Virtual care platforms have many benefits for nurses, patients, and their families, say these healthcare leaders.
Many organizations are turning to virtual nursing to address staffing and wellbeing, and with the current trajectory virtual care will be an integral part of the future of healthcare.
The use of telemedicine following the COVID-19 pandemic kick started the virtual nursing movement. And while some systems are just getting started, many have been utilizing virtual nursing for years and continue to expand.
Researchers at Brigham and Women’s Hospital used AI to help understand when radiation treatments can cause dangerous heart arrhythmias.
Healthcare researchers are now using AI to gain a better understanding of when patients should and should not receive radiation as part of their treatment.
In a study published in JACC: CardioOncology, a team from Brigham and Woman’s Hospital used an AI tool to better understand the risk of cardiac arrhythmia for patients undergoing radiation treatment for lung cancer. The results not only could lead to better treatment plans but also improve care for the estimated 1 in 6 patients who experience severe side effects, including death.
“Radiation exposure to the heart during lung cancer treatment can have very serious and immediate effects on a patient’s cardiovascular health,” Raymond Mak, MD, director of clinical innovation for the Department of Radiation Oncology at Brigham and Women’s and corresponding author for the study, said in a press release. “We are hoping to inform not only oncologists and cardiologists, but also patients receiving radiation treatment, about the risks to the heart when treating lung cancer tumors with radiation.”
The study is just the latest effort by health systems and hospitals to apply AI to clinical care pathways.
This research targets patients receiving radiation therapy to treat non-small cell lung cancer (NSCLC), for which arrhythmias can be a common side effect. Because NSCLC tumors and the treatment to eradicate them occur close to the heart, the heart can be affected by those doses of radiation.
The Brigham and Women’s team used AI to gain a more focused understanding of how the heart is affected by that radiation treatment. Researchers analyzed data from 748 patients who had been treated with radiation for locally advanced NSCLC to identify different types of arrhythmia that can occur. They found that 1 in 6 patients experience at least one grade 3 arrhythmia within roughly two years of treatment, and 1 of every 3 of those patients experienced “major adverse cardiac events.”
“An interesting part of what we did was leverage artificial intelligence algorithms to segment structures like the pulmonary vein and parts of the conduction system to measure the radiation dose exposure in over 700 patients,” Mak said in the press release. “This saved us many months of manual work. So, not only does this work have potential clinical impact, but it also opens the door for using AI in radiation oncology research to streamline discovery and create larger datasets.”
Mak and his team concluded that radiation oncologists should collaborate with cardiology specialists when developing radiation treatment plans, including embracing strategies that “actively sculpt radiation exposure” away from the areas of the heart that are susceptible to arrhythmias.
Nurses need to be healthy so they can take care of patients, says this nurse leader.
On this episode of HL Shorts, we hear from Dr. Shakira Henderson, Dean, Chief Administrative Officer, and Associate Vice President for Nursing Education, Practice and Research at the University of Florida College of Nursing, and System Chief Nurse Executive of UF Health, about how nurse leaders should implement recruiting and retention strategies that address burnout as well as the nursing shortage. Tune in to hear her insights.
PCORI has issued grants totaling more than $27 million to three research projects comparing virtual care to in-person care.
Three healthcare organizations exploring the use of telehealth in care management are getting grants from the Patient-Centered Outcomes Research Institute (PCORI).
The non-profit, which focuses on clinical effectiveness research (CER), announced more than $27 million in grant awards for three projects comparing care delivery via telehealth against traditional care methods.
"At the center of comparative clinical effectiveness research is a recognition that patients’ needs are diverse and not all treatments or interventions have the same effects for everyone,” Harv Feldman, MD, MSCE, PCORI’s deputy executive director for patient-centered research programs, said in a press release. "These CER studies will generate evidence about how different approaches to care may work better for some patients for health concerns facing different people every day."
The three projects are:
Tapan Mehta, PhD, of the University of Alabama at Birmingham, is receiving almost $11.5 million to study how two different telehealth programs—remote patient monitoring (RPM) and digital health coaching—might help with care management for people living with type 2 diabetes who have multiple chronic conditions and physical disabilities. The study will examine each approach individually as well as together.
Stephen Henry, MD, MSc, and Aimee Moulin, MD, MAS, of the University of California, Davis, are receiving $6.4 million to compare treatments for patients living with substance use disorder (SUD). The research will compare outcomes for patients who start buprenorphine treatment in the emergency department and transition to an outpatient program by telehealth as compared to those undergoing in-person treatment.
Richard Skolansky, DSC, and Kevin McLaughlin, PT, DPT, of Johns Hopkins University, are receiving almost $9.6 million to study the effectiveness of a telerehabilitation program for people living with chronic low back pain against in-clinic treatment.
The grant awards are part of a larger group of 10 awards totaling $165 million for CER research projects. Since 2010, the organizations has awarded more than $4.5 billion in grants for CER research.
