Telemedicine emerged as a tool to provide basic primary care services to rural/remote locations by conducting virtual visits via videoconference or a phone call. Before the onset of a global pandemic, the utilization of remote patient monitoring (RPM) was minimal. In recent times, telemedicine has become the limelight in healthcare practices. Its impact on the industry has been substantial and continues to grow. Barring all geographical restrictions, patients are now able to receive the care they need from their comfort zone, reducing the risk and overcrowding.

Telehealth enhanced chronic disease management (CDM) through frequent monitoring and communication between healthcare providers and patients with chronic conditions. This proactive approach leads to better disease management and improved patient outcomes. Telemedicine is immensely valuable for specialized services like psychiatry, dermatology, etc. With telemedicine, patients often experience shorter wait times for appointments as they can access care more quickly than traditional in-person visits. This is particularly important for non-emergency care. Virtual appointments are less likely to be missed by patients, leading to improved continuity of care and better patient adherence to treatment plans.

Telemedicine platforms include patient portal and educational resources, enabling patients to access information about their conditions and treatment options, fostering better health literacy.

Investments in AI are expected to grow as the health industry recognizes the value of AI in enhancing patient care, addressing some of the challenges faced in healthcare delivery.

Wearable medical devices and sensors play a vital role in telemedicine, providing continuous, real-time monitoring of vital signs, health metrics and activity levels. This continuous data stream allows for more comprehensive insights into patient’s health. These devices can detect subtle changes in the parameters, allowing early detection of potential health issues. Some wearables remind patients of their medications or dosage instructions. This improves medication adherence, and is of help for individuals, particularly with complex medication regimes.

With the introduction of artificial intelligence (AI), telemedicine revolutionized the way healthcare services are delivered, monitored and managed remotely. AI technologies are integrated into EMR to enhance accessibility, efficiency, accuracy and outcomes. AI can analyze data and trends for anomalies, allowing healthcare providers to intervene proactively in chronic disease management. Natural Language Processing (NLP) algorithms can transcribe and analyze during telehealth visits, reducing the provider documentation time and yielding appointment slots for more visits. AI is deemed to be promising in provider satisfaction by reducing administrative workload. Better financial outcomes can be fostered from more accurate documentation and coding.

Although the COVID-19 pandemic heightened the adaption of telemedicine as an initial encounter for patient screening, throughout the country, many health systems struggled with enabling their legacy EMR systems to provide telemedicine features. Practices experienced challenges procuring technology and changing their workflows designed for in-person encounters.

Some healthcare programs that swiftly enabled their practices with telemedicine, grappled with clinical staff adoption. A diminutive percentage of physicians remain conservative of the telemedicine practice compared with in-person care. Preeminent reasons are identifying patients for in-person versus televisit, low reimbursement rates for virtual visits, technological barriers etc. Telemedicine limits physician’s ability to perform physical examinations, which are crucial for diagnosing certain conditions. Physicians may need to rely on patients’ descriptions and observations, potentially leading to incomplete assessments.

The limitations of adaption of telemedicine are not only with practices, but also with patients. The barriers may not be the same as they were a few years ago, but they are still persistent among the patient demographics, technology literacy and financial circumstances. Especially in underserved and rural areas, patients may not have access to smartphones, computers or internet connections to utilize telemedicine. Older adults may lack the digital literacy skills needed to schedule appointments and utilize video conferencing.  Patients with disabilities may encounter accessibility issues with telemedicine platforms, such as screen readers, captions, or other assistive technologies. In addition, the providers and patients experience privacy and security concerns. Ensuring the security and privacy of patient information during virtual consultations is a significant affair. Physicians must adhere to the regulations and utilize secure communication tools.

To address these adaptation issues, healthcare organizations should offer training and support to the clinical staff as well as patients. Implement user-friendly telemedicine platforms, and ensure clear policies and procedures are in place. One strategy is to leverage super users along with providers for an effortless experience of virtual care encounters. The provider should be supported by technology platform experts readily available to troubleshoot any issues that emerge during the encounter. Another way is to engage patients via technology bar (Tech-Bar) during in-person visit and empower them with the tools they need to utilize telehealth services for better disease management.

Over time, as AI in telemedicine becomes more integrated into healthcare systems, it brings about a wide range of benefits and transformations. And as physicians gain experience, many of these challenges can be overcome, leading to more widespread acceptance and effective use of telemedicine in medical practice. However, it also brings challenges related to data privacy, ethics, and ensuring AI technologies are adopted responsibly and equitably across diverse patient populations. Investments in AI are expected to grow as the health industry recognizes the value of AI in enhancing patient care, addressing some of the challenges faced in healthcare delivery. These investments encourage innovations, driving research and development, and creating solutions that potentially benefit patients and providers.

The post The Role of Telemedicine in Healthcare and its Transformative Impact on the Industry appeared first on HealthTech Magazines.

Healthcare’s primary problem is not the lack of data, but the lack of fidelity and usability of the available data. The challenge is collating, interpreting, and distilling data to a usable state and getting those data to the right person, at the right time. Additionally, healthcare data is unwieldy and fractured, continuing to fracture exponentially as more care channels and options emerge. New channels generate new data silos that make safe, effective care difficult. Compounding this issue, costs of health insurance, care delivery, and medications continue to rise, placing adequate healthcare out of reach for many. As a result, the quality of care across the US continues to lag significantly behind other countries.

Patients are the reason healthcare exists, and yet, they are rarely centered in their information or care.

Also, the US healthcare is experiencing an unprecedented period of change, brought on by industry pressures, which makes an already complex system more cumbersome and perilous.

These pressures include: 

• Dramatic shifts in consumer expectations: Younger consumers are not satisfied with traditional healthcare, and consumers of all age groups are more willing than ever to try non-traditional services. Millennials and gen Z, who make up 42% of the population and 21% of healthcare services, expect convenience, affordability, transparency, and quality and are redefining how they engage in every stage of their care.
  
