP) methods, including text pattern-matching and traditional machine-learning techniques, have been developed for this task. In this article, we use the term traditional machine learning to refer to all machine-learning methods that are not deep learning, and these terms will be defined in detail in the sections that follow. More recently, novel deep-learning methods for NLP have shown great promise for … Read More

Experiences of Health Centers in Implementing Telehealth Visits for Underserved Patients During the COVID-19 Pandemic

“Before the pandemic, most health centers did not offer telehealth visits for primary care or behavioral health, in large part because of reimbursement policy. In spring 2020, dramatic policy changes removed many of the restrictions on telehealth delivery, and health centers responded by standing up large telehealth programs. This sudden and dramatic change in health care delivery posed numerous challenges. Health centers had to quickly make changes to technology, workflows, and staffing to accommodate telehealth visits. To support health centers in these efforts, the California Health Care Foundation established the Connected Care Accelerator (CCA) program, a quality improvement initiative that … Read More

Learning from Real-World Implementation of Daily Home-Based Symptom Monitoring in Patients with Cancer

“Routine use of home-based symptom monitoring and management using electronic patient-reported outcomes (ePRO) to improve care delivery is on the horizon. Randomized clinical trials demonstrate that use of patient-reported symptoms can have marked impact on patient outcomes, including minimizing symptom burden, enhancing quality of life, reducing hospitalizations, increasing time receiving cancer treatments, and, in some studies, improving survival. [..] few health systems have successfully, fully integrated ePRO. [..] In the study by Daly and colleagues, the authors begin to tackle an important question of frequency of assessment administration in ePRO. This study used daily symptom assessment in contrast to the … Read More

Remote Postdischarge Treatment of Patients With Acute Myocardial Infarction by Allied Health Care Practitioners vs Standard Care: The IMMACULATE Randomized Clinical Trial

“β-Blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARBs) are beneficial after AMI [acute myocardial infarction], and adjustment of these medications to moderate to high doses is recommended in the setting of reduced LV ejection fraction (LVEF) or heart failure. Initiation and adjustment of these medications can be challenging during hospitalization, particularly among patients with borderline or low systemic blood pressure because of an emphasis on shortening length of stay and the challenges in organizing frequent face-to-face visits early after discharge. Telemedicine has enabled the transition from face-to-face care and is set to play a key role in the post–coronavirus disease-19 … Read More

Digital Health—The Need to Assess Benefits, Risks, and Value

“Digital health is a broad spectrum of measurement technologies that include personal wearable devices and internal devices as well as sensors in people, homes, cars, and communities. Digital health can help identify health risks and assist with diagnosis, treatment, and monitoring of health and disease conditions and offers novel ways to capture continuous data on individuals and populations that complement the episodic data on individuals that are captured by current health care approaches. [..] Digital health technologies may enhance capabilities for improving health through 3 modalities: improved data communications, miniaturization, and decentralization of devices. Electronic medical records, mobile health apps, … Read More