Adaptive techniques could improve diagnostic effectiveness in five key disease areas, a Government Accountability Office report states, but only if the data is high quality.

Low-quality data is hampering artificial intelligence (AI) and machine learning (ML) from making more inroads in healthcare diagnostics, according to a new report from the US Government Accountability Office (GAO).

In addition, the report found, these technologies are yet to fully demonstrate real-world performance in diverse clinical settings.

"Our policy options--like improving data access and collaboration--may help address the challenges," the report stated.

Potential benefits of machine learning in the diagnostic process include earlier detection of diseases, more consistent analysis of medical data, and increased access to care, particularly among underserved populations, the report said.

The GAO identified a variety of ML-based technologies for five selected diseases: certain cancers, diabetic retinopathy, Alzheimer's disease, heart disease, and COVID-19. Most rely on imaging data such as x-rays or magnetic resonance imaging (MRI), but the report noted that these technologies have yet to be widely adopted.

Three broader approaches could assist these diagnoses: autonomous, adaptive, and consumer-oriented ML diagnostics.

According to the GAO, relying upon information supplied by the US Food and Drug Administration (FDA), which oversees use of these algorithms in diagnoses, incorporating additional data during the machine learning process (the adaptive approach) may improve accuracy, but only if the data being automatically updated is of high quality. Barring that, these processes could cause algorithms to perform poorly or inconsistently.

Diagnostic errors affect more than 12 million Americans each year, with aggregate costs likely in excess of $100 billion, the GAO said, citing a report by the Society to Improve Diagnosis in Medicine.

The report recommends that policymakers promote collaboration among technology developers, providers, and regulators when developing or adopting machine learning diagnostic technologies. This collaboration could expedite the creation of ML-ready data, according to officials at the National Institutes of Health interviewed by the GAO.

Providers should consider setting aside time for their employees to engage in these innovation activities, the GAO said.

Research by the Children's Hospital of Philadelphia saw good results in a telemedicine platform used by providers to manage care at home for children.

Researchers are encouraged by early efforts to read pediatric epilepsy patients via telemedicine, but say more work is necessary to reach wider populations.

The Epilepsy Neurogenetics Initiative (ENGIN) at Children’s Hospital of Philadelphia (CHOP) reported that across nearly 50,000 visits, patients continued to use telemedicine effectively, even when outpatient clinics reopened a year after the onset of the COVID-19 pandemic.

Still underrepresented, though are socially vulnerable families and racial and ethnic minorities, the hospital reported.

These findings represent the largest study of telemedicine in child neurology to date, and were recently published in the journal Developmental Medicine & Child Neurology.

Telemedicine as a novel method of care in child neurology has not been systematically explored until now, CHOP officials said. A prior study in Neurology in 2020 reported that patients and clinicians were highly satisfied with telemedicine, and were looking forward to utilizing telemedicine for future visits.

The latest observational study was based on a cohort of 34,837 in-person visits and 14,820 telemedicine outpatient visits between October 2019 and April 2021, spanning a total of 26,399 child neurology patients.

“In 2020, the COVID-19 pandemic necessitated the use of telemedicine visits, but now that telemedicine visits have been established as part of the care we are able to deliver, we had the opportunity to compare them more thoroughly to in-person visits,” the study’s primary author, Michael Kaufman, MS, a data scientist with ENGIN at CHOP, said in a press release. “With data on nearly 15,000 telemedicine visits, we were able to identify trends in how telemedicine was being used by individuals of different demographic backgrounds, neurological conditions and other variables.”

Certain patients used telemedicine more often than in-person visits--in particular, patients with epilepsy and attention-deficit hyperactivity disorder. Other patients, including those with certain neuromuscular and movement disorders, younger patients, and those needing specific procedures, were less likely to receive telemedicine care.

Self-reported racial and ethnic minority populations in the study as well as those with the highest social vulnerability--a measure of community resilience to stressors on human health--participated at lower rates in these telemedicine visits.

Compared to less vulnerable individuals, some the most vulnerable individuals studied were less likely to utilize online patient portals, and were at greater risk to receive delays in care, the study found.

Healthcare organizations are using a digital health platform to help care teams monitor wounds in real time and reduce the chance of hospital-acquired pressure injuries.

Healthcare organizations are embracing new technologies to improve wound care, which can lead to serious complications, including death, if not managed properly.

