What did we learn during the pandemic, and what should we watch moving forward?
Those are two of the key questions that many professional conversations center on these days. On Thursday, they were approached by a group of digital health experts who came together for a virtual forum organized by the Economic Alliance of Greater Baltimore and Rockville-based BioHealth Innovation.
Over three panel discussions, leaders from the Baltimore region and beyond made clear that data and AI are playing a role in shaping healthcare. It’s also an increasingly important part for the economy in a state where researchers, practitioners and innovators are clustered at university medical centers, federal institutions and businesses.
But it’s not just about the tools: To be effective, new technology must gather the right data that’s effective in the clinical setting and can be acted upon. That’s leading to a need to work together between clinicians, healthcare providers, payers and tech companies. So a call for collaboration, whether it was across healthcare departments or across organizations, was among the loudest on the day.
“From the beginning of the project, we’ve got to work together,” said Dr. Eun-Shim Nahm, director of the University of Maryland School of Nursing’s master’s degree program in informatics.
Like so many other parts of society in the last year, the pandemic has brought a lot of change. It accelerated tech adoption, and exacerbated divides that have long existed. The event took place at a time when we have a year of experience in a pandemic, and at the same time are thinking about what comes after vaccines and widespread reopening. Here are a few trends to watch that rose to the top of conversation:
Tech transformation has been sped up across many disciplines. In healthcare, a prime area was telemedicine, as folks turned to virtual appointments with clinics closed. It was an area where Baltimore’s LifeBridge Health saw visits rise in the early days of the pandemic. Pothik Chatterjee, executive director of innovation and research at LifeBridge, said the hospital network also increased use of remote patient monitoring tools. Chatterjee said LifeBridge used a mobile, automated tool from GetWell Network called Loop that allowed automation for monitoring patients who were tested for COVID-19, as well as keeping track of potential employee COVID-19 symptoms or vaccine side effects.
Going forward, there will be room to incorporate virtual visits into more interactions with healthcare. Ricardo Johnson, head of Healthworx, the innovation arm of regional health insurer CareFirst, is seeing virtual health continue, even as reopening begins. He said a key transition point will happen when virtual health is less “transactional” — i.e. centered on getting one specific test or one check — and more “longitudinal,” where primary care is completely virtual.
“The fact that a large group of Americans got a taste of virtual health and liked it — it will transform,” said Johnson.
Alongside telemedicine, tools that can screen a patient at home or diagnose a symptom remotely are also showing promise, said Dr. Kenyon Crowley, managing director of the Center for Health Information and Decision Systems in the University of Maryland’s Smith School of Business, and of the Health Insights AI Lab.
The pandemic showed “the ability to move more care services to the home environment, where appropriate,” he said. “If Amazon is getting to the point where it can send a package in two to three hours, the ability of a clinical service provider to have a test at your door in a day or two is not far off.”
With new technology tools comes more data. That means there is more technical work in combining data streams, as well as cleaning and helping the data work together. The need for interoperability has been especially pronounced as been especially pronounced amid wider tech adoption, said Dr. Zariel Johnson, technical program manager at UPMC Enterprises, the innovation and commercialization arm of University of Pittsburgh Medical Center and leader of the Pittsburgh Health Data Alliance.
“I think that’s something going beyond specific digital health interventions that the pandemic has brought to the forefront,” she said.
Social determinants of health
The pandemic and racial justice movement of 2020 exacerbated the existing divides in society. In healthcare, this is leading to a focus on social determinants of health, which are the condition in a person’s environment that play a role in their health, panelists throughout the day said.
Digital health plays a role in this area. Johnson pointed out that this requires tools that will collect data around the factors outside the clinic that are so important to social determinants of health.
It has also led to new approaches to connect with folks outside those walls. Chatterjee discussed LifeBridge Health’s community mobile clinics, which launched last summer with teams of nurses and social workers heading out with medical equipment and iPads. They visited patients in areas where the environment meant higher risk of COIVD-19 complications. This allowed LifeBridge to not only reach COVID-19 patients, but also folks in the community who had unmet needs like hypertension and diabetes.
The factors that result in disparities don’t only affect health outcomes. For instance, the same areas where the clinic visited are also more likely to be on the disconnected side of the digital divide. Reaching them with tools will require digital adoption in the community, as well.
“You will not be able to achieve health equity without achieving digital equity in underserved communities,” Johnson said.
Time to market
The need to respond to a crisis sped up the timeline for development of new tools. Taking what may become the most famous example, Crowley pointed out the COVID-19 vaccines, where scientists smashed the previous record of four years by getting shots into arms in less than a year. There’s a lesson broadly for healthcare when considering time to market for innovation broadly, he said. Nate Weiner, cofounder of Baltimore digital health company Avhana Health, which was recently acquired by Amalgam Rx, said a willingness to partner from healthcare providers in the pandemic sped up innovation.
At its most successful, innovation is driven by collaboration across all of the stakeholders in care. Collaboration between payers and providers will also be important to implement new technologies. LifeBridge Health and Healthworx established a partnership in recent years that will soon result in the first cohort of startups to participate in the 1501 Health incubator program.
Weiner, whose company came through a prior digital health accelerator program in Baltimore, said such collaboration is a good sign for the future of new digital health tools being not just used there, but developed locally, as well.
It was because of [the Baltimore ecosystem] that we got started and were able to have a success, ” he said. It has a ton of value in health systems and talent and VC activity. I’m excited to see what the next round of companies look like.”
As technology becomes more a part of the healthcare experience, it can allow for tools that are more precise to an individual’s condition. Weiner talked about Amalgam’s insulin titration tool. It’s an app that is prescribed by doctors and contains an algorithm to adjusted doses.
“We’re seeing a lot more comfort with technology on the patient side as well as the provider side,” he said. “I think we’re going to see a lot more around personalized care.”
Looking forward, more digital health tools will mean having professions and leaders who can de-risk new projects, strategize and create culture around effectively using data. To that end, the University of Maryland’s business school is launching a new course sequence for its certificate in AI Leadership for Healthcare this spring, Crowley said.
There will also be increasing need to root out bias in AI and ensure it is not propagated in new tools that are built. This will come with work on “having ways to appropriately evaluate that they are not only providing correct clinical outcomes, but are they doing so in a socially and culturally appropriate way.”
As digital health development takes place, the technology that can analyze and predict specific needs can be applied to other areas of care. One of those is mental health, Johnson said. It’s an area where we’ve seen the need for care rising, even as the pandemic made treatment tougher to access.