Amazon’s app-based employee healthcare service could be first step toward retailer becoming a disruptive force in healthcare; federal VA develops its own mHealth apps
More consumers are using smartphone applications (apps) to manage different aspects of their healthcare. That fact should put clinical laboratories and anatomic pathology groups on the alert, because a passive “wait and see” strategy for making relevant services and lab test information available via mobile apps could cause patients to choose other labs that do offer such services.
Patient use of apps to manage healthcare is an important trend. In January, Dark Daily covered online retail giant Amazon’s move to position itself as a leader in smartphone app-based healthcare with its launch of Amazon Care, a virtual medical clinic and homecare services program. At that time, the program was being piloted for Seattle-based employees and their families only. Since then, it has been expanded to include eligible Amazon employees throughout Washington State.
Mobile health (mHealth) apps are giving healthcare providers rapid access to patient information. And healthcare consumers are increasingly turning to their mobile devices for 24/7 access to medical records, clinical laboratory test results, management of chronic conditions, and quick appointment scheduling and prescription refills.
Thus, hearing ‘There’s an app for that’ has become part of patients’ expectations for access to quality, affordable healthcare.
For clinical laboratory managers, this steady shift toward mHealth-based care means accommodating patients who want to use mobile apps to access lab test results and on-demand lab data to monitor their health or gain advice from providers about symptoms and health issues.
Amazon, VA, and EMS Develop Their Own mHealth Apps
The Amazon Care app can be freely downloaded from Apple’s App Store and Google Play. With it, eligible employees and family members can:
Communicate with an advice nurse;
Launch an in-app video visit with a doctor or nurse practitioner for advice, diagnoses, treatment, or referrals;
Request a mobile care nurse for in-home or in-office visits;
Receive prescriptions through courier delivery.
The combination telehealth, in-person care program, mobile medical service includes dispatching nurses to homes or workplaces who can provide “physical assessments, vaccines or common [clinical laboratory] tests.”
“Amazon is a company that is experimenting a lot with a variety of opportunities in healthcare,” Glen Tullman (above), Executive Chairman of Livongo, a healthcare company specializing in treating diabetes, and an Amazon partner company, told CNBC. “It’s one to watch.” (Photo copyright: CNBC.)
However, the US federal Department of Veterans Affairs (VA) also is becoming a major player in the mHealth space with the development of its own mobile app—VA Launchpad—which serves as a portal to a range of medical services.
Veterans can access five categories of apps that allow them to manage their health, communicate with their healthcare team, share health information, and use mental health and personal improvement tools.
“The VA was an early adopter of digital health tools and remains a leader within US healthcare in leveraging technology to enhance patient engagement,” Neil C. Evans, MD (above), Chief Officer in the VA Office of Connected Care, told Healthcare IT News. “These digital tools are allowing veterans to more actively understand their health data, to better communicate with VA clinical teams, and to engage more productively as they navigate their individual health journeys,” Evans added. (Photo copyright: Department of Veterans’ Affairs.)
mHealthIntelligence reported that mobile health tools also are enabling first responders to improve emergency patient care. At King’s Daughters Medical Center in Brookhaven, Miss., emergency medical technicians (EMTs) are using a group of mHealth apps from DrFirst called Backline to gain real-time access to patients’ HIPAA-compliant medication histories, share clinical data, and gain critical information about patients prior to arriving on the scene.
Using Backline, EMTs can scan the barcode on a patient’s driver’s license to access six months’ worth of medication history.
“In the past, we could only get information from [patients] who are awake or are willing to give us that information,” Lee Robbins, Director of Emergency Medical Services at King’s Daughters Medical Center in Brookhaven, Miss., told mHealthIntelligence. “Knowing this information gives us a much better chance at a good outcome.”
Smartphone App Detects Opioid Overdose
The opioid crisis remains one of the US’ greatest health challenges. The federal Centers for Disease Control and Prevention (CDC) reported 47,600 opioid-related deaths in 2017, and the problem has only gotten worse since then.
To curtail these tragic deaths, University of Washington (UW) researchers developed a smartphone app called Second Chance, that they believe can save lives by quickly diagnosing when an opioid overdose has occurred.
The app uses sonar to monitor an opioid user’s breathing rate and, according to a UW press release, can detect overdose-related symptoms about 90% of the time from up to three feet away. The app then contacts the user’s healthcare provider or emergency services.
