Nurse leaders must do their best to help maintain patient privacy and be prepared to pivot as regulatory requirements change.

As nurse leaders, it's important to guide the workforce to do their best to safeguard patient rights and privacy.

On June 2, the FBI released a call to action via its official X account stating that they wish for individuals to report tips of any "hospitals, clinics, or practitioners" performing surgical procedures on children "under the guise of gender-affirming care."

This calls into question the issue of patient rights to privacy, and it presents an ethical problem for nurses who want to care for their patients to the best of their ability. CNOs need to understand the current policies regarding the release of patient information to best equip their nurses to care for transgender and gender nonconforming patients.

Current policy

Under the Biden administration, HHS' Office of Civil Rights (OCR) implemented the 2022 HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy (2022 OCR Notice and Guidance), which stated that medical interventions for transgender minors may improve physical and mental health outcomes.

The notice specifically stated that healthcare providers and entities could not disclose protected health information (PHI) about gender-affirming care without patient authorization. This provided transgender patients with protections under HIPAA. The only exception was in circumstances where providers were explicitly required by the law to do so.

However, on Feb. 20, 2025, that guidance was rescinded, in response to Executive Order 14187, "Protecting Children from Chemical and Surgical Mutilation," which was put forth by the Trump administration. HHS stated that their basis for recission was that the 2022 OCR Notice and Guidance lacked legal basis under federal privacy laws, including HIPAA Privacy, Security, and Breach Notification Rules.

What comes next

So, what does this mean for health systems, and, more specifically, for nurse leaders?

As of right now, EO 14187 has been put on hold as two different legal challenges to the EO make their way through the courts. According to analysis from law firm Husch Blackwell, this means that currently providers and health systems do not have to choose between complying with the 2022 OCR Notice and Guidance and EO 14187, pending the outcome of those legal challenges.

For CNOs and other clinical leaders, it's important to remain in compliance with current legal requirements and to be proactive by creating internal policies that can evolve with regulatory updates. CNOs should instruct their nurses to remain in compliance with HIPAA requirements and work to safeguard PHI for transgender patients.

The Nashville-based health system’s new chief digital & transformation officer says it’s her goal to create lasting relationships between the health system and its patients. And that begins with helping providers.

Ask Anika Gardenhire about transformation, and she’ll bring up a concept that has only recently entered the healthcare lexicon: The idea of stickiness.

“[My] priorities are really building experiences for all of our different [patients] and making those experiences extremely sticky,” says Gardenhire, RN, CHCIO,  Ardent Health’s new chief digital & transformation officer.  And her goal, she says, is to “be able to have the type of trusted relationship across the [patient’s journey].”

That idea of stickiness, of enticing a consumer to continue to visit Ardent Health and develop loyalty to the Nashville-based 30-hospital for-profit network, is quickly becoming a catchphrase for many healthcare organizations these days. No longer can a hospital sit back and wait for patients for waltz through the front door; hospital leaders need to be proactive, reaching out to people and meeting them where they need or want their care, creating a sense of partnership.

It's not an easy path to follow at a time when healthcare services can be accessed via telehealth networks, or by visiting retail health centers, or even ordered through Amazon, but that’s the nature of consumer-focused care. And health systems and hospitals are finding they have to embrace new ideas like stickiness to create the relationships they need to survive.

Gardenhire, who became Ardent Health’s first chief digital and information officer in 2023, had “information” replaced with “transformation” in her title this past March. The title change reflects a shift in the healthcare narrative toward value-based care, along with the idea that the industry needs to transform itself to meet consumer preferences.

That means, she says, making a connection with the consumer.

“I don’t think there will be a time where a mom looks through the legs and sees a robot delivering the baby,” she says. “That’s always a very human experience. But how do you surround the obstetrician with the right data and the right tools and the removal of tasks that don’t require the very unique art of building a human-to-human connection? Get all of those things out of the way of that connection happening.”

Anika Gardenhire, chief digital & transformation officer at Ardent Health. Photo courtesy Ardent Health.

