UPMC has sold a virtual consult tool developed during the pandemic to virtual care company eVisit and, along with MedStar Health, is investing in the company to foster future innovation opportunities.

A virtual consult tool developed by UPMC during the height of the COVID-19 pandemic is being sold to eVisit to enhance its inpatient telemedicine platform.

At the same time, both UPMC Enterprises and MedStar Health are investing in the Arizona-based virtual care company “to pursue co-development opportunities.”

The transactions point to the shifting nature of health system-based telemedicine and the value of hospital-vendor partnerships in expanding enterprise-wide platforms. More and more healthcare organizations are the seeing the benefits of developing and marketing their own capabilities to companies who can then integrate those tools into a much larger platform.

[Also read: New Report Details Health Systems Investments in Innovation.]

"Our guiding mission at UPMC Enterprises is to develop solutions to the clinical needs identified by the thousands of physicians at UPMC who provide lifesaving care to our patients," Brenton Burns, executive vice president at UPMC Enterprises, said in a press release. "When we create something like the teleconsult technology that so brilliantly achieves that goal and becomes a vital part of our clinical operations, we look for partners who can help us make it available to clinicians and patients outside our walls. We're excited to have found that partner in eVisit. Bringing these two technologies together creates a powerful end-to-end virtual care platform."

UPMC developed the technology in 2020 to facilitate virtual consults between bedside clinicians and specialists in stroke, neurology, critical care, psychology, and toxicology. The idea behind the tool was to help clinicians in rural locations and those beleaguered by a crush of pandemic patients to access help on demand, improving care management and speeding up care coordination. According to the health system, the tool has facilitated 40,000 consults and curbed wait times by 92%.

Bolting that capability onto eVisit’s virtual care platform will give more health systems the opportunity to use it. That includes Maryland-based MedStar Health, which has worked with eVisit since 2018 and collaborated with the vendor to develop its MedStar Health Connected Care transformation model.

[Also read: The Exec: MedStar Health's William Sheahan Sees A Future in Connected Care.]

"Our growing partnership with eVisit continues to redefine what is possible with care delivery powered by the best digital innovation and expertise," William Sheahan, the health system’s  chief innovation officer and executive director of the MedStar Institute for Innovation, said in the release. "As we expand our work together, we sharpen our focus on acute care to strengthen newer capabilities such as virtual nursing, while continually pushing past boundaries through bold new innovation and action across the continuum of care." 

CNOs must come up with innovative ways to prevent workplace violence.

Nurses across the country are experiencing record levels of workplace violence, for many different reasons. 

CNOs are responsible for the health and wellness of their nursing workforce, and it is imperative that they implement prevention measures and prepare nurses for what they might face. 

Here's what you need to know about workplace violence, according to Mary Beth Kingston, executive vice president and CNO at Advocate Health, and Gail Schuetz, associate CNO of inpatient services at the University of Kansas Health System, interim CNO at Olathe Medical Center, and HealthLeaders Exchange member. 

Click here to read the full story.

The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page. 

To inquire about attending a HealthLeaders Revenue Cycle Exchange event, email us at exchange@healthleadersmedia.com. 

The California health system is partnering with Best Buy Health to launch a remote patient monitoring platform to serve patients living with hypertension.

UC Davis Health is partnering with Best Buy Health on a remote patient monitoring program targeting hypertension control.

The Sacramento-based health system has signed a deal with the retail giant’s care-at-home business, Current Health, to supply RPM equipment, including digital blood pressure cuffs and scales, and a monitoring platform to selected patients. All data collected from that platform is then integrated into the health system’s EHR platform and accessed by the UC Davis Health Connected Care Center.

“Our integrated approach will provide patients with blood pressure monitoring and clinical support in real-time,” Bruce Hall, UC Davis Health’s chief clinical officer, said in a press release. “This collaboration is another example of how we are finding innovative ways to make health care more convenient, and more accessible to every patient, no matter who they are or where they live.”

[Read also: Assessing the Evolution of Remote Patient Monitoring Programs.]

