The power of remote patient monitoring

There is limited data comparing remote post-discharge patient treatment to that of standard in-person care, but a new clinical trial has done exactly that.

This multicenter randomized control trial measured safety events, medication adjustment and left ventricular reverse remodeling outcomes.  The subjects were low-risk patients with acute myocardial infarction treated for 6 months after discharge by a centralized nurse practitioner–led telehealth program compared with standard in-person care by a cardiologist. There were no differences in achieved medication doses or indices of left ventricular remodeling.

This clinical trial set out to answer an important question for healthcare in a COVID and post-COVID landscape:

“Is remote post-discharge treatment of low-risk patients with acute myocardial infarction by a centralized nurse clinician team under physician supervision feasible and safe?”

The answer is: Absolutely. In fact, it’s both safe and effective.

What’s next?

Researchers now want to conduct a similar clinical trial with higher-risk patients, in an effort to further test the capabilities of remote intensive patient management and care. Read this impactful new study here:

Remote Postdischarge Treatment of Patients With Acute Myocardial Infarction via JAMA Cardiology

The future is here:

cliexa-PULSE Home Health Monitoring Platform co-developed by cliexa and American College of Cardiology

“Imagine the ability to effectively capture RPM in the cardiology’s major disease states – HTN, CHF, CAD, and AFib in an easy-to-use-tool without all the data overload: Enter cliexa!” Dr. Andrew M. Freeman, MD – Director of Clinical Cardiology and Operations Director Cardiovascular Prevention & Wellness at National Jewish Health

Through the ACC Innovation Program with our partners at the American College of Cardiology (ACC), we have developed one of our latest modules, cliexa-PULSE to digitally transform and ultimately optimize cardiovascular care and outcomes. cliexa-PULSE is a mobile application designed for patients to track their symptoms, medications, episodes, complications and daily activity to manage Atrial Fibrillation providing real-time data to their clinicians. The expansion of cliexa-PULSE in 2021 will provide treatment tracking tools for patients with Hypertension, Congestive Heart Failure and Coronary Artery Disease, as well as launching a population health module. cliexa-PULSE is the ideal mobile app for clinicians to fully leverage patient-reported data, improving treatment decision-making and the overall patient experience. Learn more about cliexa-PULSE HERE

 

Clinics and hospitals have substantially reduced in-person visits to reduce potential COVID-19 exposure, the result? Telehealth solutions have become near-essential and their adoption rapidly accelerated. When we look back at the last major digital transformation for the health industry: the adoption of Electronic Medical records (EMR), digitizing the medical field comes with the intention of proficiency, but this can result in growing pains. Digital integration was implemented with the intention of reducing time and overhead connected to administrative duties and paperwork, but that shift has also resulted in one of the leading causes of physician burnout.

“As the flow of data from virtual visits, remote monitoring devices, and wearables increases, we must be sure providers don’t shoulder the cognitive burden of swiveling among even more screens and data feeds to manage patient care. It’s critical for data to be brought together on a unifying platform, where providers and staff have a “single pane” view of the patient journey. Artificial intelligence, machine learning, and voice technologies play crucial roles in reducing documentation burden by quickly filtering and surfacing the most useful and relevant data for understanding the patient story and delivering the right care.” –Ashwini Zenooz, MD

Virtual healthcare platform solutions are here to stay, but the way data is managed in these processes creates different clinical efficiency impacts. Integrating patient-reported data into actionable insights requires more than a simple digital intake platform. cliexa has created tailored workflow solutions focused on quality reporting and billing data that seamlessly integrate into EMR systems.

Over a third of medical practitioners report burnout symptoms and more than half are due to the global health crisis. Finding the right virtual health platform is harder than ever and finding one that makes life easier on patients and physicians alike is essential. This is why cliexa builds end-to end systems that improve quality of care and reduces burden on physicians. Learn more:

https://hbr.org/2020/11/telehealth-is-working-for-patients-but-what-about-doctors

 

In a recent announcement, we teased our upcoming Adolescent Resiliency and Wellness Webinar with cliexa-OPTIONS. We are excited to announce this webinar is now live! Join Lisa Rue, PhD & Senior Advisor at cliexa, for Part I of our cliexa-OPTIONS Webinar Series featuring a discussion on assessing adolescent risk and resiliency in modern healthcare.

