Digital Health, Virtual-ICU, & Tele-Health Investments – Things to Contemplate & Red Flags Part One
By: Tim Kuebelbeck, Chief Customer Officer at Ambient Clinical Analytics
Executive Brief
This is part one of a two-part series on digital health. I have read many articles on Digital Health, Virtual-ICU and Tele-Health investments that are centered on what to look for, and what the red flags are when evaluating platforms and solutions. Although many were helpful, I noticed they barely scratched the surface of the topic. After reading these articles, I was left with the impression that evaluating digital health is easy. We all know that technical and clinical evaluations of digital health solutions is not easy. Most of the articles I read were a short, three or four-minute read. They didn’t give an in-depth understanding, which is not surprising in today’s blog, sound bite, and meme-driven culture. The articles were absent of deep descriptions of what to look for in the digital health, virtual-ICU, and tele-health landscapes. This is why I decided to write a two-part, in-depth piece on digital health. In part one we will cover seven major topics to consider when evaluating digital health solutions. The last two topics we will cover on digital health are ‘Build vs. Buy & Certification and Verification’ which by themselves are long and difficult topics to grasp, so we will publish those topics in the later part of the series.
It is critical to note that digital health, virtual-ICU and tele-health solutions are not just about rules, algorithms, connectivity, or video conferencing. It is much greater, and true virtual and digital solutions should provide a procedural and operational foundation for digital care delivery. Digital health platforms that offer a procedural and operational foundation for digital delivery of care will be more likely to deliver highly reliable healthcare. Highly reliable healthcare is something hospitals and health systems have been trying to achieve for decades.
During the pandemic, health systems rushed to implement standalone digital health and tele-health solutions and, in some cases, virtual-ICU solutions. Now health systems and hospitals are looking back at lessons learned and planning for connected platforms that cross the various stand-alone verticals of care. Comprehensive digital health from the hospital to the home will disrupt and redefine care delivery models in addition to changing the relationship between clinician, provider, personal caregiver, and patient, making digital health strategy the most important part of building a patient-centered healthcare system.
As organizations look to evaluate digital health, virtual-ICU, and tele-health solutions that cross verticals and disciplines, within a singular enterprise platform, there are several topics that executives should, and in some cases must, consider for their healthcare organization. While you may not agree with all my evaluation points, this discussion will help you think critically about digital health and tele-health markets. If you're looking for an in-depth understanding of what to look for and what to watch out for, this is the right place for you.
Adaptability and Flexibility
It seems obvious that a foundation for digital care delivery requires a platform that is adaptable and flexible. Adaptability requires an agnostic approach that allows for different bedside devices, camera systems, and EHR integration into the digital health platform. More important than just taking data from those systems is the ability for doctors and nurses to have a standardized user interface and user experience regardless of the EHR, bedside devices, or camera systems so that those physicians and nurses can monitor multiple sites and facilities in the same workflow environment and user interface.
Flexibility requires that the data does the work for you rather than making you captive to the data. It demands that the solutions provide a library of rules and indicative algorithms in the base platform as well as the ability to add site-specific algorithms, including AI or ML but not exclusively relying on it. Flexibility requires a customizable configuration. I know customizable and configuration seem contrary to each other, but as we dive deeper into this article it will become clear that it is not. This is extremely important and very few vendors have this capacity. Vendors that have this functionality are rare and have mastered controlled chaos by allowing for site and unit-specific adjustments to the solution within a framework that provides the ability to configure over one-off customization.
Clinical Situational Awareness
Doctors and nurses need tools that provide clinical situational awareness through access to meaningful patient data and clinical developments with a mere hover over, or perhaps one click. This situational awareness requires workflow integration with the EHR alongside the adaptability and flexibility mentioned earlier. One-click or hover over access to data that provides situational awareness may seem like a bridge too far, or perhaps futuristic, but it’s not. There are companies with platforms who are doing this today and doing it well. Today's EHRs are legacy billing systems converted to clunky nested spreadsheets with clinical data and they are not built to deliver situational awareness, never mind with a click or a hover over. In fact, they are not working at all for physicians and nurses who are attempting to deliver high-quality care. Many argue that today’s EHR model is what is holding the US healthcare market back from delivering highly reliable healthcare. An excellent example appeared in a recent Healthcare IT News article1 about a JAMA Internal Medicine2 published and peer-reviewed study that has proven EHR’s do not deliver acceptable clinical performance for digital health and are likely a major contributor to the national quality of care crisis.
Safeguarding our patients requires delivering and receiving the right care, in the right setting, at the right time. Health systems today are utilizing legacy e-ICU and EHR solutions that don’t provide situational awareness, much less fulfill clinical needs. Hospitals need digital health, virtual-ICU, and tele-health tools that provide the right care, at the right time, in the right setting to improve patient outcomes while better managing patient capacity and system assets. Your goal as a clinical leader or administrative leader in evaluating digital health & tele-health partners is to find a platform that leads the market in furthering and developing new digital-driven and tele-driven care models for all clinicians. Your vendor’s solution must cross the various stand-alone verticals and disciplines of care. Keep in mind there are many stand-alone vertical solutions and some are effective at what they do. A great example of this is a virtual-ICU or a tele-ICU solution. It works great for Intensivists in the ICU, but not so much for hospitalists, certainly not for nurses who are monitoring for sepsis in remote locations, and certainly doesn’t play well in the skilled nursing or in the home environment. You need a digital health partner who provides access across these environments, or across more than one environment, with the ability to expand across all over time.
