The organization is issuing almost $590,000 to nine healthcare organizations who will study how EHRs can be used to reduce stress and burnout, improve workflows, and boost value-based care.
Nine healthcare organizations have been tagged by the American Medical Association to study how EHRs can be used better.
The organizations will receive grants from the AMA's Electronic Health Record Use Research Grant Program, which supports research into how EHRs can help "prevent clinician burnout and turnover, enhance high-quality patient care, and improve workflows, teamwork, and resource allocation at the practice level."
“The EHR Use Research Grant Program allows the AMA to work with researchers who are leading efforts to expand insight into EHR systems and measure the technologies’ capacity to support or undermine the delivery of efficient and effective clinical work,” AMA Vice President of Professional Satisfaction Christine Sinsky, MD, said in a press release.
More than $2 million has been doled out by the AMA since 2019 to support 26 studies aimed at giving the often-criticized EHR a better reputation and highlighting capabilities and advancements that have made the technology more beneficial.
That research is particularly important now, as healthcare organizations are struggling with high rates of burnout and stress and dwindling workforces and need their technology platforms to step up. Backed by the emergence of AI, health systems are hoping that EHRs can be used to not only improve workflows, but also reduce expenses and boost clinical outcomes.
“Burdensome EHR systems are a leading contributing factor in the physician burnout crisis and demand urgent action as outlined in the AMA’s Recovery Plan for America’s Physicians," Sinsky said in the press release. "The research supported by the AMA grant program builds the evidence base to help change EHR technology into an asset to medical care, and not a demoralizing burden.”
The organizations receiving funding from the $589,000 grant program are:
AllianceChicago, which plans to use EHR event log data to explore both the prevalence and the facilitators of relational continuity among patients, physicians, and care teams in primary care.
Brigham and Women’s Hospital, which will investigate factors that influence the amount of time spent using an EHR and the impact of inbox messages on EHR burden, all in a primary care setting.
MedStar, which will study primary care physician EHR inbox prioritization.
The Stanford University School of Medicine, which will use EHR event log data and other information to evaluate the frequency of text messaging in the inpatient setting and the relationships between team stability and inbox message frequency, as well as whether higher text message interruptions during order entry is associated with increased order entry errors.
The University of California San Francisco, which will study the impact of e-visit billing on clinician EHR inbox time, work on the EHR after patient scheduled hours and overall EHR burden.
The University of Colorado School of Medicine, which will investigate whether inpatient EHR-based audit log data can serve as a useful tool in identifying when work design and workloads are leading to physician burnout and patient harm.
The University of Wisconsin-Madison, which will use EHR event log data to study any links between team support for medication orders and physician time spent on order entry and time on inbox in primary care.
The Wake Forest University School of Medicine, which will analyze time spent in the EHR by primary care physicians during paid time off.
The Yale University School of Medicine, which will expand on previous research into physician retention, clinical productivity, and patterns of EHR use in the emergency department.
The 23-member task force will develop recommendations to make pharmacists a more integral part of healthcare and give them guidelines for prescribing and managing digital therapeutics and other services.
Federal officials have launched a task force aimed at making pharmacies a more integral part of healthcare.
The Pharmacy Interoperability and Emerging Therapeutics Task Force was unveiled by Tricia Lee Rolle, a senior advisor for the Health and Human Services Department's Office of the National Coordinator for Health IT (ONC), during a June 15 meeting of the ONC's Health Information Technology Advisor Committee (HITAC).
The 23-member task force is charged with developing new ideas to integrate pharmacies and pharmacy services with clinical care, including creating protocols to support the prescribing and management of new technologies and treatments, such as digital therapeutics, and direct-to-consumer (DTC) services.
The group's co-chairs are Hans Buitendijk of Oracle Health and Shelly Spiro of the Pharmacy Health Information Technology Collaborative. Some of the members were appointed by Congress, while others were selected by the Government Accountability Office and the HHS Secretary.
The task force has two short-term goals: To identify standards and data needs for pharmacists to participate in emergency use interventions, and to determine if there are actions that the ONC can take to enable data exchange to support public health emergency use cases.
Long-term goals consist of:
Recommending ways to integrate pharmacy systems and data for public health surveillance, reporting, and interventions;
Identifying opportunities to improve interoperability between pharmacies to promote pharmacy-based clinical services and care coordination;
Identifying standards to support the prescription and management of emerging therapies, such as digital therapeutics, specialty medications, and gene therapies; and
Identifying technology and policy requirements for DTC services.
The task force will have a November 9 deadline to return its recommendations.
