Technology is everywhere in healthcare, but budgeting for it lands on the shoulders of the CFO.

Healthcare organizations are at the forefront of technology. From clinical areas to the revenue cycle, every facet of an organization is seeing some sort of new technology or AI. While technology and innovation are needed, CFOs are the ones left to figure out how to pay for it all.

As reducing costs is a top concern for CFOs, especially since bottom lines have been severely stressed and new technology costs are adding up—what are the solutions?

This has been one of the challenges at the forefront of conversations so far at the HealthLeaders CFO Exchange, as dozens of finance leaders from across the country are currently talking shop in San Diego.

Why AI?

Changes in the workforce landscape are forcing CFOs to be more creative, meaning many are looking toward AI and other technology to fill those workforce gaps and optimize processes.  

“AI is great, especially for our workforce issues, but how do we pay for it and redeploy resources?” Jim Wilson, CFO at Mayo Clinic Health Systems, asked the crowd during the morning’s general session.

This is a complex question that explains why it will take more time for healthcare leaders to add in more AI.

And How?

Speaking of budget, budgeting for automation and the impact on future work demands is crucial for preparing for technological advancements, but it’s not as easy as it sounds. And since using AI to automate workflow in clinical and non-clinical departments can lead to improved efficiency and accuracy, CFOs need to prioritize this cost. But how?

Well, many CFOs at this event are starting to figure it out.

A good place to start? Creating a consolidated AI plan. “We have leaders in every pocket of the system asking for AI in their department, but there is no overarching AI strategy in place which makes budgeting disjointed,” said Donna Wallace, VP of financial accounting from Integris Health.

It’s not all bad, though. In fact, one CFO at the event is piloting AI for physicians that creates clinical notes based on the verbal conversations the physician has with patients. The added AI saves so much time for physicians that it allows them to see more patients in a day, helping to pad that bottom line.

This is just a sliver of conversation at this year’s event, so stay tuned as the Exchange continues to unfold over the next two days.

Our Spring 2024 CFO Exchange is taking place until May 10 at the Fairmont Grand Del Mar in San Diego.

Are you a CFO or finance leader interested in attending an upcoming event? To inquire about attending the HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.

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

A UCSF study has found that a ChatGPT-4 LLM can prioritize Emergency Department patients for treatment with 89% accuracy

Healthcare organizations looking for help prioritizing patients in the Emergency Department could benefit from an AI tool developed by researchers at the University of California San Francisco (UCSF).

Researchers tested the ChatGPT-4 large language model (LLM) on 10,000 sets of patients seen at the UCSF ED between 2012 and 2023, and found that the tool accurately assessed clinical acuity in 89% of the cases. A subset of 500 cases evaluated by a clinician as well as AI found that AI outperformed the clinician, 88% to 86%.

The study, which appears this week in JAMA, could give health systems a valuable tool for triaging ED patients, particularly during times of heavy traffic or staff shortages. By assessing severity more quickly, the hospital could direct ED staff to those patients in need of emergency care and speed up time to treatment, eventually improving clinical outcomes.

“Imagine two patients who need to be transported to the hospital but there is only one ambulance, or a physician is on call and there are three people paging her at the same time, and she has to determine who to respond to first,” Christopher Williams, MB, BCHir, a UCSF postdoctoral scholar at the Baker Institute and lead author of the study, said in a UCSF press release.

Using data from more than 250,000 ED visits, Williams and his colleagues used an AI model to extract data from clinical notes and determine the severity of the injury. They then compared that analysis to the patient’s score on the Emergency Severity Index (ESI), which rates patients on a scale of 1-5 and is used by ED nurses to prioritize care delivery.

The ESI “uses an algorithm to categorize patients arriving at the ED, estimating the severity of their condition and anticipated future resource use,” Williams and his colleagues said in the study. “The ESI is assigned based on a combination of initial vital sign assessments, the patient’s presenting symptoms, and the clinical judgment of the triage clinician, who is often a trained registered nurse. By capturing clinical acuity at triage, the ESI can be used as a surrogate marker to evaluate, at scale, whether LLMs can correctly assess the severity of a patient’s condition on presentation to the ED. This can be achieved by providing the LLM with patient clinical histories documented in ED physician notes, prompting the model to compare histories to determine which patient has the higher acuity, and evaluating the model output against the ground truth as determined by ESI score.”

