By Olivia R. Weidner, DHIT Global Intern | July 16, 2020

On Friday, July 10th, 2020, the Digital Health Institute for Transformation (DHIT) hosted the eighth installment of its digital web series in collaboration with the ASSIST Center at North Carolina State University.

The DHIT Frequency Webinar Series, which takes place biweekly, is a way to keep our community connected while many work from home. Each segment will be co-hosted by DHIT’s President, Michael Levy, and Adam Curry, ASSIST Innovation Ecosystem Director. The series will spotlight distinguished guests from across the ecosystem to discuss the state of digital health in the time of COVID-19.

Amidst widespread fear and uncertainty, DHIT explores the role of digital health in the global response to COVID-19, gaining insight into the ways this crisis has catalyzed the usage and acceptance of telehealth and other digital health technologies. Last week’s panelists included:

  • Eric Eskioglu, Chief Medical Officer at Novant Health
  • Gul Ege, R&D Senior Director at the SAS Institute
  • Brian Carter, SVP of Product at Validic

Last Friday’s installment of the COVID Unites Us All series shifted from the recent focus on remote monitoring and biometrics to big data and the determinants of health. With insights from three distinguished guests, DHIT and the ASSIST Center explored the connections between remote monitoring, data usage, and social determinants of health in the current moment and beyond. The first panelist was Dr. Eric Eskioglu, Chief Medical Officer at Novant Health, who shared his experiences within this major health system. Brian Carter, Senior Vice President at Validic, discussed his company’s data processing platform and use cases for COVID-19. Finally, Dr. Gul Ege, Senior Director of Research and Development at the SAS Institute, emphasized the importance of parsing and refining data to optimize usage.

Dr. Eskioglu kicked off the conversation by providing an overview of the impact of and response to COVID-19 at Novant Health. Data analysis has been critical to informing this system’s response to the virus; Novant has monitored a number of relevant metrics to appropriately address the virus across the communities it serves. According to Eskioglu, Novant started the process of data and analytics development about two years ago. With the onset of the pandemic, Novant adapted these processes to serve the needs of the ongoing crisis. An active dashboard was formed on Microsoft Teams that included each of Novant’s hospitals, providing hourly updates on test results, positivity and admission rates, and resource availability. These insights into key variables enable the strategic shifting of resources as the situation develops. This has been especially important with the difference in positivity rates seen across the geographical regions Novant serves; Eskioglu points out that even as little as 50 miles apart, there have been drastic discrepancies in the number of individuals testing positive for COVID-19 infection. Social determinants contribute significantly to the variance observed, in that disadvantaged or marginalized populations are hit harder by the COVID-19 virus. Eskioglu acknowledges and emphasizes the importance of addressing social determinants:

“A basic promise of democracy is basic access to healthcare. We all know that there are inequities in healthcare delivery; we’ve known that for years. But COVID-19 has really brought these inequities to the surface. What impacts patient outcomes the most is what happens beyond the four walls of the clinic.”

“The COVID application has been a way for physicians and health systems to monitor their patients, especially those who tested positive but weren’t critical enough to require an ICU bed or hospitalization. Moreover, the application enables providers to determine who needs to be brought back in. We’ve been told [by clients] that through this monitoring, some patients who were initially sent home were later identified as needing additional care; it’s very likely that they wouldn’t have made it without this alert. Among those patients who were sent home were what we call the ‘happy hypoxic:’ their O2 levels were at 80% or 75%, but they felt fine.”

Medical treatment is rendered incomplete if social determinants are not considered; providers and health systems need to be attuned to the challenges faced by patients on an individual basis. Housing, food insecurity, and a lack of access to transportation are but three examples of social determinants that can have an immense impact on an individual’s health and well-being. Housing is especially important to consider amidst the COVID-19 pandemic, as homeless shelters and other forms of congregate housing present an increased risk for infection and a substantial barrier to following isolation or quarantine protocol.

At Validic, Brian Carter and his team seek to harness the data gathered from the vast ecosystem of personal health apps and consumer-grade medical devices. Over the past three years, Validic has worked to develop and deploy a data processing app to help healthcare systems and other organizations make sense of the massive amounts of data collected through these mediums. For example, one of the primary metrics analyzed by Validic’s clients is activity level, especially for individuals undergoing surgical procedures. “Prehab” and rehab activity levels are collected and compared to measure changes in physical functioning among these patients. With the onset of COVID-19, Validic released a stand-alone application created solely for the monitoring of COVID symptoms.

