The Oakland-based payer with about 4.8 million members has announced a partnership with Microsoft to build an integrated data hub, called the Blue Shield Experience Cube, on Microsoft's Azure cloud platform. Officials say the hub will enable payers, providers, and other parties to access usable data more quickly and efficiently to streamline and improve care management for members.
“Our goal is to create high-tech, high-touch experiences for our members that are holistic and personalized by removing longstanding silos and bringing together data in the cloud,” Lisa Davis, BSC's executive vice president and chief information officer, said in a press release. “Microsoft’s cloud technology can help Blue Shield better coordinate with providers to open up greater access to care and services for our members. When data is available in near real-time, it enables shared decision-making among members and providers to improve health outcomes and reduce the cost of care.”
The news follows an announcement in May of a collaboration between BSC and Google Cloud to pilot an AI program aimed at expediting the prior authorization process.
“We want to help ease the administrative burden on our healthcare providers so they have more time to deliver the best care possible," Davis said at that time "Leveraging Google Cloud technologies and artificial intelligence, we are working to ensure our members get timely access to clinically necessary care and services."
With Microsoft, BCS is now turning its attention to improving the care journey for its members. The first project to be launched through the Blue Shield Experience Cub will be the development of an integrated digital health record, which will include a member's health information, medications, labs, ER visits, healthcare utilization, plan coverage, and other data.
"The information brought together by the Experience Cube will facilitate more data-driven care coordination to recommend actions that help members through transitions of care or prompt Blue Shield care managers to create programs that connect members to resources that address social determinants of health," officials said in the press release.
BCS has already moved some of its services into Azure, reportedly enabling the health plan to process billions of transactions in weeks instead of months. Future plans include expanding the capabilities of the Experience Cube to integrate more data, including costs of healthcare services, and incorporate AI tools.
Mainstay Life Services, which offers support for people with intellectual and/or developmental disabilities in Pennsylvania, reduced ER and urgent care clinic visits and improved clinical outcomes through virtual care.
A Pennsylvania-based support provider serving people with intellectual and/or developmental disabilities (I/DD) has reportedly saved almost $100,000 in emergency care costs over the past two years through telehealth.
Pittsburgh-based Mainstay Life Services, which currently supports roughly 400 people and their families across 42 sites, has partnered with New Jersey-based StationMD, which offers specialized telehealth services for people with I/DD in 21 states. Through that collaboration, StationMD has facilitated 245 telehealth visits over that two-year span.
According to a press release issued by StationMD, 92% of those visits were resolved without need of a medical transport, and 27% of those visits (67 visits) would have resulted in transport to an ER or urgent care clinic had telehealth not been available. This resulted in a savings of $98,758 in reduced hospital and emergency care costs.
“People with I/DD often have complex medical issues in addition to their underlying disability diagnosis," Maulik Trivedi, MD, FACEP, co-founder and chief strategy officer for StationMD, said in the press release. "Our clinicians are able to address and resolve over 90% of the medical concerns via our telehealth solution. We’re providing a backbone of care and serving as a critical medical resource 24/7 for individuals, families, and support staff.”
The savings point to the value of virtual care for a specific population that faces extra challenges in accessing healthcare. Whether living at home or in a structured setting, people with I/DD often need specialized care and aren't able to easily visit a doctor's office or clinic.
"Research shows that organizations have increased their use of telehealth technologies to better serve individuals with I/DD," the brief states. "Some reported benefits of telemedicine for people with I/DD include lower cost of care, lower transportation costs, improved medication reconciliation communication, and less exposure to communicable diseases especially during the [COVID-19 Public Health Emergency]. By assessing the impact of telehealth on individuals with I/DD, healthcare providers can continue to adapt and innovate ways to better serve people with I/DD through the use of various telehealth modalities."
According to a separate RIC brief, a 12-month pilot partnership in 2018 between StationMD and New York's Partners Health Plan resulted in 679 telehealth visits, of which 90% were resolved without need for further medical care. That, in turn, saved Partners $2.2 million in ED and hospitalization costs, $20,800 in transportation costs and $1,900 per member in medical costs.