Digital health tools such as smart bandages and sensors and reporting tools within the EHR that include images can help care teams keep close tabs on wounds and avoid hospital-acquired pressure injuries (HAPIs), which are listed by the Centers for Medicare & Medicaid Services as "never events." The agency has estimated that HAPIs can add more than $43,000 in costs to a hospital stay, with severe cases running into the hundreds of thousands of dollars.

One such health system facing that challenge is New York's Northwell Health system.

“We were taking ruler measurements, and it was extremely inaccurate because I might be off by a millimeter or two,” Alisha Oropallo, MD, FACS, FSVS, FAPWCA, FABWMS, director of the Department of Vascular and Endovascular Surgery's Comprehensive Wound Care Center in Lake Success, said in a recent e-mail. “Then the nurse might measure the next week and have a slightly different measurement; sometimes, the depth would not be taken; and rulers don’t provide an accurate square surface area, so if you wanted it, you had to manually calculate it.”

Northwell Health has partnered with Pittsburgh-based digital health company Net Health to deploy its Tissue Analytics (TA) software for wound care management. The technology is integrated into the health system's EHR platform to give clinicians more accurate wound data and allow for real-time monitoring.

HealthLeaders recently spoke, virtually, with Roxanne Elling, RN, BA, BSN, CWOCN, a wound care specialist at Good Samaritan Hospital Medical Center in West Islip on New York's Long Island, part of the Catholic Health system, about how the technology improves the wound care process at her hospital.

Q. What impact does wound care have on your organization?

Elling: Wound care has a great impact on all healthcare organizations. With the implementation of the EMR, the demands for all clinical documentation have increased, which of course includes a complete wound assessment. With time constraints, staffing challenges, competing priorities, and thorough documentation needs, these can be difficult to complete during one’s shift.

Q. What challenges are you facing with wound care? (e.g., number of patients with wounds increasing, impact of COVID, HAPI penalties, compliance, MIPS, etc.)

Elling: Health disparities within our population have given rise to untreated chronic conditions and loss of optimal health. Pressure injuries are caused by poor nutrition, limited mobility, and chronic conditions. When these conditions are left untreated or poorly managed, a sicker, more vulnerable patient is admitted. This is especially a concern among the elderly, and was also more common during COVID. Like most hospitals, GSH is challenged by pressure injuries, and their impact on our reimbursement and overall ratings. 

Q. How was wound care handled prior to the adoption of technology?

Elling: Prior to the use of Tissue Analytics (TA) technology, the clinician spent a large amount of their time carefully measuring and documenting each of the patient’s skin related challenges, including but not limited to Incontinence Associated Dermatitis, pressure injuries, skin fold challenges, and traumatic wounds. This documentation was often significantly subjective. Despite the overwhelming amount of education given to both physicians and nurses, there was a consistent challenge with documentation accuracy among various clinical groups.

Q. How has new technology improved wound care?

Elling: With the use of TA technology we have the ability to see what the clinician saw at the time of admission through pictures. This allows the Certified Wound Ostomy and Continence Nurse (CWOCN) to review and expertly evaluate without actually being at the patient’s bedside at the time of admission.

This is especially helpful for challenging documentation. With the adoption of the technology, accurate and/or progressing wounds that are in question can be better monitored.

We were fortunate to have adopted TA in our facility over two years ago. While change is generally a challenge, TA has now become part of the culture and part of our practice as clinicians. As EHRs and technology evolve, such as documenting on smartphones, the need for a HIPAA-protected environment is a necessity for sharing information for evaluation. TA gives all clinicians involved in patient care the ability to see what is going on “below the blankets.”  It is essential that all team members are able to visualize, acknowledge and update the plan of care regularly. Tissue analytics allows our physicians to review pictures at their fingertips in real time and within a protected environment.    

For our facility, and throughout our hospital system, TA is being used as an inpatient tool. It allows the CWOCN to see what challenges each patient has, and it enables us to structure our days, prioritize our patient load and maximize time management strategies. For our physicians, TA has greatly improved the ability to collaborate by allowing the patient’s photos to be included in their assessment and ongoing evaluation. Keeping physicians continuously updated with photographs of skin conditions has become an essential communication tool used in patients’ ongoing treatment plans. 

As a society we expect immediate results. With the capability of virtual visits and remote chats online with physicians, the need for more real time evaluation in acute care is required. With TA, staff at the bedside has the ability to enter a photo into the chart that can be viewed by physicians elsewhere in real time. Ongoing and progressive photographs within the EMR can demonstrate effective improvement in wound condition and character and assist us in driving successful management.

Q. What are the challenges or barriers to using these new techniques?  

Elling: Similarly with any technology, the challenges are generally related to user education and usability as well as the reliability of hardware and connectivity.   

