PCORI Biweekly COVID-19 Scan: Big Data to Improve Diagnosis, Virtual Reality to Support Mental Wellbeing (July 7-20, 2022)
The Briefing provides an at-a-glance view of some important developments in the information universe surrounding COVID-19. The views presented here are solely those of ECRI Horizon Scanning and have not been vetted by other stakeholders.
Experts caution that the Omicron variant of the SARS-CoV-2 virus might continue to evolve in unexpected ways and a new variant might arise because many precautions against transmission have been abandoned (e.g. masking and social distancing) and clinical trials are showing waning vaccine-induced immunity.
Despite the majority of current COVID-19 cases being mild, most available treatments are for people with severe disease or increased risk of hospitalization. Researchers exploring treatments for milder COVID-19 cases hope that clearing mild infections more quickly could slow viral mutation by breaking transmission routes.
Evidence suggests that the risk of experiencing post-COVID conditions (PCC) might be similar across all disease severities. A recent study, not peer reviewed, found spike protein present in patients’ blood for up to 12 months after initial infection, suggesting a lingering viral reservoir. Investigations are striving to better classify these PCC patients for improved diagnosis and management (see leveraging big data in Topics to Watch). And the US Department of Labor (DOL) has launched an online forum for employees and employers to explore and address the challenges of this “mass disabling event.”
Details on the consequences to overall US health during the pandemic continue to emerge, from accelerated antimicrobial resistance to increased prescribing of mental health drugs (see Topics to Watch for a nonpharmaceutical alternative). Meanwhile, monkeypox continues its global spread with concerns about containment, a shortage of vaccines, delayed test results, high hurdles to obtain treatment, and a shortage of funding for sexual health clinics.
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.
Leveraging Big Data to Improve Diagnosis of Post-COVID-19 Conditions
At a Glance
- Symptom variability of post-COVID conditions (PCC; commonly referred to as long COVID) and symptom similarity to those of other conditions have complicated diagnosis of PCC. A need exists for standardized, evidence-based diagnostic criteria.
- Using modern computation techniques to analyze patient health, so-called big data may reveal new patterns and insights that could inform our understanding of the distinct clinical manifestations of PCC.
- National efforts curating big datasets include the National COVID Cohort Collaborative, All of Us Program, and Million Veterans Project.
- Using big data, recent research supports the feasibility of using computational algorithms to identify PCC in adults and children, enroll patients in relevant clinical trials, and guide treatment as options become available.
The variability of PCC symptoms among patients has made it difficult to establish standardized diagnostic criteria. This symptom variability complicates patient management and clinical trial enrollment. Several parallel efforts are using big data sources, such as electronic health records (EHRs), with goals including advancing our understanding of PCC and identifying patients who have it.
The term big data refers to data sets that are extremely large and/or complex and, thus, must be analyzed using modern computational approaches, such as machine learning algorithms.
Large, COVID-19-related patient health datasets have been curated by the National COVID Cohort Collaborative (N3C), which contains data on more than 5 million COVID-19-positive patients (13 million people total) and more than 14 billion rows of data; the All of Us Research Program, which recently made available the health data of 20 000 people who have had SARS-CoV-2 infection; and the Million Veteran Program, which collected additional, COVID-19-related information in its MVP COVID-19 Survey.
A study published online in May 2022 found that a machine learning model developed using the N3C database identified a diagnosis of PCC in adults with roughly 90% accuracy. Another study, not yet peer reviewed, suggests that applying an EHR-based algorithm to serology testing in children whose SARS-CoV-2 infection went undetected by PCR testing might help to identify children previously infected and at risk of developing PCC. These and future studies might help health care providers make PCC diagnoses, enroll patients in relevant clinical trials, and guide treatment as options become available.
Although an estimated 15% of US adults have or have had PCC, its diagnosis remains challenging. Ongoing, large-scale analyses of patient health data might help establish standardized diagnostic criteria, which might better support clinical research and improve patient management and health outcomes.
Early feedback from ECRI internal stakeholders suggested the initiatives providing big data for PCC analysis are valuable, although big data approaches are largely diffused in public health and clinical research, potentially limiting overall disruption. Stakeholders expressed concern that the PCC diagnostic criteria that the models establish might be the same ones being used to judge their own diagnostic accuracy, limiting objectivity. However, if this and future research yield a definitive set of risk factors for developing PCC, or help to identify the most effective treatments, clinical practice could be substantially disrupted.