Mainstay, which has increased its use of telehealth services by 288% since January 2022, plans on expanding its relationship with StationMD. They also plan to talk about the partnership at the 2023 Rehabilitation & Community Providers Association (RCPA) conference this October in Hershey, Pennsylvania.
“StationMD has helped the people we support to connect immediately from the comfort of home with doctors who understand them best," Kim Sonafelt, Mainstay's chief executive officer, said in the press release. "We’re seeing better health outcomes. Their team is happier, and the cost-savings allow us to offer better services.”
The hospital has created a high-tech command center to monitor patient progress through the hospital and address any pain points and potential care concerns.
As healthcare organizations across the country embrace telemedicine and digital health platforms within the hospital, they're creating high-tech command centers to manage all those new connections and capabilities.
One of the latest is Children's Mercy Kansas City, which partnered with GE HealthCare to craft a NASA-inspired Patient Progression Hub, a 6,000-foot "mission control center" that allows care providers to track a wide range of services, from patient care and supply chain to weather and traffic beyond the hospital's walls.
"It gives us a complete look at the patient as well as the surrounding community," says Stephanie Meyer, the health system's senior vice president and chief nursing officer. "We're looking at the entire patient flow instead of just a piece of it."
The hub brings together many of the new technologies that comprise healthcare innovation strategy these days, including remote monitoring, audio-visual telemedicine, predictive analytics and AI, and technologies built into the EMR platform that allow administrators to monitor a patient's progress through the hospital from admission to discharge.
The strategy is an expansion of the central nurse's station on a patient floor, where nurses could keep an eye on many patient rooms through connected devices and audio-visual telemedicine feeds. That idea gained value during the pandemic, when health systems looked to monitor contagious patients without sending nurses or other staff into each room.
Today's command centers are much larger, monitoring more than one wing, even entire hospitals. Some are located in large rooms built for that purpose, while other health systems are carving out empty space left over from previous expansions or even in nearby office buildings or warehouses. The development of wireless monitors, expanded connectivity, and more sophisticated telemedicine platforms gives health systems more opportunities to gather data and track patients and staff from a distance.
Meyer and Jennifer Watts, MD, an emergency medicine physician and Children's Mercy Kansas City's chief patient progression medical officer, says the hub took several years to design and build and involved input from many different departments and people, from IT staff to nurses.
While some parts of the hub were tested out over the past half-year, the hub officially opened in April. And it comes at a perfect time, as healthcare leaders look to virtual care technology to reduce stress and burnout among staff and create more engaging workflows.
"For a long time people were just fixated on what was right in front of their faces," Watts says of the hard times caused in no small part by the pandemic. "We wanted to get all of our [employees and staff] to look up and see things from an enterprise level. The processes we could make easier, the workflows we could affect. We wanted to make things meaningful again."
The hub features a video wall containing customized apps, or tiles, to monitor the flow of patients through the health system. Those working in the hub can drill down and follow specific patients, look at staff schedules and scheduled services like labs and tests, even manage open beds and identify bottlenecks. Data analytics and AI tools on the back end track not only current activity but plan out future tasks, identifying surges and problems before they affect staff or patient care.
"Prior to implementation, the organization relied on manual processes and often retrospective data to understand patient census and anticipate discharges," Jodi Coombs, MBA, BSN, RN, Children's Mercy's executive vice president and chief operating officer, said in an April press release announcing the hub's opening. "Now we have visibility into operations across the entire system to make faster and smarter complex decisions as soon as vital workflows change. The Patient Progression Hub journey enables endless possibilities for using real-time data to drive actions that deliver excellent patient care and supports our team members."
Watts and Meyer say the NASA-inspired command center can be intimidating at first because of the high-tech look and feel, and that caused some trepidation among nurses and staff members who would be working there. Many of those people were brought into the planning stages early on to add input on how the technology and layout could be designed to be less intimidating.
