Redesigning post-discharge care to include mental health resources can reduce return visits and rehospitalizations and improve recovery and clinical outcomes

Health system leaders are constantly looking for strategies to reduce rehospitalizations. A new study says redesigning post-discharge care to include mental health services, including through digital health and virtual channels, could cut that return rate in half.

The study, conducted by a team of researchers at the University of Washington, focuses on the millions of hospitalizations each year that are caused by a traumatic injury. Many of those patients return to the hospital after discharge because of mental health issues tied to that trauma, with as many as 40% dealing with post-traumatic stress disorder (PTSD).

Improving the care coordination process after a hospital visit is one of the top innovation challenges facing health systems. So many care gaps are created when the patient leaves the hospital and heads either to a rehab or SNF facility or back home. Doctor’s orders and prescriptions are forgotten or even ignored, care plans are interrupted or dropped altogether, and recovery is delayed, often leading to negative clinical outcomes, including rehospitalization.

The study, led by Laura Prater, PhD, MPH, MHA, an assistant professor at The Ohio State University of Public Health, and published in the Annals of Surgery, tracked 171 patients who were treated at a University of Washington trauma center. Half were treated via the traditional process, and half were involved in a five-year, three-step program that included enhanced care specific to mental health needs during hospitalization and 24/7 access to mental health services after discharge.

According to the study, 27% of patients undergoing traditional care were rehospitalized within three to six months, compared to 16% of patients involved in the mental health intervention program. After 12 to 15 months, 31% of the traditional-care patients were back in the hospital, compared to 17% of those in the intervention program.

“Being able to manage PTSD and other mental health concerns early on and receive regular follow-up support can prevent adverse long-term health problems and increase a survivor’s ability to live a productive, meaningful life,” Prater said in a press release issued by The Ohio State University. 

The intervention program included digital health tools aimed at offering on-demand services to those patients.

“The immediate text message or phone call response to questions and concerns is potentially the most meaningful element of the intervention, from the perspective of the survivors,” Prater said. “A lot of places use MyChart or another form of messaging, but responses can be delayed and that is problematic if someone is feeling overwhelmed. Having an immediate connection helped patients and their families to feel like they weren’t in it alone.” 

The study reinforces research done earlier this year at Vanderbilt University, which used a National Institutes of Health grant to study new methods of addressing post-intensive care syndrome (PICS), which can affect as many as 80% of patients discharged from a hospital after an ICU stay. That study found that a reconfigured post-discharge care management and coordination program focused on virtual care could reduce rehospitalizations and improve clinical outcomes.

Both studies point to a need to change how hospitalized patients are treated after they leave the hospital, with more emphasis placed on the traumatic nature of a hospital stay and improved access to mental health services to help patients recover—mentally as well as physically—from their health concerns.

“Being in the emergency department is traumatic in its own right, plus returning to the scene where you first received care following an injury or assault is not ideal,” Prater said in the press release. “Managing trauma and the mental health fallout from that trauma is best done at home, where you’re in a safe location.” 

Be brave enough to know what you don't know and to learn things you haven't learned before, she says

As president and CEO of Sumitomo Pharma America (SMPA), Myrtle Potter sets a high level of work performance for herself and her team members. And she doesn't apologize for it.

"I set really high standards as a leader and I demand a lot, but at the same time, I'm also a nurturer," she says. "I think my employees would be disappointed in me if I didn't expect great things from them. I believe they can deliver great things.”

“My job is to make sure the organization can deliver against its objectives, and to ensure it is prepared to do that," she adds.

Setting high standards of performance for your employees doesn't mean you aren't a caring boss, Potter says. There are many layers to running an organization, and an important one is being responsible for the growth and development of your employees.

Leaders must drive the strategy plan, the implementation, the follow-up, and meeting the financial goals. At the same time there's a responsibility to the health and well-being of the employees.

Potter says her ability to build strong, diverse teams is the key to her success.

"The secret to my success is I think strategically about team building, about leadership development, and the selection of leaders who I choose to have on my team," she says. "I make it a point not to hire people who are just like me, because I believe that different points of view are essential for the advancement of innovation and for the best problem solving."

Myrtle Potter, president and CEO of Sumitomo Pharma America. Photo courtesy SMPA. 