  
• Fragmentation: The delivery of care through established service paths (e.g., doctors, clinics, and medical centers) must now compete with non-traditional service paths that represent emerging types of service delivery (e.g., walk-in or retail clinics, outpatient surgery hospitals, virtual health, on-demand services, in-home services, or digital therapeutics).
  
  
• Increased regulatory pressures: The burden of new and existing laws regulating healthcare—such as HITECH, HIPAA, ACA, FDASIA, and MACRA/MIPS—affects providers by increasing their administrative load and by adding or increasing penalties for services that do not meet a set of prescribed quality, interoperability, and performance criteria. These burdens slow the delivery of care and reduce patient interface time with doctors and their clinical staff, alongside a host of other factors that can negatively impact care delivery, patient outcomes, and provider reimbursement.
  
  
• Hyper-specialization as the knowledge about diseases accelerates: Medical research continues to reveal the complexity behind disease causes and treatments. As research unravels the genome, microbiome, and proteome, referred to as multiomics, to understand their role in health and wellness, physicians become more specialized to turn discoveries into better outcomes for patients.
  
  

Data is duplicated and conflicting due to issues with standards

Because most health record systems do not consolidate information, numerous patient and provider-reported health records result in duplication, retention of outdated information, and leave room for error. Also, payer data often inaccurately reflects patient care and services provided due to the complicated nature of billing practices. Often, to ease workflow, patient services are billed based on a short list of memorized codes or the first code to populate a search, resulting in loss of fidelity. Therefore, providers don’t uniformly have access to accurate reference records which creates an overwhelming burden on providers trying to find the information needed to make recommendations.

Projects to enable interoperability are costly and time-consuming

Traditional data transformation and sharing methods are complex and deduplicating of the data with any precision is time-consuming and risky. Important changes in a patient’s record can take weeks or even months to emerge, as the data integration does not happen in near real time. There are existing methods of sharing more cleanly within like EMRs, but even in that method, there are issues reconciling data due to the differences in system setup (x field in system A is blood pressure, whereas it’s y field in system B).

The patient is never in control of their data

Patients are the reason healthcare exists, and yet, they are rarely centered in their information or care. They have little control of their data and, in most cases, have no concept of how the data is used and where it’s shared. Also, all too often, patient-provided information fails to be integrated with the patient’s record thereby ignoring critical pieces of information. By ignoring the patient as a vital part of healthcare and its interoperability, data sharing and cleansing become complex and diminishes the capabilities of healthcare providers to make data-based diagnoses and treatment decisions.

What can and should be done?

We should strive for a single, golden record for every person on Earth that is updated in real-time as changes happen and allows for notification of significant events to be delivered to the right person at the right time. And that record should be owned by the individual, not the system.

There have been many barriers to this in the past, but the most significant challenge has been to uniquely identify each person and all of the entities and assets they interact with.

Luckily, technologies and tools emerging on the market now can systematically address these issues through AI and machine learning. Tasks considered nearly impossible, like merging 20 medical records and distilling the information down to a single record, can now be done at scale, with the patient owning the overall outcome.

One emerging company consolidates health and wellness data into a single, standardized record under secure control of the patient that facilitates seamless data exchange amongst healthcare and life science constituents. The technology leverages syntactic, structural, and semantic interoperability techniques in addition to patient-level interventions when AI cannot resolve the data cleansing automatically.

In addition to focusing on rich medical data, this company continuously fills gaps with real-time, real-world data from multiple sources (e.g., wearable and medical devices), in conjunction with social determinants of health (SDOH) and patient-reported information.

How do we get there?

While companies like this are working to solve this problem, there are cultural barriers in the US that need to be overcome. To truly achieve patient-owned interoperability, data hoarding and profiteering concepts need to be addressed. Healthcare needs to be democratized for a more equitable landscape. Platforms that democratize health information shift people from passive to active participants within their own health outcomes. After all, it is ultimately the patient that bears the burden of adverse health outcomes, not the providers.

The post Transitioning to Patient-owned Data appeared first on HealthTech Magazines.

Healthcare brings unique challenges to technology adoption. The data representing people, diseases, and medicine is complex and voluminous. Consumers and providers of healthcare desire easy-to-use and increasingly mobile solutions and need more virtual options to keep up with the ever-changing landscape, while researchers want safe access to data at scale to make discoveries that increase knowledge and improve care. The healthcare industry needs solutions that provide a simple yet engaging experience, as well as mechanisms to leverage massive amounts of complex data safely – all with a level of reliability appropriate when dealing with the health and wellbeing of individuals and communities. On top of that, for non-profits like Memorial Sloan Kettering Cancer Center (MSK), these solutions and mechanisms cannot be cost-prohibitive. Collectively, these needs seem daunting, but cloud technology is proving to be capable of making innovation more efficient and agility more feasible.

Cloud technology has become an engine for transformative change in a business setting. Hyperscale cloud platforms offer unparalleled compute capabilities, offering a seemingly unlimited capacity that can scale dynamically. Additionally, this technology includes rapidly evolving services that take care of more and more infrastructure heavy-lifting, enabling a concerted focus on feature functionality. Little upfront or capital investments are needed, and you only pay for what you use, making experimentation more feasible. This combination of elastic scalability, on-demand advanced functionality, and minimal commitment makes the cloud the ultimate fuel for transformation, especially when coupled with a rich ecosystem of SaaS offerings.

At MSK, we embarked on a cloud journey that emphasized innovation. This journey was based on the premise that providing our clinical and research technology teams access to cloud services with minimal friction while adhering to standards would result in innovative solutions. Cloud services can easily handle the volume and variety of healthcare data while still meeting institutional needs for security and reliability. However, we have already experienced how the cloud enables us to respond rapidly to the changing needs of healthcare and create solutions that allow us to reach new markets with fewer physical presence requirements.

