Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Carolyn Foster ◽  
Dana Schinasi ◽  
Kristin Kan ◽  
Michelle Macy ◽  
Derek Wheeler ◽  
...  
Keyword(s):  
Health Care ◽  
Digital Literacy ◽  
Care Delivery ◽  
Digital Health ◽  
Health Care Team ◽  
Models Of Care ◽  
Health Data ◽  
Care Needs ◽  
Case Examples ◽  
Health Technologies

Remote patient monitoring (RPM) is a form of telemedicine that involves the collection and transmission of health data from a patient to their health care team by using digital health technologies. RPM can be leveraged to aggregate and visualize longitudinal patient-generated health data for proactive clinical management and engagement of the patient and family in a child’s health care. Collection of remote data has been considered standard of care for years in some chronic pediatric conditions. However, software limitations, gaps in access to the Internet and technology devices, digital literacy, insufficient reimbursement, and other challenges have prevented expansion of RPM in pediatric medicine on a wide scale. Recent technological advances in remote devices and software, coupled with a shift toward virtual models of care, have created a need to better understand how RPM can be leveraged in pediatrics to improve the health of more children, especially for children with special health care needs who are reliant on high-quality chronic disease management. In this article, we define RPM for the general pediatric health care provider audience, provide case examples of existing RPM models, discuss advantages of and limitations to RPM (including how data are collected, evaluated, and managed), and provide a list of current RPM resources for clinical practitioners. Finally, we propose considerations for expansion of this health care delivery approach for children, including clinical infrastructure, equitable access to digital health care, and necessary reimbursement. The overarching goal is to advance health for children by adapting RPM technologies as appropriate and beneficial for patients, families, and providers alike.

Digital Health

2021 ◽  
Author(s):  
Eric D. Perakslis ◽  
Martin Stanley ◽  
Erin Brodwin
Keyword(s):  
Health Care ◽  
Side Effects ◽  
Care Delivery ◽  
Digital Health ◽  
Detailed Examination ◽  
Medical Diagnostics ◽  
Medical Interventions ◽  
Health Technologies ◽  
Solid Models ◽  
Medical Side

Digital health has been touted as a true transformation of health care, but all medical interventions have associated risks that must be understood and quantified. The Internet has brought many advancements, which quickly jumped from our computers into our pockets via powerful and completely connected mobile devices that are now being envisioned as devices for medical diagnostics and care delivery. As health care struggles with cost, inequity, value, and rapid virtualization, solid models of benefit-risk determination, new regulatory approaches for biomedical products, and clear risk-based conversations with all stakeholders are essential. Detailed examination of emerging digital health technologies has revealed 10 categories of digital side effects or “toxicities” that must be understood, prevented when possible, and managed when not. These toxicities include cyberthreat, loss of privacy, cyberchondria and cyber addiction, threats to physical security, charlatanism, overdiagnosis and overtreatment, medical/user error, and the plague of medical misinformation. For digital health to realize its promise, these toxicities must be understood, measured, warned against, and managed as concurrent side effects, in the same fashion as any other medical side effect.

The Physical Therapy and Society Summit (PASS) Meeting: Observations and Opportunities

2010 ◽  
Vol 90 (11) ◽  
pp. 1555-1567 ◽  
Author(s):  
Colleen M. Kigin ◽  
Mary M. Rodgers ◽  
Steven L. Wolf
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Care Delivery ◽  
Cost Effective ◽  
Steering Committee ◽  
Health Care Team ◽  
Health Care Environment ◽  
Care Needs

The construct of delivering high-quality and cost-effective health care is in flux, and the profession must strategically plan how to meet the needs of society. In 2006, the House of Delegates of the American Physical Therapy Association passed a motion to convene a summit on “how physical therapists can meet current, evolving, and future societal health care needs.” The Physical Therapy and Society Summit (PASS) meeting on February 27–28, 2009, in Leesburg, Virginia, sent a clear message that for physical therapists to be effective and thrive in the health care environment of the future, a paradigm shift is required. During the PASS meeting, participants reframed our traditional focus on the physical therapist and the patient/client (consumer) to one in which physical therapists are an integral part of a collaborative, multidisciplinary health care team with the health care consumer as its focus. The PASS Steering Committee recognized that some of the opportunities that surfaced during the PASS meeting may be disruptive or may not be within the profession's present strategic or tactical plans. Thus, adopting a framework that helps to establish the need for change that is provocative and potentially disruptive to our present care delivery, yet prioritizes opportunities, is a critical and essential step. Each of us in the physical therapy profession must take on post–PASS roles and responsibilities to accomplish the systemic change that is so intimately intertwined with our destiny. This article offers a perspective of the dynamic dialogue and suggestions that emerged from the PASS event, providing further opportunities for discussion and action within our profession.

