Workbook for Health Insurance Today - E-Book: A Practical Approach

Workbook for Health Insurance Today - A Practical Approach (Electronic book text, 5th ed.)

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Diagnosis to Survivorship Managing Your Practice: Ethically, Effectively, Economically Marks.

Fractures Master Techniques in Orthopaedic Surgery: Pediatrics Master Techniques in Orthopaedic Surgery: Head and Neck Surgery: Breast Surgery Master Techniques in Surgery: Cardiac Surgery Master Techniques in Surgery: Colon and Rectal Surgery: Abdominal Operations Master Techniques in Surgery: Anorectal Operations Master Techniques in Surgery: Esophageal Surgery Master Techniques in Surgery: Gastric Surgery Master Techniques in Surgery: Hernia Master Techniques in Surgery: Arterial Procedures Master Techniques in Surgery: Patient Workbook Mastering Endovascular Techniques: Couples, Families, and Children.

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Medical Toxicology of Natural Substances: Medication Interest Model, The: Salud y enfermedad Memory and Brain Memory and Emotion: Reconsidering the Differences Men in Nursing: History, Challenges, and Opportunities Men's Health: Treatment Nuances in Contemporary Neurosurgery Menopathy: Fighting for Social Justice Mentoring in Nursing: Manifestations, Pathogenesis, and Management Migraines: Using S-Plus Modern Colposcopy: Principles and Practice Molecular Pharmacology: Modern Uses for Ancient Medicine Molecules: Nucleation, Aggregation and Crystallization: An Electrophoretic Guide Multiple Myeloma: A Practical Manual Multiple Sclerosis: Diagnosis and Therapy Multiple Sclerosis: A Teaching File Musculoskeletal Imaging: The Essentials Musculoskeletal Injuries and Conditions: Emerging Cancer Therapeutics Myocardial Failue: Therapeutic Principles in Practice Neonatal Nursing: An Illustrated Guide Neoplastic Hematopathology: A Teaching File Neuroimaging: Methods, Guidelines, and Imaging Fundamentals Neuroradiology: Scope and Standards of Practice Neuroscience of Attention: The Basics Nuclear Medicine: Text with Access Code Nurse Practitioners: Diseases Nurse's 5-Minute Clinical Consult: Procedures Nurse's 5-Minute Clinical Consult: Diagnostic Tests Nurse's Quick Check: Diseases Nurse's Quick Check: Fluids and Electrolytes Nurse's Quick Check: Application to Clinical Practice Nursing Ethics: Nursing From The Inside-Out: History as Evidence Nursing Know-How: A Core Curriculum Nursing Preceptorship: A Qualitative Perspective Nursing Staffing Deciphering Diagnostic Tests Nursing: Perfecting Clinical Procedures Nursing: The Ultimate Study Guide Nursing: Understanding Diseases Nursing's Leading Edges: Nutrition Made Incredibly Easy!

UK Edition Nutrition Psychology: Science to Practice Obsessive Compulsive Disorder: Diagnosis and Treatment Ocular Therapeutics Handbook: Gynecology Operative Techniques in Gynecologic Surgery: A Conceptual Approach Organ Transplantation: Foot and Ankle 5 Orthopaedic Knowledge Update: Musculoskeletal Infection Orthopaedic Knowledge Update: Musculoskeletal Tumors 3 Orthopaedic Knowledge Update: Pediatrics 5 Orthopaedic Knowledge Update: Shoulder and Elbow 4 Orthopaedic Knowledge Update: Spine 5 Orthopaedic Knowledge Update: Sports Medicine 5 Orthopaedic Knowledge Update: Trauma 5 Orthopaedic Manual, The: A Guide for Clinicians Osteoporosis: An Atlas of Investigation and Management Osteoporosis: Acute Medicine Oxford Desk Reference: Cardiology Oxford Desk Reference: Most remote monitoring has been developed with the capability to monitor several different vital signs including electrocardiogram, heart rate, respiratory rate, blood pressure, blood glucose, etc.

Some also include the ability to record information from an accelerometer and gyroscope for posture and activity, electrodermal activity sensors to try to assess emotional status, and ambient sensors to record information on the general context of a user location, temperature, humidity, etc. Lastly, digital health technologies as part of a multimodal approach to remotely monitor patients has been shown to improve health and quality of life. They also found that the use of these devices in conjunction with psychological counseling improved quality of life, reduced health care service access, hospitalization and all associated costs.

Many digital health technologies are focused on consumer-facing technologies. Patients who spend more time on self-care lower costs for everyone within the health care system. Effective self-care allows for prevention of avoidable visits to the emergency department and physician offices, and reduces the chance for lengthy hospitalizations. An unfortunate reality of these devices, however, is that there is a barrier to use them among those who would benefit the most. To make this kind of remote monitoring a success there will continue to be a need for advancement of more user-friendly devices that provide information when and where people want it, as well as automatic algorithms for online data interpretation, event s classification, and identification of invalid data.

