The Mayo Clinc Platform, the health system's innovation base, is adding Israel's Sheba Medical Center, Brazil's Hospital Israelita Albert Einstein, and Canada's University Health Network to its distributed data network, which already includes Missouri's Mercy health system.
The Mayo Clinic is expanding its AI-based data sharing network on a global scale.
The health system's innovation base, Mayo Clinic Platform, announced today that its distributed data network, called Mayo Clinic Platform_Connect, will include Hospital Israelita Albert Einstein in Brazil, Sheba Medical Center in Israel, and University Health Network in Canada. They join the Missouri-based Mercy health system, which joined the platform in 2022.
The announcement adds an international flavor to a fast-developing segment of healthcare. Those within the Mayo Clinic network will be able to use de-identified clinical data on the Data Behind Glass platform to test AI-enhanced solutions for clinical care.
"We describe the data needed for fair, equitable AI as having depth (types of information), breadth (number of patients) and spread (heterogeneity)," Mayo Clinic Platform President John Halamka, MD, said in a press release. "To transform healthcare globally, we must expand our distributed data networks to every continent. We must protect privacy, adhere to international laws and regulations, and incorporate knowledge from every language."
Officials said the partnership will initially focus on:
Information Collaboration. "Secure cloud-based use of Data Behind Glass allows each collaborator to base decisions on a wider range of clinical outcomes gathered over time," officials said. "The information will help scientists analyze patterns of effective disease treatment and, more importantly, disease prevention in new ways, based on reviews of incremental clinical patient data over time."
Solution and Algorithm Development, Validation, and Deployment. "The resulting AI-based solutions will provide proven treatment paths based on years of patient outcomes, representing the next generation of proactive and predictive medicine that can be used by care providers around the world," the press release noted.
The Mayo Clinic has been on the front lines of integrating AI into healthcare, and is a member of the Coalition for Health AI (CHAI), launched just last month. In 2021, the health system launched the Remote Diagnostics and Management Platform (RDMP), designed to aid AI and clinical diagnostics opportunities in remote patient monitoring programs.
This latest announcement pushes the platform out into the global healthcare market, with partnerships with three health systems known for their innovation.
"We are thrilled to be part of this historic alliance to transform the future of health," Eyal Zimlichman, MD, chief transformation officer and chief innovation officer at Sheba Medical Center and director and founder of ARC Innovation at Sheba Medical Center, said in the press release. "Creating a truly global network that will break down language barriers and enable the inclusion of diverse populations, we are unlocking the potential of AI solutions to revolutionize health care worldwide. This is not just a game-changer, but a visionary leap toward data-driven healthcare."
Reacting to a wave of complaints against its earlier proposed revision of rules for prescribing controlled substances via telemedicine, the DEA is changing course yet again.
The US Drug Enforcement Administration is revising proposed regulations for the prescription of controlled substances via telemedicine after receiving thousands of complaints.
A statement issued today by DEA Administrator Anne Milgram says the DEA, coordinating with the Health and Human Services Department, is submitting a draft temporary rule to the Office of Management and Budget for the "Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Substances."
Details of the new rule will be released when it is published in the Federal Register.
"The Drug Enforcement Administration received a record 38,000 comments on its proposed telemedicine rules," Milgram said in her statement. "We take those comments seriously and are considering them carefully. We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities while we work to find a way forward to give Americans that access with appropriate safeguards."
The use of telemedicine in prescribing controlled substances has long been stringently regulated by the federal government. Passed into law in 2008, the Ryan Haight Online Pharmacy Consumer Protection Act severely restricts the prescription of controlled substances, and requires an in-person exam by a qualified provider before those drugs can be prescribed via telemedicine. Enforcement is handled by the DEA.
The DEA had eased its rules during the pandemic to allow healthcare providers to prescribe controlled substances via telemedicine without the need to first conduct an in-person exam. With the COVID-19 public health emergency scheduled to end on May 19, the agency unveiled a proposed revision in February that would have expanded some telemedicine uses but also established a new set of guidelines.
The FDA's proposed rules would allow providers to use telemedicine to prescribe 30-day supplies of Schedule III-V non-narcotic controlled medicationsand buprenorphine, the latter specifically for the treatment of opioid abuse disorder, for new patients and without the need for an in-person evaluation..
"Leading professional associations, respected think tanks, and experienced clinicians submitted compelling and noteworthy comment letters explaining how the proposed rule will result in limitations on access to care, harm patients in rural and urban areas alike, and likely result in otherwise avoidable overdoses and deaths when patients are denied access to their medically-important medications," several lawyers from the Foley & Lardner law firm wrote in a blog.
Nathaniel Lacktman, a partner in the firm and chair of its national Telemedicine & Digital Health Industry Team, and his colleagues produced a legal guidebook shortly after the proposed rules were unveiled, and submitted a 15-page letter picking apart various aspects of the rules on March 30. Others submitting critical comments (the Foley & Lardner team called it a "tsunami of criticism") include the American Telemedicine Association, the Alliance for Connected Care, and a group composed of members of the Brookings Institution, Harvard Medical School, David Geffen School of Medicine at UCLA, and Harvard T.H. Chan School of Public Health.
Healthcare organizations across the country are launching RPM programs aimed at monitoring specific patient populations outside the hospital.