Clinically validated algorithms might help providers identify patients at risk of developing PCC. Remote risk-stratification using EHR data, combined with increasing availability of telehealth consultations and decentralized clinical trials, might help mitigate geographic or socioeconomic disparities in access to care for PCC. However, the lack of FDA-approved treatments for PCC might limit the benefits of improving diagnosis on patient outcomes. Patients who have not sought regular health care, and therefore have less information in their EHR, might also see less benefit.
- Categories: Screening and Diagnostics
- Areas of potential impact: Patient outcomes, population health, health care delivery and process, health care costs, and health care disparities
Virtual Reality to Support the Mental Wellbeing of Health Care Workers
At a Glance
- The COVID-19 pandemic caused significant psychological distress to the general public, with frontline health care workers experiencing high rates of stress, anxiety, and burnout.
- Virtual reality (VR) might be a scalable intervention to help healthcare workers recover from psychological distress and promote ongoing mental wellbeing.
- These electronic interventions are being developed and investigated for use outside of clinical settings to mitigate psychological distress. Examples are Ohio University's Game Research and Immersive Design (GRID) Lab’s Tranquil Cinematic-VR and Reulay Inc's VR simulations.
- A growing evidence base suggests that VR might reduce short-term stress and anxiety and improve a sense of mental well-being among health care workers.
- The cost of VR headsets is estimated to be from $150 for mid-range equipment to upwards of $400.
Virtual reality (VR) interventions are being investigated for use outside of clinical settings to mitigate psychological stress in the general public. These VR interventions might be a useful tool to improve health care workers’ psychological well-being and promote ongoing mental wellbeing. There is a need because the COVID-19 pandemic caused significant psychological distress to the general public and to frontline health care workers, who experienced high rates of stress, anxiety, and burnout.
The International Data Corporation (IDC) reported that the worldwide market for augmented reality (AR) and VR headsets grew by 92% year over year in 2021. Whereas augmented reality overlays digital elements onto one's real-world surroundings, virtual reality visually replaces one's surroundings with an immersive, interactive computer-generated world. Virtual reality (VR) is being increasingly used across health care, and its use continues to expand in the wake of the pandemic. A recent systematic review suggested that VR might be a beneficial psychological intervention for adults with COVID-19-related mental health problems.
Multiple VR interventions have demonstrated reductions in psychological stress among health care workers. For example, recent pilot studies found that both Ohio University’s Game Research and Immersive Design (GRID) Lab’s Tranquil Cinematic-VR simulation and Reulay, Inc’s (Long Island City, New York), Reulay VR intervention effectively reduced subjective stress for frontline health care workers. Additionally, Healium (Columbia, Missouri) has developed a VR model that incorporates nature-based escapes, meditation, and neurofeedback with an optional EEG headband, to improve aspects of “mental fitness” such as feelings of focused calm. It can be used at home or in the workplace.
The cost of VR headsets has been estimated to be upwards of $400 for higher-end models, whereas mid-range headsets might be available at $150.
The COVID-19 pandemic caused substantial psychological distress to people, especially in health care workers. Interventions are needed to bolster and sustain the mental health of frontline care workers. The pandemic saw increased use of technology within health care. VR might offer a scalable, convenient intervention for supporting mental wellbeing in health care workers.
Early feedback from internal ECRI stakeholders suggested that evidence-based VR programs might support the mental wellbeing of frontline health care workers who cannot take time off from their high-stress work environments. VR might be a widely accessible, affordable, and practical-to-implement tool to mitigate stress and anxiety and improve quality of life in the short term. VR might also be incremental to other available mobile health applications and established relaxation techniques, such as breathing exercises or meditation.
Additionally, without standardization and quality control, the level of benefit to frontline personnel could vary significantly. Individuals might experience unintended negative consequences of VR, including fatigue, claustrophobia, headaches, motion sickness, and seizures. Therefore, qualified mental health care professionals should be involved in the development, and ongoing implementation of VR programs for this indication, including a path for referral to additional care when necessary.
- Categories: Treatment
- Areas of potential impact: Clinician and/or caregiver health outcomes, population health outcomes, health care costs, and health care disparities
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.
In May 2021, the COVID-19 supplement was modified and merged with the HCHSS. The Biweekly COVID-19 Scans continue, while the Status Reports and High Impact Reports were folded into the PCORI Horizon Scanning Database and High Potential Disruption Reports.
Commentary in this COVID-19 Scan reflects preliminary views of ECRI Horizon Scanning and internal ECRI stakeholders.
The information contained in this document has not been vetted by other stakeholders.
We welcome your comments on this Scan. Send them by email to [email protected].
Posted: July 28, 2022
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