Potter grew up in a small southwest town in a family of eight. She credits learning how to share a bathroom with five other siblings for her team-building skills. Rather than being a hindrance to her sizable aspirations, she says her small-town upbringing set her on the path to becoming a strong leader.

"I was raised to be very brave," Potter says. "Fearlessness was instilled in me. Even though I grew up in a small town, where everybody knew each other, my aspiration was to go to the University of Chicago. My parents helped me financially to get there. It took a lot of guts to get on that plane by myself and head off to the big city of Chicago. But I grew up in an environment where I was encouraged to stretch, and I believe this is an important trait for anyone looking to do great things in their career. "

When Potter is mentoring others, she sets up the same encouraging environment that her parents did.

"I advise people to leave their handprint on every job they take. In other words, don't just warm a seat, make a difference," she says. "People will remember you because of the contributions you've made and the difference that you've made in the business."

Potter also encourages others to be brave, as her parents taught her.  

"Be brave enough to know what you don't know and to learn things you haven't learned before. Seek out the education and the support that you need to round out your understanding and your knowledge base."

Establishing a Career Trajectory

At the University of Chicago, Potter took a couple of jobs at the University Hospital. She worked in a lab, as well as on a patient floor for seriously ill patients with dermatological diseases and neurological diseases.

"I was a ward clerk,” she says. “I really loved it because I got to essentially be a part of the medical teams. That was the defining moment that motivated me to be in the biopharmaceutical industry, that and my dad having been a medic in the Army. I was really close to medicine my whole life. And so that was really the impetus for me joining the pharmaceutical industry."

Over the past 30 years Potter has served as vice president at Merck, president at Bristol-Myers Squibb, and chief operating officer and president of commercial operations at Genentech, as well as the Vant Operating Chair at Roivant Pharma. She also ran her own consulting business, Myrtle Potter & Company, for more than 13 years. 

Over this time frame, she says she has honed her leadership skills.

"Today, I understand the power of listening,” she says. “Listening for congruence, listening for alignment, listening for gaps in strategy, listening for times when an organization might feel freer, or they need to be bolstered up, listening for when they feel empowered. Developing others, thinking ten to 12 steps ahead, supporting the organization through the good times, and the tough times. Those are the kinds of things I think about now, versus when I got my very first management job."

Facing the Challenges of a Large Merger

Earlier this year Potter faced a new challenge: The merger of not two companies, but seven. She was instrumental in successfully bringing Sumitovant, Myovant Sciences, Urovant Sciences, Enzyvant Therapeutics, Sumitomo Pharma America Holdings, Sumitomo Pharma Oncology, and Sunovion Pharmaceuticals together to form SMPA. 

"As you can imagine, that was just a Herculean task," she says. "Combining a couple of companies is challenging, and I have done that before, but we're talking about seven."

Potter led the companies through the challenge, following a strategy that allowed the transitioning employees of all seven companies to choose whether to join the new company. Mergers can be stressful for employees, and she says she tried to give everyone the opportunity to engage in their future role at the new company.

As opposed to just bringing all the employees together and saying, 'This is your new job, now go off and do it,' Potter says she brought people to the organization with a lot of integrity and honor.

"We literally gave every single transitioned employee a new offer letter, a new description of their role, and gave them the choice to say yes or no," Potter says. "It was very empowering to hear people say, 'Yes, I want to be a part of what you and your leaders are building.'"

While that was a huge task accomplished in just a matter of months, it isn't the proudest moment of Potter's career. That was at Genentech, when the biotech held record sales and earnings growth for 19 of 20 consecutive quarters and launched seven novel therapies in just five years.

"When I joined Genentech, we thought we might have two product launches," she says. "We never anticipated that everything would just keep growing the way that it did. I was co-chair of the Product Portfolio Committee, and we created the most valuable drug pipeline in the world at that time. That's something I'm very, very proud of. We really made a big difference for a lot of patients."

Charting the Future of SMPA

Potter is also proud of SMPA's endeavors to deliver needed therapies to patients who live with difficult to manage conditions.

The company’s portfolio includes treatments in psychiatry, neurology, oncology, urology, women's health, and gene therapy for cystic fibrosis. One of SMPA’s most interesting projects is a treatment for children with congenital athymia, an ultra-rare disease characterized by the absence of a functioning thymus. Most congenital athymia babies die within three years, even with supportive care.