Nurse leaders should follow these steps to determine what staffing model works best for both patients and nurses, says this CNO.
When implementing new staffing models, there are several factors to consider. CNOs must prioritize what works best for patients while also meeting the needs of their nurses.
According to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children's Healthcare, there are four steps that CNOs should take to determine what staffing model works best for their health system.
HealthLeaders CEO editor Jay Asser is joined by Kat Kemper-Kelly, senior consultant with Vizient security management, to discuss key strategies to help health systems improve safety and security, including cultural buy-in and integration of technology.
New York’s largest health system has launched a production company that is developing scripted and unscripted media content, including documentaries and docudramas. The intent, says Ramon Soto, Northwell’s SVP and chief marketing and communications officer, isn’t to make money or discover the next George Clooney, but to market the brand and give the health system an avenue to produce issues-driven content.
“Northwell wants to just show up differently to consumers, and we compete in a hyper competitive market,” he says. “So when we show up, how do we get a consumer to take notice of Northwell and to choose us … particularly when you have great choices?”
Soto says the strategy encompasses two main goals.
“One, we can invite consumers in and see all the things that happen behind the glass that they never get exposure to,” he says. “And it’s wonderful content. There’s a reason why Grey’s Anatomy is super successful. You show the power of health and how it fuels your life, your love, your passions, your careers, [with] really deep human interest stories.”
“The second part is we found a lot of value in telling stories about socially important topics that society has to have more conversations around,” he adds. “And sadly, there are too many of these.”
The idea for Northwell Studios—and Soto is quick to point out this isn’t a movie studio out in Hollywood developing the next St. Elsewhere or ER—came when the health system was introduced to a pair of Israeli showrunners who had developed successful documentaries and docudramas in Europe and wanted to expand to the UK and US.
The two, Ruthie Shatz and Adi Barnash, signed a contract with Northwell in 2017 to create Lenox Hill, a nine-part documentary on Lenox Hill Hospital that appeared on Netflix in 2020. The success of that show led to Emergency NYC, an eight-part documentary that aired on Netflix in 2023.
A third documentary series, called One South: Portrait of a Psych Unit, is now airing on HBO and some streaming services. It focuses on a unique program developed by Northwell at Zucker Hillside Hospital in Queens for college students at risk of suicide, and follows a handful of those students through their treatment.
And that’s when Northwell leadership decided to become a more active participant in the process.
One South “has been very beneficial in that regard to the point where we said, ‘Look, let's turn this into a business and let's do more of these,’” Soto says. Northwell Studios, launched this year, aims to produce at least two pieces of content per year.
It also highlights what Northwell wants to do with that medium.
“The reality is Northwell has millions of square feet of footage with which we dispense clinical care,” he notes. “We've got 21 hospitals, we’ve got 88,000 employees, hundreds of operating rooms, thousands of doors that consumers can walk through to engage with us, and that is my stage. So that’s where we capture the content, and it can be incredibly compelling content just given the number of people we touch: 2 million unique patient visits a year, 6 million patient encounters.”
Developing Northwell-branded content is tricky, given that the health system doesn’t want the public to assume this is carefully cultivated to make Northwell look good. Soto says story ideas are reviewed by a third party who is neither a Northwell employee nor a member of the production crew to ensure that the content is both entertaining and accurate. Contracts are carefully and meticulously drafted to ensure HIPAA compliance and patient privacy and safety, and the health system has a limited impact on the editing process.
Limited, but necessary. This is about more than just a stray Starbucks coffee cup showing up in Game of Thrones.
“It's fascinating to be in the edit room because I literally have a team of 20 people in there scrutinizing and you have typically a producer, director, maybe five people on the production side of it,” he says. “And we're not shy. Every once in a while you have the inadvertent camera scan across the room and a computer screen is up. And you know, our guys have heart attacks--not really, but we're just hyper-vigilant about that.”
And while Northwell’s doctors may be expert at treating patients and saving lives, that might not translate to the screen. Soto recalls a casting call for one production that drew 55 doctors for four roles—and having to deal with 51 doctors who didn’t make the cut.
“Picking doctors who know when the red light goes on” can be challenging, he says.
Soto noted that Northwell Studios won’t be making a profit for the health system—and that’s important, because Northwell Health is a non-profit entity. The value of this business venture, however, is significant. It’s far better than any billboard, TV ad or newspaper or magazine insert.
“This is about content creation that can do social good, that can benefit the communities that we serve and that allows us to develop brand [recognition],” he says, noting that 1% of all babies born in the U.S. are in Northwell facilities. “We really are intimate partners with consumers along their lives.”
It’s important, Soto says, to not only shine the light on healthcare’s heroes, but to direct that spotlight on important public health and population health issues, such as the high suicide rate among teens and young adults.