Q. How do patients feel about these services? 

Elling: Prior to taking any pictures, patients and family members are educated and understand the need for us to photograph their skin to validate treatment and monitor healing over time.

Hospitalizations are always stressful. In using TA technology, the care team has been able to demonstrate wound healing to family members while participating in the patient’s plan of care.  This allows open communication of challenges with the patients’ clinical status, in an ongoing effort to help everyone collaborate for better goals of care for each patient. 

Q. How do you measure success with this technology? 

Elling: We have data to suggest that between 6% and 10% of pressure injuries were incorrectly staged on arrival to our facility. We believe that without the use of TA, the appropriate prevention and treatment interventions could be overlooked as well as the risk of potential financial penalties as a result of incorrect documentation.

Researchers have found that telehealth performed better than in-person care in 11 of 16 HEDIS quality performance measures, but that doesn't mean virtual care is superior to the office visit.

New research published in the Journal of the American Medical Association (JAMA) finds that telehealth was superior to in-person care in 11 of 16 quality performance measures for primary care.

The study, conducted by researchers at the Robert Graham Center in Washington DC and Pennsylvania-based Wellspan Health, focused on more than 526,000 patients receiving healthcare services at roughly 200 Wellspan Health outpatient sites between March 1, 2020, and November 30, 2021, and used HEDIS (Healthcare Effectiveness Data and Information Set) measurements.

The researchers, led by Derek Baughman, MD, of the Robert Graham Center and Wellspan Good Samaritan Hospital in Lebanon, Pennsylvania, and Yalda Jabbarpour, MD, and John Westfall, MD, MPH, both of the Robert Graham Center, said the results don't mean that health systems should close their clinics and focus on virtual care. Rather, they should offer telehealth as a part of the overall care plan, particularly for those who face barriers to accessing in-person care.

The study noted that in-person care showed better results for all medication-based measures, while telehealth offered better results in testing and counselling measures, such as vaccinations, chronic disease testing, and cancer and depression screenings.

"Notwithstanding the statistical significance, the clinical relevance of these findings is perhaps more meaningful at the population health level for evaluating the outcomes of adding telemedicine as a care venue," Baughman and his colleagues noted. "Moreover, telemedicine exposure (especially blended office and telemedicine care) likely simulates a likely real-life scenario for the health consumer."

"Practically, these findings provide reassurance for health entities seeking to add telemedicine to their care capacity without reducing quality of care," they added. "And as we found, embracing telemedicine for enhancing certain aspects of care might be an avenue for enhancing quality performance in primary care."

Baughman and his team said it wasn't clear why telehealth outperformed in-person care, though they noted that a telehealth platform offers better opportunities for care providers to reach out multiple times to patients to "engage in quality measure-promoting intervention." They also noted that some treatments, such as the initiation of a lifelong or life-changing medication program, are best begun in person,  and perhaps shifted to virtual platforms for follow-up.

"Future studies could provide more granularity on optimizing the specific role of telemedicine in clinical scenarios, eg, understanding whether there is an association between stages of hypertension and effect modification attributable to the management venue or an association between venue and number of blood pressure medications," they wrote. "This would provide insight on where to invest in health care infrastructure and what clinical venue would be most valuable. This could also guide venue selection for patients initiating antihypertensive therapy vs patients requiring a third antihypertensive. Such insight would promote win-win environments to increase value: improved health outcomes for patients and incentive for clinicians and health systems operating in value-based care models."

The Jacksonville health system is deploying two life-sized (and selfie-capable) robots designed to perform tasks for staff and care providers that would otherwise take them away from the bedside.

Jacksonville, Florida-based Baptist Health is using a robot to improve clinical workflows and give patients and visitors 'someone' to snap selfies with.

Baptist Medical Center Jacksonville and Wolfson Children's Hospital have deployed Moxi, developed by Austin, Texas-based Diligent Robotics, to help staff and care providers with tasks that might otherwise take up time away from patients, such as transporting equipment and lab samples and even picking up items left for patients at the front desk.

“Today, our team members spend time retrieving and gathering supplies, medicine and patient items,” Tammy Daniel, DNP, Baptist Health's senior vice president and chief nursing officer, said in a press release. “Moxi’s support will allow them to focus on people as opposed to tasks, and on what they do best: patient care.”

