Health Information Technology Commons^™

Perspectives From Patients With Chronic Lung Disease On A Telehealth-Facilitated Integrated Palliative Care Model: A Qualitative Content Analysis Study, Jeannette Kates, Carrie Tompkins Stricker, Kristin L. Rising, Alexzandra Gentsch, Ellen Solomon, Victoria Powers, Venise J. Salcedo, Brooke Worster

Department of Medicine Faculty Papers

BACKGROUND: Chronic lung disease affects nearly 37 million Americans and often results in significant quality of life impairment and healthcare burden. Despite guidelines calling for palliative care (PC) integration into pulmonary care as a vital part of chronic lung disease management, existing PC models have limited access and lack scalability. Use of telehealth to provide PC offers a potential solution to these barriers. This study explored perceptions of patients with chronic lung disease regarding a telehealth integrated palliative care (TIPC) model, with plans to use findings to inform development of an intervention protocol for future testing.

METHODS: For this qualitative …

The Design Of A Quality Improvement Dashboard For Monitoring Spinal Cord And Column Injuries, Zahra Azadmanjir, Mohsen Sadeghi-Naini, Mohammad Dashtkoohi, Maziar Moradi-Lakeh, Jalil Arabkheradmand, James Harrop, Vafa Rahimi-Movaghar

Department of Neurosurgery Faculty Papers

Background: Interactive dashboards are a powerful tool for dynamic visualization and monitoring of patient performance and serve as a useful to for optimal decision-making. The National Spinal Column and Cord Injury Registry of Iran (NSCIR-IR) was designed to efficiently display and broadcast important patient care data. This has been achieved through an electronic dashboard display (graph and visual displays), rather than traditional static paper reports (text). Objectives: The objective of this study was to design and develop an electronic visual dashboard as a display system to monitor the quality of care in the NSCIR-IR collaborating centers. Methods: The indicators chosen …

Relationship Between On-Demand Telehealth Visits And Emergency Department And Hospital Surge During The Covid-19 Pandemic, B. H. Slovis, Xin Ji, Anna Marie Chang, John C. Kairys, Judd Hollander

Department of Emergency Medicine Faculty Papers

OBJECTIVES: The relationship between COVID-19-related telehealth calls could be used to predict emergency department visits and hospital surges 3 days later potentially facilitating staffing adjustments in advance of patient arrivals. The purpose of this research was to study the temporal association between frequencies of on demand telehealth calls and emergency department surges during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

METHODS: This cohort study examined patients who self-initiated synchronous audio-video on-demand telehealth calls between January 1, 2020 and June 30, 2022, and compared these to emergency department arrivals. The exposure in question was a synchronous audio-video on-demand telehealth …

Individual- And Neighborhood-Level Characteristics Of Lung Cancer Screening Participants Undergoing Telemedicine Shared Decision Making, Christine S. Shusted, Hee-Soon Juon, Brooke Ruane, Brian M. Till, Charnita Zeigler-Johnson, Russell K. Mcintire, Tyler Grenda, Olugbenga Okusanya, Nathaniel R. Evans, Gregory C. Kane, Julie Barta

Division of Pulmonary and Critical Care Medicine Faculty Papers

BACKGROUND: Although lung cancer screening (LCS) for high-risk individuals reduces lung cancer mortality in clinical trial settings, many questions remain about how to implement high-quality LCS in real-world programs. With the increasing use of telemedicine in healthcare, studies examining this approach in the context of LCS are urgently needed. We aimed to identify sociodemographic and other factors associated with screening completion among individuals undergoing telemedicine Shared Decision Making (SDM) for LCS.