The UW researchers are applying for US Food and Drug Administration (FDA) clearance. They published their findings in the journal Science Translational Medicine.
While Demand for mHealth Apps Grows, Concern over Privacy and Security also Increases
According to mobile data and analytics company App Annie, global downloads of medical apps grew to more than 400 million in 2018, up 15% from two years earlier.
“As with mobile banking, consumers are showing they trust mobile apps with their most sensitive information and are willing to leverage them to replace tasks traditionally fulfilled in-person, such as going into a bank branch or, in the case of medical apps, to a doctor’s office,” App Annie’s website states.
However, the proliferation of mHealth apps has raised privacy and safety concerns as well. While the FDA does regulate some mobile health software functions, it does not ensure an mHealth app’s accuracy or reliability.
Fierce Healthcarereported that federal lawmakers are worried veterans who use the VA’s 47 mHealth apps could find their sensitive healthcare information shared or sold by third-party companies. In fiscal year 2018, veterans participated in more than one million video telehealth visits, a VA press release reported.
US Rep. Susie Lee, D-Nevada, Chairperson of the House Veterans’ Affairs Subcommittee on Technology Modernization, told Fierce Healthcare, “As we assess the data landscape at the VA and the larger health IT space, we need to look at where protections exist or don’t exist and whether we need more guardrails.”
What does all this mean for clinical laboratories? Well, lab managers will want to keep an eye on the growing demand from consumers who want direct access to laboratory test data and appointment scheduling through mHealth apps. And, also be aware of HIPAA regulations concerning the sharing of that information.
Because patient satisfaction continues to drive Medicare scoring, interest grows in technologies that reduce or remove pain from the patient’s experience, particularly when a phlebotomist draws blood for clinical laboratory testing
This is why hospital administrators are devoting more
attention—and budget dollars—to products that have the potential to reduce the
pain experienced by patients. And patient satisfaction surveys regularly
identify pain during phlebotomy procedures as an issue.
Enter PIVO,
a sterile single-use device created by San Francisco-based Velano Vascular Technologies that
attaches to an existing peripheral
intravenous (PIV) line to extract blood samples from patients through the
use of a vacuum tube or syringe, relieving the pain of additional needle
sticks.
Needle-free blood draws is not a new concept. But the fact
that hospitals are adopting such technologies indicates that the need to
improve the patient experience is motivating more hospitals to spend money on
these types of devices.
Velano Vascular’s PIVO device (above) works by pushing a small, flexible flow tube through the IV line and directly into the vein to collect as much blood as needed for medical laboratory testing. After the blood collection has been completed, PIVO is retracted and removed from the IV and discarded. As public demand for pain free healthcare increases, will the practice of phlebotomy in all healthcare settings need to adopt as well? (Photo copyright: HIT Consultant.)
Nurses Approve of No-Stick Technology
The Centura Health system in Centennial, Colo., utilizes
PIVO at all 17 of its hospitals throughout Colorado and western Kansas.
Centura’s goal is to “eliminate some of the suffering that goes along with
needlesticks for inpatients,” Rhonda Ward, MSN,
Vice President Nursing Services and Chief Nursing Officer, South Denver Group, Centura Health, told Modern
Healthcare.
“It adds no pain to the patient,” she said. “Unfortunately,
nurses, just by nature of their work, have to create discomfort in some of the
things that they have to do. So not creating more pain for the patient has been
a big satisfier.”
Velano Vascular first gained
FDA marketing clearance for its proprietary intravenous blood-draw device
in 2015. Later that same year, Intermountain
Healthcare in Salt Lake City became the first healthcare system in the
country to implement the PIVO device. Intermountain now uses PIVO in all 22 of
its hospitals.
“Blood draws are critical, common elements in modern medicine, but they cause an unnecessary amount of anxiety, pain and risk due to the use of century-old technology and practice,” said Kim Henrichsen, MSN, Senior Vice President, Clinical Operations/Chief Nursing Executive, Intermountain Healthcare, in a press release. “We are thrilled to offer a new standard of care that, over time, will help obviate the need for needles used for hospital blood collection. This commitment to standardizing draws will enhance quality for both patients and practitioners.”
According to the Velano website, there are 400 million
inpatient blood draws in the US each year, with each patient receiving 10 to 20
needlesticks per hospital stay. The site also states there are more than 1,000
practitioner needlestick injuries per day in the US and that approximately one
in five people in the country are needle phobic. The company claims the
advantages of the PIVO device include reducing patient pain and anxiety, making
blood draws easier for Difficult Venous Access (DVA) patients, and making the
blood extraction process safer for practitioners.