That’s where the “digital” part of her title comes in. Gardenhire, who spent time as the AVP of digital transformation at Intermountain Healthcare and chief digital officer and chief customer experience officer at Centene before coming to Ardent Health, sees digital health technology as the framework around which the healthcare experience is created. That means giving both patient and provider the technology they need to make the encounter better, from online scheduling to remote monitoring to AI tools that reduce administrative tasks on both ends and smooth out clinical care.

This doesn’t mean using any and all technology at one’s disposal. Gardenhire says Ardent Health’s technology strategy has to be very purposeful and directed.

“If we want healthcare to be a very human experience, then you probably can’t put a lot of shiny baubles between the human connection,” she says. “You need to be thinking very intentionally about how you put technology in the background and … promote human connection.”

For example, Gardenhire says she’s fascinated by what she calls “calm technologies.” They’re the tools that sit in the background, quietly gathering and assessing data (such as the doctor-patient conversation) and enriching care management without standing between the doctor and patient or disrupting the experience.

She also feels that innovation and transformation should have a destination, rather than being a continuous, even incremental, process.

“Sometimes we can get into a place where we’re trickling in transformation and nobody actually knows when to click into it,” she says. “I think that’s really dangerous, especially in our clinical spaces. [We need to] be very clear about this transformation. This is the ‘from’ and the ‘to,’ and we won’t be ‘ing’ing forever.”

In other words, tell your clinicians what you’re doing, and give them ownership over the transformation process.

“At the end of the day it has to be clinician-led transformation,” she says.

Gardenhire sees a lot of opportunities for healthcare innovation, from the supply chain to the hospital room of tomorrow. She anticipates more clinical uses for consumer tech, especially is the industry develops smaller, lighter and more nimble tools that can reliable and securely capture data. And as telehealth and virtual care gather momentum, the idea of transporting a patient from one hospital to another will become as quaint as the rotary phone.

In fact, Gardenhire sees the home as the next big care site, enhanced with technology that can gather daily information, capture social determinants of health, interact with users and connect with care providers.

There will come a time, she says, “when you can actually see that person at home, surrounded by the things they need to care for them and [for them to] manage their chronic diseases, but which allows them to still move through their house and walk their dog down the street, all while they’re monitoring themselves. Or [you’ll have technology] that allows a child with asthma to be monitored during the night and not have to wake up because we can raise the humidity in the room or release a nebulizer without sleep being disrupted.”

“When you imagine all of those things coming together that we’ve built out – not only the applications and not only the cool technology but also the infrastructure,” she concludes. “I think it’s a really awesome time to be in this space.”

CNOs need to keep tabs on the current state of nursing education so they can adjust accordingly.

In the U.S., industry leaders and experts often discuss the nursing shortage and its impact on the healthcare industry. Shortages can leave the entire workforce feeling burned out, resentful, and angry, and the impact on patient care is even greater.

As CNOs work to recruit and retain nurses, both locally and internationally, it's important to understand that the nursing industry in the U.S. is only one piece of the puzzle. Globally, the situation is incredibly complex and the challenges go beyond just workforce shortages.

Nursing education is just as important for CNOs to keep an eye on, and according to the World Health Organization’s (WHO) State of the world’s nursing 2025 report, the education situation is a mixed bag. 

Here's what CNOs need to know. 

Click here to read the accompanying article.

There are several positive and not-so-positive trends that CNOs should pay attention to in the workforce, says this CEO.

On this episode of HL Shorts, we hear from Phil Dickison, CEO of The National Council of State Boards of Nursing (NCSBN), about what the 2024 National Nursing Workforce study reveals about the current state of the nursing workforce. Tune in to hear his insights.

A new survey finds that home health agencies are abandoning virtual care due to complexity and a lack of reimbursement. This could hinder efforts by healthcare leaders to extend more hospital services into the home.

Home health agencies embraced telehealth during the COVID pandemic to support patient care, but a growing number are giving up on virtual care, saying it’s too complicated for their patients and unsustainable.