"This is a very complex, multi-faceted technology," Meyer says. "It involved a lot of buy-in and training on how to interact with everything."
The benefits, meanwhile, are numerous—and discovered on an almost daily basis. Patient care is coordinated and streamlined right up through an expedited and more efficient discharge process, which reduces stress for staff as well as patients and their families. If a patient is showing signs of distress or his or her data is trending in the wrong direction, a nurse in the hub can identify that concern and take action before it becomes an emergency. Even external issues like dangerous storms, accidents, and traffic jams are monitored so that the hospital can prepare for new patients.
"We're looking at the future of pediatric care," says Meyer. "And it gives [staff and employees] a renewed hope in the future of healthcare."
Meyer says Children's Mercy Kansas City will add new technologies and capabilities in time, including more AI and predictive analytics tools, remote patient monitoring programs that extend from the hospital to the home, and wearables and other digital health tools.
We're going to do things that we haven't even thought of yet," says Watts. "We're just starting on this journey."
The Virginia hospital will use an analytics platform integrated with its EHR to track patient feeding metrics, identify pain points, and offer best practices to improve staff workflows and clinical outcomes.
A children's hospital in Virginia is integrating digital health technology into its neonatal intensive care unit to improve care management for preterm babies and infants with acute medical conditions.
The partnership between Roanoke-based Carilion Children's Hospital and Astarte Medical will enable NICU staff to access the latter's NICUtrition platform, which analyzes patient feeding practices and outcomes to identify feeding protocol effectiveness, patient risk factors, and best practices that can positively impact patient outcomes.
The technology, which will be integrated with the hospital Epic electronic health record platform, is critical to a 60-bed hospital that typically operates at or close to capacity.
NICUtrition "is able to reflect both longitudinal and real-time patient feeding and growth metrics that help our care teams make evidence-based decisions," Dena Goldberg, PhD, RDN, a clinical dietitian and neonatal specialist at Carilion Children's Hospital, said in an e-mail to HealthLeaders. "Because the platform streamlines data-gathering, we no longer have to collect nutrition and growth outcome data by hand and then use statistical software to analyze it. It's not replacing any jobs but augmenting our teams and reducing the burden placed on resources."
The fast-paced, stressful environment of an NICU often puts high demands on staff who are monitoring frail babies and tracking key vital signs and metrics every hour, if not more often. Digital health tools that can accessed through the EHR can help with that data gathering and analysis, offering crucial clinical decision support when and where needed.
Goldberg said the technology will be evaluated over the next 3-6 months to see how it affects daily workflows as well as clinical outcomes. That research may be used to help expand the platform to other areas of pediatric care, including cardiac care and cerebral palsy.
A survey of more than 200 healthcare executives by IDC and Redox finds that despite the tough economy, health systems will be spending more on technology like AI and RPM to address workforce issues and improve clinical care pathways.
The push to stay on top of the digital health landscape is prompting healthcare organizations to increase their technology investment in the coming year. And they're very interested in automation and remote patient monitoring solutions.
That's the takeaway from a new survey from Redox and global tech advisory firm IDC, which analyzed the insights of some 205 IT executives at US-based health systems. Of that sampling, 88% said they plan to increase their third-party technological investments in 2023-24.
While the results of the survey might be surprising considering many health systems are struggling to stay in the black during an uncertain economy, the emphasis on technology investment isn't. Recent events like the American Telemedicine Association conference, HLTH, HIMSS, and ViVE have all been dominated by discussions on using technology to improve back-end processes and clinical care pathways and address workforce shortages, stress and burnout.
According to the survey, more than half of healthcare IT executives see digital transformation as the most important goal for their organization, with 35% citing cost reduction and 31% picking either improving quality of care or improving patient safety as critical goals. Another 30% selected using data as a strategic asset.
Those priorities are intersecting with two trends in healthcare: The development of AI and the shift of services from the hospital to the home.
According to the survey, almost 70% of healthcare executives see telemedicine and other virtual care solutions as playing a key role in addressing staff shortages, still the biggest pain point facing health systems. More than 60% say RPM programs will be critical, and just over 40% see increased value in automated appointment scheduling tools.