The product, Rethymic, was approved by the FDA in November 2021; it’s the only FDA-approved tissue-based treatment for this condition.

"Rethymic greatly improves [the] survival [rate] for these children," Potter says. "There may be only 20-25 of these children diagnosed in the United States a year, but we care greatly about all of them."

Another SMPA objective is to use technology and AI to advance new technologies to transform operations through the acceleration of digital.

"Our industry is changing so much and one of the things that's really exciting is we truly are leveraging technology in a way that other companies just simply aren't doing," Potter says. "When you're thinking about driving innovation and cultivating leaders, you need to think about who is comfortable talking about AI and natural language processing and using it to solve problems."

Sumitomo has built two in-house technology platforms that use the latest generative AI and machine learning tools to improve the efficiency and effectiveness of research to find new targets, clinical trials, and commercialization of new therapies.

The supermarket chain is redesigning its in-store health clinics to focus on seniors in Medicare plans, who often face challenges accessing primary care and are looking for better services.

A new partnership aims to give seniors another option for primary care: The supermarket.

Kroger Health, the healthcare arm of the Cincinnati-based retailer with more than 2,700 grocery stores in 35 states and the District of Columbia, is joining forces with the Better Health Group to focus its 225 Little Clinic in-store walk-in clinics on primary care services for seniors on Medicare, including Medicare Advantage plans.

Kroger joins a growing list of disruptors from other industries entering the healthcare market with consumer-focused primary and specialty care services. Companies like Amazon, Walmart, Publix, Google, and national pharmacy chains like Walgreens, CVS Health, and Rite Aid are all looking to replicate the success of the retail experience in healthcare for people who face barriers to accessing care or are more comfortable going to a store than a hospital or doctor’s office.

[See also: ATA Urges Clinicians to Take Charge, Own Virtual Care Innovation.]

Some within the healthcare industry have called this the battle for primary care, with health systems and medical practices looking to keep their patients and attract new ones in the face of competition from outside organizations. According to a Bain & Company study issued in 2030, these disruptors could capture 30% of the primary care market within six years.

“As the industry continues to shift toward value-based reimbursement, there has been an increase of nontraditional players and models in primary care,” Erin Ney, MD, an associate partner at Bain & Company, said in a press release accompanying the report. “As we look ahead, rising costs, physician shortages, consumerism and digital disruption will continue putting pressure on traditional healthcare models, paving the way for additional growth of models that promote more efficient care, improved outcomes and reduced total cost.”

Health system executives have been urged to improve the patient experience, including adopting virtual care and digital health tools, and embrace retail strategies that focus on convenience and reliability.

With organizations like Kroger, Amazon, and Walmart offering alternatives to the doctor’s office or hospital, experts say health systems need to identify and focus on what they can offer that others can’t—which in many cases is the connection to a respected hospital or medical group. Critics, meanwhile, say cost, complexity, and challenges to access are turning consumers away from healthcare and opening the door for the disruptors.

[See also: Assessing the Biggest Disruptors in Healthcare.]

The Better Health Group, which launched in 2016 at Physician Partners, operates more than 160 VIPcare clinics focused on senior services and partners with more than 1,200 providers. Officials at both Kroger Health and Better Health say the partnership will advance value-based care for a population desperately in need of focused services and better access to care.

The collaboration will begin at selected Kroger supermarkets in the Atlanta area before branching out in 2024 to other stores.

Amid geopolitical conflict, financial headwinds, and ramped nursing shortages and unrest, there's a lot of healing that needs to happen. Starting with the healers. 

Editor’s note: This is part 2 of a two-part series. Part 1 was published on Monday, December 18.

To set the stage for success in 2024 and beyond, CNOs must build up their teams, both in number and resilience, nurse execs and experts tell HealthLeaders. That means making compensation compelling, fostering shared purpose, redesigning care models, and playing a very long game when it comes to recruiting.

Here are some more of the ways that CNOs are improving teamwork going into 2024. 

For more information, check out the full article here. 

A hardware breakdown prompted Deborah Heart and Lung Center to outsource its data storage services. How do other health systems decide if and when to make that move?

Health systems have different motivations for migrating to the cloud. A catastrophic disk failure may be the best reason.

