Challenges for Transformative Innovation in Emerging Digital Health Organizations: advocating service design to address the multifaceted healthcare ecosystem

2020 ◽  
Vol 25 (4) ◽  
Author(s):  
Arthur A Boni
Keyword(s):  
Joint Venture ◽  
Early Stage ◽  
Medical Center ◽  
Digital Health ◽  
Academic Medical Center ◽  
Digital Pathology ◽  
Service Design ◽  
Digital Radiology ◽  
Value Propositions ◽  
Ibm Watson

This article uses mini- case studies of three early stage organizations that pursued different pathways or models for bringing emerging, transformative digital technologies to the healthcare market.  These organizations were each focused on different applications of digital health: Stentor was a venture capital backed, university spinoff focused in the field of digital radiology; Omnyx was formed as a joint venture (JV) by an academic medical center and industrial partner to transform the field of digital pathology; and, IBM Watson operating as an IBM unit, focused on the promise of artificial intelligence and machine learning for broad uses in cancer diagnosis and treatment. Each took a different organizational and business model path that resulted in mixed outcomes. While there are always many reasons for success or failure, we observe that these digital healthcare markets are more complex than typical consumer or technology markets. While any solution in healthcare demands patient centricity; healthcare markets additionally require a strong understanding and appreciation of the supporting ecosystem or network consisting of physicians and providers; and of constraints from payers and regulators.  The value propositions of each member of the ecosystem must be understood and addressed. To meet this challenge, we advocate the formation of an integrated multidisciplinary commercialization team that addresses the multidimensional value proposition across the company life cycle. And importantly, that team should work collaboratively, and include service design as a key team member - along with the technology, business, marketing, reimbursement, and regulatory components.

Application of RSClin to guide treatment recommendations for premenopausal patients with early-stage hormone-positive breast cancer and intermediate risk oncotype recurrence scores.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12511-e12511
Author(s):  
Brittney Shulman Zimmerman ◽  
Shana Berwick ◽  
Alaina J Kessler ◽  
Danielle Seidman ◽  
Sara Malin Hovstadius ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Medical Center ◽  
Academic Medical Center ◽  
Recurrence Score ◽  
Treatment Recommendations ◽  
Definitive Treatment ◽  
Treatment Recommendation ◽  
Intermediate Risk ◽  
Premenopausal Patients

e12511 Background: The RSClin model, which incorporates the Oncotype Recurrence Score (RS) and clinicopathologic features, was recently developed to further tailor prognosis and prediction of chemotherapy benefit for patients with early-stage hormone positive (HR+) breast cancer (BC) (Sparano et al, 2020). The RSClin calculator is available online to assist treatment planning for situations where chemotherapy benefit is uncertain. Covariates include Oncotype RS, tumor grade, tumor size and patient age. The risk calculator generates a 10-year distant recurrence risk and absolute chemotherapy benefit. This tool may be especially helpful to determine treatment management for premenopausal patients with early-stage HR+ BC with intermediate risk (IR) Oncotype RS (16-25). We retrospectively applied RSClin to this patient population to determine if it would have changed treatment recommendations. Methods: We identified premenopausal women with node-negative early-stage BC with IR RS (16-25) within our large Oncotype database. Using the RSClin model, we selected >5% absolute chemotherapy benefit as a reasonable cutoff to recommend chemotherapy. We compared the treatment recommendation based on RSClin with the treatment previously recommended by breast oncologists at our large academic medical center in New York City. Results: There were 86 patients who met criteria with a median age of 46 years. Of these, 26 patients (30%) were recommended chemotherapy plus endocrine therapy (ET) and 60 (70%) were recommended ET alone. After applying the RSClin model (data available for 83/86 patients), 19 (23%) would have resulted in a change in treatment recommendation and 64 (77%) would have remained unchanged. Overall, 8 (10%) would have withheld chemotherapy when it was previously offered and 11 (13%) would have recommended chemotherapy when it was previously excluded. There were 8 (9%) secondary invasive breast events in this population, with 2 (2%) being ipsilateral, 3 (3%) being contralateral and 3 (3%) metastatic at a median follow up of 46.9 months. Conclusions: The RSClin model would have changed management of premenopausal patients with IR RS in 23% of patients. This model, although not yet prospectively validated, may help individualize therapy for patients with less definitive treatment plans. Using RSClin, we can aim to minimize recurrence rates and avoid unnecessary chemotherapy in selected patients. This model is easy to apply and will have important clinical utility moving forward.