That’s the key takeaway from a study commissioned by the National Institute on Aging and conducted by the University of California, Irvine, and several other universities. Conducted between 2023 and 2024 of roughly 260 home health agencies, it places blame for the drop-off on a lack of Medicare reimbursement, and raises questions about whether home-based care programs can support telehealth at a time when health systems and hospitals are moving more services to the home.

“Our findings suggest that without [Centers for Medicare & Medicaid Services] reimbursement, many agencies may abandon telehealth, potentially missing opportunities to improve care and manage costs as home health demand skyrockets,” Dana Mukamel, a UC Irvine Distinguished Professor of Medicine and corresponding author for the study, said in a press release.

According to the study, published online in Health Services Research, telehealth adoption among home health agencies stood at roughly 23% in 2019, then surged to 65% in 2021, during the height of the pandemic. By 2024, however, 19% of those organizations had opted to discontinue virtual care, due to a lack of Medicare reimbursement and concerns about sustainability.

On a side note, one-third of all the home health agencies responding to the survey haven’t embraced telehealth at all, saying it’s inappropriate for their hands-on model of care. The study was tilted toward organizations that focus on elderly patients, especially those dealing with dementia-related health concerns.

“These patterns suggest that COVID-19 disrupted telehealth’s natural diffusion into home healthcare, which was gaining traction pre-pandemic,” the press release points out. “The study posits that without the pandemic, telehealth might have continued spreading as agencies recognized its benefits. However, the lack of reimbursement and perceptions of telehealth’s limitations for older adults pose barriers to sustained use.”

The study raises two important points.

First, many surveys have shown a decline in telehealth adoption after the pandemic, the inevitable result of patients wanting to get back in front of their doctors after relying almost exclusively on video visits. Telehealth advocates say this pendulum effect should wear off as both providers and patients understand the value of virtual visits and work toward a hybrid strategy that mixes in-person care and telehealth.

The monkey wrench in the works here is reimbursement. Federal and state lawmakers enacted a number of waivers during the pandemic to ease restrictions on telehealth use and boost coverage. While some states have moved to make pandemic-era conditions permanent, the federal waivers are set to end this fall. Many advocates fear that without those waivers, particularly those having to do with Medicare reimbursement, healthcare organizations will scale back their telehealth programs.

Second, there’s the pesky little fact that America’s population is aging, with a large chunk set to hit retirement age soon, and they’re healthier than their predecessors and looking to stay at home and out of the nursing home or assisted living center. The healthcare industry isn’t ready to handle that extra workload – it’s already struggling with workforce shortages and questionable costs. Telehealth offers a channel for providing care to this population while reducing the stress on providers.

While aligning federal policy to improve telehealth reimbursement is a critical piece to telehealth strategy moving forward, the home healthcare industry also needs to rally around virtual care tools and platforms that are effective and intuitive. With health systems and hospitals looking to extend their services into the home, through remote patient monitoring, Hospital at Home and other strategies, they’ll need support from the home health industry to make those services effective and sustainable.

Now that immigration enforcement can happen in hospitals, CNOs must prepare their nurses.

Many things in healthcare have changed since the beginning of the year from a policy perspective.

On Jan. 20, the Trump Administration revoked a policy that protected sensitive locations, including hospitals, from Immigration and Customs Enforcement (ICE) and Customs and Border Patrol (CBP) enforcement actions.

In the wake of these removed protections, preparedness is key. CNOs need to take a look at their health system's policies and provide guidance to nurses who might have future interactions with ICE or CBP agents.

Guidance for organizations

According to the ACLU, there are two laws that health systems should remember when considering immigration enforcement policy: the Fourth Amendment and HIPAA. The Fourth Amendment prohibits illegal searches or seizures, and depends on the reasonable expectation of privacy. Patients can expect privacy in a hospital room.

Currently, health systems are required to allow ICE agents into general areas that are open to the public, such as lobbies, waiting areas, and other public areas. ICE agents can be barred from entering clearly distinguished and enforced private areas, such as treatment rooms, inpatient units, offices, and any space closed to the public.

