ABSTRACT
Goals: To (1) monitor the blending of telehealth- and COVID-19–related apps with digital properly being information (EHRs) over time, (2) set up the primary efficiency of apps designed to assist the COVID-19 response, and (3) take a look at whether or not or not apps on the market earlier to the pandemic added new telehealth- or COVID-19–related functionalities all through the pandemic.
Study Design: Data had been collected from public EHR app galleries on a month-to-month basis from December 31, 2019, by way of June 1, 2021.
Methods: Apps had been acknowledged as concerning COVID-19 or telehealth using textual content material analysis of the app promoting and advertising and marketing provides. Descriptive analyses had been carried out to characterize telehealth- and COVID-19–related apps discovered by way of the app galleries, set up their main efficiency, and take a look at whether or not or not any apps added new telehealth- or COVID-19–related functionalities all through the pandemic.
Outcomes: The number of COVID-19–related apps elevated from 0 in March 2020 to 19 a month later and continued to develop to 62 as of June 2021. The number of telehealth-related apps better than doubled from prepandemic ranges (n = 41) to a whole of 87 apps by June 2021. These apps had been 2 situations additional extra prone to comprise specialised capabilities used to assist COVID-19 response efforts, akin to protected messaging, vaccine administration, and laboratory testing, in distinction with all apps listed inside the EHR app galleries.
Conclusions: These findings reveal the potential of integrating third-party apps into EHRs to develop the fluctuate of devices that properly being care suppliers can use to diagnose, take care of, and discuss with victims.
Am J Manag Care. 2023;29(1):In Press
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Takeaway Elements
The findings from this analysis current early insights into how properly being information know-how insurance coverage insurance policies may be advancing the place that third-party apps carried out in supporting efforts to reply the COVID-19 pandemic.
- In May 2020, the federal authorities finalized a protection that sought to make integration of third-party apps with digital properly being information (EHRs) easier by requiring EHR builders to undertake protected, standards-based software program programming interfaces.
- We seen a quick enhance in telehealth- and COVID-19–related apps integrating with EHRs following the onset of the pandemic.
- These apps equipped properly being care suppliers with an influx of latest devices that may be used to diagnose, take care of, and discuss with victims.
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On March 11, 2020, the World Properly being Group declared COVID-19 a worldwide pandemic.1 Following this declaration, worldwide places shortly sought supplies and belongings to examine for contaminated individuals, defend properly being care workers treating victims, and begin enchancment of prescription drugs to take care of and cease the unfold of COVID-19.2
In response, software program program and properly being information know-how (IT) builders moreover began to shortly create and deploy digital devices that may be used to help take care of victims and assist inside the fight in the direction of COVID-19. Telehealth was acknowledged as a method of properly being care provide that will reduce sickness transmission, defend personal defending instruments, and reduce the affect of affected individual surges on properly being care facilities.3,4 Totally different digital utilized sciences, akin to cell telephones, distant monitoring devices, and web-based apps, had been moreover used to assist epidemiologic surveillance, contact tracing, and evaluation of public properly being interventions.5 This paper highlights the quick integration of telehealth- and COVID-19–related software program program capabilities with digital properly being information (EHRs) all through the pandemic from January 2020 to June 2021.
App integrations are usually carried out using EHR software program programming interfaces (APIs). APIs permit easier entry and alter of data by way of automated and predictable communications amongst completely completely different laptop computer applications. The mixture of third-party apps using APIs has the potential to develop the fluctuate of devices properly being care suppliers can use to diagnose, take care of, and discuss with victims previous the functionalities that their EHR developer may assist.6 Totally different evaluation has confirmed that the number of apps that mix with EHRs is rising7; nonetheless, little is known regarding the place of EHR-integrated apps in supporting COVID-19 response efforts. This paper provides early insights into the blending of these apps all through a public properly being emergency.
We examined apps present in EHR public app galleries to determine telehealth- and COVID-19–related apps that had been built-in sooner than and after the onset of the COVID-19 pandemic within the USA. The goals of this analysis had been to (1) monitor the blending of telehealth- and COVID-19–related apps over time, (2) set up the primary efficiency of apps designed to assist the COVID-19 response, and (3) take a look at whether or not or not apps discovered earlier to the pandemic added new telehealth- or COVID-19–related functionalities all through the pandemic.