That’s what happened at the Deborah Heart and Lung Center, an 89-bed New Jersey-based hospital that focuses exclusively on cardiac, vascular, and lung disease. In 2015, the hospital’s systems pretty much shut down for close to two days after a drive ceased to function on its in-house electronic health record (EHR) system.

As the healthcare industry embraces more technology (especially digital health tools) and ramps up its data collection and analysis capabilities, how that data is stored and protected becomes critical. A July 2021 online survey by the College of Health Information Executives (CHIME) found that more than 80% of health system executives are conducting at least some services in the cloud, while nearly 10% are fully invested in the cloud and some 60% are adopting a hybrid approach.

The reasons for moving to the cloud are numerous. According to KLAS, roughly half of health systems are doing so to reduce costs and capital expenses, while 40% see the cloud as an opportunity to expand resources they don’t have on-site. Almost 30% are using the cloud to enhance services or capabilities, while 11% are looking to improve system performance and 9% see opportunities to improve data security.

That was the motivation for the Deborah Heart and Lung Center.

“It took everything down,” says Rich Temple, the hospital’s vice president and chief information officer, who’d come onto the job just six weeks prior. “It kind of came right out of the blue. We were struggling mightily to try to get backup [up and running]. It was the longest two days of my life.”

Temple says the health system had backups in place just for this occurrence, but the initial disk failure was so profound that some of the backups were corrupted as well. Ultimately, a backup file was restored and, two days later, the system was finally brought back up.

Shortly thereafter, leadership decided to outsource data storage and management for its EHR to CloudWave, healthcare data security experts.

Rich Temple, vice president and chief information officer, Deborah Heart and Lung Center. Photo courtesy Deborah Heart and Lung Center.

Moving to the cloud isn’t cheap—that’s the top concern and barrier that health system executives cite in making the decision whether to outsource those services, though studies have suggested it doesn’t take long for a health system to recoup those costs in savings. In a tight economy, with many health systems struggling to stay in the black, giving the green light to a costly capital expenditure isn’t easy.

“We knew then we couldn’t risk that happening again,” Temple says. “But you don’t do this as a money-saver. You do it for risk-avoidance.”

Aside from the initial cost, many health systems struggle with the operational changes required to make the switch. Every department is affected by the transition, requiring the C-Suite to get out ahead and develop a comprehensive change management strategy.

“It’s truly a multi-dimensional project,” says Temple. “We knew there were going to be a lot of twists and turns, and there were even more twists and turns than we expected.”

One familiar problem, he says, was getting buy-in. Despite the chaos caused by the disk failure, some providers were hesitant to want to adapt to a new system and expressed worries about what are commonly called “last-mile issues,” or problems unforeseen and encountered just as the new system is turned on.

“We’ve always done down-time drills, but everyone is so dependent on electronic health records,” says Temple, noting the health system has been using EHRs since 1998.

Temple says the health system worked long and hard to make sure the transition from on-site to cloud was as seamless as possible. That meant identifying everyone who would need access to the system and determining what they could and couldn’t access, creating licensing and multi-factor authentication and understanding the bandwidth needed to support back-and-forth operations, even understanding all the different platforms within the health system that have some interaction with the EHR.

In addition, he says, the fallout caused by the disk failure gave the Deborah Heart and Lung Center’s leadership the opportunity to look more closely at how the hospital handles its technology at a time when things aren’t working. What should a disaster recovery and business continuity model look like? And how should that model be adjusted when outsourcing certain operations to the cloud? Additionally, how does a health system create a plan to stay up and running after a data breach or a ransomware attack?

“Make sure your eyes are wide open before you start,” Temple concludes.

Amid geopolitical conflict, financial headwinds, and ramped nursing shortages and unrest, there's a lot of healing that needs to happen. Starting with the healers. 

Editor’s Note: This is part 1 of a two-part story. Part 2 will be published on Wednesday, December 20.

To set the stage for success in 2024 and beyond, CNOs must build up their teams, both in number and resilience, nurse execs and experts tell HealthLeaders. That means making compensation compelling, fostering shared purpose, redesigning care models, and playing a very long game when it comes to recruiting.

Here are some of the ways that CNOs are improving teamwork going into 2024. 

For more information, check out the full article here. 

Violence is on the rise, but so is technology that can turn the tide, as long as those on the frontlines lead the way. 

It’s a sobering reality across healthcare: Workplace violence is on the rise.

