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TECHNOLOGIES

CONTEXT

In this context, “technologies” encompasses myriad elements, including clinical and computational advances that have led to more precise, predictive, and personalized medicine, therapeutic and device innovations, and changes enabled by digital innovation (e.g., telehealth, virtual care, remote patient monitoring, and integration of devices/wearables to support prevention, diagnosis, treatment, and rehabilitation). The meetings described in this Special Publication focused on how to optimize the way that new technologies intersect with health and health care, including opportunities for emerging technologies to sharpen understanding of the comparative effectiveness of different treatments and ways that technologies would promote health equity. Testament to the prospects for technologies to help accelerate patient and family engagement has been especially manifest in the rapid expansion and use of telehealth tools during the COVID-19 pandemic. Similarly, and at another site on the technology spectrum, is the possibility that applications of precision medicine, fueled by “omics” and clinical data and guided by artificial intelligence and machine-learning technologies, could eventually offer a more promising treatment journey for many patients if thoughtfully deployed. Technology also offers the ability to engage people and connect them based on affinities—including the shared illness experience. Given that health-related technologies are proliferating, PCORI has already begun to expand its research portfolio in this area, particularly with respect to its “Improving patient-centered outcomes research (PCOR) Methods” funding opportunities, which call out artificial intelligence and machine learning as priority topics.

COMPELLING RESEARCH QUESTIONS

Many technological innovations and ways of accelerating the use of data derived from health experiences are proliferating, particularly in the digital health space. Yet, the evidence base for many of these innovations has not fully kept pace. Hence, along with developing and leveraging new technologies, a corollary aspect is to examine intended and unintended consequences as these technologies diffuse at scale. To this end, future research could address the following topics:

• How might data use and data sharing be advanced in a way that takes advantage of progress made and lessons learned during a global health crisis?
• How can predictive and personalized interventions be deployed most effectively and with a clear focus on equity, given the current configuration of U.S. health care?
• In what ways could technology be leveraged to accelerate evidence generation and mobilization in practice?
• How can virtual care models be optimized and integrated with traditional care delivery, and what are the ways in which virtual care can be tailored to patients’ preferences and needs?
• What knowledge gaps must be addressed to better understand how patients/caregivers might regard precision medicine, including behavioral, attitudinal, and other psychosocial aspects that affect uptake?

DISCUSSION HIGHLIGHTS

Joshua Denny, M.D., M.S., Chief Executive Officer of the National Institutes of Health’s All of Us Research Program, gave a presentation at the initial meeting on the role of technologies in health and health care. Dr. Denny reflected on improving health via technology, large national cohorts, and precision medicine, using All of Us as the cornerstone example. The key objectives of All of Us are nurturing relationships over decades with 1 million diverse participant-partners, while developing a robust ecosystem of users and funders and a rich biomedical dataset that is freely accessible, easy to use, and highly secure. All of Us is geared toward the future of research and medicine, with the intention of creating a cohort of participants that reflects the United States with respect to demographic and geographic attributes. Participant partners help co-design research, can volunteer from anywhere, and can utilize their own devices to contribute data. Returning results to participants is a key aspect of delivering value to them and honors the time and effort of participating in research. Dr. Denny described complex

data aggregation and harmonization processes that he refracted through the lens of interoperability, noting that All of Us curates data from 16 electronic health record (EHR) vendors. To this end, thinking about the importance of investing in common data models as a research utility was noted. PCORI has already invested heavily in common data models via the PCORnet^® initiative. An additional facet of All of Us with implications for the field is that it brings researchers to the data, rather than the data to researchers. Storing data in the cloud obviates the need to replicate infrastructure at every location and facilitates collaboration. Dr. Denny concluded by offering several examples of how medicine and technology could be transformed by 2030, including how research is conducted, greater diversity of both participants and researchers, EHRs as key research resources, and greater focus on privacy, trust, data security, transparency, and engagement (Denny and Collins, 2021).

The technologies breakout group noted many additional aspects for consideration in this space, including the creation of trustworthy technologies that are widely and equitably accessible and which enable people to be at the center of their own heath journey. Moreover, the use of data in practice needs to be fashioned in partnership with patients, helping them connect how evidence is related to their own health outcomes. At this point, the lack of an open and fully interoperable system prevents patients from being active participants at the research and care nexus. This is also hampered by the disconnect between health care research, public health, and quality improvement in addition to the lack of time for both clinicians and researchers to integrate innovations into the care delivery workflow. Yet, the same challenge could be reframed as an opportunity, in that aligned incentives, deliberate attention to centering technology on people/patients, and concerted efforts to reduce the time demands of technologies could support better care and better outcomes. Considering the question, “What else would it take for technologies to have a measurable and positive impact in the next 5 years?” participants encouraged strengthening connections between academia and health systems, developing partnerships with technology platforms that exist at scale to advance health (including partners in nontraditional sectors), and taking stock of changes and accomplishments (e.g., telehealth) that have resulted from the COVID-19 pandemic to determine whether there are applications for the other identified obstacles to progress.

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