‘We lose $100 million a year on behavioral health services,” he says, “yet we created a two-episode docudrama on it because it’s an important social conversation right now.”
This is an easier way to draw blood, says this CNO.
HealthLeaders spoke to Anna Kiger, system chief nurse officer at Sutter Health, about how introducing technology for needless blood draws would improve the patient experience.
Virtual nursing is not a fad. It's so transformative that we are near the first generation of nurses who may never touch a patient.
Welcome to our August 2024 cover story. Each month, our editors will be taking a deep dive into the topics that matter most to you in our cover story series. From ways to win the payer/provider war to AI governance, we have a lot of stories up our sleeves this year.
So, what did our team look into this month? Well, nurses are feeling overworked and burned out, and there are not enough nurses to fill the gaps left by those leaving the industry. This means your hospital halls will soon be empty, but not for the reason you think. Your nursing staff will be virtual.
Many organizations are turning to virtual nursing to address staffing and wellbeing, and with the current trajectory virtual care will be an integral part of the future of healthcare.
So, while your rooms won’t be completely devoid of in-person nurses, soon an entire department of onsite clinical staff will be a thing of the past.
Our CNO editor G Hatfield spoke to some of the best in the industry in virtual nursing and dug into how nurse leaders can adapt and advance.
Did you miss our July cover story on the rise of the advanced practice provider? No worries, you can read it here.
Ochsner Health and Kaiser Permanente are the latest to integrate the technology, which documents the patient encounter and prepares it for the EHR.
Healthcare organizations are increasingly drawn to ambient AI as a means of quietly and unobtrusively capturing the doctor-patient conversation.
Ochsner Health recently announced a partnership with Deepscribe to make its ambient clinical documentation tool available on the Epic EHR platform to clinicians in the health system’s 46 hospitals and 370 health and urgent care centers. And Kaiser Permanente has unveiled a deal with Abridge to make a similar AI tool available to clinicians in 40 hospitals and more than 600 sites across eight states and Washington DC.
The technology acts as a medical scribe, listening to the doctor-patient encounter and transcribing the interaction for the medical record. The finished product is available shortly after the encounter, enabling clinicians to quickly review and edit the information before it’s populated in the EHR.
The attraction for healthcare executives is threefold. Ambient AI is designed to target three pain points:
Improve patient care by personalizing care management;
Boost operational efficiency by improving documentation and care coordination; and
Improve data extraction by pulling relevant information from the EHR (and, potentially, other sources) to improve patient care and identify cost savings.
Ambient AI is “probably one of the fastest growing products that we have witnessed in terms of how quickly physicians are taking to it and adopting it,” Harjinder Sandhu CTO at Microsoft’s Health and Life Sciences Platforms and Solutions,” said in a HealthLeaders interview this past February in advance of the ViVE conference in Los Angeles. “It is starting to make an enormous difference in how physicians view their work and their work-life balance.”
Healthcare executives say the tool aims to remove the barrier of technology between patient and doctor, by taking the pressure off of clinicians to document the patient encounter and enabling them to talk and interact with the patient.
“We believe that ambient listening … is a reliable, affordable, and scalable solution which we can use to help alleviate the burden of documentation to our wide group of over 4,000 providers across Louisiana, Mississippi, and Texas,” Jason Hill, Ochsner Health’s innovation officer, said in an e-mail to HealthLeaders.
“There are multiple steps of quality analysis which exist within Deepscribe as well as internally that we have done and continue to perform to ensure that our documentation is of the highest quality and reflective of the patient and provider conversation,” Hill added. “We feel that the capability to access the audio transcripts of the patient/provider interviews provides a superior source of truth vs. the current process, which puts the burden on the provider to remember all of the information that they were required to document.”
Ramin Davidoff, MD, executive medical director and chair of the board with the Southern California Permanente Medical Group, said Kaiser Permanente has worked with Abridge for the past year to integrate the new tool into clinician workflows.
"Our physicians strive to make every interaction with patients matter and work to establish a good rapport with our members so they know they are understood and heard," he said in a press release, noting the tool isn’t used without the patient’s consent. "Creating space for the patient and the physician connection is what inspired us to implement this technology. And we hope that those connections and improved efficiencies will help with the sustainability of the practice of medicine for many doctors."
Stanford Medicine partnered with Microsoft’s Nuance Communications to launch a DAX Copilot ambient AI app this past spring, following a pilot program at Stanford Health Care.
“This could have a transformative impact on the way we provide clinical care,” Niraj Sehgal, MD, CMO at Stanford Health Care, said in a new story published by the health system. AI tools will never replace the clinician, but it might replace parts of their workflow,” Sehgal said.
That could eventually include AI tools that not only capture the conversation, but suggest diagnoses and appropriate treatments.
“As people get more comfortable using AI-powered technology, it creates a fertile ground to continue adapting other tools for the workplace that support providers, freeing them to better care for patients,” Sehgal said.