As healthcare organizations look to improve care management for patients outside the hospital setting, they're embracing remote patient monitoring in droves. New programs launched across the country are using everything from digital health tools and wearables to smart home technology and telehealth to connect patients to care teams.
"It's truly a new service model," says Karie Ryan, clinical transformation lead for connected care at Philips, who has been watching the growth of programs for the healthcare technology giant. "A lot of hospitals know it's the right thing to do and know it has value, but they don't know how to do it."
Ryan says large health systems "are well-positioned to own RPM" because they can use the platform as a population health tool, but smaller hospitals might not have the numbers to achieve sustainability and are looking at outsourcing to an RPM provider.
"There are many different ways" to develop an RPM program, she says. "None of them are wrong, but hospitals have to be very careful in planning these programs. We've seen many that were implemented during COVID that were never meant to be long-term solutions."
To that end, Ryan says she's worried that some health systems "jumped on the bandwagon" before plotting a sustainable use case, and they’re either just barely hanging on or dropping the program and giving RPM a black eye.
Among the factors that health system leaders need to address in developing an RPM program:
Identifying the right patients to be monitored at home;
Assessing the patient's home environment to ensure an RPM program will work;
Understanding what data needs to be collected, and how to collect it;
Identifying the technology needed, both at home and at the health system;
Identifying participating members of the care team and developing or adjusting workflows to monitor patients at home;
Establishing parameters and protocols for interventions, including emergency consults and hospitalizations;
Setting parameters for the length a patient participates in an RPM program, and how to return technology once that participation has ended;
Setting benchmarks for a program's success, sustainability, and scalability; and
Incorporating other care providers into the program to address SDOH.
Among the more common reasons for launching an RPM program is to monitor patients living with chronic care needs, or helping patients recover and rehabilitate at home after a hospital stay. The more common goals are reduced hospitalizations or adverse health events, a reduction in healthcare costs and in-person visits, and improved clinical outcomes.
Ryan says the RPM model will evolve as the technology becomes more sophisticated and health systems understand more about how they want to collaborate with patients at home. She says the platform could also be used in advance of a hospital stay, to prepare patients for scheduled treatments such as surgeries.
To gauge how RPM is evolving, HealthLeaders spoke with three different health systems about their programs.
Using RPM for Chronic Care Management
Community Health Systems opted to partner with Cadence in 2022 to launch an RPM program covering hypertension and congestive heart failure, and has since added diabetes to the roster. Through this partnership, the Tennessee-based, 79-hospital network relies on care teams employed by Cadence to handle daily monitoring duties, with more urgent cases handled by CHS providers.
"We had had physicians that had tried [to launch RPM programs] and they were just overwhelmed by all the data," says Lynn Simon, MD, MBA, the health system's president of clinical operations and chief medical officer. "So we had to focus on reducing that burden on our physicians. Once we had the process down, it became very easy."
Lynn Simon, MD, MBA, president of clinical operations and chief medical officer, Community Health Systems. Photo courtesy CHS.
Simon says CHS wanted to focus on chronic conditions that would show improvement with regular monitoring and adjustments to the care plan, alongside a patient population that could manage using devices at home to gather data for the care team. The health system looked at more than a dozen RPM vendors before choosing Cadence, opting for a company that would help the health system's primary care providers with enrollment and monitoring. and loop in clinicians when necessary.
"We did a lot of work to select the right partner and make sure our doctors were on board," she says. "We didn't want it to feel like we were handing our patients off to another company, and that [Cadence care teams] were part of our care team. We also wanted to make sure there is still that connection to the primary care providers."
Simon says CHS held webinars and meetings to educate its providers on the value of an RPM program, and used a handful of early adapters to highlight the partnership with Cadence.
CHS has enrolled more than 2,300 patients in its programs to date, with plans to give another 700-800 providers access to the program and scale up to more patient populations. So far, she says, only about 1% of the RPM encounters has had to be elevated to a physician intervention.
"I thought it would be a little more challenging to get enough information back," she says. "But that hasn't been the case. And we're hearing anecdotal information [and] some good stories about how we've been able to avoid hospitalizations."
Targeting a High-Risk Population
At Kentucky-based Baptist Health, officials launched an RPM program in late 2021 to address care management for high-risk patients living with CHF. The health system partnered with Current Health, the healthcare arm of Best Buy, to launch the program with plug-and-play technology, which includes a tablet, blood pressure cuff, and a wearable.
Steven Heatherly, MD, the nine-hospital health system's medical director of heart failure and pulmonary hypertension, says Baptist Health specifically targeted an at-risk population that is 18% more likely to be rehospitalized and/or develop acute health concerns. These patients, he says, have an average age in their 70s, and often have problems following doctor's orders in between visits.
Through the RPM program, care teams gather data from patients three times a day and connect with patients via phone when necessary.
Steven Heatherly, MD, medical director of heart failure and pulmonary hypertension, Baptist Health. Photo courtesy Baptist Health.
"We decided not to do routine phone calls," Heatherly says, noting nurses would call if they weren't getting data from the devices in the patient's home or if that data indicated a health concern. "We didn't get excessive amounts of workflow out of this. It worked very well for us and didn't overwhelm" the care providers.
In the first 10 months of the program, he says, the health system did see an increase in clinic visits—not exactly a surprise, given the patients' ages and their acute conditions. But only one patient was rehospitalized, for an unrelated medical concern, and only two patients died. In addition, the patients in the program paid more attention to their care plans.
