#mHealth #TelemedNow w Circulation CQO #outcomesjc

#TelemedNow Twitter Chat Wednesday, March 3 – 8 PM ET Introduction & Welcome: Ritu Thamman (@iamitu) – Moderator #mHealth #TelemedNow w Circulation CQO #outcomesjc

Q1: While mHealth is touted as a game changer,it’s often conditioned by financial issues, allocation of resources, environmental/ infrastructure factors. How can mHealth help address these concerns & impact life-style behavior change or Pilladherence? How can mHealth help address these concerns and impact life-style behavior change or medication adherence?

A1 Notable Responses: Jamey Edwards (@jameyedwards) With Supercomputers on our hips/wrists, gentle nudges & in your face alerts can help "remind us" to better #healthcare. We need to be careful that alert fatigue & fitness trackers need to allow customization to fit users personality or they stay on the dresser Jessie Golbus (@JRGolbus) (1) mHealth’s value proposition is that it can extend healthcare resources outside of traditional clinical settings. Providers are limited in the time they can devote to modifying behaviors that impact health outcomes – nutrition, etc. These are esp relevant for CVD. #OutcomesJC (2) mHealth can be tailored to individuals in a way that is challenging for providers to replicate. mHealth can meet patients where they are in their phases of behavior change and support them in their natural environments. #OutcomesJC Andrew Watson (@arwmd) Jessie, thank you, and one key point that you make is that you can tailor the intervention easily at home #TelemedNow This will help behavioral change. Connie Hwang (@hwangc01) I'm intrigued by how artificial intelligence can be built inside mHealth apps and devices, prompting evidence-based suggestions and nudges in real-time. Andrew Watson (@arwmd) And what is the best vehicle for mHealth ? #TelemedNow. Smart phone, computer, watch ?? I personally do not include phone calls in this mix. Ritu Thamman (@iamritu) If #mHealth can get the right message at the right time & change someone’s behavior that will be incredible,it will take multiple “interventions” texts etc to reinforce healthy behaviors & using social media to deliver these interventions will be Helen Burstin (@HelenBurstin) mHealth offers remarkable potential to tailor and appropriately "dose" interventions based on patient needs. It doesn't have to be one-size-fits all. Ritu Thamman (@iamritu) Exactly @HelenBurstin what works for one person may not work for another human behavior is complex and to find out what motivates someone can take time #TelemedNow #outcomesjc Salim Saiyed (dr_salim_MD) mhealth can impact changes by - making it simple & easy for patients - frequent nudges - gamification - challenges with other cohorts or family Helen Burstin (@HelenBurstin) Agree @jameyedwards. Huge potential, especially around customization. I'm "over" being told to stand by my apple watch, but it doesn't mean I don't want mHealth apps to nudge me away from the next cookie in my sights! #TelemedNow #outcomesjc Matt Sakumoto (@MattSakumoto) mHealth can start the journey toward continuous vs episodic care. Recognizing that care needs to occur outside the clinic walls (and supported by financial, institutional, and infrastructure) Rashmee Shah (@rashmeeshah) I'm very interested to see how/if mHealth improves health in diverse populations. I have some skepticism, but I'll keep an open mind. We wrote about it here for the @theNAMedicine here, with @MichaelEMatheny and others. Beza Merid (@BezaMerid) Yes, I think it's important to think broadly about the many kinds of support structures that are needed to help patients to sustainably use mHealth interventions to continue improving health Ritu Thamman (@iamritu) Your editorial on @SpatzErica article brought up a key point - having HCW as support for #mhealth is great for a study but should also be covered by insurance #Telemednow #outcomesjc Andrew Watson (@arwmd) If this technology can exist in a risk arrangement, such as bundle care, then in theory it is already covered. That is, the provider services are covered. The big challenge would be the technology cost and connectivity cost. #TelemedNow Q2: Will #mHealth be limited to only certain groups or can it work more generally? A2 Notable Responses: Jamey Edwards (@jameyedwards) It can absolutely work generally as well as w/ specific use cases. fitness trackers to diet, #RPM to testing, #DigitalHealth tools are part of daily medical practice. They bring convenience & #healthcare to #patients wherever they are & on their terms. Jessie Golbus (@JRGolbus) mHealth can support anyone. I think it's important that these interventions are user-centered and that end-users are involved in design. I think it’s also important that we make enroll diverse