Integrating Third-Celebration Apps With Digital Well being Information to Assist COVID-19 Response

ABSTRACT

Goals: To (1) observe the mixing of telehealth- and COVID-19–associated apps with digital well being data (EHRs) over time, (2) determine the first performance of apps designed to assist the COVID-19 response, and (3) look at whether or not apps obtainable previous to the pandemic added new telehealth- or COVID-19–associated functionalities through the pandemic.

Examine Design: Information have been collected from public EHR app galleries on a month-to-month foundation from December 31, 2019, by means of June 1, 2021.

Strategies: Apps have been recognized as referring to COVID-19 or telehealth utilizing textual content evaluation of the app advertising and marketing supplies. Descriptive analyses have been performed to characterize telehealth- and COVID-19–associated apps found by means of the app galleries, determine their major performance, and look at whether or not any apps added new telehealth- or COVID-19–associated functionalities through the pandemic.

Outcomes: The variety of COVID-19–associated apps elevated from 0 in March 2020 to 19 a month later and continued to develop to 62 as of June 2021. The variety of telehealth-related apps greater than doubled from prepandemic ranges (n = 41) to a complete of 87 apps by June 2021. These apps have been 2 occasions extra more likely to comprise specialised capabilities used to assist COVID-19 response efforts, similar to safe messaging, vaccine administration, and laboratory testing, in contrast with all apps listed within the EHR app galleries.

Conclusions: These findings reveal the potential of integrating third-party apps into EHRs to develop the vary of instruments that well being care suppliers can use to diagnose, deal with, and talk with sufferers.

Am J Manag Care. 2023;29(1):In Press

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Takeaway Factors

The findings from this examine present early insights into how well being data expertise insurance policies could also be advancing the position that third-party apps performed in supporting efforts to reply to the COVID-19 pandemic.

• In Could 2020, the federal authorities finalized a coverage that sought to make integration of third-party apps with digital well being data (EHRs) simpler by requiring EHR builders to undertake safe, standards-based software programming interfaces.
• We noticed a speedy improve in telehealth- and COVID-19–associated apps integrating with EHRs following the onset of the pandemic.
• These apps offered well being care suppliers with an inflow of latest instruments that may very well be used to diagnose, deal with, and talk with sufferers.

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On March 11, 2020, the World Well being Group declared COVID-19 a worldwide pandemic.¹ Following this declaration, nations quickly sought provides and assets to check for contaminated people, defend well being care staff treating sufferers, and start improvement of prescribed drugs to deal with and stop the unfold of COVID-19.²

In response, software program and well being data expertise (IT) builders additionally started to quickly create and deploy digital instruments that may very well be used to assist deal with sufferers and help within the struggle in opposition to COVID-19. Telehealth was recognized as a way of well being care supply that might cut back illness transmission, protect private protecting tools, and reduce the influence of affected person surges on well being care services.^3,4 Different digital applied sciences, similar to cellphones, distant monitoring gadgets, and web-based apps, have been additionally used to assist epidemiologic surveillance, contact tracing, and analysis of public well being interventions.⁵ This paper highlights the speedy integration of telehealth- and COVID-19–associated software program functions with digital well being data (EHRs) through the pandemic from January 2020 to June 2021.

App integrations are generally carried out utilizing EHR software programming interfaces (APIs). APIs allow simpler entry and alternate of information by means of automated and predictable communications amongst totally different pc methods. The mixing of third-party apps utilizing APIs has the potential to develop the vary of instruments well being care suppliers can use to diagnose, deal with, and talk with sufferers past the functionalities that their EHR developer could assist.⁶ Different analysis has proven that the variety of apps that combine with EHRs is rising⁷; nevertheless, little is thought in regards to the position of EHR-integrated apps in supporting COVID-19 response efforts. This paper supplies early insights into the mixing of those apps throughout a public well being emergency.

We examined apps found in EHR public app galleries to determine telehealth- and COVID-19–associated apps that have been built-in earlier than and after the onset of the COVID-19 pandemic in the USA. The aims of this examine have been to (1) observe the mixing of telehealth- and COVID-19–associated apps over time, (2) determine the first performance of apps designed to assist the COVID-19 response, and (3) look at whether or not apps found previous to the pandemic added new telehealth- or COVID-19–associated functionalities through the pandemic.