The adult-sized robot, equipped with a gripper at the end of an arm, uses AI technology and an array of sensors to navigate busy hallways without bumping into objects or people, can maneuver through doors and elevators, and learns as it goes. Hospital officials also describe it as "intelligent, dedicated to its job, has expressive eyes, and is happy to pose for selfies."

“We are continually looking for innovative ways to support our team in caring for our patients, which is why I am so pleased to see this project begin,” Michael A. Mayo, DHA, FACHE, the health system's president and CEO, said in the release. “Artificial intelligence combined with robotic process automation in a tool like Moxi provides a way to improve hospital functions – giving our team members time back in their day to work where they are most needed.”

Once called COWs (Computers On Wheels), robots have been used for years for various functions within the hospital setting, ranging from manual pickup and delivery to providing audio-visual communication between patients and care providers in other locations. As the form factor and technology have improved, they've been assigned other duties, and are even being used in remote locations like health clinics, assisted living communities and homes.

[See also: Baptist Health's New Tower Offers the Latest in Critical Care Innovation for Kids.]

Baptist Health is using two Moxi robots, one in Wolfson Children's Hospital and the second in the adjoining J. Wayne and Delores Barr Weaver Tower at Baptist Jacksonville, and officials expect to evaluation their performance in six to eight months. The project is supported by the Reid Endowment for Technology at Baptist Health, established in 2008, and the Miller Electric Technology Endowment at Baptist Health, established in 2014.

The Detroit-based federally qualified health center is using digital health tools to improve care outcomes.

A Detroit-based federally qualified health center (FQHC) is using digital health technology integrated with its electronic health record platform to improve care management for patients living with high blood pressure.

The MicroMD electronic health record software in use in three clinics at the Institute for Population Health (IPH) was integrated in less than four weeks with Carium, a leading virtual care platform, in a partnership with Smartlink Health Solutions.

A private nonprofit, IPH took over Detroit's public health functions in 2012 as the city was approaching bankruptcy. Although most such services transferred back to Detroit in 2015 after the city emerged from bankruptcy, IPH continued to offer clinical outpatient services at three locations in the city.

The Health and Human Services Department's Health Resources and Services Administration (HRSA) has continued to fund IPH operations to the tune of $650,000 per year in 2020 and 2021. IPH provides general primary care and health screenings including mental health, prenatal care, telehealth, and adult dental services.

Prior to Carium's integration, the IPH team was manually notifying clinicians of patients with abnormal vital readings captured through remote monitoring. Now, Carium-supplied blood pressure cuffs report data directly into IPH's EHR.

The integration creates a more complete patient record, incorporating data from within the patient's daily routine, such as blood pressure or weight.

With this data, the IPH care team can better monitor, assess, alert, intervene, educate, coach, and communicate with patients.

The integration between MicroMD and medical devices deployed and supported by Carium allows physicians at IPH to click-to-order virtual services like remote patient monitoring directly through their MicroMD EHR, seamlessly enrolling patients to Carium.

IPH went live with this integration on June 10.

"The integration between Carium and our EHR allows us to be there for our patients every day," says IPH Chief Operating Officer Anthony Harris, MSW. "Our patients know we care and are keeping an eye on them, and it's also a great tool for accountability. Before, we didn't know if they took their medication until they come in the next time for a follow-up. Now we take their blood pressure twice a day, so we have an accurate account of what they're doing."

Anthony Harris, MSW, chief operating officer for the Institute of Population Health. Photo courtesy IPH.

"The integration process was easy, straightforward, and the project team was very responsive," adds Mark Lynn, IPH's chief information officer for technology services. "By incorporating the timely data from patients' daily life into our clinicians' workflows, they're able to communicate more efficiently, and make recommendations or adjustments in real-time when necessary."

In addition, discrete data automatically flows from Carium-managed devices to the connected EHR, enabling the IPH team to easily run required quality reports.

Harris has served health departments during a 25-year career, starting out managing HIV and STD patients, then moving on to IPH when it formed in 2012.

"People still kept coming here, so we stayed open," Harris says.

In his role as COO, "I have 10 hats here," he says.

So far, IPH has enrolled 30 patients in the remote monitoring program, but the funding provides for up to 80 patients, so recruitment continues to fill the remaining spots.

The Carium platform also allows for tracking more conditions over time, and Harris says the organization will expand its base to monitor chronic conditions like diabetes.

The EHR used by IPH did not have a complete set of application program interfaces (APIs) required to fully integrate the Carium platform, which is where the partnership with Smartlink Health Solutions enters the picture.