While proving the value of the AI tool, Williams pointed out that the technology shouldn’t be introduced to an ED just yet. An incorrect assessment could cause delays in treatment that could harm the patient or even lead to death. In addition, AI tools could reflect biases caused by the data used to train the model, further expanding care gaps for underserved populations.

“It’s great to show that AI can do cool stuff, but it’s most important to consider who is being helped and who is being hindered by this technology,” William said in the press release, while calling for more clinical trials and research. “Is just being able to do something the bar for using AI, or is it being able to do something well, for all types of patients?”

Nurse wellbeing makes the rest of the healthcare team succeed, says this nurse leader.

Nurse wellbeing is essential to the success of a health system, and it is the CNO's job to make sure they are providing programs and support to help keep their staff safe and well.

April Prunty, director of nursing professional development at Allina Health, spoke to HealthLeaders about how CNOs can be visible and provide support, and redesign workflows to give nurses time to prioritize their mental health. Tune in to hear her insights.

Click here to read the accompanying article. 

The South Carolina health system, part of the HealthLeaders Virtual Nursing Mastermind series, is learning to measure ROI in specific, actionable tasks, such as communication

A key component to launching an effective Virtual Nursing program is communication. How will the virtual nurse communicate with the floor nurse, as well as with the patient?

“Clear delineation of roles and communication is going to be really important,” says Emily Warr, administrator for the Center of Telehealth at the Medical University of South Carolina (MUSC), which launched a second iteration of its Virtual Nursing program about six months ago and is now monitoring the program in five hospitals.

Warr says it’s critical to identify specific KPIs in evaluating the success of a Virtual Nursing program, and to focus on small, measurable actions rather than larger concepts. For example, it’s great to say such a program will reduce time spent on admissions and discharge, but there are many factors that go into those processes that Virtual Nursing won’t affect.

“A virtual nurse, as one member of the team, cannot carry all of the factors that impact, say, an HCAHPS score on a unit,” she points out. A more effective way of measuring value would be to focus on single factor, such as how communication between nurses affects admissions or discharge times.

MUSC is one of a handful of health systems across the country that are taking part in the HealthLeaders Virtual Nursing Masterminds program, a series of virtual meetings capped off by an in-person event in June. The program is taking a deep dive into virtual nursing strategies with perspectives from some of the top health systems and executives in the country.

MUSC launched its first version of a Virtual Nursing program about two years ago, with a focus on mentoring new nurses.  Warr said that program didn’t produce the ROI needed to be sustainable, so the health system looked for more “hard outcomes.” That led to a discussion about how to identify meaningful outcomes and understand the KPIs that go into defining a program’s value.

“We needed to focus on something that we felt we could impact and choose to measure,” she says, such as “very specific, task-oriented things.”

In the six months that version 2.0 has been in play, Warr says they’ve learned a few things about those tasks. During the first two months, as everyone was getting used to the new approach, the virtual nurse would often reach out to the floor nurse to take tasks. But as time has passed, the floor nurse is reaching out more often tp the virtual nurse to hand off tasks. In other words, the two nurses are communicating more freely (and equally) about their workflows.

Warr anticipates those conversations will lead to a smoother or more seamless collaboration between floor nurse and virtual nurse, which in turn will lead to better administrative outcomes and, eventually, improved clinical outcomes.

“We’re still learning and evolving (in) what we’re tracking … and where we’re able to make a measurable impact,” she says. But the results so far are truly encouraging.

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 on exceling 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.

CNOs should implement new technologies with careful consideration.

New technologies are popping up constantly in the healthcare industry, and many health systems are eager to jump in and start using them.

From virtual nursing to smart rooms to AI, there are plenty of new opportunities to enhance patient care and outcomes. In nursing, this technology also has the potential to improve workload, turnover, and retention.

