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1. More isn’t always better: Technology in the intensive care unit

   https://doi.org/10.1097/HMR.0000000000000398  

   Olsen, Esther; Novikov, Zhanna; Sakata, Theadora; Lambert, Monique H; Lorenzo, Javier; Bohn, Roger; Singer, Sara J (February 2024, Health Care Management Review)

   BackgroundClinical care in modern intensive care units (ICUs) combines multidisciplinary expertise and a complex array of technologies. These technologies have clearly advanced the ability of clinicians to do more for patients, yet so much equipment also presents the possibility for cognitive overload. PurposeThe aim of this study was to investigate clinicians’ experiences with and perceptions of technology in ICUs. Methodology/ApproachWe analyzed qualitative data from 30 interviews with ICU clinicians and frontline managers within four ICUs. ResultsOur interviews identified three main challenges associated with technology in the ICU: (a) too many technologies and too much data; (b) inconsistent and inaccurate technologies; and (c) not enough integration among technologies, alignment with clinical workflows, and support for clinician identities. To address these challenges, interviewees highlighted mitigation strategies to address both social and technical systems and to achieve joint optimization. ConclusionWhen new technologies are added to the ICU, they have potential both to improve and to disrupt patient care. To successfully implement technologies in the ICU, clinicians’ perspectives are crucial. Understanding clinicians’ perspectives can help limit the disruptive effects of new technologies, so clinicians can focus their time and attention on providing care to patients. Practice ImplicationsAs technology and data continue to play an increasingly important role in ICU care, everyone involved in the design, development, approval, implementation, and use of technology should work together to apply a sociotechnical systems approach to reduce possible negative effects on clinical care for critically ill patients. 

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2. Building a Diabetes Educator Program for Remote Patient Monitoring Billing

   https://doi.org/10.1177/19322968241308920  

   Bishop, Franziska_K; Chmielewski, Annette; Leverenz, Jeannine; Lin, Shannon; Conrad, Barry; Martinez-Singh, Anjoli; Pike, Laura; Scheinker, David; Prahalad, Priya; Maahs, David_M (December 2024, Journal of Diabetes Science and Technology)

   Objective:Develop workflows and billing processes for a Certified Diabetes Care and Education Specialist (CDCES)-led remote patient monitoring (RPM) program to transition the Teamwork, Targets, Technology, and Tight Control (4T) Study to our clinic’s standard of care. Methods:We identified stakeholders within a pediatric endocrinology clinic (hospital compliance, billing specialists, and clinical informatics) to identify, discuss, and approve billing codes and workflow. The group evaluated billing code stipulations, such as the timing of continuous glucose monitor (CGM) interpretation, scope of work, providers’ licensing, and electronic health record (EHR) documentation to meet billing compliance standards. We developed a CDCES workflow for asynchronous CGM interpretation and intervention and initiated an RPM billing pilot. Results:We built a workflow for CGM interpretation (billing code: 95251) with the CDCES as the service provider. The workflow includes data review, patient communications, and documentation. Over the first month of the pilot, RPM billing codes were submitted for 52 patients. The average reimbursement rate was $110.33 for commercial insurance (60% of patients) and $46.95 for public insurance (40% of patients) per code occurrence. Conclusions:Continuous involvement of CDCES and hospital stakeholders was essential to operationalize all relevant aspects of clinical care, workflows, compliance, documentation, and billing. CGM interpretation with RPM billing allows CDCES to work at the top of their licensing credential, increase clinical care touch points, and provide a business case for expansion. As evidence of the clinical benefits of RPM increases, the processes developed here may facilitate broader adoption of revenue-generating CDCES-led care to fund RPM. 

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3. A Qualitative Analysis of Remote Patient Monitoring: How a Paradox Mindset Can Support Balancing Emotional Tensions in the Design of Healthcare Technologies

   https://doi.org/10.1145/3710922  

   Jonassen, Zoe; Lawrence, Katharine; Wiesenfeld, Batia Mishan; Feuerriegel, Stefan; Mann, Devin (May 2025, Proceedings of the ACM on Human-Computer Interaction)

   Remote patient monitoring (RPM) is the use of digital technologies to improve patient care at a distance. However, current RPM solutions are often biased toward tech-savvy patients. To foster health equity, researchers have studied how to address the socio-economic and cognitive needs of diverse patient groups, but their emotional needs have remained largely neglected. We perform the first qualitative study to explore the emotional needs of diverse patients around RPM. Specifically, we conduct a thematic analysis of 18 interviews and 4 focus groups at a large US healthcare organization. We identify emotional needs that lead to four emotional tensions within and across stakeholder groups when applying an equity focus to the design and implementation of RPM technologies. The four emotional tensions are making diverse patients feel: (i) heard vs. exploited; (ii) seen vs. deprioritized for efficiency; (iii) empowered vs. anxious; and (iv) cared for vs. detached from care. To manage these emotional tensions across stakeholders, we develop design recommendations informed by a paradox mindset (i.e., both-and rather than and-or strategies). 

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4. Patients Waiting for Cues: Information Asymmetries and Challenges in Sharing Patient-Generated Data in the Clinic

   https://doi.org/10.1145/3512954  

   Oh, Chi Young; Luo, Yuhan; St. Jean, Beth; Choe, Eun Kyoung (March 2022, Proceedings of the ACM on Human-Computer Interaction)

   Patient-generated data (PGD) show great promise for informing the delivery of personalized and patient-centered care. However, patients' data tracking does not automatically lead to data sharing and discussion with clinicians, which can make it difficult to utilize and derive optimal benefit from PGD. In this paper, we investigate whether and how patients share their PGD with clinicians and the types of challenges that arise within this context. We describe patients' immediate experiences of PGD sharing with clinicians, based on our short onsite interviews with 57 patients who had just met with a clinician at a university health center. Our analyses identified overarching patterns in patients' PGD sharing practices and the associated challenges that arise from the information asymmetry between patients and clinicians and from patients' reliance on their memory to share their PGD. We discuss the implications of our findings for designing PGD-integrated health IT systems in ways to support patients' tracking of relevant PGD, clinicians' effective engagement with patients around PGD, and the efficient sharing and review of PGD within clinical settings. 

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5. Preventing Urgent Pediatric Readmissions: The Need for and Promise of Real-Time Monitoring

   https://doi.org/10.2196/60802  

   Thapa, Isha; Han, Brian; Rosenthal, David N; Roth, Stephen J; Shin, Andrew Y; Bambos, Nicholas; Scheinker, David (June 2025, JMIR Pediatrics and Parenting)

   Abstract Urgent pediatric hospital readmissions are common, costly, and often preventable. Existing prediction models, based solely on discharge data, fail to accurately identify pediatric patients at-risk or urgent readmission. Remote patient monitoring (RPM) leverages wearable technology to provide real-time health data, enabling care teams to detect and respond to early signs of clinical deterioration. Emerging evidence suggests RPM may be a promising strategy to improve pediatric postdischarge outcomes and reduce urgent hospital readmissions. 

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