How Connected Health Tech Bolsters Chronic Care, Behavioral Health

October 25, 2023 - Connected healthcare technologies are transforming care delivery, patient outcomes, and provider workflows, particularly in the chronic disease management and behavioral healthcare arenas.

The adoption and use of these technologies, including telehealth tools and healthcare wearable devices, skyrocketed during the COVID-19 pandemic. This resulted in healthcare provider organizations launching and scaling technology-enabled services. Even as in-person care resumed, connected health models for chronic disease management and behavioral healthcare proliferated.  

In October, healthcare leaders speaking at Xtelligent Healthcare Media's 4th Annual Connected Health Virtual Summit detailed their use of connected health technology to boost chronic care and address behavioral healthcare gaps, as well as the potential benefits and challenges of these care models.

USING CONNECTED HEALTH WEARABLES TO ADDRESS CHRONIC DISEASES

Amid the growing popularity of healthcare-focused wearable devices, provider organizations are increasingly employing them to enhance chronic disease management between clinic visits.

New York City-based Mount Sinai Health Partners, a clinically integrated network comprised of Mount Sinai Health System's faculty physicians, associated community clinicians, and seven hospitals, leverages wearable devices for numerous programs, including its condition management program.

The condition management program focuses on chronic disease patients, including those with hypertension, congestive heart failure, and diabetes, said Darryl Hollar, senior product owner in the Digital Product Delivery team at Mount Sinai Health Partners, during a panel. The patients are provided with preconfigured wearable devices that track their vital signs. The data is transmitted to the care team at Mount Sinai.

“I ultimately think the goal is to use these wearables and devices to intervene more quickly and more intelligently, just so that patients can be more engaged, and providers can be more effective,” Hollar said.

However, adopting and using these devices poses several challenges, both on the provider and patient side.

From the healthcare provider perspective, incorporating wearables into clinical practice often means workflow changes.

“Even though it might seem easy just to slap a watch or a continuous glucose monitor on somebody, the providers have to want to look at the data, make decisions about the data, engage with the patient. These are all very time-consuming projects... [and] I can tell you that physicians are a difficult bunch,” said Lisa Finkelstein, DO, medical director of telehealth at Jackson, Wyoming-based St. John's Health, during the panel. “We are not easy to convince that something new is possibly better than what we've done in the past.”

Thus, buy-in is critical when implementing wearable technology and related processes and protocols. Finkelstein noted that bringing C-suite leadership on board and then identifying a physician champion can help create buy-in and foster adoption across organizations.

On the other end of the spectrum are the patients. As the end users of the devices, patients must understand how to use the devices and remain engaged.

“In the wearable world, the patients have a greater role, so one of our jobs is to be the co-pilot,” said Emerson Perin, MD, PhD, medical director at Texas Heart Institute, during the discussion. “So, I can sit there and tell the patient all day long, ‘You got to eat this,’ and they're never going to do anything I tell them to do. They have to experience it and be educated.”

Patients with the most difficulty adapting to new technology often need them the most. For example, older patients with heart problems benefit significantly from wearable devices but have trouble using them. According to Perin, patient education, device-specific training, and intuitive technology interfaces can go a long way toward helping patients glean the clinical advantages of healthcare wearables.

Newark, Delaware-based ChristianaCare has created a new role to support patient use of healthcare technology, including wearable devices, said Catherine Burch, vice president of the Health and Technology Innovation Center at the health system, during the panel discussion.

Called patient digital ambassadors, these health system staff members help patients use the devices sent to them, as well as identify devices they already own that could be used to provide healthcare data to clinicians.

“Because depending on your population, they're vulnerable,” Burch said. “And now is not the time for them to be learning new tech — [that is,] when they're discharged, or when they're dealing with something new and challenging in their life.”

Additionally, ChristianaCare conducts small pilots before deploying technology to pinpoint and address barriers to use. For instance, in one pilot, the care team discovered that the device was not transmitting data to the health system as programmed because the patient spent most of their time in the basement, where there was no internet connectivity.