Portable, Integrates with and Extends Existing EHR Workflows
Portability, integration, and extending the EHR workflows are a few of the most central items for consideration from a technology perspective because they drive ease of use and ease of adoption. The ability to have physicians and nurses utilize remote patient monitoring from anywhere for any acute care setting, including a virtual-ICU, will drive massive efficiency and help ease the current and escalating pain EHRs are causing. First, it will reduce the stress placed on nurses and physicians (or any provider for that matter) from technology designed for billing rather than clinical care. Second, the efficiency from these systems will allow clinicians the ability to effectively care for larger numbers of patients without creating fatigue and stress, ultimately helping alleviate the current labor shortage hospitals are experiencing.
Portable real-time digital health, virtual-ICU, and tele-health solutions that have full EHR clinical data integration eliminate the need for a physician or nurse to flip back and forth between the virtual digital health system and EHR’s. Having all the data in one place, combined with standard algorithms and AI and ML algorithms to help assess and treat patients, gives physicians and nurses the ability to monitor many more patients than they can in an EHR. Having portability so clinicians can monitor from anywhere renders expensive hub-style command centers much less important and over time will make them irrelevant.
Platforms that leverage integration with the EHR to provide real-time clinical data in the digital health solution using both standard and AI/ML based algorithms significantly reduce the amount of time required to assess and treat patients. In addition, peer-reviewed research shows it reduces errors by up to 50% thereby also reducing a primary driver of clinician and nursing time, fixing errors.3 One platform was developed by combining Health IT with human factor ergonomics and system engineering to design a system that extracts high-value clinical data from the EHR and presents it to the clinical and nursing teams in patient-centric information packages.4
Solutions designed as above drive highly reliable healthcare. Highly reliable healthcare is something health systems and hospitals have been and are still struggling with since the digitization of healthcare that fueled a decade of EHR deployments. Digital Health and tele-health solutions that reduce the time to assess and treat patients and provide a clear clinical view of patient data, drive clinical situational awareness and are additive to EHRs. They provide tremendous clinical value for both physicians and nurses while driving highly reliable healthcare. Improved patient care is one thing, but hospitals and health systems that provide enhanced value and efficiency to doctors and nurses via digital health platforms, deliver a much-needed win for both providers, patients, and the health system.
Enhanced Data Access, Improved Outcomes, Cost Reduction
Enhanced data access to real-time data from the EHR and bedside devices that promotes clinical situational awareness for physicians and nurses is a prerequisite for any digital health or tele-health platform. This type of user experience (UX) will improve outcomes, elevate the patient experience, and reduce the cost of care. This should be a major articulation point in your search for digital health solutions. A solution whose use cases cross clinical disciplines and are driving real-time clinical situational awareness of a patient's condition should be a must-have during your evaluation process.
Data integration is pivotal for successful digital health and tele-health solutions. With an absence of real-time feeds, digital health solutions lose much-needed efficacy to serve as a clinical solution that enhances the EHR and end up with low adoption rates. Is the digital health solution you’re evaluating adding to the proficiency your clinicians already experience inside the current EHR model or just taking them out of that workflow? If the solutions don’t enhance the UX, is it really improving care? Vendors that fully leverage data or better said, democratize data, predictably can deliver an improved UX.
If it doesn’t enhance the EHR, is it really improving care? That is a great question, and improving care is another substantial evaluation point for digital health and tele-health solutions. “Solutions that create a better and more engaging consumer experience are more important than ever before,” said Todd Dunn, Vice President of Innovation at Atrium Health. “However, they must deliver measurable business and clinical outcomes. The burden of proof has never been higher.”5 As mentioned earlier, validation on a clinical level is important but it is also centered on a financial level. Make sure your vendor can build a Cost-Benefit Analysis (CBA) with you that shows an excellent Return on Investment (ROI). If the platform truly gives you clinical situational awareness, then it will also drive considerable efficiencies and should have a strong demonstrable ROI. Solutions without published clinical validation and demonstrable ROI are highly unlikely to move the UX, quality, or cost needles in any organization. Any digital health platform or tele-health platform must have both published and peer-reviewed clinical validation along with a CBA that shows an ROI. Note, ROI requirements apply to custom-built vs. purchased solutions as well which we will cover in part two of this blog.
Case in point, a recent article in MedCity News talks about ROI and why it’s important for any digital health investment. The article states, “As the Covid-19 pandemic continues to strain healthcare organizations across the country, enterprise health leaders indicated they are seeking innovative solutions to address pain points exacerbated by the crisis as well as new models of care delivery. This includes doubling down on improving patient experience and access to virtual health along with solutions to reduce widespread clinician burnout and provider shortages.
However, only solutions with demonstrable ROI that integrate into the EHR and existing workflows are getting serious consideration.”6
Sustainable Business Model & Competitive Advantage
A sustainable business model is fixed to a competitive advantage, especially with early-stage innovative organizations. The power of sustainability should not be overlooked during an evaluation since it will ultimately drive the long-term health of any partner or vendor organization you may choose for your digital health solutions. Furthermore, sustainability will ensure they can add and deliver useful and needed functionality down the road. Almost all innovative digital health and tele-health organizations are newer and smaller organizations. Considering this fact, you must ask if the digital health vendor(s) you're evaluating have a reasonable business model and the staying power to make it in their vertical. Even more essential, does the vendor have a platform or a solution? In other words, is it a one-trick pony solution for a niche market, or is it a platform that can be expanded over time to become a true enterprise solution that cuts across various digital health verticals? Being a niche vendor is not necessarily a negative thing, especially if they can solve a problem for you that others can't. However, having a platform that can expand over time as more innovations come to the market is also an important consideration. The ability to manage a small number of solutions or just one platform has advantages. So be careful in choosing one that is capable of expansion and has the long-term vision and roadmap to fulfill your requirements and considerations.