Almost overnight, the demands of our telemedicine options exploded where the cloud played a vital role in operations.

We are aware that, beyond MSK, there is potential for ramifications globally. Atti Riazi says, “Although the cloud helps lower the volume of greenhouse gases by reducing the number of servers used by so many of us, much of the electricity needed to maintain the cloud, unfortunately, is derived from fossil fuels and coal. We as technologists must take a position on the impact of technology on the environment, especially e-waste. We need to be a society and a collective of organized responsibility as technologists and innovators.”

In a regulated industry like healthcare, security and governance are must-haves. Our institution needed effective cloud governance and controls provided by default and mechanisms to ensure security was baked into the design of each cloud application. Next, we needed to level-up the cloud technical skills of our existing teams, and supplement them with cloud experts acquired in today’s highly competitive market. We also needed to balance our desire for agility and innovation with fiscal responsibility and transparency, understanding the risks of adopting the cloud with a blank-check mindset. And above all, we needed to maintain our standard of premium care.

While our cloud adoption approach includes many facets, a few core pillars have proved essential to the success we have experienced to date. A central cloud platform team was created to build a common foundational layer in our two clouds—AWS and Azure—that provide standardized configurations of our cloud accounts and shared services for cloud application teams to consume. We then established a Cloud Center of Excellence (CCoE) as a central body to drive cloud policies and standards in close collaboration with our compliance, cybersecurity, cloud platform, and cloud application teams, as well as initiate FinOps practices and organize a cloud community of practice.

During the COVID-19 pandemic, many clinical services needed to pivot to a more virtual experience for the safety of our patients and care providers. Almost overnight, the demands of our telemedicine options exploded where the cloud played a vital role in operations. In response, a plan was formed to reimagine our telemedicine solution as a cloud-native application, capable of dynamically scaling with demand, leveraging the built-in reliability and security of cloud services, and providing a rich, integrated experience for the patient and the care provider. This new telemedicine solution would use Microsoft Teams and cutting-edge Azure services such as Azure Communications Service and the Azure Bot framework. An agile approach coupled with close collaboration with our Microsoft Azure team would enable the rapid and iterative development needed to deploy quickly.

In a matter of months, our telemedicine offering was transformed. The central cloud platform team implemented our cloud platform on Azure to provide standard networking, audit logging, security controls, and dedicated cloud accounts for all the telemedicine environments. The telemedicine application team developed the infrastructure code (IaC) and application code for the new solution, fully automating the deployment via Azure DevOps pipelines. This empowered the application team to experiment with various Azure services, finding the right mix to meet their functional and non-functional requirements. This new telemedicine solution now serves 30% of our outpatient visits, up from 1% before COVID-19, and will scale up and down as demand changes and the pandemic evolves.

In retrospect, we have experienced positive impacts of cloud technology in healthcare with some challenges. Our development teams are more empowered and building valuable new skills. When they can spend more time focused on user needs and have robust cloud services in their toolbox, innovative solutions can be deployed rapidly. However, cloud technology is complex and evolves quickly. Our code-first DevOps approach asked our developers to learn new skills and own things in a way they did not before. The collaborative culture at MSK and the support of Microsoft has eased this task, but we understand learning must be continuous.

And then there are those global ramifications to keep an eye on.

Running our telemedicine solution on cloud-native services has given us unprecedented visibility into the costs and usage, which creates unique opportunities to optimize code to improve performance and increase cost-efficiency.

The post How the Cloud is Transforming Healthcare appeared first on HealthTech Magazines.

Healthcare in the United States is hard as is: without a global pandemic. But imagine being a CIO going through this in an area where there are financial, structural, and staffing challenges. How do you take a health system that has been in recovery for over five years to 2022 in a year?? The answer: If I knew that, I would write a book and sell it!

I am a [fairly new] CIO from the Southeast but now working in beautiful St. Croix in the US Virgin Islands. In 2017, two category five (5) hurricanes ravaged this area back to back. The damage can still be seen today and nowhere more evident than the hospital I work in. Since then, we have had to close areas due to not being safe for patients or staff or items being broken beyond repair. It is a struggle, but the team there has been the greatest group ever. They come in despite all of the setbacks and give 110% every shift and provide the best care.

I always like to sit with staff who have been at the facility the least amount of time; the reason for that is they have not been indoctrinated in the ways and are less resistant to changes.

I am happy to say that we are near completion on a temporary hospital and will start building a brand new hospital to provide the top-notch service to the community and all those who travel to the USVI.

With all that, healthcare and, more specifically, the Healthcare Technology industry does not stop while we wait for a new facility. And epically does not when you are the only acute-care facility on the island. When I arrived, I made it my goal to accelerate technology through all areas to improve patient care, financial outcomes, and overall satisfaction.

An island that is eighty square miles is a lot like rural areas in mainland United States. I have worked in several rural areas and one thing I can tell you is this: change is difficult in technology. Even if you know you are improving all aspects of the health system, you will face resistance. There are so my times I have been told by staff that they like the way they do a process because that is how we always do it.

So how do I combat this: well, I find if you sit with people on a personal level and explain the current process and show them the new process that does have a positive outcome…but not all the time. I once (true story) had a Director of Nursing quit on me the day of go-live because she could not handle the technology being used. I always like to sit with staff who have been at the facility the least amount of time; the reason for that is they have not been indoctrinated in the ways and are less resistant to changes. I then go to senior staff and explain them that I am there to work with them and see what their true concerns are. Sometimes I find that there is just a fear of the unknown. Everyone is scared of the unknown: that’s human nature.

I also want to say to all of my clinical friends coming from a non-clinical person: I get it. You men and women have so much to do with patient care that one more software or device seems like too much. We are not trying to make your life harder. I feel for new staff who get frustrated with technology, especially in areas where technology is not at the forefront. We on the Healthcare IT side want to work with you and bring the best outcome for everything needed.