Heatherly says Baptist Health is now expanding the RPM program to other patients, including those with COPD and hypertension, and will be using the platform to follow patients after they've been discharged from a hospital. They're also opening the program to more hospitals and clinics.
"We've seen how it works with high-risk patients, so now we know what we can do," he says. "There are a lot more patients that can benefit from this.
Heatherly also wants to track data on quality of life and medication adherence, among other factors. And they'll be talking to payers about the benefits of the program.
'Even I was skeptical at first," he says. "But the results so far have been very good."
Continuing Care From the Hospital to the Home
The Beacon Health System launched its first RPM program earlier this year with a focus on patients with complex chronic conditions who'd been recently discharged from a hospital. The Indiana-based health system is partnering with Biofourmis on the population health program, using a platform that includes digital health tools and a mobile dashboard for clinicians. Biofourmis also assists in monitoring patients for the health system, primarily overnight and on weekends.
Roughly 80% of the patients chosen for the program are monitored episodically, with data gathered at specific times during the day or week; the other 20% are monitored continuously.
"We're really looking at the patients who need the most intervention to stay stable in the ambulatory space," says John Bruinsma, Beacon Health's manager of care coordination and population health. "These are high-need, high-cost patients who go through a cyclical pattern of needing multiple readmissions."
John Bruinsma, manager of care coordination and population health, Beacon Health System. Photo courtesy Beacon Health.
Bruinsma says the health system pulled in staff from care coordination, population health, IT, health information management, and finance to plan out the program, which was initially funded by COVID-19 funding from the CARES Act.
He says one of the biggest challenges was designing a process that matched the right care providers with the right patients after they went home.
"It took a lot of talking with the key stakeholders, but we're very optimistic about the answers that this program will provide up front," he says. "This is another tool we can use to help patients who are struggling to manage their symptoms at home or to interpret their symptoms."
Bruinsma says Beacon Health is looking at long-term outcomes with this program, as well as identifying and addressing social determinants of health that may be affecting access to care from the home. They're also tracking ED visits, rehospitalizations, adherence with scheduled doctor's appointments, and medication management and adherence.
He anticipates that patients might spend up to 30 days in the program before transitioning out.
"We might integrate with in-person visits, maybe look at a Hospital at Home program," he says. "We've looked at it, and we decided to start in the middle for now. Factoring in long-term care management might be the next step."
Researchers say their AI algorithm can analyze clinical data and images of a patient's heart and calculate the probability of cardiac arrest and other concerns over several years.
Researchers at Cedars-Sinai have developed an AI algorithm aimed at predicting heart attacks before they happen.
A team led by Piotr Slomka, PhD, the hospital's director of innovation in imaging and a research scientist at the Smidt Heart Institute's Division of Artificial Intelligence in Medicine, created a tool that collects and sifts through climical data and images of a patient's heart to identify cardiac concerns and determine the likelihood of a heart attack, requirement for an invasive cardiovascular intervention (such as a stent or bypass surgery) or even death over several years.
“This general patient data, together with heart imaging, is what the deep-learning platform uses to make cardiac health predictions,” Slomka said in a press release. “Doctors and patients can use these graphs to track how risk changes over time and to identify individual risk factors. They can also interactively modify certain risk factors to see how it impacts a patient’s particular risk.”
“AI algorithms of this nature could enable physicians to communicate more personalized information regarding potential timing of imminent heart disease events, allowing patients to engage more meaningfully in the shared decision-making process,” added Sumeet Chugh, MD, director of the Center for Cardiac Arrest Prevention in the Smidt Heart Institute and director of the Division of Artificial Intelligence in Medicine and the Pauline and Harold Price Chair in Cardiac Electrophysiology Research. “Even more importantly, this tool has the potential to lend data-led, appropriate urgency to heart disease prevention efforts by both patients and providers.”
The results of the project were recently published in NPJ Digital Medicine. It's being touted as the first study to "evaluate prediction at multiple time points of multiple events in a large multi-site registry of cardiovascular imaging data that also explicitly takes advantage of time-to-event data during model training."
"The model relies on the combined predictive potential of the clinical features, stress test data, and direct image analysis, similarly to the way clinicians try to integrate all available information to provide the most accurate study interpretation," the research team wrote in its study. "Moreover, this approach also leverages time-to-event data to provide more robust risk estimation over time, which could potentially be applied to a broad range of AI tasks."
"In addition to informing the physician about the rationale behind model predictions, the visualization of factors contributing to increased risk of adverse events might serve as a powerful tool in shared decision-making after the exam, utilizing all available information," the team concluded. "When discussed with the patient, a special focus might be given to modifiable risk factors such as high BMI, hypertension, diabetes, and dyslipidemia, leading to optimal, goal-directed medical therapy of these risk factors. That could be a starting point for a discussion on how these factors can be targeted through lifestyle modifications and medications. Such an approach could be an important step towards patient empowerment and could improve adherence to physicians’ recommendations."
The State-level Mobile Unit Capacity Building grant program, overseen by the Leon Lowenstein Foundation, recognizes community health centers that have launched mobile health clinics to address challenges to healthcare access among underserved populations, including social determinants of health. The $12,500 grants are awarded in three categories: policy (improving sustainability and/or operational effectiveness); training and technical assistance for mobile unit growth and development; and technical assistance for emergency preparedness.