Lisa Stephenson, chief nursing informatics officer at Houston Methodist, spoke with HealthLeaders about new technologies in nursing, and how CNOs and CNIOs can implement smart technology and AI to solve some of the biggest challenges in nursing.

Implementation and messaging

The most important factor to consider when introducing a new technology into workflows is whether it will become a burden to those using it. For CNOs, this means the technology should not hold back nurses from being able to do their jobs efficiently and effectively.

According to Stephenson, it's critical to include nurses and get their input on new technologies before bringing them in. Will the actually solve a problem or help improve a workflow? Communication about these topics is important.

"Really [understand] how it can help the clinician, make sure it is something that will be beneficial," Stephenson said. "You can't communicate enough on technology."

Additionally, everybody involved should be fully informed as early as possible to address hesitancies and avoid confusion. Staff, providers, and patients should all be made aware of things like cameras for virtual nursing, and other technologies that will impact them.

"Having communication available for all levels and even talking points for nurses to talk to patients about it," Stephenson said, "I think will really help with the adoption and acceptance when you get into [the] actual training and implementation mode."

Stephenson emphasized that implementing new technology into healthcare has always been a challenge, and that the first iteration will likely not be perfect.

"Getting that technology out there with some foundational use cases [really] lays the groundwork to be able [to] then build on that, and increase your use cases," Stephenson said, "and optimize processes, and really make [the] technology continue to work for you."

Training

After implementation, nurses need the necessary training to use the new technology. According to Stephenson, the informatics team at Houston Methodist partners closely with the implementation teams to develop training materials and come up with a good support plan.

Stephenson said they follow a super user model, where the nurses who are going to be directly impacted can get in-person classroom training. The majority of nurses will get online training, for efficiency's sake. A support team assists the super users

"If it's something new that they haven't really experienced before," Stephenson said, "it can be challenging until you really get your hands on it."

Houston Methodist also partners with their clinical educators to make sure programs are in place to train new hires. According to Stephenson, they use online training modules and encourage nurses to "touch, see, and do" with the technology.

“We have new technology that they need to be prepared [for], that they may not [have] even seen at other hospitals [up to] this point," Stephenson said.

AI privacy

Privacy is a top concern for CNOs and CNIOs when implementing any new technology, especially AI. Patient safety is always a priority, and that includes keeping data and personal information safe.

 Houston Methodist has updated its policies to state that staff are not allowed to use public-facing AI models like ChatGPT with any sort of patient information.

" You can't use patient information to put into that model to get some kind of note or summary," Stephenson said. "They have to use the models and tools that we have baked into our EHR or other [Houston Methodist] system."

That way, any data given to those models passes security standards and is kept private and secure, Stephenson said. CNOs and CNIOs should consider adopting similar policies to ensure privacy .

Data safety

As healthcare technologies change, nurses need to be aware of their own contribution to keeping data safe. For instance, nurses might want to send a quick text to a provider, or someone they work with, on their personal device, Stephenson said.

"We've made it clear [that] they need to be using secure texting platforms, which are things that we have on our Houston Methodist devices through our applications," Stephenson said. "We want to make sure people aren’t using any kind of private devices to do any of that type of communication or photography of anything."   

Additionally, patients might have concerns about technologies like virtual nursing cameras, and this is where that communication piece is key. Patients must be informed about when the cameras are on and recording.

"The cameras point up and away from patients when they're off, so it's clear that they're off and can't be recording," Stephenson said. "And when they are active, the nurse does kind of a knock to say 'Hey, are you ready?' "

The important factor is transparency and communication, so that patients, staff, and providers are all aware of what is happening with the technology around them.

"Communication, communication, communication," Stephenson said, "to make sure everybody's aware of what's going on and how to best use the technology as well."

The health system will be launching a new platform this month to improve care management for patients in cancer treatment

As health systems across the country look for small but significant ways to use AI, Intermountain Health is putting the technology to work improving care management for patients in cancer treatment programs.

The Salt Lake City-based health system is partnering with San Francisco’s Memora Health on a care management platform designed to reduce the workload on nurses and give patients quick and seamless access to the resources they need.