Additionally, 43% said they have RPM programs in place now or are making additional investments, and 55% said their using the platform to manage patients with chronic conditions or to trigger real-time clinical interventions, while 45% plan to use RPM to enable earlier discharge of high-risk or frail patients. Some 77% of those surveyed said they'll have between five and 20 RPM programs by 2024, and amny said they'll be expanding to cover behavioral health treatment as well.
Just as important, if not more so, is the use of automation to gather and analyze healthcare data coming into the enterprise. Almost 50% of those surveyed say automation will be a key benefit when deploying new technology, while 43% cite reduced costs, 40% cite data reliability, and 39% list data availability. Another 31% point to organizational agility as a top benefit, hinting at the growing issue of competition in the healthcare space.
On the flip side, integration and interoperability are still key challenges in getting all that new technology to work. Some 40% of healthcare executives surveyed cited integration and middleware as their biggest IT headaches, coming just ahead of privacy, security, and data protection.
“Delivering health data that’s complete, accurate, and standardized at the point of care makes it possible for providers to offer the personalized care that consumers want,” Redox CEO Luke Bonney said in an accompanying press release. “But before that can happen, the data must be usable; clinicians, as users, must be able to customize their data experience, accessing only the data they want, when and where they need it.”
As far as multimodal strategies go, roughly half of those surveyed see mobile applications as the most beneficial digital patient engagement platform, while a third also call it the most challenging to use and deploy.
Finally, healthcare leaders say in-person trade events, which have been on the rebound since the end of the pandemic, are their most influential source of information on new technologies. Some 30% selected events, while 27% picked peer review sites, and 26% selected either interactions with sales executives or vendor advertising.
PCORI has announced $208 million in funding awards for 17 clinical effectiveness research (CER) studies, as well as a separate, $2 million award for a project that aims to improve access to mental healthcare services for people undergoing dialysis.
The awards are part of a continuing program to apply new technologies and strategies to many of healthcare's common problems, such as chronic care management, palliative care, senior services and care for people living with rare diseases.
“These awards present significant opportunities to address urgent health challenges and empower patients and their families with actionable information about their health care choices,” PCORI Executive Director Nakela L. Cook, MD, MPH, said in a press release. “Facing a complex healthcare system and many care options, patients, caregivers, clinicians, and other health decision makers need reliable information to help them understand which care options will best meet individual patient needs and circumstances. PCORI-supported evidence will improve healthcare and outcomes for people across the nation.”
Included in the list of projects are three that use telehealth to improve care management for people living with multiple chronic conditions in primary care settings, with a focus specifically on COPD and sleep apnea, obesity and asthma in children, and care for medically fragile children.
Four large studies receiving PCORI funds will compare:
The treatment of coronary artery disease with either open-heart surgery or less invasive stent placement, with a focus on women and underserved populations.
Palliative care delivery for seriously Ill hospitalized patients by specialists against the same care delivered by trained general care practitioners.
Various medications as second-line treatment for the 25 percent of children with a severe form of juvenile idiopathic arthritis who do not get better taking a first-line biologic drug.
The impacts of annual wellness visits for older adults with complex healthcare needs against a program that adds integrated care involving interprofessional teams and at-home visits.
The $2 million award targets a project that will compare two treatments proven effective in a previous PCORI-funded project, medication and a cognitive behavioral therapy program delivered via telehealth, in dozens of dialysis units across several states.
“PCORI’s stewardship of patient-centered comparative clinical effectiveness research extends to ensuring useful findings can have a salutary impact in everyday clinical care, which is why we fund projects that encourage uptake of results,” Harv Feldman, MD, MSCE, PCORI’s deputy executive director for patient-centered research programs, said in the press release. “As a result of PCORI’s latest implementation funding awards, clinicians and patients confronting decisions about mental health while undergoing dialysis may experience better care and outcomes.”
A teledermatology clinic that was launched in a church is the model for a program aimed at creating new channels for underserved residents to access healthcare.