With large vendor organizations, or any health care vendor for that matter, as the organization matures, there is an inherent flatness that makes innovation very difficult. We see this occur repeatedly as organizations that were once innovative with sustainable business models become giants in the healthcare industry. The question increasingly becomes, does the giant really solve new real-world problems that are currently gaps for providers or patients? Or are they just trying to plug a round innovation hole with a square peg? This issue is interconnected to the build vs buy argument in part two of this blog. It is important to consider the core question, is the vendor still on the edge of innovation or are they just trying to retain revenue and keep clinicians trapped in their workflows? Artificially keeping clinicians in a workflow pushes vendor value in mature solutions that probably is not making any discernable difference in the user experience, quality of patient care, clinical efficiency, and cost reduction. Forcing physicians or nurses to use an ineffective solution is painful for front-line healthcare workers, a waste of money for health systems, endangers patients, and never ends well.
In innovative markets, like today’s digital health and tele-health market, organizations typically are evaluating younger more innovative vendors. Epic was once innovative as was Teledoc and Amwell, and today they are all very large organizations. The thing they all have in common is they once were nimble, smaller, and innovative organization with a sustainable business model. The model for younger organizations should start with a low-end disruption that has enormous high-end disruption potential. A great example of this is an organization solving a singular issue, like sepsis, yet the platform has the ability to expand the model to solve much more, such as CAUTI, SSI, CLABSI, AKI, or any patient condition for that matter. High-end disruption potential is something you need to look for and is one of the central issues you must understand about your potential digital health partners.
While I used solution and platform interchangeably throughout this discussion, there is a key difference between the two. A solution that does not have high-end disruption potential means you are choosing a ‘niche solution’ and ‘not a platform’. That’s not always bad. But to be successful in your digital health strategy, you should be aware of this precondition and understand what you are committing to as a health system. The best way to grasp this is to understand the roadmap, and just as fundamental, the vision of your potential partner. If those vendors don't make the right decisions about their business model and vision, then their long-term relevance is likely in question. If you choose them, you may end up with a nice-to-have solution that delivers some value but doesn't get you to where you need to go in the long run.
Verifying that your potential digital health or tele-health partner has a legitimate sustainable competitive advantage, and is not a one-trick pony, is pivotal in choosing your digital health platform. A tell-tale sign of a sustainable business model and a competitive advantage is the possession of patented technology, algorithms, or analytics. If the answer to do they have a patented platform is yes, then you may be looking at a potentially great digital health vendor. You also want to ask, does the solution make health or disease management better and more efficient? If it does, and they have published data to prove it, along with the patents, then it’s likely you’re evaluating a vendor who is not only great but is going to produce a remarkable change in the healthcare industry.
A great example of this is Ambient Clinical Analytics (ACA) who has been granted three (3) patents and has three (3) patents pending for its core digital health and core tele-health applications. ACA is continuing to develop new features and products through joint development research projects with highly respected medical university teaching hospitals along with one of the world’s highest-ranking health systems for the last 10 years. Utilizing this type of development approach will likely result in more patents and amazing innovation. Utilizing an organization with this nature of early-stage pedigree is extremely important. Mostly because it demonstrates that the solutions are clinically vetted, developed with physicians and nurses, and that they are continuing to invest major resources in delivering continued innovation to the digital health, virtual-ICU, and tele-health markets.
Vendor Relationship As you evaluate your prospective vendors there are many variables to consider. One that should not be overlooked is what kind of vendor relationship you want to engage in. Does the typical vendor and client relationship fit what you’re looking for or are you looking for the relationship to resemble more of a marriage or a true partnership? While much of this consideration is nuance, it is important to understand, consider, and discuss openly with vendors because it positions the direction and needs of the relationship.
While I won't spend a lot of energy writing about this topic, it is very critical to understand what you're looking for as you embark on your evaluation. As we all have experienced, the more mature the organization, the harder it is to push them to provide the required functionality.
Understandably so, but if you're looking at innovative solutions then you will likely need the flexibility and closeness in a relationship that is more closely matching a true partnership or marriage. In addition, how fast can this added functionality be delivered? This is essential to keep top of mind, especially with this market just starting to truly emerge and with lots of innovation on the horizon, you may need the ability or at a minimum, the influence, to help guide and drive the direction of the platform as it moves towards maturity.
Custom or Configurable
Implementation and the degree to which each customer is a one-off build is also a consideration. Another way to say this is ‘configurability or customization’. It’s important to understand for so many reasons. The most important of which is customization tends to create lack of continuity of care across the US health system and is difficult to deploy at scale. While configurability drives high reliability and is less difficult to deploy at scale. If a solution requires customization across the continuum, that frustrates any hope for continuity at a system level, never mind a national level.
For example, most hospitals that have deployed a sepsis algorithm, have a highly customized algorithm to drive sepsis alerting and detection. This is part of the reason sepsis performance in the US is so poor. It is almost impossible to maintain continuity of care with such a highly customizable approach from one location to another. Additionally, detecting sepsis but failing to drive the clinical bundle or the clinical process after a sepsis alert adds to an already poor adherence to the bundle elements. Having customizable one-off algorithms is not really all that bad but because there is no real software driving the bundle delivery after the fact, every deployment of an algorithm is a one-off customization along with a self-developed and highly manual process to deliver at risk elements after the detection.
