PCORI Biweekly COVID-19 Scan: Smartphone Applications, Surveillance Programs (January 9-22, 2021)

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

The availability of multiple COVID-19 vaccines through FDA Emergency Use Authorizations has created a need for large public vaccine initiatives: education campaigns, effectiveness monitoring, appointment scheduling, and reporting of side effects. Several applications are under development to help government agencies and health care professionals communicate about and schedule COVID-19 vaccines. With an initial absence of federal protocols for managing COVID-19 vaccinations, state and local governments have developed their own policies and procedures, using approaches that include smartphone apps and other electronic tools to educate the public and help administer an orderly vaccine rollout.

For example, GetWellNetwork (Bethesda, MD) has developed an app that supports vaccine distribution, education, and guidance for health care organizations across the country. The app delivers patient communications through smartphones, smartwatches, and computers. It allows users to schedule vaccine appointments, report side effects, learn more about the vaccines, and receive reminders about second doses. The app also sends users reminders to remain engaged in protective measures even after receiving their vaccinations. Other vaccine-management app developers include Skedulo Holdings, Inc (San Francisco, CA), Mozzaz Corp (Philadelphia, PA), and RSVPify LLC (Chicago, IL).

Commentary

Smartphone applications to manage COVID-19 vaccine communications and scheduling might increase public knowledge about these initiatives, which could, in turn, improve adherence to COVID-19 vaccine dosing schedules. However, the widespread use of smartphone apps for vaccine scheduling and follow-up could raise concerns about patient data confidentiality.

Early feedback from ECRI internal stakeholders suggested that implementing these apps with COVID-19 vaccine rollout programs could improve vaccine uptake, if well-timed and convenient for users. Stakeholders noted that similar apps (eg, appointment reminders, symptom checkers) are increasingly common across health care, suggesting that the public might be open to adopting familiar technology for COVID-19 vaccination efforts.

On the other hand, stakeholders thought that the technology’s usefulness could be limited if users disregard app recommendations or instructions. Single-language-only apps might limit vaccination efforts and increase disparities in some communities. Also, the use of multiple vaccine-related apps by different health systems or municipalities might fragment vaccine rollout efforts and slow overall progress, compared with more centralized national health systems.

• Categories: Systems and management
• Areas of potential impact: Health care delivery and process

Description

In December 2020, two genetic variants of SARS-CoV-2 with higher transmissibility were identified in the United Kingdom (variant B.1.1.7)​ and South Africa (variant B.1.351)​. They have subsequently been detected in countries around the world. Although B.1.1.7 and B.1.351 do not seem to increase disease severity, the variants might be more transmissible than the previously dominant variant and, thus, lead to an increase of COVID-19–related deaths. Moreover, available vaccines might offer less-than-robust protection against other variants. One such variant is B.1.351, which contains at least 1 mutation in a region of the spike protein that serves as a key target for neutralizing antibodies.

Surveillance​ programs are needed to support public health responses to these emerging variants. This will require expanded testing and genomic sequencing to identify where the variants are starting to spread, followed by contact tracing and quarantine programs to decrease transmission. With support from the CDC, the genomic sequencing companies Illumina (San Diego, CA) and Helix (San Mateo, CA) will expand the national surveillance infrastructure to track the emergence and prevalence of new variants. The CDC has also ​​partnered with clinical laboratories, national laboratories, state and local health departments, and universities​ to ramp up sequencing-based surveillance and contact tracing.​​  

Commentary

The pandemic has strained health care facilities, caused financial hardship, and increased anxiety. The emergence of resistant strains causes even more burden. Early detection of emerging coronavirus strains in communities might help suppress their spread.

Initial comments from ECRI internal stakeholders suggested that surveillance programs might help provide officials with data to direct the creation of new public health guidelines that can be applied to prevent the new variants from becoming dominant coronavirus strains. Surveillance programs combined with vaccine monitoring might help determine the efficacy of vaccines against emergent strains and so direct the plans for targeted vaccination campaigns. Surveillance programs that help limit coronavirus spread might improve population health, decrease hospitalizations, and reduce health care costs.

Stakeholders noted that the success of these programs relies on having reporting systems that share information at a national level among the CDC, its partners, and health officials. However, well-structured systems might not be established before novel strains arise. Surveillance programs might also use resources that are already limited in the overburdened testing process.  

• Categories: Systems and management
• Areas of potential impact: Clinician and/or caregiver safety, health care delivery and process, health care costs, health care disparities, patient outcomes, population health

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.