Last New Year’s Eve, the first COVID-19 case was reported in Wuhan, China. Since then, the virus has spread all over the world. Today, more than 70 million coronavirus cases and nearly 1.6 million deaths associated with the virus have been reported, according to the World Health Organization.
By February, health systems were quickly responding and rethinking their care-delivery model. Over the last year, MobiHealthNews has closely reported on how providers are using digital health to treat, triage and combat the virus. This year, efforts by provider organizations have been robust and comprehensive. This roundup is only the tip of the iceberg of digital initiatives implemented worldwide by providers.
Providers’ efforts to tackle the coronavirus crisis:
On Jan. 19, a patient came into one of the Providence facilities' urgent care centers presenting with a cough and reported recently returning from Wuhan, China. The nurse practitioner treating the patient called the CDC for next steps and tested the patient for the coronavirus. One day later, the patient was admitted to the hospital with a positive case of COVID-19, marking the first case in the U.S.
This jump-started Providence’s COVID-19 efforts, which included several digital strategies. By the middle of March it had created a symptom-checking chatbot linked to an on-demand patient-care visit, where the user could get in touch with a clinician, usually a nurse practitioner, and go through symptoms. Through this tool patients can also get connected to a nurse line.
The health service also quickly set up drive-through testing units, as well as developing their own testing system. During this time telehealth also became a major component to care.
"We worked very closely with our telehealth group, and they were able to create at capacity to give patients seen in the ED a thermometer and a pulse oximeter, and have them monitor at home using our telehealth capacity to be able to say, 'How are you doing, and are you safe to stay at home, and are you going the wrong way?' It's one of the things we've seen with this particular germ, that patients can be OK for a while, then decompensated rapidly," Dr. Amy Compton-Phillips, chief clinical officer for Providence St. Joseph Health, told HIMSS.
These type of efforts were seen all over the country. In November, LifeBridge Health’s Pothik Chatterjee, the executive director of innovation and research, shared the system's innovations at Accelerate Health. The health system launched its own PPE factory on the hospital grounds employing sewing machines and 3D printers.
LifeBridge also teamed up with tech company GetwellNetwork to build a mobile app that would help monitor patients who were tested at drive-through testing centers.
This kind of tech-enabled effort was seen globally. In February, Israel’s Sheba Medical Center prepared to take custody of the 12 Israeli passengers onboard the Diamond Princess, the cruise ship that has been quarantined in Japan for several weeks because of COVID-19.
While none of the 12 had confirmed cases, Sheba took precautions to house the group in a special quarantined area of the campus and treat them in a way that minimized contact with staff.
Sheba worked with at least three vendors to make telemedicine care work for these patients, starting with longtime remote monitoring partner Datos, whose platform they used to develop a monitoring program and treatment protocols, and Tyto Care, a new partner who would provide the devices and the consumer-friendly user experience essential to allow patients to conduct exams without medical staff present.
A third solution, from recent Teladoc acquisition InTouch Health, is a robotic telemedicine cart called Vici, equipped with a camera, screen and medical equipment that can be sent into a quarantined patient area and controlled remotely by a doctor or nurse.
This wasn’t the only system aiming to protect its workers through tech. Researchers from Johns Hopkins University and Medicine developed a robotic system that allows medical staff to remotely control ventilators and other bedside machines from outside the room of patients with infectious diseases.
The system, which is still being tested, was developed at the beginning of the COVID-19 pandemic to help conserve personal protective equipment, limit staff exposure to contagious patients and give more time for clinical work.
Mapping the spread
In the U.S., several health systems set up COVID-19 tracking maps. Buoy Health, a triage chatbot, teamed up with Boston Children’s Health Map team. As part of the initiative Buoy Health can give Health Map information about what patients are reporting at home. Health Maps can give Buoy an idea of how the disease is spreading in a broader context.
Additionally, a team from Johns Hopkin’s Center for System Science and Engineering released a new live dashboard that integrates information from the WHO and CDC to track the virus in real time. The dashboard includes information about cases by region and country, as well as the deaths. The information is displayed in a map and in corresponding charts.
Turning to telemedicine
Telemedicine and phone services also became increasingly popular. In the Spring, the health service in England launched a new NHS 111 online tool to help those wanting to get quick advice about the new coronavirus after it saw a surge in the number of queries received about the outbreak.
