Category Archives: TELEMEDICINE

Telemedicine: UCM Digital Health Aids NY Hospitals

Telemedicine could soon offer relief local emergency rooms desperately need.

UCM Digital Health offers a digitally integrated, whole person health solution that provides patients with immediate access to care on their terms.

UCM combines a digital front door platform, multi-disciplinary team of providers, and a 24/7 telehealth triage, treatment, and navigation service to provide a range of patient services, including emergent and urgent care, primary and specialty care, behavioral health, and more. Care begins digitally and can seamlessly integrate across other points of care for a simple patient experience.

UCM brings together clinical expertise, advanced technology and compassionate care to offer powerful advantages for insurers, employers, patients and providers.

Artificial Intelligence: Its Benefits For Radiology

Using artificial intelligence in health care seems like a futuristic concept, but it’s something that’s being used now to complement the knowledge of doctors. Radiology was one of the first areas that saw a lot of AI applications.

Dr. Bradley Erickson, director of Mayo Clinic’s AI Lab, says in the case of radiology, machine learning is used to complete some of the more time-consuming work. Beyond that, the diagnostic capabilities of AI are what attracts a lot of the appeal. While imaging-related AI has seen a lot of advancements, Dr. Bhavik Patel, director of AI at Mayo Clinic Arizona, says the next step is looking at AI applications for preventive health and shifting the mindset from pipeline to platform thinking.

There are a broad area of applications (for AI), starting in radiology, but really spreading into the rest of the clinic, including cardiology and even pathology.

Telemedicine: New Survey Finds Virtual Care Is Now Mainstream Care Delivery

“Telemedicine is here to stay,” said Dr. Rahul Sharma, professor and chair of emergency medicine at Weill Cornell Medicine and co-author of a commentary on the results. “Health care organizations really need to think about the next steps regarding the future of virtual care, such as how we integrate it into our systems, and how to make sure we are meeting the needs of both our clinicians and our patients.”

The survey, conducted in March, polled members of NEJM’s Catalyst Insight Council who are clinicians, clinical leaders and executives in organizations that deliver care. The survey received 984 responses from around the world, 609 from the United States. Dr. Sharma, who is also emergency physician-in-chief at New York-Presbyterian/Weill Cornell Medical Center and executive director of the Center for Virtual Care at Weill Cornell Medicine, helped formulate the questions with his co-author Dr. Judd E. Hollander, senior vice president of health care delivery innovation at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.

Of U.S. respondents, 71 percent reported that telemedicine has improved patient health, while a similar proportion said it provides at least moderate quality specialty or mental health care. For primary care, that share was 81 percent. When responses across all countries are included, the results differ only slightly from those of U.S. respondents.

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Technology: Smart, Voice-Assisted Operating Rooms

Are Amazon Alexa and Google Home limited to our bedrooms, or can they be used in hospitals? Do you envision a future where physicians work hand-in-hand with voice AI to revolutionize healthcare delivery? In the near future, clinical smart assistants will be able to automate many manual hospital tasks—and this will be only the beginning of the changes to come.

Voice AI is the future of physician-machine interaction and this Focus book provides invaluable insight on its next frontier. It begins with a brief history and current implementations of voice-activated assistants and illustrates why clinical voice AI is at its inflection point. Next, it describes how the authors built the world’s first smart surgical assistant using an off-the-shelf smart home device, outlining the implementation process in the operating room. From quantitative metrics to surgeons’ feedback, the authors discuss the feasibility of this technology in the surgical setting. The book then provides an in-depth development guideline for engineers and clinicians desiring to develop their own smart surgical assistants. Lastly, the authors delve into their experiences in translating voice AI into the clinical setting and reflect on the challenges and merits of this pursuit.

The world’s first smart surgical assistant has not only reduced surgical time but eliminated major touch points in the operating room, resulting in positive, significant implications for patient outcomes and surgery costs. From clinicians eager for insight on the next digital health revolution to developers interested in building the next clinical voice AI, this book offers a guide for both audiences.