The ACLU recommends that health systems work with their legal departments to identify and distinguish private spaces from public areas, and leverage signs and security guards to clarify private areas. ICE agents cannot access private spaces without a valid judicial warrant that is signed by a judge and identifies the name of the patient and specific location. Organizations should have their legal counsel review warrants before deciding to grant access. Additionally, a deportation or arrest order does not permit agents to enter private spaces.

CNOs should take a look at their policies and make sure to include a list of designated private areas, and procedures for how to interact with ICE and CBP agents and handle law enforcement requests, according to the ACLU. Health systems should appoint a trained individual or legal advocate who can interact with ICE agents when they arrive.  

In states where it is not required for patients to disclose their immigration status, the ACLU recommends instructing healthcare staff not to ask questions regarding that status, and to inform the patient that they may decline to answer such questions. Currently, there is no legal obligation for health systems to record a patient's immigration status unless required by state laws.

Guidance for Nurses

CNOs must prepare nurses for what to do when ICE agents arrive at the hospital. According to the Ohio Nurses Association (ONA), the nurse's first priority should be advocating and caring for patients while protecting their rights and privacy. ONA emphasized that nurses should only engage with ICE agents to direct them to the correct authority figure or department. These include legal services, security, and/or a compliance officer.

ONA recommends nurses state politely, "I'm not authorized to provide information. Let me notify the appropriate person to assist you," while not revealing the patient's location, status, or care without explicit authorization from the legal team. The nurse's supervisor or security team should check the ICE agent's identification and verify any judicial warrants that are presented, and notify the legal team if that is the case.

Patient safety is also critical. CNOs should instruct nurses not to discuss a patient's health, immigration status, or any identifying details in the presence of ICE agents or any other unauthorized individuals. Patient care must not be delayed or interrupted by ICE agents, the ONA states. If a patient expresses fear or a safety concern, the nurse should immediately contact their supervisor, social worker, or hospital security.

ONA recommends that nurses document any incidents they witness regarding immigration enforcement. The date, time, location, agents and individuals involved, and actions taken should be recorded and forwarded to the nurse's supervisor and to the health system's legal office. CNOs must make sure nurses are familiar with all policies regarding immigration enforcement, and disseminate those policies throughout the workforce.

For more information, you can view the ACLU guidance and ONA guidance here.

The New Jersey health system is rolling out two new vehicles this summer as part of its Eat Well program, which connects patients to nutritious food and other resources.

The Food is Medicine movement suggests that people who eat nutritious meals will see better health outcomes, and that proper nutrition should be a part of the care plan. The challenge for healthcare innovators lies in connecting patients to the foods they should be buying and preparing.

Virtua Health has been addressing that issue since 2017 with its Eat Well program, which began with a mobile farmer's market and two brick-and-mortar 'Food Farmacies,' where patients could get food 'prescribed' by their primary care providers and access resources on nutrition.

More recently, the New Jersey-based health system has gone mobile, bringing food to those who can't easily get to the market or grocery store.

This past April, Virtua Health unveiled a new Eat Well Mobile Grocery Store, a 40-foot vehicle that visits neighborhoods where food insecurity is an issue. And the health system will soon be adding the Eat Well Mobile Food Farmacy, a mobile version of its brick-and-mortar program that will be dispatched to primary care locations where doctors are prescribing nutritious meals for selected patients.

Identifying the Barriers to Care

Stephanie Fendrick, Virtua's EVP and chief strategy officer, says non-profits traditionally use health needs assessments to gain a better understanding of the barriers to care faced by their patients.

"This assessment has consistently shown us that food insecurity is a top concern in our local community," she said. "So that really put it on our radar."

Stephanie Fendrick, EVP and Chief Strategy Officer for Virtua Health. Photo courtesy Virtua Health.