A DC-based health system has launched a grant program aimed at using telehealth to expand access to dermatology services in underserved neighborhoods.
The clinic offers access to care for treatment of inflammatory dermatoses, such as Atopic Dermatitis, which affects more than 30 million children and adults in the US.
“During the pandemic, the healthcare divide became even more apparent across many underserved areas,” Adam Friedman, MD, chair of dermatology and residency program director at the GW School of Medicine and Health Sciences, said in a press release. “However, as telemedicine enhanced access to dermatologic medical care for many, we also noticed that the divide itself was widened not just because there was a health desert, but now there’s also a technology desert.”
“Specific populations are at greatest risk for physical, emotional, and financial losses associated with inflammatory dermatoses," he added. "And it is well established that there are significant racial disparities in healthcare and disease burden. For example, those who identify as Black tend to have more Atopic Dermatitis [and] have more severe disease, but make up fewer of the appointments seen by a dermatologist for this condition. While finally receiving the attention it deserves, this disparity has been long-lived and pervasive in all areas of medicine.”
Friedman's program is one of many across the country aiming to address lack of access to healthcare by putting clinics and/or telehealth stations in areas where communities tend to gather, like churches, malls, pharmacies, salons, community centers, homeless clinics, and libraries.
"I appreciated that utilizing and partnering with a community lighthouse, so to speak, would engender a sense of trust and comfort for those potential patients in the area," Friedman said in an e-mail exchange with HealthLeaders. "Using a familiar location demystifies an unknown and unfamiliar program."
The grant program, offering grants of up to $250,000, aims to identify healthcare organizations that can take this model and expand to other underserved areas and communities. Applications are due by August 24, with programs expected to start by January 2024 and continue for as long as 18 months.
"First and foremost, I want applicants who are just as excited as I am to explore new ways and approaches to improving healthcare outcomes to those who need it most," Friedman told HealthLeaders. "I want to not only see how the applicant and their team will employ our telehealth help desk model within their community, but how they plan to sustain beyond the period of the grant. The funds can be used to support medical students interested in pursuing dermatology to dedicate, coordinate, and oversee the execution of the clinics; to compensate community partners for their time and investment in the project's success; [and] to purchase supplies and tools needed for a successful series of clinics and marketing/advertising to ensure a steady stream of patients."
The telehealth help desk, established in a church with more than 15,000 members, offers resources and education on how to access and use telehealth and specific dermatologic diseases like Atopic Dermatitis and Alopecia Areata, and can link a visit to a specialist for a free virtual visit. Patients are registered through GW's EHR platform and can be scheduled for follow-up visits.
“The number of dermatologists/dermatology clinics in this area of the district is disproportionately low to serve the health needs of this large population," Friedman said in the press release. "In fact, there is not a single dermatologist practicing in this area of DC. Though the reasons for underutilizing telemedicine can vary from patient to patient, we believe that improving access to technology and increasing awareness of teledermatology will lead to more patients using this type of healthcare to seek diagnosis and treatment before symptoms become too severe.”
Friedman told HealthLeaders the process of finding partners to establish clinics and good locations for those clinics isn't easy. Good programs need high traffic and visibility and a steady base of volunteers.
He hopes to expand this model not only to other locations, but to address other chronic conditions.
"This grant program, even the telehealth help desk we established and can now continue thanks to [support from organizations like (Pfizer and Lilly] is an amazing example of how academic and pharmaceutical partnerships can be meaningful [and] productive and achieve the shared goal of improving patients’ lives," he said. "I am very grateful we have the opportunity to take the learnings and experience from our free clinic and support those we fund to launch this model in other cities to ensure success."
The chief innovation and transformation officer at Israel's largest hospital talks about the ARC innovation model and efforts to forge international partnerships.
One of the world's most innovative healthcare organizations is Sheba Medical Center, located near Tel Aviv in Israel. In 2019, the hospital launched the ARC innovation model, and set its sights on guiding the evolution of healthcare across the globe. Earlier this year Sheba signed an agreement with Deloitte Consulting to facilitate adoption of the ARC model in other countries.