scholarly journals Establishing a digital health platform in an academic medical center supporting rural communities

2020 ◽  
Vol 4 (5) ◽  
pp. 384-388
Author(s):  
Anita Walden ◽  
Aaron S. Kemp ◽  
Linda J. Larson-Prior ◽  
Thomas Kim ◽  
Jennifer Gan ◽  
...  
Keyword(s):  
Rural Communities ◽  
Mobile Health ◽  
Medical Center ◽  
Digital Health ◽  
Academic Medical Center ◽  
Healthcare Providers ◽  
Training Models ◽  
Health Technologies ◽  
Regional Conference ◽  
Patient Advocates

AbstractThe University of Arkansas for Medical Sciences (UAMS), like many rural states, faces clinical and research obstacles to which digital innovation is seen as a promising solution. To implement digital technology, a mobile health interest group was established to lay the foundation for an enterprise-wide digital health innovation platform. To create a foundation, an interprofessional team was established, and a series of formal networking events was conducted. Three online digital health training models were developed, and a full-day regional conference was held featuring nationally recognized speakers and panel discussions with clinicians, researchers, and patient advocates involved in digital health programs at UAMS. Finally, an institution-wide survey exploring the interest in and knowledge of digital health technologies was distributed. The networking events averaged 35–45 attendees. About 100 individuals attended the regional conference with positive feedback from participants. To evaluate mHealth knowledge at the institution, a survey was completed by 257 UAMS clinicians, researchers, and staff. It revealed that there are opportunities to increase training, communication, and collaboration for digital health implementation. The inclusion of the mobile health working group in the newly formed Institute for Digital Health and Innovation provides a nexus for healthcare providers and researches to facilitate translational research.

“I had already made up my mind.” The impact of prior experience and health care perceptions on decision making in women with early-stage breast cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 228-228
Author(s):  
Rebecca England ◽  
Valerie Lawhon ◽  
Audrey S. Wallace ◽  
Stacey A. Ingram ◽  
Courtney Williams ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Stage ◽  
Medical Center ◽  
Comparative Method ◽  
Academic Medical Center ◽  
Axillary Node ◽  
Additional Treatment ◽  
Early Stage Breast Cancer ◽  
The Impact

228 Background: Shared decision-making (SDM) occurs when informed patients partner with their oncologists to incorporate personal preferences into treatment. Even before engaging with an oncologist about treatment options, patients may have personal experiences or knowledge of other’s experiences with breast cancer that frame their decision-making. This study sought to understand how prior experiences and knowledge drive preferences in early stage breast cancer treatment approaches. Methods: This qualitative study included early stage breast cancer (BC) patients at an academic medical center in the Deep South. Women age ≥18 with an AJCC stage I-III BC diagnosis were invited to complete semi-structured interviews with a trained interviewer. Interviews were audio-recorded, transcribed, and analyzed by two independent coders utilizing a constant comparative method from an a priori conceptual model based on the Ottawa Framework. Major themes and exemplary quotes related to decision-making preferences were extracted. Results: Women (n = 33) interviewed were an average age of 74 (4.2 SD), and 19% of participants were African American. Many women were given the option to omit treatments, such as chemotherapy or radiation therapy, based on hormone receptor status and axillary node involvement. Major themes related to a desire for more treatment were past experiences with family members having cancer or an impression that additional treatment would be more effective. For women that opted out of treatments, prior knowledge of potential physical side effects from friends, family, and other cancer survivors were cited as a major deterrent. Perceptions of low recurrence risk also influenced desire to forgo treatments. Conclusions: Women presenting with early stage BC had varied healthcare experiences, which resulted in preconceived ideas about receiving breast cancer treatments. Consideration of these themes may aid physicians’ ability to address individual concerns to further personalize patient care, thus enhancing the patient-physician partnership. These findings will ultimately assist in improving patient engagement in SDM.