“For those who are unhoused, young people, those in active addiction, people in rural and urban areas alike, and many others in disenfranchised communities, mobile healthcare delivery is an essential service that increases access to healthcare,” Stewart Hudson, executive director of the Leon Lowenstein Foundation, said in a press release. “The Leon Lowenstein Foundation continues to be an engaged partner and funder to support the National Association of Community Health Centers (NACHC) in their efforts to build capacity for mobile units at health centers. These units are an important part of the work toward health equity in the US.”
Wilson, an Air Force veteran who has advised the Congressional Black Caucus on issues like health equity, talks about the evolution of diagnostic and imaging services.
HealthLeaders recently caught up to Cedric Wilson, MBA, RT, an executive director at Stanford Medicine Children's Health, for a virtual chat about the evolution of diagnostic and imaging services and the role that innovation plays in this segment of the healthcare industry.
Wilson served more than 20 years in the Air Force, and he has spoken with and supported the Congressional Black Caucus on issues ranging from health equity to opportunities for minorities in healthcare.
Q. You're leading the Diagnostic Imaging Innovations effort at Stanford Medicine--tell me a little bit about that. What do you focus on?
Wilson: My role is an incredibly rewarding one. I am the executive director of diagnostic and imaging services at Stanford Medicine Children’s Health. At its core, it constitutes leading diagnostic testing and imaging strategies, navigating the evolving continuum of care surrounding chronic diseases, and moving to preventative approaches in healthcare.
All of this is underpinned by research. I oversee about 180 or so experts that cover all facets and all modalities of radiology, as well as developing a leadership team. As an aside, I also spent more than 20 years in the United States Air Force, and in that role as a senior leader and superintendent, [in] the Pacific as well as Europe. This, along with my background, drives a large part of my service mindset and work promoting health equity, healthcare education and policy strategy in my work as a speaker at the Congressional Black Caucus.
Q. How have new technologies and strategies changed diagnostic imaging?
Wilson: Radiology in a children’s hospital differs from that in the adult setting. The majority of patients who receive MRIs, for example, are adults, so the equipment on the market and tools developed reflect that. Those are not always best for children or young adults. Sticking with the MRI example, children find it harder to sit still, they are smaller, they breathe faster, and more. This makes clear imaging challenging.
Cedric Wilson, MBA, RT, executive director of diagnostic and imaging services, Stanford Medicine Children's Health. Photo courtesy Stanford Medicine Children's Health.
Recent innovations in MRI equipment were a must. We’ve collaborated with engineers at UC-Berkeley to produce new designs and methods for smaller equipment. Flexible, lightweight MRI signal-receiving coils that increase imagery for children and lower scan times. Adding to this are advancements in image-reconstruction algorithms. Motion-correction sharpens images and artificial intelligence reduces scan times by using computer technology to reconstruct MR images with less raw data. We’re seeing large time savings across cardiac and oncologic examples, for example, with scans now able to be completed in 10 or so minutes versus an hour.
Q. What are the biggest challenges or barriers faced by radiology providers?
Wilson: A major challenge that has risen to prominence over the past few years is disparity in education and understanding of radiology among diverse populations. This didn’t happen overnight; it was passed from generation to generation.
For example, for many minorities or culturally diverse patients and families, there’s a fear of going to the doctor or of having diagnostic tests. This runs the gamut from X-Rays to MRIs and many tests in between. It hinders the industry’s ability to catch diseases early or provide optimal care plans. Many radiology departments, including ours at Stanford Medicine Children’s Health, deal with some of the most critically ill and rare cases from around the world. We’re working hard to lead the industry in dispelling myths and promoting education around radiology. This extends to engaging our patients in new ways to understand their unique cultural behaviors. This will empower healthcare to better care for increasingly diverse patient populations. It remains a core component to an equitable health future.
Q. How can these new technologies or strategies improve clinical outcomes?
Wilson: One of the goals of technology in radiology is to limit (or, in some cases, eliminate) a child’s exposure to radiation. Another is to improve diagnostic capabilities.
A good example of this is how we’ve developed a way to test for vesicoureteral reflux, a kidney condition that impacts approximately one in 10 children, without the use of radiation. Another would be pioneering the use of PET/MRI instead of PET/CT scans in pediatrics. This strategic approach limits radiation exposure and eliminates the need for separate appointments — and because it provides more information to our experts in relatively the same amount of time, it enables a more accurate diagnosis and faster time to providing the right treatment options. Our team also participates in the Image Gently campaign, which seeks to reduce radiation exposure in pediatric imaging across the nation.
Q. How can these new technologies or strategies improve provider workflows and reduce stress?
Wilson: Any radiology innovation must be considered as supplemental to a diverse, multidisciplinary care team that accounts for the holistic well-being of patients. The high-acuity, critically ill patients we work with are children or young adults. They are growing and experiencing trauma during transformative years of their lives. There’s a lot more that goes into caring for them than simply treating an ailment or disease. So new imaging technologies and techniques capture images with increasing levels of detail, clarity, and speed. It gets the right people in the room earlier on in the process. This shares the load when it comes to caring for patients and puts experts in a position to maximize their impact.
Q. Is there a shortage of qualified technicians for this field? What steps might be taken to ensure the stability of the workforce?
