EHR metadata provides useful objective metrics for assessing the impact of AI and automation on how physicians enter clinical notes and interact with patient records. However, from my perspective, leading a very gifted Wellness Informatics team that implemented an ambient AI transcription solution, a more meaningful measure of success comes directly from the lived experiences of the clinicians using it.

We are a clinical informatics team that prioritizes clinician wellness by living in the narrow yet very important intersection of technology and humanity. After thousands of interactions, our team has identified the main challenges that our physicians and APPs face. We also have corroborated our subjective findings with analytics tools offered by our EHR vendor to develop multiple avenues of personal, practice, and system-level support.

One of the ways we support our physicians and APPs is through direct observation. It gives us the privilege of being with our providers in the exam room with their patients. I remember thinking during one observation how marvelous a particular specialist physician was. Patients love this guy. He also has played a pivotal role in the health of a multitude of patients – including patients we shared.

I distinctly recall a 1:1 support session with him that made me realize we needed to take our advocacy and support to the next level. He confided that he wanted to leave the organization and possibly the profession. This doctor did not need to learn a new skill or technique. Instead, he needed to delegate some of his daily responsibilities to others. As we collected data, it became apparent that we needed a way to reduce our providers’ clinical documentation workloads.

Time previously spent writing notes can now be used for other complex tasks, such as addressing abnormal results.

We began in 2017 with in-person scribes. We still use the service today. The physicians who took advantage of it were extremely pleased. Job satisfaction improved and time available for other important tasks – such as in-basket management – increased. All combined, this decreased overall time in the EHR for these physicians. An unexpected benefit was the ability of these great physicians to mentor the next generation of practitioners. However, the cost of in-person scribes and staffing shortages precipitated by COVID-19 led us to look at AI-based options.

In 2020, we evaluated several vendors and selected one who provided AI transcription that was reviewed by a human before the final note was added to the physician’s preferred note template for review. Users felt that the service was hit-or-miss, with the quality of final note being highly dependent on the human reviewer. Most physicians who stayed with the service appreciated not having to worry about their documentation. Still, the inconsistent quality and cost were major drawbacks.

In 2022, we went live with a newer, fully automated version of the same company’s ambient AI transcription solution and we could not have been more pleased. Objective data show that the attrition rate is significantly lower than the version with human review, notes are delivered within seconds instead of hours, and any editing needed is much simpler and more efficient.

The subjective data obtained directly from the clinicians using the ambient AI solution is even more telling; participants have reported:

• Less burnout or fatigue.
• Reduced cognitive burden
• Better work/life balance
• Higher job satisfaction
• More likely to stay at their current organization
• More likely to remain in clinical practice

Specific comments from our physicians and APPs include:

• “Liberating! More time in the exam room where I can give the patient my undivided attention. I no longer feel like a well-paid data entry clerk!”
• “Much better documentation of historical data to support the level of visit.”
• “It might even give my career a few more years of longevity.”
• “Overall, very happy with this product. It has increased my job satisfaction and improved work-life balance.”
• “Wow! They documented things I would have forgotten.”
• “Very thankful for this service.”
• “I simply will not practice the rest of my career without some form of scribing, no matter the cost.”
• “I used to be working on labs from four to five days ago. Now, I work on yesterday’s labs.”
• “Another important part is that it allows me to look at my patients more and be more present to them during their appointments. I am no longer trying to partially complete notes in the room. The only things on the computer that I do in the room now are place orders or look up study results with the patients.”

As a user of ambient AI, I want to highlight the importance of reducing cognitive load. It feels very liberating to be able to concentrate on the patient and not have to stress about how to record what I am being told. Time previously spent writing notes can now be used for other complex tasks, such as addressing abnormal results.

Is this technology for everyone? No. Is it perfect? No. But it is incredibly good. Quite frankly, this technology is still in its early days and at its  “worst.” However, the learning nature of AI means that it will continue to improve and evolve. We have noticed significant improvements since we first went live, including stylistic changes in how the AI transcribes the note.

The sky’s the limit as to what this technology will do for us as clinicians. It will queue orders as it hears them. Also, it will soon generate summaries of relevant facts about a patient’s health issues. There are many more advancements planned, and I can’t wait to see what’s to come.

I appreciate a technology that enhances my human abilities when I am with my patients in the exam room. Simply put, it feels great to feel like a clinician again. 

The post Allow Your Clinicians to be Clinicians appeared first on HealthTech Magazines.

Healthcare is complicated. Knowing the correct medications, procedures, and care plans requires years of education and experience. The average family member of a patient does not have this knowledge, and most do not claim to have it.

However, what the average family member does know is their loved one who is lying in that hospital bed. They know their “normal” behavior and when the patient is deviating from that; what makes them comfortable, what will cause them distress, what will help with their healing and what will hinder it. Sometimes they know the patient’s past medical history better than the patient does.

