An AI driven tool used by Mercy and called the Chen Chemotherapy model is helping patients steer clear of complications after chemotherapy
With the potential to reduce workloads, streamline services, and aid in patient care quality, AI is rapidly becoming a popular tool in healthcare.
The technology has now entered the cancer care unit. The Mercy healthcare system is using AI to help cancer patients - by texting them.
Often, chemotherapy patients find themselves struggling with side effects such as general pain, fever, diarrhea, fatigue, and vomiting; these are red flags that frequently lead to hospitalizations. According to a study by the National Institutes of Health, “of 18,486 patients who received chemotherapy for metastatic cancer, 92% were hospitalized at least once for any reason, including 51% hospitalized for a likely toxicity.”
Care units need a way to track these symptoms before they lead to patient hospitalization. Enter the Chen Chemotherapy model.
Named after lead data scientist Jiajing Chen, who lost their own battle with cancer in 2023, the model notifies doctors before these symptoms become severe, keeping patients out of the hospital.
The program works by creating a risk score for non-leukemia chemotherapy patients over 18 years old. As the program learns, it’s able to predict how likely it is that a patient who is experiencing symptoms will be hospitalized within 30 days after their chemotherapy treatment.
Once patients are opted into the smart texting platform, they will receive a text each day for seven days, minus weekends and holidays, to monitor their symptoms. When a patient selects a symptom, they rate it and, based on their answers, the information may be sent to their provider.
Prior to this model, providers were oblivious as to which patients were experiencing problems until patients called or showed up at the emergency room.
This tool allows providers to be more involved in the process of chemotherapy recovery.
“The Chen Chemotherapy Model and smart texting allows us to proactively manage these patients and identify when they are having problems earlier in the journey,” Jay Carlson, DO, medical director of Mercy oncology service line, said in a press release. “This means they may be able to be treated in the office, recover faster and feel better overall.”
The success of AI in cancer care has led to the development of several other tools by different creators. Last year a neurobiology and human genetics professor at the University of Utah, along with a 20 person team, created an AI algorithm to help identify more than 200 ‘micro-symptoms’ for cancer patients, such as behavior, speech, and vocal patterns. These range from abnormal neurological phenotypes and eye movements to sadness in the vocal tone. A clinical trial of the tool is scheduled to start in January 2024 at the Moffitt Cancer Center. Identifying these small changes can help assess how patients are handling the treatment and can even predict changes in future symptoms.
Healthcare providers have also been using AI to improve breast cancer screenings. According to The Lancet Oncology, a recent survey of 80,000 women in Sweden found that, when put up against two experienced radiologists, AI-enabled breast cancer screenings outperformed their standard readings.
Cancer is the second leading cause of death in the U.S., compelling the need for new innovations and screening technology. In recent years the U.S. Food and Drug Administration has approved more than 500 AI and machine learning-enabled medical devices, ranging from imaging software to remote cardiac monitoring devices.
Burnout is everywhere, and it has become a matter of patient safety.
It’s no secret that nurses and healthcare professionals across the industry are burnt out.
Nurses are feeling overworked and undervalued, and since the COVID-19 pandemic and the massive nursing shortage, it has only gotten worse.
Nurse and nurse practitioner burnout is known to have a direct impact on the patient’s experience, and now it’s leading to more emergency department visits.
A recent study from the Columbia School of Nursing found two pieces of key information: A sizeable proportion of primary care nurse practitioners are burnt out, and primary care practices with higher rates of nurse practitioner burnout are seeing higher rates of older patients with chronic conditions receiving acute care.
The problem
Out of the nurse practitioners included in the study, 26.3%, or more than 1 in 4, reported burnout, which is comparable to the levels of burnout amongst other clinicians, such as physicians and registered nurses. According to the authors of the study, Lusine Poghosyan, PhD, MPH, RN, and her colleagues, these numbers should cause concern, and they indicate the need for more attention and research on burnout among nurse practitioners, since most of the research currently available was conducted on physicians or registered nurses.
The effects of burnout on patient care go beyond nurse practitioners. The authors cite previous research that states that hospitals with high nurse burnout rates have extended lengths of stay and greater odds of patient mortality. This new study clearly supports the idea that burnout is affecting patient safety, and that addressing burnout must be a priority for health systems.