"The moment a person is diagnosed with cancer, their life changes,” Derrick Haslem, MD, Intermountain’s senior medical director for cancer care, said in a March press release announcing the partnership. “Being able to provide consistent communication with patients to address questions and concerns about their care is critical and very important to us, Memora's technology helps our busy care teams with daily tasks and empowers them to focus on what matters most: delivering high-quality care to our patients."

Phil Wood, program director for Intermountain Ventures, says the health system is looking for ways to insert AI into care management pathways that typically take a lot of time and effort. By using the technology to handle messaging, which is primarily and administrative task, Intermountain is freeing up its nurses and clinicians to focus on clinical work.

“It doesn’t change the messaging,” Wood points out. “Clinicians want to have control over the patient’s care. This [creates] a more effective way of communicating … and gives nurses back their time to focus on more acute and urgent cases.”

The platform uses AI to help patients with their care plan once they’ve left the hospital or doctor’s office, answering patient questions and guiding them to online resources. When a question or concern is complex, the system connects the patient with the care team for follow-up.

Wood, noting Intermountain hopes to have the program up and running by the end of this month, says success hinges on whether the patients engage with the platform and feel comfortable with the technology. Early KPIs will focus on engagement surveys and patient satisfaction scores, while other benchmarks will target whether patients follow their care plans, especially in medication adherence, and whether operational workflows are improved.

As health systems look to adopt consumer-facing technology, healthcare leadership will need to focus on those questions. Where can technology replace a clinician and where might it interfere with the relationship between doctor (or nurse) and patient? And can the platform (and the health system) adjust to patients uncomfortable with the technology and preferring more in-person interactions?

Wood says the oncology space is the ideal space to test the platform because of the importance of communicating with patients at home. Once this program is established and the value proven, he expects to expand it to other surgical services, and perhaps eventually into chronic care management. At the same time, Intermountain will be looking for new opportunities for EHR integration as the health system continues its switch from Cerner to Epic.

“Having an easy way for the patient to interact with the health system” is crucial to improving patient engagement and clinical outcomes, he says.  

Nurse wellbeing is critical to positive patient outcomes and the overall success of a health system.

Being a nurse is difficult.

The job entails long hours, substantial workloads, and the heavy emotional burden of guiding patients through some of the toughest moments of their lives.

Nurse wellbeing is essential to the success of a health system, and it is the CNO's job to make sure they are providing programs and support to help keep their staff safe and well.

According to April Prunty, director of nursing professional development at Allina Health, more than half of the healthcare workforce is made up of nurses or nurse-related positions, so the wellbeing and success of nurses affects everyone. If nurses are not in top shape, Prunty explained, that causes a decline in patient outcomes.

"If our nurses and our nursing team members aren't doing well, they are not in a good position to provide that excellent patient care," Prunty said. "There is also some evidence to suggest that if nurses are doing well, the rest of the healthcare team is doing well."

Understanding wellbeing

Wellbeing looks different for each nurse. Some might prioritize flexible scheduling and better work-life balance, while others might want more opportunities to connect with others or time to process events.

" One of the key tenets of nurse wellbeing is really understanding what wellbeing means for the individual nurse," Prunty said. " It does look different for everybody, but there's some key principles that can be woven throughout to support wellbeing."

CNOs need to show their support and learn about their staff to understand what those needs are.

"One of the things that we often hear from nursing staff is that they really appreciate visibility," Prunty said. 

Nurse leaders should take time to informally round on units and connect with staff, Prunty recommended. CNOs can take that opportunity to listen to what the nurses are telling them, so they can provide the correct support and continue to advocate for them.

"Continuing to advocate for staff [at] whatever table they're sitting at to make sure that staff have the resources that they need to continue providing excellent patient care is always important," Prunty said.

Changing the environment

The next step is to make the work environment healthier and safer. Prunty referenced the uptick in workplace violence as one of the key challenges in the healthcare industry, as well as the increased levels of care required by patients.

"We're seeing a lot of changes in some of our healthcare settings," Prunty said, "and we need to make sure that our staff feel safe coming to work, and that they're adequately prepared to care for the complexity of patients that we're seeing."

