PCORI Biweekly COVID-19 Scan: Intelligent Automation for Patient Engagement, Transcranial Direct Current Stimulation (November 10-23, 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.
Some patients have developed new health care habits since the pandemic began in 2020. For example, some people have delayed routine screening and treatment (see Topics to Watch for new systems intended to reengage patients and help stressed care providers).
Others have developed new health conditions that might be connected, in some way, to the pandemic. For example, eating disorders increased among teenagers and young adults. Emergency department inpatient admissions for eating disorders had been rising just 0.7 percent per month prior to the pandemic. Then, between February 2020 and April 2021, admission rose by 7.2 percent per month—a staggering increase highlighting a crucial need for prevention and care.
Care delivery also changed significantly during the pandemic. In particular, pharmacists in the United States provided unprecedented levels of care. From the start of the pandemic through September 2022, community-based pharmacists and their teams gave more than 270 million COVID-19 vaccinations, tested patients 42 million times, delivered more than 100,000 monoclonal antibody treatments and aided hospital care for 5.4 million COVID-19 patients. The leveraging of pharmacists to provide direct patient care, authorized by the Public Readiness and Emergency Preparedness (PREP) Act, might have helped keep as many as 8 million patients out of the hospital and saved more than 1 million lives and $450 billion in health care costs.
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.
Intelligent Automation to Streamline and Boost Patient Engagement
At a Glance
- Many adults delayed obtaining health care during the COVID-19 pandemic to reduce their risk of infection. However, as a result, population health outcomes have worsened overall. Although routine clinic visits decreased, hospitalizations surged due to SARS-CoV-2, leading to burnout among health care staff and causing many to leave their professions.
- Intelligent automation (IA) refers to technologies that combine artificial intelligence, business process management, and robotic process automation to streamline resource-intensive tasks and increase operational efficiencies.
- Use of IA to regularize appointment scheduling and reminders might improve patient engagement and health outcomes by prompting and facilitating routine care.
- Use of IA for administrative tasks might also relieve some burden on staff, potentially improving their work environment and well-being, increasing staff retention, and increasing time for patient care.
- Across industries, IA has been estimated to cut business process costs by 25% to 40%.
Nearly 1 in 5 adults delayed seeking health care services during the COVID-19 pandemic to reduce their risk of infection. The decrease in routine screenings has worsened population health outcomes, especially for cancer. Patients in poorer health were even likelier to delay care, potentially exacerbating preexisting health conditions and disparities.
Although patients scheduled fewer appointments for routine visits, surges in hospitalizations due to COVID-19 still increased overall patient intake.
Conventional robotic process automation (RPA) uses specialized computer programs that can perform repetitive tasks such as sending reminders about medications to patients. Doing so reduces the staff's effort in managing these repetitive business processes. IA combines RPA and business process management with artificial intelligence. IA can prove helpful to healthcare facilities since it integrates an AI component to learn and handle more complex tasks and create more efficient workflows than standard RPA technology. Using IA, healthcare facilities can assess patients' clinical and scheduling data to identify care gaps (for example, if a patient is due for, or missed, a routine screening). The IA system uses these data to establish a line of communication between the patient and the provider. Patients might then use the IA platform to directly schedule appointments or to inform the provider if they have received care elsewhere, so their records are updated.
Services from Bamboo Health (Louisville, Kentucky) provide real-time insights into patient care gaps, along with best practices to close those gaps and customized workflows to follow up with and engage patients quickly. North Kansas City Hospital partnered with Notable (San Mateo, California) to automate vaccine clinic enrollment at the hospital, which improved engagement and outreach initiatives. The Nividous (Mumbai, India) IA platform uses chatbots to automate appointment scheduling, help patients determine eligibility and insurance coverage for health care services, and submit claims. Across industries, IA has been estimated to cut business process costs by 25 to 40 percent on average, as cited in a white paper by Deloitte.
IA might reduce access barriers for patients and encourage them to participate in decision-making regarding their health.