Families can provide a wealth of knowledge that, combined with the expertise of medical professionals, can create an equation for better patient outcomes…as long as both sides take the other seriously.

Respectful and frequent communication with a patient’s family needs to be a priority in the healthcare environment. When a family member brings a concern to a care team member, it should be listened to and considered. While the requests or concerns may not always have merit, and the healthcare professional may have clinical knowledge that overrides the request, it is important that the family feels heard and considered. Sometimes what the family brings will truly impact the patient’s outcomes and overall health.

This collaboration can be facilitated using various technology platforms in the healthcare environment. If implemented effectively, they allow for information sharing that can lead to inclusive and effective care plans. The following sections outline some examples of technology that can assist in family-inclusive care.

Family-inclusive care has immense potential to improve patient care and outcomes.

TeleSitter

TeleSitter technology has become more prevalent in healthcare settings in recent years, as the industry has faced staff shortages and a global pandemic. This technology utilizes cameras, two-way video and audio, an alarm system, and centrally located monitor technicians to monitor multiple patients at once.

When patients are placed on TeleSitter via a provider order, a reason is indicated (i.e., altered mental status, attempting to remove medical devices, fall risk, etc.). With this information, the monitor technicians know what to look for on the video feed, and if they see an issue requiring an in-person response they communicate that with the patient’s bedside care team. If the response is needed urgently, the monitor technicians can also set off a loud alarm in the clinical space.

TeleSitter monitor technicians should also be encouraged to communicate with the patient and their family members in the room via the two-way audio/video capabilities. These conversations have several benefits: the patient and family are able to meet the technician who will be keeping an eye on them, the family can convey any concerns they have about the patient, or give the technician tips on things to look out for, and everyone can feel more comfortable that the patient will be safe.

Perhaps the family knows a loud alarm would make the patient’s delirium worse because they suffer from PTSD. They could communicate this to the technician, who can then take all appropriate steps to avoid the need to use the alarm. Or the patient’s spouse knows they always get up at night to use the restroom. The technician can proactively be prepared to speak to the patient over the device and ask them to wait for assistance so they avoid a fall. These anecdotal pieces of information can significantly improve the patient’s experience.

EMR Patient Portals

Patient portals provide an easily accessible window into a patient’s medical record. Patients can see test results, notes, immunization history, problem lists, and other information. Patients can communicate with their providers via secure chats, and in some cases, schedule appointments. These tools have become commonplace in healthcare, with new features continually being developed.

If leveraged correctly, these tools can improve communication in the Inpatient setting. A perfect example would be configuring the Electronic Medical Record (EMR) to send provider and nursing notes to the portal. This allows the patient and their family to always be up-to-date on the patient’s status and the care provided without having to track down a staff member for a verbal report. This is particularly helpful when family members cannot physically be at the hospital. It is a streamlined and efficient way to communicate.

Family Participation in Provider Rounds

Multi-disciplinary provider rounds are a standard communication tool amongst healthcare team members, and have been shown to enhance patient care and decrease lengths of stay. Mobile access to the EMR via a smartphone or tablet can easily allow clinicians to reference patient data during these meetings, making the discussions more specific and effective. This rounding method could also easily be expanded to be inclusive of families with the help of some additional technology.

For example, the Case Management team could coordinate with the patient’s family member(s) and establish an audio or video call so the family could participate in the conversation with the care team. If Rounds occur outside of visiting hours when the family cannot be there, they would still be able to ask questions, share information, and be part of the care planning process.

Conclusion

Family-inclusive care has immense potential to improve patient care and outcomes. Family members bring valid and important information to the table, and with some mutual respect, the healthcare team and family members can collaborate to benefit the patient’s ability to heal. Technology can be leveraged to facilitate this inclusion. Health systems should be taking steps to make family-inclusion part of their culture, providing education and tools to the healthcare team to encourage collaboration.

The post Family-Inclusive Care: Using Technology to Facilitate Coordination and Improve Outcomes appeared first on HealthTech Magazines.

Health care providers continue to experience financial pressures due to various internal and external factors, like declining reimbursement rates, rising inflation, declining workforce availability and complex regulatory requirements. Marshfield Clinic Health System has not been immune to these factors and has been focused on a Financial Improvement Plan throughout 2023. As part of this Financial Improvement Plan, the health system embarked on a comprehensive revenue cycle optimization effort that looked at traditional and innovative solutions to create meaningful financial impact.

Areas of Focus

The health system has undergone a multi-year Electronic Medical Record (EMR) installation over the last couple years. This resulted in a 2023 focus for revenue cycle optimization on (a) a one-time cash acceleration by reducing the Discharge Not Final Billed (DNFB) and billed Accounts Receivable (A/R) backlogs; and (b) a sustainable net revenue improvement through comprehensive revenue integrity and reduction of administrative write-offs.