Fendrick says Eat Well was launched with the idea of giving primary care physicians a tool to address nutrition in care management, particularly for patients who are living with chronic issues. She says those doctors "are some of our biggest champions."

"Our physicians are acutely aware of the fact that it's hard to be healthy if you don't have access to healthy foods," she says. "They know that [with] many of the chronic diseases that they're facing every day, it's important that their patients have access to fresh fruits and vegetables and understand how to make a healthy meal, how to combine different ingredients to create those healthy meals."

The mobile program, Fendrick says, came from an understanding that food insecurity often goes hand-in-hand with transportation barriers. So instead of asking their patients to go to the market, Virtua Health is bringing the market to the patient.

"You can recommend all of that, but if you don't have access to the food, then how is someone going to change their lifestyle and incorporate [healthy eating] into their lifestyle?" she asks. "We felt that the mobile piece of it was important, to take food where people needed it,"

Virtua Health launched its first mobile grocery store in 2020, and April's rollout of a refurbished bus given to the health system by the New Jersey Transit Authority replaces the original bus, which was also a NJ Transit vehicle. A $1.5 million donation this year from the state of New Jersey paid for two vehicles (at $500,000 each), as well as renovations to the health system's distribution center, food and staff.

Fendrick says the mobile food program targets neighborhoods where food insecurity is high. The buses are parked at public locations like health centers, churches and senior housing complexes. Anyone in the neighborhood is welcome to shop at the bus, which offers nutritious foods at prices 40% to 50% lower than retail sites.

in some cases, Fendrick says, the food choices are tailored to the neighborhood's cultural identity. In Camden, for instance, roughly half of the population is Hispanic, so resources are offered in Spanish as well as English and certain foods are added to the bus.

"We're establishing trust with our community," she says.

Virtua Health has a fleet of six vehicles altogether, with three devoted to mobile programs such as pediatrics and cancer screenings. In some instances the health system will pair a food truck with another vehicle to offer multiple services in one location.

"We're really trying to wrap services around our patients to keep them healthy in their communities," Fendrick says.

Prescribing Food as a Part of the Care Plan

The Food Farmacy, meanwhile, is more focused. The program – which now consists of brick-and-mortar Food Farmacies in Camden and Mount Holly – enables primary care providers to prescribe certain food to patients who have food insecurity as well as a chronic condition like diabetes, high blood pressure or heart disease. The program gives patients free groceries that are "medically tailored" to their care plan, as well as access to nutrition counseling and other resources, for up to six months.

"Having access to certain healthy foods is great, but having the knowledge of what to do with them and how to use them to make healthy meals is also a very important part of the program," Fendrick points out.

The new mobile Food Farmacy will offer the same services, and will visit primary care offices (initially in Hammonton and Washington Township) where doctors are giving their patients prescriptions for the program.

According to Virtua executives, the outreach is showing positive results. The mobile grocery store program saw more than 7,500 transactions in 2024 and has grown year over year, while all of the Eat Well programs saw more than 47,000 transactions in 2024, an 8.6% increase over the previous year.

In addition, according to a survey of participants, 94% of customers to the mobile grocery store reported consuming more fruit and vegetables, and 88% say they've prepared more nutritious meals as a result.

Fendrick says this data is important, but the real test of the program's value will come over time, as the health system looks at clinical outcomes. For patients with chronic conditions, short-term details like weight loss, A1c levels and blood pressure will be charted. Over the long run, they'll be keeping track of health and wellness metrics and quality of life.

"That's taking us a little more time to get our arms around," she says. "Are we truly making an impact on their health outcomes?

The long run also means developing connections with the retail community and others to ensure a steady supply of food. Since the program's launch in 2017, more than $10 million in philanthropic donations have been invested in the program.

"We're looking for different types of partnerships and relationships to help keep this sustainable," Fendrick adds.

As for where the program goes from here, Fendrick says she wants to see steady growth for now, along with more education for both providers and patients about the value of good nutrition. She notes that Virtua Health sent one of its buses down to Atlantic City for a while at the request of the governor, and the program was such a success that a local provider is now running its own program there.