To explore the global implications of the ARC model, HealthLeaders sat down, virtually, with Eyal Zimlichman, MD, MSc (MHCM), chief transformation officer and chief innovation officer at Sheba Medical Center. Prior to joining Sheba, he was lead researcher at Boston-based Partners Healthcare, now part of Mass General Brigham, and conducted research for Brigham and Women's Hospital and the Harvard-affiliated Center for Patient Safety Research and Practice on using technology to improve quality and patient safety.
Q. What is the ARC innovation model and how does it benefit healthcare organizations?
Zimlichman: ARC is short for accelerate, redesign, and collaborate. The ARC innovation model allows healthcare institutions to accelerate transformation efforts to answer the many challenges that healthcare systems currently face while also turning healthcare innovation into an engine of economic growth.
Based on our experience at Sheba Medical Center, we were able to build a model that can really move the needle on both aspects simultaneously. The model was built in a way that is very structured, enabling it to be implemented successfully anywhere in the world not just specifically at Sheba. To our knowledge, it is the only model of its kind in the world.
Q. Several large health systems in the US have created their own innovation centers and programs. How does the ARC model differ from those programs?
Zimlichman: ARC is not really an innovation center; it's much broader because it has a global aim. ARC aims to transform healthcare around the world, and to do so by the year 2030. This goal requires a very specific strategy that will enable us to reach the global standard we've set for ourselves.
To achieve this goal, ARC has built a global ecosystem that now includes more than 140 members in almost 30 countries. These members are all working together to lead transformation efforts for themselves, but also drive this as a global effort. This is unique because other hospitals typically focus internally to create solutions to be deployed only in their institutions.
Our partners include leading medical centers such as Mayo Clinic, Mass General, and Cedars Sinai, in addition to many international industry partners, governments, academia, startups, and more.
Q. What are the challenges or barriers to healthcare innovation that ARC addresses?
Zimlichman: ARC is looking to address the most critical challenges facing healthcare.
One of these challenges, for example, is quality and patient safety. There are huge gaps in quality and patient safety around the world which we've not been able to address over the last 30 years.
Another challenge we're facing is the workforce shortage and burnout, which is a critical problem right now, especially post-pandemic. ARC is focused on finding solutions to address this by taking the load off clinical teams and creating solutions that can replace some tasks that today are carried out by humans.
A third challenge is the rising cost of healthcare. Healthcare costs are on the rise in every developed country around the world and they are reaching unsustainable levels. It requires innovation to be able to provide a high level of care at a lower cost.
Finally, how do we build a system that will be more focused on the patient's needs and expectations and have the patient play a critical role within the system? This is another barrier that current healthcare systems have not been able to bridge. ARC is working on solutions to try and solve that.
Q. How are new or emerging technologies integrated into the ARC model?
Zimlichman: To really see the vision for the future of health come alive and make these transformations a reality, technology needs to play a central role in disrupting how we're delivering healthcare today.
We need to focus on two avenues to create these technological solutions. One is organic innovation, and the other is open innovation.
Organic innovation is technologies we develop in-house, based on the needs that we realize in the market. We then find the right teams to create solutions that we can implement and take to market, to have large-scale implementations across multiple institutions.
However, organic innovation is never enough to create meaningful transformation. For that, you also need to have open innovation, which is the ability to look outside of your own walls. We find the best technology outside and bring it in, so that we can create impact for our patients.
This is a central component of ARC as well. We've built an open innovation platform that constantly allows us to find the right technology, prove that it works, and take it to large-scale implementation.
Q. Would you say that's like a venture arm within ARC? Is that a good way to describe it?
Zimlichman: There is also a venture arm within ARC. The funds work to recognize the right technology, give it the support needed to grow, and get to a point where it can impact many patients.
In 2019, we identified the need for capital within ARC and established our first fund, Triventures. This was followed by two more funds, including Shoni Health Ventures. They are critical as well to ensure we get great ideas and great technologies to scale up.