“It is baffling that in an era of smartphones and space
travel, clinicians draw blood by penetrating a vein with a needle—oftentimes in
the early morning hours,” said Todd
Dunn, Director of Innovation at Intermountain Healthcare Transformation Lab
in the Intermountain press release. “Through our Design for People program, we
resolved to find a better way for our phlebotomists and nurses to more humanely
and consistently draw blood. Following 15,000 PIVO draws on adults and children
with no adverse events and overwhelmingly positive feedback from patients and
caregivers alike, it is clear that we are together establishing a new standard
of care.”
According to a
survey commission by Velano Vascular and conducted by Charter Oak Research of more than 6,500
nurses from 24 hospitals regarding the blood collection process:
Eight out of ten nurses are concerned about
needle safety.
One in three patients are considered tough
sticks.
88% of the nurses felt that blood collection
sticks and re-sticks negatively impact the patient experience.
76% of the nurses would prefer to use needle-free
blood draws over venipuncture.
84% of the nurses said they would advocate for a
needle-free blood draw device.
One of the key findings in the survey found that there is a
lack of standardization in blood collection, and that there is “significant variability
in who and how blood is collected across patient floors and time of day.”
“Commercial demand for PIVO and our family of novel solutions is being driven by a move to one-stick hospitalization and a growing realization that removing needles from blood draws improves the patient experience, protects practitioners, and boosts the bottom line,” Eric Stone, Chief Executive Officer and co-founder, Velano Vascular, told FierceBiotech.
More Research versus Patient Outcomes
Though there are peer-reviewed studies and white papers
outlining positive patient outcomes surrounding the use of the PIVO device,
some professionals feel more research on the product is needed.
“All of these studies would suggest that additional study
would be warranted,” Diane Robertson,
Director Health Technology Assessment and ECRIgene Information Services at the ECRI Institute, told Modern Healthcare.
“But while the evidence is inconclusive at this point on a number of the
potential benefits, in studies and in our look at safety information, there’s
been no indication that there’s been any harm from this technology. It’s
reasonable for hospitals to consider it. It goes back to weighing the
patient-oriented outcomes.”
The need to improve the patient experience and improve
patient satisfaction scores is motivating hospital administrators to spend
money and resources on products like the PIVO device. Clinical laboratory
leaders should be aware of the rate of adoption of such products by healthcare
systems.
Continued growth in products that can collect medical
laboratory specimens without a traditional venipuncture performed by a
phlebotomist could give innovative labs a new way to add value in patient care
in both inpatient and outpatient settings.
These virtual office visits use artificial intelligence and text messaging to allow real physicians to diagnose patients, write prescriptions, and order clinical laboratory tests
Clinical laboratories may soon be receiving test orders from physicians who never see their patients in person, instead evaluating and diagnosing them through a smartphone app. In response to major changes in the primary care industry—mostly driven by consumer demand—mobile app developers are introducing new methods for delivering primary care involving smartphones and artificial intelligence (AI).
Medical laboratories and pathology groups should prepare for consumers who expect their healthcare to be delivered in ways that don’t require a visit to a traditional medical office. One question is how patients using virtual primary care services will provide the specimens required for clinical laboratory tests that their primary care providers want performed?
Two companies on the forefront of such advances are 98point6 and K Health, and they provide a glimpse of primary care’s future. The two companies have developed smartphone apps that incorporate AI and the ability to interact with real physicians via text messaging.
Virtual Primary Care 24/7 Nationwide
Dark Daily has repeatedly reported that primary care in America is undergoing major changes driven by many factors including increasingly busy schedules, the popularity of rapid retail and urgent care clinics, consumer use of smartphones and the Internet to self-diagnose, and decreasing numbers of new doctors choosing primary care as a career path.
Writing in Stat, two physicians who had just completed internal medicine residencies, explained their own decisions to leave primary care. In their article, titled, “We were inspired to become primary care physicians. Now we’re reconsidering a field in crisis,” Richard Joseph, MD, and Sohan Japa, MD, cited factors that include long hours, low compensation in comparison with specialty care, and deficiencies in primary care training. At the time of their writing they were senior residents in primary care-internal medicine at Brigham and Women’s Hospital in Boston.