The CONNECT For Health Act has been filed again in both the Senate and House, and supporters say the groundswell for expanded telehealth coverage and services could finally give the bill the momentum it needs for passage.
A bill that aims to improve and expand Medicare coverage for telehealth is back for a fifth time before Congress.
The CONNECT for Health Act of 2023, filed this week by US Senators Roger Wicker (R-Mississippi), Cindy Hyde-Smith (R-Mississippi), and Brian Schatz (D-Hawaii), continues a lengthy campaign by telehealth advocates to address the Centers for Medicare & Medicaid Services' restrictive rules around who can use telehealth and what services are reimbursable.
A companion bill has been introduced in the House by US Reps. Mike Thompson (D-California), Doris Matsui (D-California), David Schweikert (R-Arizona), and Bill Johnson (R-Ohio).
Eliminate geographic restrictions on telehealth use and expand the list of allowed "originating sites" to include the home and other sites;
Allow federally qualified health centers and rural health clinics to provide telehealth services;
Expand the list of eligible healthcare providers to use telehealth;
Eliminate the in-person visit requirement for telemental health services;
Allow for a waiver of telehealth restrictions during future public health emergencies; and
Mandate studies on how telehealth is used, how it impacts quality of care, and how it can be improved to support patients and providers.
The bill, first introduced in 2016, has a long list of supporters—some 60 senators are supporting this latest version—but has been unable to cross the finish line. Several provisions of previous versions of the CONNECT for Health Act were signed into law through separate bills or adopted by CMS, including actions to improve telemental health and telestroke care and integrate telehealth in home dialysis programs.
Supporters say the rapid and successful use of telehealth during the pandemic should give this bill a better chance of success.
“The pandemic showed us just how valuable telehealth is to ensuring folks receive care, but telehealth’s use goes far beyond navigating public health emergencies,” Hyde-Smith said in a press release announcing the bill's reintroduction this week. “Mississippians and Americans face many obstacles accessing healthcare, whether it’s living in rural areas, old age, or mobility issues. This legislation would be key to providing them with the quality, affordable care they need and deserve. It’s time to get this done.”
“While telehealth use has skyrocketed these last few years, our laws have not kept up," added Schatz, a well-known telehealth advocate. "Telehealth is helping people in every part of the country get the care they need, and it’s here to stay. Our comprehensive bill makes it easier for more people to see their doctors no matter where they live.”
Many of the flexibilities sought in this bill are in place through the end of 2024, thanks to an omnibus spending bill passed by Congress in December. Supporters say these provisions need to be made permanent to that healthcare organizations can map out long-term telehealth strategies and programs and consumers can access them without fear that they would be eliminated in a few years.
Among the many organizations supporting the bill is the American Telemedicine Association.
“Since originally introduced in 2016, the CONNECT for Health Act has envisioned a world where Medicare beneficiaries have access to virtual care services where and when they need them," Kyle Zebley, the ATA's senior vice president of public policy and executive director of ATA Action, said in a press release. "Today, our esteemed policy champions in Congress reintroduced an updated version of the CONNECT Act, including new and revised provisions that will help more people access telehealth services.”
“The pandemic showed us that we need to use technology to deliver care when and where it is needed," added Rene Quashie, vice president of digital health for the Consumer Technology Association, the driving force behind the annual CES show in Las Vegas, in an e-mail to HealthLeaders. "Extending telehealth access for Medicare beneficiaries will help bridge gaps in distance, accessibility, and availability of crucial health services in communities across the nation. The CONNECT for Health Act is a step in the right direction to modernize our health care system, and CTA is proud to endorse it.”
The recent AIMed Global Summit painted a positive picture for the technology in tackling healthcare's biggest pain points, but a scramble to govern and regulate AI could make things tricky.
While healthcare organizations are scrambling to understand how and where AI can best fit in, there's a mad rush to figure out policy and regulations as well.
During the recent AIMed Global Summit in San Diego, Alya Sulaiman, a partner in the McDermott Will & Emery law firm who focuses on digital health, described an active landscape in which federal agencies like the Health and Human Services Department's Office of the National Coordinator for Health Information Technology (ONC), the U.S. Food and Drug Administration and the Federal Trade Commission were competing with the likes of state attorneys general to regulate the technology.
The ONC, for instance, recently floated a proposal to create new transparency and risk management expectations for artificial intelligence and machine learning technology that aid in decision-making in healthcare, including any technology that integrates with EHRs.
"There's an increasing [number] of very specific health AI [bills]," she said, that would add regulations and chains of approval to any health system using the technology within a specific state's borders.