In the U.S., the Trump administration announced that it would expand Medicare telehealth benefits to fight COVID-19. At the time HHS announced that, under the expansion, Medicare will temporarily pay clinicians for telehealth services nationwide to help stem the spread of the novel coronavirus.
Due to the uptick in telemedicine, the American Medical Association created a new resource for doctors to turn to for advice on telehealth in the age of the coronavirus, called the Telemedicine Quick Reference Guide, aimed at helping clinicians figure out best practices for implementing the tech. The guidelines cover everything from policy and coding to implementation.
The association also released a new resource on the code of ethics during the coronavirus pandemic. Doctors can also tap into a collection of AMA Journal articles on related ethics.
In April, telehealth got another boost when Federal Communications Commission Chairman Ajit Pai proposed a $200 million program that would combat the COVID-19 crisis by bankrolling telecommunications equipment and services for qualifying healthcare providers.
The plan is fueled by funds appropriated in the $2 trillion CARES Act signed by Congress and President Donald Trump in March. If approved after review by the agency's five commissioners, Pai wrote, the plan could bring additional telehealth services to more patients and provider organizations.
Telemedicine also got attention from that federal legislation. In May, a bipartisan group of U.S. senators wrote to the leaders of both lawmaking chambers advocating that greater broadband funding for healthcare providers be included in upcoming coronavirus relief packages.
The letter, dated May 8, specifically calls for $2 billion to be added to the existing Rural Health Care (RHC) Program to offset telehealth demand driven by the health emergency.
During the pandemic, Planned Parenthood announced that it is expanding its telehealth services to include all 50 states. Patients will be able to tap into the service for some birth control needs, sexually transmitted infection testing, gender-affirming hormone therapy, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), urinary tract infection screen and the morning after pill.
Select Planned Parenthood health centers also offered abortion counseling through the telehealth services. The organization pitched this as a way for patients to get care during the coronavirus.
We also saw telemedicine become more democratized. Doctor on Demand and the state of Massachusetts made a deal to provide 24-7 access to free COVID-19 telehealth visits to uninsured Massachusetts residents.
Research and detection
The pandemic has also led to new research about detection and tracking. Scripps Research Translational Institute led the DETECT (Digital Engagement & Tracking for Early Control & Treatment) Study. It combines heart-rate, activity and sleep data collected through a range of devices – such as Fitbits, Apple Watches, Garmins, Oura Rings or any others that can share data with Google Fit or Apple HealthKit – and pairs it with participant-submitted symptom reports.
The project aims to not only identify areas with viral outbreaks such as COVID-19 more quickly, but to "develop more individualized approaches to health care" using person-specific vital-sign readings.
In August, Scripps Research Translational Institute came out with results from its DETECT study, finding that symptom-based COVID-19 screening can be improved by incorporating data collected from wearable sensors into prediction algorithms. This is an approach that could complement ongoing testing efforts by spotting symptomatic and pre-symptomatic individuals early, according to a research letter recently published in nature medicine
Later in the year, UC San Francisco announced the TemPredict Study. This effort is inviting Oura Ring users to release their device-collected physiological data and complete daily surveys on their condition. It, too, looks to "identify patterns that could predict onset, progression, and recovery in future cases of COVID-19. If this approach is successful, it could open the door for research into tracking and managing other illnesses and conditions."
In the fall, Fitbit inked a nearly $2.5 million deal with the U.S. Department of Defense through the U.S. Army Medical Research and Development Command to expand its work in developing an algorithm that can detect COVID-19 before symptoms show.
In addition to the award, Fitbit announced a study with Northwell Health’s Feinstein Institutes for Medical Research to further advance the early detection algorithm.
While telemedicine and other technologies were rapidly adopted this year, these advancements are expected in the future. For example, Dr. Joe Kvedar, senior advisor of virtual care at Mass General Brigham, says he sees telemedicine and other tools being used to help care for seniors in the future.
“In 2050, there will be twice as many people on the planet over 65 as there will be under 5, and it just keeps getting more and more dramatic because, luckily, we are living longer. But as we live longer, we need more healthcare services,” he told MobiHealthNews.
Although the future of health, including vaccine distributions, are still unclear, tech will inevitably be in the picture.
Taking Stock of Progress and Looking Ahead
This December, we look back at a challenging year – and forward to what we hope is a better, stronger, more connected and resilient healthcare ecosystem.