ECRI Horizon Scanning has selected the topics below as those with potential for impact relative to COVID-19 in the United States within the next 12 months. All views presented are preliminary and based on readily available information at the time of writing.

Because these topics are rapidly developing, we cannot guarantee the accuracy of this information after the date listed on this publication. In addition, all views expressed in the commentary section are solely those of ECRI Horizon Scanning and have not been vetted by other stakeholders. Topics are listed in alphabetical order.

Description

Software developers have created integrated platforms that keep employee COVID-19 test results in one place and provide real-time information to employers. With the workforce resuming normal operations, proactive testing is important to reduce asymptomatic transmission. The Centers for Disease Control and Prevention (CDC) offers guidance for employers on incorporating COVID-19 testing into workplaces that are not healthcare facilities.  Given rapid changes in the pandemic landscape, however, employers struggle to keep their return-to-office plans current. 

Intrivo's Diagnostic as a Service (DaaS) solution manages the data and logistics of testing and tracing in one place, which might streamline return-to-office plans. The company has linked the delivery of FDA-authorized rapid antigen COVID-19 self-tests to employees’ homes or the office for weekly testing with employer human resource systems. 

Such integrated platforms could reduce the burden of separate test manufacturers, ambiguous population-management software, and disorganized communication strategies. For example, Axiom Medical Consulting, LLC, developed a mobile application (app) called CheckIn2Work that allows quick, self-service attestations for workplace point-of-entry checks for employees returning to work. The mobile app is integrated with an employer’s Human Resource Information System, enabling real-time reporting of the employee’s COVID-19 infection status. Color Health, Inc, has also developed a HIPAA-compliant platform that helps employers manage multiple testing protocols with built-in notification systems to remind employees who are not compliant.​

Commentary

Integrated testing and reporting apps might streamline workplace test-to-return and test-to-stay processes. Early feedback from internal ECRI commenters suggested that these apps might have a low-to-moderate overall impact on population health outcomes. They might create disparities among workplaces in providing safe work conditions to employees if only some employers can afford the cost of implementing the platforms. Some of the platforms encourage weekly testing, which might be unsustainable, given current COVID-19 test shortages.

Commenters also  reported concerns that some companies might rely on self-testing kits to make operational decisions. Although integrated testing platforms are intended to identify employees who have COVID-19 and prevent SARS-CoV-2 spread in the workplace, they might not accurately identify all employees with COVID-19. After false-negative test results, people might gain a false sense of security and stop observing public health measures (e.g. masking and social distancing). Some employees might also have health privacy concerns, even though the platforms are HIPAA-compliant.

• Categories: Systems and management, screening and diagnostics
• Areas of potential impact: Population health outcomes, disparities

Description

Vaccine mandates have been expanding to include vaccine-eligible children, to limit SARS-CoV-2 transmission in the community. This is because of rising numbers of COVID-19 cases, coupled with decreasing rates of new vaccinations, which have prompted public health authorities to consider additional measures to increase vaccine uptake. Vaccine mandates for children might positively affect population health outcomes by limiting  COVID-19 cases and disease severity in both children and adults.

Although vaccination is recommended by the CDC in children aged 5 years or older, rates are lagging, resulting in some states imposing vaccine mandates for children who want to take part in sports, in-person learning, or public dining and activities.

Vaccine mandates for children started with teen athletes, band members, and after-school program participants. Early adopters of the mandates included Hawaii, Los Angeles public schools, Washington, DC, public schools, and New York City students in “high risk” public league sports and extracurricular activities. ​Many states and school districts have also announced upcoming mandates for children who participate in in-person learning.

New York City and Philadelphia have both announced they will require proof of vaccination for entry into most businesses, including theaters, gyms, and restaurants. Children will need to be partially vaccinated by the start dates of the mandates and fully vaccinated within the month.

Commentary

With COVID-19 cases rising and variants circulating, greater efforts to prevent COVID-19 are needed. COVID-19 vaccine mandates for children might effectively raise vaccination rates and protect children and those around them from infection.

Early feedback from ECRI internal stakeholders suggested that vaccine mandates for children might improve patient and population health outcomes by helping prevent severe COVID-19 in children and reduce community transmission of the virus, reducing the incidence of COVID-19 in the general population. Mandates might create safer conditions within schools and reduce the amount of time children and adults miss school and work. However, they might increase the burden on schools and businesses to enforce the mandates. They might also help to keep more patients out of the hospital, allowing people requiring services for illnesses other than COVID-19 to access health care. Disparities might arise if some parents need to take time away from their responsibilities to ensure their children are vaccinated. Opposition to childhood vaccination might create barriers to mandate implementation and make it more difficult to engage the public in coordinated COVID-19 mitigation efforts going forward.

• Categories: Systems and management, public health
• Areas of potential impact: Patient outcomes, patient management, health care disparities, health care costs

Horizon scanning is a systematic process that serves as an early warning system to inform decision makers about possible future opportunities and threats. Health care horizon scanning identifies technologies, innovations, and trends with potential to cause future shifts or disruptions—positive or negative—in areas such as access to care, care delivery processes, care setting, costs of care, current treatment models or paradigms, health disparities, health care infrastructure, public health, and patient health outcomes.

The PCORI Health Care Horizon Scanning System (HCHSS) conducts horizon scanning to better inform its patient-centered outcomes research investments. Initially, PCORI defined the HCHSS project scope to focus on interventions with high potential for disruption in the United States in 5 priority areas: Alzheimer’s disease and other dementias, cancer, cardiovascular diseases, mental and behavioral health conditions, and rare diseases. In addition, the system captures high-level disruptive trends across all clinical areas, which may lead PCORI to expand the project scope to include other priority areas in the future.

In early 2020, the COVID-19 pandemic created a fast-moving, widespread public health crisis. In May 2020, PCORI expanded its HCHSS to elucidate the landscape of potentially impactful applications for COVID-19. The HCHSS COVID-19 supplement scans for, identifies, monitors, and reports on emerging and available COVID-19-related treatments, diagnostics, preventive measures, management strategies, and systems changes with potential for high impact to patient outcomes—for individuals and populations—in the United States in the next 12 months.

The HCHSS COVID-19 supplement produces 3 main outputs:

• Biweekly COVID-19 Scans (eg, this document) provide ECRI Horizon Scanning with a vehicle to inform PCORI and the public in a timely manner of important topics of interest identified during ongoing scanning and topic identification or through the ECRI stakeholder survey process.
• Status Reports (quarterly) briefly list and describe all COVID-19-related topics identified, monitored, and recently archived.
• High Impact Reports (every 4 months) highlight those topics that ECRI internal stakeholders (eg, physicians, nurses, allied health professionals, public health professionals, first responders, health systems experts, clinical engineers, researchers, business and finance professionals, and information technology professionals) have identified as having potential for high impact relative to COVID-19 in the United States.