METHODS: This retrospective study examined patients who completed Shared Decision Making (SDM) via telemedicine between May 4, 2020 - March 18, 2021 in a centralized LCS program. Individuals were …

A Novel Virtual-Based Comprehensive Clinical Approach To Headache Care, Thomas Berk, Stephen Silberstein, Peter Mcallister

Department of Jefferson Headache Center papers and presentations

One major innovation, a result of the coronavirus pandemic, has been the proliferation of telemedicine. Telehealth can help solve the access problems that plague headache medicine, allowing patients in areas with no headache expertise to consult and work with a headache specialist. This is a retrospective chart review of patients seen by Neura Health, a comprehensive app-based telehealth headache center. Patients are seen by a specialist and, in addition to any medical recommendations, are given care plans individualized to their condition and recommendations at the end of their clinical appointments. The primary outcome of this study is a decrease in …

Racial Disparities In Access To Dbs: Results Of A Real-World U.S. Claims Data Analysis, Michael Frassica, Drew S Kern, Mitra Afshari, Allison T Connolly, Chengyuan Wu, Nathan Rowland, Juan Ramirez-Castaneda, Mwiza Ushe, Claudia Salazar, Xenos Mason

Farber Institute for Neuroscience Faculty Papers

INTRODUCTION: Deep brain stimulation (DBS) is an effective and standard-of-care therapy for Parkinson's Disease and other movement disorders when symptoms are inadequately controlled with conventional medications. It requires expert care for patient selection, surgical targeting, and therapy titration. Despite the known benefits, racial/ethnic disparities in access have been reported. Technological advancements with smartphone-enabled devices may influence racial disparities. Real-world evidence investigations can shed further light on barriers to access and demographic disparities for DBS patients.

METHODS: A retrospective cross-sectional study was performed using Medicare claims linked with manufacturer patient data tracking to analyze 3,869 patients who received DBS. Patients were …

Impact Of Social Media And Multimedia Platforms: View From The Jacc: Case Reports Some Editors, Estefania Oliveros, Yevgeniy Brailovsky, Alessandro Beneduce, Hooman Bakshi, Edoardo Zancanaro, Indah Sukmawati, Mrinali Shetty, Gina Lundberg

Division of Cardiology Faculty Papers

No abstract provided.

Development Of 5g-Based Remote Ultrasound Education: Current Status And Future Trends, Jiaojiao Ma, Xinying Jia, Guanghan Li, Dandan Guo, Xuehua Xi, Tongtong Zhou, Ji-Bin Liu, Bo Zhang

Department of Radiology Faculty Papers

The rapid advancement of 5G technology has opened new possibilities for remote ultrasound education, offering the potential to enhance training, real-time consultation, and quality control for primary ultrasound doctors. The 5G remote ultrasound education has the potential to revolutionize the way primary ultrasound doctors are trained and supported, ultimately leading to improved patient care and outcomes. By understanding the current status and development trends of this cutting-edge educational approach, the medical community can better prepare for and contribute to its ongoing evolution. Looking towards the future, the development trends in 5G remote ultrasound education are expected to revolve around continuous …

Telehealth Clinical Appropriateness And Quality, Lulu Wang, Anthony Fabiano, Arjun K. Venkatesh, Nick Patel, Judd E. Hollander

Department of Emergency Medicine Faculty Papers

Contrary to common perception, telehealth is not simply a substitute for in-person care. With an array of modalities—live audio–video, asynchronous patient communication, and remote patient monitoring, to name a few—telehealth creates entirely new avenues of care delivery (Table 1). Although our current care model is reactive—relying on episodic visits to an office or hospital—telehealth allows us to be proactive, filling in the gaps to provide a continuum of care. Widespread uptake of telehealth has created fertile ground for long-overdue health system reform. In this study, we describe essential next steps: redefine telehealth clinical appropriateness, evolve payment models, provide necessary training, …

Demographic Data Associated With Digital Inequity Reported In Patient-To-Provider Teledermatology Studies In The United States From 2011 To 2021: Scoping Review, John Miller, Patrick Ioffreda, Shannon Nugent, Elizabeth Jones

Department of Dermatology and Cutaneous Biology Faculty Papers

Background: Patient-to-provider teledermatology relies on a patient’s access to technology to ensure a successful visit. However, access to broadband internet and technology varies across populations in the United States—leading to the digital divide. While teledermatology has been recognized as a model to improve access, little is known about how often demographic data associated with digital inequity are captured in studies. Objective: Given the expansion of teledermatology over the past decade, we sought to determine how often demographic data associated with digital inequity are reported in patient-to-provider teledermatology studies. Methods: A scoping literature review search was conducted using the search term …