The study also offers an alternative explanation to blaming exhausted clinicians for lack of care quality. The authors suggest that there are broader failures within health systems that have policies and working conditions which lead to burnout.
So, what’s the solution?
In the study, the authors state that poor work environments for nurse practitioners are those where there is a “lack of autonomy, inadequate support for care delivery, and poor relationships with practice administrators.” These issues carry over into all of nursing, where there are continuous calls for better working conditions and more support from health systems.
CNOs have a responsibility to their nurses to deliver better working conditions and help them maintain a better work-life balance. According to Lisa Dolan, Senior VP and CNO at Ardent Health Services, there are many things that can be done to help solve this issue.
“One of the initial things is just to be open and talk about burnout,” she says, “and recognize that it’s a real situation.”
Dolan suggests implementing wellbeing check-ins and debriefings after serious incidents, and potentially offering support programs for new mothers or those caring for aging parents. She also emphasizes the importance of celebrating wins as they come, and using patient feedback as a method of uplifting nurses’ spirits.
“If we have great outcomes,” Dolan says, “let’s celebrate every opportunity we [can].”
Maribeth McLaughlin, Chief Nurse Executive and Vice President at UPMC, chats with nursing editor G Hatfield about workforce challenges, team-based models, travel nurses, and the different strategies CNOs can use to improve recruitment and retention.
The annual consumer technology event, expected to attract more than 100,000 attendees to Las Vegas next week, will showcase the latest in innovative technology, as well as digital health trends affecting the healthcare industry
Healthcare executives gearing up for the 2024 International CES event next week in Las Vegas are focusing on one big question: How can I use consumer technology and digital health tools to improve the healthcare experience for my patients?
That’s always been the question for healthcare decision-makers intrigued by the massive consumer technology show, which takes over nearly every hall in the Las Vegas Convention Center and Venetian and is expected to draw 130,000 attendees this year. But while healthcare has long been overshadowed by cars, games, entertainment systems, and the odd robot and smart birdfeeder, digital health is now an integral part of the show, with its own space and session track.
The challenge lies in identifying the trends and technologies that hold value for healthcare executives, not just the latest and most innovative gadgets for consumers that a hospital or doctor might like to use. Health systems have long sought to integrate clinical uses with consumer technology to spur adoption and continued engagement, with often mixed results.
That’s especially true in this economy, which leave little room for innovation.
“CES is an opportunity for these digital health innovations to shine brightly in a dark moment in medicine as we face more hospital closures, high rates of clinician burnout, and increasing demand from consumers for a better experience,” Arielle Trzcinski, a principal analyst with Forrester, said in an e-mail to HealthLeaders.
Among the hot topics are, of course, AI, digital health apps, wearables, remote patient monitoring (RPM) tools and platforms, and smart technology in the home setting, a highlight of two concurrent events at CES, the CONNECTIONS Summit hosted by Parks Associates and AARP’s AgeTech Summit. The latter will feature the Samsung Health House, a smart home designed by Samsung in collaboration with AARP to show how seniors can age in place in the future.
“As medical deserts emerge for consumers, there is a growing opportunity for health systems and health insurers to tap into remote monitoring and wearables to empower consumers and keep them connected to much needed care,” Trzcinski added.
For healthcare execs focused on digital health, CES is bringing back its Digital Health Summit, a series of panels taking place Tuesday and Wednesday.in Room 250 of the Las Vegas Conference Center’s North Hall:
Other events of interest for healthcare executives include keynotes by the CEOs of Siemens, Walmart, Intel, Elevance Health, Qualcomm, and Best Buy, along with the CES Innovation Policy Summit, which includes a session titled Can Policy Affect Health Innovation? , a panel on AI governance around the world, and a special series of interviews, called “Conversations with a Commissioner,” that includes FDA Commissioner Robert Califf, FTC Commissioner Rebecca Slaughter, and FCC Commissioners Brendan Carr and Anna Gomez.
And finally, CES gives healthcare executives an opportunity to see where innovation is going in the consumer tech space, even if it is a bit far-fetched for hospitals and health systems at this time. They can look at unique ideas such as smart toilets, toothbrushes and home appliances, footwear and apps that track gait and balance, digital health tools for veterinarians, wearables, health and wellness apps, new sensors that track biometric data, and AR and VR tools.