"Smartlink has the ability to automate some user interface procedures, where we can then interface with Smartlink's APIs to drive the pushing of the data in the EMR using the user interface and a set of automation technology that really does mouse clicks and button pushes within the EMR," says Scott Pradels, Carium's chief operating officer and co-founder.

Carium provides a range of connected remote monitoring devices from various manufacturers, using both cellular and Bluetooth connectivity. The platform is also able to support connectable devices supplied by patients.

Carium charges a small monthly fee for each connected patient, Pradels says.

With Sutter Health Chief Design and Innovation Officer Chris Waugh leading the way, health system executives attending the HealthLeaders Innovation Exchange learned how to bring compassion and empathy back into healthcare.

Healthcare providers may be able to bring care to the patient, but do they really care for the patient?

Roughly two dozen chief information officers and other health system executives charged with setting innovation strategy gathered in Boston recently for the HealthLeaders Innovation Exchange, where they were told that the industry often lacks empathy for the people it's supposed to treat. And that connection to the patient will be vital as the industry shifts to value-based care.

"What's happening in healthcare is we peg patients by condition and we have absolutely no idea who they are," said Chris Waugh, vice president and chief design and innovation officer for California-based Sutter Health. "We know that precision medicine will be amazing [and] we know about precision genetics, but what about precision care?"

An expert in human-centered design, Waugh was vice president of design at the San Francisco-based One Medical Group and held an entrepreneurial leadership role at IDEO, a Bay Area design and innovation firm, before joining Sutter Health. His accomplishments there include the development and launch of Tera, the health system's virtual visit platform.

At the Innovation Exchange, he gave the attendees a Master Class on human-centered design, which focuses on thinking about the person you're treating as you plan the treatment. While in other businesses it's designed to make the customer happy and support return engagement, in healthcare the strategy is vital to not only boost engagement but improve clinical outcomes.

[See also: Healthcare Executives Plot a Path Forward With Digital Health Transformation}.

As an example, he detailed how Sutter Health creates baby books for new mothers that detail the baby's journey from the hospital to the home. Those books include interviews conducted by Sutter Health staff with the new mother on everything from Mom's emotions to the weather, and are given to the mother 30 days after discharge—at a time when family and friends usually drift away to leave the new family alone, post-discharge care plans with the hospital or doctor tail away, and post-partum issues like stress and depression creep in.

The book, Waugh said, not only gives new mothers an emotional link to the hospital, it helps to reconnect them with the hospital to seek additional care, a strategy to tackle high rates of depression and improve outcomes for both mother and child over the long run.

Waugh then split the audience into groups, gave them a profile of a patient or care provider, and asked them to develop a care management plan (or, in the case of the provider, a workflow) that would meet their needs and boost engagement.

The purpose of the exercise was to encourage healthcare executives to look beyond traditional care management pathways and identify other ways to deliver care, including using digital health tools that allow patients and providers to access more resources. In doing so, they were compelled to look at care delivery from the patient's point of view, identifying the gaps and challenges that affect patients and their families, that might be overlooked by providers.

James McElligott, MD, MSCR, executive medical director for telehealth and an associate professor at the Medical University of South Carolina's Children's Hospital, pointed out that the delivery of healthcare may be a business to clinicians, but it's personal to their patients, and clinicians need to find or reinforce that emotional connection.

The concept isn't new. The American Telemedicine Association focused on the idea of bringing humanity back to healthcare at their annual conference this past May in Boston. But as the pandemic eases and healthcare organizations redirect their energies to the shift from episodic care to value-based care, those in charge of innovation need to focus their investment on new technologies and strategies that highlight the value in care delivery.

That focus will also help health systems as they deal with post-pandemic challenges ranging from workforce shortages, stress and burnout, and pressure from non-traditional healthcare resources that include telehealth providers, payers and health plans with their own provider services, and retail giants like Amazon, Walmart, CVS, and Google.

With those pressures, Waugh and others noted, health system leaders will need to be innovative to keep their patients engaged and attract consumers to their brand. That will include incorporating services that address the social determinants of health, such as ride-sharing, nutrition and exercise, and housing and financial assistance. It might also include childcare services or coupons for a night out for new parents or stressed-out staff.

And that, attendees at the Innovation Exchange learned, is what makes healthcare intriguing right now.

"I'm excited about building the foundation of better [healthcare]," noted Saad Chaudhry, MSc, MPH, CHCIO, CDH-E, chief information officer at Maryland's Luminis Health.

The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Follow the community on LinkedIn. To inquire about attending a HealthLeaders Exchange, email us at exchange@healthleadersmedia.com.