scholarly journals Predicting Opportunities and Challenges Prior to Transitioning to Digital Pathology: An Interview Envisioning Study with 11 Pathologists

2019 ◽  
Vol 8 (1) ◽  
pp. 9-12
Author(s):  
Emily S. Patterson ◽  
Lauren Mansour ◽  
Metin N. Gurcan ◽  
Zaibo Li ◽  
Anil Parwani
Keyword(s):  
Digital Libraries ◽  
Medical Center ◽  
Academic Medical Center ◽  
Digital Pathology ◽  
Structured Interview ◽  
Primary Diagnosis ◽  
Whole Slide Imaging ◽  
Implementation Challenges ◽  
Academic Medical ◽  
A Current

There is growing interest in implementing whole-slide imaging (WSI) for primary diagnosis. Ten subspecialized pathologists (2-39 years of experience) were interviewed from diverse subspecialty areas in a large academic medical center. Relevant semi-structured interview questions included image quality, workflow, and usability during clinical use. Analysis revealed that WSI implementation would raise some concerns: 1) delaying turn-around time for preliminary diagnoses as well as final reports, 2) delaying access to order ancillary tests, which could impact scheduling for some patients for follow-on surgery, 3) making it hard to track what has been reviewed and at what level of magnification, 4) potentially increase wrist pain from using a mouse or neck pain while viewing the monitor, and 5) increase vulnerability when a computer, monitor, or network goes down. However, WSI implementation would enable 1) increased flexibility for slide access remotely during nights, weekends, and work trips, 2) easier consults among peers and with mentors, 3) easier detection and recovery when images are routed to the wrong person, 4) creating digital libraries, including previous slides from a current patient, and 5) giving greater access to images for presentations, publications, and to other clinical personnel. Implementing digital slides and associated workflow will introduce many challenges and barriers. Studies such as the current one are much needed to explore the pathologist’s perspective on these workflow and implementation challenges prior to and during the installation of the digital pathology systems. These perspectives are important to understand in order to improve the experience of the pathologists and lab personnel as they interact with these systems.

scholarly journals Using Dynamic Virtual Microscopy to Train Pathology Residents During the Pandemic: Perspectives on Pathology Education in the Age of COVID-19

2021 ◽  
Vol 8 ◽  
pp. 237428952110068
Author(s):  
Robert J. Christian ◽  
Mandy VanSandt
Keyword(s):  
Light Microscope ◽  
Medical Center ◽  
Academic Medical Center ◽  
Digital Pathology ◽  
Educational Innovation ◽  
Digital Camera ◽  
Teaching Experience ◽  
Virtual Microscopy ◽  
Available Technology ◽  
Pathology Education

The COVID-19 pandemic has forced educational programs, including pathology residency, to move to a physically distanced learning environment. Tandem microscopic review (also known as “double-scoping”) of pathology slides is a traditional cornerstone of pathology education. However, this requires the use of a double- or multi-headed optical light microscope which is unfortunately not amenable to physical distancing. The loss of double-scoping has forced educational innovation in order to continue teaching microscopy. Digital pathology options such as whole slide imaging could be considered; however, financial constraints felt by many departments often render this option cost-prohibitive. Alternatively, a shift toward teaching via dynamic virtual microscopy offers a readily available, physically distanced, and cost-conscious alternative for pathology education. Required elements include a standard light microscope, a mounted digital camera, computers, and videoconferencing software to share a slide image with the learner(s). Through survey data, we show immediate benefits include maintaining the essence of the traditional light microscope teaching experience, and additional gains were discovered such as the ability for educators and learners to annotate images in real time, among others. Existing technology may not be initially optimized for a dynamic virtual experience, resulting in lag time with image movement, problems focusing, image quality issues, and a narrower field of view; however, these technological barriers can be overcome through hardware and software optimization. Herein, we share the experience of establishing a dynamic virtual microscopy educational system in response to the COVID-19 pandemic, utilizing readily available technology in the pathology department of a major academic medical center.