According to this CNO, here’s what nursing leaders are facing in the new year.
2024 is gearing up to be another hectic year for healthcare. With the never-ending stream of new AI technologies on the rise, and the upcoming presidential election, there are sure to be some curveballs thrown at the entire industry, including nursing.
While the impacts of these changes cannot always be predicted, there are many trends that can be.
To get a glimpse at what to expect in nursing this year, we sat down with Lisa Dolan, CNO at Ardent Health Services, to discuss what she thinks are the top five biggest challenges facing CNOs, and the impacts of new technologies and virtual nursing.
This transcript has been edited for clarity.
What do you predict will be the top 5 biggest challenges in nursing in 2024?
Well, of course, at the top of the list is just the supply of nurses. The demand is far outpacing the supply. So that'll be a key piece.
Second to that is stabilization of support roles. As nursing becomes more and more taxed, it's especially important that we have a support team around the nurse. We're finding it more and more difficult to be competitive in our staffing of support roles. That's a that's a key worry and concern as well.
I think another key piece is innovation. There's so much great innovation going on, but how we incorporate that so that it's helpful to the nurse and not adding additional burden to the nurse is especially important.
Frontline nursing leaders and being able to retain the nursing leader. That's a very difficult position, in fact, I always say it's one of the toughest positions in the hospital. Being able to retain and support those frontline leaders will be key.
And then last but not least is really just burnout in general of the clinical staff. The roles are so difficult at times, and so [having] a healthy work environment for people to feel comfortable and not experience the rate of burnout that they have over the past several years [will be critical].
What can CNOs do to help mitigate those challenges?
Well, probably one of the biggest things is just to create efforts that reenergize their communities and their markets around nursing and healthcare careers in general. I think COVID-19 initially painted healthcare workers in a positive light, and on the heels of COVID-19 we had a lot of people think, “Gosh, I really don't know that I'd want to do that for a living.” So, really trying to help reenergize the public about healthcare careers and how fulfilling they can be is a key piece and a key role for the CNOs going forward in their communities.
Additionally, I think really creative partnerships with academic settings to help produce more healthcare workers. We've got healthcare settings that need support and staff, but then the academic settings also need help and are short staffed. If we can be creative in our partnership efforts with those academic settings to help augment their staffing and clinical instructors, and allow them to take additional students, [that] would all be very helpful as well.
What do you foresee being the next technological trend in nursing next year? How can that technology aid CNOs and their teams?
There's several that I wanted to make sure that I mentioned. I think virtual care and virtual care platforms are key for our future. Virtual care in nursing can assist with data collection. We can help admit patients, discharge patients, do patient education, family education. There are many things that a virtual nurse can assist a bedside nurse to complete and do, and actually feel like they have more time to spend with the patient. So that's a key piece.
Additionally, I think virtual provider support, and what I mean by that is bringing specialist to the bedside, and that might be a specialist in nursing, to offer support to maybe a newer nurse, or it could be a certain specialist physician to see a patient. Where those resources might be scarce, it can help bring that provider or that specialist to the bedside much quicker. So that whole virtual platform is going to be a huge benefit to nursing and bedside care in general.
One of the other pieces that's pretty significant are wearable technologies to monitor vital signs and monitor the patient's status. So that is just going to open [everything] up. One, it allows more continuous monitoring of vital signs. It frees [up] the staff so they don't actually have to do the task of taking vital signs, but can spend time with their patients doing other things.
Then we have just that continuous and reliable monitoring that can then feed into systems, which takes me to AI and the future of taking that information and that data and helping to support the clinician to make decisions. [AI] can even add alerts and pick up things quicker to aid the team at the bedside.
So, lots of technologies. There’s also the whole notion of smart rooms, and creating smart room technology that allows you to monitor patient movement within the patient room. You can look for things like patients who are at risk of falling that might be sitting out of bed, or is a patient turning as often as they should, and then driving alerts to the team to help with an intervention if needed.
One really exciting piece is the smart room that can hear and listen, so the opportunity might be there for transcription, or [doing] documentation just by talking through the room and having that assist with my documentation. Or, if I'm in a potential safety situation, then I could say keywords or call for assistance and be able to get help if I needed it in the room.