We are all here for one reason; To care for the patient: Full Stop. I think the care team of a patient is not just those that are in the room, but those outside of the room as well. The environmental services workers who clean the room. The dietary department who makes sure you [and sometimes your family] are nourished. The medical records department who either retrieves your records or prepares them if you need them. The facilities department who keeps everything going 24 hours a day/7days a week. And yes, your neighborhood IT guy who makes sure your Wi-Fi is working so you can catch up on your favorite show or play your favorite game.

We don’t like all the new tech sometimes, but we embrace it. It is like a new drill for a surgical case or a new modality in radiology. It comes with the jobs we do and the times we are in. Think about it, ten years ago, the cryptocurrency did not exist and electric cars were being laughed out of conferences. But now, everyone has embraced these things like the drill or modality. It is not easy all the time, but it is for the greater good. It just takes everyone involved to make the transition smoother. Technology may start with the CIO, but it ends with the entire team.

The post Adapting Technology Change in Rural Areas appeared first on HealthTech Magazines.

Health Information Technology (HIT) became a lifeline during COVID by allowing health care organizations across the United States to utilize digital tools to engage patients and provide care. Historically, many health care providers have viewed technology as adding to their workload, contributing to job dissatisfaction and impeding the patient-provider relationship. The pivot to using more digital tools has inspired many to envision the endless possibilities of connected care. Furthermore, this experience allowed many health care professionals and patients to experience the value proposition of HIT. Capitalizing on this reconceptualization of HIT can enable healthcare to move beyond solving problems only for this pandemic but lay the groundwork for what’s next. 

Prior to the pandemic, the healthcare industry struggled to keep up with staffing demands and COVID has compounded this issue, particularly now that many are leaving the healthcare profession. The combination of staffing shortages, increased life expectancies and chronic conditions are creating a perilous course for the healthcare industry. As a result, there is an urgency to develop innovative solutions to address these challenges and HIT is well poised to meet all of these challenges by building new integrated, efficient, consumer-friendly, and cost-effective digital tools. 

Technology has transformed how we interact and created a ‘new normal’ for interactions. The increased use of HIT during the pandemic allowed many to experience how these tools can fit into their daily lives and the healthcare landscape. We are seeing a level of connectivity and conducting business from our devices that has never been seen before. Patients have come to expect similar accessibility in healthcare and are increasingly deciding where they get care based on their digital experience. Traditional methods of providing in-person care have struggled to meet population health needs, particularly for vulnerable and underserved populations. Moreover, the “one size fits all” approach to care delivery has led to many health inequities and disparities. Health care organizations that don’t address these patient needs will be challenged by bigger market players that seek to attract new business and impede existing patient-provider relationships. 

Bridging the digital divide requires involvement of a diverse representation of patients throughout the product development process.

The “No Wrong Door” approach enables consumers to engage in care through the route or program that best meets their needs. Digital platforms can support the “No Wrong Door” approach by meeting people where they are through increased engagement and retention in care. HIT’s nimbleness can address patient needs more quickly, remove barriers and foster patient engagement in ways that are not possible in manual processes. Despite these promising benefits, HIT has neglected to create products that are accessible across different demographic groups. Over the years, HIT developers evolved to be more inclusive of clinical care teams throughout the product development process which has increased satisfaction and widespread adoption. Unfortunately, this approach has not translated to patient-facing digital tools. Even though the marketplace is rife with patient digital tools, these are often developed with the organizational management of these tools at the forefront rather than the patient. Moreover, product developers have neglected to engage patients throughout the development process like they do clinicians. Bridging the digital divide requires involvement of a diverse representation of patients throughout the product development process. Engaging consumers in the process helps ensure the usability and accessibility of their products. Additionally, creating consumer-friendly tools will prevent care teams from becoming their patients’ tech support and instead, they can focus on providing vital care. 

Patients who see value in using these digital platforms are more likely to utilize these systems and remain loyal to their existing healthcare organization. Instead of HIT being an impediment to provider-patient relationship, reframing the use of digital tools such that these tools can be harnessed to support patient care allowing care teams to focus on tasks that cannot be automated or digitized. Oftentimes, care teams are the gatekeepers of health information for patients (e.g., referrals to resources) which can delay access to needed services or resources. Using digital tools to provide real-time information can create a more positive patient-centered experience while addressing patient needs more quickly.  As a result, competition is increasing and organizations that respond with these new automated and patient-friendly tools will be better positioned. 

Combining HIT and data analytics can create a precision-medicine like experience for patients and clinical care teams by combining complex algorithms and automation to make personalized recommendations and move beyond the ‘one size fits’ all approach of population-based medicine. Quality measures serve an important role by recommending services or procedures a patient is due for. While these recommendations provide the necessary guidance, these broad-based guidelines have led to disparities by ignoring individual health needs (e.g., anatomy) and not factoring in other health equity issues (e.g., social determinants of health). However, innovations like machine learning can develop algorithms to assess each individual’s care needs and tailor recommendations to close care gaps. Systems that automate reminders, recommendations and information sharing to patients based on their individual needs, particularly in real-time, are likely to see improved satisfaction from both the patient and care teams. Advanced algorithms and automation can replace manual tasks, often with more accuracy, speed and at lower costs. Furthermore, tailored messaging will more likely resonate with a patient and may increase compliance with care recommendations and support better engagement in care.  

The healthcare crisis is on a precipitous course and we must pull every lever to address these challenges. The pandemic previewed how HIT can fit into the healthcare landscape, but we need to meet both patients and clinical care teams where they are. The integration of more robust, automated digital tools can address inequities, bridge the digital divide, close care gaps and reduce strain on the healthcare workforce. While HIT cannot solve all the health care problems, digital tools have immense potential to both fill the voids and enhance the health care experience.

The post Digital Tools: At A Pivotal Point appeared first on HealthTech Magazines.