Sulaiman also noted that AI may soon be referenced in lawsuits in which a health system might be held liable if it doesn't use available AI technology.
"That's a real example that we're starting to see in [potential] litigation," she said. "AI is being interjected into the standard of care."
In this fast-moving landscape, the three-day conference offered an opportunity to highlight how the healthcare industry is approaching AI—sometimes called augmented intelligence, rather than artificial intelligence, to focus on the idea of technology assisting clinicians and other healthcare staff rather than replacing them or acting on their behalf.
The conference featured a number of keynotes and panel discussions on the challenges and benefits of using AI in healthcare, which is still very much in its infancy. It included a 'Shark Tank' styled main stage event in which several start-ups in search of investment funding pitched their business plans to a board of investors. The start-ups encompassed a wide range of AI-in-healthcare ideas, including wound care analytics, drug discovery trials, consumer-facing search engines, identifying and addressing a patient's risk of falling in a hospital, heart health, oxygen therapy, and identifying and addressing mental health issues in high school students.
David Higginson, executive vice president and chief innovation officer at Phoenix Children's Hospital and a participant in more than one panel at the event, said healthcare organizations are moving slowly but steadily forward with AI. They're launching small programs that address care gaps or "low-hanging fruit" to score easy wins, then scaling up and out to tackle bigger issues.
"It's good to know we're getting there," he said. "We have to take those chances."
At the same time, healthcare leaders need to be aware of the shifting policy and regulatory landscape.
On a state level, 23 attorneys general have submitted a letter to the National Telecommunications and Information Administration (NTIA), a part of the U.S. Department of Commerce, calling for transparency and accountability with AI technology. They also argued that AGs "should have concurrent enforcement authority in any Federal regulatory regime governing AI."
“AI is increasingly a part of our lives, influencing transactions and decisions big and small," California Attorney General Rob Bonta said in a June 14 press release announcing that he'd joined the coalition. "We need policies governing this technology that prioritize transparency, audits, and accountability, and that put consumer protection front and center.”
At the same time, the American Medical Association—whose president-elect, Jesse Ehrenfeld, MD, MPH, gave a keynote at the AIMed conference—addressed AI during its recent Annual Meeting. The organization's House of Delegates announced plans to "develop principles and recommendations on the benefits and unforeseen consequences of relying on AI-generated medical advice and content that may or may not be validated, accurate, or appropriate."
“AI holds the promise of transforming medicine," AMA Trustee Alexander Ding, MD, MS, MBA, a practicing physician and assistant professor at the University of Louisville School of Medicine, said in a press release issued by the AMA. "We don’t want to be chasing technology. Rather, as scientists, we want to use our expertise to structure guidelines, and guardrails to prevent unintended consequences, such as baking in bias and widening disparities, dissemination of incorrect medical advice, or spread of misinformation or disinformation.”
“We’re trying to look around the corner for our patients to understand the promise and limitations of AI," he added. "There is a lot of uncertainty about the direction and regulatory framework for this use of AI that has found its way into the day-to-day practice of medicine.”
The AMA also adopted a policy regarding the use of AI in one of the more controversial topics in healthcare: Prior authorizations. This follows a ProPublica report claiming that Cigna denied more than 300,000 claims over two months through a process that used AI, enabling doctors to spend an average of 1.2 seconds on a claim.
"The use of AI in prior authorization can be a positive step toward reducing the use of valuable practice resources to conduct these manual, time-consuming processes," AMA Board Member and Pennsylvania physician Marilyn Heine, MD, said in an AMA press release. "But AI is not a silver bullet. As health insurance companies increasingly rely on AI as a more economical way to conduct prior authorization reviews, the sheer volume of prior authorization requirements continues to be a massive burden for physicians and creates significant barriers to care for patients. The bottom line remains the same: we must reduce the number of things that are subject to prior authorization.”
Regardless of the challenges around regulation and policy, the mood at the AIMed conference was that healthcare stands in good position to benefit from the technology as long as researchers and providers move slowly and steadily and don’t rush forward expecting to solve all of healthcare's problems within a few months, or even years.
Healthcare is "a complex system," Robert Groves, MD, executive vice president and chief medical officer for Banner | Aetna, said in a keynote on the last day of the event. "There are just so many boxes to select, so many things to do … [but] complexity is the nature of advancement."
The key, said Groves and several others, is to understand that AI can help as long as it's used as a tool and not a replacement. At the end it's important, Groves said, to "value caring over curing."
In a Q&A, Joann Ferguson, the health system's VP of revenue cycle, explains how the technology saves time and money and improves revenue cycle and clinical processes.