Validic’s COVID application has been instrumental for keeping tabs on patients who tested positive for coronavirus infection; by checking in on patients twice a day, the app gathers and shares vital information with providers to inform the care delivery process. As Carter mentions, many patients can feel fine, but may actually be in a dangerous position, particularly when it comes to oxygen saturation. By regularly gathering critical data about metrics such as SpO2 (oxygen saturation), temperature, and other symptoms, the ‘happy hypoxic’ and other high-risk sub-populations can be identified and directed to the appropriate care team. In this sense, Validic has combined data analytics and remote monitoring to improve the quality of care for patients facing COVID-19.

For Dr. Gul Ege and her team at the SAS Institute, the process of data analysis for wearable devices is not without its challenges:

“One of these challenges is that in these large amounts of data, there’s an incredible amount of noise, especially when it comes to wearables. Thus, denoising algorithms are important for ensuring that data collected is not misleading. The next question is: ‘how much of the enormous amounts of data being collected is meaningful to keep for further analysis?’”

At the SAS Institute, Ege and her coworkers must cut down the data collected to filter out any extraneous or irrelevant data and ensure that only the “meaningful bits” remain. Additionally, a large part of the research and development at SAS involves the creation of algorithms for detecting specific anomalies in real-time. For example, in the context of COVID-19, it would be useful to be able to detect and classify a cough recorded through audio monitoring, so that the appropriate action could be taken. A common symptom of COVID-19 infection is dry cough; thus, developing an algorithm for differentiating this type from other variations could be valuable for ensuring that patients are directed to the appropriate care facility.

Despite the challenges outlined by Ege, wearable devices and remote monitoring also come with significant possibilities. As discussed in previous webinars, wearable devices and applications for remote data collection can provide important measures of health and disease without the need to visit a clinic. Aside from the convenience factor, digital health approaches enable healthy patients to stay at home, thus reducing their risk of infection from visiting a medical facility. Additionally, remote monitoring has the potential to democratize care. According to Carter, some of the most effective interventions conducted by Validic’s clients involved the utilization of technology to address social determinants that created obstacles to health improvement. For example, one system distributed low-cost mobile phones to patients, providing easy and cheap “lifeline” communication back to the healthcare system. Another example involved free battery exchange services for glucose monitors, which increased adherence and thus enabled more continuous glucose monitoring. As the world continues to weather the storm of COVID-19, similar remote monitoring interventions could be vital to tracking both individual and population health metrics on a large scale. Moreover, low-cost, accessible tools for monitoring and addressing COVID infection and symptoms could catalyze increased democratization of care, thus reducing the negative impact of social determinants on COVID-19 outcomes.

DHIT thanks its guests for serving on the panel, and everyone who tuned in! If you were not able to catch last week’s webinar, check out DHIT’s Media page to see what you missed. DHIT and ASSIST would also like to give a special shoutout to our Program and Innovation Champions: Pfizer Digital, RIoT, Excelerate Health Ventures, Device Solutions, Medallia, Charlotte AHEC, Elsevier, Cone Health Ventures, Hangar6, SotoIP, and Duke MEDx.

We are excited to announce DHIT’s partnership with the ASSIST Center to launch a Virtual Incubator using Crowdicity to collect crowdsourced ideas from the digital health community focusing on remote care. This innovation engine will serve as a catalyst to advance remote care by sourcing ideas from the ecosystem and nurturing them from inception to implementation. For more information, see our landing page for the Incubator and mark your calendar for Friday, July 24th for the next installment of the DHIT Frequency Webinar Series. Until then, stay safe, everyone!

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ABOUT DHIT

The Digital Health Institute for Transformation (DHIT) is a 501(c)(3) non-profit education and research institute supporting communities through the process of digital health transformation. We collaborate with leading academic institutions, associations, and industry to cultivate talent and ecosystems with our immersive learning platform, harnessing real-world experiences that drive the adoption of next generation skills, emerging technologies, and mindsets needed to foster the digital health leaders and innovators of the future, today. For more information, visit dhitglobal.org.

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