The partnership is the latest in a series of collaborations for Best Buy Health and Current Health, which bring a consumer-facing retail strategy into the mix for health systems eager to improve care management at home as they more programs and services out of the hospital setting. The company is working with Baptist Health, OSF HealthCare, Geisinger, Atrium Health, Mount Sinai, NYU Langone Health, and Mass General Brigham, which signed a deal last September to support its Home Hospital program.

The UC Davis partnership takes aim at a condition that kills roughly 860,000 Americans each year, according to the American Medical Association, but can be easily monitored and even controlled through an RPM platform that gives care teams and on-demand link to patients at home.

Through that platform, the care team can track each participating patient’s blood pressure and weight throughout the day, and intervene with care recommendations or even adjust a care plan if a patient’s readings trend in the wrong direction.

The Best Buy link takes the technology and the monitoring workflow out of the hands of the care team, allowing them to focus on patient care, and puts it in the hands of Current Health staff, who visit the patient’s home 9much like the well-known Geek Squad) and set up the patient for the RPM platform, then make sure that platform is collecting and sending data properly.

In the long run, UC Davis Health can use that platform to add other care management services, such as offering group classes, one-on-one coaching and other resources. The health system also plans to expand the RPM program to serve patients living with other chronic conditions.

Deloitte pulls in billions of dollars from states and the federal government for supplying technology it says will modernize Medicaid. So far, that hasn't gone very well. 

By Rachana Pradhan and Samantha Liss

Deloitte, a global consultancy that reported revenue last year of $65 billion, pulls in billions of dollars from states and the federal government for supplying technology it says will modernize Medicaid.

The company promotes itself as the industry leader in building sophisticated and efficient systems for states that, among other things, screen who is eligible for Medicaid. However, a KFF Health News investigation of eligibility systems found widespread problems.

The systems have generated incorrect notices to Medicaid beneficiaries, sent their paperwork to the wrong addresses, and been frozen for hours at a time, according to findings in state audits, allegations and declarations in court documents, and interviews. It can take months to fix problems, according to court documents from a lawsuit in federal court in Tennessee, company documents, and state agencies. Meanwhile, America’s poorest residents pay the price.

Deloitte dominates this important slice of government business: Twenty-five states have awarded it eligibility systems contracts — with 53 million Medicaid enrollees in those states as of April 1, 2023, when the unwinding of pandemic protections began, according to the Centers for Medicare & Medicaid Services. Deloitte’s contracts are worth at least $5 billion, according to a KFF Health News review of government contracts, in which Deloitte commits to design, develop, implement, or operate state systems.

State officials work hand in glove with Deloitte behind closed doors to translate policy choices into computer code that forms the backbone of eligibility systems. When things go wrong, it can be difficult to know who’s at fault, according to attorneys, consumer advocates, and union workers. Sometimes it takes a lawsuit to pull back the curtain.

Medicaid beneficiaries bear the brunt of system errors, said Steve Catanese, president of Service Employees International Union Local 668 in Pennsylvania. The union chapter represents roughly 19,000 employees — including government caseworkers who troubleshoot problems for recipients of safety-net benefits such as health coverage and cash assistance for food.

“Are you hungry? Wait. You sick? Wait,” he said. “Delays can kill people.”

KFF Health News interviewed Medicaid recipients, attorneys, and former caseworkers and government employees, and read thousands of pages from contracts, ongoing lawsuits, company materials, and state audits and documents that show problems with Deloitte-operated systems around the country — including in Arkansas, Colorado, Florida, Georgia, Kentucky, Pennsylvania, Rhode Island, Tennessee, and Texas.

In an interview, Kenneth Smith, a Deloitte executive who leads its national human services division, said Medicaid eligibility technology is state-owned and agencies “direct their operation” and “make decisions about the policies and processes that they implement.”

“They’re not Deloitte systems,” he said, noting Deloitte is one player among many who together administer Medicaid benefits.

Alleging “ongoing and nationwide” errors and “unfair and deceptive trade practices,” the National Health Law Program, a nonprofit that advocates for people with low incomes, urged the Federal Trade Commission to investigate Deloitte in a complaint filed in January.

“Systems built by Deloitte have generated numerous errors, resulting in inaccurate Medicaid eligibility determinations and loss of Medicaid coverage for eligible individuals in many states,” it argued. “The repetition of the same errors in Deloitte eligibility systems across Texas and other states and over time demonstrates that Deloitte has failed.”

