Patient engagement, artificial intelligence, telemedicine, virtual reality, and more trends dominated the provider headlines.

How the digitization of hospitals and health systems marched on in 2018

By Jonah Comstock
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Another year gone by, another flurry of activity in the digital health space. Hospitals and health systems around the world worked with startups or in house to launch and develop new programs and increasingly digitize their care. 

One thing we've left out here is Apple, which partnered with a number of health systems this year to roll out its Health Records system. You can read more about that here in our roundup of 2018 Apple news.

Read on for a roundup of noteworthy trends and moves in the provider space, with links back to our original coverage.

Patient engagement

Patient engagement in 2018 took many different forms, from AI chatbots and voice tech to more traditional apps.

As MobiHealthNews’s Laura Lovett reported in November for our AI month, leaders in the triage chatbot space have begun teaming up with major providers and health systems.

For instance, in August, Buoy announced a new partnership with Boston Children’s Hospital. As part of the deal Buoy will be creating a version of its product for the hospital’s website and work with doctor’s from the hospital to get help evaluating its pediatric algorithm. 

Over in the UK, Babylon teamed up with the NHS to roll out the NHS GP at Hand service, which lets patients see a practitioner through the app once they have switched from their current GP. According to the website, the service is available for people living or working within 40 minutes of one of their clinics. If needed a patient can see a physician in person. Currently there are five clinics all within Greater London. 

Of course, Babylon and its relationship with the NHS have not been without controversy.

And in China, Ping An Good Doctor took the model one step further, announcing a plan to roll out unstaffed clinics powered by AI.

On the patient app side, the quarter saw Cedars-Sinai update its mobile app for patients to include that an interactive map of its medical facilities. The tool will now provide step-by-step walking directions to 400 points of interest, as well as help users mark and find their parking spot.

Toronto-based Seamless MD, which makes a patient-facing app for use cases like surgery recovery, reported a few different customer wins, one with the University of Alabama at Birmingham Health System, one with Saint Peter’s Healthcare System in New Jersey, and one with Hospital Sisters Health System in Illinois and Wisconsin.

And Babyscripts announced that its prenatal care app has become available to mothers and doctors at the Froedtert & Medical College of Wisconsin health network. The network will also enable mothers to opt into the service’s data sharing component to allow remote patient monitoring tool for OB/GYNs.

Remote patient monitoring

The quarter also saw some novel remote patient monitoring deployments and partnerships.

Children’s Health, a Texas-based pediatric health system, teamed up with Proteus to pilot a new program aimed at tackling adherence issues in pediatric heart transplant patients by inserting ingestible sensors into prescribed pills, which can track when the medication was taken. 

The Mayo Clinic joined forces with smart stethoscope company Eko to develop a new product that will employ machine learning and a digital stethoscope to assist doctors in detecting potentially dangerous heart conditions. The pair plan to build a machine learning-based algorithm that can screen for a low ejection fraction, which means a weak heart pump in patients. The team developing the product will be able to use the Mayo Clinic’s cardiovascular database and combine it with Eko’s cardiac monitoring platform, according to the organizations. The pair plan to first run the technology through clinical trials and then submit for FDA clearance. 

And Nevada-based Renown Health brought PeriGen’s PeriWatch labor surveillance and analysis software into its childbirthing unit. The company’s FDA-cleared PeriWatch Cues software uses AI to provide objective, consistent assessments of fetal heart rates, and is directly integrated into Epic’s EHR system.

Finally, Hill-Rom, a medical technology company best known for its hospital beds, announced that it is integrating EarlySense’s contact free monitor into its Centrella model bed

The companies claim that the new technology will be able to measure heart rate and respiratory rate over 100 times per minute.  

Telemedicine

With regards to telemedicine, Health Affairs' mammoth December issue gave a pretty good snapshot of where the industry stands (we round it up here): Adoption is increasing fast, but still slow compared to the size of the market overall. A JAMA study came to the same conclusion.

Additionally, and somewhat worryingly, a report from the US Department of Agriculture in November found that rural residents were actually less likely than their urban counterparts to partake in online health research, maintenance and monitoring services. The report describes the results of a telecommunications and eHealth questionnaire that was sent out to 50,000 households (accounting for roughly 130,000 individuals) alongside a population survey from 2015. 

For hospitals and health systems, plenty of deals this year revolved around telemedicine.

Virtual care provider Teladoc Health highlighted two major collaborations with academic institutions focused on the advancement of telehealth delivery and practices.

The first of these, conducted with Pennsylvania-based Jefferson Health, launched what the pair consider to be “the industry’s first academic fellowship program in the field of telehealth.” The program, which launched during this year’s fall semester, was equated to a public health degree in that it looks to educate and prepare students for a career managing telehealth programs. The two-part fellowship program is held onsite at Jefferson Health, as well as delivered directly by Teladoc.

The second collaboration, announced earlier today, is a five-year, grant-funded research project Teladoc will conduct alongside Northwestern University and the University of Southern California. Specifically, the three parties will be observing antibiotic prescribing practices and behaviors during telehealth interactions, with the ultimate goal of developing behavioral interventions that can curb unnecessary prescription.

Telemedicine provider Advanced ICU Care inked a deal with Penn Highlands DuBois to provide ICU telemedicine tools to the hospital. Advanced ICU Care’s service allows for 24-7 oversight of patients by certified intensivists, reducing the strain on the hospital’s in-person staff.