STUDY DESIGN AND METHODS
Data Sources
Data had been collected from public app galleries hosted by 4 EHR builders: Allscripts,8 Athenahealth,9 Cerner Firm,10 and Epic Strategies Firm,11 together with Boston Youngsters’s Hospital’s SMART (or Substitutable Medical Apps and Reusable Utilized sciences).12 For this analysis, we ponder any app present in these galleries as an EHR-integrated app. Data had been collected on a month-to-month basis from December 31, 2019, by way of June 1, 2021. Month-to-month cumulative COVID-19 case counts within the USA had been obtained from the CDC’s COVID Data Tracker.13
Identification of Telehealth- and COVID-19–Related Apps
Apps had been acknowledged as telehealth within the occasion that they talked about “telehealth,” “telemedicine,” “video search the recommendation of,” or “video go to” inside the app promoting and advertising and marketing provides pulled from each gallery. Equally, apps had been acknowledged as concerning COVID-19 within the occasion that they talked about “COVID,” “coronavirus,” or “pandemic” of their app promoting and advertising and marketing provides.
For the wants of this analysis, March 1, 2020, was thought-about the onset of the pandemic. Apps that had been acknowledged earlier to the onset had been categorized as “discovered earlier to pandemic,” and folks discovered after the onset had been categorized as “added all through pandemic.” Quite a lot of apps that had been initially acknowledged earlier to the onset of the pandemic updated their promoting and advertising and marketing provides after the onset to include new functionalities or use situations related to the pandemic. These apps had been categorized as “added functionalities,” and individuals who did not make any updates to their promoting and advertising and marketing provides had been categorized as “no changes.”
Textual content material analysis was carried out to determine the primary efficiency of each app, and a handbook analysis was carried out to verify its accuracy. Further particulars regarding the methods used to create this information set and the textual content material analysis program have been beforehand printed.7
Statistical Analysis
Descriptive analyses had been carried out to characterize telehealth- and COVID-19–related apps discovered by way of the app galleries, set up their main efficiency, and take a look at whether or not or not any apps added new telehealth- or COVID-19–related functionalities all through the pandemic. Two-sample t exams had been carried out to examine for statistically important variations (P < .05). All analyses had been carried out using SAS mannequin 9.4 (SAS Institute).
RESULTS
Decide 1 displays the general number of distinctive telehealth- and COVID-19–related apps listed all through the 5 galleries, along with month-to-month cumulative COVID-19 case counts. As of the beginning of March 2020, the USA had 1199 cumulative COVID-19 situations. Presently, 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, initially of April 2020, the cumulative number of COVID-19 situations grew to 257,751, and the first COVID-19–related apps (18 in full) emerged in these galleries. The number of telehealth-related apps moreover grew to 53. As a result of the cumulative number of COVID-19 situations continued to develop all by 2020 and into 2021, the general number of telehealth- and COVID-19–related apps moreover grew. Although the general number of telehealth apps shortly elevated all through the primary half of 2020, these apps peaked in July 2020 (88 apps), then leveled off by way of the remainder of the analysis interval. Within the meantime, the general number of COVID-19–related apps steadily elevated all by the size of the analysis and was at its highest diploma inside the ultimate month of data assortment (62 apps).
Decide 2 displays the proportion of telehealth- and COVID-19–related apps listed in galleries by whether or not or not that they had been acknowledged earlier to the onset of the pandemic and whether or not or not the app added new telehealth- or COVID-19–related functionalities all through the pandemic. Amongst telehealth apps marketed as of June 1, 2021, 51% had been newly added to a gallery all through the pandemic, 29% had been discovered earlier to the pandemic with current telehealth functionalities, and 21% had been discovered earlier to the pandemic and added telehealth-related functionalities after the onset of the pandemic. This exhibit moreover displays that 0 apps had been marketed with COVID-19–related functionalities earlier to the pandemic on account of it was a novel virus. We found that 42% of apps with COVID-19–related functionalities existed earlier to the pandemic nevertheless added COVID-19–related functionalities after the onset. Fifty-eight p.c of COVID-19 apps had been newly added to the galleries all through the pandemic.