Advances in user-friendly, meaningful analytics will also be necessary to process the data in real-time and to make meaningful inferences from the data by all stakeholders involved.

Patient education is incredibly important and the cornerstone of many public health initiatives. Due to the sheer volume of individuals interacting through digital technologies such as social media, such a platform could be a useful tool for patient education. Social media works similarly to traditional educational methods in that specific platforms are more effective in communicating with specific audiences.

Some have concern that social media is only used by certain age groups; however, the number of US adults using social networking sites has increased from 8 to 72 percent from to , and the number of U. Aside from traditional social media sources, there are stakeholders in health care that are attempting to build custom mobile technologies for the purpose of patient education.

Certain stakeholders have begun to develop digital health technologies intended to educate patients including those who are involved in clinical trials. Their hope is to expand these tools for general use around the globe, creating versions that support multiple languages and countries.

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Some pharmaceutical companies, for example, have used this type of global educational solution in their clinical trials. Mobile research systems hold great potential to reduce costs and patient burden, increase efficiency, and facilitate recruitment while curbing loss to followup. The perceived benefit of these systems solutions is their ability to give researchers access to a global, existing population while providing researchers with secure and Health Insurance Portability and Accountability Act HIPAA compliant data-collection options.

Globally, mobile health technologies are being used to perform disease and pharmacovigilance surveillance. Recently, in Cambodia, mobile phone-based, SMS text messages were used to conduct pharmacovigilance on 17 different vaccines. There is high unmet need for such a system because of the higher risk for patients in developing countries to be subjected to illegal and counterfeit drugs and vaccines. Developed nations such as Australia have also used similar technologies with SMS text messages to monitor adverse events following immunization.

See Case Example 1 for additional information on how SMS is being used in Australia to monitor adverse events post immunization. Active safety vaccine surveillance with mobile Health mHealth technology. FNY prompts users every Monday to report symptoms of influenza-like illness experienced during the previous week. Throughout the — season, , reports were submitted showing potential to serve as a viable complement to existing outpatient, hospital-based, and laboratory surveillance systems. Digital health technology to monitor new cases of influenza.

Many researchers and clinical programs are using mobile technology to provide clinical information to patients, to send out reminders for clinic visits, and also to collect data from patients remotely. The benefits of wearable health sensors are that they collect both self-reported data and high quality structured data that can be used to evaluate the safety and efficacy of a trial.

Given that these data can be collected from the patient while they are at home, these digital technologies should significantly reduce cost over time and reduce patient burden. This technology could also amass a larger pool of data that can be analyzed more thoroughly for signs of side effects and other long-term problems. With the increase in FDA approved health-sensors, the need for technology that can evaluate and that can integrate with these data should be prioritized to ensure that these data are being used to their full potential.

Short message service SMS text reminders to improve prenatal care uptake. A unique tool that could be used along with other digital technologies was recently developed to allow patients to record short videos and send them to their medical team via a mobile device. Since patients use the tool to record free-form videos, patients can provide unrestricted comments to medical teams at the press of a button.

The tool allows for the medical team to respond to patient videos as well, potentially enhancing the patient-doctor relationship. However, confidentiality of patient data is paramount and must be considered when designing any sort of digital health technology. The level of risk is typically commensurate with how sensitive the information being collected is and how large the data files are.

Few researchers and companies are actively soliciting health care data from digital health technologies such as adverse event [AE] reports , but a majority are passively monitoring. Many of these entities are using a combination of automated and manual processes to identify individual case safety reports. For example, social listening, the manual or automated collection of patient-generated data that is unsolicited and available publicly or with permission, enables a stakeholder to capture a large amount of patient-generated data.

Patients first-hand experiences and perspectives provide a valuable data source that can be used to improve the care they receive. Automated data processes typically employ normalization, text-matching, and natural language processing techniques to collect and filter data. When considering the evaluation of social media data, analytical processes should include the following qualities: Each form of social media has demographic characteristics associated with it and, as in all technology, the people who employ a given platform changes over time.

Facebook is most useful for specific medical conditions, peer-to-peer support, fundraising, and sharing research amongst researchers and health care providers. Some physicians deliberately decide to connect with their patients on social media; however, most have reflected that they are wary of doing so. These communities are often engaged in the health care industry through data-sharing partnerships to improve products, services and care for patients. Initial pilot studies on the impact of crowd-sourced research protocol designs indicate that patient participation has increased, and provider burden has been partially alleviated.