scholarly journals Interactive Digital Health Tools to Engage Patients and Caregivers in Discharge Preparation: Implementation Study

10.2196/15573 ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. e15573 ◽  
Author(s):  
Theresa E Fuller ◽  
Denise D Pong ◽  
Nicholas Piniella ◽  
Michael Pardo ◽  
Nathaniel Bessa ◽  
...  
Keyword(s):  
Text Messaging ◽  
Medical Center ◽  
Digital Health ◽  
Academic Medical Center ◽  
Care Team ◽  
Patient Portal ◽  
Implementation Barriers ◽  
Secure Messaging ◽  
Patient Admissions ◽  
Patient Reported

Background Poor discharge preparation during hospitalization may lead to adverse events after discharge. Checklists and videos that systematically engage patients in preparing for discharge have the potential to improve safety, especially when integrated into clinician workflow via the electronic health record (EHR). Objective This study aims to evaluate the implementation of a suite of digital health tools integrated with the EHR to engage hospitalized patients, caregivers, and their care team in preparing for discharge. Methods We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify pertinent research questions related to implementation. We iteratively refined patient and clinician-facing intervention components using a participatory process involving end users and institutional stakeholders. The intervention was implemented at a large academic medical center from December 2017 to July 2018. Patients who agreed to participate were coached to watch a discharge video, complete a checklist assessing discharge readiness, and request postdischarge text messaging with a physician 24 to 48 hours before their expected discharge date, which was displayed via a patient portal and bedside display. Clinicians could view concerns reported by patients based on their checklist responses in real time via a safety dashboard integrated with the EHR and choose to open a secure messaging thread with the patient for up to 7 days after discharge. We used mixed methods to evaluate our implementation experience. Results Of 752 patient admissions, 510 (67.8%) patients or caregivers participated: 416 (55.3%) watched the video and completed the checklist, and 94 (12.5%) completed the checklist alone. On average, 4.24 concerns were reported per each of the 510 checklist submissions, most commonly about medications (664/2164, 30.7%) and follow-up (656/2164, 30.3%). Of the 510 completed checklists, a member of the care team accessed the safety dashboard to view 210 (41.2%) patient-reported concerns. For 422 patient admissions where postdischarge messaging was available, 141 (33.4%) patients requested this service; of these, a physician initiated secure messaging for 3 (2.1%) discharges. Most patient survey participants perceived that the intervention promoted self-management and communication with their care team. Patient interview participants endorsed gaps in communication with their care team and thought that the video and checklist would be useful closer toward discharge. Clinicians participating in focus groups perceived the value for patients but suggested that low awareness and variable workflow regarding the intervention, lack of technical optimization, and inconsistent clinician leadership limited the use of clinician-facing components. Conclusions A suite of EHR-integrated digital health tools to engage patients, caregivers, and clinicians in discharge preparation during hospitalization was feasible, acceptable, and valuable; however, important challenges were identified during implementation. We offer strategies to address implementation barriers and promote adoption of these tools. Trial Registration ClinicalTrials.gov NCT03116074; https://clinicaltrials.gov/ct2/show/NCT03116074.

scholarly journals Results of a portfolio approach to intramural research funding at an academic medical center

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241425
Author(s):  
Anu Swaminathan ◽  
Frank S. David ◽  
Lauren N. Geary ◽  
Jacqueline M. Slavik
Keyword(s):  
Early Stage ◽  
Medical Center ◽  
Descriptive Analysis ◽  
Academic Medical Center ◽  
Academic Rank ◽  
Federal Grant ◽  
Diverse Range ◽  
Grant Programs ◽  
Academic Medical ◽  
Funding Program

