If nothing else, the unfolding coronavirus has advanced the implementation of a wide variety of digital health tools. Perhaps moving that ahead more in a matter of weeks than perhaps might otherwise have been achieved over years. Panelists at the World Medical Innovation Forum on May 11 explored several current use cases for digital health tools, including connected devices, telehealth, chatbots and symptom checkers as well as contact tracing.
These technologies have proven useful in enabling more remote management of patients during the ongoing crisis. Various stakeholders noted rapid deployments of digital health tools, as well as examined what will be needed to continue to improve and sustain them beyond these initial few months. Documentation and sharing of best practices, as well as firmly establishing reimbursement, are expected to prove key for this digital health surge to become firmly entrenched in the U.S. health care system.
The virtual event was presented by Mass General Brigham Innovation, a unit of the Boston-based health care system, and included physicians, entrepreneurs, major corporate executives and academics.
“You're going to see sensors in your bathroom, in your car, in your bed that are going to alert you in a predictive manner before you have a heart attack,” predicted the CEO of virtual care startup Mytonomy Inc., Anjali Kataria. “We're just at the beginning of that. What happened with COVID is really profound because it would have taken us five years to get to what happened in five weeks.”
“In terms of the user adoption, the experience of telehealth and virtual care that allow for this shift now. Patients will take more of that care on,” she continued. “Now, the next step is to find ways to educate and amplify those messages at scale. We're in a rapidly evolving environment where we're learning more about COVID – and there may be other COVIDs that occur in our lifetime. So, we need to be able to train people to take on the responsibilities of caring for their health in a home environment with these devices and sensors coming into play as well.”
She likened the transition to at-home, remote health care to the adoption of ATMs in finance – and argued that the technology has met a threshold of usefulness and ubiquity that could transform health care unless it is allowed to slip away. Another panelist, Jag Singh, a MGH cardiologist who presented based on his own experience of being treated for COVID-19, suggested that roughly half of health care interactions will continue to be virtual even after the current situation has subsided.
In the current pandemic, technology solutions are often aimed at introducing and maintaining a safe distance between patients and health care providers. In addition to the home, many are simply focused on reducing the need for the physical presence of a health care worker in the hospital room.
“We’re donating the Alexa Show device to hospitals, so that a nurse or a clinician can use that device to drop in on another device at the bedside of the patient,” said Amanda Goltz, a principal in business development at Amazon Alexa Health & Wellness. “What this does is it allows that clinician to respond to the patient's request on a nurse call, or to check an alarm that's going on in the room without having to glove up and use individual personal protective equipment before going into the room to avoid that risk of infection exposure and also to save that precious PPE as long as we can.”
Courting regulators, payers
Some digital health technologies are proving useful in both the home and the hospital for patient monitoring. Alivecor Inc. offers a smartphone-linked, medical grade ECG device that is being used both in the hospital to monitor COVID-19 patients for potentially perilous QT prolongation associated with some medications that can lead to drug-induced sudden cardiac death (DI-SCD).
The U.S. FDA recently issued guidance that permits the Alivecor six-lead device, Kardiamobile 6L, to be used for this monitoring in the hospital or at home. The FDA had previously cleared the device to detect atrial fibrillation, bradycardia, tachycardia, and normal rhythm in an ECG. The consensus across several panelists was that the regulatory agency has been working hard to facilitate access to safe and effective innovations as rapidly as it can under the current circumstances.
“Digital health was growing before and the fact is that knowledge is growing even faster. COVID-19 has this issue under a spotlight,” said Priya Abani, CEO, Alivecor. “Physicians and health systems have no choice but to focus our efforts on digital and remote patient monitoring. In order to provide care for the patients outside of the examination room all the way to their homes. While this adoption hasn’t been seamless, we are seeing promise and hopefully this will help us make a big impact. Every effort that we make to progress during this time – and the learning from this time that we have today – should have the aim of correcting this for the future.”
Ultimately, several panelists stressed the need for this ongoing accumulation of data that can be used to help to show how telemedicine and connected devices have been useful. Even after the pandemic passes, this could form the basis to solidify, retain and build upon digital health adoption gains that are being made now. Studies done now could help to prove the case to regulators and payers in the future when the immediate pressures have eased.
“The thing that really keeps me up at night every night, is that without a lasting sustainable economic model, these innovations will not be able to continue,” said Brooke LeVasseur, the CEO of virtual specialty care startup AristaMD. “As an industry, we need to really be focused on working to get reimbursement models in place that reflect the value that these new innovations can deliver so that ultimately providers will have their incentives aligned to continue to adopt and use these tools that do have demonstrated efficacy and that have demonstrated value.”