One of the more interesting challenges that health system IT executives face today is evaluating and prioritizing new clinical applications for AI. Among the rapidly expanding number of innovations covering nearly every aspect of health system clinical and administrative operations, ambient AI is one of the more compelling technologies because of the immediate and longer-term value it provides. In our experience, the process of implementing an ambient AI solution can also serve as a model for testing and deploying other advanced intelligence solutions.

Our journey to ambient AI

We first considered ambient AI technology after Nuance Communications introduced its DAX system in late 2019 to mitigate physician burnout by reducing clinical documentation workloads. We were generally familiar with the Nuance system because it uses speech processing technology that evolved from its Dragon Medical One software used by physicians at SCL Health and other health systems. In mid-2021, we began deploying Nuance’s DAX system at our $2.8 billion faith-based, nonprofit healthcare organization serving patients in Colorado, Montana and Kansas.*

The tool works automatically in the background, securely capturing conversations between clinicians and patients during in-person or telehealth visits. The keyboard and screen that typically require the physician’s attention are replaced by an unobtrusive, low-cost device like a smartphone or tablet. DAX records and converts the interaction into AI-generated clinical notes which are routed through a quality review process to ensure accuracy. The system continuously learns and becomes increasingly accurate and efficient with each word.

The resulting documentation is presented to clinicians to quickly and easily review and approve in the EHR system as part of their day-to-day workflow. If a physician has any questions about the generated notes, the recorded interaction is available for review.

Goals and deployment plan

We first defined how the system aligned with our strategic goals for improving physician satisfaction, expanding digital patient engagement, and using EHR system as a platform for innovation. We also viewed our implementation of the Nuance system as a critical opportunity to work with a technology vendor as a trusted partner vs. following the traditional buyer-supplier model.

We then identified cohorts of providers as early adopters. We included specialties best suited for DAX usage including cardiology, orthopedics, and other clinical areas with relatively standardized terminology and exam procedures. We also incorporated family medicine providers to assess the system’s ability to learn more diverse vocabulary and patient scenarios. In addition, physician need was determined by analyzing signal data from our Epic EHR showing providers who spent more time working on documentation either during or after clinic hours.

We narrowed an initial target list of 50 providers to 25, 10 of whom declined to participate in the initial deployment for various reasons. Deployment began in May, followed in September by an assessment of system performance in a total of 5,426 patient encounters.

AI outcomes and benefits

We evaluated the AI system’s performance based on:

• Increased operational efficiency through reduced documentation time, increased throughput, and greater access to care:
  • An average of 13minutes saved per encounter (family medicine)
  • A 50% reduction in physician documentation time
  • An average of 1.7 appointments added per clinic day (family medicine)

• Higher clinician satisfaction from reduced administrative workloads and higher quality documentation:
  • 50% reduction in feelings of burnout and fatigue
  • 60% of physicians were satisfied with documentation turnaround time
  • 60% would be disappointed if they no longer had access to this system
  • 70% of physicians say the system has improved documentation quality

• Better financial outcomes through time savings and incrementally higher revenue from more accurate clinical documentation and appropriate coding:
  • $104,537 in annual added value through time-saving per provider (family medicine)

• Improved provider and patient experiences with clinicians feeling more rested, focused, and engaged with patients, and patients having positive experiences in encounters with physicians using AI. Patients familiar with consumer voice applications felt comfortable with the system and felt they had chosen modern, well-equipped providers and facilities:
  • 80% overall increase in the quality of the overall patient experience
  • 60% of physicians report higher-quality patient interactions
  • 70% of patients report an increase in provider face time

Additionally, documentation turnaround time steadily declined from 5.26 hours in May to 2.19 hours in September, while utilization of the system increased to 60% of scheduled appointments.

Today, we have a fully voice-enabled and ambient exam room environment using this AI technology. The system frees clinicians to focus on their patients, gives them back time in their day, and enables them to practice at the top of their license. From an IT perspective, the system reduces complexity because it enables a single cloud platform and single workflow solution for all clinical environments.

Implementing ambient AI represents an opportunity to establish partnerships with IT vendors.

Best practices and outlook

Implementing ambient AI represents an opportunity to establish partnerships with IT vendors. We worked closely with Nuance, collaborating on everything from iterative system changes and improvements to pricing, and making service level agreements and shared risk an integral part of our relationship. In addition, Nuance has consistently shown a willingness and ability to respond to user feedback. The DAX systems we use today are small, inexpensive devices that replaced the bulky, wall-mounted, first-generation designs introduced in 2019.

We also worked closely with physicians who understood the challenges and opportunities of implementing ambient AI to empower them as technology champions for their peers.

Looking ahead, we plan to offer DAX to clinicians in other clinical areas through a repeatable process of expanding small, targeted deployments to more users, incorporating learnings from each one to maximize the value of our investment. We see this process as a transferable model to future implementations of advanced technologies.

* SCL Health and Intermountain Healthcare are planning to merge in early 2022 and form a 33-hospital system with more than 58,000 caregivers across six states and provide about one million people with health insurance.

The post Optimizing EHR value, documentation quality, and physician and patient experiences with Ambient AI appeared first on HealthTech Magazines.

As health systems navigate their way through an unparalleled age of technological advancement, CIOs can tap into an overwhelming number of state-of-the-art solutions capable of driving their digital transformation strategies forward. From wearables to mobile health devices, augmented reality to machine learning, the choices are seemingly endless.

And while all this technology is captivating, it also can be blinding. It’s too easy for health systems to let technology run the business of health care. Instead, it’s the business of health care that must drive the technology, because digital transformation will only make a real impact on a health system if it ultimately helps to improve care delivery and patient outcomes.