Prunty recommends that CNOs allow for adequate breaks throughout the day so that nurses can take a breather, while feeling empowered to do so.

Prunty said there are a few different phases to supporting staff who have experienced a traumatic event or high-stress situation.

The first is to provide support in the moment allow the nurse to take a step back, and reassure them that a colleague or a nurse manager has their back. The second is to make sure that the nurse has time to process what happened.

Prunty said Allina Health implemented both employee assistance programs and a spiritual care team that can support staff in real time.

"We need to be attuned to the impact of the experiences that our nurses are feeling," Prunty said. "I think the importance is having the support and resources in the right place at the right time."

Leaders also need to ensure that nurses feel like their tasks are a value add, and that they are giving nurses back time at the bedside.

"It's really important for executive nursing leaders to think about what [our workflows are] and what [our processes are], and how [we can] improve efficiency," Prunty said, "so that we are maximizing the time that we have with our patientsand making sure that we're promoting a healthy work environment."

Supplying resources

Prunty suggested that CNOs try something creative when providing resources to support nurse wellbeing. In addition to the standard employee assistance programs, a few of the sites across the Allina Health system have calming rooms, where nurses can go to take a break.

"It's a space [where] you can listen to calming music [or] meditate and take a deep breath," Prunty said. "A space where you can physically close the door and sort of separate yourself from what's happening on your unity during your clinic."

Allina Health also has robust employee well-being programs through the Penny George Institute for Health and Healing. The programs allow staff to receive coaching on a variety of different topics through online asynchronous learning.

"I think this is really our opportunity to say OK, what's working, [and] what's not working," Prunty said, "and it's OK, we can try something else."

It's critical that CNOs communicate the existence of resources as well, so that nurses can find and use them. Prunty emphasized the difficulty of communicating with nurses, since nurses do not have time to frequently check their e-mails.

Allina Health has tiered huddles that are focused on safety issues, and a communications team that disseminates all the necessary information on a weekly basis to staff. Prunty said they are also looking at ways to integrate resources into the EHR, including a button that can be pressed if nurses need resources during the documentation process.

Prunty also explained that they are leveraging social media and signage to provide even more avenues of communication.

"As our health system continues to grow in complexity and expand in geographic areas," Prunty said, "we really need to think about how [we can] reach all of our staff, because that's part of feeling included . Knowing what’s going on and not feeling left out of messaging."

Preparing new nurses

CNOs need to find innovative ways to build resiliency among new nurses. According to Prunty, the disruption to academic programming by the COVID-19 pandemic caused many new nurses to enter the industry with less clinical experience.

"I think it really is an opportunity for us to think differently about how we bring people in and help them through that transition," Prunty said.

Allina Health has implemented a strong nurse residency program that Prunty says is addressing the needs of the new generation of nurses. The program gives nurses the opportunity to build community with those going through similar experiences.

"We're talking a lot about moral distress, moral injury, processing grief and loss, [and] having crucial conversations," Prunty said. " Things that are really challenging for folks as they enter the nursing workforce."

There is also an opportunity to revamp academic programs and partnerships sto support nurses in their transition to the workforce.

Prunty emphasized the need for leaders to stay flexible.

"I would say the agility and curiosity in approaching the new needs of this workforce are going to be critical," Prunty said, "to make sure that they have what they need to take care of patients."

Leading by example

There are a few things CNOs can do to positively influence the work environment and keep spirits high, and visibility is a key component.

"I think rounding and making sure people see you as a person," Prunty said, "and you [making] that connection with your teams is critically important."

CNOs need to keep advocating for nurses in as many spaces as possible, and to help people outside the nursing realm understand the role of a nurse.

It's difficult to explain to others the invisible labor that is associated with providing excellent patient care, Prunty stated, and it's important that that's recognized and acknowledged as a critical part of providing care.

"I think any opportunity to just be curious and help people understand," Prunty said, "and tell our story as nurses, I think is really important." 

While disruptors are having a hard time figuring out healthcare, health systems and hospitals are embracing telehealth as a standard of care

As the American Telemedicine Association gathers next week for its annual conference, attendees will find plenty to discuss.