And of course, now that Virtua Health has a mobile farmer's market and grocery stores, could a food truck or two not be far behind?

"I would never say never," Fendrick says.

The next goal of this health system's virtual nursing program is to see how virtual care can impact other areas, says this nurse leader.

Health systems everywhere are experimenting with virtual nursing, and there are many key strategies that they can learn from each other.

Maria Brown, nursing excellence manager at ChristianaCare, outlined what ChristianaCare wants to accomplish with their virtual nursing model.

Brown is a part of the HealthLeaders Virtual Nursing Mastermind series, an exclusive, six-month series of calls and an in-person event where several health systems discuss the ins and outs of their virtual nursing programs.

Goals for the program

ChristianaCare launched a pilot of their virtual care program in 2022 with the primary goal of reducing burden at the bedside and giving time back to nurses to care for patients. The program then expanded to 500 beds in 2023, starting on med surg units and growing to include a postpartum unit and other specialty units, such as elderly, stroke, and cardiac step-down units.

According to Brown, the virtual acute care nurse program has had a significant impact on patient experience and on new nurses.

"Our experienced nurses function as clinical coaches," Brown said. "For those new nurses or novice nurses that are at the bedside providing hands-on patient care, if they have questions on clinical situations or need an experienced perspective, they're able to call the virtual nurse."

Brown says there is the possibility of using the virtual care program to keep tenured nurses in the workforce. ChristianaCare specifically uses experienced nurses in the program so they can provide the best care and guidance to other nurses.

"We definitely want to be able to keep our nurses practicing as nurses as long as they can, even if their bodies may not be able to physically do it, but they really want to continue as a nurse," Brown said.

Logistics

According to Brown, the nurses taking part in the program are pulled from practice areas to function as a virtual nurse—they are not being hired externally.

"We do have a few full-time nurses that have transitioned from those areas to a full-time virtual nurse role," Brown said.

The virtual nurses are housed in a remote location together and they are not allowed to work from home.

As for technology, ChristianaCare is leveraging a homegrown app paired with iPads at the bedside, which were initially used during the COVID-19 pandemic.

"They are in each patient's room purposely placed at each bedside—they don't come out," Brown said. "The only thing that comes out is the patients from admissions and discharges."

The health system created a dashboard to keep track of metrics such as length of stay, 30-day readmissions, and some harm metrics. Brown noted the significant impact on patient experience.

"We definitely think that's attributed to that nurse one-on-one time with the individual patient, and [the nurse] not being called [away] for a phone call or to help the patient in the next room, and those kinds of things," Brown said.

From present to future

According to Brown, both the nurses and the patients are positively reacting to the program. The nurses see the program as an opportunity to take a physical break from the bedside and connect with patients in a more focused manner.

"Culture change is hard, especially when you've been doing this for many, many years, and then we throw technology into the mix and then a different care delivery model into practice," Brown said. “Sometimes it takes a little bit of getting used to, but I think overall, nurses also support this new model."

Going forward, Brown believes that the health system's current staffing model may change from pulling nurses off of units to having a fully staffed virtual nursing model. The next goal is to expand further and see how virtual nursing can impact other areas.

"We hope to evolve to all other kinds of settings, meaning potential ICU type areas and EDs," Brown said. "We are doing some pilots in different types of areas, like an ambulatory space to kind of see how nurses could function that was as well."

As for technology, Brown expressed that the model is evolving, and due to the significant cost of switching technologies, some patience is necessary.

"I don't know if we've found that perfect technology that does everything, and so we wanted to wait and see what we can do with what we have," Brown said. "By the time we are able to decide on a technology, I think we would include things that have AI technology, maybe some ambient listening, [and] maybe some ways to use predictive analytics."

Advice for CNOs

For those CNOs and other nurse leaders who are attempting virtual nursing for the first time, Brown had several pearls of wisdom.

"I would say first and foremost, don't wait for the perfect scenario, because there never is a perfect scenario," Brown said. "If you're waiting for perfection in technology [or] staffing, you're going to be waiting a long time."

