Healthcare Technology Innovations for Identifying and Managing COVID-19 Patients

Overview

Analysis

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The COVID-19 pandemic is pushing global healthcare systems to and beyond their limits. Exponentially increasing demand, higher patient acuity and the need to rapidly develop new capabilities such as contact tracing and mass temperature screening are creating crisis situations at the health service and population levels.

In Italy, the number of patients requiring critical care and ventilation exceeded the health system’s capacity. As a result, medical staff were forced to decide to whom the scarce resources would be allocated. On 11 March 2020, the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care released guidelines for rationing care.

Spain’s health system is also under considerable strain. Hospitals are reporting a lack of basic protective equipment, with healthcare workers making up more than 13% of the number of people infected with the virus across the country. Current bed capacity modeling for the U.S. is predicting that, even if hospitals cancel all elective procedures, there will be no available intensive care beds by the end of April, and beds in medical and surgical units will reach capacity by mid-May.

In this time of crisis, healthcare provider CIOs are actively engaged in the response of their HDOs. Early efforts are focusing on:

• Updating the core electronic health record (EHR) to support COVID-related workflows

• Scaling virtual care programs

• Scaling capacity to enable staff to work from home

• Meeting new data and analytics requirements to provide real-time COVID-19 operational insights

• Ensuring core infrastructure, especially network infrastructure, has the capacity to manage the additional load

• Managing increased cybersecurity risk

At the same time, healthcare IT vendors, academic institutions and healthcare providers are rapidly deploying new technologies in a bid to address the critical capability and capacity gaps across HDOs and at the population level (see Figure 1). Healthcare provider CIOs must focus their attention on identifying ongoing gaps across their organizations that can be addressed through new technology and develop a plan for fast-tracking implementation.

A large number of virtual assistants using natural language conversational interfaces and artificial intelligence (AI) technologies are being developed to provide COVID-19-specific education, screening, triage and home monitoring. These assistants are reducing unnecessary demand on acute care services by supporting the worried well and directing patients to the right services at the right time.

Examples include:

• U.K.-based Telehealth and GP Service Babylon Health has released the COVID-19 Care Assistant, freely available within its app. The app provides information and videos, a symptom checker, 24/7 live chat access, virtual consultations, and hospital referrals. The app also enables daily symptom logging and guidance. The Care Assistant is currently available in the U.K., and the provider has plans to roll out elsewhere.

• Orbita has launched a COVID-19 Chatbot Screener and Knowledge Base for HDOs and large employers across the globe. The free version is deployed to the organization’s website, providing education and screening of symptoms based on information from the CDC and other clinically vetted sources. Additional functionality such as the ability to direct patients to custom endpoints like virtual visits and appointment scheduling tools, and the ability to complete secure assessments, are available in the paid version.

• Providence St. Joseph Health has leveraged Microsoft’s Healthcare Bot to build a screening chatbot that is integrated into its website. The solution uses a series of questions to determine risk of infection and direct the individual to the most appropriate care. To support rapid deployment of COVID-19 bots, Microsoft has made a set of response templates, including risk assessment, triage and education, available for customers to use and customize.

• Hyro, a Tel-Aviv-based healthcare AI startup, has released a free COVID-19 virtual assistant. Using content from the World Health Organization (WHO) and other sources such as the U.S. Centers for Disease Control and Prevention (CDC), the assistant has the capability to answer questions, direct patients to COVID-19-related content and triage symptoms. According to the vendor, the solution can be deployed within 24 hours and is fully customizable based on client requirements.

• Patient engagement software company Gyant has rolled out a COVID-19 Emergency Response Assistant. The capabilities of the solution include screening, care navigation, and patient education on symptoms, prevention and preparedness.

• Innovaccer has released a free COVID-19 Management System that supports early community-based triage through automated assessments, remote patient monitoring and education.

The presence of fever is one of the key symptoms of COVID-19 infection. Therefore, governments and health systems across the globe are working to build capabilities for mass temperature screening through thermal scanning and imaging technologies.

Examples include:

• Across China, thermal imaging technology has been widely deployed across public areas such as airports and railway stations,including using drones that are able to scan crowds and identify individuals with a fever from more than 100 feet away. Police and epidemic control units are using helmets fitted with infrared cameras that enable them to measure temperatures from up to five meters away.