Commentary from internal ECRI stakeholders suggested IA might streamline medical care by leveraging technology to relieve staff of responsibilities for administrative tasks. The COVID-19 pandemic placed unprecedented burden and stressors on health care staff. A reduced workload might relieve professional burnout and allow more time for patient care. These improvements might help health care organizations retain staff who might otherwise have left their profession, as many others have done during the pandemic.
Stakeholders expressed concerns about IA’s impact on data privacy, noting that it opens another channel for data breaches. Additionally, health care disparities might increase if facilities use a form of communication that patients cannot access (e.g., electronic correspondence requiring internet access). However, a flagging system that notifies patients of recommended visits and procedures might encourage timely care, improving population health and quality of life.
- Category: Systems and management
- Areas of potential impact: Population health outcomes, health care costs, health care disparities, health care delivery and process, protected health information security
Transcranial Direct Current Stimulation to Treat Post-COVID Conditions
At a Glance
- Preclinical evidence suggests that loss of synaptic connections between neurons might contribute to long-term cognitive impairment occurring after COVID-19 infection, one of the most commonly reported post-COVID conditions (PCC, also known as long COVID).
- Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that uses a wearable device to deliver low-intensity electrical currents to the scalp to modulate brain activity. Research suggests the technique may increase synaptic connections and improve communication between neurons.
- Clinical studies suggest that tDCS might be an effective treatment for several neurological conditions (e.g., multiple sclerosis, stroke, Parkinson disease) whose symptoms overlap with PCC, such as depression, cognitive impairment, fatigue, and pain.
- Multiple groups, within the United States and internationally, are investigating the efficacy of tDCS for treating cognitive symptoms associated with PCC, with primary completion dates expected between November 2022 and July 2023. Some hospitals have already begun administering tDCS off-label in PCC recovery programs.
- We were unable to find information regarding the potential cost of tDCS to treat PCC. However, the cost of tDCS to treat pain is about $168 per session.
tDCS is a noninvasive brain stimulation technique being investigated to treat PCC. tDCS is typically administered using wearable devices that modulate neuronal excitability by applying a small electrical current to the scalp.
Preclinical evidence suggests loss of synaptic connections between neurons might contribute to long-term cognitive impairment following COVID-19 infection. Research suggests tDCS may increase synaptic connections and improve communication between neurons. In prior studies, tDCS has been shown to improve several conditions with symptoms that overlap with PCC, including depression, cognitive impairment, fatigue, and pain, with minimal side effects.
Multiple groups are investigating tDCS to treat cognitive symptoms associated with PCC, such as memory, attention, and processing. Groups investigating tDCS for PCC, both with and without concurrent cognitive training, include the University of Iowa, the University of Minnesota, Massachusetts General Hospital, the University of São Paulo (Brazil), and Greifswald Medical School, University of Greifswald (Germany), with primary completion dates expected between November 2022 and July 2023. tDCS is also being used off-label in some PCC recovery programs, such as NYU Langone Health.
We were unable to find information regarding the potential cost of tDCS to treat PCC. However, the cost of tDCS to treat pain is estimated at $168 per session.
Cognitive impairment is common after COVID-19, and effective interventions are needed to promote complete recovery from PCC symptoms.
Initial comments from ECRI internal stakeholders suggest that, as a noninvasive, at-home treatment, tDCS might be a safe, convenient way to alleviate cognitive symptoms in patients experiencing PCC. However, potential benefits require additional study to confirm and might require consistent use of the treatment for extended periods. Patients might face challenges related to scheduling and the need for remote monitoring.
Additionally, because the underlying causes of PCC remain poorly understood, uncertainty remains regarding whether tDCS addresses these mechanisms. Therefore, stakeholders expect tDCS will be used as an adjunctive therapy, along with multidisciplinary rehabilitation and symptom management. Furthermore, disparities in access are likely to arise because only a limited number of facilities offer tDCS for PCC and because of treatment costs.
- Category: Treatment
- Areas of potential impact: Patient outcomes, 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.
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: December 5, 2022
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