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

Association of Electronic Prescribing of Controlled Substances With Opioid Prescribing Rates

“[Introduction] In this study, we aim to build on the existing research by analyzing the association of the adoption of EPCS [electronic prescribing of controlled substances] with opioid prescribing across the United States. We specifically examine trends in the adoption and use of EPCS and 2 measures of opioid prescribing across the United States from 2010 to 2018. In doing so, we aim to provide policy makers, prescribers, and patients with evidence of the association of the use of EPCS with the opioid epidemic. [..] [Methods] [..] We used data from annual reports published by Surescripts, a near-monopoly supplier of … Read More

Effect of Remote Monitoring on Discharge to Home, Return to Activity, and Rehospitalization After Hip and Knee Arthroplasty: A Randomized Clinical Trial

“[Introduction] Hip and knee replacements are the most common inpatient surgical procedures for Medicare beneficiaries in the US, with substantial cost and variability in care during the hospitalization and through postacute care. Most hospitals are participating in a bundled payment program for hip or knee replacement surgery, such as the comprehensive care for joint replacement model, with the goal of reducing unnecessary postacute care and rehospitalizations. Patients discharged from hospitals to facilities have higher costs and not necessarily improved outcomes, and payment policies have not resulted in substantially reduced rehospitalizations. [..] Behavioral science has revealed that humans have predictable biases … Read More

Sensor-aided continuous care and self-management: implications for the post-COVID era

“In the USA, virtual care in its current form, like conventional outpatient care, is still episodic and transactional via a fee-for-service model. This transactional nature occurs despite the knowledge that disease, or even wellness, is a continuous state and flare ups do not coincide with periodic, predetermined follow up clinic visits. In the peri-pandemic period, medical professionals must develop an economic model that would encourage the delivery of continuous care. Maybe there is something to learn here from the role of remote monitoring with pacemakers, loop recorders, and defibrillators. In the not-so-distant past, patients with implanted devices were evaluated in-person … Read More

Automated Identification of Adults at Risk for In-Hospital Clinical Deterioration

“We previously described an automated early warning system that identifies patients at high risk for clinical deterioration. Detection is achieved with the use of a predictive model (the Advance Alert Monitor [AAM] program) that identifies such patients. Beginning in November 2013, we conducted a pilot test of this program in 2 hospitals in Kaiser Permanente Northern California (KPNC), an integrated health care delivery system that owns 21 hospitals. The system generates AAM scores that predict the risk of unplanned transfer to the ICU or death in a hospital ward among patients who have “full code” orders (i.e., patients who wish … Read More

Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change: A Randomized Clinical Trial

“Population health management is a team-based approach in which nonclinical staff members identify and reach out (typically outside face-to-face visits) to specific groups of patients with unmet preventive and chronic condition care needs. Population health management has been increasing across primary care and is associated with improved outcomes, but to our knowledge, it has not previously been used for patients with overweight or obesity. The purpose of this trial was to examine whether integrating an online weight management program with population health management support would enhance its effectiveness and lead to greater weight loss at 12 months among primary care … Read More

Accelerating Science-Driven Reimbursement For Digital Therapeutics In State Medicaid Programs

“For evidence-based, prescribed digital therapeutics to reach the most vulnerable populations, they need to be reimbursable by Medicaid. [..] One example is WellDoc, an FDA-cleared digital therapeutic that has been shown to improve outcomes for patients with Type 2 Diabetes, leading to cost savings for employers and health plans. Another example is the FDA-cleared digital health platform Propeller Health, an evidence-based platform for asthma and chronic obstructive pulmonary disease (COPD). There are also digital therapeutics earlier in the FDA-clearance pipeline with growing literature demonstrating reproducible clinical effect. One example is Cognoa, an evidence-based FDA breakthrough-designated company that focuses on diagnosis … Read More

Rethinking Physician Visit Workflows with the AMA’s New Documentation Requirements Starting January 1, 2021

We in health information technology are optimistic that clinicians will update their clinical documentation practices so they use nomenclatures (e.g., Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT], Logical Observation Identifiers Names and Codes [LOINC], RxNorm) in designated fields and then add more details within the free text portions of their electronic medical record documentation. While medical informaticists might expect to use natural language processing to extract more elements out of physician documentation, the American Medical Association (AMA) has worked to reduce documentation requirements starting January 1, 2021.1 Given the amount of time clinicians spend interacting with electronic medical records … Read More