Minnesota-based Winona Health deployed Bright.md’s telehealth services through the latter’s asynchronous SmartExam platform. Bright.md’s service enables remote care for more than 400 common conditions around the clock, offering patients treatment plans from in-network providers often within the hour, according to the company.

And virtual care and patient engagement platform maker Vivify Health has struck a new agreement with Coffyville, Kansas-based Windsor Place At-Home Care. The partnership replaces the remote care management services of another unnamed large telehealth vendor with Vivify’s own, and will allow certain physicians to remotely monitor biometrics and nursing notes with Windsor patients.

Finally, T-Mobile announced that, as part of a larger Department of Defense contract, it will be providing 70,000 lines of wireless service to the Department of Veterans Affairs to increase the availability of telehealth services to veterans.

AI and Clinical Decision Support

Although patient engagement and the consumerization of healthcare continue to be big focus areas, plenty of innovation continued to happen this year in hospitals that didn’t necessarily involve the patient directly.

On the clinical decision support side, AI and deep learning systems continued to evolve and saw increasing adoption across the provider sector. For instance, Sierra Madre, California-based Wound Care Advantage, a manager of outpatient wound treatment centers, partnered with Baltimore-based Tissue Analytics to use the digital health startup's technology to measure wounds and develop improved treatment protocols. Tissue Analytics has an app that uses artificial intelligence and computer vision to measure and identify a wound based on a five-second smartphone video. The company also provides an interoperable workflow that brings that data into most EHRs via a SMART-on-FHIR protocols.

Halifax Health reported this year that its implementation of Nuance Healthcare’s AI workflow and coding software has increased the productive and satisfaction of its physicians. In addition, the software tools led to a 63 percent reduction in severity queries, as well as a 20 percent increase in case coverage.

The year also saw a number of AI algorithms cleared by the FDA, like IDx-DR, an AI software system for the autonomous detection of diabetic retinopathy in adults who have diabetes, MaxQ AI’s Accipio Ix, an AI workflow tool designed to help clinicians prioritize adults patients likely presenting with acute intracranial hemorrhage, and Imagen’s OsteoDetect, which uses an AI algorithm to scan X-ray images for a common type of wrist bone fracture, known as distal radius fracture. 

Even NASA has been looking hard into AI and CDS, deploying Wolters Kluwer’s UpToDate tool on the International Space Station and working with VisualDx to build a diagnostic tool for deep space missions.

Clinical collaboration

We saw some deals and deployments this year around clinical collaboration.

Boston Children’s Hospital tapped 2nd.MD’s specialist consultation platform. In addition to receiving virtual second opinions, the deal also allows 2nd.MD users to more easily transfer their care to the hospital if necessary.

Nicklaus Children’s Health System in Miami, Florida is deployed an app-based clinical image sharing tool, working with startup WinguMD and medical imaging company Dicom Systems. WinguMD’s BodyMapSnap app allows clinicians to take pictures and share them with one another on a social media-like platform. Images can be associated with particular patients either from the start or retroactively and, thanks to technology integration provided by DICOM, clinicians can also upload those images to the EHR and other data repositories.

Medical communications company Spok announced a deal with Standard Communications to expand its Spok Care Connect messaging service to more VA healthcare systems. Spok's system allows providers to send secure text messages, set preferences and encrypt paging. It can also assist in physician and nurse scheduling and set clinical alerts and notifications.

Health system collaboration

And it was a good year for collaboration amongst hospitals too. An all-volunteer group, currently called the Digital Health Collaborative (the group plans to adopt an official name next year), was conceived at and first met at the HIMSS18 Global Conference in March. At this years CHC in Boston, they presented a progress report.

The group of health systems, startups, and other stakeholders are banding together to create a series of standardized frameworks for innovators, starting with a standardized security assessment for business associate agreements.

Xcertia, a standards and guidelines body for mobile apps, also announced this year the draft release of its updated Privacy and Security Guidelines, a document consisting of practical and descriptive advice for health app designers. Xcertia is a collaborative organization backed by the American Medical Association, American Heart Association, DHX Group and HIMSS that was first launched at 2016’s Connected Health Conference.

And the American Medical Association was busy this year with a number of initiatives to improve collaboration around health system innovation, including its Physician Innovation Network, a collaborative online platform that connects startups and hospitals, and its Digital Health Implementation Playbook, launched in October.

Virtual reality

Finally, while the VR and AR trend slowed down this year, there was some notable news, with Oculus itself getting in on the healthcare game through a partnership with VRHealth.

A team from Beth Israel Deaconess Medical Center’s Cardiac Magnetic Resonance Center have detailed, in a piece published in PLoS One, how Microsoft’s HoloLens could be used to create 3D holographic visualization of heart scarring. These images could be created and displayed for cardiologists as they conduct a procedure using the stand-alone augmented reality device.

And Cedars-Sinai Medical Center in Los Angeles teamed up with LA-based Giblib to offer what the organizations say is the first accredited continuing medical education (CME) course delivered entirely via virtual reality. The course, called Essential GI Surgeries will be available through Giblib's website. It will include 25 hours of real surgeries recorded in 360 VR (as well as in a traditional video format), with additional overlays like patient imaging and laparoscopic and robotic camera feeds.

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