scholarly journals Um Novo Paradigma em Investigação em Saúde: Dados FAIR (Localizáveis, Acessíveis, Interoperáveis, Reutilizáveis)

2020 ◽  
Vol 33 (12) ◽  
pp. 828
Author(s):  
Marta Almada ◽  
Luis Midão ◽  
Diana Portela ◽  
Ines Dias ◽  
Francisco J. Núñez-Benjumea ◽  
...  
Keyword(s):  
Health Care ◽  
Ethical Issues ◽  
Digital Health ◽  
Individualized Medicine ◽  
Health Data ◽  
Sensitive Data ◽  
General Data Protection Regulation ◽  
Health Technologies ◽  
Health Care Models ◽  
Care Models

The digital era, that we are living nowadays, is transforming health, health care models and services, and the role of society in this new reality. We currently have a large amount of stored health data, including clinical, biometric, and scientific research data. Nonetheless, its potential is not being fully exploited. It is essential to foster the sharing and reuse of this data not only in research but also towards the development of health technologies in order to improve health care efficiency, as well as products, services or digital health apps, to promote preventive and individualized medicine and to empower citizens in health literacy and self-management. In this sense, the FAIR concept has emerged, which implies that health data is findable, accessible, shared and reusable, facilitating interoperability between systems, ensuring the protection of personal and sensitive data. In this paper we review the FAIR concept, ‘FAIRification’ process, FAIR data versus open access data, ethical issues and the general data protection regulation, and digital health and citizen science.

scholarly journals Exploring an Innovative Care Model and Telemonitoring for the Management of Patients With Complex Chronic Needs: Qualitative Description Study

JMIR Nursing ◽  
10.2196/15691 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e15691 ◽  
Author(s):  
Kayleigh Gordon ◽  
Carolyn Steele Gray ◽  
Katie N Dainty ◽  
Jane DeLacy ◽  
Patrick Ware ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Conditions ◽  
Chronic Care ◽  
Care Delivery ◽  
Models Of Care ◽  
Integrated Model ◽  
Qualitative Description ◽  
Model Of Care ◽  
Care Needs ◽  
Delivery Models

Background The growing number of patients with complex chronic conditions presents an urgent challenge across the Canadian health care system. Current care delivery models are overburdened, struggling to monitor and stabilize the complex needs of this growing patient population. Objective This qualitative study aimed to explore the needs and perspectives of patients and members of the care team to inform the development of an innovative integrated model of care and the needs of telemonitoring (TM) for patients with complex chronic conditions. Furthermore, we explored how these needs could be successfully embedded to support this novel model of complex chronic care. Methods A qualitative description design was utilized to conduct and analyze 29 semistructured interviews with patients (n=16) and care team members (CTM) (n=13) involved in developing the model of care in an ambulatory care facility in Southern Ontario. Participants were identified through purposive sampling. Two researchers performed an iterative thematic analysis using NVivo 12 (QSR International; Melbourne, Australia) to gain insights from examining multiple perspectives of different participants on complex chronic care needs. Results The analysis revealed 3 themes and 13 subthemes, including the following: (1) adequate health care delivery remains challenging for patients with complex care needs, (2) insights into how to structure an integrated care model, and (3) opportunities for TM in an integrated model of care. Participants not only identified continued challenges in accessing and navigating care in a fragmented and disconnected delivery system but also identified the need for more self-management support. Patients and CTM described the structure of an integrated model of care, including the need for a clear referral and triage processes and composing a tight-knit circle of collaborating interdisciplinary providers led by a nurse practitioner (NP). Finally, opportunities for TM in an integrated model of care were identified, including increasing access and communication, the ability to monitor specific signs and symptoms, and building a clinical workflow around TM-enabled care. Conclusions Despite entrenched health care service delivery models, a new model of care is acutely needed to care for patients with complex chronic needs (CCN). NPs are in a unique position to lead TM-enabled integrated models of care. TM can facilitate frequent and necessary monitoring of patients with CCN with more than one condition in integrated models of care.