Q. How do you measure success in the program?
Zimlichman: There are several metrics that we use. Some specifically look at the impact on our patients. For example, clinical outcomes or cost reduction. For technology solutions, we generally measure how much we're able to improve efficiency as well as effectiveness. That's one angle.
The other angle, of course, is financial. Are we able to really drive the economy and make this a successful and sustainable commercial model? We measure how many companies are born out of ARC. How much money have they raised? What are their accumulated valuations? How much are they selling on the market? These are all metrics that we've been following since the launch of ARC three and a half years ago.
Q. Could you point to a specific pain point in the healthcare industry that the ARC model has already helped to address?
Zimlichman: One example is our focus on technologies specifically related to artificial intelligence, which allows us to help clinicians improve decision-making and efficiency. A company called AI Doc that started at Sheba and is now deployed in 1,200 hospitals around the world, and is transformative in the way that it helps radiologists in the emergency department read the scans in a much more efficient manner. That has led to an improvement in patient outcomes--reducing mortality rates, for example, but also creating a reduction in cost for the hospitals due to the increased efficiency of radiologists. This is an example of where we could help in terms of being more sustainable, both in terms of trying to reduce our dependency on the human factor and improving quality and patient safety.
Q. What are the biggest challenges that healthcare organizations face in adopting the ARC model?
Zimlichman: One significant aspect is the culture. It requires a culture of innovation, a culture of being open to change. That is not always existent from the get-go, but part of the ARC model is about improving the culture.
We firmly believe that culture can be transformed and become a culture that's more open to innovation and change. This is part of the model of implementing ARC. Of course, it's always a challenge, especially when you start, and there's a lot of reluctance to change from your own staff. That's challenge number one.
Challenge number two is funding. Innovation is costly in many ways, especially if you want to build something robust and big enough to have a long-lasting impact. There are many opportunities for funding, such as government support, competitive grant funding, or even philanthropy, that will allow academic medical centers to build this much-needed infrastructure. But it is a challenge. Finding the source of funding, as we all know, is a challenge.
Q. How will the Deloitte partnership help this program?
Zimlichman: After spending three years building the ARC model, we started implementing it in different sites around the world. We very quickly understood that this was not our business; we're not consultants, we're a hospital. In addition, we don't have the capacity to do this for more than three or four institutions a year.
As the demand for ARC increased around the world and we realized that we don't have the capacity to teach organizations how to build ARC, it was evident we needed to find a partner in the consulting space to help us scale up the ARC model. As a result of an RFP that was put out, with five consulting firms applying, Deloitte emerged as the winner. Now we're at a stage where we're putting together a joint product that Deloitte will take the lead in implementing around the world, with ARC's help to make sure it accurately encompasses what ARC is about.
We believe Deloitte is a critical partner to deliver a more professional product and enables us to scale up. Instead of doing just three or four implementations each year, we will be able to do 40 a year, which is our ultimate aim, to be able to scale up significantly.
Q. How do you see this program evolving?
Zimlichman: We see the ARC ecosystem growing, becoming stronger, and building better ways to collaborate. It's always a journey that we're on. ARC will have a substantial impact on what healthcare around the world will look like, accelerating transformation efforts through creating new solutions that will be able to answer the many challenges that we are facing.
Eventually we see ARC as a global force that will lead to two key outcomes that we're focused on. The first is improving the health of populations around the world through transformation. The second is driving the economy, within the local ecosystems, through investments, job creation, growth in businesses and so on.
Regarding our partnership with Deloitte, I personally am very excited about the possibilities. We found a great partner in Deloitte, with a very similar way of thinking.
We're confident that the Deloitte-ARC joint product will be the leading model around the world to drive transformations and growth in the healthcare sector and the economy. I would like to relay the dedication and excitement of the entire team on this new journey we're taking together with our partners.
The initiative, which has received support from close to a dozen healthcare organizations, is the latest in a string of programs aimed at supporting nationwide interoperability.