FTC spokesperson Juliana Gruenwald Henderson confirmed receipt of the complaint but did not comment further.

Smith called the allegations “without merit.”

The system problems are especially concerning as states wade through millions of Medicaid eligibility checks to disenroll people who no longer qualify — a removal process that was paused for three years to protect people from losing insurance during the covid-19 public health emergency. In that time, nationwide Medicaid enrollment grew by more than 22 million, to roughly 87 million people. At least 22.8 million have been removed as of June 4 , according to a KFF analysis of government data.

Advocates worry many lost coverage despite being eligible. A KFF survey of adults disenrolled from Medicaid during the first year of the unwinding found that nearly 1 in 4 adults who were removed are now uninsured. Nearly half who were removed were able to reenroll, the survey showed, suggesting they should not have been dropped in the first place.

“If there is a technology challenge or reason why someone can’t access health care that they're eligible for, and we're able to do something,” Smith said, “we work tirelessly to do so.”

Deloitte’s contracts with states regularly cost hundreds of millions of dollars, and the federal government pays the bulk of the cost.

“States become very dependent on the consultant for operating complex systems of all kinds” to do government business, said Michael Shaub, an accounting professor at Texas A&M University.

Georgia’s contract with Deloitte to build and maintain its system for health and social service programs, inked in 2014, as of January 2023 was worth $528 million. This January, state officials wrote in an assessment obtained by KFF Health News that its eligibility system “lacks flexibility and adaptability, limiting Georgia’s ability to serve its customers efficiently, improve the customer and worker experience across all programs, ensure data security, reduce benefit errors and fraud, and advance the state’s goal of streamlining eligibility.”

Deloitte and the Georgia Department of Community Health declined to comment.

Deloitte is looking ahead with its “path to Medicaid in 2040,” anticipating sweeping changes that will expand its own business opportunity.

“State Medicaid leaders and policymakers are hungry to know what the future of health care holds,” the company said. “Deloitte brings the innovative tools, subject matter expertise, and time-tested experience to help states.”

Trouble in Tennessee

When Medicaid eligibility systems fail, beneficiaries suffer the consequences.

DiJuana Davis had chronic anemia that required iron infusions. In 2019, the 39-year-old Nashville resident scheduled separate surgeries to prevent pregnancy and to remove the lining of her uterus, which could alleviate blood loss and ease her anemia.

Then Davis, a mom of five, received a shock: Her family’s Medicaid coverage had vanished. The hospital canceled the procedures, according to testimony in federal court in November.

Davis had kept her insurance for years without trouble. This time, Tennessee had just launched a new Deloitte-built eligibility system. It autofilled an incorrect address, where Davis had never lived, to send paperwork, an error that left her uninsured for nearly two months, according to an ongoing class-action lawsuit Davis and other beneficiaries filed against the state.

The lawsuit, which does not name Deloitte as a defendant, seeks to order Tennessee to restore coverage for those who wrongly lost it. Kimberly Hagan, Tennessee Medicaid’s director of member services, said in a court filing defending the state’s actions that many issues “reflect some unforeseen flaws or gaps” with the eligibility system and “some design errors.”

Hagan’s legal declaration in 2020 gave a view of what went wrong: Davis lost coverage because of missteps by both Tennessee and Deloitte during what’s known as the “conversion process,” when eligibility data was migrated to a new system.

Tennessee’s Medicaid agency, known as “TennCare, along with its vendor, Deloitte, designed rules to govern the logic of conversion,” Hagan said in the legal declaration. She also cited a “manual, keying error by a worker” made in 2017.

Davis’ family was “incorrectly merged with another family during conversion,” Hagan said.

Davis regained coverage, but before she could rebook the surgeries, she testified, she became pregnant and a serious complication emerged. In June 2020, Davis rushed to the hospital. A physician told her she had preeclampsia, a leading cause of maternal death. Labor was induced and her son was born prematurely.

“Preeclampsia can kill the mom. It can kill the baby. It can kill both of you,” she testified. “That’s like a death sentence.”

Deloitte’s Tennessee contract is worth $823 million. Deloitte declined to comment on Davis’ case or the litigation.