What do you think the impact of remote patient monitoring and virtual nursing will be?
I think what we're going to see is significant impact to certain outcomes. I would anticipate that virtual care is going to be able to help us manage our length of stay for patients. It'll eliminate some delays, possibly, in a specialist coming to the bedside. I think we'll be able to pick up on patient deterioration much quicker if we've got continuous vital sign monitoring.
I think that the assistance it provides will help retain nurses, because it's going to free their time from doing tasks, [and] maybe they can use that time to spend with patient at the bedside, with emotional support, actually caring and [doing] compassionate activities with a patient, which is going to be very fulfilling for the nurse. That's typically why nurses go into this career. It frees them up from doing being so task focused and allows them to really take care of activities that are much more fulfilling and provide the patient with support.
How can CNOs help their staff avoid burnout and maintain a healthy work-life balance?
Gosh, there's a lot that can be done. I think one of the initial things is just to be open and talk about burnout and recognize that it's a real situation. We can do things like having well-being check ins, [or] debriefings after a serious patient event, [and] we can do things creatively to help our staff adjust with key life events. You know, maybe offer support programs that are geared toward new moms or people who are taking care of aging parents.
I think the thing that we forget so often is just to recognize people and celebrate wins. If we have great outcomes, let's celebrate every opportunity we have, and then make sure that we harvest especially patient feedback to recognize our nurses anytime we can.
Are there any other trends you’re seeing that you think will continue into the new year?
I think we're going to see continued emphasis on quality and safety measures. That whole focus of pay for performance and meeting all of those key metrics is going to continue to be really important.
I think we're going to see a transition. I know that at Ardent, we will see a transition from a focus on patient experience in the hospital to almost a consumer experience across the care continuum. So, what is the experience for our patients when they interact with the system? That might be making appointments, it may be their experience when they access their information through their epic chart. Those are all key things.
I think the other piece that we'll see a lot of is different pilots on care delivery models. Because we know we don't have enough nurses to support historic approaches, we'll see people do different team approaches to care. The ability for people to work as a collaborative group and come together and care for a patient, I think it's going to be key into the future over the next year.
New research from the Regenstrief Institute gives health system executives specific recommendations on how to use their EHRs to help clinicians identify and prescribe drugs to their patients.
New research out of the Regenstrief Institute gives health system executives specific recommendations on how to use EHRs to reduce dangerous drug-drug interactions.
“Drug-drug interactions are very common, more common than a lot of people outside the healthcare system expect,” Michael Weiner, MD, MPH, a researcher with the US Department of Veterans Affairs, Regenstrief Institute, and Indiana University School of Medicine and senior author of the study, said in a press release. “In the US, these interactions lead to hundreds of thousands of hospitalizations in any given year at an enormous cost. Most of these drug interactions are preventable.”
With the advent of EHRs and digital health technology, health systems are looking to reduce those interactions by pinpointing when they can occur and giving clinicians on-demand access to information to prevent them. But that technology depends on understanding how clinicians prescribe drugs and how they look for dangerous interactions.
“This study was needed because we previously didn’t have a great understanding of how clinicians actually make decisions in assessing these interactions,” Weiner said. “No one had really taken apart the thinking process step-by-step to understand it from the beginning to the end. There's a patient, there's a drug and another drug. There is now a potential interaction. There's been a decision about how to resolve it following an assessment and then a resolution process. Understanding all this is very important if we are hoping to design improvements to the medical system that enhance patient safety.”
The study, recently published in BMJ Open, identified 19 information cues used by clinicians to manage drug-drug interactions, including information on the potential severity of a drug reaction, side-effects, a patient’s expected duration of exposure to an interaction, patient-specific conditions, a patient’s need for those drugs, and the characteristics of safer medications. Using that list, Weiner and his colleagues developed recommendations for designing alerts through the EHR.
They are:
Provide information on the expected range of timing of potential drug-drug interaction effects (days, weeks, months, or years).
Give clinicians a platform to review multiple electronic drug-drug interaction reference sources directly from the alert, side-by-side.
Leverage data analytics to populate drug-drug interaction alerts with "smart" displays of alternative drugs that align with three criteria used by clinicians.
Provide recommendations on the alert along with associated patient characteristics (for example, “monitor, if patient indicates willingness and capability of measuring blood pressure daily”).