The Webinar Series

Part I of our cliexa-OPTIONS Webinar Series covers the impact of virtual screening tools in healthcare and how practitioners can leverage resiliency factors with their adolescent patients. More than ever, maintaining the continuum of mental health in adolescents is top priority for clinicians. Through proper utilization, digital health tools provide valuable insight into adolescents’ mindset and mental health.

In this webinar, Dr. Rue takes a deep dive into how promoting resiliency in adolescents can lead to improved mental health and prevention of risky behaviors. Our proprietary OPTIONS assessment, co-developed with the National Mental Health Institute of Colorado, quantifies this resiliency and provides clinicians a measurable insight into adolescent resiliency and wellness.

The cliexa-OPTIONS Platform

Our cliexa-OPTIONS solution assesses adolescent risk and resiliency to provide pediatric, primary, and family care practitioners a thorough view of their patient’s health. The OPTIONS Model is designed for youth and young adults and measures 6 dimensions of supportive factors through a set of 22 questions proven to increase supportive factors. With the continuum of care shifting to virtual interventions, having a digital tool to connect with adolescents in real-time is extremely important. One of our pilot site leads added onto this notion by stating, “[patients] feel safer disclosing more personal and relevant information about their mental health, sexual activity, and overall well-being.”

The modular application structure of cliexa-OPTIONS supports implementation across a wide variety of care settings. As one of our clinicians through the University of Northern Colorado shared, “when clients have the option to disclose information through a virtual platform this informs the counselor of various topics the client may feel uncomfortable bringing up in session.” We have seen great success in both family medicine practices and primary care locations, while venturing into non-clinical settings that have an immediate impact on adolescents.

Watch the Webinar

Tune in to learn more about how cliexa-OPTIONS solution assesses adolescent risk and resiliency! If you are interested in piloting cliexa-OPTIONS in your practice, Contact Us at the link provided for more information.

Click Here to register and download Part I of this Webinar Series!

Artificial Intelligence Model with UCDenver

With a team of Computer Science students from the University of Colorado Denver, cliexa built its’ first artificial intelligence software. This AI Model assesses the comparative impacts of behavioral health metrics on the risk of opioid addiction. The project is our initial AI model, contributing to our larger goal of unleashing the power of AI in healthcare.

The Senior Design Program

The Senior Design Program at the University of Colorado Denver partners with local companies to mentor students on a cumulative project for software development. Organized by Debra Parcheta and the School of Computer Science and Engineering, students in the Senior Design class use their prior learning and experiences to design and build working software for real-world problems. We’re proud to sponsor a project for the 2019-2020 academic year, which resulted in our first AI model.

The Initial Project Proposal

Tackling our first AI project was a daunting task, but we knew this would lead to opportunities across other subspecialties. Our initial brainstorming session produced the design of a convolutional neural network algorithm.  This method enables the algorithm to flag potential flareups, unplanned hospitalizations, and other risk factors. We recognized that if we could harness the power of AI to identify correlations within patient-reported data, our platform could revolutionize the personalization of healthcare.

This initial project proposal proved to be a larger concept than what was feasible in a 9-month project timeline. The idea behind this served as the driving factor in the development of our resulting AI model. We narrowed our focus on integrated pain management, where we developed something truly novel in digital health technology.

The Artificial Intelligence Model

Our team, led by Research & Development Lead, Ronald Berry III, consisted of three students: John Williams, Mengistu Shuma, and Uriah Moeller. Over the first semester, our project scope honed in on integrated pain management. After outlining technical specifications, we landed on the idea of improving the risk stratification of modern pain management to flag at-risk patients based on a myriad of behavioral and physical health assessments.

Throughout development, the students made the decision to pursue a convolutional neural network, rather than an alternative form called clustering. When the overarching architecture was decided on, the team went to work on their first-ever machine learning model. They structured the model with seven assessment inputs with an output structure of “low”, “medium,” and “high” risk for potential opioid misuse or addiction. Once the initial structure was defined, the students utilized 1,300 unique de-identified data points to test the model.

The final challenge was fine-tuning the algorithm to obtain an accurate output in relation to the Screener for Opiate Addiction in Patients with Pain (SOAPP-14). Widely used in pain management, the SOAPP-14 is the gold standard for identifying chronic pain patients’ risk of opioid addiction. Upon the final iteration, the AI model achieved a 96.3% accuracy when compared to the SOAPP-14.

Without a doubt, this project proved successful across all deliverables outline in the project specifications. While our model is accurate in comparison to the SOAPP-14, we plan to clinically validate our tool for pain management.