STUDY DESIGN AND METHODS

Information Sources

Information have been collected from public app galleries hosted by 4 EHR builders: Allscripts,⁸ Athenahealth,⁹ Cerner Company,¹⁰ and Epic Techniques Company,¹¹ along with Boston Kids’s Hospital’s SMART (or Substitutable Medical Apps and Reusable Applied sciences).¹² For this evaluation, we take into account any app found in these galleries as an EHR-integrated app. Information have been collected on a month-to-month foundation from December 31, 2019, by means of June 1, 2021. Month-to-month cumulative COVID-19 case counts in the USA have been obtained from the CDC’s COVID Information Tracker.¹³

Identification of Telehealth- and COVID-19–Associated Apps

Apps have been recognized as telehealth in the event that they talked about “telehealth,” “telemedicine,” “video seek the advice of,” or “video go to” within the app advertising and marketing supplies pulled from every gallery. Equally, apps have been recognized as referring to COVID-19 in the event that they talked about “COVID,” “coronavirus,” or “pandemic” of their app advertising and marketing supplies.

For the needs of this evaluation, March 1, 2020, was thought-about the onset of the pandemic. Apps that have been recognized previous to the onset have been categorized as “found previous to pandemic,” and people found after the onset have been categorized as “added throughout pandemic.” A number of apps that have been initially recognized previous to the onset of the pandemic up to date their advertising and marketing supplies after the onset to incorporate new functionalities or use instances associated to the pandemic. These apps have been categorized as “added functionalities,” and those who didn’t make any updates to their advertising and marketing supplies have been categorized as “no adjustments.”

Textual content evaluation was carried out to determine the first performance of every app, and a guide evaluate was performed to confirm its accuracy. Additional particulars in regards to the strategies used to create this information set and the textual content evaluation program have been beforehand printed.⁷

Statistical Evaluation

Descriptive analyses have been performed to characterize telehealth- and COVID-19–associated apps found by means of the app galleries, determine their major performance, and look at whether or not any apps added new telehealth- or COVID-19–associated functionalities through the pandemic. Two-sample t checks have been carried out to check for statistically important variations (P < .05). All analyses have been performed utilizing SAS model 9.4 (SAS Institute).

RESULTS

Determine 1 reveals the entire variety of distinctive telehealth- and COVID-19–associated apps listed throughout the 5 galleries, together with month-to-month cumulative COVID-19 case counts. As of the start of March 2020, the USA had 1199 cumulative COVID-19 instances. Right now, there have been 41 apps listed in these galleries to assist telehealth and 0 apps marketed to assist COVID-19 response efforts. One month later, originally of April 2020, the cumulative variety of COVID-19 instances grew to 257,751, and the primary COVID-19–associated apps (18 in whole) emerged in these galleries. The variety of telehealth-related apps additionally grew to 53. Because the cumulative variety of COVID-19 instances continued to develop all through 2020 and into 2021, the entire variety of telehealth- and COVID-19–associated apps additionally grew. Though the entire variety of telehealth apps quickly elevated through the first half of 2020, these apps peaked in July 2020 (88 apps), then leveled off by means of the rest of the examine interval. In the meantime, the entire variety of COVID-19–associated apps steadily elevated all through the period of the examine and was at its highest degree within the final month of information assortment (62 apps).

Determine 2 reveals the proportion of telehealth- and COVID-19–associated apps listed in galleries by whether or not they have been recognized previous to the onset of the pandemic and whether or not the app added new telehealth- or COVID-19–associated functionalities through the pandemic. Amongst telehealth apps marketed as of June 1, 2021, 51% have been newly added to a gallery through the pandemic, 29% have been found previous to the pandemic with present telehealth functionalities, and 21% have been found previous to the pandemic and added telehealth-related functionalities after the onset of the pandemic. This exhibit additionally reveals that 0 apps have been marketed with COVID-19–associated functionalities previous to the pandemic as a result of it was a novel virus. We discovered that 42% of apps with COVID-19–associated functionalities existed previous to the pandemic however added COVID-19–associated functionalities after the onset. Fifty-eight % of COVID-19 apps have been newly added to the galleries through the pandemic.

Determine 3 categorizes telehealth apps by whether or not their major functionalities embrace video or nonvideo capabilities (eg, scheduling and billing, safe messaging, affected person satisfaction surveys), in addition to any adjustments made after the onset of the pandemic. General, 10 telehealth apps (11%) primarily offered video-only performance, 36 offered each video and nonvideo functionalities (41%), and 41 offered solely nonvideo functionalities (47%). Most apps that added telehealth functionalities or have been newly found through the pandemic have been primarily apps with solely nonvideo capabilities. Greater than half of telehealth-related apps that have been found previous to the onset and didn’t make any adjustments through the pandemic offered each video and nonvideo functionalities. Equally, roughly 4 in 10 apps added through the pandemic additionally offered each video and nonvideo functionalities.

The Desk lists the meant use or practical class for telehealth- and COVID-19–associated apps. Scheduling and billing have been the commonest functionalities for apps marketed to assist pandemic response efforts. Almost two-thirds of COVID-19 apps and greater than three-fourths of telehealth-related apps supported these administrative features. The subsequent most typical makes use of for COVID-19–associated apps have been for vaccine administration and administration (26%), affected person training (24%), and well being data administration (21%). Different widespread functionalities for telehealth apps included supplier effectivity instruments (36%), safe messaging (26%), and digital check-in (18%).