Alissa Russ-Jara, PhD, a researcher at the Purdue University College of Pharmacy and US Department of Veterans Affairs, Regenstrief Institute affiliated scientist, and the study’s lead author, said the research highlighted the fact that no two clinicians use the same protocols in assessing drug-drug interactions.
After interviewing all of the clinicians involved in the study, she said in the press release, “many … expressed surprise at how much nuance went into their own decision. Their decisions often occur so rapidly, yet involve so much expertise. Ours was the first study to really unpack that for their decisions around drug-drug interactions.”
“We expect our findings can improve the design and usability of drug-drug interaction alerts for clinicians, and so they can more effectively aid patient safety,” she added. “Our study focused on clinical decision-making, regardless of whether the clinician was warned by an alert or not, so our findings have implications for clinicians, informatics leaders, and patients, and for any EHR system.”
The use of EHRs has grown substantially over the last decade, but patients still face problems getting to their health data
EHRs may be commonplace in healthcare, but that doesn’t mean everyone can access them, according to a new report from the Health and Human Services Department’s Office of the National Coordinator for Health IT.
Now that patients have had a taste for easy access to their health records, they’re demanding more. During the pandemic, patients wanted access to their records following a telehealth visit and to obtain COVID 19 test results. More patients also wanted to message their providers following the pandemic, at a rate of 53% in 2018, and climbing up to 64% in 2022.
Healthcare apps have made access to records even easier, and by 2022 more than half of patients were using apps to access their EHR data. They were also looking at their records more frequently than web-based portal users. In 2020 the ONC’s Cures Final Rule Act required certified health IT developers to create broader patient access through apps with standards-based application programming interfaces (APIs).
According to the ONC, healthcare organizations are seeing three barriers to patients being able to access their data:
Not All Apps Are Created Equal
Currently, a majority of patients are not using emerging third-party apps that have adopted APIs; Instead, they’re using apps provided by their healthcare provider or an online patient portal. APIs make information more widely available across smartphone apps, and they do so in a more secure method than other apps and web-based portals. By encouraging patients to use these API based apps, healthcare providers can ensure their patients are easily accessing their data in the most secure manner.
But What Does It Mean?
Another problem with EHR technology is that they don’t offer detailed explanations of diagnoses or test results. Patients may have access to their health records, but that doesn’t mean they understand them, especially complicated diagnoses. Research shows that patients like having timely access to their test results on their patient portal, rather than waiting for a call from their doctor. Going forward, health IT developers will need to monitor this and evolve the technology to add more context for patients.
Disparities and Barriers
Lastly, certain populations still face barriers to accessing their medical records. There are “disparities in patient access by race and ethnicity, education, income, and other socio-demographic factors,” according to a study by the Health and Human Service Department’s Office of the National Coordinator for Health IT. Other barriers include internet access, health literacy, and language. Although the ONC provides resources for patients to access and manage their health records through different methods, this issue persists.
The healthcare industry’s rocky relationship with EHRs will continue as long as patients have problems accessing their information. Providers need to step up and take action to ensure all patients have access to, understand, and can manage their health records
Technology can be a huge disruptor if implemented incorrectly.
On this week’s episode of HLM Shorts, we hear from Betty Jo Rocchio, Senior Vice President and Chief Nurse Executive at Mercy, about the technological challenges that her team faced while building Mercy’s new nursing innovation unit. Tune in to hear her insights.
Transcript (edited for clarity):
Have there been any unexpected challenges or outcomes regarding Mercy’s new nursing innovation unit?
Rocchio: Getting technology to play nice in the clinical environment with that ease of use is a heavy lift, which is why it can be such a big disruptor. If it's not put in and worked into workflow, we end up working around the technology.
So, making sure that the technology we pick is delivering to the satisfaction of the front lines is key. It's as simple as vital signs being taken by a machine and automatically having them documented in our electronic medical records, so nobody has to touch it.
That was a heavy lift with a lot of interfaces and things that you wouldn't think in the background, so our Mercy technology team has really been working overtime to lean in and help us.