Wilson: On the theme of health equity and how that impacts radiology, a lack of education also extends to the opportunities to work or build a career in radiology.
Radiology is quite unique in that so much of the profession is driven by technology--and how to then empower caregivers with information to better care for patients. I have spent a lot of time over the past few years explaining my journey to people and educating others to the modalities in radiology. Two reasons: First, there are non-traditional ways into radiology, and we need to be open to inviting all types of talent into our field. Second, the industry doesn’t do a good enough job of highlighting the computer science elements of our work. Behind the bench and bedside care that upholds radiology is an intricate and innovative layer of computing and imaging systems. Do you like technology? Then wonderful, there’s potential in radiology. You’re looking at a future in artificial intelligence, machine learning, or cloud computing systems? We offer that, too.
Q. How will radiology fit into the hospital of the future?
Wilson: Radiology will remain critical in the hospital of the future.
The earlier and more specifically imaging can identify potential illness or disease, the more opportunity that opens up to provide the right care. I believe it will fundamentally change how we care for patients across the healthcare continuum. For example, we are currently planning imaging around enamel to assess brain function at a younger age. This information can be used to better predicted disease before the child ages, leading to earlier treatment potential.
Radiology is also moving into care models that enable multidisciplinary approaches to healing. This includes not only the AI, ML, or advanced technology applications we’ve discussed earlier, but also broader conversations around systems, operations, and education. For multidisciplinary or holistic care strategies, we’ll see radiology play a critical function in care, accompanied by providers from other specialties or domains. Think mental health, physical health, emotional health, and more.
Q. What new technologies or strategies are on the horizon? How will this field evolve?
Wilson: I am glad that you mentioned strategy within this question. Often in pediatrics, strategy is just as important as research and technology innovation.
Here’s an example that shows how strategies are evolving to provide better care to patients. Years ago, we discovered that children who needed an MRI for orthopedic indications had a slow and cumbersome experience with the healthcare system. The child and parents would take a day off from school/work to see a specialist, who then requests an MRI. Then the families go home, wait for insurance pre-authorization, and then take another day off to come for the MRI.
So the radiology and imaging team worked together to innovate a new process that leverages our understanding of MRI physics and uses high-performance computing to enable the MRI to be done in under 10 minutes. That, coupled with a new process that waives insurance pre-authorization, allows immediate walk-in MRIs. Instead of care taking days or weeks, now we can take just a single visit to set a child on the path to recovery.
A HIMSS 2023 panel debated whether pharmacists could help beleaguered primary care doctors by taking on some non-acute care services.
Primary care providers are under a lot of stress these days. Pharmacists can help them.
That was the takeaway from an intriguing panel at last week's HIMSS 2023 conference and exhibition in Chicago. Hosted by Surescripts, the panelists maintained that pharmacists now have the technology and workflows at their disposal to support the PCP and improve the patient's healthcare journey.
"Pharmacies did step up" during the COVID-19 pandemic, noted Kevin Nicholson, vice president of policy, regulatory, and legal affairs for the National Association of Chain Drug Stores (NACDS), the Virginia-based advocate for traditional, supermarket-based and mass market pharmacies. "The proof is there that pharmacies can do it."
There were roughly 60,000 retail pharmacies in the US as of 2021, according to the Commonwealth Fund, roughly one-third of which are independent and rest located in retail chains, supermarkets, or mass retailers. Dominated by the likes of Walgreens, Rite-Aid, and CVS, the pharmacy has pushed its way into the spotlight as the neighborhood hub, offering not only prescriptions but health and beauty supplies, groceries, and other retail items.
Frank Harvey, CEO of Surescripts, the healthcare IT company that supports e-prescription and other health information exchange platforms, pointed out that many rural communities in the US have four or less PCPs per 1,500 residents, making primary care access at a distinct challenge. But most, if not all, have a pharmacy nearby.
And they have the technology to connect with care providers and access the patient record.
The idea, the panel said, is to have pharmacists take some of the duties traditionally reserved for PCPs, such as treatment for minor health concerns, thereby giving residents who can't easily access a doctor or who don’t want to go to the hospital or retail clinic an easy avenue to quick treatment. Most people, they said, would rather go to a pharmacy than a doctor's office or hospital for basic care services if they had the choice.
"We're not talking about complicated services," said Anita Patel, vice president of pharmacy services development for Walgreens. "We're talking low-acuity, very basic care."
The challenge? Pharmacists haven't traditionally been considered healthcare providers, and they're not recognized as providers in Medicare Part B plans. They weren't part of the meaningful use movement, and are often on the outside looking in when patient care is discussed.
The pandemic did prove that pharmacies could handle more care duties, and several states have since enacted legislation that allow pharmacists to be classified as providers, but federal officials haven't made that move.
Nicholson said NACDS has been working with states to redefine the pharmacist as a provider and has been talking to the Center for Medicare & Medicaid Innovation (CMMI) about developing a model program.
Eric Weidmann, chief medical officer for eMDs, a provider of ambulatory EHR and practice management software and revenue cycle management services, was hesitant to accept that change. He said pharmacists might be accepted as care providers in a team setting and for low-acuity health concerns, but there are too many exceptions to the rule that could affect the patient.
"It will be a rocky road," he said.
Weidmann also pointed out that pharmacies aren't as interoperable with other segments of the healthcare network as they can be, creating significant gaps in care. The challenges to integrating the pharmacy into the care network, he added, won’t be easy to overcome.