On the other hand, dropping customization into a well-thought-out framework makes that same customization morph into configurability. If your framework allows configurability of an algorithm for a specific site, down to a unit level, and that same framework drives a standardized clinical process to meet CMS requirements or best practice, you have now adapted customization into configurability. This also drives easier implementations at scale while affording the individual health systems the ability to employ clinical bundles that work best for their specific populations. Custom vs configure has ebbed and flowed over the last few decades and making a digital health solution that allows for highly reliable customization via configurability is in everyone's best interest.
Summary
The three-year long Covid pandemic has unleashed rapid changes in healthcare and highlighted an enormous need for other technology advancements, primarily around digital health and managing acute patients from a distance. There are many considerations in selecting a vendor or partner for digital health ranging from build vs. buy, defined use cases, to competitive advantages. Although build vs buy will be in part two, my hope is this whitepaper has helped you appreciate why these considerations are essential to your selection process.
Executives owe it to themselves and the health system they work in to understand the digital health market and to mitigate risk around any selection processes. They should also recognize that even with mitigation they will likely take some sort of calculated risk. Most innovative digital health vendors are either startups or early-stage companies. Grasping selection concepts like clinical validation, certification, enhanced data access, sustainable business models, configurable solutions, etc... don’t necessarily guarantee a digital health vendors efficacy, health, or long-term success. However, if you have considered the evaluation points discussed above, it is likely you will choose a solid provider of digital health, virtual-ICU, or tele-health solutions that meets your organization’s needs.
If you haven’t embarked on this journey previously, it is likely you will in the very near future. Making it necessary for both clinical and IT executives to assess some facet of digital health, virtual-ICU, or tele-health solutions. I hope the material we covered above on seven of the topics to consider when evaluating digital health solutions was helpful. The eighth topic on digital health is ‘Build vs. Buy, Certification & Verification’, which alone is a challenging topic to grasp, and will be published in Part-Two of this digital health series blog.
AWARE™ Critical Care
Ambient has achieved FDA Class II Clearance, CE Marking, and ISO 13485:2016 Certification on the AWARE™ platform. AWARE™ provides tele-ICU or virtual-ICU remote patient monitoring along with predictive analytics. Combined with our novel clinical decision support tools we decrease provider fatigue, reduce errors, and save lives. Created by clinicians for clinicians, AWARE™ delivers portable real-time virtual ICU surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in critical care and general inpatient areas.
AWARE’s (Ambient Warning and Response Evaluation) virtual ICU solution is designed to provide bedside and remote patient monitoring using data visualization and clinical analytics. The AWARE™ Multi-Patient Viewer (MPV) and Single-Patient Viewer (SPV) allows all nurses and physicians to view a patient through the eyes of a intensivists regardless of their location. Critical care requires turning massive amounts of raw data into actionable knowledge. We make the data work for you.
An inability to process the required data is commonly known as information overload. Information overload frustrates clinicians and exposes patients to diagnostic errors and therapeutic harm. AWARE™ is different, it was built by intensivists at Mayo Clinic using principles of human factors engineering, gathering the data that’s important to critical care teams and displaying it in a way that minimizes cognitive load. AWARE™ is the gold standard for how smart clinical analytics and data visualization can improve communication, efficiency, situational awareness, and safety. Unlike any other system, AWARE™ shows you what you need to see, at the point of care and in virtual ICU settings, organized the way an intensivist approaches their patients’ data.
AWARE Clinical Control Tower™ is a solution designed to provide a virtual ICU for AWARE™ Critical Care and Sepsis DART™ with centralized or decentralized remote patient monitoring and collaboration for physicians and nurses. Our Clinical Mesh Network™ with AWARE™ and Sepsis DART™ capabilities delivers to any location in a standardized format, eliminating EMR differences. Clinical Control Tower™ provides distributed tele-health, virtual ICU and remote patient monitoring within your system and with contracted facilities.
Whether deployed in an ICU or as a virtual ICU solution, the AWARE™ enterprise class family of solutions including Sepsis DART, AWARE Critical Care, and Clinical Control Tower all help you approach your patients in an efficient, more effective, informed, and organized fashion while decreasing provider fatigue, reducing errors, and saving lives. Created by clinicians for clinicians, AWARE™ delivers real-time surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in critical care and general inpatient areas.
Ambient’s predictive analytics and advanced clinical decision support tools is clinically validated to reduces errors, improve patient outcomes, reduce the cost of care, and deliver best-care practices for any acute care setting from the ICU to the home. AWARE’s predictive analytics system provides a “smart view” via data visualization of Electronic Health Record data that reduces the risk of medical errors and improves patient outcomes with high reliability healthcare. It works with your EMR and bedside monitors to present only relevant information for care delivery.
For detailed information on Ambient Clinical Analytics and Virtual ICU or Remote Patient Monitoring solutions for your hospital or health system, or for our published studies on AWARE™ please contact tim.kuebelbeck@ambientclinical.com.
About Ambient Clinical Analytics - As an industry leader, Ambient is supporting leading healthcare systems and has done so since its founding in 2013. Our solutions are designed by clinicians to be easy-to-use by every caregiver in your organization and are configured to be up and running rapidly. We are trusted by a community of high-performing healthcare providers across the United States. Our solutions are powerful real-time point-of-care and remote healthcare platforms designed to deliver life-saving solutions using data visualization, communication, and analytics based clinical decision support.