Faced with competition from disruptors, health systems are expanding their pharmacy services to capture additional income and improve clinical care
Amid increased competition from disruptors and retail chains, health systems are expanding their pharmacy operations beyond the hospital, in some cases building stand-alone community pharmacies or co-locating them with clinics to compete directly with the likes of Walgreens, Rite Aid, and CVS.
“It’s a huge opportunity,” says Rebecca Taylor, vice president of the pharmacy service line at UPMC, which now has 17 pharmacies within its network, some located inside clinics. “Ambulatory pharmacies have been around for a long time, but there are a lot of factors that are driving this new opportunity” for health systems to expand their reach.
With intense competition in the healthcare space, health systems are seizing on the opportunity to expand pharmacy services as a means of improving the scope of services they provide to patients. Many want to keep the patient within the hospital’s network, integrating all healthcare services through the medical record, a strategy that segues into the concept of value-based care and the medical home.
Others see the pharmacy as an attractive business line. Through the 340B Drug Pricing Program, health systems can be reimbursed through Medicaid for outpatient drugs sold to uninsured and low-income patients. They’re also looking to capture more specialty pharmacy services and prescriptions lost to neighborhood and community pharmacies, not to mention the profits from other goods and services sold through a retail location.
And while neighborhood and community pharmacies are looking to adopt more healthcare services and become community health centers, they’re also struggling. Rite Aid has filed for bankruptcy, while Walgreens and CVS are closing hundreds of stores, leaving communities without that resource for filling prescriptions. Health systems can fill that gap with their own pharmacies.
Making an Argument for Pharmacy Expansion
Nicole Faucher, MS, president of Clearway Health, a Massachusetts-based company spun out of Boston Medical Center that partners with health systems and hospitals to strengthen their specialty pharmacy programs, says health systems have three primary reasons for expanding their pharmacy services:
Creating a new service line. When patients fill their prescriptions at a local pharmacy, they’re taking business away from the hospital. A health system can keep that business in-house with its own pharmacy service, as well as influencing the patient to consider more health and wellness services and products.
Improving clinical outcomes. By keeping pharmacy services in-house, a health system can link all of those services through the medical record, ensuring continuity of care and reducing gaps in care or siloed services. In addition, the pharmacist becomes an integral part of the care team and the care management plan, improving medication adherence and helping patients with any medication-based issues that might otherwise be delayed or go unanswered.
Improving patient loyalty and engagement. Health systems that include pharmacy services are seen by patients as being more attentive to and involved in care management and coordination. That patient will be more likely to stay with the health system, listen to advice on other services and resources within the health system, and recommend that health system to family and friends.
The decision to expand pharmacy services can’t be taken lightly. These projects are expensive, and they require plenty of research and planning. One look at how Walgreens, Rite Aid, and CVS are doing right now with the healthcare ambitions would be enough to scare anyone away.
“This isn’t just ‘Build it and they will come,’” warns Faucher, who says health system leadership needs to think long and hard about whether to take this on.
Among the considerations that go into planning a pharmacy expansion:
Understanding the patient population and community. Will patients shift their allegiance from local pharmacies to a hospital-run pharmacy?
Site selection and staffing. Will a stand-alone pharmacy work, or should these services be co-located with a clinic, medical offices, or other programs? Building and/or rental costs will figure prominently in this strategy, as will costs for staffing a stand-alone pharmacy.
Delivery. Will this be a traditional pharmacy that handles over-the-counter and walk-in traffic, or will it be strictly mail-order? If the latter, how will deliveries be handled? If the former, will the pharmacy handle prescriptions only or offer other goods and services?
Contract negotiations. A health system will need to handle contracts with pharmacy benefit managers (PBMs), payers, and health plans, along with any delivery services. In addition, there will be contracts with drug distributors to consider.
Sustainability. How much business will a pharmacy need to generate to be sustainable? This will determine what other services or products are offered.
Alongside managing the aspects of a 340B program, Faucher says a health system must also decide how to manage business with other pharmacies. Some 15% of all prescriptions involve medications that are handled by specialty pharmacies.
“There really isn’t a one size that fits” for every health system, she says.
Addressing Both Clinical and Business Goals
At Signature Healthcare, based in southeastern Massachusetts, the decision to expand pharmacy services addressed both clinical and business goals. A significant percentage of the health system’s patient base are members of government health plans, making the 340B program an attractive addition to their bottom line.