scholarly journals Virtual models of care for people with palliative care needs living in their own home: A systematic meta-review and narrative synthesis

2021 ◽  
pp. 026921632110244
Author(s):  
Domenica Disalvo ◽  
Meera Agar ◽  
Gideon Caplan ◽  
Fliss EM Murtagh ◽  
Tim Luckett ◽  
...  
Keyword(s):  
Palliative Care ◽  
Systematic Reviews ◽  
Video Conferencing ◽  
Digital Health ◽  
Models Of Care ◽  
Care Needs ◽  
Health Technologies ◽  
Virtual Models ◽  
Meta Review ◽  
Palliative Care Needs

Background: Access to palliative care in the community enables people to live in their preferred place of care, which is often home. Community palliative care services struggle to provide timely 24-h services to patients and family. This has resulted in calls for ‘accessible and flexible’ models of care that are ‘responsive’ to peoples’ changing palliative care needs. Digital health technologies provide opportunities to meet these requirements 24-h a day. Aim: To identify digital health technologies that have been evaluated for supporting timely assessment and management of people living at home with palliative care needs and/or their carer(s), and the evidence-base for each. Design: A systematic review of systematic reviews (‘meta-review’). Systematic reviews evaluating evidence for virtual models of palliative or end-of-life care using one or more digital health technologies were included. Systematic reviews were evaluated using the Risk of Bias Tool for Systematic Reviews. A narrative approach was used to synthesise results. Data sources: Medline, Embase, Web of Science, CINAHL and Cochrane Database of systematic reviews were searched for English-language reviews published between 2015 and 2020. Results: The search yielded 2266 articles, of which 12 systematic reviews met criteria. Sixteen reviews were included in total, after four reviews were found via handsearching. Other than scheduled telehealth, video-conferencing, or after-hours telephone support, little evidence was found for digital health technologies used to deliver virtual models of palliative care. Conclusions: There are opportunities to test new models of virtual care, beyond telehealth and/or video conferencing, such as 24-h command centres, and rapid response teams. Systematic review registration number: Prospero CRD42020200266

scholarly journals Use of Synchronous Digital Health Technologies for the Care of Children With Special Health Care Needs and Their Families: Scoping Review (Preprint)

2019 ◽  
Author(s):  
Marissa Bird ◽  
Lin Li ◽  
Carley Ouellette ◽  
Kylie Hopkins ◽  
Michael H McGillion ◽  
...  
Keyword(s):  
Health Care ◽  
Scoping Review ◽  
Digital Health ◽  
Special Health Care Needs ◽  
Health Programs ◽  
Health Care Needs ◽  
Care Needs ◽  
Special Health Care ◽  
Health Technologies ◽  
Special Health

BACKGROUND Use of synchronous digital health technologies for care delivery to children with special health care needs (having a chronic physical, behavioral, developmental, or emotional condition in combination with high resource use) and their families at home has shown promise for improving outcomes and increasing access to care for this medically fragile and resource-intensive population. However, a comprehensive description of the various models of synchronous home digital health interventions does not exist, nor has the impact of such interventions been summarized to date. OBJECTIVE We aim to describe the various models of synchronous home digital health that have been used in pediatric populations with special health care needs, their outcomes, and implementation barriers. METHODS A systematic scoping review of the literature was conducted, guided by the Arksey and O’Malley Scoping Review Framework. MEDLINE, CINAHL, and EMBASE databases were searched from inception to June 2018, and the reference lists of the included systematic reviews and high-impact journals were hand-searched. RESULTS A total of 38 articles were included in this review. Interventional articles are described as feasibility studies, studies that aim to provide direct care to children with special health care needs, and studies that aim to support family members to deliver care to children with special health care needs. End-user involvement in the design and implementation of studies is evaluated using a human-centered design framework, and factors affecting the implementation of digital health programs are discussed in relation to technological, human, and systems factors. CONCLUSIONS The use of digital health to care for children with special health care needs presents an opportunity to leverage the capacity of technology to connect patients and their families to much-needed care from expert health care providers while avoiding the expenses and potential harms of the hospital-based care system. Strategies to scale and spread pilot studies, such as involving end users in the co-design techniques, are needed to optimize digital health programs for children with special health care needs.

scholarly journals Insurance Customers’ Expectations for Sharing Health Data: Qualitative Survey Study