“I'm glad we've learned that with only five versus rolling out to 500 or waiting for perfection and rolling out to 5,000. So, there's so much value in those small trials,” Burch said.

BREAKING DOWN BEHAVIORAL HEALTHCARE BARRIERS WITH CONNECTED CARE

An enduring use case for connected health technologies is behavioral healthcare, as these tools can fulfill the urgent need for easy, convenient, and stigma-free access to mental health support.

“Really for patients that would normally shy away from in-person care in the traditional clinic, that doesn't want to show up at the front door of a mental health clinic, it's given them the access and helped, particularly with those with anxiety, [feel] confident to reach out,” said Tim Lovell, director of connected care operations at Salt Lake City-based Intermountain Health, at a panel discussion.

Intermountain Health launched a virtual behavioral health clinic during the COVID-19 pandemic, which initially offered psychiatry services and then expanded to talk therapy. Lovell said over 50 percent of Intermountain’s outpatient behavioral health visits are taking place over telehealth.

The health system has also launched a phone line that provides basic triage services to connect patients across Utah, Nevada, and Idaho with healthcare services that are accessible to them.

“We usually think about video or maybe digital when we think about connected health, but certainly the phone is a tried-and-true method of helping patients out and is another valuable asset in really guiding patients to where they need to go,” he said.

But, the digital divide, caused by factors like a lack of access to technology and unstable internet connectivity, can prevent patients from accessing digitally enabled behavioral healthcare.

According to Gena Carney, director of virtual care-ambulatory services at Indianapolis-based Indiana University Health (IU Health), a key strategy for combating the digital divide is identifying patients who need behavioral health support and urging them to try virtual visits.

The health system has created depression and anxiety screenings for all primary care patients. Clinicians then contact those who screen positive for suicide risk and attempt to engage them in virtual care.

“Encouraging patients maybe just to give this a try for a few visits and if this doesn't feel like the right fit for them, navigating them toward maybe a more traditional face-to-face model,” Carney said. “And what we do see frequently is that patients, after they do get engaged, they say, ‘I enjoy this. I like this.’”

High-quality research is another critical aspect of closing behavioral healthcare gaps.

During the panel, Manish Sapra, MD, executive director of the behavioral health service line at New York City-based Northwell Health, noted that research can help quantify the digital divide.

For example, it's not enough to know whether a household has broadband access to ensure access to behavioral healthcare. Healthcare provider organizations need additional information, like whether the patient has a private space within their home to engage in a virtual visit and whether they have devices other than smartphones.

Then, there is the rapid growth of digital mental health applications, backed by venture capitalists and often lacking safety and efficacy evidence.  

“I'm particularly worried with the use of AI [artificial intelligence], especially generative AI and using as chatbots and things of that nature…there's just so much of dearth of proper research in digital mental health,” Sapra said. “We do so much research on the pharma side before we bring a drug into the market, but even for some of the digital therapeutics that have come into the market with FDA approvals, that real research is lacking.”

John Gachago, DHA, executive director for telehealth technology and innovation at Texas Tech University Health Sciences Center in Lubbock, Texas, echoed Sapra, stating that while there is a huge opportunity to leverage AI to enhance behavioral healthcare, there are potential risks.

The opportunities for AI use in behavioral healthcare include early detection and prevention, personalizing treatment, enhancing monitoring and data analytics, training and skill development for professionals, and care integration and quality improvement, according to Gachago.

“But even to leverage AI models, those models have to be validated within the healthcare environment,” he said. “Now, are there any specific rules for validating these models? No, there are guidelines, but there's nothing in place that says this is how this technology must be regulated, yet we know it has tremendous potential for behavioral health.”

Not only is guidance lacking, but data privacy and ethical challenges linked to AI use must also be addressed.

Thus, technology implementation is not just about using technology; it is about ensuring the people at the heart of healthcare operations are comfortable using it and have the support they need.

“You have to balance tech advancement with ethical and compassionate care,” Gachago said.