Speaking broadly, Smith said, “data conversion is incredibly challenging and difficult.”

Hagan called the problems one-time issues: “None of the Plaintiffs’ cases reflect ongoing systemic problems that have not already been addressed or are scheduled to be addressed.”

States leverage Deloitte’s technology as part of a larger push toward automation, legal aid attorneys and former caseworkers said.

“We all know that big computer projects are fraught,” said Gordon Bonnyman, co-founder of the nonprofit Tennessee Justice Center. “But a state that was concerned about inflicting collateral damage when they moved to a different automated system would have a lot of safeguards.”

TennCare spokesperson Amy Lawrence called its eligibility system “a transformative tool, streamlining processes and enhancing accessibility.”

When enrollees seek help at county offices, “you don’t get to sit down across from a real human being,” Bonnyman said. “They point you to the kiosk and say, ‘Good luck with that.’”

A Backlog of 50,000 Cases

As part of the Affordable Care Act rollout about a decade ago, states invested in technological upgrades to determine who qualifies for public programs. It was a financial boon to Deloitte and such companies as Accenture and Optum, which landed government contracts to build those complex systems.

Problems soon emerged. In Kentucky, a Deloitte-built system that launched in February 2016 erroneously sent at least 25,000 automated letters telling people they would lose benefits, according to local news reports. State officials manually worked through a backlog of 50,000 cases caused by conflicting information from newly merged systems, the reports say.

“We know that the rollout of Benefind has caused frustration and concern for families and for field staff,” senior Deloitte executive Deborah Sills said during a March 2016 news conference alongside Gov. Matt Bevin and other senior officials after Kentucky was bombarded with complaints. Within two months, roughly 600 system defects were identified, found a report by the Kentucky state auditor.

In Rhode Island, a botched rollout in September 2016 delayed tens of thousands of Social Security payments, The Providence Journal reported. Advocacy groups filed two class-action lawsuits, one related to Medicaid and the other to food stamp benefits. Both were settled, with Rhode Island officials denying wrongdoing. Neither named Deloitte as a defendant.

In a 2018 statement for a Statehouse hearing, Sills of Deloitte said, “We are very sorry for the impact that our system issues have had on your constituents, on state workers, and on service providers.” The state’s top human services official resigned.

A 2017 audit by a top Rhode Island official prepared for Gov. Gina Raimondo found that Deloitte “delivered an IT system that is not functioning effectively” and had “significant defects.” “Widespread issues,” it said, “caused a significant deterioration in the quality of service provided by the State.”

“Deloitte held itself out as the leading vendor with significant experience in developing integrated eligibility systems for other states,” the audit read. “It appears that Deloitte did not sufficiently leverage this experience and expertise.” Deloitte declined to comment further about Rhode Island and Kentucky.

Deloitte invokes the phrase “no-touch” to describe its technology — approving benefits “without any tasks performed by the State workers,” it wrote in documents vying for an Arkansas contract.

In practice, enrollee advocates and former government caseworkers say, the systems frequently have errors and require manual workarounds.

As it considered hiring Deloitte, Arkansas officials asked the company about problems, particularly in Rhode Island.

In response, the company said in 2017, “We do not believe Deloitte Consulting LLP has had to implement a corrective action plan” for any eligibility system project in the previous five years.

Arkansas awarded Deloitte a $345 million contract effective in 2019 to develop its system.

“It had a lot of bugs,” said Bianca Garcia, a program eligibility specialist for the Arkansas Department of Human Services from August 2022 to October 2023.

Garcia said it could take weeks to fix errors in a family’s details and Medicaid enrollees wouldn’t receive the state’s requests for information because of glitches. They would lose benefits because workers couldn’t confirm eligibility, she added.

The enrollees “were doing their part, but the system just failed,” Garcia said.

Arkansas Department of Human Services spokesperson Gavin Lesnick said: “With any large-scale system implementation, there occasionally are issues that need to be addressed. We have worked alongside our vendor to minimize these issues and to correct any problems.”

Deloitte declined to comment.

‘Heated’ Negotiations

In late 2020, Colorado officials were bracing for the inevitable unwinding of pandemic-era Medicaid protections.