Patel said the pharmacy can be folded into a value-based care model, using infrastructure already in place for diagnostic testing and data-sharing. Nicholson pointed out that pharmacists were among the first to use technology, with e-prescribing platforms that in many cases pre-date the EHR.
Patel also noted that pharmacists don’t need to access the entire medical record to conduct basic care services.
"We don't need all of that data," she said. "How complicated are we going to make this? It's more like how simple can we make it."
And she emphasized that pharmacists wouldn't be competing with PCPs, but would help them. They could handle the low-acuity services, then send that data onto the PCP, reducing their workload and allowing them to focus more on care management. That, in turn, would benefit the patient.
"You actually have a care team for you," she said.
The health system has upgraded its clinical decision support technology to give care providers on-demand, FHIR-enabled access to important data at the point of care.
Intermountain Health has launched a new, FHIR-enabled tech platform aimed at giving its care providers instant access to clinical decision support (CDS) resources through digital health apps.
The platform highlights the Salt Lake City-based health system's efforts to create an interoperable platform that uses AI to give providers real-time information, including entering and pulling data from the EHR, events, and imaging and diagnostic services.
The EHR capabilities are important—and intriguing. By building on a Fast Healthcare Interoperability Resources (FHIR) framework and operating outside of any one EHR, users are able to securely read from and write into many different medical record platforms in real-time.
“This advanced approach to using data builds on the strong culture of innovation we foster at Intermountain Health," Craig Richardville, Intermountain's chief digital and information officer, said in a press release. "Patient care is often complex and very personal. This gives providers another tool to help them give patients the best, individualized care possible and helps ensure the right decision is being made at the right time."
“The platform has the capability to effectively perform and represent complex clinical processes and enables more rapid development of both clinical and business workflows," added Kathryn Kuttler, PhD, FAMIA, the health system's advanced decision support director. "This will help create a more seamless experience for patients."
The announcement touches on a number of themes at last week's Healthcare Information and Management Systems Society (HIMSS) annual conference and exhibition in Chicago: Interoperability, AI, and the development of healthcare services outside the hospital setting. With AI technology that sorts through and identifies relevant data to put at a provider's fingertips, the platform enables care teams at any location within the 33-hospital network to grab the information they need to support and improve patient care.
The health system is using this platform to support an updated version of its ePneumonia app, which was launched in 2011 and is now used in Intermountain Medical Center in Murray, Utah, to help emergency department personnel identify and treat patients dealing with pneumonia. Among other things, the app determines a patient's likelihood of having pneumonia and its severity and recommends appropriate clinical treatments, including whether the patient should be hospitalized.
“In the studies, we demonstrated a 36% relative decrease in 30-day mortality for pneumonia patients, which is more than 100 lives saved annually," Nathan Dean, MD, section chief of pulmonary and critical care medicine at Intermountain Medical Center and principal investigator of the studies, said in the press release. "We observed [a] 17% increase in outpatient disposition from the emergency department and increased the use of antibiotic best practices."
“This ePneumonia app is one of the most complicated apps to build, as there are more than 50 data elements that go into diagnosis, assessment of illness severity, and decision making for patients with pneumonia,” he added. “Published pneumonia care guidelines have been historically difficult to follow at the bedside and have a complex workflow.”
Officials say they'll soon expand use of this app to other EDs within the health system, and they'll be launching other apps with these capabilities as well.
With HIMSS23 in the rear-view mirror, we look back and the challenges, solutions, and strategies that brought healthcare leaders to the Windy City.
HIMSS 2023 packed a punch this week in its hometown of Chicago, with large crowds, a busy agenda, and an exhibit hall that sought to take on the many challenges facing the healthcare industry. But the question remains: Are healthcare leaders ready to embrace change and, in effect, transform a struggling industry?
"Everyone is wondering what the next generation of healthcare is going to look like," said Yan Chow, MD, MBA, a former Kaiser Permanente executive who now serves as a global industry leader for Automation Anywhere, which develops intelligent automation software. "Are we ready to take that step?"
An Eye on Automation
Chow's company is part of an automation and AI wave that permeated almost every nook and cranny of McCormick Place, reflecting a desire by the industry to embrace technologies and strategies designed to make workflows easier and boost efficiency and outcomes. There were plenty of stories about health systems using AI to improve back-end business services or sort through available data to pull out the right information for the right task, either business or clinical.
Many see automation as a tool to addressing healthcare workforce shortages, clearly one of the biggest challenges facing the industry. With burnout and stress at record levels and clinicians, IT specialists, and other support staff retiring or quitting, health systems are looking to improve workflows to reduce stress and create virtual and hybrid care platforms that give employees more leeway (and, hopefully, satisfaction with their job). Key to that is automating repetitive tasks and processes that focus on data entry and analysis.
"What [clinicians] would like to do is practice medicine," noted Paul Brient, chief product officer at athenahealth. "What they don’t want to do is all that other crap."
Chow said C-level executives are now getting involved in the decision-making process because they see the value of innovation and technology, and they're mapping out enterprise-wide strategies. That was seen at ViVE as well, which attracted an impressive number of CIOs, CTOs, and even some CEOs.
The upshot: They're thinking of organizational change, not incremental steps forward.