In response to stagnant Federal grant funding levels and to catalyze early stage or high-risk research not currently supported by the NIH, many academic medical centers (AMCs) provide supplemental intramural funding to faculty investigators. However, it can be challenging to decide how to deploy these funds for maximum impact. We conducted a retrospective, descriptive analysis to explore trends in applications and awards associated with an institution-wide intramural funding center at a major U.S. AMC. From 2010 to 2017, the Brigham Research Institute at Brigham and Women’s Hospital awarded a total of 354 grants totaling over $9 million to affiliated researchers through six distinct and complementary grant programs. The number of applicants remained essentially stable, despite expansion of the funding program portfolio. Distribution of applicants and awardees by academic rank and gender generally reflected that of medical school faculty at large. This descriptive analysis demonstrates interest in a diverse range of intramural funding programs among AMC faculty, and a lack of overt rank or gender bias in the programs’ awardees. However, it highlights the institution’s need to better understand the amount of residual unmet demand for intramural funding; the degree to which underrepresented constituencies can and should be actively supported; and the “return on investment” of these grants.

scholarly journals Temporal and Atemporal Provider Network Analysis in a Breast Cancer Cohort from an Academic Medical Center (USA)

Informatics ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 34 ◽  
Author(s):  
Bryan Steitz ◽  
Mia Levy
Keyword(s):  
Breast Cancer ◽  
Social Network ◽  
Social Network Analysis ◽  
Network Analysis ◽  
Early Stage ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Breast Cancer Patients ◽  
Analysis Model

Social network analysis (SNA) is a quantitative approach to study relationships between individuals. Current SNA methods use static models of organizations, which simplify network dynamics. To better represent the dynamic nature of clinical care, we developed a temporal social network analysis model to better represent care temporality. We applied our model to appointment data from a single institution for early stage breast cancer patients. Our cohort of 4082 patients were treated by 2190 providers. Providers had 54,695 unique relationships when calculated using our temporal method, compared to 249,075 when calculated using the atemporal method. We found that traditional atemporal approaches to network modeling overestimate the number of provider-provider relationships and underestimate common network measures such as care density within a network. Social network analysis, when modeled accurately, is a powerful tool for organizational research within the healthcare domain.

scholarly journals Interactive Digital Health Tools to Engage Patients and Caregivers in Discharge Preparation: Implementation Study (Preprint)

2019 ◽  
Author(s):  
Theresa E Fuller ◽  
Denise D Pong ◽  
Nicholas Piniella ◽  
Michael Pardo ◽  
Nathaniel Bessa ◽  
...  
Keyword(s):  
Text Messaging ◽  
Medical Center ◽  
Digital Health ◽  
Academic Medical Center ◽  
Care Team ◽  
Patient Portal ◽  
Implementation Barriers ◽  
Secure Messaging ◽  
Patient Admissions ◽  
Patient Reported

BACKGROUND Poor discharge preparation during hospitalization may lead to adverse events after discharge. Checklists and videos that systematically engage patients in preparing for discharge have the potential to improve safety, especially when integrated into clinician workflow via the electronic health record (EHR). OBJECTIVE This study aims to evaluate the implementation of a suite of digital health tools integrated with the EHR to engage hospitalized patients, caregivers, and their care team in preparing for discharge. METHODS We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify pertinent research questions related to implementation. We iteratively refined patient and clinician-facing intervention components using a participatory process involving end users and institutional stakeholders. The intervention was implemented at a large academic medical center from December 2017 to July 2018. Patients who agreed to participate were coached to watch a discharge video, complete a checklist assessing discharge readiness, and request postdischarge text messaging with a physician 24 to 48 hours before their expected discharge date, which was displayed via a patient portal and bedside display. Clinicians could view concerns reported by patients based on their checklist responses in real time via a safety dashboard integrated with the EHR and choose to open a secure messaging thread with the patient for up to 7 days after discharge. We used mixed methods to evaluate our implementation experience. RESULTS Of 752 patient admissions, 510 (67.8%) patients or caregivers participated: 416 (55.3%) watched the video and completed the checklist, and 94 (12.5%) completed the checklist alone. On average, 4.24 concerns were reported per each of the 510 checklist submissions, most commonly about medications (664/2164, 30.7%) and follow-up (656/2164, 30.3%). Of the 510 completed checklists, a member of the care team accessed the safety dashboard to view 210 (41.2%) patient-reported concerns. For 422 patient admissions where postdischarge messaging was available, 141 (33.4%) patients requested this service; of these, a physician initiated secure messaging for 3 (2.1%) discharges. Most patient survey participants perceived that the intervention promoted self-management and communication with their care team. Patient interview participants endorsed gaps in communication with their care team and thought that the video and checklist would be useful closer toward discharge. Clinicians participating in focus groups perceived the value for patients but suggested that low awareness and variable workflow regarding the intervention, lack of technical optimization, and inconsistent clinician leadership limited the use of clinician-facing components. CONCLUSIONS A suite of EHR-integrated digital health tools to engage patients, caregivers, and clinicians in discharge preparation during hospitalization was feasible, acceptable, and valuable; however, important challenges were identified during implementation. We offer strategies to address implementation barriers and promote adoption of these tools. CLINICALTRIAL ClinicalTrials.gov NCT03116074; https://clinicaltrials.gov/ct2/show/NCT03116074.

