Deploying digital health tools within large, complex health systems: key considerations for adoption and implementation

Marwaha, Jayson S.; Landman, Adam B.; Brat, Gabriel; Dunn, Todd; Gordon, William J.

doi:10.1038/s41746-022-00557-1

Cited by 120 publications

(101 citation statements)

References 27 publications

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“…Recently, the Academy of Managed Care Pharmacy convened a forum that brought digital therapeutic innovators, payers, pharmacy benefit managers, and other key stakeholders to discuss the role of digital interventions as therapeutic options ( 74 ). While implementation of digital health technologies within health care systems is both inevitable and challenging ( 75 – 77 ), it will be important for payers to consider their health care coverage, especially as more evidence emerges with the potential opportunity of lowering overall health care costs and increasing clinical outcomes. An initial cost-effectiveness analysis of the reimbursement rate for digital therapeutics for low back pain suggests economic benefits for health care in Germany ( 78 ).…”

Section: Discussionmentioning

confidence: 99%

“…Integrated healthcare systems and hospitals can create VR simulation centers for patient education about their diagnosis and treatment options including digital interventions ( 94 , 95 ). Educating pharmacists, nurses and physician assistants about digital health technologies will accelerate clinical workflow redesign to incorporate their “internal champions” roles in decision making for pain management ( 64 – 66 , 77 , 96 ). For opioid prescription and tapering for chronic pain, revisions and updates to the CDC guidelines and payer pharmacy coverage should include the use of digital therapeutics for pain relief and management ( 97 ).…”

Section: Discussionmentioning

confidence: 99%

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Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Giravi

Biskupiak

Tyler

et al. 2022

Front. Digit. Health

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Digital therapeutics (DTx, mobile medical apps, software as a medical device) are rapidly emerging as clinically effective treatments for diverse chronic diseases. For example, the Food and Drug Administration (FDA) has recently authorized a prescription virtual reality (VR) app for treatment of moderate to severe low back pain. The FDA has also approved an adjunct digital therapy in conjunction with buprenorphine for opioid use disorder, further illustrating opportunities to integrate digital therapeutics with pharmacotherapies. There are ongoing needs to disseminate knowledge about advances in digital interventions among health care professionals, policymakers, and the public at large. This mini-review summarizes accumulating clinical evidence of digital interventions delivered via virtual reality and mobile apps to improve opioid-based analgesia. We identified relevant randomized controlled trials (RCTs) using Embase and PubMed databases which reported pain scores with a validated pain scale (e.g., visual analog scales, graphic rating scale, numeric rating scale) and use of a digital intervention in conjunction with opiates. Among identified RCTs, the majority of studies reported improved pain scores in the digital intervention group, as compared to “treatment as usual” group. Our work suggests that VR and mobile apps can be used as adjunct digital therapies for pain management. We discuss these findings in the context of how digital health technologies can transform patient-centered pharmacy care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Giravi

Biskupiak

Tyler

et al. 2022

Front. Digit. Health

View full text Add to dashboard Cite

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“…These institutions, which may provide primary and general care to large local populations, and tertiary level care across a much larger geographic region, often must tailor solutions to these two prongs of care with consideration of patients’ social drivers of health. Further, the potential solutions must meet key tenants of adoption, many of which have been outlined by Marwaha et al and others 1 , 47 , 48 . Attention to these tenants ensures patients can access, understand, use, and benefit from the technologies, including marginalized, lower socioeconomic, or older populations.…”

Section: Epoch Iii: Digital Health In Academic Health Institutions Lo...mentioning

confidence: 99%

“…Recently in npj Digital Medicine, Marwaha and colleagues offer a useful approach to implementing digital health products and services within large, complex medical systems 1 . Their paper provides practical guidance, containing nine assessment categories to help health systems successfully select and implement digital health solutions toward elevating the pursuit of excellence in care.…”