Telehealth had its moment in the spotlight with the pandemic, when both the healthcare industry and consumers found they couldn't live without it. While adoption dropped with the return to in-person care, the general consensus is that telehealth is now a part of the care spectrum. The best evidence of this may be the announcement that both the Joint Commission and the National Committee for Quality Assurance are developing new accreditation standards for virtual care.

That said, telehealth advocates are still waiting for policy and regulations to catch up. Many states have upgraded their telehealth guidelines in the wake of the pandemic, and the Centers for Medicare and Medicaid Services (CMS) has made some of its pandemic-era telehealth waivers permanent while extending others to the end of this year. Several bills before Congress aim to make those waivers permanent, but there's no guarantee that any action will be taken on those bills.

Finally, the direct-to-consumer and primary care telehealth marketplace is seeing some upheaval. Walmart's recent announcement that it is shuttering its in-store clinics as well as its telehealth program wasn't entirely unexpected—UnitedHealth is shutting down Optum Virtual Care, CVS Health isn't seeing any growth, and both Amwell and Teladoc have been encountering problems as well. Those companies are finding that telehealth for primary care isn't profitable, while health systems are finding those telehealth services are still in demand, and necessary.

At the ViVE 2024 conference earlier this year in Los Angeles, Sheeza Hussein, Steady MD's chief growth officer, noted that the direct-to-consumer telehealth industry is awash with small companies (and providers) offering virtual care for specific services, like pediatric care, sexual health, and weight loss. This, along with functional medicine, or testing and diagnostic services for chronic care, and pharma companies are driving the growth in DTC telehealth.

These issues and more will dominate the discussion at ATA's Nexus event next week. For a further look at what to expect, listen to this podcast with Nate Lacktman, a partner in the Foley & Lardner law firm, chair of its national Telemedicine & Digital Health Industry Team, and a member of the ATA's Board of Directors.

These new AACN guidelines have the potential to impact how CNOs handle staffing in their health systems.

The American Association of Critical Care Nurses (AACN) hast published the AACN Standards for Appropriate Staffing in Adult Critical Care, in an effort to help health systems tackle nurse staffing.

The standards

The seven key standards are designed to help leaders "incorporate appropriate staffing into everyday operations and patient care," according to a press release. They are also meant to promote a healthy work environment in line with the AACN's HWE standards.

The new standards recommend the following:

1. Direct care nurses participate in all aspects of staffing, including planning, implementation, and evaluation.
2. Hospital patient care areas establish, evaluate, and refine unit-specific staffing guidelines based upon their impact on patient and nurse outcomes.
3. For every shift, patient assignments are based on an accurate assessment of the current nursing workload generated by each patient's needs and align nurse competency with patient characteristics.
4. Clinical leaders such as charge nurses, educators, and nurse managers are not included in patient assignments, except in rare crisis situations.
5. Staffing plans and patient assignments support the unique needs of nurses who are new to the unit.
6. Organizational staffing plans are designed to prioritize the health of the work environment and thus drive nurse retention and optimal patient outcomes.
7. Organizational staffing plans anticipate that critically ill or injured patients generally require a ratio of one nurse to two patients.

According to Vicky Good, chief clinical officer at AACN, the standards provide a potential solution to multiple issues in the nursing industry.

"The link between healthy work environments and patient safety, nurse recruitment and retention, and an organization's bottom line is irrefutable," Good said in the press release. "These standards, coupled with a deep commitment to collaboration and change, provide an opportunity for evidence-based transformation that can profoundly improve the U.S. healthcare system's ability to meet patients' needs."

CNO impact

What do these standards mean for CNOs?

Though not mandatory, the new AACN guidelines can serve as a potential blueprint or starting point for nurse leaders to reference when looking at staffing policies and making changes that reflect a healthier work environment.

Good previously told HealthLeaders that the research shows the positive impact of healthy work environments on staff and patient outcomes. Patient outcomes improve, nurse turnover decreases along with burnout and moral distress, and the perception and quality of care improve.  

“The evidence is clear that having a healthy work environment is [a] cornerstone to nurse well-being and retention,” Good said, “but now the research even demonstrates [the impact on] our patients.”