They also pointed to a decline in office visits to primary care doctors. “Patients are increasingly choosing urgent care centers, smartphone apps, telemedicine, and workplace and retail clinics that are often staffed by nurse practitioners and physician assistants for their immediate health needs,” they wrote.
One solution to declining populations of primary care physicians is a smartphone app created by Seattle-based 98point6. The service involves “providing virtual text-based primary care across the entire country, 24/7 of everyday,” explained Brad Younggren, MD, an emergency physician and Chief Medical Officer at 98point6, in a YouTube interview. “It’s text-based delivery of care overlaid with an AI platform on top of it.”
The service launched on May 1, 2018, in 10 states and is now available nationwide, according to press releases. 98point6 offers the service through individual subscriptions or through deals with employers, health plans, health systems, and other provider organizations. The personal plan costs $20 for the first year and $120 for the second, plus $1 per “visit.”
Subscribers use text messaging to interact with
an “automated assistant” that incorporates artificial intelligence. While
messaging, they can describe symptoms or ask questions about medical topics.
“After the automated assistant has gathered as many
questions as it deems necessary, it hands [the information] off to a
physician,” Younggren said. In most cases, all communication is via text
messaging. However, the doctor may ask the subscriber to send a photo or participate
in a video meeting.
The doctor then makes a diagnosis and treatment plan. Prescriptions can be sent to a local pharmacy and the subscriber can be referred to a clinical laboratory for tests. LabCorp or Quest Diagnostics are preferred providers, but subscribers can choose to have orders sent to independent labs as well, states the company’s website.
Younggren claims the company’s physicians can resolve more
than 90% of the cases they encounter. If, however, they can’t resolve a case, they
can refer the patient to a local physician. And because most of 98point6’s
interactions with subscribers are text-based, that messaging serves as reference
documentation for other doctors, he said.
“We’ve set out to dramatically augment the primary-care physician with deep technology by delivering an on-demand primary-care experience,” Robbie Cape (above), CEO and co-founder of 98point6, told Modern Healthcare. (Photo copyright: Seattle Business Magazine.)
The 98point6 physicians are full-time employees and work with the company’s technologists to improve the AI’s capabilities, Younggren said. The company claims its doctors can diagnose and treat more than 400 conditions, including: allergies, asthma, skin problems, coughs, flu, diabetes, high blood pressure, and infections. For medical emergencies, subscribers are advised to seek emergency help locally.
98point6 also can function as a front end for interacting
with patients in health systems that have their own primary-care doctors,
Younggren said. The company’s health system clients “don’t actually have a good
digital primary care front end to deliver care,” he said. “So, we can
essentially give them that, and then we can also get some detailed
understanding of how to coordinate care within the health system to drive
patients to the care that they need.” For example, this can include directing the
patient to an appropriate sub-specialist.
Leveraging Patient Data to Answer Health Questions
K Health in New York City offers a similar service based on its own AI-enabled smartphone app. The app incorporates data gleaned from the records of more than two million anonymous patients in Israel over the past 20 years, explained company co-founder Ran Shaul, co-founder and Chief Product Officer, in a blog post.
The software asks users about their “chief complaint” and
then compares the answers with data from similar cases. “We call this group
your ‘People Like Me’ cohort,” Shaul wrote. “It shows you how doctors diagnosed
those people and all the ways they were treated.”
The K Health app is free, but for a fee ranging from $14 for a one-time visit to $39 for an annual subscription, users can text with doctors, the company’s website states.
Unlike 98point6, K Health’s doctors are employed by “affiliated physician-owned professional corporations,” the company says, not K Health itself.
“The doctor you chat with will discuss a recommended treatment plan that may include a physical exam, lab tests, or radiology scans,” states K Health’s website. “They may send you directly for some of these tests, but others will require you to visit a local doctor.”
These are just the latest examples of new technologies and
services devised to help patients receive primary care. How a patient who uses
a smartphone app gets the necessary clinical laboratory tests performed is a
question yet to be answered.
Clinical laboratory leaders will want to watch this shift in
the delivery of primary care and look for opportunities to serve consumers who
are getting primary care from nontraditional sources.
Miniaturization of clinical laboratory testing continues to intrigue pathology researchers, medical scientists, and diagnostics developers who see the technology as a way to bring pathology diagnostics to resource deficient areas
Can useful, fast, and cheap medical laboratory tests be performed using the million-pixel cameras found in today’s smartphones, in combination with microchips and other technologies? A team of researchers at Princeton University believe they are on the path to achieving those goals.