We’re fortunate at Atlantic Health System to have innovative, diverse leadership and a team of health care professionals covering a span of generations—baby boomers, Gen Z’ers, millennials and Gen X’ers—that embody this philosophy. Working together, we tackle digital transformation with a single question: What is the problem we’re trying to solve? Many times, the answers come from the clinical side rather than the technical side.

This methodical, collaborative approach gives us a system of checks and balances that ensures the technologies we invest in will help us achieve a specific ROI. It also allows us to make technological enhancements that augment—and not replace—the care our health care professionals deliver. We always include the human element in our workflows to strengthen the patient-clinician bond.

Over the past 12 – 18 months, we’ve seen encouraging results from two particular technologies: AI and Big Data. In both cases, the primary measurement is how well these solutions can help health care professionals treat disease sooner, creating better health throughout the communities we serve.

How AI enhances Medical Imaging

As Atlantic Health System grows and cares for more people, delivering highly sophisticated medical imaging takes high priority. As we searched for optimal imaging solutions, we prioritized technology that could help our radiologists and health care professionals get more efficient, find abnormalities faster and contact patients sooner for follow-up tests and appointments that can save lives.

To achieve these goals, we implemented three highly integrated solutions. The first, a modern picture archive and communication system (PACS), streamlines the entire radiology workflow.

By integrating our PACS solution with our Epic EHR, our radiologists can now access patient information and images from a single cloud-based system with enterprise-grade security that offers enhanced protection from ransomware and other malicious attacks. Our clinicians report high satisfaction with the quality of images on our new PACS system.

The second tool in our radiology arsenal is a FDA-approved decision support software solution. It uses AI to scan large volumes of images (such as CT scans), flag images that contain abnormalities and move them to the top of a radiologist’s or health care professional’s to-do list.

While the technology flags suspected acute pathologies, the human element is the key factor in this workflow. That’s because it’s the clinician who reviews the flagged images, identifies potential life-threatening anomalies—intracranial hemorrhage, acute spinal fractures, pulmonary emboli—and expedites patient care so patients with the most acute needs get seen right away.

Rounding out our medical imaging technology cycle is a radiology report management solution. It uses AI and NLP to comb through clinical notes and imaging scans. It then notifies the care team if and when patients need to follow up. This helps our health care professionals close the loop with patients faster and find potential diseases earlier.

We used EDAP data to identify potential COVID-19 hot spots and quickly ramp up supplies, staffing and resources in facilities that served those communities.

Viewing Big Data from an enterprise-level

Most businesses today are ingesting more data than ever before, and health care is no exception. However, most health care organizations have data spread across multiple legacy systems or locked in department-specific silos, which reduces the ability to act on that data. We faced the same challenge of bringing data together so we could make optimal business decisions.

Our answer: building an Enterprise Data and Analytics Platform (EDAP). The EDAP solution gathers data from 63 different sources, including our Epic EHR, claims data, health quality data, financial data and more. EDAP allows us to ingest, curate, create and model data, giving us a robust data pipeline capable of creating predictive and prescriptive models.

In addition to investing in EDAP, we’ve recruited highly skilled data scientists and aligned them with each vertical inside our health system. The expertise of our data analysts, combined with EDAP technology, allows us to identify operational, financial and clinical efficiencies and ultimately improve patient care.

One real-world example of how EDAP benefits patient care came during the COVID-19 pandemic. We used EDAP data to identify potential COVID-19 hot spots and quickly ramp up supplies, staffing and resources in facilities that served those communities.

Fueling adoption of innovative technologies

Implementing emerging AI-powered technologies and other modern solutions is just one part of the battle. The second is fully adopting them. At Atlantic Health System, we incorporate both e-learning and in-person instruction to make sure all health care professionals and users know how to use the technology, understand the workflow and interpret the data they’re reviewing, fueling widespread adoption and competency.

And while AI and Big Data are showing the best results for us right now, we’re also introducing many other emerging platforms—from customer experience technology to machine-learning-driven solutions and even augmented reality. Each is at a different maturity level. By looking at these solutions through the lens of problem-solving, then taking a pragmatic approach to implementation and training, we’ll keep developing innovations that help us expand the number of people we can help in our communities and enhance the care we provide them.

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The concept of cognitive Telehealth has been around for many years. It’s convenient, fast and when accomplished without technical snags, is quite efficient. If we broaden our definition to include all non-in-person visits such as simple, voice-only telephone encounters, the number climbs even further. However, despite this apparent utility, the numbers of total U.S. cognitive telehealth visits up to and including 2019 remained relatively low. We had the technology. In fact, we had the technology in place, ready to use—primarily through a module within the EHR as well as stand-alone platforms. But many doctors were reluctant to move forward. Some cited a sense of depersonalization; some felt the telehealth framework did not allow for an adequate physical exam and some were, at the time, averse to technology.

Then, in March 2020, COVID-19 hit. ERs across the country were busting at the seams while ambulatory medical clinics were shutting down as non-emergent, in-person visits posed too high a risk. If this were to keep up, the impact to the long-term physical and emotional health of patients and the financial impact to providers would be catastrophic. A collective and simultaneous realization occurred across the medical community—Telehealth would allow for continued interactions between doctors and patients without the risk of spreading COVID. This physical separation would serve to both decrease the risk of aerosolized transmission of the virus as well as simultaneously preserve, what was at the time, scarce Personal Protective Equipment (PPE). Suddenly, the country pivoted on a dime. Many utilized their EHR Telehealth platforms, while some leveraged other platforms. To aid in this rapid utilization, CMS announced that it would temporarily suspend the previous tight restriction on using non-medical grade platforms such as Apple’s FaceTime, Google’s Duo and Microsoft’s Skype. This restriction had been put in place to protect patient privacy in line with HIPAA federal law. At this stage, the public health risk of not having patients seen for their care was deemed to be greater than patient privacy risks if a breach occurred. And, in lockstep, payers began to reimburse Telehealth visits on par with in-person visits. That lit the powder keg and physicians use of Telehealth platforms to investigate, diagnose and treat patients exploded. The weekly number of telehealth visits rose from 16,540 to 397,977 per week — a 23-fold increase — from the pre-COVID-19 period to the COVID-19 period(Healio). Between June 26 and November 26 of 2020, Telehealth visits accounted for a whopping 30.2% of weekly Telehealth visits (CDC data).