Citations
Executive Brief
This is part one of a two-part series on digital health. I have read many articles on Digital Health, Virtual-ICU and Tele-Health investments that are centered on what to look for, and what the red flags are when evaluating platforms and solutions. Although many were helpful, I noticed they barely scratched the surface of the topic. After reading these articles, I was left with the impression that evaluating digital health is easy. We all know that technical and clinical evaluations of digital health solutions is not easy. Most of the articles I read were a short, three or four-minute read. They didn’t give an in-depth understanding, which is not surprising in today’s blog, sound bite, and meme-driven culture. The articles were absent of deep descriptions of what to look for in the digital health, virtual-ICU, and tele-health landscapes. This is why I decided to write a two-part, in-depth piece on digital health. In part one we will cover seven major topics to consider when evaluating digital health solutions. The last two topics we will cover on digital health are ‘Build vs. Buy & Certification and Verification’ which by themselves are long and difficult topics to grasp, so we will publish those topics in the later part of the series.
It is critical to note that digital health, virtual-ICU and tele-health solutions are not just about rules, algorithms, connectivity, or video conferencing. It is much greater, and true virtual and digital solutions should provide a procedural and operational foundation for digital care delivery. Digital health platforms that offer a procedural and operational foundation for digital delivery of care will be more likely to deliver highly reliable healthcare. Highly reliable healthcare is something hospitals and health systems have been trying to achieve for decades.
During the pandemic, health systems rushed to implement standalone digital health and tele-health solutions and, in some cases, virtual-ICU solutions. Now health systems and hospitals are looking back at lessons learned and planning for connected platforms that cross the various stand-alone verticals of care. Comprehensive digital health from the hospital to the home will disrupt and redefine care delivery models in addition to changing the relationship between clinician, provider, personal caregiver, and patient, making digital health strategy the most important part of building a patient-centered healthcare system.
As organizations look to evaluate digital health, virtual-ICU, and tele-health solutions that cross verticals and disciplines, within a singular enterprise platform, there are several topics that executives should, and in some cases must, consider for their healthcare organization. While you may not agree with all my evaluation points, this discussion will help you think critically about digital health and tele-health markets. If you're looking for an in-depth understanding of what to look for and what to watch out for, this is the right place for you.
Adaptability and Flexibility
It seems obvious that a foundation for digital care delivery requires a platform that is adaptable and flexible. Adaptability requires an agnostic approach that allows for different bedside devices, camera systems, and EHR integration into the digital health platform. More important than just taking data from those systems is the ability for doctors and nurses to have a standardized user interface and user experience regardless of the EHR, bedside devices, or camera systems so that those physicians and nurses can monitor multiple sites and facilities in the same workflow environment and user interface.
Flexibility requires that the data does the work for you rather than making you captive to the data. It demands that the solutions provide a library of rules and indicative algorithms in the base platform as well as the ability to add site-specific algorithms, including AI or ML but not exclusively relying on it. Flexibility requires a customizable configuration. I know customizable and configuration seem contrary to each other, but as we dive deeper into this article it will become clear that it is not. This is extremely important and very few vendors have this capacity. Vendors that have this functionality are rare and have mastered controlled chaos by allowing for site and unit-specific adjustments to the solution within a framework that provides the ability to configure over one-off customization.
Clinical Situational Awareness
Doctors and nurses need tools that provide clinical situational awareness through access to meaningful patient data and clinical developments with a mere hover over, or perhaps one click. This situational awareness requires workflow integration with the EHR alongside the adaptability and flexibility mentioned earlier. One-click or hover over access to data that provides situational awareness may seem like a bridge too far, or perhaps futuristic, but it’s not. There are companies with platforms who are doing this today and doing it well. Today's EHRs are legacy billing systems converted to clunky nested spreadsheets with clinical data and they are not built to deliver situational awareness, never mind with a click or a hover over. In fact, they are not working at all for physicians and nurses who are attempting to deliver high-quality care. Many argue that today’s EHR model is what is holding the US healthcare market back from delivering highly reliable healthcare. An excellent example appeared in a recent Healthcare IT News article1 about a JAMA Internal Medicine2 published and peer-reviewed study that has proven EHR’s do not deliver acceptable clinical performance for digital health and are likely a major contributor to the national quality of care crisis.
Safeguarding our patients requires delivering and receiving the right care, in the right setting, at the right time. Health systems today are utilizing legacy e-ICU and EHR solutions that don’t provide situational awareness, much less fulfill clinical needs. Hospitals need digital health, virtual-ICU, and tele-health tools that provide the right care, at the right time, in the right setting to improve patient outcomes while better managing patient capacity and system assets. Your goal as a clinical leader or administrative leader in evaluating digital health & tele-health partners is to find a platform that leads the market in furthering and developing new digital-driven and tele-driven care models for all clinicians. Your vendor’s solution must cross the various stand-alone verticals and disciplines of care. Keep in mind there are many stand-alone vertical solutions and some are effective at what they do. A great example of this is a virtual-ICU or a tele-ICU solution. It works great for Intensivists in the ICU, but not so much for hospitalists, certainly not for nurses who are monitoring for sepsis in remote locations, and certainly doesn’t play well in the skilled nursing or in the home environment. You need a digital health partner who provides access across these environments, or across more than one environment, with the ability to expand across all over time.
Portable, Integrates with and Extends Existing EHR Workflows
Portability, integration, and extending the EHR workflows are a few of the most central items for consideration from a technology perspective because they drive ease of use and ease of adoption. The ability to have physicians and nurses utilize remote patient monitoring from anywhere for any acute care setting, including a virtual-ICU, will drive massive efficiency and help ease the current and escalating pain EHRs are causing. First, it will reduce the stress placed on nurses and physicians (or any provider for that matter) from technology designed for billing rather than clinical care. Second, the efficiency from these systems will allow clinicians the ability to effectively care for larger numbers of patients without creating fatigue and stress, ultimately helping alleviate the current labor shortage hospitals are experiencing.