Applying AI in Healthcare

With a background in Computer Science, Mehmet Kazgan has a comprehensive understanding of machine learning and neural networks. This experience, in addition to his time as VP of Engineering at Aetna, establishes him as an expert in leveraging AI technology in modern healthcare as our CEO & Founder. Over the past year, Mehmet joined industry leaders to discuss the role of artificial intelligence in modern healthcare.

#AskTheCEO Podcast

Back in March, we joined the #AskTheCEO podcast with Avrohom Gottheil in a thorough conversation on how cliexa aims to implement machine learning on the Azure Marketplace. The two discuss the importance of utilizing innovative technology to stay at the forefront of patient care. With data collection and AI capabilities rapidly advancing, we hope to see this shift across healthcare.

Colorado Advanced Industries Grant

Fast forward to May, the Colorado Office of Economic Development and International Trade awarded our team the Advanced Industries Accelerator Grant with the purpose of developing a machine learning module for cardiovascular risk. The Colorado OEDIT Advanced Industries Early-Stage Capital and Retention Grant is designed to support early-stage start-ups with viable products that meet a market need and are established in Colorado. Our proposed project is to expand the cliexa-PULSE home-health monitoring platform and develop a predictive risk model for cardiovascular disease. This machine-learning algorithm would expand upon this model for opiate risk and reconfigure to analyze for risk of cardiovascular disease.

Who Would Have Thought Podcast

A few weeks ago, Robert Niichel and Sacha Heppell with SmartTab interviewed Mehmet on their podcast where they took a deep dive into the value of patient-reported data in AI models. In this episode, they discuss the value of patient-reported data and how cliexa leverages artificial intelligence (AI) in the platform. Some of the key topics include improving Crohn’s disease outcomes, patient-centered tools, data in healthcare, and the future of AI.

Featured Publication with CU Boulder’s CANLab

Most recently, our partners at the CU Boulder’s CANLab published their research on applications of AI in chronic back pain. Their focus on patients’ emotional health and its’ impacts on pain severity leverages machine learning to predict future episodes. For the full publication and more information on this fascinating research, check out our announcement!

The Future of AI in cliexa

So now what? Where are we going from here with our AI goals?

In short, the opportunities are endless. As a subspecialty agnostic platform, our long-term goals with AI will expand to other areas outside of integrated pain management. Already, partnering with the American College of Cardiology, our focus shifts to an interventional AI risk model for cardiovascular diseases. As our experience with machine learning expands, we aim to find institutional partners to enter the world of AI with. To get in touch with our team, reach out via our Contact Us page.

Our Next Steps

Although COVID-19 changes the outlook of this upcoming academic year, we are proud to sponsor another project with UCDenver. We look forward to working with our 2020-21 cohort of students on a new project exploring the workflows for claims verification.

Congratulations to John, Mengistu, and Uriah on graduating this past May and best of luck to you all on your future endeavors!

Rural Patient Access Digital Health Tools

Introduction

It is well known that with COVID-19 cases on the rise in much of America, extra stress has been put on healthcare workers and departments. One specific area of great focus includes rural areas, where hospitals were financially ill-prepared for the onset of COVID-19. Rural hospitals are finding themselves in vulnerable positions as they consider how to manage both the extreme loss in revenue due to canceled elective surgeries and the costly nature of acquiring ventilators. 

Due to the precarious situation rural hospitals have encountered (only having an average of 21.3 days of cash on hand for Rural PPS Hospitals 26-50 beds), multiple rural hospitals across the US have been forced to close and many more are under threat of closure. These increasing closures in many rural areas cause residents to grapple with overall decreased access to care. With restricted access to care and hefty provider costs, healthcare workers are scrambling to find adaptive, modern solutions. 

However, access to care in rural settings has always been a critical issue in the US as there has been much need for the development of medical infrastructure providing affordable and high-quality care to 20% of the population. In fact, of the 170 rural hospitals that have closed in the US since 2005, only 11 have shut down in 2020. With this context, it is important to understand what barriers to healthcare are still present for rural patients today, as well as what potential modern solutions will help increase overall access to care in the US. 

Distance and Transportation

One of the main barriers to healthcare in rural areas is transportation. Since rural areas tend to be less densely populated, patients often travel long distances to see their medical providers. In a study by the Pew Research Center, the average urban travel time to a hospital was 10 minutes, while the average rural travel time was 17 minutes, with the top 25 percentile over 35 minutes.