To achieve these objectives, the revenue cycle optimization efforts were divided across four pillars of work: DNFB Reduction, A/R and Denial Management, Revenue Assurance and Pricing and Denial Prevention. Each pillar identified and implemented initiatives across people, processes and technology.

The remainder of this article will focus on the technology initiatives, especially ones considered innovative solutions that go beyond the traditional EMR optimization.

Solutions

Limited availability of revenue cycle resources and rising labor costs have been key driving factors to look for innovative solutions to create meaningful impact across the revenue cycle. To create this impact, organizations need to rely on various avenues like data science and machine learning (ML), intelligent automation and data analytics, versus relying on just one solution like Robotic Process Automation (RPA).

Data Science and ML

As most readers know, revenue cycle within any health system is driven by data. With over 73,000 diagnosis codes, 10,000 procedure codes, 80 locations, 400 health plans and other key variables, there are billions of reasons why an individual encounter becomes a revenue cycle issue. At the health system, we rely on the use of practical data science and ML to organize work quickly for our revenue cycle teams that has exceeded the capabilities of rules-based systems designed in the past.

For the DNFB reduction initiative, we targeted high-value encounters buried inside of complicated system logic or worklists, identified programmatic fixes that may be available and worked with Information Services and other teams to resolve and optimized our resources and team structures based on the patterns identified through data science.

For the billed A/R and denials management initiative, we used data science and ML to drive enhanced collections performance across the entire account population by connecting similar work across revenue cycle functions. We have embarked on a comprehensive A/R prioritization effort that goes well beyond the high-dollar and aged worklists that have been traditionally used to drive work in the back end of the revenue cycle.

At Marshfield Clinic Health System, we rely on the use of practical data science and ML to organize work quickly for our revenue cycle teams that has exceeded the capabilities of rules-based systems designed in the past.

Automation

Intelligent automation is being used across several revenue cycle functions. Forexample, we are  implementing automated administrative intake in partnership with a leading intelligent automation company. We have automated appointment reminder outreach, collection of demographic information, consent forms, insurance forms and insurance cards. Another area being evaluated for RPA is the resolution of credit balances. Health System teams are engaged in developing Process Definition Documents (PDDs) that will be used to design automation for these processes.

Data Analytics

The health system relies on robust data analytics for decision-making in partnership with our internal Analytics Center of Excellence (ACE). Working with ACE, we developed a comprehensive set of dashboards to monitor revenue and usage reporting, pre-claim edits, claims, billed A/R and denial and write-offs. These dashboards allow our leadership teams to track the health of our revenue cycle metrics, use underlying data to root cause issues and collaborate across revenue cycle, operational and clinical areas.

AI Governance

As the health system continues to expand the use of AI across the system, in the summer of 2023, we established an AI governance program that ensures responsible and ethical adoption of AI technologies within the health system enterprise. The goal of this program is to mitigate risks and harms that can be caused by AI systems. The governance council comprises a diverse group of individuals charged with the responsibility of reviewing all requests to develop or acquire AI technology. It also provides oversight of the ongoing responsible use of AI technology.

Workforce Impact

As we implement AI and automation solutions, the need to accommodate the impact of these solutions on our workforce is ever-increasing. With the adoption of these solutions, there is a constant need to address our workforce levels, reallocate and re-educate our staff constantly and allocate resources to implement these solutions. At the health system, we are exploring avenues to address these needs, like flexing our vendor resources based on automation levels and maintaining a cross-functional pool of resources for problem-solving and technology implementation.

Path Forward

As we continue our revenue cycle optimization journey in 2024, we expect to double down on our use of intelligent automation and responsible AI throughout the revenue cycle. While the journey continues along the various initiatives listed in this article, we will continue to look at other areas to automate to improve our patient experience.

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The Integrated EMR and Diagnostic Imaging

In the last 25 years, medical imaging has successfully transitioned from bulky film and paper-based workflows to digital image archives. Organizations deployed RIS, PACS with advanced Visualization capabilities. They integrated them with Structured Reporting (SR) and Voice Recognition (VR) systems to create mature workflows built to be fast, efficient, and accurate.

The HITECH Act and ACA in 2009 and 2010, respectively, heralded the Meaningful Use era in clinical care and delivery. Incumbent to these regulations, Accountable Care demands of the ACA emphasize quality, outcome, and costs across the care continuum. At the same time, the HITECH act mandated urgent computerization of medical records and clinical documentation, focusing on the EHR being at the center of all clinical care initiatives.