"I can't bring in point solutions any more—I need platforms," said Eve Cunningham, MD, MBA, a vice president and chief of virtual care and digital health at Providence Health, who was there to scrutinize digital health products and unveil the health system's new Hospital at Home program.
Cunningham's thoughts are also reflective of a change in the healthcare innovation space, seen at HIMSS, ViVE, and other events. An industry that once focused on brand-new technology and tools is now more interested in how they're being used, and especially how they're showing value. Telehealth, of and by itself, isn't an innovation any more, but how it's used in different situations and how it's showing ROI are the attention-getters.
Cunningham noted Providence has a telestroke platform that allows two neurologists to cover more than 90 hospitals within the network, and a telemental health program that can treat patients in more than 40 hospitals from one clinic. That's what healthcare leaders want to see and talk about.
"There are a lot of health systems that have innovation fatigue," she said. Events like HIMSS, she added, allow health system leaders to "get the lay of the land and hear from thought leaders" on how to make their technologies work.
"It's all about evidence now," she said.
ChatGPT: The Shiny New Object
That doesn't mean HIMSS was devoid of shiny new ideas. One of the shiniest, of course, is ChatGPT.
"The reason ChatGPT became so big is that they gave wide access to it," Chow said of OpenAI's chatbot, one of the industry's fastest-growing tools and the focus of the HIMSS opening keynote. Both Epic and Microsoft have quickly embraced the technology, aiming to integrate it within the EHR platform.
Chow said a number of academic medical centers have approached him with requests to help develop an AI strategy that includes ChatGPT.
Sophy Lu, senior vice president and chief information officer at Northwell Health, said ChatGPT is certainly intriguing, with a variety of use cases that will be good for healthcare, but at the moment the hype is overshadowing the practicality. Health systems and vendors are jumping on the bandwagon without taking the time to wait for the technology to become more mature.
From Disruption to Transformation
ChatGPT might be considered disruptive because it's prompting healthcare executives to change how they look at healthcare delivery, but many are starting to think that "disruption" might be the wrong way to describe the forces of change within healthcare these days. Noted digital health influencer and radio host Gil Bashe said the attitude in Chicago was one of transformation, even enthusiasm.
"Just as the world is rebooting as the COVID cloud perceptually passes, HIMSS23 shows that the health IT community has returned with a passion for learning what’s just around the corner and a practical mindset for maximizing investments in infrastructure to improve care and reduce cost," he wrote in a recent analysis of the event.
Indeed, while the post-COVID economy edges toward a recession and healthcare organizations struggle to stay afloat, McCormick Place was busy. The two exhibit halls were crowded, the booths larger and more festive than last year's muted affair in Orlando, and the keynotes and sessions spread out across the sprawling complex were well-attended.
And HIMSS, facing spirited competition from the likes of HLTH and ViVE, was ready to put on a show, adding exhibit hall social events with drink carts, a puppy pavilion (now seemingly a standard at all events), and a 'Taste of HIMSS' food court.
"You come to HIMSS because it is HIMSS," athenahealth's Brient pointed out. "It really is a connecting event for us."
Making a Pitch For Partnership
Even the so-called disruptors were there, and looking to prove that the healthcare industry should be focused on collaboration rather than competition.
"We know they're getting pressure from new [participants in the healthcare space]," said Chris McGhee, co-founder and CEO of Current Health, the home-based care services platform acquired by Best Buy in 2021. "We give them a way to consumerize healthcare."
Best Buy made waves earlier this year when it announced a partnership with Atrium Health to support the North Carolina-based health system's Hospital at Home program. Hospital and Home and remote patient monitoring platforms are two of the fastest growing services in the industry, and they represent and effort by healthcare to expand the care platform away from the hospital, clinic, and doctor's office and into the patient's home.
“This is the coming together of technology and empathy,” Rasu Shrestha, executive vice president and chief innovation and commercialization officer for Advocate Health, part of Atrium Health, said in a press release announcing the partnership. “We're able to leverage the power of social workers, paramedics, nurses and physicians, but also technology to take care of the patients in their homes. We can bring forward things like remote patient monitoring and sophisticated wearable devices that capture their vital signs and combine it with the human touch – bringing it directly into our patients’ homes."
Hospital at Home and RPM were part of the playbook at HIMSS as well, and McGhee was on hand to explain how health systems should be pairing up with the retail industry to give both providers and patients access to the tools they need to enhance those pathways.
"We're fundamentally changing healthcare," he said, noting the Best Buy can pick and choose the technology needed to make the best and most reliable connections between a patient in the homes and his or her care team at a hospital. "Hospitals value that curation."
Indeed, with companies like Amazon, Google, Walmart, and Salesforce entering the space, the talk at HIMSS was not about how to counter those retail giants, but how to work with them.
Salesforce, which moved into the healthcare space roughly eight years ago with data products based in the cloud, is also trying to get hospitals interested in consumerism. The company's lavish, shrubbery-filled booth offered an attractive, oasis-like invitation to customer relationship management (CRM), from which it unveiled its new Customer 360 for Health platform.
"We're offering an engagement and relationship layer that healthcare definitely needs," said Amit Khanna, the company's senior vice president and general manager of health and life sciences. "Healthcare needs those relationship tools."
Khanna said healthcare organizations have been slow to embrace consumer-facing care, and they're facing a backlash from consumers and patients who have seen the retail, banking, travel, and entertainment industries meet their needs and want health systems to do the same.
