Digital Epidemiology: on-demand public health

Guest Editor Sarianne Gruber (@subtleimpact) reviews the meta-trend of digital epidemiology, which gathers ‘digital exhaust’ information through social networks, chat rooms and other online media, analyzes it at the population level and tracks localized outbreaks of diseases like the Zika virus and flu. It even has inspired new models of vaccine delivery and patient transportation such as Uber Health and Circulation.

The Internet has a rather detailed picture of the health of the population, coming from digital sources through all of our connected devices, including smartphones. This is digital epidemiology: the idea that the health of a population can be assessed through digital traces, in real time. Digital Epidemiology: Tracking Diseases in the Mobile Age. M. Salathé, J. Brownstein et al.

As a Harvard Medical School Professor and the Boston Children’s Hospital Chief Innovation Officer, the plights of patients and the hurdles in care are Dr. John Brownstein’s starting points for questions and discovery. When the Community Transportation Association study reported “an estimated 3.6 million patients the United States miss at least one appointment due to lack of access to transportation”, Brownstein was determined to make this challenge his own. This fall, he launched the first customizable patient-centric digital transportation system – Circulation – a new vision for non-emergency medical transportation. As a Klick Health Muse attendee and having had the privilege to speak with John Brownstein, Ph.D., co-founder of Circulation, I would like to share what I learned about his journey as an epidemiologist, public health educator, and innovator.

Social Media’s Big Data: Preventing Epidemics and Tracking Drug Safety
Digital epidemiologists think in terms of “digital phenotype” to understanding the health of individuals. Uncovering critical information about what is happening at the population level is collectively called “digital exhaust”. These digital traces that are left behind, help track local outbreaks around the world. “In fact, you don’t need surveys, just mine what people are saying online. We combine social media to get real insights as to what is happening on the ground: facts and sentiment. The ability to understand risk and population health is fantastic with these emerging technologies,” opened Dr. John Brownstein at the 2016 New York City KlickMuse event.

Social media mixed with disparate sources of health data was how Brownstein began solving public health risks. In 2006, he designed HealthMap, a publicly available, online real-time disease surveillance system, with the capacity to monitor emerging public health threats such as dengue fever, Zika virus, influenza and Ebola. “Data mining was actually the first indication of hemorrhagic fever in Kenya and how it spread across West Africa. And even more recently using emerging technologies, big data, data mining from social networks and online chat groups, we have been able to show the expansion of Zika virus as it emerged across South America and Central America,” shared Brownstein.

Getting insights into issues at the population level that doesn’t come through any traditional channels makes social media a priority and a necessity.

As a way to troll for drug adverse events, Brownstein created real-time a pharmacovigilance app that mines twitter and other social networks. The FDA now uses Medwatcher to monitor safety signals from drugs. He also developed StreetRX, an app that allows for anonymously reporting and a crowdsourcing approach to capturing black market prices for prescription drugs. The information aids in detecting which prescription drugs are being abused. “What are we going to do once we know about this risk? What will be actionable to take from the risks that we know in populations?” are Brownstein’s theme questions.

Uber Health takes on Public Health: On-Demand Vaccine Delivery
Two years ago, Brownstein had been running the Vaccine Finder to organize vaccine supply for Walmart, CVS and Walgreens. With over 70,000 locations over the country, 60 percent of adults were still not getting their annual influenza flu shots, which is a lifesaving vaccine. The percentage of non-vaccine users were also far worse in younger age groups. “You know that patients don’t have a lack of faith in the vaccine. It is a lack of awareness and education. Even though the vaccine is a block away, people aren’t willing to walk a block to get it. This is when we came up with the idea of Uber Health. Why not get vaccines to the people just like people getting deliveries of anything on demand? Why can’t that be transformative in healthcare in as well?” shared Dr. Brownstein.

The story began one day in 2014 with the launch of a 4-hour on-demand campaign to prevent the flu. How? The answer was Uber. They put a few little tabs on the Uber app saying Uber Health. In four cities, New York, Boston, Chicago and Washington DC, Uber customers had a $10 flu delivered with a click. “It was extremely successful. We didn’t have enough supply of nurses to meet the demand. People were taking selfies while getting vaccines. Going viral, we got really excited selfies coming back at us of people getting vaccines. This was really a transformative moment for us because we then realized that you are actually having an impact on a public health level with on-demand service.” recalled Brownstein.
A post-treatment survey revealed 42% of the vaccine recipients did not have a one the prior year, and over 90% believed that an on-demand access was important in their decision. Once again there is a bigger concept. In fact, this past year across 40 cities, Uber Health showed the same level of enthusiasm within this population. On-demand healthcare is now being pursued by a majority of companies in telemedicine with growing number offering house calls and drug delivery.

Circulation: A Cost-Saving and Patient-Centric Transportation System

On-demand healthcare is the key to patient access and engagement. “Our question is why Uber can’t be for healthcare?” asked Brownstein. The Circulation co-founder had been grappling with the flaws and risks of the Non-Emergency Medical Transportation (NEMT) system for quite some time. Under the status quo, sick, disabled low-income patients encountered many frustrations such as: limited ride options, 48 hour bookings prior to pick up, waiting over 3 hours for ride to finally arrive and third-party services lacking new mobility software. The consequence – missed appointments that threaten a patient’s well-being, which can lead to terrible outcomes on the part of the patient. “So this is really a concern not just to individual but the healthcare system overall which spends billions of dollars currently on transportation services. Over $5 billion [Medicare & Medicaid $3 billion and health plans $2 billion] is spent on moving patients around getting patients to appointments, getting them out of hospitals and getting them to clinical trials. So now we have a huge amount of cost and low patient satisfaction. There has to be a better way to do this. So we have a new vision for transportation–Circulation. Taking modern approaches to transportation and bringing them into healthcare,” announced Brownstein.

The official partnership of Circulation and Uber launched in late September. The digitized patient-centric transportation platform was piloted at Boston Children’s Hospital, Mercy Health System in Pennsylvania and Nemours Children’s Health System in Wilmington, Delaware. Succeeding in integrating the current work flow of operations, the system demonstrated interoperable interfaces with patients’ electronic health records, which also met HIPAA requirements for compliance. On-demand scheduling in real-time ensured patient arrival information was received by physicians, nurses, and caregivers; and rides were billed and payment reconciliation fulfilled on the backend. The intuitive cloud-based software platform brings on-demand convenience and efficiency to the world of NEMT so that the growing number of pediatric patients and geriatric patients will be able to show up for doctor appointments. On-demand transportation – Circulation – another win-win for digital epidemiology.

This article was originally published in RCM Answers and is republished here with permission and with appreciation to Sarianne plus Answers Media Company LLC’s Roberta Mullins and Carol Flagg.

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