Physicians’ initial reluctance has given way to the practical reality that technology can bring a host of benefits not previously recognized.

On a separate yet equally exciting track, procedural Telehealth has been evolving at a rapid clip. That is, video technology specifically orchestrated to maximize the result of a surgical procedure. Consider the example of a patient in Peru who requires cleft-lip corrective surgery, but facial reconstructive surgeons are not locally available. Years ago, this required a surgeon and his/her team to travel to the destination country and physically perform every procedure.  Now, surgeons can work in teams—a local general surgeon who performs the procedure and a specialty trained surgeon connected via a video fed computer platform who can guide, advise and assure the quality of the procedure. And the outcomes are impressive. 30-40% improvements in cosmetic results were suddenly possible.

In lockstep, video capability has been expanding dramatically with heightened bandwidth and advanced computer and data storage power. Together, the clinical use case combined with advancing technology has effectively made this dream a reality. A London-based company is pioneering procedural Telehealth. Their technology provides a digital user interface, on both sides of the equation. Their platform applies basic and advanced tools to allow surgeons to highlight key aspects of the procedure as well as more advanced capability such as augmented reality. Local video storage is frequently accompanied by cloud-based storage in AWS which will allow for a centralized repository of searchable procedures. How cool is that? Imagine a doctor searching the database to see the specific procedure he/she is studying.

The implication of having these databases of video procedures for medical training are huge: medical students, interns, residents and ongoing continuous training for established surgeons. Imagine the doctor preparing to assist on an appendectomy. He/she can now watch the surgery –from initial incision to last closing suture. He/she can pause and rewind on particularly complex aspects until it is clear. In short, the physician can now really see and understand what is supposed to happen before actually doing so on a live human.

Further, surgical credentialing of established physicians, is being impacted as the old process to credential a doctor is being supplanted by this new technology. Previously, for the hospital to allow a surgeon to perform a procedure that is new to him/her, it required the physician to watch 10 of these specific surgeries and then perform 10 of these surgeries with supervision. Now, both the observing and proctored surgeries can be accomplished via a technology platform. Zero travel. And a full recording for reference. 

Where Cognitive and Procedural Telehealth goes in the near to medium-term future, will depend largely on several key factors including payer reimbursement, levels of federal and state support and, I believe, ease of technology use. If physicians and patients can continue to derive and prove massive value from this expanded use of both cognitive and procedural Telehealth, then it is likely to continue to expand as a fundamental healthcare delivery vehicle for the foreseeable future. Physicians’ initial reluctance has given way to the practical reality that technology can bring a host of benefits not previously recognized. And the technology can be delivered in such a way as to make the experience beneficial for both the patient and the doctor. And, ultimately, patients are benefitting from technology which finally unburdens both the physician and the patient while connecting all of us in meaningful and objectively measurable ways.

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BOTS! Love them or hate them, but they have been in existence for ~ 50 years based on some estimates. In simplistic terms, a Bot is a software robot (“Robotic”) that is given instructions (“Process”) to perform (“Automation”). Therefore, RPA is written rules/instructions you tell a software to do in an automated manner.

In this day and age, you have probably recently encountered software robots as chatbots. These chatbots may have scheduled an appointment for you or even performed a task such as booking a hotel room. Beyond chatting, you might have tried to buy tickets to a concert/game or purchase a certain clothing item (such as the notorious streetwear brand Supreme) only to get beat out by someone who deployed a bot. Leveraging bots allows you to tell the application software to complete a transaction in <1 second. My personal online transaction time is about 15-20 seconds, so I often do not get the hyped item I intended to buy. Despite the annoyances many encounter with bots, they play a significant role in automating repetitive mundane tasks (copy-pasting text into structured fields on a template). Let’s explore how this applies to healthcare…

Right now, there is a lot of interest in the “Digital Front Door” for patient care. How can I prep a patient before they see a physician? Scheduling quickly comes to mind, but you can also have the RPA engine copy/paste certain health information to tee up your data at the moment you will see a physician. Imagine having your latest labs, outside records, images, and medications ready to go so that your encounter is meaningful and full of decisions in your health journey! This has yet to be realized in our current health systems. Often, we scramble to gather information at the right moment, looking through many tabs and unstructured data. Leveraging RPA could be a link to realize functional interoperability without true interoperability. You also remove having humans pull open charts and re-chart in new documentation packages. All of these mundane tasks can be completed in split seconds in the background. As electronic record keeping in healthcare continues to be burdensome, deploying Bots with RPA technology can really get the right information to the right person at the right moment in a workflow. That is the holy grail with regards to healthcare applications.

Mundane task elimination can be realized through deployed RPA. Therefore, RPA integration will be part of the new world order in healthcare that brings back the human touch!

Looking beyond the digital front door, there has been a success with the use of chatbots for procedure-related preparation. For those of you who have had a colonoscopy, you are aware that the most difficult part is the preparation, not the procedure itself. Engaging patients with automated messaging and specified “conversation” can help better troubleshoot or understand the process of preparing for any procedure. Think of this as a real-time directed FAQ based on your medical procedure. If your prep is done right, your procedure will go smoother and be of higher utility. My definition for this type of technology is simply “patient engaging applications”. Patients are being engaged in a relevant manner on the topic of interest, such as bowel prep. As you can imagine, the development in this space is red hot as you can create pathways and algorithms for so many different medical conditions, procedures, preparation, etc. Everyone wants very minimum no-shows and improved compliance with personalized health delivery.