communities in the research supporting these interventions. #OutcomesJC#TelemedNow Yvonne Commodore-Mensah (@ycommodore) Couldn’t agree more! Design *with* the end-user rather than *for* the end-user. Dr. Salim Saiyed (dr_salim_MD) depends on how we design it! Certain groups will require more careful thought on implementation. grants to support devices, internet all can be plan for #mhealth #TelemedNow Beza Merid (@BezaMerid) I think this is a matter of the values that inform how we design and use these technologies. We can work to equitably distribute benefit, but that involves intent and capacity and a commitment to justice as a core value in health tech design #Telemednow#outcomesjc Ritu Thamman (@iamritu) JITAIs should work but may be more effective at changing behaviors if culturally sensitive;chat dm study had multiple dm messages crafted in a way the population studied could understand easily &they had positive behavioral change. Yvonne Commodore-Mensah (@ycommodore) #Equity should be a priority. Digital divide persists in low income Americans who have lower levels of tech adoption. Read more here. Helen Burstin (@HelenBurstin) More than engage in research; need co-design with diverse populations. It reminds me of @emilyslist which is actually an acronym (Early Money is Like Yeast). I think early patient engagement in design mHealth is the yeast we need! Connie Hwang (@hwangc01) An important step in addressing the digital divide is increasing broadband access. Good to hear that yesterday's hearing at House Committee on Energy & Commerce's health subcommittee emphasized boosting broadband access. @_ACHP #TelemedNow Q3: Can JITAIs Just in Time Adaptive Interventions help address the digital divide? What factors are likely to worsen existing disparities? A3 Notable Responses: Jamey Edwards (@jameyedwards) We need thoughtful #digitalhealth tools to properly bridge #digitaldivide instead of broadening it. PulseOx needs to take into account skin pigmentation. #AI needs to NOT be fed biased data. #mHealth needs to be: Any Language, Any Device, Anytime Jessie Golbus (@JRGolbus) (1) Smartphone and wearable device ownership has increased broadly across age, race, and socioeconomic groups. 71% of those making <$30,000/yr own a smartphone. So this is less of an issue in the current era. (2) mHealth can worsen disparities if diverse communities are not involved in their design. On the flip side, in patients with limited access to care, you can potentially reach more people and do so more frequently. I think we still have a ways to go though. Andrew Watson (@arwmd) Jamey - were you able to learn much from your experience with #Telemedicine in translation services? You must have seen disparities in the digital divide here. Jamey Edwards (@jameyedwards) Yes. Most #telemedicine platforms haven't taken language into account or made accommodations for underserved populations. We need to do better in meeting people where they are with practical solutions. the phone is more ubiquitous... Andrew Watson (@arwmd) Are you able to, or are other companies able to, evaluate disparities based on language in location? #TelemedNow#outcomesjc Ritu Thamman (@iamritu) depends on the cultural appropriateness of JITAIS- vernacular & language used, whether someone has enough data plan to receive texts so mHealth may widen #digitaldivide But given most people in have phones,getting broadband access should be a priority #TelemedNow#outcomesjc Sam Lippolis (@samiamlip) Like when the phone automatically tells me how many minutes my drive is at commute time (lol pre covid) I think I love this idea for #mHealth. Can it notice when I stand in front of the fridge and remind me I was just there 30 minutes ago? Yvonne Commodore-Mensah (@ycommodore) #JITAIs have the potential to reduce disparities in health outcomes by collecting contextual information that may disproporationately impact persons who are socio-economically disadvantaged. #OutcomesJC Pedja Klasnja (@pklasnja) Smartphones have high penetration in low SES communities than any other type of technology, with ownership on par with high-SES groups. This allows for greatly increased access. #OutcomesJC Judd Hollander (@JuddHollander) They do, but regular phones have even better penetration. Although that may change one day. #TelemedNow Helen Burstin (@HelenBurstin) Need to demonstrate effectiveness across all pops, including those at greatest risk. @CMSGov reported 2800% increase Medicaid #telehealth services. If CV mHealth reduced costs and improved outcomes, could we get payment for devices? Andrew Watson (@arwmd) Agree Helen. I wonder if there is a cheap enough carrier that would enable this. At times there’s such a cost pass-through with hardware in connectivity, it makes the starting price so high.