Colorado was three years into what is now a $354.4 million contract with Deloitte to operate its eligibility system. A state-commissioned audit that September had uncovered widespread problems, and Kim Bimestefer, the state’s top Medicaid official, was in “heated” negotiations with the company.

The audit found 67% of the system notices it sampled contained errors. Notices are federally required to safeguard against eligible people being disenrolled, said MaryBeth Musumeci, an associate teaching professor in public health at George Washington University.

“This is, for many people, what’s keeping them from being uninsured,” Musumeci said.

The Colorado audit found many enrollee notices contained inaccurate response deadlines. One dated Dec. 19, 2019, requested a beneficiary return information by Sept. 27, 2011 — more than eight years earlier.

“We’re in intense negotiations with our vendor because we can’t turn around to the General Assembly and say, ‘Can I get money to fix this?’” Bimestefer told lawmakers during the 2020 legislative audit hearing. “I have to hold the vendor accountable for the tens of millions we’ve been paying them over the years, and we still have a system like this.”

She said officials had increased oversight of Deloitte. Also, dozens of initiatives were created to “improve eligibility accuracy and correspondence,” and the state renegotiated Deloitte’s contract, said Marc Williams, a state Medicaid agency spokesperson. A contract amendment shows Deloitte credited Colorado with $5 million to offset payments for additional work.

But Deloitte’s performance appeared to get worse. A 2023 state audit found problems in 90% of sampled enrollee notices. Some were violations of state Medicaid rules.

The audit blamed “flaws in system design” for populating notices with incorrect dates.

In September, Danae Davison received a confusing notice at her Arvada home stating that her daughter did not qualify for coverage.

Lydia, 11, who uses a wheelchair and is learning to communicate via a computer, has a seizure disorder that qualifies her for a Medicaid benefit for those with disabilities. The denial threatened access to nursing care, which enables her to live at home instead of in a facility. Nothing had changed with Lydia’s condition, Davison said.

“She so clearly has the need,” Davison said. “This is a system problem.”

Davison appealed. In October, a judge ruled that Lydia qualified for coverage.

The notice generated by the Deloitte-operated system was deemed “legally insufficient” because it omitted the date Lydia’s coverage would end. Her case highlights a known eligibility system problem: Beneficiary notices contain “non-compliant or inconsistent dates” and are “missing required elements and information,” according to the 2023 audit.

Deloitte declined to comment on Colorado. Speaking broadly, Smith said, “Incorrect information can come in a lot of forms.”

Last spring in Pennsylvania, Deloitte’s eligibility role expanded to include the Children’s Health Insurance Program and 126,000 enrollees.

Pennsylvania’s Department of Human Services said an error occurred when converting to the state’s eligibility system, maintained by Deloitte through a $541 million contract. DHS triaged the errors, but, for “a small window of time,” some children who still had coverage “were not able to use it.”

These issues affected 9,269 children last June and 2,422 in October, DHS said. A temporary solution was implemented in December and a permanent fix came through in April.

Catanese, the union representative, said it was another in a long history of problems. Among the most prevalent, he said: The system freezes for hours. When asked about that, Smith said “it's hyperbole.”

Instead of the efficiency that Deloitte touted, Catanese said, “the system constantly runs into errors that you have to duct tape and patchwork around.”

KFF Health News senior correspondent Renuka Rayasam and correspondents Daniel Chang, Bram Sable-Smith, and Katheryn Houghton contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Workplace violence incidents in healthcare are seemingly on the rise. Let's take a look at why, according to these nurse leaders.

Nurses across the country are experiencing record levels of workplace violence.

According to a National Nurses United report, in 2023, eight in 10 nurses experienced at least one type of workplace violence within the past year. Additionally, 45.5% of nurses reported an increase in workplace violence on their unit in the previous year.

The nurses involved in the report cited many types of violence, with 67.8% reporting verbal threats and 38.7% reporting physical threats. Nurses experienced being pinched, scratched, punched, kicked, spat on, and groped at alarming rates. Only 18.4% of participants reported no experiences of workplace violence.

CNOs are responsible for the health and wellness of their nursing workforce, and it is imperative that they come up with innovative ways to prevent workplace violence.