The Data Usability Taking Root Movement is designed to "make health data more useful" by encouraging organizations to follow guidance posted by the Sequoia Project Interoperability Matters Data Usability Workgroup.
“Over three years, more than 260 health organizations worked together through The Sequoia Project to develop practical guidance to make health data more useful for healthcare providers, health IT vendors, public health, health information exchanges, and patients,” Mariann Yeager, the Sequoia Project's CEO, said in a press release. “It’s time to put this guidance into action for the public good.”
“Implementers choose to work on areas that matter most to them,” added Didi Davis, the group's vice president of informatics, conformance, and interoperability. “For some, this could mean working on data provenance and traceability of change, data integrity and trust, or data tagging and searchability. For others, it could mean effective use of codes, reducing the impact of duplicates, effective use of narrative, or any combination they choose.”
Close to a dozen healthcare groups have pledged to support the initiative, including the HIMSS Electronic Health Record Association (EHRA), Epic, HCA, Health Gorilla, and Optum.
Several virtual events are planned this summer, leading up to a Data Usability Taking Root Summit on September 6 in Washington DC.
“Data usability is part of the DNA of the health information profession," AHIMA Chief Executive Officer Amy Mosser said in the press release. "We support this work not only because the public and private sectors together have made significant strides in health data interoperability, but because for over 96 years, AHIMA has been laser-focused on ensuring the completeness and usefulness of health data. Implementation of data usability guidance on a national scale will promote consistency across technologies that share data, at a time when more data are available and shared than ever before.”
The effort is the latest in a series of projects aimed at establishing a nationwide health information
Researchers have developed algorithms that can scrub EHR notes for references to specific social factors, giving providers the data they need to improve care management and treatment.
Researchers have developed natural language processing tools to pull data from clinical notes that will help address social drivers of health.
The technology aims to help healthcare providers address SDOH in care management and treatment plans for patients.
“Health and well-being are not just about medical care," Joshua Vest, PhD, a faculty member at both the Regenstrief Institute and Fairbanks School of Public Health and the study leader, said in a recent press release. "Mostly, they are about our behaviors, our environment, our social connections. More and more healthcare organizations are having to deal with social determinants because it is factors like financial resources, housing, and employment status that really drive costs that make people unhealthy. The challenge for healthcare organizations is effectively measuring and identifying patients with social risks so that they can intervene.”
Vest and his team developed three rule-based NLP algorithms and scanned notes from two different Indiana-based health systems, targeting keywords specific to three social factors.
"The demand from payers, policy-makers, and advocates for information on patients’ social factors and needs is substantial and multiple approaches are requested to obtain this information," they noted in their study. "In recent years, coding standards for recording social risks as structured data within EHRs using ICD-10 or LOINC codes have advanced substantially. Nevertheless, these structured data are very underutilized in practice."
The study noted that this technology would work best as part of an overall social health measurement strategy.
"It is important to not discard clinical text in favor of screening or other structured methods for data collection," the researchers noted. "However, social factors extracted via NLP could be utilized to impute missing survey results, augment survey data, or—given the ability to apply retrospectively—provide a longitudinal description of social factors. As products of a clinical encounter, these patient interactions and the information within clinical notes are important. However, it is also critical to remember that the text is, by nature, selective, filtered, and containing omissions (either left unrecorded by the provider or never volunteered by the patient). A comprehensive health measurement strategy will include formalized screening as well as information garnered from clinical documentation."
Vest said the study is one of the first to apply NLP tools to SDOH collection, and it points to the value of using a "relatively simplistic" tool to collect data from notes rather than more sophisticated AI tools that many health systems can't use or afford.
“We purposely designed a system that could run in the background, read all the notes and create tags or indicators that says this patient’s record contains data suggesting possible concern about a social indicator related to health," he said in the press release.
"Our overall goal is to measure social determinants well enough for researchers to develop risk models and for clinicians and healthcare systems to be able to use these factors—housing challenges, financial security and employment status—in routine practice to help individuals and to provide a better understanding of the overall characteristics and needs of their patient population.”