Teledermatology In Medical Student, Postgraduate Trainee, And Global Dermatology Education: A Systematic Review, Heli Patel, Rishab Revankar, Aly Valliani, Nikita Revankar, Shivani Yerigeri, Nadine Kaskas, Benjamin Stoff

Student Papers, Posters & Projects

BACKGROUND: In the aftermath of the COVID-19 pandemic, medical students and residents in the U.S. and globally have gained more exposure to teledermatology, both for the purposes of clinical practice and education.

OBJECTIVE: We conducted a systematic review to assess outcomes from teledermatology interventions for dermatology trainees in the U.S. and globally in accordance with Preferred Reporting Items for Systematic Reviews (PRISMA).

METHODS: We searched MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL for articles written in English and published database inception to November 20, 2022.

RESULTS: In total, 15 studies met the inclusion criteria. Outcomes reported ranged broadly from …

A Training Curriculum For An Mhealth Supported Peer Counseling Program To Promote Exclusive Breastfeeding In Rural India, Roopa M. Bellad, Niranjana S. Mahantshetti, Umesh S. Charantimath, Tony Ma, Yukiko Washio, Vanessa L. Short, Katie Chang, Parth Lalakia, Frances J. Jaeger, Patricia J. Kelly, Geetanjali Mungarwadi, Chandrashekar C. Karadiguddi, Shivaprasad S. Goudar, Richard J. Derman

Department of Pediatrics Faculty Papers

BACKGROUND: Despite strong evidence about the benefits of exclusive breastfeeding, that is the baby receiving only breast milk, no other foods or liquids, rates have remained relatively unchanged over the past two decades in low- and middle-income countries. One strategy for increasing exclusive breastfeeding is through community-based programs that use peer counselors for education and support. The use of mobile health applications is also gaining increasing applicability in these countries. Minimal information is available about training peer counselors in the use of mobile technologies to support exclusive breastfeeding. The present article describes our curriculum in the state of Karnataka, India …

The Development Of A Mobile App-Focused Deduplication Strategy For The Apple Heart Study That Informs Recommendations For Future Digital Trials, Ariadna Garcia, Justin Lee, Vidhya Balasubramanian, Rebecca Gardner, Santosh E. Gummidipundi, Grace Hung, Todd Ferris, Lauren Cheung, Sumbul Desai, Christopher B. Granger, Mellanie True Hills, Peter Kowey, Divya Nag, John S. Rumsfeld, Andrea M. Russo, Jeffrey W. Stein, Nisha Talati, David Tsay, Kenneth W. Mahaffey, Marco V. Perez, Mintu P. Turakhia, Haley Hedlin, Manisha Desai

Department of Medicine Faculty Papers

An app-based clinical trial enrolment process can contribute to duplicated records, carrying data management implications. Our objective was to identify duplicated records in real time in the Apple Heart Study (AHS). We leveraged personal identifiable information (PII) to develop a dissimilarity score (DS) using the Damerau-Levenshtein distance. For computational efficiency, we focused on four types of records at the highest risk of duplication. We used the receiver operating curve (ROC) and resampling methods to derive and validate a decision rule to classify duplicated records. We identified 16,398 (4%) duplicated participants, resulting in 419,297 unique participants out of a total of …

Dyadic Digital Health Interventions: Their Rationale And Implementation, Kelly M. Shaffer, Lindsay S. Mayberry, Emily Georgia Salivar, Brian D. Doss, Amanda M. Lewis, Kimberly Canter

Department of Pediatrics Faculty Papers

While most psychosocial and behavioral digital health interventions have been designed to be consumed by an individual, intervening at the level of a dyad – two interdependent individuals – can more comprehensively address the needs of both individuals and their relationship. The clinical utility of the dyadic digital health intervention approach, as well as the practical implementation of this design, will be demonstrated via three examples: eSCCIP, FAMS, and OurRelationship.

