The need for a Serious Illness Digital Ecosystem (SIDE) to improve outcomes for patients receiving palliative and hospice care.


Palliative and hospice care services produce immense benefits for patients living with serious illness and for their families. Due to the national shift toward value-based payment models, health systems and payers share a heightened awareness of the need to incorporate palliative and hospice services into their service mix for seriously ill patient populations. During the last decade, a tremendous amount of capital has been invested to better integrate information technology into healthcare. This includes development of technologies to promote utilization of palliative and hospice services. However, no coordinated strategy exists to link such efforts together to create a cohesive strategy that transitions from identification of patients through receipt of services. A Serious Illness Digital Ecosystem (SIDE) is the intentional aggregation of disparate digital and mobile health technologies into a single system that connects all of the actors involved in serious illness patient care. A SIDE leverages deployed health technologies across disease continuums and geographic locations of care to facilitate the flow of information among patients, providers, health systems, and payers. Five pillars constitute a SIDE, and each one is critical to the success of the system. The 5 pillars of a SIDE are: Identification, Education, Engagement, Service Delivery, and Remote Monitoring. As information technology continues to evolve and becomes a part of the care delivery landscape, it is necessary to develop cohesive ecosystems that inform all parts of the serious illness patient experience and identifies patients for the right services, at the right time.





Published Version (Please cite this version)


Publication Info

Nicolla, Jonathan, Hayden B Bosworth, Sharron L Docherty, Kathryn I Pollak, Jeremy Powell, Nichole Sellers, Bryce B Reeve, Greg Samsa, et al. (2020). The need for a Serious Illness Digital Ecosystem (SIDE) to improve outcomes for patients receiving palliative and hospice care. The American journal of managed care, 26(4 Spec No.). pp. SP124–SP126. 10.37765/ajmc.2020.42960 Retrieved from

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Sharron Lee Docherty

Associate Professor in the School of Nursing

Dr. Docherty’s research is aimed at improving outcomes for children, adolescents, young adults and families undergoing treatment for life-limiting and chronic conditions. She studies how to improve care models, symptom management, and decision making from diagnosis through end of life.  She has methodological expertise in the use of qualitative, mixed-methods, trajectory science and visualization methodologies for complex data exploration, and intervention development and testing.


Kathryn IIonka Pollak

Professor in Population Health Sciences

Dr. Pollak is a social psychologist who designs and tests behavioral interventions to promote smoking cessation, reduce health disparities, and improve clinician-patient communication. She also is one of the Multiple Principal Investigators of the Palliative Care Research Cooperative that supports multi-site palliative care trials. Finally, Dr. Pollak serves as a Communication Coach where she teaches clinicians effective communication techniques.

Area of expertise: Health Behavior


Bryce B. Reeve

Professor in Population Health Sciences

Dr. Bryce Reeve is a Professor of Population Health Sciences and Professor of Pediatrics at Duke University School of Medicine.  He also serves as Director of the Center for Health Measurement since 2017.  Trained in psychometric methods, Dr. Reeve’s work focuses on assessing the impact of disease and treatments on the lives of patients and their caregivers.  This includes the development of clinical outcome assessments using both qualitative and quantitative methods, and the integration of patient-centered data in research and healthcare delivery settings to inform decision-making.  From 2000 to 2010, Dr. Reeve served as Program Director for the U.S. National Cancer Institute and oversaw a portfolio of health-related quality of life research in cancer patients. From 2010 to 2017, he served as Professor of Health Policy and Management at the University of North Carolina.  From 2011-2013, Dr. Reeve served as President of the International Society for Quality of Life Research (ISOQOL).  In 2015, he received the John Ware and Alvin Tarlov Career Achievement Prize in Patient-Reported Outcomes Measures.  In 2017, 2018, 2019 and 2021, he was ranked in the top 1% most-cited in his respective field over the past 11-year period.


Gregory P. Samsa

Professor of Biostatistics & Bioinformatics

Greg Samsa is an applied statistician whose primary interests are in study design, instrument development, information synthesis, practice improvement, effective communication of statistical results, and teaching. He is a believer in the power of statistical thinking, as broadly defined.


Linda Marie Sutton

Professor of Medicine



Arif H Kamal

Associate Consulting Professor in the Department of Medicine

health services and outcomes research, information-technology enabled registries, supportive oncology and palliative care, quality assessment and improvement

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