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New tools may soon connect you to your patients at home. [ABSTRACT FROM AUTHOR]

An email-based telemedicine service was implemented in two remote village communities in Cambodia. Volunteer physicians at the Brigham and Women's Hospital, Massachusetts General Hospital and the Sihanouk Hospital Center of Hope in Phnom Penh provide monthly consultations to the local clinicians. Between February 2001 and May 2005, there were 469 teleconsultations. The 214 telemedicine cases involving new patients managed in the first 28 months were reviewed. The mean duration of the chief complaint at the initial patient visit was 37 months for the first six months and had dropped to eight months by the end of the study period. Of 63 adult patients surveyed, all were either satisfied (54%, n = 34) or very satisfied (46%, n = 29) with their experience in the telemedicine clinic. About 78% (n = 49) were willing to pay, on average, 0.63 US dollars for their visits. The introduction of basic point-of-care laboratory testing in November 2004 was associated with a reduction in patients requiring off-site referral for completion of laboratory testing (69% before to 35% afterwards, P < 0.001). The success of the pilot telemedicine programme confirms the value of email support for non-physician health-care workers in the developing world. [ABSTRACT FROM AUTHOR]

Digital medicine interventions are currently transforming health care and have created new efficiencies in the delivery process. The business model along with physician payment models are crucial drivers for the adoption of innovations. In the U.S., physician payment is mostly codified in the Current Procedural Terminology (CPT). Until recently, CPT codes related to digital medicine activities were mainly limited to telephone services. To embrace the evolving implementation of the various modalities of digital medicine, the American Medical Association (AMA) determined that a more comprehensive codeset is needed. Thus, the Digital Medicine Payment Advisory Group (DMPAG) was initiated in late 2016. Since then, the DMPAG has achieved a significant and measurable impact on digital medicine intervention adoption by introducing CPT codes for remote physiologic monitoring, remote therapeutic monitoring, artificial intelligence, and other digital innovations., (© 2022. The Author(s).)

Background: There has been much recent discussion about the reimbursement of telehealth virtual visits. Advocates argue strongly for payment parity with in-person encounters, whereas payers insist that telehealth visits should be reimbursed at a lower value. Methods: Using the Resource-Based Relative Value Scale structure as a guideline (where physician compensation is divided into categories: time/medical decision making/malpractice expense and practice expense), we developed a framework to examine the difference in practice expense of an in-person practice compared with a scaled virtual practice. Results: We found that for current procedural terminology (CPT) code 99213, the total relative value unit (RVU) for a virtual visit would be 1.62. The in-office RVU for CPT code 99213 is 2.09. This difference could serve as the basis for a rational discussion on differential reimbursement for virtual visits.

Patient-generated health data (PGHD) have not achieved widespread clinical adoption. However, the COVID-induced shift to telemedicine may have created opportunities for PGHD as surrogates for vital signs collected in person. We assessed whether this shift was associated with greater ambulatory care PGHD use. We conducted an interrupted time series analysis of physician enrollment in, and patient-initiated vital sign transmission of non-COVID-associated PGHD through, a national PGHD platform (Validic). Ten health systems, 4695 physicians, and 51 320 patients were included. We found a significant increase in physician enrollment (slope change of 0.86/week, P = .02). Platform application programming interface calls continued their pre-COVID upward trend, despite large reductions in overall encounters. These findings suggest significantly greater pandemic-associated clinical demand for PGHD, and patient supply disproportionate to encounter rates. Increasing clinical use and ongoing efforts to reduce barriers, could help seize current adoption momentum to realize PGHD's potential value., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

