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This qualitative study draws on interviews and observations with nurses working in a virtual intensive care unit and using algorithms to track patient progress. It overviews how health practitioners navi- gate algorithmic systems to build relationships with other providers and patients, with attention to strategies for accountability and ad- vocacy in virtual healthcare contexts.
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An Overview Of Synergistic Organizational Resources In Algorithm-enabled Virtual Patient Care
The Covid-19 pandemic has brought the rapid expansion of virtual services and automated patient care. While there is a growing body of research on how organizations can leverage algorithm-enabled systems to make patient decisions, attention to the synergistic combination of organizational resources surrounding the use of these systems in providing virtual patient care has been limited. More importantly, the enablement of new avenues for value-creation has been overlooked. This presentation report how health practitioners within virtual contexts successfully use algorithm-enabled patients care systems based on interviews with health professionals working in a Virtual Intensive Care Unit.
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- Award ID(s):
- 2026607
- PAR ID:
- 10327791
- Date Published:
- Journal Name:
- INFORMS Annual Meeting
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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null (Ed.)Background The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalized in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. Objective The aim of this study is to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. Methods We conducted a narrative review of literature on health equity and virtual care during the COVID-19 pandemic published in 2020, describing strategies that have been proposed in the literature at three levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. Results We highlight three strategies for promoting health equity through virtual care that have been underaddressed in this literature: (1) simplifying complex interfaces and workflows, (2) using supportive intermediaries, and (3) creating mechanisms through which marginalized community members can provide immediate input into the planning and delivery of virtual care. Conclusions We conclude by outlining three areas of work that are required to ensure that virtual care is employed in ways that are equity enhancing in a post–COVID-19 reality.more » « less
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Background Remote patient monitoring (RPM) technologies can support patients living with chronic conditions through self-monitoring of physiological measures and enhance clinicians’ diagnostic and treatment decisions. However, to date, large-scale pragmatic RPM implementation within health systems has been limited, and understanding of the impacts of RPM technologies on clinical workflows and care experience is lacking. Objective In this study, we evaluate the early implementation of operational RPM initiatives for chronic disease management within the ambulatory network of an academic medical center in New York City, focusing on the experiences of “early adopter” clinicians and patients. Methods Using a multimethod qualitative approach, we conducted (1) interviews with 13 clinicians across 9 specialties considered as early adopters and supporters of RPM and (2) speculative design sessions exploring the future of RPM in clinical care with 21 patients and patient representatives, to better understand experiences, preferences, and expectations of pragmatic RPM use for health care delivery. Results We identified themes relevant to RPM implementation within the following areas: (1) data collection and practices, including impacts of taking real-world measures and issues of data sharing, security, and privacy; (2) proactive and preventive care, including proactive and preventive monitoring, and proactive interventions and support; and (3) health disparities and equity, including tailored and flexible care and implicit bias. We also identified evidence for mitigation and support to address challenges in each of these areas. Conclusions This study highlights the unique contexts, perceptions, and challenges regarding the deployment of RPM in clinical practice, including its potential implications for clinical workflows and work experiences. Based on these findings, we offer implementation and design recommendations for health systems interested in deploying RPM-enabled health care.more » « less
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As the general population ages and life expectancy increases in the United States, demand for virtual health care is also on the rise. Undoubtedly, the next several decades will see a rise in automated patient care and the widespread use of data-driven warning systems, trends which have already accelerated in the wake of Covid-19. Thus, understanding how traditionally trained healthcare practitioners respond to predictive analytics, like early warning systems, is vital for their successful implementation in the future. Our findings both reinforce and also extend previous research on tele-ICU’s and early warning systems, offering important insights into the relational and organizational dynamics that underlie their implementation. Overall, healthcare workers are more willing to accept the use of technology in their workplace when they see tangible benefits to themselves. Administrators who were removed from everyday interactions with algorithmic systems were highly skeptical of their utility.more » « less
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Abstract This study provides data on the feasibility and impact of video-enabled telemedicine use among patients and providers and its impact on urgent and nonurgent healthcare delivery from one large health system (NYU Langone Health) at the epicenter of the coronavirus disease 2019 (COVID-19) outbreak in the United States. Between March 2nd and April 14th 2020, telemedicine visits increased from 102.4 daily to 801.6 daily. (683% increase) in urgent care after the system-wide expansion of virtual urgent care staff in response to COVID-19. Of all virtual visits post expansion, 56.2% and 17.6% urgent and nonurgent visits, respectively, were COVID-19–related. Telemedicine usage was highest by patients 20 to 44 years of age, particularly for urgent care. The COVID-19 pandemic has driven rapid expansion of telemedicine use for urgent care and nonurgent care visits beyond baseline periods. This reflects an important change in telemedicine that other institutions facing the COVID-19 pandemic should anticipate.more » « less
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