DISCUSSION

This examine supplies early perception into the speedy integration of third-party apps with EHRs in scientific settings through the COVID-19 pandemic. The variety of COVID-19–associated apps listed in these galleries quickly elevated from 0 in March 2020 to 19 a month later and continued to develop to 62 as of June 2021. The variety of telehealth-related apps greater than doubled from prepandemic ranges (n = 41) to a complete of 87 apps by June 2021. This progress could replicate elevated demand for digital applied sciences to assist pandemic response efforts.

HHS briefly issued a number of measures to make it simpler for sufferers to obtain medical care by means of telehealth through the public well being emergency.¹⁴ Considered one of these measures included flexibility for well being care suppliers and their sufferers to make use of video communication apps that didn’t adjust to Well being Insurance coverage Portability and Accountability Act laws for telehealth functions. Roughly half of the telehealth apps recognized throughout this evaluation had video performance. Nonvideo telehealth apps supported functionalities for scheduling and billing, digital check-in, safe messaging, and affected person training.

COVID-19–associated apps supported administrative features and essential duties associated to pandemic response efforts at greater charges in contrast with all apps listed within the 5 galleries. Greater than half of COVID-19 apps supported administrative features, similar to scheduling and billing and digital check-in, which enabled social distancing by stopping overcrowding in ready rooms. COVID-19–associated apps have been additionally used for vaccine administration, well being data administration, safe messaging, laboratory testing, and affected person monitoring at greater charges.

Though the entire variety of COVID-19– and telehealth-related apps elevated considerably all through the course of the pandemic, this improve doesn’t essentially replicate new improvement of apps. Solely roughly half of all COVID-19–associated apps (58%) and telehealth-related apps (51%) have been newly found within the app galleries through the pandemic. Roughly 2 in 5 COVID-19–associated apps and roughly 1 in 5 telehealth-related apps have been listed in an EHR app gallery previous to the pandemic however up to date their advertising and marketing supplies to incorporate details about how the app can be utilized to assist telehealth- or COVID-19–associated efforts through the pandemic. We’re unable to conclude whether or not these apps actually added new functionalities or whether or not the builders recognized new COVID-19 or telehealth use instances that the app’s present capabilities may assist.

Moreover, the itemizing of an app in an EHR app gallery doesn’t essentially replicate use of that app. Future analysis ought to take into account exploring novel information sources that present insights into the precise use of those apps by sufferers or clinicians, similar to app downloads, person scores, or system-generated information from APIs managed by well being care organizations.

CONCLUSIONS

In Could 2020, the Workplace of the Nationwide Coordinator for Well being IT finalized the twenty first Century Cures Act remaining rule that sought to make integration of third-party apps with EHRs simpler by requiring sure builders of licensed well being IT to undertake safe, standards-based APIs utilizing the Well being Degree Seven Quick Healthcare Interoperability Assets information alternate commonplace and by making obtainable particular enterprise and technical documentation essential to work together with their licensed API expertise. The aim of those insurance policies was to create a extra open well being IT ecosystem that promotes innovation, buyer alternative, and speedy scalability.

The findings from this examine present early insights into how these insurance policies could also be advancing the position that third-party apps performed in supporting efforts to reply to the COVID-19 pandemic. We noticed a speedy improve in telehealth- and COVID-19–associated apps integrating with EHRs following the onset of the pandemic. These apps offered well being care suppliers with an inflow of latest instruments that may very well be used to diagnose, deal with, and talk with sufferers, in addition to instantly assist pandemic response efforts.

As extra EHR applied sciences allow information alternate by means of standards-based APIs and undertake practices that facilitate integration, a dynamic ecosystem of apps can exist to handle well being care wants and assist public well being. 

Writer Affiliations: Workplace of the Nationwide Coordinator for Well being Data Expertise, HHS (CJ, WB), Washington, DC.

Supply of Funding: None.

Writer Disclosures: The authors report no relationship or monetary curiosity with any entity that may pose a battle of curiosity with the subject material of this text.

Authorship Data: Idea and design (CJ, WB); acquisition of information (CJ, WB); evaluation and interpretation of information (CJ, WB); drafting of the manuscript (CJ, WB); essential revision of the manuscript for essential mental content material (CJ, WB); statistical evaluation (CJ, WB); administrative, technical, or logistic assist (CJ, WB); and supervision (CJ, WB).

Deal with Correspondence to: Wesley Barker, MS, Workplace of the Nationwide Coordinator for Well being Data Expertise, HHS, 330 C St SW, Flooring 7, Washington, DC 20024. Electronic mail: Wesley.Barker@hhs.gov.

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