Another advantage of the increased use of mobile technologies is that it has shown potential for overcoming the digital divide previously identified in the digital health space. The digital divide refers to the chasm between those with regular access and ability to use digital technologies, such as the internet and those lacking such access. Past studies describe the realities of inequities in digital access by race and income and describe fears of the s that the Internet would not scale economically to encompass users of all demographics. However, past barriers to information access such as costs of laptop and desktop devices and broadband access have been circumvented by the smart phone.

In lower income groups, smart phones provide regular access to communication and information with fewer cost and access constraints than traditional broadband services.

Research on population level data of ownership and access to mobile technology show tremendous uptake of smart phone technologies across the country for all Americans, as 91 percent of the adult U. It is estimated that digital health technologies are being used to recruit patients in only 11 percent of all industry clinical trials. One study reported being able to recruit enough patients for their entire trial in less than a month, a task that would have taken years to complete through traditional channels. While digital health technologies have proven useful for patient recruitment, it is not considered a worthwhile tool to screen for eligibility.

Moreover, many digital health technology users are concerned about privacy in public forums and will refrain from discussing the type of medical information that would be needed to determine eligibility. Although there are many advantages to digital health approaches, there are also current limitations and challenges to its implementation in registries.

Therefore, engaging with people in the targeted population directly is important to gather data and develop insights that would influence the registry design process. Although they add more work, this patient insight driven approach is critical to enabling the successful integration of digital health technologies into registries see Figure These approaches may also be effective in enhancing recruitment and engagement in non-digital strategies.

Process for collecting patient insights to impact registry design. In an effort to incorporate digital health approaches, it may be important to evaluate the following questions in the early phases of registry design:. Using an iterative design that incorporates user insights and experts in developing user-centered designs as an institutional part of the process before integrating digital health approaches may continue to influence better registry designs and improved data collection.

There are many concerns when it comes to communicating with patients via digital technologies. Engaging patients on social media can provide a public service and comfort to patients and their caregivers. While it is worth noting that the number of these violations committed by physicians is relatively low, Grajaless et al. As many registries are developed for long-term, multiyear, longitudinal engagement with patients, a challenge to launching these registries with digital health approaches is that the technologies will continue to rapidly update and enhance over time.

Many of the digital health innovations today are simply being added to registries. This can increase the complexity and cost of the program, which is the opposite effect of what these solutions were intended to achieve and ultimately makes the uptake of these solutions more challenging. Using these approaches as primary solutions, integrated within broader registry operations, is a challenge. This challenge is overcome by designing registries that employ digital health approaches to replace standard processes i. Establishing a digital health approach early in the registry development process is critical to building an integration strategy that takes into account the real-world use of the approach.

Integration can be documented and achieved with inclusion in the following project assets:. A worksheet is provided at the end of the chapter to assist with determining which digital health approach should be used in a registry. It is intended to serve as a guide in the decision making process and is not comprehensive of all study issues that should be evaluated prior to the use of a digital health approach or device within a registry. The convergence of emerging, digital health technologies promises a paradigm shift in the world of health care. The technologies are the enablers, as the intention in many nations is to focus much more on the patient.

Our bodies generate data 24 hours per day, 7 days per week, and generally those data are only captured by registries in routine health care visits. Although data captured at health care visits and entered into electronic medical records are generally some of the best health care information available today, with the expert provider as the intermediary creating the data entry, there remains a huge gap in understanding what happens to the patient outside of these visits.

Patient-generated health information can help fill in these gaps. Some may find it hard to imagine a future where useful data can be captured from outside traditional health care settings. However, many leaders have bold visions of the future, and are making changes to their organizations today, to prepare for that future. We predict that patient-generated data will be much larger in volume than electronic health care records.

The sources of health data in the future may be different from the sources that exist today. Startups such as DataCoup, have emerged to allow consumers to be paid for sharing their personal data. Since data are increasingly viewed as an asset, a potential threat is the availability of individual level data, particularly if some individuals refuse to share their data or will only share it at the right price. As sensor technology improves, we are likely to see sensors embedded in devices above and beyond the activity trackers and smart watches that appear to be cutting edge at present.

For example, sensors in flexible bioelectronics, such as smart bandages or smart strips that could be easily affixed and removed from the human body. The NIH has initiated a challenge for a wearable alcohol biosensor that would be able to monitor blood alcohol levels in real time. To better understand medication non adherence, there are new developments such as pill boxes with sensors that can track when a patient opened the box as well as containers and syringes that illuminate brighter and brighter as a reminder system. Going a step further, Proteus Digital Health has developed an ingestible sensor that can measure medication adherence patterns.