On July 24, 2020, a workshop sponsored by the National Brain Tumor Society was held on innovating brain tumor clinical trials based on lessons learned from the COVID-19 experience. Various stakeholders from the brain tumor community participated including the US Food and Drug Administration (FDA), academic and community clinicians, researchers, industry, clinical research organizations, patients and patient advocates, and representatives from the Society for Neuro-Oncology and the National Cancer Institute. This report summarizes the workshop and proposes ways to incorporate lessons learned from COVID-19 to brain tumor clinical trials including the increased use of telemedicine and decentralized trial models as opportunities for practical innovation with potential long-term impact on clinical trial design and implementation., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Due to the complexity and chronicity of heart failure, engaging yet simple patient self-management tools are needed., Objective: This study aimed to assess the feasibility and patient engagement with a smartphone app designed for heart failure., Methods: Patients with heart failure were randomized to intervention (smartphone with the Habits Heart App installed and Bluetooth-linked scale) or control (paper education material) groups. All intervention group patients were interviewed and monitored closely for app feasibility while receiving standard of care heart failure management by cardiologists. The Atlanta Heart Failure Knowledge Test, a quality of life survey (Kansas City Cardiomyopathy Questionnaire), and weight were assessed at baseline and final visits., Results: Patients (N=28 patients; intervention: n=15; control: n=13) with heart failure (with reduced ejection fraction: 15/28, 54%; male: 20/28, 71%, female: 8/28, 29%; median age 63 years) were enrolled, and 82% of patients (N=23; intervention: 12/15, 80%; control: 11/13, 85%) completed both baseline and final visits (median follow up 60 days). In the intervention group, 2 out of the 12 patients who completed the study did not use the app after study onboarding due to illnesses and hospitalizations. Of the remaining 10 patients who used the app, 5 patients logged ≥1 interaction with the app per day on average, and 2 patients logged an interaction with the app every other day on average. The intervention group averaged 403 screen views (per patient) in 56 distinct sessions, 5-minute session durations, and 22 weight entries per patient. There was a direct correlation between duration of app use and improvement in heart failure knowledge (Atlanta Heart Failure Knowledge Test score; ρ=0.59, P=.04) and quality of life (Kansas City Cardiomyopathy Questionnaire score; ρ=0.63, P=.03). The correlation between app use and weight change was ρ=-0.40 (P=.19). Only 1 out of 11 patients in the control group retained education material by the follow-up visit., Conclusions: The Habits Heart App with a Bluetooth-linked scale is a feasible way to engage patients in heart failure management, and barriers to app engagement were identified. A larger multicenter study may be warranted to evaluate the effectiveness of the app., Trial Registration: ClinicalTrials.gov NCT03238729; http://clinicaltrials.gov/ct2/show/NCT03238729., (©Kevin S Wei, Nasrien E Ibrahim, Ashok A Kumar, Sidhant Jena, Veronica Chew, Michal Depa, Namrata Mayanil, Joseph C Kvedar, Hanna K Gaggin. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 20.01.2021.)

This article reviews the current experience and the flaws encountered in the rush to deploy telemedicine as a substitute for in-person care in response to the raging coronavirus (COVID-19) pandemic; the preceding fault lines in the U.S. health care system that exacerbated the problem; and the importance of emerging from this calamity with a clear vision for necessary health care reforms. It starts with the premise that the precursors of catastrophes of this magnitude provide a valid basis for planning corrective measures, improved preparedness, and ultimately serious health reform. Such reform should include standardized protocols for proper deployment of telemedicine to triage patients to the appropriate level and source of care at the point of need, proper use of relevant technological innovations to deliver precision medicine, and the development of regional networks to coordinate and improve access to care while streamlining the care process. The other essential element is a universal payment system that puts the United States at par with the rest of the industrialized countries, regardless of variation among them. The ultimate goal is creating an efficient, effective, accessible, and equitable system of care. Although timing is uncertain, the pandemic will be brought under control. The path to a better future after the pandemic offers some consolation for the massive loss of life and treasure during this pandemic.