scholarly journals The Impact of Providing a Tool Kit for Innovators in an Academic Medical Center to Scale Digital Health Innovation (Preprint)

2018 ◽  
Author(s):  
Ritika Saxena ◽  
Josephine Elias ◽  
Chenzhe Cao ◽  
Haipeng Zhang ◽  
Adam Landman
Keyword(s):  
New Technologies ◽  
Medical Center ◽  
Digital Health ◽  
Academic Medical Center ◽  
External Support ◽  
Case Review ◽  
Health Innovation ◽  
Academic Medical ◽  
Internal Barriers ◽  
The Impact

BACKGROUND An internal iHub survey shows that 72% of innovators within Academic Medical Centers abandon their ideas due to a lack of direction for their visions. While internal innovators are frustrated without direction and support to launch their ideas, hospitals need to balance innovation while ensuring information security-HIPPA compliance. Brigham and Women's Hospital houses a digital innovation hub (iHub) that fosters innovation for Brigham clinicians, scientists, researchers, administrators, and staff. In 2014, BWH founded a program called Digital Health Innovation Guide (DHIG) to provide structure for innovators to pilot new and novel technology in a safe, efficient, and successful manner. As a continuous cycle of innovation, the iHub identified successes and ways to improve the DHIG process and quality of service. OBJECTIVE We gathered and analyzed data from participants of the DHIG and creators of the program to project the outcomes of the Digital Health Innovation Guide. With that information, we were able to quantify the impact of providing these resources and determine ways to improve the process of helping scale and structure digital health innovation. METHODS We conducted a case review of existing data on DHIG projects. This included gathering data on projects from 2014-current. We reached out to 40 participants that went through the DHIG program to fill out a survey of questions regarding logistics of their project, successes and failures they faced, their thoughts on DHIG process, and its impact on the piloting process. We interviewed 10 participants to discuss the impact of the DHIG process, and to quantify where more support is needed from the iHub to better aid innovators to utilize and innovate new technologies in health care. RESULTS From the responses collected, 50% of the innovators collaborated with external startups, while the other 50% were custom developments. 86% of teams had over 4 members, and of the remaining 14%, only 20% were still actively working to pilot completion. Conversely, 100% of stalled projects had less than 4 members. Participants listed that upholding deadlines and maintaining communication with internal stakeholders as well as external, such as developers and other hospitals, brought on successes for their project. Internal bottlenecks like indeterminate delays of IRB approval timelines and info sec reviews slowed down progress and, in some cases, led to withdrawal from sponsors. CONCLUSIONS Based off team sizes and member engagement, we found that it is crucial to have a team of at least 4 members with an engaged clinical champion, administrative champion, and project manage to ensure pilot completion. The iHub and DHIG process can improve pilot completion by expanding external support resources such as developers and other hospitals. The DHIG, while successful in providing a clear and rigid structure for innovators in an AMC to further develop their innovations, must continue to breakdown internal barriers by acting as an expediter.

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