Understanding the numbers

According to Mary Beth Kingston, executive vice president and CNO at Advocate Health, it's hard to say one way or another that the incidents are rising, but it has become a more publicized issue.

"I'm not sure we have a have a good baseline to even say that [incidents are] increasing," Kingston said. "With that being said, it certainly feels as though things are increasing and we’re hearing about it more and more."

However, Kingston explained that in health systems implementing basic measures to prevent workplace violence, there have been improvements. Those measures include training and better reporting processes that can help identify where issues are, so health systems can target their approach. Health systems should also have risk and assessment processes, mobile duress technology, and behavioral health response teams.

"There's a number of basic foundational things that we can put in place to help keep all those providing care safe," Kingston said, "and not just those providing care, but everybody in the whole environment safe."

According to Gail Schuetz, associate CNO of inpatient services at the University of Kansas Health System, interim CNO at Olathe Medical Center, and HealthLeaders Exchange member, the uptick is due to more reporting and less tolerance amongst nurses.

"Historically, nurses sort of accepted that there was a certain amount of abuse that they would have to take as part of their job," Schuetz said, "so it was and is drastically under reported."

Schuetz also said that the lack of resources for people with mental health conditions might also be contributing to the issue.

"If someone has a challenging life situation that requires some type of care in a facility, those facilities are not always available," Schuetz said, "and so the hospital becomes kind of the de facto place to put the patients so that they're kept safe."

Identifying the root cause

CNOs and other leaders need to first identify the reasons workplace violence is occurring in their health systems. For Kingston, it's important to consider the patient's perspective.

"It could be fear of the unknown or a fear of diagnosis that causes them to react, or pain," Kingston said. "Sometimes it can result from frustrations in some of our processes, [such as] long wait times."

For other patients, it could be cognitive difficulties or behavioral health issues. However, Kingston emphasized that it's important not to stereotype those patients.

"This is not to say that it is patients who have behavioral health problems are the ones that cause violent incidents all the time," Kingston said, "and I think sometimes we do jump to that decision, but there are certainly circumstances."

Kingston also mentioned that recently, there has been a general lack of boundaries between patients and nurses. CNOs must work to reemphasize the role of the patient and the nurse in a healthcare environment, and reinforce those boundaries between the patient and their care team.

"So again, [there are] many, many reasons [that workplace violence occurs]," Kingston said, "which makes it difficult to have the formula to say here's what we can do in every situation to prevent or to mitigate."

Training the workforce

One of the best things CNOs and other nurse leaders can do for their nurses is prepare and train them properly. According to Schuetz, nurses need to know how to identify and assess patients that may be at risk for violence. It's critical that nurses use the proper assessment tools so that they can get the support they need.

"Coming into the hospital, you might have a patient that has not and does not appear to be violent or have violent tendencies," Schuetz said. "The added stress of being in the hospital often just brings out the worst in people that already have a propensity to act out in certain situations."

Nurses also need to be aware of their environments and know the proper procedures for when incidents do occur. De-escalation training is crucial, according to Kingston and Schuetz.

"We have yearly training around how to de-escalate patients that are escalating," Schuetz said. "Sometimes, we're inadvertently causing patients to be escalated."

"It's really about listening and trying to understand what's going on before something erupts," Kingston said. "Practicing with de-escalation, even having folks act in the patient role and being able to practice that, I think is important."

Kingston believes more advanced training is necessary for nurses who work in high-risk areas, including self-defense.

"I don't know that everyone needs that, but certainly de-escalation and more of a focus on trauma informed care," Kingston said, "understanding where that patient is at as they're coming in…so that we can try to understand [and] mitigate before it becomes very difficult."

Peer support training is also key, so that nurses know how to help each other in the workplace setting.

"That to me is so important because [in] these situations, if our response is elevated and the patent is not as elevated yet, they will rise up to meet us," Kingston said.

According to Kingston, training should start as soon as possible while the nurses are in their undergraduate degree programs. To Schuetz, it comes down to looking at the tools that are available to you, and utilizing both mandatory and optional training.

"For nursing, there's so many things that we have to teach and train," Schuetz said. "Healthcare workers are just inundated with information and so they don't always know what's available to them."