Background/objectives: Store-and-forward teledermatology provides pediatricians with specialist guidance in managing skin disease. This study evaluates wait times and face-to-face (FTF) dermatology visit avoidance associated with a pediatric dermatology eConsult program at an urban academic medical center., Methods: In this retrospective cohort study, electronic medical records were reviewed for patients under age 18 for whom a dermatology eConsult was completed between November 1, 2014, and December 31, 2017. Wait times for eConsult completion and initial FTF dermatology appointments were calculated and compared to average wait times for new patient dermatology office appointments from 2016 to 2017. Recommendations for FTF dermatology visits were assessed, along with FTF visit attendance and potential cost savings., Results: One hundred eighty pediatric patients with 188 unrelated skin conditions ("cases") were referred to the program. Of 188 cases, FTF dermatology visits were recommended for 60 (31.9%). Actual FTF dermatology visit avoidance was 53.7% of total cases (n = 101 for whom FTF visit was not recommended and no dermatology visit occurred within 90 days after eConsult submission). The program generated potential savings of $24 059 ($9840 out-of-pocket) in 2016 dollars. Average turnaround for eConsult completion was 1.8 calendar days (median: 1 calendar day, target: 2 business days). Average wait time to initial FTF dermatology evaluation was 37.3 calendar days (versus 54.1 days for pediatric patients referred directly to dermatology clinic between 2016 and 2017)., Conclusion: Pediatric dermatology eConsults reduce wait times for specialist care, triage cases for in-office evaluation, reduce need for FTF dermatology visits, and offer potential cost savings for payers and patients., (© 2020 Wiley Periodicals LLC.)

Background: Our understanding of chronic diseases, such as atopic dermatitis (AD), could benefit from the ability to rapidly collect patient-reported, longitudinal data from a large population., Objective: This study aimed to determine whether a smartphone app can be used to collect demographic and longitudinal symptom data and recognize prescribing patterns and affordability of medications to study the burden of AD., Methods: We collected data using the myEczema smartphone app between July 2017 and April 2018. The data were de-identified and analyzed., Results: A total of 519 users (94.2%) completed the initial demographic survey. The majority of users were female (n = 387; 70.2%) and Caucasian (n = 358; 65.0%). A total of 335 users (60.8%) had at least a university degree and were employed (n = 348; 63.1%). A total of 189 users (29.2%) reported difficulty affording their medications, and 363 users (65.9%) took advantage of the itch score recording feature. Finally, 184 users (33.4%) logged their treatments, with the highest number of users (65.2%) listing topical steroids as one of their treatments., Limitations: The operating platform was limited to iPhones, and the results were subject to reporting bias., Conclusion: A smartphone-based research app can be used to rapidly collect patient-reported data to study the burden of AD and to highlight the prescribing patterns and affordability of medications., (© 2020 Published by Elsevier Inc. on behalf of Women's Dermatologic Society.)

Background: It is well reported that tracking physical activity can lead to sustained exercise routines, which can decrease disease risk. However, most stop using trackers within a couple months of initial use. The reasons people stop using activity trackers can be varied and personal. Understanding the reasons for discontinued use could lead to greater acceptance of tracking and more regular exercise engagement., Objective: The aim of this study was to determine the individualistic reasons for nonengagement with activity trackers., Methods: Overweight and obese participants (n=30) were enrolled and allowed to choose an activity tracker of their choice to use for 9 weeks. Questionnaires were administered at the beginning and end of the study to collect data on their technology use, as well as social, physiological, and psychological attributes that may influence tracker use. Closeout interviews were also conducted to further identify individual influencers and attributes. In addition, daily steps were collected from the activity tracker., Results: The results of the study indicate that participants typically valued the knowledge of their activity level the activity tracker provided, but it was not a sufficient motivator to overcome personal barriers to maintain or increase exercise engagement. Participants identified as extrinsically motivated were more influenced by wearing an activity tracker than those who were intrinsically motivated. During the study, participants who reported either owning multiple technology devices or knowing someone who used multiple devices were more likely to remain engaged with their activity tracker., Conclusions: This study lays the foundation for developing a smart app that could promote individual engagement with activity trackers., (©Amanda Jayne Jayne Centi, Mursal Atif, Sara Bersche Golas, Ramin Mohammadi, Sagar Kamarthi, Stephen Agboola, Joseph C Kvedar, Kamal Jethwani. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 24.10.2019.)