Brown also recommended getting stakeholders involved in the project as early on as possible, and ensuring that buy-in and support are present from all participating departments.

"You want to make sure that they're involved and have a stake in the process," Brown said, "and that everything is bought in, so that your program is successful."

The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights into excelling your virtual nursing program. Please join the community at our LinkedIn page.

To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.

A new tool assesses coronary inflammation, which is often overlooked in measuring the risk of a heart attack. One doctor says this test could detect problems years in advance and save lives.

An AI tool that can detect inflammation in the coronary artery could help clinicians diagnose heart disease much earlier, even decades before the patient shows any outward signs of distress.

CaRi-Heart Technology, developed by Connecticut-based Caristo Diagnostics, was recently given its own Category III CPT code by the American Medical Association’s CPT Editorial Panel, an important step in the path to adoption after FDA approval and, just as important, payer reimbursement. The technology has also shown promising results in trials conducted in 2024 at five National Health Service hospitals in the UK, where reports indicate more than half of patients analyzed by the AI tool had their treatments changed.

To clinicians, the tool could be a critical step forward in the diagnosis and treatment of heart disease, the leading cause of death in the country.

“Cardiology disease is very different than other diseases in terms of how we treat it,” says Stephen Bloom, MD, MSCCT, FASNC, FAHA, FACP, FACC, a cardiologist with Midwest Heart and Vascular Specialists in Overland Park, Kansas, part of the HCA Midwest Health System. “We do mammograms before people have breast cancer. We do colonoscopies before people have colon cancer. And then in cardiology, we wait until they have symptoms, and then we do our best to treat our patient, now with established disease. It doesn't even make sense.”

AI has the potential to analyze data from tests, such as a CT scan, more quickly and with more detail than the human eye. While traditional imaging can identify visible plaques that cause narrowing and blockages, the CaRi-Heart tool zeroes in on perivascular fat, or coronary inflammation, which is overlooked in assessing someone’s heart health.

And since acute MIs occur when non-calcified plaque ruptures, any method for detecting non-calcified plaque better and earlier would save lives.

“[AI] could actually look at each coronary [artery], each segment, if you break it down to three, and [it] can actually summarize not only how much calcified plaque you have, but also non-calcified vulnerable plaque, which  has more of a tendency to rupture and cause a heart attack,” Bloom says.

Bloom notes that inflammation can be present in many diseases and measured by a blood test (c-reactive protein (CRP)). However, this blood test is not specific for the heart and less sensitive.

But with coronary CT with AI, clinicians can drill down further than they’ve been able to in the past. Bloom says doctors often use stress testing, but these tests only become positive for heart disease when the patient has a coronary blockage greater than 70%. This can create a false sense of security. Analyzing inflammation with plaque analysis  from a CT could create a much better definition of a patient’s cardiac risks.

And it could be done long before any signs of heart disease are evident.

“We can take patients even before they have symptoms and diagnose whether or not they have early coronary disease and treat them with appropriate medication as well as a change in their diet [and] exercise,” Bloom says.

The challenge, as always with new technologies, is reimbursement. Most payers currently don’t cover tests like nuclear cardiac stress testing, MRI stress scans or even coronary CTs unless there are symptoms. Bloom is hoping that the results of the UK tests and the newly approved CPT code will prod payers to cover the CaRi-Heart test.

“The good thing is it’s simple [and] it’s painless and less expensive than nuclear and other tests like MRI, and so it could be the gatekeeper to reducing heart disease by finding it early and treating the patient in the early stages,” he says.

“The next five years will probably dramatically change the way we treat our patients with coronary disease,” Bloom adds, adding that plaque analysis from a CT has only been approved for reimbursement this past year. As more clinicians use these new tools with coronary CT and gather data on its effectiveness, they’ll build a better argument for coverage.

“We will  be able to diagnose and treat coronary disease well before symptoms occur and finally reduce heart disease as the number one cause of death today ”.