Uninsured Individuals in Rural Settings

While urban residents benefit from public transportation and the relative proximity of their providers, for rural residents large travel times can be a serious problem for those who require immediate care. However, they can also act as an obstacle for more mild cases, deterring patients from reporting symptoms, completing patient onboarding, or seeking primary care. The significant increase in travel time introduces a myriad of other burdens for rural residents. When a patient travels to seek medical attention, they may suffer from lost wages, time away from home, and transportation fees. Patients should not have to weigh these costs in their consideration of receiving healthcare. 

cliexa’s solutions in Remote Patient Monitoring alleviate these difficulties in transportation by lowering the number of unnecessary hospital visits. Through a focus on patient engagement, wearables integration, and self-reported patient outcomes, providers can deliver high-quality care to patients exclusively through mobile devices. Also, patient intake and registration forms can be completed remotely, saving time for patients and clinicians. With the ability to receive care from the comfort of their home, patients no longer have to face the barrier of transportation. 

Workforce Issues

Healthcare Professional Shortage by Area United States

 Source: https://www.ruralhealthinfo.org/rural-maps 

Health Professional Shortage Areas (HPSA’s) are more abundant in rural locations. While many countries regulate the geographic distribution of healthcare providers, the US does not.Instead, physicians have complete discretion on where to work, leading to unequal health professional coverage across the country. According to the Bureau of Health Workforce, 61% of the country’s HPSA’s are located in rural areas. As a result, rural patients are less likely to have regular access to care. 

Healthcare workforce shortages present a dangerous situation to rural residents who may have difficulty finding an appropriate provider. In urban areas, there are about 84 physicians per 100,000 people; however, in rural areas this number drops to 68. cliexa alleviates stress on HPSA’s by virtually connecting patients and their providers. By eliminating travel times and automating digital intake, telehealth solutions dramatically increase efficiency, allowing health professionals to reach more patients. 

Poor Health Literacy

Health literacy is an important topic in modern day healthcare as new developments in the field, including new forms of treatment, can sometimes confuse patients or leave them feeling like they are not an important part of their own care decisions. According to the Rural Health Information Hub, poor health literacy can negatively impact “a patient’s ability to understand health information and instructions from their healthcare providers.” The bottom line is, poor health literacy can deter patients from taking a major role in their health journey and, in some cases, from even pursuing care in the first place. 

This is a real problem especially in some rural areas where there may not be an interpreter on the staff to help non-native English speakers understand health information and services related to their care. Even aside from that case, according to the US Department of Education, only “12 percent of adults had proficient health literacy,” and “adults living below the poverty level had lower average health literacy than adults living above the poverty threshold.”Furthermore, this plays a significant role in rural areas given that The United States Department of Agriculture reports that “the large majority (301 or 85.3 percent) of the persistent-poverty counties are nonmetro… ”

However, cliexa helps patients be engaged and educated in regards to their care. All of our services have at least some features built into them to support patient education so they can be proficient in the subspecialty of care that is most relevant to them. From the Office of Disease Prevention and Health promotion, studies have shown that “adequate health literacy may increase a person’s capacity to take responsibility for their health and their family’s health,”further promoting their access to care 

Another way that cliexa supports improving health literacy is through our telehealth services. Telehealth is the “delivery and facilitation of health care services through the use of remote mobile technologies.” We know that our telehealth services help patients be more connected and active in their care. With remote access to care, rural residents can utilize our telehealth services to improve their poor health literacy and find easier solutions to their barriers to care.

Health Insurance Coverage

Health insurance coverage plays a crucial role in determining access to healthcare. Rural areas tend to have consistently less coverage than metropolitan areas. According to a U.S. Census report, 9.1% of rural populations live without any health insurance compared to 8.4% of urban populations. Additionally, an article from ACA Implementation reveals that premiums are higher in rural areas and “on average, $39 more per month (10% higher) than those in urban areas”.

Distance to Nearest Provider Rural Settings

A higher percentage of uninsured individuals can lead to significant gaps in healthcare in rural areas. A report from the Office of the Assistant Secretary for Planning and Evaluation found that more than 25% of uninsured individuals withheld from receiving healthcare due to costs. This issue has become even more prevalent in the last few months as 5.4 million Americans have become uninsured due to Covid-related job losses.

cliexa combats sparse health insurance coverage in rural areas with innovations in telehealth. Telehealth allows patients to receive health care at lower costs than in-person visits. Virtual visits also provide a safer alternative to access care under the current conditions of COVID-19 in America, potentially saving thousands of dollars for vulnerable, uninsured individuals.