Decide 3 categorizes telehealth apps by whether or not or not their main functionalities embrace video or nonvideo capabilities (eg, scheduling and billing, protected messaging, affected individual satisfaction surveys), along with any changes made after the onset of the pandemic. Common, 10 telehealth apps (11%) primarily equipped video-only efficiency, 36 equipped every video and nonvideo functionalities (41%), and 41 equipped solely nonvideo functionalities (47%). Most apps that added telehealth functionalities or had been newly discovered all through the pandemic had been primarily apps with solely nonvideo capabilities. Higher than half of telehealth-related apps that had been discovered earlier to the onset and did not make any changes all through the pandemic equipped every video and nonvideo functionalities. Equally, roughly 4 in 10 apps added all through the pandemic moreover equipped every video and nonvideo functionalities.
The Desk lists the supposed use or sensible class for telehealth- and COVID-19–related apps. Scheduling and billing had been the commonest functionalities for apps marketed to assist pandemic response efforts. Virtually two-thirds of COVID-19 apps and better than three-fourths of telehealth-related apps supported these administrative options. The following commonest makes use of for COVID-19–related apps had been for vaccine administration and administration (26%), affected individual education (24%), and properly being information administration (21%). Totally different frequent functionalities for telehealth apps included provider effectivity devices (36%), protected messaging (26%), and digital check-in (18%).
DISCUSSION
This analysis provides early notion into the quick integration of third-party apps with EHRs in scientific settings all through the COVID-19 pandemic. The number of COVID-19–related apps listed in these galleries shortly elevated from 0 in March 2020 to 19 a month later and continued to develop to 62 as of June 2021. The number of telehealth-related apps better than doubled from prepandemic ranges (n = 41) to a whole of 87 apps by June 2021. This progress may mirror elevated demand for digital utilized sciences to assist pandemic response efforts.
HHS shortly issued quite a few measures to make it easier for victims to acquire medical care by way of telehealth all through the general public properly being emergency.14 One in every of these measures included flexibility for properly being care suppliers and their victims to utilize video communication apps that did not modify to Properly being Insurance coverage protection Portability and Accountability Act legal guidelines for telehealth capabilities. Roughly half of the telehealth apps acknowledged all through this analysis had video efficiency. Nonvideo telehealth apps supported functionalities for scheduling and billing, digital check-in, protected messaging, and affected individual education.
COVID-19–related apps supported administrative options and needed duties related to pandemic response efforts at elevated fees in distinction with all apps listed inside the 5 galleries. Higher than half of COVID-19 apps supported administrative options, akin to scheduling and billing and digital check-in, which enabled social distancing by stopping overcrowding in prepared rooms. COVID-19–related apps had been moreover used for vaccine administration, properly being information administration, protected messaging, laboratory testing, and affected individual monitoring at elevated fees.
Although the general number of COVID-19– and telehealth-related apps elevated significantly all by the course of the pandemic, this enhance does not primarily mirror new enchancment of apps. Solely roughly half of all COVID-19–related apps (58%) and telehealth-related apps (51%) had been newly discovered inside the app galleries all through the pandemic. Roughly 2 in 5 COVID-19–related apps and roughly 1 in 5 telehealth-related apps had been listed in an EHR app gallery earlier to the pandemic nevertheless updated their promoting and advertising and marketing provides to include particulars about how the app could be utilized to assist telehealth- or COVID-19–related efforts all through the pandemic. We’re unable to conclude whether or not or not these apps really added new functionalities or whether or not or not the builders acknowledged new COVID-19 or telehealth use situations that the app’s current capabilities may assist.
Furthermore, the itemizing of an app in an EHR app gallery does not primarily mirror use of that app. Future evaluation must ponder exploring novel data sources that current insights into the exact use of these apps by victims or clinicians, akin to app downloads, client scores, or system-generated data from APIs managed by properly being care organizations.