Some technology companies anticipate that this is just the beginning. Sensors could become ubiquitous in measuring health data, perhaps even monitoring our health during our daily commutes. Even though Ford Motor Company has halted research into installing heart rate sensors in car seats, could data collected from car journeys be of medical value one day? In Beijing, China a pilot project added sensors to straps in buses that are held on to by commuters during rush hour.

Project H, a research project in the Netherlands is evaluating a shopping cart that can capture data such as heart rate, one-lead electrocardiogram ECG , and blood oxygen saturation level SpO 2 from the person pushing the cart around the supermarket. Also, with regard to food, what if people wanting to track their calorie intake could do so simply by taking a picture of their meal using their smartphone?

One of the major drivers behind collecting all of this data is the need to improve health outcomes, to keep patients out of the hospital through remote monitoring, and to reduce costs. Some insurers and employers are also interested in these new sources of data to help them manage risk. Perhaps an airline wants to track sleep data of their pilots to reduce the risk of pilot error in a flight due to fatigue? Researchers need to be mindful that as more data have been collected, concerns about privacy have also grown. The registry of could look dramatically different from the registry of today.

Some researchers are excited about the concept of digital phenotyping, and Dr. The , Genomes project in England is the largest national sequencing project of its kind in the world. While computable phenotypes using clinical, social, and behavioral data from electronic health records and PROs are possible today, it is the emerging sources of unstructured data outside of health care settings, such as Twitter, along with other patient generated data that are making researchers curious about how we might better characterize diseases in this modern era. Digital health is a collection of emerging disciplines and technologies that appear to be evolving and converging at an increasingly rapid pace.

Indeed, as digital health technologies continue to demonstrate ways to measure health activities and complement or supplement the traditional approaches to collecting health information, opportunities for registries abound. Opportunities provided by utilizing digital health technologies include improved recruitment and retention, reduced burden on researchers, enhanced uptake of technology solutions by the health care system, and collection of information that is not routinely captured. However, there are still considerable risks with privacy, quality, and control of data analysis and communication.

As new digital technologies are developed, researchers must acquire new skillsets to navigate their use appropriately. New methods will also be needed to appropriately integrate various sources of information and transform unstructured fields to formats that can be used for evaluating the safety and effectiveness of treatments used in the real world. Investments are needed now to prepare for the decade of new digital technologies and their use within registries. Digital health technology will not transform clinical practice and health care research without being designed with the complex needs of users in mind, as well as the careful assessment and appropriate level of training on the use of these tools by health care professionals.

Issues related to interoperability of systems, user engagement, measurement validation, regulatory use in studies, meaningful clinical interpretations, privacy and security, among others, will need to be carefully addressed as these new technologies are utilized in clinical medicine and research. Download MS Word 73K. Turn recording back on.

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National Center for Biotechnology Information , U. The Rise of Digital Health While computing and the Internet have been a part of research for decades, the use of digital technologies for health research is much more recent. Utilization of Digital Health in Clinical Research Smartphones have become an important way for patients to acquire health care information. Vital Signs The capabilities of digital health technologies are constantly expanding.

Activity Tracking Many digital health technologies are focused on consumer-facing technologies. Education Patient education is incredibly important and the cornerstone of many public health initiatives. Mobile Research Systems Mobile research systems hold great potential to reduce costs and patient burden, increase efficiency, and facilitate recruitment while curbing loss to followup. Examples of Digital Health Uses in Global Patient Registries Globally, mobile health technologies are being used to perform disease and pharmacovigilance surveillance.

Case Example 1 Active safety vaccine surveillance with mobile Health mHealth technology. Case Example 2 Digital health technology to monitor new cases of influenza. Greater Access to Minority Populations Via Mobile Devices Another advantage of the increased use of mobile technologies is that it has shown potential for overcoming the digital divide previously identified in the digital health space. Reduced Time and Potential for Increased Retention and Long-Term Followup of Patients It is estimated that digital health technologies are being used to recruit patients in only 11 percent of all industry clinical trials.

Current Limitations and Challenges To Using Digital Health in Patient Registries Although there are many advantages to digital health approaches, there are also current limitations and challenges to its implementation in registries.

Figure Process for collecting patient insights to impact registry design. Is the user willing to try a digital health approach? What are their interests and comfort with technology? What aspects of the digital health approach were not understood or caused concerns with the user?

Workbook for Health Insurance Today : a Practical Approach.

What would motivate and encourage the user to continue engaging with the digital health approach over the course of the study? Communicating to Patients Through Digital Technologies There are many concerns when it comes to communicating with patients via digital technologies. Longitudinal Nature of Registries: Challenges Due to the Speed of New Technology As many registries are developed for long-term, multiyear, longitudinal engagement with patients, a challenge to launching these registries with digital health approaches is that the technologies will continue to rapidly update and enhance over time.

Researching and maintaining deep insight on digital health product updates i.

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