Provider Experiences Of Virtual Reality In Clinical Treatment, Christine Vincent, Margaret Eberts, Tejal U. Naik, Victoria Gulick, C. Virginia O'Hayer

Department of Medicine Faculty Papers

Background: Virtual reality (VR) has proven effective in the treatment of specific phobias and trauma particularly when in-vivo exposure therapy might be costly (e.g. fear of flying, combat scenes). Similarly, VR has been associated with improvement of chronic pain and of acute pain during medical procedures. Despite its effectiveness as a healthcare tool, VR technology is not well-integrated into common practice. This qualitative study aims to explore the provider perception of the value of VR and identify barriers to VR implementation among healthcare providers.

Methods: A 66-item self-report survey was created to examine application of VR to clinical practice, perceived …

Integrating Telemedicine Services In Ophthalmology: Evaluating Patient Interest And Perceived Benefits, Eric Shiuey, Yehuda Fox, Adam Kurnick, Rony Rachmiel, Shimon Kurtz, Michael Waisbourd

Department of Medicine Faculty Papers

Purpose: The purpose of this study was to assess patient interest and willingness to pay (WTP) for teleophthalmology services, whose benefits include improved healthcare access and potential cost savings.

Patients and methods: Cross-sectional study of 215 patients attending a single tertiary center to assess their interest in teleophthalmology. Comparisons between those interested and those not interested were conducted; logistic regression was used to evaluate the effect of price on interest.

Results: Two thirds (66.5%) of patients were interested in teleophthalmology instead of in-person clinic visits. Those interested were significantly younger than uninterested patients (48.8±22.7 vs 62.4±18.3 years) and were more …

Addressing The Limitations Of Neurosurgical Care Via Telemedicine, Nikolaos Mouchtouris, Md, Robert Sergott, Md, Mark Moster, Md, Michael Karsy, Md, Laura Sweeney, Crnp, Christopher Farrell, Md, James Evans, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Novel telemedicine software successfully automates cranial nerve assessment of patients from the comfort of their home

Collaboration Therapy: Telehealth Principles And Case Studies, Elliot Cole, Phd, Larry M. Starr, Phd

School of Continuing and Professional Studies Faculty Papers

While conventional in-clinic Traumatic Brain Injury (TBI) rehabilitation serves the needs of the vast majority of patients many of whom go on to resume their lives a significant percentage of patients continue to have enduring cognitive disabilities despite long-term and skilled therapy. However, these patients can rapidly achieve gains which typically continue to increase toward substantial self-sufficiency when engaged in Collaboration Therapy (CT). CT is directed toward patient populations appropriate for a telehealth service who meet the following criteria: 1) patients have plateaued in conventional in-clinic therapy; 2) in-patients are too distant from an appropriate outpatient facility; and 3) individuals …

Solving Community Sars-Cov-2 Testing With Telehealth: Development And Implementation For Screening, Evaluation And Testing., Aditi Joshi, Resa E. Lewiss, Maria Aini, Bracken Babula, Patricia C. Henwood

Department of Emergency Medicine Faculty Papers

BACKGROUND: Telehealth has emerged as a crucial component of the SARS-CoV-2 pandemic emergency response. Simply stated, telehealth is a tool to provide health care from a distance. Jefferson Health has leveraged its acute care telehealth platform to screen, order testing, and manage patients with COVID-19-related concerns.

OBJECTIVE: This study aims to describe the expansion and results of using a telehealth program to increase access to care while minimizing additional potential exposures during the early period of the COVID-19 pandemic.

METHODS: Screening algorithms for patients with SARS-CoV-2-related complaints were created, and 150 new clinicians were trained within 72 hours to address …

Telemedicine Certified Recovery Specialists For Patients With Opioid Use Disorders In The Emergency Department In Covid-19, Kory S. London, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

COVID-19 is a staggering tragedy in a number of manners, but the lack of available access points to healthcare services due to federal, state, local and institutional regulations and decisions creates higher levels of patient vulnerability.

Patients with opioid use disorders (OUD) are especially vulnerable given high levels of coexistent housing insecurity, food insecurity and lack of primary care at baseline. These patients frequently utilize the emergency department for both medical and non-medical concerns.