Social Stigma and Privacy Issues

A common trend across rural areas is the lack of anonymity associated with living there. This plays an important role in healthcare as some rural residents may avoid seeking necessary care as a result of social embarrassment or privacy concerns. The main avenues of care that this directly impacts includes substance abuse, mental health, sexual health, and chronic illness. 

In fact, a report from the US National Library of Medicine National Institutes of Health reports that although HIV cases in rural areas have been on the rise since before 2005, “HIV-related stigma can significantly impact care utilization and health outcomes including quality of life and medication adherence and people living in rural regions often experience high levels of HIV-related stigma.” Not only is HIV-related stigma a prevalent factor in rural social settings, mental health is not regarded as much in rural areas as in urban areas. The CDC reports that “children in rural areas with mental, behavioral, and developmental disorders face more community and family challenges than children in urban areas with the same disorders.”

Although “rural adults have higher rates of alcohol abuse, tobacco use, and methamphetamine use, [and] prescription drug abuse and heroin use has grown in towns of every size… rural areas often lack options for specialty substance abuse treatment programs… which may discourage treatment utilization among vulnerable, underserved populations.” Learn more about how cliexa is taking part in Combating the Opioid Crisis with Pain Management Technology

cliexa’s platform is perfectly geared towards helping rural residents receive care without social stigma or fear of privacy issues. Our Remote Patient Monitoring Platform lets patients report their symptoms and update their care providers securely and privately. Furthermore, our forms and assessments, such as the Fagerström Test for Nicotine Dependence (NIDE), offered on our Behavioral Health Platform, help providers have easy, reliable access to information about multiple patients coming from a wide range of areas. Finally, our Adolescent Resiliency Platform is perfectly geared towards users at risk for a number of personal health issues including sexual health, depression, and anxiety. Overall, it is clear that cliexa’s options will greatly help improve access to care for rural residents, by providing ways to circumnavigate social stigma and privacy concerns.  

Conclusion

Rural health is in a critical state in the modern day healthcare world due to rural hospitals being financially at risk, rural residents at risk for a variety of serious conditions (including substance abuse outcomes and chronic illnesses), as well as physical and organizational barriers that limit patients’ access to care. As Georgetown University’s Health Policy Institute cleanly states, “the rural population is consistently less well-off than the urban population with respect to health.”

cliexa, however, is a virtual health platform that is set on improving access to care for rural residents via remote patient onboarding, remote patient monitoring, telehealth, secure and private form access, and patient education models. One of our fundamental goals is improving outcomes, a goal which is greatly limited due to access to care being restricted for a variety of reasons in the rural world. We are confident that our host of solutions are perfectly suited to resolving these issues and improving outcomes in one of the most critical areas of the modern healthcare world. 

References

[1] UNC Rural Health Research Program; Findings Brief: Most Rural Hospitals Have Little Cash Going into COVID, May 2020. https://www.shepscenter.unc.edu/programs-projects/rural-health/projects/north-carolina-rural-health-research-and-policy-analysis-center/publications/

[2] UNC Rural Health Research Program: 170 Hospital Closures: 2005 – Present. https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/

[3]https://www.pewresearch.org/fact-tank/2018/12/12/how-far-americans-live-from-the-closest-hospital-differs-by-community-type/

[4]https://www.graham-center.org/rgc/publications-reports/publications/one-pagers/unequal-distribution-2013.html

[5]Designated Health Professional Shortage Areas Statistics, Bureau of Health Workforce Health Resources and Services Administration (HRSA) U.S. Department of Health & Human Services, June 30, 2020.

[6]https://www.graham-center.org/rgc/publications-reports/publications/one-pagers/unequal-distribution-2013.html

[7] https://nces.ed.gov/pubs2006/2006483.pdf

[8]https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/#demographics

[9]https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/health-literacy#5

[10] https://www.cliexa.com/solutions/telehealth/

[11]https://www.rwjf.org/en/library/research/2018/11/are-marketplace-premiums-higher-in-rural-than-in-urban-areas.html

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169533/

[13] https://www.cdc.gov/ruralhealth/about.html

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995852/

[15] https://hpi.georgetown.edu/rural/