10.2196/16102 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e16102
Author(s):  
Casandra Grundstrom ◽  
Olli Korhonen ◽  
Karin Väyrynen ◽  
Minna Isomursu
Keyword(s):  
Health Care ◽  
Health Services ◽  
Data Sharing ◽  
Social Exchange ◽  
Digital Health ◽  
Health Data ◽  
Survey Study ◽  
Insurance Companies ◽  
Care Needs ◽  
The Social

Background Insurance organizations are essential stakeholders in health care ecosystems. For addressing future health care needs, insurance companies require access to health data to deliver preventative and proactive digital health services to customers. However, extant research is limited in examining the conditions that incentivize health data sharing. Objective This study aimed to (1) identify the expectations of insurance customers when sharing health data, (2) determine the perceived intrinsic value of health data, and (3) explore the conditions that aid in incentivizing health data sharing in the relationship between an insurance organization and its customer. Methods A Web-based survey was distributed to randomly selected customers from a Finnish insurance organization through email. A single open-text answer was used for a qualitative data analysis through inductive coding, followed by a thematic analysis. Furthermore, the 4 constructs of commitment, power, reciprocity, and trust from the social exchange theory (SET) were applied as a framework. Results From the 5000 customers invited to participate, we received 452 surveys (response rate: 9.0%). Customer characteristics were found to reflect customer demographics. Of the 452 surveys, 48 (10.6%) open-text responses were skipped by the customer, 57 (12.6%) customers had no expectations from sharing health data, and 44 (9.7%) customers preferred to abstain from a data sharing relationship. Using the SET framework, we found that customers expected different conditions to be fulfilled by their insurance provider based on the commitment, power, reciprocity, and trust constructs. Of the 452 customers who completed the surveys, 64 (14.2%) customers required that the insurance organization meets their data treatment expectations (commitment). Overall, 4.9% (22/452) of customers were concerned about their health data being used against them to profile their health, to increase insurance prices, or to deny health insurance claims (power). A total of 28.5% (129/452) of customers expected some form of benefit, such as personalized digital health services, and 29.9% (135/452) of customers expected finance-related compensation (reciprocity). Furthermore, 7.5% (34/452) of customers expected some form of empathy from the insurance organization through enhanced transparency or an emotional connection (trust). Conclusions To aid in the design and development of digital health services, insurance organizations need to address the customers’ expectations when sharing their health data. We established the expectations of customers in the social exchange of health data and explored the perceived values of data as intangible goods. Actions by the insurance organization should aim to increase trust through a culture of transparency, commitment to treat health data in a prescribed manner, provide reciprocal benefits through digital health services that customers deem valuable, and assuage fears of health data being used to prevent providing insurance coverage or increase costs.

scholarly journals Exploring an Innovative Care Model and Telemonitoring for the Management of Patients With Complex Chronic Needs: Qualitative Description Study (Preprint)

2019 ◽  
Author(s):  
Kayleigh Gordon ◽  
Carolyn Steele Gray ◽  
Katie N Dainty ◽  
Jane DeLacy ◽  
Patrick Ware ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Conditions ◽  
Chronic Care ◽  
Care Delivery ◽  
Models Of Care ◽  
Integrated Model ◽  
Qualitative Description ◽  
Model Of Care ◽  
Care Needs ◽  
Delivery Models

BACKGROUND The growing number of patients with complex chronic conditions presents an urgent challenge across the Canadian health care system. Current care delivery models are overburdened, struggling to monitor and stabilize the complex needs of this growing patient population. OBJECTIVE This qualitative study aimed to explore the needs and perspectives of patients and members of the care team to inform the development of an innovative integrated model of care and the needs of telemonitoring (TM) for patients with complex chronic conditions. Furthermore, we explored how these needs could be successfully embedded to support this novel model of complex chronic care. METHODS A qualitative description design was utilized to conduct and analyze 29 semistructured interviews with patients (n=16) and care team members (CTM) (n=13) involved in developing the model of care in an ambulatory care facility in Southern Ontario. Participants were identified through purposive sampling. Two researchers performed an iterative thematic analysis using NVivo 12 (QSR International; Melbourne, Australia) to gain insights from examining multiple perspectives of different participants on complex chronic care needs. RESULTS The analysis revealed 3 themes and 13 subthemes, including the following: (1) adequate health care delivery remains challenging for patients with complex care needs, (2) insights into how to structure an integrated care model, and (3) opportunities for TM in an integrated model of care. Participants not only identified continued challenges in accessing and navigating care in a fragmented and disconnected delivery system but also identified the need for more self-management support. Patients and CTM described the structure of an integrated model of care, including the need for a clear referral and triage processes and composing a tight-knit circle of collaborating interdisciplinary providers led by a nurse practitioner (NP). Finally, opportunities for TM in an integrated model of care were identified, including increasing access and communication, the ability to monitor specific signs and symptoms, and building a clinical workflow around TM-enabled care. CONCLUSIONS Despite entrenched health care service delivery models, a new model of care is acutely needed to care for patients with complex chronic needs (CCN). NPs are in a unique position to lead TM-enabled integrated models of care. TM can facilitate frequent and necessary monitoring of patients with CCN with more than one condition in integrated models of care.

