“While telehealth is often used as an umbrella term for all patient care conducted by phone or audiovisual technology, it is important to note that these 2 methods have very different implications. For example, the Centers for Medicare & Medicaid Services specifies that “the provider must use an interactive audio and video telecommunications system” to conduct a virtual visit. We do not have to look far for an example of the inequity encoded by this strict definition. Recently, a patient under our care was denied home health services because his telephone visit with his primary physician did not qualify as … Read More
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“High-quality health data research and the development of ML [machine learning] models requires meaningful data at a sufficient scale. Such data undoubtedly exist. Most health institutions hold clinical imaging data at a scale ranging from tens of thousands to tens of millions of scans. However, these data are often inaccessible to researchers, even where there is an intention to make them available for research, because of barriers of access and usability. Barriers of access can include: governance barriers (difficulties in understanding and working through governance frameworks regulating data usage); cost barriers (there can be considerable overhead costs to datasets and … Read More
“Our randomized controlled trial (RCT) found a physician-focused decision support tool to be effective in increasing CVD risk assessment when embedded within the primary care clinical record system. In particular, personalized risk score information that is explained on a visually interesting interface, can make the impact of improving biometric risk factor values (for example, blood pressure), or behaviors (for example, smoking cessation), more compelling. Hypothesized as a useful springboard to more engagement by patients with CVD risk factor control, the concept was adapted to a consumer-facing resource in the current trial. Other trials have demonstrated the benefits of apps for … Read More
Published 2020.9.30 I am involved in several health information technology (health IT) interoperability efforts including the Da Vinci project (a private sector initiative that addresses the needs of the Value Based Care community by leveraging the HL7 [a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services] FHIR platform), Office of the National Coordinator for Health IT Fast Healthcare Interoperability Resources (FHIR) at Scale Taskforce (ONC FAST, a group of “motivated … Read More
“Technology-enabled eHealth programs represent potentially cost-efficient and practical means for customized PA [physical activity] guidance to diverse groups. Most people targeted by eHealth, however, are well educated, younger than 50 years, and of non-Hispanic White ancestry, potentially intensifying health disparities. [..] This investigation tested whether a virtual advisor could increase 12-month walking to an extent similar to a comparably structured human advisor program among Latino adults. The human advisor program was delivered by trained peer advisors—a resource-efficient approach that is well accepted by Latino and other diverse groups but may be less convenient and scalable than computer-based programs. [..] Both … Read More
Suggestions to improve the FDA’s system to detect safety issues with medical devices
“This systematic review identified and summarized EHR-integrated systems to remotely collect patient-reported symptoms and examined their anticipated and realized benefits in long-term conditions. [Results] We included 12 studies representing 10 systems. Seven were in oncology. Systems were technically and functionally heterogeneous, with the majority being fully integrated (data viewable in the EHR). Half of the systems enabled regular symptom tracking between visits. We identified 3 symptom report-guided clinical workflows: Consultation-only (data used during consultation, n = 5), alert-based (real-time alerts for providers, n = 4) and patient-initiated visits (n = 1). Few author-described anticipated benefits, primarily to improve communication and resultant health outcomes, were realized based … Read More