Among the many uses for AI technology in the healthcare space is in medical coding, which affects both clinical and revenue cycle processes.
Detroit-based Henry Ford Health recently expanded its collaboration with CodaMetrix to include patient bedside visits, where abstraction takes an average of 40 minutes per patient and accounts for 20% of the health system's overall coding costs.
"Inpatient hospital stays due to serious medical conditions, injuries, surgical procedures, and medical emergencies such as strokes, heart attacks, broken bones and burns, routinely require bedside physician consultation," the health system said in a press release announcing the CodaMetrix deal. "Evaluations and management of patients at the bedside, by hospitalists and other specialists, as well as bedside procedures, need to be abstracted into medical codes for reimbursement. Depending on health systems’ policies, the coding function is usually performed by physicians, medical coders, or both. In scenarios where physicians are responsible for coding, not only is it an extra burden, but it increases the number of missed opportunities for accurate reimbursement."
To learn how AI can be integrated into the bedside procedures, HealthLeaders spoke virtually with Joann Ferguson, RN, BSN, MBA, CRCR, vice president of clinical revenue cycle at Henry Ford Health.
Q. How does Henry Ford use AI to improve the coding process?
Ferguson: As one of the nation’s premier academic and integrated health systems, Health Ford Health has more than 110,000 inpatient visits per year across five hospitals and 2,300 staffed beds. We hold ourselves to a high standard not just in our care, but operationally as well. We’re always looking for the best ways to support our teams, from our doctors and nurses to our coding and billing departments in their everyday workflows.
Joann Ferguson, RN, BSN, MBA, CRCR, vice president of revenue cycle, Henry Ford Health. Photo courtesy Henry Ford Health.
We began exploring new technological options across our revenue cycle operations because we were dealing with many of the same issues that are putting pressure on healthcare providers and employers across the country, including attrition via retirement and difficulty filling open positions. We needed to improve efficiency in our workflows, resulting in lower costs, reduced backlogs, and enhance patient and provider experiences.
After an extensive review of our internal work streams and technologies we decided to pursue implementing an AI coding solution for our bedside professional services. With more than 700,000 inpatient bedside services performed each year, it’s one of our highest volume specialties. We needed an alternative solution to keep up with rising volumes and to reduce backlogs.
AI improves our bedside medical coding process in several ways. First, it automatically codes the simplest procedures, taking that work off our coders’ plates. By 'simplest,' we mean the procedure notes that match closely or exactly with how the ICD codes themselves are written. It does this by bringing together all the complex information required to identify, understand, and code a bedside professional charge. It then predicts and assigns charges and diagnosis codes, automating cases directly to billing.
For bedside procedures where the AI platform does not reach our confidence level threshold, AI gives our coders an optimized view of the information required to code a case and pre-populates code suggestions for non-automated cases. The coder can then validate and edit from a selection of probable codes rather than start from scratch.
Additionally, before a coder releases the case for further processing, the case is checked against standard edits. This means the original coder resolves the edits rather than them being sent along to a standalone edit team, streamlining the process.
Q. How did the health system approach this process prior to using AI?
Ferguson: We had built a custom access database, which we used to aggregate coding information and look for charge gaps. Unfortunately, it was cumbersome to use and almost impossible to scale and maintain.
Q. What are the benefits to using AI in coding? What specific improvements are you seeing?
Ferguson: Inpatient bedside visit coding accounts for 20% of our overall coding costs. By implementing AI, we will increase workflow efficiency by reducing errors, missed charges, billing backlogs, and claim denials while lowering costs.
The platform also creates a nuanced understanding of our patient journey and can identify potential charge gaps where services were likely provided but there is no documentation. Once identified and routed to coders for follow up with providers, these estimated charge gaps can equal as much as 8% of overall bedside revenue that was previously left unbilled.
Workforce challenges are addressed, too. Because staffing is at a premium, by automating our bedside visit coding, we can shift resources to other areas of need. Regarding the big picture on the people side of Henry Ford Health, it reduces the daily workloads on physicians, medical coders, and billing administrators, driving better financial and operational performance while improving our coders’ job satisfaction.
Finally, Al improves the patient experience by reducing denials.
Q. What are the concerns or challenges to using this technology?
Ferguson: As with onboarding any new technology, the biggest challenges we face are overcoming staff nervousness about learning and using a new system, training staff to then use that system correctly, and ensuring the AI is coordinated with our other systems. However, we find we can get around some of the roadblocks and hesitation that come with using new technology by taking time to highlight the short-term and long-term benefits to employees’ everyday workloads, while also laying out how it helps the organization as a whole. When people see the benefits on both ends of the spectrum, we’ve found they’re very willing to make the leap to AI.