Q4: Why hasn't cardiovascular diseases embraced #mHealth like other areas have? A4 Notable Responses: Matt Sakumoto (@MattSakumoto) I think actually leads the mHealth interventions (@AliveCor FitBit and more) #TelemedNow Ritu Thamman (@iamritu) CVD is complex w many preventive strategies that are not remunerated as much as procedures such as BP control or exercise #mHealth is promoted by consumer demand: CVD has not focused on #mHealth perhaps for the heavy lift to get it covered by insurance #TelemedNow#outcomesjc Andrew Watson (@arwmd) At some point I think we have a vernacular issue as well. Remote patient monitoring, mobile health, telemedicine, telehealth, eHealth, store and forward, video visits.... Jessie Golbus (@JRGolbus) I think mHealth hasn’t reached it potential broadly, not just in CVD. Traditional modes of studying interventions are slow and the technology often outpaces the research. One of the advantages of MRTs is their ability to efficiently study interventions. #OutcomesJC Connie Hwang (@hwangc01) Same thought here! My mind went to AppleHealth and their HR and arrhythmia detection, ReDS system for CHF lung fluid monitoring, etc. Sam Lippolis (@samiamlip) Yes, yes and yes. And the fixation on definitions. If everyone has a different definition, then no one know what we're talking about. And as tools change definitions MUST change. I vote for: Healthcare using the tool of ___________ (fill in the blank) Ritu Thamman (@iamritu) That’s half the battle with understanding something- what’s the name & the overlapping meanings #TelemedNow#outcomesjc Andrew Watson (@arwmd) Virtual care is also popping up...... Sam Lippolis (@samiamlip) "Virtual first" also a new popular one Q5: How will collecting data be perceived by users? Will users feel comfortable with contextual #mHealth information being collected & used in these decisions? A5 Notable Responses: Jamey Edwards (@jameyedwards) Consumers / Patients traded #privacy long ago for convenience & better more relevant information. I think same is true of #healthcare. Depends on context in contextual as well. No one wants people at same office, know what ails them. Jamey Edwards (@jameyedwards) I also always go back to the #patient owning their data and granting their #healthcare team access to document in their record. Would love to see that in the world! Andrew Watson (@arwmd) One area that may make them more comfortable is whether or not we give them real time feedback. Either verbally, or graphics, or dashboards. have to be careful about feedback that is only with bad results. puts a negative valance on the experience. Jessie Golbus (@JRGolbus) I think being upfront with users is important. There are also way to collect that data that protects users privacy. Walter Dempsey (@walthdempsey) I think this strongly depends on context. Specifically explaining what the data is being used for and explicitly stating what it will not be used for as best as possible. Informed consent is a complex issue with passive data that can be used in myriad ways Ritu Thamman (@iamritu) Most folks don’t realize their internet data is being sold all the time. Data transparency is not prime time yet. If folks knew perhaps they would feel more comfortable with sharing their data #outcomesjc#TelemedNow Jessie Golbus (@JRGolbus) 1/2 I think being upfront with users is important. There are also way to collect that data that protects users privacy. 2/2 For example, a geofence puts a digital fence places a virtual perimeter around geographic locations. When a geofence is crossed, instead of encoding the specific location, the smartphone can encode a more general location such as “home.” #OutcomesJC Beza Merid (@BezaMerid) I like this, because I start with a presumption of users' skepticism about efforts to collect data Susan Murphy Iab (@SusanMurphyIab1) People should always have the ability to easily make the mHealth intervention go into "privacy mode" so the individual is in control. There is a tradeoff--if the individual really benefits then the individual is more likely to share their data. @iamritu #outcomesjc Pedja Klasnja (@pklasnja) Transparency about what is being collected is key. But so is helping users understand what they are getting in return. People can only make informed decisions when they have a clear sense of what the tradeoffs are. Pedja Klasnja (@pklasnja) Another thing that has emerged from the early privacy work with mobile tech is that you can often provide core functionality with low-sensitivity sensing (e.g., steps), but let users turn on other functionality that involves more invasive sensing. Give users control #outcomesjc Sam Lippolis (@samiamlip) seems like 'who' is collecting the data changes perception. For some reason we all easily give apple & fitbit health data but healthcare specific companies we apprehensive. May not be totally logical on 'patient|consumer' perception Helen Burstin (@HelenBurstin) Perceptions will likely depend on the use case. Patients likely comfortable if #mHealth data supports MY care (e.g., adjust meds/devices), but higher discomfort if uses unknown. Transparency about how data will be used is (Key) Dennis Ko (@denniskomd) This is super interesting -- I wondering if anyone knows or has done study to ask patients about perceived view of #mHealth devices in tracking their health Q6 How to keep folks #mHealth data safe? If collected as research it’s #HIPAA protected but if that same data’s collected by X study applications can be sold to commercial entities? Notable Responses: Jamey Edwards (@jameyedwards) All patient info should be opt in. Give patient control over their information. While still overwhelming to manage, at least sets a baseline level of protection. Jessie Golbus (@JRGolbus) 1/2 Putting the onus on patients is probably not realistic. I think providers need to be aware of how data and be used and have honest conversations with our patients around privacy issues. #OutcomesJC 1/2 There is also the potential to strengthen legislation. The EU General Data Protection Regulation applies to all potentially identifiable personal data and mandates strengthened consent, prespecified uses, and individuals’ rights to obtain their data. #OutcomesJC Ritu Thamman (@iamritu) Until everyone owns their own data and can use it as their own currency instead of commercial entities, nothing will change. Their is no financial incentive for businesses to change until data is legislated. #TelemedNow#outcomesjc Ritu Thamman (@iamritu) This is different than in USA where legislation of data will be key to getting hospital systems to “share” their data #TelemedNow#outcomesjc Salim Saiyed (dr_salim_MD) this is so important to keep #data safe #TelemedNow now more than ever with exploding of collection of various data points CME Information For #TelemedNow CME - the website to set up an account, register your cell and / or claim CME : If you registered your cell text the code to 412-312-4424 Tonight’s code for 1h of category 1 CME: COGTON Thank you @UPMC for supporting our chat CME

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