And nurses, who are at the heart of care, are at especially high risk. In a 2022 National Nurses United survey, nearly half of hospital-based respondents reported an increase in workplace violence, a 57% increase from the rate reported in their previous survey in late 2021.

“The examples, what people describe—years ago, you would never have heard of these kinds of incidents,” says Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE, FAAN, founder and CEO of Innovation Advantage, a healthcare innovation consultancy specializing in virtual nursing care delivery models. She recalls being in a hospital earlier this month when a patient who had just given birth punched a nurse following a communication breakdown over discharge plans.

It's an alarming escalation of a longstanding issue.

“Healthcare in general is an emotionally intense kind of field,” says Sharon Pappas, PhD, RN, NEA-BC, FAAN, chief nurse executive at Emory Healthcare in Atlanta, who co-chaired the American Organization for Nursing Leadership committee on evidence-based approaches to combatting workplace violence in 2014. “So even prior to the pandemic, it was something that of course we were concerned about.”

The pandemic brought with it a host of new challenges, like visitation restrictions that ratcheted up stress during an already fraught time.

“It predisposed us to more emotional reactions by family members, and maybe even patients themselves, because they were among strangers,” Pappas explains.

Beyond rising violence, nurses’ workplace expectations are evolving. Younger nurses tend to be “less tolerant of bad behavior,” Clipper says.

“I don’t think they’re wrong," she says. "We have to figure out how to make it comfortable and safe for everyone. Being a healthcare professional doesn’t mean we have to tolerate violence.”

That figuring out needs to happen fast—and at scale—to avoid sweeping loss.

“If we don't protect healthcare professionals, our numbers, turnover, is only going to accelerate,” Clipper says.

Nursing-Focused Tech Can Help

Two-thirds of U.S. chief nursing officers are already interested in, researching, or deploying a virtual nursing care model, Clipper says. And the involved solutions provide strong bones for safety strategy. For example, patient rooms wired with cameras, speakers, microphones, and more offer extra eyes and ears attuned to threats.

“We're on the precipice, and we’re starting to use some of those things to help us,” Clipper says.

And yet, the current crisis calls for even swifter uptake.

“We really have to have more of a sense of urgency in adopting these technology solutions that are going to help us not only provide better patient care, but also protect our caregivers more,” she says.

Beyond just-in-time tools like wired rooms and badge alert buttons, technologies with emerging safety applications run the gamut in terms of size, complexity, and point of intervention. AI solutions, while still baking, show potential for predicting and preempting behavioral risks, while virtual reality can make de-escalation training more resonant. Seamless incident reporting, meanwhile, can incentivize uptake and produce more insights to shape prevention strategies.  

But before beelining to the latest innovation, consider the broader strategic context to avoid doing more harm than good, nurse executives and experts advise.

Some considerations Clipper addresses with her virtual nursing clients include:

• What’s the real, underlying problem that needs to be solved?
• What’s the model going to look like in the organization?
• What are the specific use cases?
• How are nurses being brought in to help identify solutions?

Then, design with humans in mind. That means tapping diverse disciplines—security who respond to threats, AI and data experts who can explore predictive applications, and, of course, nurses who are at the fore, Clipper says.

“They're the ones that have to be involved to say, ‘Hey, here was the trigger of this event,’ or ‘there was no warning whatsoever, and here’s what happened,.’” she says. And on the other end of the spectrum, they can share ideas for “proactively identifying precipitating events to predict and thus avoid violence in the first place."

Pappas agrees with the importance of an interdisciplinary approach.

Emory convened a group to probe workplace safety performance and implement structures to facilitate daily discussion on incidents and improvement opportunities.

“That's how you learn, and that’s how you get better and get safer,” Pappas says.

The health system named two co-chairs, a chief nurse and an operations leader, who in turn recruited a behavioral health expert to help guide the effort.

The diverse representation was intentional.

“This isn’t something that you do top down,” Pappas says. “We wanted to get people as connected and oriented toward the first line of workers as we possibly could.”

It’s working. The two inaugural co-chairs are still at the helm today, and Emory’s foresight to form the group “prepared us very well for the increase in some of those workplace safety issues that occurred during and following the pandemic,” Pappas says.

Keep An Eye On AI

With sound safety strategies and decision-making frameworks in place, nurse executives can explore specific technology applications.