We also build trust with our coders by using a 'glass-box' AI partner. That means our team can see the evidence behind every code and every case, so we are not asking them to blindly trust the AI’s recommendations.
Q. How do you ensure accuracy and reliability with this technology?
Ferguson: The AI system we use through CodaMetrix is being built to learn and adapt over time based on the feedback provided by our medical coding teams, so it’s constantly improving. That’s the power of machine learning, which keeps the system from becoming brittle when new ICD and CPT codes are released throughout the year.
We are in constant contact with CodaMetrix in every step of the build process to ensure we have a successful launch of the technology. We set our own quality standards for coding accuracy, giving us an additional layer of control of the AI. Through our partnership we are both committed to quality on Day 1 of implementation, having immediate access to prediction and automation information. This will keep Henry Ford Health’s revenue cycle running smoothly, while improving how we operate the system.
Q. What has surprised you, good or bad, about this technology or the outcomes you're seeing?
Ferguson: We like the level of control we have. We set the quality thresholds, which means we can use the coding AI to our standards rather than those set by someone outside of the organization. We also look forward to the transparency with which the platform operates. We’re able to see 'under the hood' at all times, so our medical coding team does not have to guess why CodaMetrix chose a particular code for a specific case. This helps build our team’s confidence in the AI solution, which we anticipate will speed ramp-up.
Q. How do you see this technology evolving? How and where else would you like to use it?
Ferguson: AI has been infiltrating the healthcare industry for years now, but recently it’s seemed to hit a critical mass. It’s already working its way into doctors’ notes and diagnoses via new products from Google and Microsoft, and it doesn’t seem like it will be long before AI is providing meaningful assistance to doctors making complicated decisions about the best way to treat their patients. It’s amazing to see everything unfold in real time and be at the center of it.
Regarding coding, as the technology matures and becomes more adaptable, I would like it to spread into new specialties and departments. Each hospital specialty has its own medical coding team, so the first step would be using AI across the entire hospital and patient billing departments. The same goes for billing and doctors’ notes, which all layer into a well-run revenue cycle. To have AI that makes revenue cycle management easier across the board via accurate automation is a big win.
Q. What advice would you give to another health system considering using this technology? What, in your opinion, would they be most likely to do wrong?
Ferguson: When it comes to using AI in medical coding, make sure to do your due diligence. Going for the quick fix or using last year’s technology because it’s cheaper will only make change more painful in the future. That means finding a partner who understands rev cycle operations and AI, and what your team needs to be successful.
AI products that will grow and can keep pace with the breakneck speed of tech innovation in healthcare are a must, not a 'nice to have.' Check out what the best and most innovative hospital systems are using; they’re usually at the vanguard of the industry and often choose the best practices.
The new services are designed to help healthcare providers and payers address key social determinants of health that affect healthcare access and outcomes.
Uber is expanding its healthcare capabilities to help providers and payers address more social determinants of health.
The rideshare company's healthcare arm, which launched in 2018 and currently focuses on non-emergency medical transportation and prescription delivery, will soon be adding groceries and over-the-counter (OTC) items delivered to the home through its Uber Eats platform.
“Value-based care is the future of healthcare, but it’s complex and labor-intensive to deliver and scale,” Caitlin Donovan, global head of Uber Health, said in a press release. “Our platform streamlines coordination across multiple benefits—non-emergency medical transportation, prescription delivery, and food and over-the-counter medication delivery, empowering payers and providers to support patients beyond the four walls of a medical office.”
The announcement tucks in nicely with the ongoing effort by health systems and payers to identify and address SDOH, or non-clinical factors that affect healthcare outcomes. This includes transportation, housing, employment, family life, education, and societal and cultural influences.
Providers and payers have been targeting transportation issues for years with programs that help patients find rides to and from scheduled healthcare appointments, an effort that has helped to reduce delayed appointments and no-shows that can ultimately affect care management and outcomes.
Many are now looking to the food-as-medicine movement, which addresses food insecurity and dietary issues that can also affect health outcomes. Studies cited by Uber Health have found that healthy meal delivery services can cut 1.6 million hospitalizations a year, reducing medical costs by some $13.6 billion, while patients who don't have access to health meals tend to incur 16% more healthcare costs than those with access to healthy meals.
"As food as medicine programs increase in prevalence and yield promising early results, Uber Health’s expansion into grocery and OTC item delivery provides healthcare organizations with yet another powerful lever to enhance the patient experience, improve health outcomes, and fully 'close the loop' on patient care," the company said in its press release. "This is especially necessary for homebound patients and those who live in food deserts—areas where accessing groceries can be particularly challenging."