Dark Daily has covered the development of “lab-on-a-chip” miniature diagnostic technologies for many years. Through these diminutive devices, clinical laboratory testing has been brought to remote regions of the world where even basic resources like electricity and adequate clean water are in short supply.
The Princeton researchers are developing their own tiny biosensor microchip. The device reads fluorescent light and could, they say, be used to diagnose disease from inside the human body.
Revolutionary Use of Standard Microchip Technology
The device developed by the Princeton University researchers
uses silicon chip technology to perform various types of clinical laboratory
assays.
“The key idea is to allow complex optical systems in modern-day chips,” said Kaushik Sengupta, PhD, Assistant Professor of Electrical Engineering at Princeton and one of the project leaders, in a press release. “All smartphones carry a million-pixel camera. How do we turn this into a device that allows laboratory-quality diagnostics?”
The miniature device (above) uses standard microchip technology consisting of tiny metal layers. It’s those layers that serve as the biosensor. The chip measures a mere four millimeters (approximately 5/32 of an inch) per side, and according to the University of Princeton scientists, it can be mass produced in a cost-effective manner using standard manufacturing techniques and does not require detailed assembly. (Photo copyright: Lingyu Hong/University of Princeton.)
The researchers discovered that existing microchip technology can be adapted to “take advantage of light’s unusual behavior when interacting with structures smaller than wavelength of light,” the press release noted.
“We show these complex optical biosensor systems can also be
realized in the same technology with absolutely no change in manufacturing the
microchip,” Sengupta said.
Employing existing manufacturing would make mass producing
the chips highly cost effective compared to other lab-on-a-chip technologies.
And, if the diagnostics are accurate as well, clinical laboratories could have
a remarkable new tool to aid physicians in the diagnosis of disease.
How It Works
The Princeton scientists say light harnessed by the fluorescence-based biosensor can detect and
differentiate biological substances ranging from bacterial Deoxyribonucleic acid (DNA)
to hormones present in humans.
They also claim their sensor can detect tiny molecules, such
as DNA and proteins, in liquid samples as small as one microliter. By
comparison, a single drop of water holds about 50 microliters. The researchers
say the sensitivity of their microchip in analyzing this tiny sample is
comparable to results achieve by diagnostic laboratories.
“We show for the first time that this level of optical field manipulation is possible in a silicon chip. By eliminating all classical optics, the system is now small enough that you could start thinking about putting it in a pill,” said Kaushik Sengupta, PhD, Assistant Professor of Electrical Engineering at Princeton. He’s shown above with Haw Yang, PhD (on right), Professor of Chemistry and Principle Investigator at the Haw Yang Laboratory at Princeton University. “You could start thinking about diagnostics inside the body in a way you could not think about before,” Sengupta concluded. (Photo copyright: Frank Wojciechowski/Princeton University.)
Like a traditional lab setup, the chip uses chemical
antibodies to target certain molecules. These antibodies are then altered to
propagate a specific light wavelength when they are exposed to a distinct
molecule. Exposure to ultraviolet light causes the antibodies to glow a faint
red color when they come into contact with the targeted substance.
Cheaper Diagnostics for the Developing World
The researchers hope that their miniature chip will someday
be used as a mainstream diagnostic technology, and that it may lead to the
development of other, similar diagnostic products.
“Once
we make the diagnostics cheaper, we can enable diagnostics in the developing
world,” stated Sengupta. “And it’s not just diagnostics. What we have come up
with here is just a low-cost, tiny fluorescent sensor and you can use
fluorescent sensing in many different things: for food and water-quality monitoring,
environmental monitoring, and industrial applications.”
More research is required to ensure the effectiveness of the
new technology. And it will need to receive clearance from the federal Food and Drug Administration (FDA) before going
into widespread production. Nevertheless, this newest miniature lab-on-a-chip
technology could prove beneficial to clinical laboratories in the future, as a
cost-effective tool to diagnose disease and better serve medical professionals
and patients in resource-strapped regions of the world.
Hand-held tests developed from the work of the NUS BIGHEART team could help caregivers in remote areas diagnose disease quickly, accurately, and inexpensively There is great demand in Asia for diagnostic tests that are cheap, accurate, and have a fast time to answer. Especially in Asia’s remote and mobile clinics where caregivers need immediate access to clinical laboratory test results at the time of patients’ visits. Researchers at the National University of Singapore (NUS) have unveiled...