Using AI during the intake process, for example, could help identify factors like diseases, conditions, substance use disorder or withdrawl, traumatic events, and family dynamics that could make patients more prone to violence, Clipper says.

It could also preempt fallible decision-making in charged situations, she says, like when the person being violent is a patient who needs care, and their behavior is the result of an underlying condition.

“If we have ways to identify, predict, and prevent, that's way easier for us to deal with than the more subjective, moral, and value-based conversations that nurses struggle with such as 'Do you press charges?' or 'Do you issue a criminal trespass warrant?'” she adds.

Of course, there are risks in relying on hyped, fast-evolving technology for weighty predictions.

“We don't want to bake in bias into our algorithms or into our predictive systems that might inaccurately identify someone that may potentially be at higher risk to behave poorly,” Clipper says. “We have to make sure that we're building these systems in a way that’s equitable."

Make Training Safe (And Sticky)

Technology can also enhance training on how to recognize and respond to violence. VR, for example, can produce realistic, scalable simulations for high-stakes skills like de-escalation and crisis prevention, Clipper says.

Plus, she adds, “the beauty of VR is that’s a failure-safe environment.”

Earlier this year, UT Southwestern Medical Center and UT Dallas designed a VR training tool that places clinicians inside a virtual hospital exam room and presents a series of realistic patient encounters so they can practice proven de-escalation tactics in a real-feeling environment, complete with a headset, vest, and gloves that mimic the sensation of being touched (or hit).

Given this capability, VR is a useful—and increasingly popular—tool for improving problem solving and “muscle memory,” Clipper says.

“When you go through those scenarios, you get to test over and over again what you should do, what you should say, how that works,” she says.

Technology can also make training more accessible and consumable in the course of a busy day.

“It's important that we look at training and newer ways that are more bite-sized as opposed to a three-day class,” Pappas says. “Technology can help with that by [creating] little vignettes, something you can access on your cellphone.”

Meet the Moment

With virtual nursing on the rise, many CNOs already have tools in place or in the works that they can weave into their safety strategy.

Such solutions range from simple, Clipper explains, such as a tablet that allows a virtual nurse to admit, discharge, or educate a patient, to sweeping: a room wired with cameras, speakers, microphones, and even sensor-enabled ambient computer vision and sound.

In the high-tech setups, the devices can act as an occasional or ongoing “extra set of eyes and ears observing what's going on or listening for things that might trigger someone’s interest,” she says.

One organization on Clipper’s radar has developed a safe phrase, “something along the lines of ‘there’s birthday cake in the breakroom,’” that “perks up” the virtual nursing system and prompts “no questions asked” action like a security visit.

It can “expedite that time it typically takes to get someone into the room to further investigate and check it out,” she explains.

Create a Strong Reporting Culture

Emory has found great success, Pappas says, using tech to improve ease of incident reporting so “you have information that you can use to understand it better and actually start to devise strategies to make the workplace safer.”

They’ve integrated reporting with their EHR to automate as much of the process as possible.

“If you can make reporting really easy, people are more prone to do it,” she explains.

As a result, Emory has seen tremendous, across-the-board improvement in levels of reporting thanks to their targeted interventions.

“We were able to detect, by operating unit, that we were having increases at just about every site in the amount of reporting that they do,” Pappas says.

It’s additional information they use daily to make the workplace better, which in turn fuels more reporting, she explains.

“The positive feedback system has helped us to continue to increase reporting and to improve safety,” she says.

To synthesize and act on findings, Emory has implemented a five-tiered huddle system, which runs from the frontlines all the way to operating unit leadership. Every day, the top tier comes together to share what they’ve learned from their own tiered huddles.

“It’s made people say, ‘Wow, if we report it, that means that people are going to talk about it, and I get a chance to improve this,’” Pappas says.

Know That Tech Alone Can’t Save You

An “aha moment” in Emory’s stepped-up reporting came from an unexpected setting: ambulatory clinics.

“The stakes aren’t quite as high [because] the patients aren't quite as sick,” Pappas explains.

And yet, their reporting revealed that some patients experiencing long wait times “would exhibit behaviors that threaten the staff,” she says. “It just was a real surprise to us.”

So they tapped their strong professional governance network, clinical nurses and other caregivers who come together on a regular basis to review competencies and patient outcomes, to review the safety reporting and help devise a response. Following these time-tested decision-making and discussion frameworks produced “some of our best interventions.”