“We make a little more of a margin on that,” says Stephen Borges, Signature’s vice president of financial operations.
But the health system also wants to create a more connected health experience for its patients, many of whom are underserved, he says. That means adding pharmacy techs in critical care units, medical offices, and clinics to be part of the care team, and locating a retail pharmacy in their largest physician office building near the hospital.
“We’re reinventing care for our patients,” Borges says.
Signature Health had partnered with the local Walgreens chain prior to this change in strategy, even enabling Walgreens pharmacists to come into the hospital to meet with patients before they were discharged. But there were still gaps in care, he says, that comes with having two separate organizations try to care for the same patient.
“We want our pharmacists to have the ability to do more with our patients,” Borges says. That includes creating a patient assistance program to work with patients who struggle to pay their bills and find other ways of meeting prescription costs.
One of the challenges to implementing this new strategy was getting buy-in from physicians who might not see the pharmacist as a member of the care team. Borges says it took some time and effort to get everyone comfortable with each other; he credits the successful integration to the work of physician champions identified ahead of time by the health system.
Another challenge was getting support from patients who have always gotten their prescriptions filled at the local pharmacy.
“We didn’t anticipate that it would be so hard to convince people to move away from CVS and Walgreens,” Borges says.
Addressing the Patient’s Needs
At UPMC, Taylor says expanding the health system’s footprint to include more pharmacy services gives them the chance to have a greater impact on clinical outcomes.
Pharmacists who are part of the health system and the care team, she says, can work with providers and patients to fine-tune medication management, identifying potential drug reactions and alternatives to costly medications. They can answer patient questions that might not be asked in a separate pharmacy, work with patients who have trouble paying for medications, and collaborate with doctors when a patient struggles with medication adherence or displays adverse effects to taking a certain medication. They can also help the health system with vaccinations and other public and community health outreach programs.
Taylor says the additional service line also enables UPMC to attract and hire skilled pharmacists, especially those who’d prefer to work with a health system rather than a retail pharmacy.
Studies back up the idea that the pharmacist—regardless of whether he/she is employed by the hospital or another company--should be part of the care team. Recent research done at Virginia Commonwealth University found that pharmacists could prevent more than 15 million heart attacks and nearly 8 million strokes and save $1.1 trillion in healthcare costs over 30 years if they were allowed to be more active in managing care for patients.
Taylor sees an improvement in reduced rehospitalizations. Pharmacists who are part of the care team can spot problems before they become serious, she notes, alerting physicians and enabling them to intervene while the patient is at home.
The Impact of Technology
One reason for heightened interest in the pharmacy space is the availability of new technology. Telehealth and digital health tools make it easier for clinicians and pharmacists to communicate with each other and with patients, creating or modifying care plans on the go and prescribing and filling prescriptions virtually. And with the popularity of online and mail-order prescriptions surging, health systems can also take advantage of online platforms to handle prescriptions in bulk and mail them to patients.
“That certainly makes it easier,” says Taylor. “And in the future, there will be other technologies that will make it feasible to do a hub-and-spoke model,” enabling health systems to manage distant pharmacy sites from one central location.
“Internet prescription fills have gone through the roof,” adds Borges.
A report recently issued by the Center for Connected Medicine finds that more than half of health systems with their own ambulatory pharmacies “believe retailers and technology companies are having either a moderate or strong influence on their hospital’s pharmacy strategy.”
According to the report, many health systems are planning to invest in digital health technology to improve their pharmacy services. Among the more popular platforms are integrated patient portals, prescription fills and refills and payments through an app, and medication adherence services (such as reminders).
Faucher, of Clearway Health, says the integration of patient portals and EHRs with pharmacy services gives health systems an opportunity to play a more active role in care management. Doctors can check in with both pharmacists and patients online to make sure prescribed medications are being taken and are effective, while pharmacists and patients can respond more quickly if something isn’t working.
Faucher says health systems have an opportunity to grow their business by single digits with a more aggressive pharmacy strategy, and by double digits if they adopt specialty pharmacy services. Beyond the profit margins, they have an opportunity to improve care by being more of a healthcare partner with patients who are demanding more collaboration with their care teams.
“Health systems need to have a pharmacy strategy,” she says. “This will be a continuing trend.”