Existing pathways to assist these patients utilize in person certified (peer) recovery specialists (CRS) who are not employed by the enterprise. Given the need to limit …

Covid-19 Student Telehealth Support Initiative, Yash Varma, Mary White, Alexandra Leto

House Staff Quality Improvement and Patient Safety Conference (2020-)

SKMC students partnered with numerous TJUH departments and developed a telehealth support initiative to:

• Help TJUH patients navigate the telehealth system
• Reduce system-wide appointment delays experienced by patients
• Provide direction to COVID-19 resources

A Volunteer Script was prepared to help patients troubleshoot common issues with accessing the telehealth system and provide up to date recommendations from the CDC to remain safe.

A Telehealth Clinical Workflow For Academic Radiation Oncology Programs During The Covid19 Pandemic, Gregor Manukian, Md, Phd, Christian Fernandez, Md, Paul Forrest, Adam Dicker, Md, Phd, Mark D. Hurwitz, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

• COVID19 has resulted in drastic measures to decrease exposure risks within healthcare systems, with cancer patients at increased risk of infection and death (Liang. Lancet Oncol. 2020).
• Telehealth is the delivery of medical care via interactive audio and/or video telecommunication services.
• Telehealth was previously used sparingly within the department of radiation oncology but has suddenly become the preferred method of contact.
• In order to maintain quality of care, patient satisfaction, resident learning, and reimbursement, a robust telehealth clinical workflow is critical.
• Our department engaged various stakeholder to quickly develop a clinical workflow.

Home Telemonitoring Of Covid Patients By Medical Students At The Christiana Care Virtual Practice, Thomas Marconi, Jr, Chelsea Richards

House Staff Quality Improvement and Patient Safety Conference (2020-)

SARS-Cov2 arrived in Delaware on March 11, 2020. By March 22, 2020, stay at home orders were in place1. During this time, CareVio, a subsidiary of ChristianaCare, was tasked with developing a strategy to monitor the Delaware community. CareVio repurposed Twistle – a telemonitoring application utilized to distribute symptom related surveys and conduct text message conversations for follow up. This service had the capability to act as a virtual information desk and triage patients to be seen by virtual practice providers or the emergency department. Patient monitoring via Twistle was initiated on March 18, 2020 and medical students from Sidney …

Utilizing Digital Health To Collect Electronic Patient-Reported Outcomes In Prostate Cancer: Single-Arm Pilot Trial, Christine Tran, Ms, Adam Dicker, Md, Phd, Benjamin Leiby, Phd, Eric Gressen, Md, Noelle Williams, Md, Heather Jim, Phd

Kimmel Cancer Center Faculty Papers

Background: Measuring patient-reported outcomes (PROs) requires an individual’s perspective on their symptoms, functional status, and quality of life. Digital health enables remote electronic PRO (ePRO) assessments as a clinical decision support tool to facilitate meaningful provider interactions and personalized treatment.

Objective: This study explored the feasibility and acceptability of collecting ePROs using validated health-related quality of life (HRQoL) questionnaires for prostate cancer.

Methods: Using Apple ResearchKit software, the Strength Through Insight app was created with content from validated HRQoL tools 26-item Expanded Prostate Cancer Index Composite (EPIC) or EPIC for Clinical Practice and 8-item Functional Assessment of Cancer Therapy Advanced …

Evaluating The Impact Of Kardiamobile On Healthcare Expenditures, Christopher Gerace, Mph, Daniel Frisch, Md

Phase 1

Background: KardiaMobile is a mobile ECG device, with smartphone connectivity, that is able to detect atrial fibrillation (a-fib). The device captures a 30 second reading and an algorithm differentiates a-fib from sinus rhythm. The mobile application can alert the user to an a-fib reading and also send the ECG output to their personal physician. By monitoring a-fib without accessing traditional care, KardiaMobile has the potential to reduce healthcare costs for patients with a-fib. This study looked to evaluate the effect of KardiaMobile on healthcare utilization for patients with suspected or diagnosed a-fib and who see a clinical cardiac electrophysiologist.