• Singapore-based Integrated Health Information Systems (IHiS) has partnered with AI startup KroniKare to develop iThermo, an automated temperature screening solution. iThermo uses AI to process and analyze images from a smartphone fitted with thermal and 3D laser cameras to accurately measure temperature from a distance of up to three meters. The solution is currently being trialed across a number of sites in Singapore.

• Tampa General Hospital in the U.S. has introduced a screening system developed by Care.ai to assess a person’s health. The solution uses camera-embedded devices stationed at its visitor entrances that analyze facial attributes such as sweating and discoloration in addition to data from a thermal scan.

In response to the COVID-19 pandemic, researchers and health IT vendors are developing new ways to support rapid diagnosis of the virus.

Examples include:

• In China, owing to the time taken for laboratory testing, national guidelines recommend CT scans as a key method for COVID-19 diagnosis. As a result, AI-based CT image interpretation systems have been developed to support diagnosis and disease progression monitoring. Solutions developed include those by Alibaba DAMO Academy,Ping An and Remin Hospital of Wuhan University.

• In the U.K., behold.ai has announced its AI-based red dot algorithm, which is able to rapidly identify abnormal chest x-rays of individuals with COVID-19. Trials are ongoing. The U.S. Food and Drug Administration (FDA) recently cleared behold.ai’s algorithm, and the company plans commercial rollout in the U.S. later this year.

• An Australian AI diagnosis tool developed by DetectED-X is being offered free of charge to healthcare providers globally. The online educational tool aims to improve clinician COVID-19 lung CT diagnostic accuracy by providing real-time feedback on accuracy and identifying where errors were made.

• Surgisphere has developed an AI-based diagnosis decision support tool using clinical signs and symptoms such as age, vital signs and presence of chronic conditions. According to Surgisphere, prospective validation of the tool has demonstrated a 95.5% accuracy. The tool is currently being tested for clinical use.

Contact tracing is the process of identifying a person who has come into contact with an infected person. It enables early diagnosis and management. When combined with social isolation, it is critical in the fight against the spread of COVID-19. Done manually, contact tracing is a labor-intensive process. Mobile applications solve this issue by leveraging Bluetooth signals and/or GPS tracking logs to compare the location trail of an individual with those diagnosed with COVID-19 to identify and alert individuals who have come into close proximity with an infected person. While these solutions hold great promise there are myriad privacy issues that must be navigated, and the effectiveness of these solutions will rely on mass population adoption.

Examples include:

• Private Kit: Safe Paths is a free and open-source app developed by MIT and Harvard. The app tracks a user’s location and shares this encrypted location data between phones in the network. When a user tests positive for the coronavirus and shares this with the app, other users who have come into close contact with that person are alerted without revealing their identity. People testing positive also have the option of sharing their location information with public health authorities.

• Singapore’s TraceTogether app works by exchanging short-distance Bluetooth signals between phones to detect other users of the app who are in close proximity. Records of these encounters are stored locally in the users’ phones. If a user tests positive, the app logs are used to identify people who cross their path. The software’s source code has been made freely available to developers globally.

Contact tracing within healthcare facilities is also vital to minimize the spread of the virus and protect healthcare workers. U.S.-based Health Catalyst has released a new module of its Patient Flow and Analytics Accelerator, Patient and Staff Tracker. The solution provides the ability to track where COVID-19-positive patients have been within a health system and identify staff members with whom they have interacted. The solution is designed to be used to inform capacity management, testing, quarantine and decontamination efforts.

The use of robots for dispensing medication, surgical procedures and transporting items within HDOs is longstanding. In the face of COVID-19, the application of this technology is being extended. Healthcare providers seek to minimize frontline staff exposure to the virus and reduce the risk of person-to-person transmission.

Examples include:

• In China, the Guangzhou Institute of Respiratory Health partnered with the Shenyang Institute of Automation under the Chinese Academy of Sciences to develop an intelligent robot to conduct throat swab sampling for the diagnosis of the coronavirus. The robot combines a mechanical arm and binocular endoscope receiving real-time instructions through a human-interaction terminal, achieving a first-time success rate of greater than 95%.

• Sheba Medical Center in Israel and Providence Regional Medical Center in Washington, U.S., have deployed “Vici,” a telemedical robot by InTouch Health that is equipped with a camera, screen and medical equipment. Vici can enter the quarantined patient’s room while being controlled remotely by clinical staff.

• Thailand has modified robots initially designed to monitor recovering stroke patients; the “ninja robots” support virtual consultations and are capable of interacting with patients, including the ability to take a patient’s temperature.