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Journals: Telemedicine And e-Health – June 2022

What Works Best to Engage Participants in Mobile App Interventions and e-Health: A Scoping Review

Enhancing participant engagement is considered a key priority for wellness and health care, especially as health care undergoes a shift toward the integration of digital technologies (e.g., mobile apps, health care monitors, and online portals with their consumer interfaces).1,2 Technological systems play a critical role in enhancing participant engagement.1,2 Among urban and low-income mothers, the use of smart-device technology for communication was a particularly important contributor to higher retention in longitudinal studies.3 Providing digital health tools has not only led to an increase in study participation adherence rates,4 but it has also contributed to measurable improvements in health care outcomes across several conditions. For instance, greater patient activation in their health care improved patient adherence to treatment prescriptions.5 Participants’ use of web portals to augment treatment of diabetes demonstrated improved glycemic control across multiple studies.6–8 Other studies have seen improvements in participants with HIV,9 with coronary artery disease,10 and with depression,11–13 highlighting how impactful the implementation of these tools can be across different clinical populations.

Schoeppe et al.14 emphasized common strategies that successful mobile interventions often use, such as goal setting, self-monitoring, and performance feedback in their app design. To our knowledge, however, there has not been a scoping review of the specific components of mobile intervention apps that increase engagement. Common across all digital health tools are the focus on increased patient engagement and “empowerment,” which is a result of several qualities inherent in these tools. Most of these technological systems improve patients’ communication with and access to health care providers,1,2,15 and provide patients with more comprehensive information about their health on demand.2,15 While these qualities are common across successful tools and play a large part in improving patient self-management and decreasing stress,2 improved engagement is no guarantee.

Furthermore, measuring engagement is a challenge that has likely contributed to our lack of knowledge on app components that effectively increase this important metric. There are now several measures that quantify the amount of engagement that patients feel toward the digital tools and apps that are being developed,2,15 but these are not widely used and engagement measurements are not standardized across studies. Some examples of such measures are the Patient Activation Measure (PAM16), Mobile App Rating Scale (MARS17), and the Patient Health Engagement scale (PHE-s18). These measures create a quantifiable standardized method by which researchers can measure the phenomenon of user engagement during program development, and are important considerations when creating new digital tools for patients and clinical research participants.

Technology: The Lancet Digital Health – July 2022

Emergency Care: Flying Intervention Team Use In Acute Ischemic Stroke

In a nonrandomized controlled intervention study published in JAMA, researchers in Germany assessed whether deployment of a flying interventional team, consisting of a neurointerventional radiologist and an angiography assistant, was associated with a shorter time to endovascular thrombectomy for patients in rural or intermediate population areas in Southeast Bavaria.

This video explains the study design. Click https://ja.ma/FIT for full details.

COMMENTARY:

Stroke prevention by a healthy lifestyle, including a good diet, regular exercise, and sleep is of course preferable to treatment.

However, stroke still claims more than 100,000 lives per year in the United States, and is a major factor in disability.

Recognition of a stroke is the first crucial step, and has been discussed in DWWR previously; FAST is the Menmonic and guiding principle. Ask the patient to smile, and it may be assymmetric, with one side drooping. Ask the patient to raise both arms, and one may drift down. Ask the patient to repeat a simple sentence, and he may be unable to do so. And above all be speedy, since time is of the essence, and treatment must take place within a very few hours.

Modern medical centers in large cities frequently have a team dedicated to treating stroke. The patient goes for a CT or MRI while  the Catheter team assembles. An intravenous clot dissolver, tPA, is often used, or possibly a catheter is inserted into an artery and guided to the  proper location. Sometimes the clot is mechanically removed as in the accompanying video.

The helicopter stroke response team featured in the posting is one aspect of the speed that is so essential; any delay will result in death, sometimes permanently, of brain cells.

Acute Heart attack treatment is basically similar to stroke, and was the pioneering venture into the interventional radiology described above. Also, the heart may be the source of the clots that lodge in the brain, especially from atrial fibrillation.

Please enjoy the following video which shows how mechanical clot removal is achieved.

—Dr. C.