City of Hope's president of health innovation and policy is focused on using new technology and strategies to give those living with cancer the care they need when and where they need it.
Consumers—especially those living with a chronic condition such as cancer—shouldn't be denied access to care just because they're poor, part of a minority or living somewhere where they can't stand in front of a doctor.
Levine is president of health innovation and policy at City of Hope, the California-based, National Cancer Institute-designated cancer research and treatment health system that last year acquired the Cancer Treatment Centers of America. And while the partnership creates a physical network of healthcare sites for research and treatment, it's the virtual connections that he's focused on.
"We have a chance to export specialty care into the community," he says. "Healthcare needs to be on a broader continuum, [where we can] define the best type of care and deliver it to the best site for care, which can be the home."
Levine, who worked for Anthem, Towers Watson, and UnitedHealth Group prior to joining City of Hope and serves on a number of advisory boards and working groups, divides innovation into three buckets: Treatment, including new advances in genomics; delivery, which encompasses digital therapeutics and remote patient monitoring; and access, which addresses social drivers of health and other barriers that keep those living with cancer from getting the care they need.
It's that third bucket that he focuses on with AccessHope, a company spun out of City of Hope that uses telemedicine to connect oncologists to specialists regardless of whether they're located. It's a spin on the 'center of excellence' approach, where instead of having specialists gathered in one location, those specialists are brought online to the oncologist (and, perhaps, the patient).
Harlan Levine, MD, president of health innovation and policy, City of Hope. Photo courtesy City of Hope.
"We have to really understand that cancer care is different," Levine says. There are many moving parts to the care regimen, ranging from chemotherapy to surgery to mental health to rehabilitation to health and wellness (including diet and exercise) to palliative care. Bringing all those resources together and asking patients and their support teams to travel multiple times a week isn't in the patient's best interests or representative of patient-centered care.
Giving the oncologist the virtual tools to collaborate with specialists not only improves the treatment process, he says, but also reduces strain on patients and their care teams.
"We don't sometimes look deeply enough and ask if the quality is there," Levine adds. "When you put the patient at the center of care and look at what it means to them, you get a different idea of what value-based care is supposed to mean."
And that's when innovation comes into play.
Levine has been particularly active in securing access to care for those who face barriers, be they racial, societal, geographic, or financial. He helped to secure the 2022 passage of the California Cancer Care Equity Act, which expanded access to specialized cancer care for residents on the state's Medicaid program who live with a complex cancer diagnosis.
“This is the first step in creating a more equitable cancer ecosystem that works better for patients and expands access to lifesaving, groundbreaking treatments for those from historically underserved communities," City of Hope CEO Robert Stone said following California Governor Gavin Newsom's signing of the bill into law.
Levine says it's vital to push for equal access to cancer treatment and care, particularly at a time when new technologies are making access to treatment more equitable.
He says the rapid pace of healthcare innovation over the past few years—due in part to the COVID-19 pandemic—is propelling the industry to redefine healthcare. Health systems are now using technology to push care out of the hospital and give providers more opportunities to connect with and monitor their patient's health journey.
"Healthcare has been built on antiquated technology platforms" that make innovation challenging, he says. "In many cases it's easier to create new programs than to build off of existing platforms."
This also changes how health systems plan new approaches to healthcare delivery. Levine says he's spending a lot of time and attention on employers, many of whom are looking for new and innovative ways to cover healthcare services for their employees—and make sure those employees are getting the best care.
"Employers have driven a lot of innovation in healthcare," he says. "They've driven many of the disease management programs that we've seen over the past 30 years."
With that in mind, City of Hope is expanding its care platform to create a network of community cancer care centers across the country, linked by one electronic health record platform. This recognizes the fact that while many services can be virtual, there is still a need for physical sites to handle in-person care and services. The community center concept also hit on the idea of taking care out of large, imposing hospitals and delivering it in more welcoming locations closer to where patients live.
As City of Hope moves forward, Levine sees a lot of work going into genomics, augmented intelligence and data analytics, so that diagnoses and treatments are more precise and targeted. More importantly, with a virtual platform that includes RPM and home-based care, patients can access the services they need on a schedule and in a place that suits them, rather than the provider.
"The challenge we're facing right now is in integrating the old and the new," he says, "to help create comprehensive cancer solutions that any patient can access."
The "Saving Limbs, Saving Lives" campaign aims to give healthcare providers access to a digital health platform that offers care management resources and a virtual connection to specialists.