CONCLUSIONS
In May 2020, the Office of the Nationwide Coordinator for Properly being IT finalized the twenty first Century Cures Act final rule that sought to make integration of third-party apps with EHRs easier by requiring positive builders of licensed properly being IT to undertake protected, standards-based APIs using the Properly being Diploma Seven Fast Healthcare Interoperability Belongings data change customary and by making on the market explicit enterprise and technical documentation important to work along with their licensed API know-how. The aim of these insurance coverage insurance policies was to create a additional open properly being IT ecosystem that promotes innovation, purchaser choice, and quick scalability.
The findings from this analysis current early insights into how these insurance coverage insurance policies may be advancing the place that third-party apps carried out in supporting efforts to reply the COVID-19 pandemic. We seen a quick enhance in telehealth- and COVID-19–related apps integrating with EHRs following the onset of the pandemic. These apps equipped properly being care suppliers with an influx of latest devices that may be used to diagnose, take care of, and discuss with victims, along with straight assist pandemic response efforts.
As additional EHR utilized sciences permit data change by way of standards-based APIs and undertake practices that facilitate integration, a dynamic ecosystem of apps can exist to deal with properly being care needs and assist public properly being.
Author Affiliations: Office of the Nationwide Coordinator for Properly being Data Know-how, HHS (CJ, WB), Washington, DC.
Provide of Funding: None.
Author Disclosures: The authors report no relationship or financial curiosity with any entity which will pose a battle of curiosity with the topic materials of this textual content.
Authorship Data: Concept and design (CJ, WB); acquisition of data (CJ, WB); analysis and interpretation of data (CJ, WB); drafting of the manuscript (CJ, WB); important revision of the manuscript for needed psychological content material materials (CJ, WB); statistical analysis (CJ, WB); administrative, technical, or logistic assist (CJ, WB); and supervision (CJ, WB).
Cope with Correspondence to: Wesley Barker, MS, Office of the Nationwide Coordinator for Properly being Data Know-how, HHS, 330 C St SW, Flooring 7, Washington, DC 20024. Email correspondence: Wesley.Barker@hhs.gov.
REFERENCES
1. Director-Widespread’s opening remarks on the media briefing on COVID-19. World Properly being Group. March 11, 2020. Accessed June 30, 2021. https://www.who.int/director-general/speeches/factor/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020
2. de Laurentiis E. COVID-19: how the World Monetary establishment helps worldwide places procure important medical supplies. World Monetary establishment Blogs. May 7, 2020. Accessed June 30, 2021. https://blogs.worldbank.org/voices/covid-19-how-world-bank-helping-countries-procure-critical-medical-supplies
3. Using telehealth to develop entry to vital properly being suppliers all through the COVID-19 pandemic. CDC. Updated June 10, 2020. Accessed June 30, 2021. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html
4. Monaghesh E, Hajizadeh A. The place of telehealth all through COVID-19 outbreak: a scientific analysis primarily based totally on current proof. BMC Public Properly being. 2020;20(1):1193. doi:10.1186/s12889-020-09301-4
5. Budd J, Miller BS, Manning EM, et al. Digital utilized sciences inside the public-health response to COVID-19. Nat Med. 2020;26(8):1183-1192. doi:10.1038/s41591-020-1011-4
6. Mandl KD, Mandel JC, Kohane IS. Driving innovation in properly being applications by way of an apps-based information monetary system. Cell Syst. 2015;1(1):8-13. doi:10.1016/j.cels.2015.05.001
7. Barker W, Johnson C. The ecosystem of apps and software program program built-in with licensed properly being information know-how. J Am Med Inform Assoc. 2021;28(11):2379-2384. doi:10.1093/jamia/ocab171
8. Licensed capabilities. Veradigm. Accessed June 1, 2021. https://expo.veradigm.com/apps
9. Market. Athenahealth. Accessed June 1, 2021. https://market.athenahealth.com/
10. App gallery. Cerner. Accessed June 1, 2021. https://code.cerner.com/apps
11. App market. Epic. Accessed June 1, 2021. https://appmarket.epic.com/
12. App gallery. SMART. Accessed June 1, 2021. https://apps.smarthealthit.org/
13. COVID data tracker. CDC. Accessed June 10, 2021. https://covid.cdc.gov/covid-data-tracker/#datatracker-home
14. Telehealth. HHS. Accessed July 15, 2020. https://www.hhs.gov/coronavirus/telehealth/index.html