"You can book an appointment with your banker easily, but you can't make an appointment to see a doctor," he pointed out.
All In For Interoperability?
Aside from the new ideas and entries in healthcare, HIMSS also highlighted a long-standing challenge in healthcare: Interoperability. Data sharing and interoperability are crucial to the expansion of value-based care. Intriguing examples were featured in the Interoperability Showcase, in various sessions and in booths across the exhibit halls, where attendees talked of sharing data from various sources, structured and unstructured, inside and outside the hospital walls, to create a complete patient record.
"We are at such an exciting time in the data interoperability journey," noted Steven Lane, MD, MPH, chief medical officer for Health Gorilla, one of six organizations recently selected by the US Health and Human Services Department to begin implementing the Trusted Exchange Framework and Common Agreement (TEFCA) standards, the first step toward becoming a designated Qualified Health Information Network (QHIN).
Lane said the TEFCA standards, QHIN announcement, recent information blocking rules, and expended revisions to the Health Insurance Portability and Accountability (HIPAA) guidelines to account for digital health technology have all been positive steps in the move toward a nationwide healthcare information exchange.
"It's getting a lot of people thinking about interoperability," he said. "And we need to be thinking about and talking about … expanding the participants. One of the challenges going forward will be how we actually put all the data to work."
"Data usability is certainly a key," added Rita Bowen, vice president of privacy, compliance and health information management policy for MRO, a clinical data exchange company, and a member of the board of director for the Sequoia Project, which was designated the TEFCA Recognized Coordinating Entity. "We think the industry is getting ready. The technology is certainly ready."
Lane admitted that interoperability isn't as sexy as ChatGPT or the Hospital at Home movement, so it might be overlooked in the HIMSS headlines and roundups, but it's a foundation to healthcare. Digital health and telehealth programs rely on the exchange of data between different platforms, and the ongoing national effort to address health equity and the social determinants of health (SDOH) will rely on the ability to pull information from a wide range of sources into the clinical record.
"Getting the data and actually working it into workflows is what matters," he said.
So as thousands of HIMSS attendees flood into O'Hare and Midway and make their way home at the end of the week, will strategies like RPM, patient engagement and activation, prior authorization, AI and automation, and digital health take hold? Will these strategies help healthcare organizations to bolster the workforce, reduce burnout and stress, boost clinical outcomes and keep the lights on in hospitals across the country?
If the attendance and activity at HIMSS—and at HLTH and ViVE prior—are any indication, the healthcare industry is shaking itself free of the COVID doldrums and looking to move forward. They're talked the talk and seen the options. It's time to walk the walk.
As the Healthcare Information and Management Systems Society's annual conference and exhibition opens in Chicago this week, attendees are looking for ideas and programs that have proven their value in addressing care gaps.
As HIMSS 2023 kicks off this week in Chicago, the topics of conversation are familiar to healthcare executives: Workforce shortages, using AI to automate back-end functions and improve workflows, and the growth of remote patient monitoring.
The annual conference and exhibition hosted by the Healthcare Information and Management Systems Society is the largest of its kind, though the pandemic and strategically placed competing events have had some effect on attendance. But the activity taking place in and around McCormick Plaza this week will still pack a punch.
Healthcare organizations know where their pain points are. They've listened to ideas around the redefining of healthcare at HLTH, caught a glimpse of some cool new toys at CES, learned about the expansion of telehealth at ATA, and seen how innovation and technology can be applied to those pain points at ViVE. Now, they want to see those ideas validated.
In the exhibit hall and in sessions over the next few days, the focus will be on how health systems have addressed stress and burnout in the workforce, how they've improved the prior authorization pathway, how they're using AI to smooth workflows, and how they're launching RPM or Hospital at Home programs to care for patients at home. Many press releases or announcements this week will likely focus on strategic partnerships to embed AI in administrative or care pathways, and new functions in products or platforms that reduce the burden on the provider and the patient.
All of these strategies are vital to a healthcare industry that's struggling to stay afloat and ahead of new competitors.
"Listen, respect, engage," Aaron Miri, senior vice president and chief digital and information officer at Jacksonville-based Baptist Health said during a pre-HIMSS presentation, noting that far more than half of their patients are expecting the same experience in healthcare that they're now getting at Amazon, Domino's and Dunkin. "If you do that, your patients will appreciate it."
Keynote speakers at HIMSS reflect the changing landscape of healthcare. They include executives from Amazon, Best Buy, VillageMD, and Microsoft, alongside HealthPartners CEO Andrea Walsh and Mayo Clinic CIO Christopher Ross.
The key to pushing value-based forward, these executives say, is to make the process more intuitive, and help both consumer/patient and provider/care team make the journey easier. Brad Reimer, CIO of the Sanford Health network, noted during a presentation that the most progressive virtual care and RPM programs won't work unless patients want them to work. And Shannon Crotwell, a clinical nurse navigator for Atrium Health, pointed out that health systems have to design programs that fit their patients, rather than trying to shoehorn a patient into an existing model.
In many cases, the conversations at HIMSS were started at HLTH, or ATA, or most likely at ViVE. They carry over to Chicago as more organizations get involved and new ideas are tested out. The strategies that work will have the data to support adoption—a key factor at a time when ROI is at the top of the list.