A new national campaign aims to reduce the number of leg amputations in the US by giving healthcare providers access to digital health tools aimed at improving care management.
The "Saving Limbs, Saving Lives" (SL2) project, unveiled at the recent New Cardiovascular Horizons (NCVH) annual conference, targets the estimated 150,000 annual lower extremity amputations, according to the National Institutes of Health. The effort to give members of the American Podiatric Medical Association access to a digital health platform developed by CarePICS that includes wound care management guidelines and best practices and virtual access to specialists.
With studies estimated that as much as 60% of lower extremity amputations could have been prevented, the project takes aim at four critical care gaps in the wound treatment process: imprecise assessment and measurement using manual tools; inadequate and inconsistent documentation; inefficient follow-up care and communication; and fragmented care coordination between initial care providers and vascular specialists.
"When we look broadly at the medical histories of patients who have undergone lower extremity amputations, the evidence reveals that only about half have ever had a vascular evaluation or were referred to a vascular specialist," Timothy Yates, MD, of Florida-based Palm Vascular Centers, said in a press release issued by CarePICS. "Their condition simply progressed to a stage where the limb could not be salvaged. This is exactly the scenario SL2 is helping avoid. Using the CarePICS app, podiatrists can quickly and easily request an electronic consult with a vascular specialist, then convert it to an electronic referral when it's indicated that the patient needs a vascular evaluation."
The campaign is part of a three-phased approach, and will run through June 2024. Organizers will evaluate the results and then determine whether to make it permanent.
Amol Vyas says the federal government has to push forward with efforts that promote interoperability, addressing current barriers like trust, security, and scale
The National Committee for Quality Assurance (NCQA) recently appointed Amol Vyas as its first vice president of interoperability, giving the non-profit organization a point man as the government and healthcare industry make progress toward nationwide health information exchange.
Vyas has more than two decades of experience in information technology, most recently with Cambia Health Solutions. He also was part of the MedicaLogic team that helped to develop one of the first electronic medical record systems, and he led development of the Common Payer Consumer Data Set and the CARIN FHIR Implementation Guide for Blue Button.
He recently sat down for a virtual Q&A with HealthLeaders on his new role.
Q. Why is the NCQA creating a VP of Interoperability now?
Vyas: We are at an important juncture in the healthcare industry’s interoperability journey. The federal government (particularly the Centers for Medicare & Medicaid Services and the Health and Human Services Department's Office of the National Coordinator for Health IT) have doubled down on standards-based health data interoperability. Both payers and providers are now mandated to share health data using interoperable APIs. In creating the VP of Interoperability role, I believe NCQA has committed to focusing on harnessing these exciting developments in the transition to full digital quality measurement.
Q. What are your priorities and goals in the year(s) ahead?
Vyas: One of my top priorities is to create an enterprise strategy that is aligned with not only the key business focus areas but also the healthcare industry's current state of maturity in interoperability. The goal is to position NCQA's products and services to leverage regulated interoperability APIs that are currently in use.
Q. What are the challenges or barriers affecting nationwide healthcare interoperability?
Vyas: The payer and provider interoperability APIs have arrived and are here to stay. However, to reach the next level of maturity, we need to address major hurdles like scale, security, and trust.
Q. Do healthcare organizations understand the value of interoperability?
Vyas: Over the last five years, healthcare organizations have come a long way in terms of understanding the value of interoperability. The 'carrots-and-sticks' approach adopted by the industry and federal government has played an important part in organizations realizing the potential of interoperability.
Q. How can new digital health tools play a part in promoting or achieving interoperability?
Vyas: Newer digital health tools are increasingly riding on the success of interoperable exchange of data. The liquidity, portability, and higher quality of data that such tools expose or ingest can fuel innovative business use cases and patient journeys.
Q. What more can or should be done to promote or achieve interoperability?
Vyas: We need to find solutions to emergent issues as part of our increasing adoption of interoperability. Scale, security, and trust are the next challenges that need to be addressed in time to maintain our momentum. The ONC’s Trusted Exchange Framework and Common Agreement (TEFCA) and CMS’ National Directory of Health Care Providers and Services are some of the evolving solutions to watch for.
Q. Should the government be incentivizing interoperability or penalizing those who aren't moving toward that goal?
Vyas: The 'carrots-and-sticks' approach adopted by the industry and federal government has played an important part in how organizations have adopted interoperability.
Q. What has surprised you, good or bad, about the path to interoperability?
Vyas: The healthcare industry's slow pace (or absolute lack) of adoption of evolving interoperability standards in the absence of incentives or penalties continues to surprise me.