Portable real-time digital health, virtual-ICU, and tele-health solutions that have full EHR clinical data integration eliminate the need for a physician or nurse to flip back and forth between the virtual digital health system and EHR’s. Having all the data in one place, combined with standard algorithms and AI and ML algorithms to help assess and treat patients, gives physicians and nurses the ability to monitor many more patients than they can in an EHR. Having portability so clinicians can monitor from anywhere renders expensive hub-style command centers much less important and over time will make them irrelevant.
Platforms that leverage integration with the EHR to provide real-time clinical data in the digital health solution using both standard and AI/ML based algorithms significantly reduce the amount of time required to assess and treat patients. In addition, peer-reviewed research shows it reduces errors by up to 50% thereby also reducing a primary driver of clinician and nursing time, fixing errors.3 One platform was developed by combining Health IT with human factor ergonomics and system engineering to design a system that extracts high-value clinical data from the EHR and presents it to the clinical and nursing teams in patient-centric information packages.4
Solutions designed as above drive highly reliable healthcare. Highly reliable healthcare is something health systems and hospitals have been and are still struggling with since the digitization of healthcare that fueled a decade of EHR deployments. Digital Health and tele-health solutions that reduce the time to assess and treat patients and provide a clear clinical view of patient data, drive clinical situational awareness and are additive to EHRs. They provide tremendous clinical value for both physicians and nurses while driving highly reliable healthcare. Improved patient care is one thing, but hospitals and health systems that provide enhanced value and efficiency to doctors and nurses via digital health platforms, deliver a much-needed win for both providers, patients, and the health system.
Enhanced Data Access, Improved Outcomes, Cost Reduction
Enhanced data access to real-time data from the EHR and bedside devices that promotes clinical situational awareness for physicians and nurses is a prerequisite for any digital health or tele-health platform. This type of user experience (UX) will improve outcomes, elevate the patient experience, and reduce the cost of care. This should be a major articulation point in your search for digital health solutions. A solution whose use cases cross clinical disciplines and are driving real-time clinical situational awareness of a patient's condition should be a must-have during your evaluation process.
Data integration is pivotal for successful digital health and tele-health solutions. With an absence of real-time feeds, digital health solutions lose much-needed efficacy to serve as a clinical solution that enhances the EHR and end up with low adoption rates. Is the digital health solution you’re evaluating adding to the proficiency your clinicians already experience inside the current EHR model or just taking them out of that workflow? If the solutions don’t enhance the UX, is it really improving care? Vendors that fully leverage data or better said, democratize data, predictably can deliver an improved UX.
If it doesn’t enhance the EHR, is it really improving care? That is a great question, and improving care is another substantial evaluation point for digital health and tele-health solutions. “Solutions that create a better and more engaging consumer experience are more important than ever before,” said Todd Dunn, Vice President of Innovation at Atrium Health. “However, they must deliver measurable business and clinical outcomes. The burden of proof has never been higher.”5 As mentioned earlier, validation on a clinical level is important but it is also centered on a financial level. Make sure your vendor can build a Cost-Benefit Analysis (CBA) with you that shows an excellent Return on Investment (ROI). If the platform truly gives you clinical situational awareness, then it will also drive considerable efficiencies and should have a strong demonstrable ROI. Solutions without published clinical validation and demonstrable ROI are highly unlikely to move the UX, quality, or cost needles in any organization. Any digital health platform or tele-health platform must have both published and peer-reviewed clinical validation along with a CBA that shows an ROI. Note, ROI requirements apply to custom-built vs. purchased solutions as well which we will cover in part two of this blog.
Case in point, a recent article in MedCity News talks about ROI and why it’s important for any digital health investment. The article states, “As the Covid-19 pandemic continues to strain healthcare organizations across the country, enterprise health leaders indicated they are seeking innovative solutions to address pain points exacerbated by the crisis as well as new models of care delivery. This includes doubling down on improving patient experience and access to virtual health along with solutions to reduce widespread clinician burnout and provider shortages.
However, only solutions with demonstrable ROI that integrate into the EHR and existing workflows are getting serious consideration.”6
Sustainable Business Model & Competitive Advantage
A sustainable business model is fixed to a competitive advantage, especially with early-stage innovative organizations. The power of sustainability should not be overlooked during an evaluation since it will ultimately drive the long-term health of any partner or vendor organization you may choose for your digital health solutions. Furthermore, sustainability will ensure they can add and deliver useful and needed functionality down the road. Almost all innovative digital health and tele-health organizations are newer and smaller organizations. Considering this fact, you must ask if the digital health vendor(s) you're evaluating have a reasonable business model and the staying power to make it in their vertical. Even more essential, does the vendor have a platform or a solution? In other words, is it a one-trick pony solution for a niche market, or is it a platform that can be expanded over time to become a true enterprise solution that cuts across various digital health verticals? Being a niche vendor is not necessarily a negative thing, especially if they can solve a problem for you that others can't. However, having a platform that can expand over time as more innovations come to the market is also an important consideration. The ability to manage a small number of solutions or just one platform has advantages. So be careful in choosing one that is capable of expansion and has the long-term vision and roadmap to fulfill your requirements and considerations.
With large vendor organizations, or any health care vendor for that matter, as the organization matures, there is an inherent flatness that makes innovation very difficult. We see this occur repeatedly as organizations that were once innovative with sustainable business models become giants in the healthcare industry. The question increasingly becomes, does the giant really solve new real-world problems that are currently gaps for providers or patients? Or are they just trying to plug a round innovation hole with a square peg? This issue is interconnected to the build vs buy argument in part two of this blog. It is important to consider the core question, is the vendor still on the edge of innovation or are they just trying to retain revenue and keep clinicians trapped in their workflows? Artificially keeping clinicians in a workflow pushes vendor value in mature solutions that probably is not making any discernable difference in the user experience, quality of patient care, clinical efficiency, and cost reduction. Forcing physicians or nurses to use an ineffective solution is painful for front-line healthcare workers, a waste of money for health systems, endangers patients, and never ends well.