Ultimately, it comes down to communication and using a combination of methods to try and prepare the nurses for what they might face.

"I'm a firm believer that it's a million little things that make a difference," Schuetz said. "If there was one thing that could solve this, that would have happened many, many moons ago."

Part two of this piece will be published on Monday, July 8, 2024.

The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page. 

To inquire about attending a HealthLeaders CNO Exchange event, email us at exchange@healthleadersmedia.com. 

Nurses need to understand how AI will impact their workflows, says this CNE. 

HealthLeaders spoke to Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy, about how to communicate with nurses about AI and its purpose. Tune in to hear her insights.

Click here to read the accompanying article. 

Cleveland-based University Hospitals is partnering with Aidoc to help radiologists screen CT scans and make care delivery more efficient

Clinicians dread the missed spot on a CT scan or X-ray that leads to a serious health concern. Now health systems are using AI to make sure those mistakes don’t happen.

University Hospitals recently announced a partnership with AIdoc to deploy the company’s aiOS platform across all 13 hospitals and dozens of outpatient facilities in the Cleveland-based health system. The technology aims to assist clinicians by giving them another tool to analyze images.

‘[We’re] looking to see if we’re finding things that we would have otherwise not seen,” says Donna Plecha, MD, the health system’s Chair of Radiology. “We work with AI – it is not replacing our reads. And I think most studies that look at AI with a radiologist, that combination usually does better than either one by itself.”

The distinction—is AI artificial or augmented intelligence?—encapsulates both the promise and the peril of the technology, which has drawn comparisons for its effect on healthcare to both the printing press and the Terminator. Advocates say AI will work best as a tool that clinicians can use to improve their work and their workflows, rather than a replacement for a doctor or nurse.

Plecha notes the difference, saying clinicians will always be reviewing AI output for accuracy. She says the presence of false negatives and false positives in early AI results supported that position.

“I think they’re realizing how careful they have to be and not believing everything that AI is marking,” she says.

As for the potential, UH officials point to the opportunity for AI to pick up on infinitesimal aspects of a CT scan or X-ray that might bypass the naked eye. That tiny spot could be a sign of a pulmonary embolism, aortic dissection, vertebral compression fracture, or pneumothorax. Identifying those and other acute health concerns early means the patient is moved more quickly to the appropriate care provider and treated more quickly and efficiently.

“The technology identifies both expected and unexpected findings, helps physicians prioritize urgent cases, and ensures all flagged conditions are reviewed by the care team,” the health system said in a press release announcing the partnership.

Plecha says the health system will review all the data collected by the AI platform for accuracy and outcomes before expanding the platform to other departments and use cases. That review process will also help clinicians better understand how to use AI and what to look for.

Aside from improving accuracy and care team efficiency, Plecha says the tool will also help University Hospitals make the most out of its limited supply of radiologists, addressing workforce shortages that are plaguing health systems and hospitals across the country. It will, she says, enable radiologists 9and, eventually, other clinicians) to work with more confidence and at the top of their license.

The idea of using AI to improve workflows isn’t new. Texas-based CHRISTUS Health, in announcing a partnership this week with Abridge to implement a clinician conversation tool, noted the effect on “cognitive load,” or the amount of mental effort needed to complete a task.

According to CHRISTUS officials, the AI tool helped reduce physician burnout by some 78% during a pilot earlier this year. With the AI tool, they said, physicians were under less stress and were able to perform their task better and more efficiently.

“I feel much less distracted with patients since I can focus on the conversation and history without pausing to take extensive notes or re-ask questions I missed during notetaking,” Myriah Willborn, MD, a family medicine doctor at the CHRISTUS Trinity Clinic in Corpus Christi, said in a statement issued by the health system.

The concern, of course, is that clinicians become too reliant on the technology, expecting it to be perfect and catch anything they miss. That’s where continuous review comes into play, along with the understanding that clinicians always have the final say in care and are using AI only as a tool to improve their decision-making.

To that end, Plecha says she sees a future where AI not only reads an image, but combs through all other information databases, from the EHR to other tests and exams, even outside sources reflecting social determinants of health, to form a more complete picture of the patient and recommend diagnoses and other treatments.

“In the future it’s going to be impossible to be a radiologist and not use AI,” she says.