Methods: …

Pilot Evaluation Of The Usability And Utility Of A Wearable Technology To Monitor And Evaluate Health Condition, Drew Nielsen, David Shipon, Md, Facc, Facp

Phase 1

Introduction: Cardiac rehabilitation programs have particularly poor attrition and rehospitalization from cardiac-related events is a large burden on the medical system, as 8.9% of patients who have acute MI are rehospitalized within one year. External barriers may exist that prevent patients from adequately completing in-house cardiac rehabilitation, which makes them strong candidates for a home-based rehab program (HBCR). Previous randomized trials have generated evidence that HBCR can achieve similar cardiac improvements in 3- 12-month clinical outcomes. With the large-scale adoption of wearable technologies, with an estimated 8.2 million devices owned by individuals over 55, we have an opportunity to incorporate …

Comparison Of Patient Satisfaction Between Telehealth And In-Clinic Post-Operative Visits, Bryan Renslo, Lillian Matthews, Deborah T. Glassman, Md

Phase 1

Introduction: Telehealth has the potential to be an efficient, affordable, and accessible means to give care. In the field of Urology, its use has large potential but has not been well studied. We hypothesize that the use of telehealth for post-op nephrectomy patients will maintain the same level of patient satisfaction. We also hypothesize that telehealth visits will take less time and save patients money by eliminating the need to travel.

Methods: From May through July 2019, post-nephrectomy patients who consented to the study were given either a telehealth or in-clinic post-operative visit. Outcome metrics and demographics information were obtained …

Assessment Of A Wearable Device For Minute Ventilation In Detecting Different States Of Ventilation, Michael Morano, Yash Patel, Marc J. Torjman, Phd, Indupriya Eedara, Ms, Moeness Amin, Phd, Channy Loeum, Jeffrey Joseph, Do

Phase 1

Introduction: Minute ventilation (MV) and breathing status are valuable vital signs to measure in patients clinically such as in detecting opioid induced respiratory depression. However, there are few devices capable of continuously monitoring MV in an accurate fashion. RTM Vital Signs, LLC and TJU are developing a non-invasive wearable Tracheal Sound Sensor to determine if a device can accurately and continuously measure respiratory rate (RR), tidal volume (TV), MV, and changes in ventilation patterns based on sound recordings of breathing.

Methods: Tracheal breathing sounds were recorded in six researchers using a prototype sensor placed on the skin above the sternal …

Comparison Of Patient Satisfaction With Telehealth And In-Clinic Post-Operative Visits, Lillian Matthews, Bryan Renslo, Deborah T. Glassman, Md

Phase 1

Introduction: Telehealth has grown rapidly in the healthcare industry as a time efficient, affordable, and accessible means to provide care. Jefferson’s Department of Urology currently employs telehealth for post-operative visits but its efficacy in post-nephrectomy patients has not been well studied. We aim to demonstrate that patient satisfaction is the same for telehealth versus in-clinic post-operative visits in nephrectomy patients. Secondarily we will examine distance saved for telehealth patients.

Methods: We will administer an IRB approved questionnaire to all nephrectomy patients via the EPIC^® EMR platform after their post-operative visit. Each questionnaire will be specific to telehealth or …

Quality Assurance In Telehealth: Adherence To Evidence-Based Indicators., Daniel Halpren-Ruder, Anna Marie Chang, Judd E. Hollander, Anuh Shah

Department of Emergency Medicine Faculty Papers

Background: Value enhancing telehealth (TH) lacks a robust body of formal clinically focused quality assessment studies. Innovations such as telehealth must always demonstrate that it preserves or hopefully advances quality. Introduction: We sought to determine whether adherence to the evidence-based Choosing Wisely (CW) recommendations (antibiotic stewardship) for acute sinusitis differs for encounters through direct-to-consumer (DTC) telemedicine verses "in-person" care in an emergency department (ED) or an urgent care (UC) center.

Materials and Methods: Study design was a retrospective review. Patients with a symptom complex consistent with acute sinusitis treated through DTC were matched with ED and UC patients, based upon …