Medical Imaging, too, has started to see a paradigm shift from volume-based operations to “value-based” care delivery. Healthcare facilities began implementing and installing EMR System software solutions, mandating CPOE workflows and CDSCDS systems. EMRs created an organic need for interoperability to enable a significantly more patient-centric view of clinical records across the care continuum.

With the right outlook, strong leadership, a well-thought-out roadmap, and effective governance, an organization can accommodate newer technological advances that will continue to successfully shape the future of medical care.

The Enterprise in Imaging: The Rise of the Vendor Neutral Archive (VNA)

Over time, the EMR has evolved from being simple billing-tracking systems to the multispecialty clinical documentation storehouse of patient data that it is today. The EMR has created an ecosystem that requires clinicians to access all kinds of clinical records, including medical and diagnostic imaging from other clinical realms. Departments like Cardiology, Pathology, Dermatology, Ophthalmology, Wound Care, and Gastroenterology, to name a few, are imaging workflow intensive. The need for documentation and imaging to integrate into the patient’s longitudinal record in the EHR presents an opportunity to garner efficiencies in managing silos of different imaging systems and enable actual patient-centric workflows instead of application or department-centric processes.

Enterprise Imaging is an organizational mindset needed to address the need to eliminate traditional imaging silos by aligning imaging technology and infrastructure essentials with universal image availability (without silos). Enterprise Imaging seeks a more consistent data storage, image access, and image lifecycle management (ILM) approach.

The evolution of the VNA market is proportional to the expansion of imaging needs across multiple departments in the enterprise. The VNA is a vital part of the Enterprise Imaging solution. It consolidates all imaging data from various modalities, departments, facilities, and vendors into a central clinical data storage infrastructure that serves as a unified longitudinal patient imaging information repository. VNAs must store and display any file format, images, multimedia content, DICOM or non-DICOM, and retrieve data in its native form. In addition, it is desirable that VNA also act as a workflow engine to create a worklist for a modality or image source and perform prefetching and notification functions as needed for optimum lifecycle and storage management.

Most organizations are experiencing a considerable challenge responding to the rising costs attributed to the storage and retention of images in their legacy storage arrays. It is not uncommon for imaging data to be the primary storage infrastructure consumer in organizations with a significant Imaging footprint. Innovations in medical imaging technology have improved clinical considerations by collecting more data while increasing the size of a study with a significant impact on storage capacity and image life cycle management. For instance, Digital Breast Tomosynthesis (DBT), as a supplement to traditional mammogram imaging, takes between 400% to 4900% more images than a digital mammogram. Organizations that do not strategize and plan for escalating costs of technology and innovation in an integrated enterprise will stare at heavy investments in infrastructure silos. Medical Imaging silos in a health system, when unplanned, is one such cost driver.

To make Medical Images accessible throughout a health system requires an enterprise viewing application and two other key components – an archive and a workflow application. In today’s healthcare ecosystem, the endpoint for an Imaging enabled organization, and health record is deploying a VNA. Based on size, complexity, and budgets, other organizations tend to prioritize aggregating imaging services in the organization and implement the VNA first.

Five critical considerations while transitioning to a VNA.

1. Develop Strategic Roadmap for Technology and Imaging:
   Organizational budgets and strategic road maps drive leaders to consider first implementing an enterprise viewing platform by replacing the viewing components of the PACS before scaling up to a VNA. Complete a thorough audit of the Imaging infrastructure by granularly examining modalities, studies, image sizes, and imaging life cycle considerations to develop a strategic road map that you can budget for
   
   
2. Establish Imaging Governance in the organization:
   Set up a committee including all Enterprise Imaging stakeholders and information technology leadership to develop and sign off on a strategy with a clearly defined scope. Make sure to include IT strategies that account for security, privacy, and compliance in addition to availability, quality, and architecture.
   
   
3. Develop an ILM strategy:
   ILM is a significant feature of a VNA application. An impactful ILM application will set up the VNA to automate the management of study deletion and retention parameters after considering all policies and legal ramifications.
   
   
4. Define your workflows:
   Recognize that many non-radiology and cardiology enterprise imaging workflows differ from a traditional “procedure-based workflow” in a radiology imaging setup. In most instances, these “encounter-based imaging workflows” have no order placed before image acquisition. These workflows are also called “Point of Care Imaging” (POC) and constitute a significant chunk of unregulated enterprise imaging.
   
   
5. Cloud Migration (Data Migration):
   VNA deployment usually requires migrating all legacy archived data into the VNA. The economics of data and storage based on usual enterprise factors of System availability, Information security, legacy data retrieval, and retention will dictate that you strongly evaluate a cloud storage strategy.

The transition from the current to the future state can be challenging. With the right outlook, strong leadership, a well-thought-out roadmap, and effective governance, an organization can accommodate newer technological advances that will continue to successfully shape the future of medical care.

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