• Mobile UV robots such as UVD Robots and LightStrike Germ-Zapping Robots are being deployed to assist with room disinfection.

As healthcare providers continue to respond to the significant impact of COVID-19 on healthcare services, there will be ongoing development of new and innovative technology solutions to support this fight.

A critical priority for all healthcare providers now is the need to put in place processes to support the triage of patients to the most appropriate setting to ensure acute health facilities are reserved for those requiring hospital-based care. As CIO, you can facilitate these efforts at your organization by immediately focusing your attention on implementing virtual assistant technology to enable community triage and education.

In this time of crisis, the challenge for healthcare CIOs is determining which of these solutions will address their organization’s critical requirements. Use scenario planning to identify clinical and business requirements, and maximize the value of IT investment. Map out the impact of COVID-19 on the organization across potential scenarios, prioritizing investment in technology capabilities that will meet requirements across multiple scenarios both in the short and long term (see ).

Expediting time to implementation is essential. However, fast-tracking this process comes with inherent risks. Minimize these risks by developing a multidisciplinary team responsible for:

• Validating clinical efficacy of the solution

• Ensuring the solution meets minimum privacy, security and legislative requirements

• Ensuring appropriate staff training and support

In addition, the following factors should be considered as a component of all new implementations:

• If the solution is implemented just to support the requirements associated with COVID-19, establish a plan for decommissioning and ensure system users are aware of this plan from the outset.

• For solutions with potential value beyond the current COVID-19 crisis, take a strategic approach to selection. Look to partner with those vendors that have capabilities aligned to your long-term strategic direction.

• Many vendors are currently offering COVID-19-related solutions free to healthcare providers. While this provides a great opportunity to reduce licensing costs, healthcare CIOs must ensure that the costs of implementing and supporting these solutions are accurately captured and budgeted for both the short and longer term.

Gartner Recommended Reading

Evidence

“Facing Covid-19 in Italy — Ethics, Logistics, and Therapeutics on the Epidemic’s Front Line,” The New England Journal of Medicine.

“Hospital Capacity and Operations in the Coronavirus Disease 2019 (COVID-19) Pandemic — Planning for the Nth Patient,” JAMA Network.

“Array Advisors’ Model Validates Fears of ICU Bed Shortage Due to Coronavirus Pandemic,” Array.

“Feasibility of Controlling COVID-19 Outbreaks by Isolation of Cases and Contacts,” The Lancet.

“Location Rules Out Nurse’s Bid to Join COVID-19 Contact Tracing Team,” Radio New Zealand.

“BlueTrace Manifesto,” BlueTrace.

“Babylon Health Launches Digital Assistant for COVID-19,” pharmaphorum.

“How the Health System That Treated U.S. Coronavirus Patient 1 Has Responded,” Health Leaders Media.

“Tech That Scans People for Fever in Big Demand Amid Coronavirus Crisis, Boosting Wuhan Company,” Forbes.

“Chinese Police Now Have AI Helmets for Temperature Screening,” South China Morning Post.

“AI-Powered Temperature Screening Solution Being Trialed in Singapore,” MobiHealthNews.

“Hospitals Tap AI to Help Manage Coronavirus Outbreak,” The Wall Street Journal.

“China Use AI in Medical Imaging to Speed Up COVID-19 Diagnosis,” BioWorld.

“behold.ai’s Red Dot AI Algorithm Identifies Chest X-Rays From COVID-19 Patients as ‘Abnormal,’” behold.ai.

“World First Tool to Improve COVID-19 Diagnosis Free and Online,” The University of Sydney.

“COVID-19 Triage Decision Support Tool,” Surgisphere.

“China Develops Robot for Throat Swab Sampling,” The Star.

“Israel’s Sheba Hospital Turns to Telehealth to Treat Incoming Coronavirus-Exposed Patients,” MobiHealthNews.

“Robotic Medicine May Be the Weapon Needed to Combat the Coronavirus,” CNBC.

“Thailand Has ‘Ninja Robots’ Monitoring COVID-19 Patients — Take a Look,” Business Insider Australia.

“Robotics Companies Help With COVID-19 Response,” Process Online.

“Delivering Information and Eliminating Bottlenecks With CDC’s COVID-19 Assessment Bot,” Microsoft.

“Spain: Doctors Struggle to Cope as 514 Die From Coronavirus in a Day,” The Guardian.