How interoperability and AI can transform treatment decisions and eliminate waste with clear, digestible information

Having a patient’s full medical history is ideal. But for today’s overextended physician—who might see four patients an hour—a concise, real-time snapshot of the patient’s most important medical history is often more practical and immediately useful.

Hamad Husainy, DO, FACEP, chief medical officer for PointClickCare, asserts that such efficiency can only be achieved through enhanced interoperability and advanced technology integration. “As we transition towards value-based care, the adoption of interoperable solutions that include AI and machine learning becomes critical. We're on the brink of providing physicians with the vital information they need, exactly when they need it,” he explains.

Drawing from his experience as an emergency physician, Husainy discusses how robust interoperability boosts physician decision-making, improves patient care outcomes, and reduces systemic waste. This shift towards streamlined, data-driven healthcare promises to transform the efficiency and effectiveness of medical treatments across the care continuum.

Q: From your experience as a physician, what are the biggest pain points around the lack of real-time patient data?

Husainy: As an emergency medicine physician, the absence of real-time data poses significant challenges. Often, we only know half of a patient’s story, lacking critical information like surgical notes or radiology results, which arrive too late. From a clinician’s standpoint, the whole rationale for EHRs is to organize information and make it accessible when it's needed most. My role frequently involves assembling a patient's history to create a story about why they are here, their prior conditions, current issues, and future needs. Access to real-time data significantly enhances our ability to complete this story and effectively treat our patients.

Q: How does physician access to real-time patient data mitigate systemic waste and contribute to the proper utilization of resources?

Husainy: Knowing that advanced tests and images have been performed or having information about a patient's inpatient admissions and observation stays enables us to ask more appropriate questions, elevate our decision-making, and utilize what’s already been done instead of repeating it. For example, recently, I treated a patient who visited their primary care physician. They were informed about high potassium levels but did not have the lab results on hand, and we couldn’t access them ourselves. I repeated their labs and discovered their kidneys were failing, leading to further questions.

If their primary care doctor had shared the patient’s data in real time, we might have determined this is an ongoing issue versus an acute medical problem, and some treatment and fluids could have resolved today’s problem with a follow-up next week. However, this patient ended up being admitted, potentially unnecessarily. When we look at inpatient admission in this case, all the risks and costs that come with it could have been avoided by real-time information sharing.

Q: What benefits can patients expect from a more seamless, value-based care journey?

Husainy: When some patients hear “value-based care,” they initially worry it implies fewer tests or less aggressive treatments. In reality, the benefits are substantial and far-reaching. Real-time data sharing equips clinicians with essential information at their fingertips, giving patients the most successful outcomes. When patients fully understand the concept of value-based care, they appreciate its advantages, such as timely and appropriate care, fewer life disruptions, and reduced risk of harm from delayed test results. Value-based care ensures that the right care and tests are administered at the right time and place. For instance, under this model, patients are seen more quickly in the most suitable settings—rather than enduring long waits in less appropriate settings. This approach allows for same-day consultations, lab work, and scans, streamlining the entire care process.

Q: What is the biggest roadblock today preventing true healthcare interoperability? What actions can organizations take to overcome this obstacle?

Husainy: The biggest obstacle is that many physicians still do not fully grasp the value of interoperability at the bedside. To overcome this issue, organizations must move beyond engaging a few physician champions and have a more comprehensive conversation to help physicians see that interoperability is the future—that it’s essential to have real-time access to the data they need. Given our dependence on technology, adopting interoperability is not just an option; it’s a necessity for effectively managing and sharing patient information.

More broadly, interoperability needs to be a bigger focus of physician and nurse education and training, and communicated that it is a key aspect of providing care. Interoperability doesn’t usurp the patient-physician relationship but rather offers the distinct advantage of ensuring information accompanies each patient across the care continuum, significantly reducing resource utilization and lowering costs.

Q: What steps must healthcare leaders take to foster buy-in from physicians when implementing an interoperable solution?

Husainy: Achieving buy-in for interoperability is challenging in our fragmented healthcare system, with regions operating under differing models—some on fee-for-service and others on value-based care. Universal buy-in is tough when physicians adhere to varied rules. However, as Medicaid and Medicare Advantage populations expand and more organizations embrace value-based models, clinicians will become more interested in understanding how interoperability improves patient care and lifestyle while enhancing provider practice environments.

Florida-based Pathways Health Partners serves as a successful example. Managing 23,000 at-risk lives, it leverages real-time data throughout the healthcare spectrum to enable timely patient interventions. This system delivers quality care that is comparable to or better than traditional fee-for-service models. Through more integrated and coordinated care, Pathways is able to drive better patient outcomes, such as reduced rehospitalizations, and better support ACO programs.

Q: What change management is required for clinicians to optimize the use of integrated health data?

Husainy: Clinicians increasingly need support in synthesizing information swiftly and effectively. At PointClickCare, we focus on delivering data insights that are relevant and easily digestible. While the EHR space offers extensive data and medical records to clinicians, the reality is that a clinician cannot absorb 15 years of medical records in a 15-minute patient visit. Our approach includes creating concise, shareable summaries that encapsulate recent encounters and utilization, including skilled nursing stays, as well as care plans, medications, mental health, and substance use indications that might not be easily viewed or accessible in their EHR addressing the most important questions a physician may have. Given the high cost of healthcare and the need for providers to see multiple patients every hour, offering actionable patient information rather than overwhelming them with a litany of medical information has significant value.

Q: What role could technologies like AI and machine learning potentially play in enhancing care logistics and patient placement across the care continuum?

Husainy: AI and machine learning are becoming essential for summarizing large volumes of documents into real-time, accessible, and actionable formats. As value-based care extends from primary care to various specialties, these dynamic technologies are crucial for delivering the most up-to-date information to providers. AI also minimizes the need for interpersonal communication by automatically integrating physician notes across multiple care settings—from ERs and clinics to post-acute care, physical therapy, and home health—into the patient record. PointClickCare is already successfully leveraging AI using our extensive senior care data to aid in predicting the return to hospital from a skilled nursing stay. As a result, we can predict the likelihood of a rehospitalization based on multiple readmission risk factors. This, in turn, provides care teams with the information they need to collaborate across the continuum and ensure that patients are getting priority care as soon as possible.

In the near future, we anticipate broader applications of AI at the bedside to analyze data and applications in predicting staffing and patient placement. Advancements that once seemed futuristic are already happening today.