Connecting the dots, RPA is what leads to the realization of promises of early diagnosis and improved quality of care. When health information is prompted in a structured manner to the right person, prioritization of care delivery can be realized (think of timely cancer screening) as the computer can automate the names of patients with the most risk factors. Everything comes down to how you leverage RPA for your desired outcome. Are you looking only to schedule more efficiently and prevent “no-shows” or are you seeking a wider efficient whole health approach to how your system/network delivers care? Once you determine how RPA can be leveraged, it’s up to you how you want to connect the dots.

What does the future hold for RPA? Obviously, more and more “simple” tasks will be automated. However, as we have all experienced frustrations of being on hold or misdirected by a chatbot (think credit card company calls), RPA will be a part of the wider advanced technology ecosystem that brings back the human touch. Just as “google it” hasn’t replaced expert consultation, bots can only go so far before human intervention is needed to weigh the risks/benefits of decision-making. Medicine is an art and what to do with diagnosis is complex depending on very personal circumstances. Mundane task elimination can be realized through deployed RPA. Therefore, RPA integration will be part of the new world order in healthcare that brings back the human touch!

The post The Age of Bots for Healthcare – Robotic Process Automation (RPA) appeared first on HealthTech Magazines.

Organizations rely on IT to deliver the right information to the right information consumers at the right time to drive information-driven decision-making. In healthcare, the information consumers include clinicians, other knowledge workers, and patients. The demand for accurate, complete, reliable, relevant, and near real-time information is higher than the supply for such information. This is due to many factors. Healthcare organizations are risk-averse, adopt new technologies late, and are concerned about the skyrocketing cost of IT. Consequently, healthcare CIOs have a demanding duty to improve the supply of high-quality actionable information.

CIOs need to lead by example, implement industry best practices, and assure that strategic and tactical decisions are driven by high-quality information. CIOs won’t be seen credible if we don’t innovate and rely on data in our own departments. Dashboards serve an important role in meeting this objective. IT and organizational leadership are the typical audiences for these dashboards. Consistent data presentation is important to compare dashboards over time. These dashboards are useful not only for managing IT but also telling a story about IT. CIOs may need multiple dashboards to show progress on a weekly, monthly, and annual basis. There is no one-fits-all dashboard. Different metrics are needed depending on the organization’s current priorities and business phase. Organizations executing a strategic transformation need different dashboards than those focusing on continuous improvement.

A weekly dashboard is used for everyday IT management. Its audiences are the executive team and IT leadership.

Annual dashboards are used for Board presentations and deliver the message of how IT adds value to the organization. An effective way of summarizing data is by presenting IT in numbers. These numbers may include computing endpoints, servers, networking equipment, user accounts, applications, and phones under management; projects completed; user tickets, and major network and security incidents resolved. If a transformation program is in progress, a high-level roadmap can show what has been accomplished, in progress, and still ahead. Strategic objectives set for the year could be presented in a table with green checkmarks showing when objectives have been met or in yellow or red if minor or major obstacles were encountered. While most of the audience will look at only the high-level dashboard, it is OK to add definitions and explanations in fine lines.

Monthly dashboards have a hybrid purpose to present strategic and tactical information. Their primary audience is the CEO, the executive team, and IT leadership. Strategic information includes the departmental mission and annual objectives. When objectives are achieved, they can be labeled with green checkmarks. Progress on a strategic transformation can be presented similar to the annual dashboard. The rest of the dashboard may include operational metrics presented as progress over time and high-level information about the project portfolio. Although the organization’s security posture is typically assessed less frequently, this dashboard is a good place to show progress over the years. For example, external auditors may score security status in the 19 HITRUST categories. Year-to-year progress can then be presented in a bar graph compared to industry averages. IT customers want to see progress on projects delivering value to their respective areas. Therefore, it’s beneficial to list major projects completed in the year and currently in progress. Month-to-month progress can be presented using various operational metrics which is important for the organization. This may include percentage of projects completed on time; changes implemented with no issues; number of hardware and application-related incidents; percentage of applications, servers, networking equipment, operating systems, and computing endpoints under vendor support; time to close helpdesk tickets; and various customer satisfaction metrics. Customer feedback can be collected by surveys attached to tickets and regular monthly surveys. Common survey questions are related to first-time resolution and professionalism. Progress on the annual budget is an important metric for managing IT. However, dependent on how widely this dashboard is disseminated, financial metrics may not be included.

A weekly dashboard is used for everyday IT management. Its audiences are the executive team and IT leadership. Availability of resources, incidents, training, helpdesk metrics, and progress on the project portfolio may be presented weekly. To facilitate understanding of the dashboard, all portions can be color-coded in green, yellow, and red dependent on whether the information presented represents preferred outcome, risks, or issues. As this is the most tactical dashboard, it’s OK to drill down to more granular details and present information by IT sections. Information on available resources may include new employees and separations. Major incidents may be listed by IT sections. The helpdesk’s operations can be summarized by the number of tickets closed or overdue broken down by major categories. To show trends over time, data on the current and five prior weeks may be presented and color-coded. In order to guide the audience, sparklines may be added and color-coded. At Howard University Hospital, we typically have 30-40 projects in progress at any given time. These projects are presented in a table with concise information on risks and issues in resources, timeline, and scope. In addition, the ETA of the project is listed and project progress is presented for the current and five prior weeks. Project scope, timeline, resources, and weekly progress are color-coded. In addition to the projects in progress, a smaller table summarizes the number of projects in various stages of the project lifecycle. Numbers of projects proposed, in due diligence, in contracting, to be scheduled, scheduled, in progress, completed, and on-hold are presented using sparklines over the six recent weeks as described above. Other categories may be presented from time to time.

These dashboards serve not only the CIO. They are communication tools within IT and also for the Board, the CEO, IT’s customers, and the executive team. Regular dissemination of these dashboards to the right audiences helps establish transparency and communicate IT’s strategy and operations.

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