This CNO has advice for the huge challenges facing nurse leaders as we enter the new year.
As we dive into the new year, CNOs must be prepared to deal with the new and ongoing challenges facing the nursing industry. Lisa Dolan, Senior Vice President and Chief Nursing Officer at Ardent Health Services, has laid out what she thinks are the five biggest issues that nurses will face in 2024.
5. Burnout
Burnout is a widespread issue for clinical staff throughout all of healthcare, especially since the pandemic.
“The roles are so difficult at times,” Dolan says, “and so being able to have a healthy work environment for people to feel comfortable in, and not experience the rate of burnout that they have over the past several years [will be key].”
CNOs should be open and talk about burnout, and validate that it is a real issue. Dolan recommends wellbeing check-ins and holding debriefings after serious incidents with patients, and finding creative ways to help staff adjust when they encounter big life events.
She also says recognizing people and celebrating their wins is crucial, and getting feedback from patients is a great way to give that recognition to the nurses who care for them.
4. Frontline nursing leaders
Retaining frontline nursing leaders will also be on many CNO agendas. Retention is already difficult in nursing, and it’s crucial that frontline nursing leaders be present long-term for their units to help promote teamwork and to maintain a strong workplace culture.
“It’s one of the toughest positions in the hospital,” Dolan says, “So being able to retain and support those frontline leaders will be key.”
3. Innovation
There are all kinds of new technologies arriving at the forefront in nursing, and it’s the CNO’s job to know how to incorporate them correctly into nursing strategy.
“There’s so much great innovation going on,” Dolan says, “but how we incorporate [technology] so that it’s helpful to the nurse and not adding additional burden to the nurse is especially important.”
Virtual nursing and virtual care platforms are keys to the future, according to Dolan. Virtual care in nursing can help with data collection, patient admission and discharge, patient education, and family education.
“There’s many things that a virtual nurse can assist a bedside nurse to complete and do,” she says, “and [they] actually feel like they have more time to spend with the patient.”
Dolan also emphasizes the benefits of wearable technology and smart rooms. Wearables can help nurses monitor vital signs and patient status, freeing up staff so they can spend time completing other tasks. Wearables also have the potential to help with hospital to home care, because patients can continue wearing the technology that will keep monitoring their progress.
Smart rooms and smart room technology also will add to further advancement in patient monitoring, and help take some of the burden off nurses. Smart rooms can hear and listen, which opens up the possibility of real-time transcription of the documentation nurses record for patients. This technology could also help prevent workplace violence or safety incidents from escalating too much, Dolan says.
2. Stabilization of support roles
One of the biggest challenges in nursing is stabilization of support roles. It’s becoming more and more difficult to be competitive in staffing support roles, which Dolan says is a key concern.
“As nursing becomes more and more taxed,” she says, “It’s especially important that we have a support team around the nurse.”
1. Supply of nurses
At the top of the list is the supply of nurses. The demand for nurses is outpacing the supply, and it is essential that CNOs use their influence to implement strategies to help fix this problem.
“Trying to help re-energize the public about healthcare careers and how fulfilling they can be is a key piece and a key role for the CNOs going forward in their communities,” Dolan says.
She also believes that creative partnerships with academic programs and institutions can help produce more nurses. Both healthcare and academic settings are short-staffed and need help, and there is an opportunity for one to provide support to the other, and vice versa.
“If we can be creative in our partnership efforts with those academic settings to help augment their staffing and clinical instructors, and allow them to take additional students,” she says, “that would all be very helpful as well.”
Jumping into the new year
Several other trends will continue to affect nursing in 2024. Dolan believes we’re going to see continued emphasis on quality and safety measures in the workplace, for both patients and staff.
“That whole focus of pay for performance and meeting all of those key metrics is going to be continue to be really important,” she says.
At Ardent Health Services, she says they will see a transition from a patient experience in the hospital to a consumer experience across the whole system. This shift in strategy considers the experience of patients when they interact with system processes, such as making appointments or accessing their health information through their Epic chart.
Additionally, health systems will experiment with new care delivery models. Since there are not enough nurses to support historic approaches, there will be new team approaches to care, Dolan says.
“That whole ability for people to work as a collaborative group, and come together [to] care for a patient,” she says, “I think is going to be key into the future over the next year.”