In innovative markets, like today’s digital health and tele-health market, organizations typically are evaluating younger more innovative vendors. Epic was once innovative as was Teledoc and Amwell, and today they are all very large organizations. The thing they all have in common is they once were nimble, smaller, and innovative organization with a sustainable business model. The model for younger organizations should start with a low-end disruption that has enormous high-end disruption potential. A great example of this is an organization solving a singular issue, like sepsis, yet the platform has the ability to expand the model to solve much more, such as CAUTI, SSI, CLABSI, AKI, or any patient condition for that matter. High-end disruption potential is something you need to look for and is one of the central issues you must understand about your potential digital health partners.
While I used solution and platform interchangeably throughout this discussion, there is a key difference between the two. A solution that does not have high-end disruption potential means you are choosing a ‘niche solution’ and ‘not a platform’. That’s not always bad. But to be successful in your digital health strategy, you should be aware of this precondition and understand what you are committing to as a health system. The best way to grasp this is to understand the roadmap, and just as fundamental, the vision of your potential partner. If those vendors don't make the right decisions about their business model and vision, then their long-term relevance is likely in question. If you choose them, you may end up with a nice-to-have solution that delivers some value but doesn't get you to where you need to go in the long run.
Verifying that your potential digital health or tele-health partner has a legitimate sustainable competitive advantage, and is not a one-trick pony, is pivotal in choosing your digital health platform. A tell-tale sign of a sustainable business model and a competitive advantage is the possession of patented technology, algorithms, or analytics. If the answer to do they have a patented platform is yes, then you may be looking at a potentially great digital health vendor. You also want to ask, does the solution make health or disease management better and more efficient? If it does, and they have published data to prove it, along with the patents, then it’s likely you’re evaluating a vendor who is not only great but is going to produce a remarkable change in the healthcare industry.
A great example of this is Ambient Clinical Analytics (ACA) who has been granted three (3) patents and has three (3) patents pending for its core digital health and core tele-health applications. ACA is continuing to develop new features and products through joint development research projects with highly respected medical university teaching hospitals along with one of the world’s highest-ranking health systems for the last 10 years. Utilizing this type of development approach will likely result in more patents and amazing innovation. Utilizing an organization with this nature of early-stage pedigree is extremely important. Mostly because it demonstrates that the solutions are clinically vetted, developed with physicians and nurses, and that they are continuing to invest major resources in delivering continued innovation to the digital health, virtual-ICU, and tele-health markets.
Vendor Relationship As you evaluate your prospective vendors there are many variables to consider. One that should not be overlooked is what kind of vendor relationship you want to engage in. Does the typical vendor and client relationship fit what you’re looking for or are you looking for the relationship to resemble more of a marriage or a true partnership? While much of this consideration is nuance, it is important to understand, consider, and discuss openly with vendors because it positions the direction and needs of the relationship.
While I won't spend a lot of energy writing about this topic, it is very critical to understand what you're looking for as you embark on your evaluation. As we all have experienced, the more mature the organization, the harder it is to push them to provide the required functionality.
Understandably so, but if you're looking at innovative solutions then you will likely need the flexibility and closeness in a relationship that is more closely matching a true partnership or marriage. In addition, how fast can this added functionality be delivered? This is essential to keep top of mind, especially with this market just starting to truly emerge and with lots of innovation on the horizon, you may need the ability or at a minimum, the influence, to help guide and drive the direction of the platform as it moves towards maturity.
Custom or Configurable
Implementation and the degree to which each customer is a one-off build is also a consideration. Another way to say this is ‘configurability or customization’. It’s important to understand for so many reasons. The most important of which is customization tends to create lack of continuity of care across the US health system and is difficult to deploy at scale. While configurability drives high reliability and is less difficult to deploy at scale. If a solution requires customization across the continuum, that frustrates any hope for continuity at a system level, never mind a national level.
For example, most hospitals that have deployed a sepsis algorithm, have a highly customized algorithm to drive sepsis alerting and detection. This is part of the reason sepsis performance in the US is so poor. It is almost impossible to maintain continuity of care with such a highly customizable approach from one location to another. Additionally, detecting sepsis but failing to drive the clinical bundle or the clinical process after a sepsis alert adds to an already poor adherence to the bundle elements. Having customizable one-off algorithms is not really all that bad but because there is no real software driving the bundle delivery after the fact, every deployment of an algorithm is a one-off customization along with a self-developed and highly manual process to deliver at risk elements after the detection.
On the other hand, dropping customization into a well-thought-out framework makes that same customization morph into configurability. If your framework allows configurability of an algorithm for a specific site, down to a unit level, and that same framework drives a standardized clinical process to meet CMS requirements or best practice, you have now adapted customization into configurability. This also drives easier implementations at scale while affording the individual health systems the ability to employ clinical bundles that work best for their specific populations. Custom vs configure has ebbed and flowed over the last few decades and making a digital health solution that allows for highly reliable customization via configurability is in everyone's best interest.
Summary
The three-year long Covid pandemic has unleashed rapid changes in healthcare and highlighted an enormous need for other technology advancements, primarily around digital health and managing acute patients from a distance. There are many considerations in selecting a vendor or partner for digital health ranging from build vs. buy, defined use cases, to competitive advantages. Although build vs buy will be in part two, my hope is this whitepaper has helped you appreciate why these considerations are essential to your selection process.