Section: Introductionmentioning

confidence: 99%

Aligning mission to digital health strategy in academic medical centers

et al. 2022

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The strategies of academic medical centers arise from core values and missions that aim to provide unmatched clinical care, patient experience, research, education, and training. These missions drive nearly all activities. They should also drive digital health activities – and particularly now given the rapid adoption of digital health, marking one of the great transformations of healthcare; increasing pressures on health systems to provide more cost-effective care; the pandemic-accelerated funding and rise of well-funded new entrants and technology giants that provide more convenient forms of care; and a more favorable regulatory and reimbursement landscape to incorporate digital health approaches. As academic medical centers emerge from a pandemic-related reactionary digital health posture, where pressures to adopt more digital health technologies mount, a broad digital health realignment that leverages the strengths of such centers is required to accomplish their missions.

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“…Clinical endorsement, champions who promoted digital health and public and professional willingness were identified as factors that support implementation of digital health ( 18 ). Another recent study from 2022 examined key considerations for adoption and implementation of digital health tools within large, complex health systems ( 19 ). These were aimed to support health systems' decision-making on how to best approach the selection and evaluation of digital health tools, how to ensure the availability of sufficient resources for deployment and long-term use and the creation of implementation strategies.…”

Section: Introductionmentioning

confidence: 99%

Success Factors for Scaling Up the Adoption of Digital Therapeutics Towards the Realization of P5 Medicine

et al. 2022

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IntroductionDigital therapeutics (DTx) can be a valuable contribution to the successful scale up of P5 Medicine (personalized, participatory, predictive, preventive, precision medicine) as they offer powerful means of delivering personalization and active patient participation in disease self-management. We investigated how the approval and adoption of DTx within health systems have been approached in five selected European countries and regions, with a view to proposing success factors scaling up their adoption.MethodologyPreliminary research established best countries or region candidates as being Germany, UK, France, Belgium, and the Spanish Region of Catalonia. The research was informed by a literature review, interviews with public bodies and industry, and a multi-stakeholder workshop to validate the findings and fill in existing gaps.ResultsTo authorize the use of digital technologies, the countries and regions passed legislation and developed policy instruments, appointed bodies to assess and certify the products and formalized mechanisms for permitting reimbursement. While DTx is not a commonly used nomenclature, there are digital health technology types defined that have similar requirements as DTx. Assessment and certification frameworks are usually built around the Medical Device Regulation with additional criteria. Reimbursement considerations often observe reimbursement of therapeutic devices and/or medicines. To be integrated into reimbursement systems, countries require manufacturers to demonstrate clinical value and cost-effectiveness. As there are currently very few DTx approved in practice, there is resistance toward clinical acceptance and organizational change, and change management is highly needed to integrate DTx into healthcare systems. The integration and secondary use of DTx data is not encountered in daily practice. Although some enablers exist, there remain technical and legal barriers.DiscussionDTx strategies should be considered as an integral part of digital health strategies and legislation, and specific DTx pathways with clear and transparent assessment and guidelines that balance regulation and innovation should be defined. To help manufacturers, countries should recommend and list methods that are widely accepted and ensure scientific robustness, aligned to the MDR requirements to support transfer of relevant and comparable data across countries. To facilitate rapid uptake of innovation, countries should add flexibility to the framework by allowing temporary market authorization to enable data collection that can support the clinical and socio-economic evaluation and data gathering phase. Certification should trigger rapid price setting and reimbursement mechanisms, and dynamic ways to adjust price and reimbursement levels in time should be established. Relevant stakeholders should be approached on the potential impacts of DTx through transparent communication and change management strategies should be considered. These findings should be validated with a wider range of stakeholders.

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Deploying digital health tools within large, complex health systems: key considerations for adoption and implementation

Cited by 120 publications

References 27 publications

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Aligning mission to digital health strategy in academic medical centers

Success Factors for Scaling Up the Adoption of Digital Therapeutics Towards the Realization of P5 Medicine

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