The conference, taking place this week in San Diego, has drawn healthcare leaders, researchers, and entrepreneurs to discuss how healthcare should map out an AI strategy.
AI is having its moment. And healthcare leaders are fully invested, excited about the potential for the technology but wary of the dangers.
The technology that's on everyone's lips and in everyone's pilot programs could be used to address healthcare's key pain points, be it a shrinking workforce, surging stress and burnout rates, or care coordination and management inefficiencies. Advocates point out that AI can handle burdensome and tedious tasks that take providers away from providing care, while also gathering and analyzing data far more quickly and efficiently than the human mind.
"It's what we hear all day, every day now," said Karen Seagraves, PhD, MPH, NEA-BC, a senior healthcare consultant and former vice president of Atrium Health's Neuroscience Institute.
But while some are calling it an unguided missile, capable of causing great harm, others see it as a transformative technology poised to reinvigorate healthcare, if only healthcare would listen.
"We wouldn't have used the iPhone," points out Chip Steiner, a product manager for healthcare at Kore.ai, a digital health company focused on language-based AI technology. "We didn't know we needed it until now we do."
The good and the bad are on display at the AIMed (Artificial Intelligence in Medicine) Global Summit, taking place this week in San Diego. The brainchild of Anthony Chang, MD, MPH, MS, MBA, a pediatric cardiologist at Children's Hospital of California (CHOC) and Freddy White, a UK-based events organizer and author of Intelligence Based Medicine, the five-year-old conference boasts a registered attendance of some 1,500 healthcare executives, clinicians, researchers, and vendors.
With a high-level and international speaker list and an intimate exhibit hall ringed by track-level stages similar to the HLTH and ViVE conferences, AIMed is poised to capture the conversation. That includes heeding the concerns of those who argue for tapping the brakes on the hype.
Just remember what happened with the EHR.
"There is enthusiasm about this disruptive technology," said Jesse Ehrenfeld, MD, MPH, a senior associate dean, tenured professor of anesthesiology and director of the “Advancing a Healthier Wisconsin Endowment” at the Medical College of Wisconsin, and president-elect of the American Medical Association, while also bringing up the "horror stories" of EHR adoption caused by a provider population that clearly wasn't ready or willing to embrace the new technology. "The existing regulatory framework is clearly not equipped to handle [AI governance]."
Ehrenfeld said the healthcare community needs to make sure that AI adoption doesn't follow the same path as EHR adoption, and that healthcare executives and clinicians play an active role in shepherding the technology forward.
"They've got to include clinician voices at the front end, not as an afterthought," he said.
During a panel composed primarily of healthcare executives, the general consensus was that AI—defined as augmented intelligence rather than artificial intelligence—would help healthcare make some early gains in reducing administrative tasks and improving workflows. That's an important selling point for an industry dealing with stress, burnout, and shortages up and down the roster, from clinicians and nurses down to tech support.
'We're always asked to do more with less," said Lynn Jeffers, MD, MBA, FACS, chief medical officer at Dignity Health.
"Efficiency is at the crux of how we solve this," added Stephanie Lahr, MD, CHCIO, the former CHIME board member and CIO and CMIO at Monument Health who's now president of digital health company Artisight.
The panel even featured one of the first and few healthcare executives whose role is specifically focused on AI: Ashley Beecy, MD, FACC, an assistant professor at Weill Cornell Medical College and medical director of AI operations at New York Presbyterian Hospital. Beecy noted her role was created to bring clinical leadership to the table when discussing AI strategy, so that clinicians can be part of the process in developing, testing, and scaling AI projects.
And that's where AI should start. While Chris DiRienzo, MD, MPP, senior vice president and chief physician executive for the American Hospital Association and an adjunct professor at the Duke University School of Medicine, pointed out that AI not only can help clinicians do their work better but also do work that clinicians can't do, the inclination is to reach immediately for the stars and use the technology to, say, find a cure for cancer. Instead, he and others said, start with the low-hanging fruit and build up the small successes.
"We have to cultivate the culture," said Eric Eskioglu, MD, MBA, chief medical and scientific officer at Novant Health.
That's going to take some time. When asked to predict the future for AI acceptance in healthcare, some foresaw 10 failures for every success and a gradual annoyance of the ChatGPT craze. But mixed with that was an understanding that healthcare leaders would move slowly to embrace more AI applications in healthcare, primarily because consumers and clinicians will be learning how to use the technology and will be pushing for more opportunities to use it.
Chang sees the landscape remaining unsettled for another one or two years, then a gradual understanding of what can and can't be done in three to five years.
"I do think there is more hope than ever before," he said.
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