Executives owe it to themselves and the health system they work in to understand the digital health market and to mitigate risk around any selection processes. They should also recognize that even with mitigation they will likely take some sort of calculated risk. Most innovative digital health vendors are either startups or early-stage companies. Grasping selection concepts like clinical validation, certification, enhanced data access, sustainable business models, configurable solutions, etc... don’t necessarily guarantee a digital health vendors efficacy, health, or long-term success. However, if you have considered the evaluation points discussed above, it is likely you will choose a solid provider of digital health, virtual-ICU, or tele-health solutions that meets your organization’s needs.
If you haven’t embarked on this journey previously, it is likely you will in the very near future. Making it necessary for both clinical and IT executives to assess some facet of digital health, virtual-ICU, or tele-health solutions. I hope the material we covered above on seven of the topics to consider when evaluating digital health solutions was helpful. The eighth topic on digital health is ‘Build vs. Buy, Certification & Verification’, which alone is a challenging topic to grasp, and will be published in Part-Two of this digital health series blog.
AWARE™ Critical Care
Ambient has achieved FDA Class II Clearance, CE Marking, and ISO 13485:2016 Certification on the AWARE™ platform. AWARE™ provides tele-ICU or virtual-ICU remote patient monitoring along with predictive analytics. Combined with our novel clinical decision support tools we decrease provider fatigue, reduce errors, and save lives. Created by clinicians for clinicians, AWARE™ delivers portable real-time virtual ICU surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in critical care and general inpatient areas.
AWARE’s (Ambient Warning and Response Evaluation) virtual ICU solution is designed to provide bedside and remote patient monitoring using data visualization and clinical analytics. The AWARE™ Multi-Patient Viewer (MPV) and Single-Patient Viewer (SPV) allows all nurses and physicians to view a patient through the eyes of a intensivists regardless of their location. Critical care requires turning massive amounts of raw data into actionable knowledge. We make the data work for you.
An inability to process the required data is commonly known as information overload. Information overload frustrates clinicians and exposes patients to diagnostic errors and therapeutic harm. AWARE™ is different, it was built by intensivists at Mayo Clinic using principles of human factors engineering, gathering the data that’s important to critical care teams and displaying it in a way that minimizes cognitive load. AWARE™ is the gold standard for how smart clinical analytics and data visualization can improve communication, efficiency, situational awareness, and safety. Unlike any other system, AWARE™ shows you what you need to see, at the point of care and in virtual ICU settings, organized the way an intensivist approaches their patients’ data.
AWARE Clinical Control Tower™ is a solution designed to provide a virtual ICU for AWARE™ Critical Care and Sepsis DART™ with centralized or decentralized remote patient monitoring and collaboration for physicians and nurses. Our Clinical Mesh Network™ with AWARE™ and Sepsis DART™ capabilities delivers to any location in a standardized format, eliminating EMR differences. Clinical Control Tower™ provides distributed tele-health, virtual ICU and remote patient monitoring within your system and with contracted facilities.
Whether deployed in an ICU or as a virtual ICU solution, the AWARE™ enterprise class family of solutions including Sepsis DART, AWARE Critical Care, and Clinical Control Tower all help you approach your patients in an efficient, more effective, informed, and organized fashion while decreasing provider fatigue, reducing errors, and saving lives. Created by clinicians for clinicians, AWARE™ delivers real-time surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in critical care and general inpatient areas.
Ambient’s predictive analytics and advanced clinical decision support tools is clinically validated to reduces errors, improve patient outcomes, reduce the cost of care, and deliver best-care practices for any acute care setting from the ICU to the home. AWARE’s predictive analytics system provides a “smart view” via data visualization of Electronic Health Record data that reduces the risk of medical errors and improves patient outcomes with high reliability healthcare. It works with your EMR and bedside monitors to present only relevant information for care delivery.
For detailed information on Ambient Clinical Analytics and Virtual ICU or Remote Patient Monitoring solutions for your hospital or health system, or for our published studies on AWARE™ please contact tim.kuebelbeck@ambientclinical.com.
About Ambient Clinical Analytics - As an industry leader, Ambient is supporting leading healthcare systems and has done so since its founding in 2013. Our solutions are designed by clinicians to be easy-to-use by every caregiver in your organization and are configured to be up and running rapidly. We are trusted by a community of high-performing healthcare providers across the United States. Our solutions are powerful real-time point-of-care and remote healthcare platforms designed to deliver life-saving solutions using data visualization, communication, and analytics based clinical decision support.
Citations
- Jercich, Kat, ‘Research Suggests Epic Sepsis Model is lacking predictive power’, June 22, 2001 - Healthcare IT News
- Wong, Andrew; Otles, Erkin; Donnely, John, External Validation of a Widely Implemented Proprietary Sepsis Prediction Model in Hospitalized-Patients - JAMA Network
- Duquesne University School of Nursing, The Shortage of Healthcare Workers in the U.S. https://onlinenursing.duq.edu/post-master-certificates/shortage-of-healthcare-workers/ , Oct. 5, 2021
- Pickering, et al., Novel Representation of Clinical Information in the ICU, Applied Clinical Informatics, 2010
- MedCity News, Healthcare CIO survey reveals a tale of two cities for innovation, Adam Dakin & Mike Ravenscroft, Feb 14, 2002
- MedCity News, Healthcare CIO survey reveals a tale of two cities for innovation, Adam Dakin & Mike Ravenscroft, Feb 14, 2002