scholarly journals Use of Synchronous Digital Health Technologies for the Care of Children With Special Health Care Needs and Their Families: Scoping Review

10.2196/15106 ◽  
2019 ◽  
Vol 2 (2) ◽  
pp. e15106 ◽  
Author(s):  
Marissa Bird ◽  
Lin Li ◽  
Carley Ouellette ◽  
Kylie Hopkins ◽  
Michael H McGillion ◽  
...  
Keyword(s):  
Health Care ◽  
Scoping Review ◽  
Digital Health ◽  
Special Health Care Needs ◽  
Health Programs ◽  
Health Care Needs ◽  
Care Needs ◽  
Special Health Care ◽  
Health Technologies ◽  
Special Health

Background Use of synchronous digital health technologies for care delivery to children with special health care needs (having a chronic physical, behavioral, developmental, or emotional condition in combination with high resource use) and their families at home has shown promise for improving outcomes and increasing access to care for this medically fragile and resource-intensive population. However, a comprehensive description of the various models of synchronous home digital health interventions does not exist, nor has the impact of such interventions been summarized to date. Objective We aim to describe the various models of synchronous home digital health that have been used in pediatric populations with special health care needs, their outcomes, and implementation barriers. Methods A systematic scoping review of the literature was conducted, guided by the Arksey and O’Malley Scoping Review Framework. MEDLINE, CINAHL, and EMBASE databases were searched from inception to June 2018, and the reference lists of the included systematic reviews and high-impact journals were hand-searched. Results A total of 38 articles were included in this review. Interventional articles are described as feasibility studies, studies that aim to provide direct care to children with special health care needs, and studies that aim to support family members to deliver care to children with special health care needs. End-user involvement in the design and implementation of studies is evaluated using a human-centered design framework, and factors affecting the implementation of digital health programs are discussed in relation to technological, human, and systems factors. Conclusions The use of digital health to care for children with special health care needs presents an opportunity to leverage the capacity of technology to connect patients and their families to much-needed care from expert health care providers while avoiding the expenses and potential harms of the hospital-based care system. Strategies to scale and spread pilot studies, such as involving end users in the co-design techniques, are needed to optimize digital health programs for children with special health care needs.

Adverse Events, Functional Decline, and Access to Allied Health Therapies for Patients With Dementia During Acute Hospitalization

2020 ◽  
pp. 073346482092421
Author(s):  
Amanda Fox ◽  
Margaret MacAndrew ◽  
Katy Wyles ◽  
Catherine Yelland ◽  
Elizabeth Beattie
Keyword(s):  
Health Care ◽  
Adverse Events ◽  
Allied Health ◽  
Care Delivery ◽  
Functional Decline ◽  
Models Of Care ◽  
Policy And Practice ◽  
Care Needs ◽  
Number Of Patients ◽  
The Impact

The number of patients attending acute care hospitals with a diagnosis of dementia is increasing. The impact of hospitalization on function and adverse events is perceived to be greater for patients with dementia than those without. This study compared adverse events (falls, wounds, delirium, medication errors, infections, and incontinence), functional decline, and allied health therapy for patients with and without dementia ( n = 240). Patients with dementia experienced significantly more adverse events and constant observation by staff, were more dependent with mobility, hygiene and feeding, more often nil by mouth, confused, and incontinent. Patients with dementia were significantly more likely to receive speech and physiotherapy, although they did not significantly improve in function during their hospital stay. Conversely, patients without dementia significantly improved in mobility and continence. The unique health care needs of patients with dementia need to inform models of care, policy, and practice to support safe health care delivery in this vulnerable population.

Sign in / Sign up

Export Citation Format

Share Document