Those interventions included targeted de-escalation training for staff in areas where patients had been demonstrating aggressive behaviors and lots of “very good discussions” about applying low- and high-tech solutions strategically, especially in high-risk areas like the emergency department.

Based on group deliberation, Pappas says, Emory installed metal detectors at certain—but not all—key entrances. They also explored the idea of placing alert buttons on badges but decided to instead voice needs and check on each other rather than introducing and keeping track of another new gadget.

“The key there is just involving the people that it impacts and getting the best direction from them about how to use devices and systems to improve safety,” Pappas says.

It's a testament to technology’s ability to augment but not replace human ingenuity and camaraderie. Safety is “everyone's job,” Pappas says. That means success comes from a shared responsibility and commitment to “take care of each other.”

Federal officials say 28 provider and payer organizations have signed on to voluntarily adhere to federal guidelines around the responsible and ethical use of AI in healthcare

As questions arise over who should be in charge of AI governance, the Biden Administration is focusing on collaborating with some of the biggest health systems and payers.

The administration this week unveiled voluntary pledges from 28 organizations “to help move toward safe, secure, and trustworthy purchasing and use of AI technology.” The announcement, coming on the heels of President Biden’s November 30 Executive Order on AI, sets the stage for what’s expected to be lively debate over whether the federal government or the healthcare industry should set the ground rules. Many within healthcare, still hurting from the thorny rollout of electronic medical records and “meaningful use” criteria, are arguing that the industry should be able to police itself.

The administration’s response, authored by National Economic Advisor Lael Brainard, Domestic Policy Advisor Neera Tanden, and Arati Prabhakar, director of the Office of Science and Technology Policy, is focused on working together.

“The commitments received today will serve to align industry action on AI around the ‘FAVES’ principles—that AI should lead to healthcare outcomes that are Fair, Appropriate, Valid, Effective, and Safe,” they wrote. “Under these principles, the companies commit to inform users whenever they receive content that is largely AI-generated and not reviewed or edited by people.”

“They will adhere to a risk management framework for using applications powered by foundation models—one by which they will monitor and address harms that applications might cause,” the three advisors continued. “At the same time, they pledge to investigating and developing valuable uses of AI responsibly, including developing solutions that advance health equity, expand access to care, make care affordable, coordinate care to improve outcomes, reduce clinician burnout, and otherwise improve the experience of patients.”

Those organizations voluntarily committing to that framework are Allina Health, Bassett Healthcare Network, Boston Children’s Hospital, Curai Health, CVS Health, Devoted Health, Duke Health, Emory Healthcare, Endeavor Health, Fairview Health Systems, Geisinger, Hackensack Meridian, HealthFirst (Florida), Houston Methodist, John Muir Health, Keck Medicine, Main Line Health, Mass General Brigham, Medical University of South Carolina Health, Oscar, OSF HealthCare, Premera Blue Cross, Rush University System for Health, Sanford Health, Tufts Medicine, UC San Diego Health, UC Davis Health, and WellSpan Health.

“We have collaborated with these innovative providers and payers to define a set of voluntary commitments to guide our use of frontier models in healthcare delivery and payment,” Paul Uhrig, Bassett Health’s chief legal and digital health officer, said in a LinkedIn posting shortly after the announcement was made.

“We applaud the efforts to convene a diverse group of healthcare organizations to coalesce around landmark voluntary commitments that will be fundamental to the future of AI and allow us to responsibly advance the use of these technologies for the benefit of those we serve," added Sanford Health President and CEO Bill Gassen. "As the largest rural healthcare provider in the country, we were honored to help lead this effort on behalf of our patients, two-thirds of whom live in rural communities in America's Heartland. It has been energizing to collaborate over the last several weeks with colleagues across the healthcare ecosystem on a framework that reflects our shared commitment to harnessing large-scale AI and machine learning models safely, securely and transparently. Such swift progress following the signing of President Biden’s executive order on AI underscores our collective acknowledgement of the myriad ways in which these technologies could help to improve healthcare quality, access, affordability, equitable outcomes, patient experience, clinician well-being and industry sustainability – likely in ways that we cannot fully anticipate today. Protecting our patients who place their trust in us is paramount as we move forward. We look forward to continuing to work with industry leaders, elected officials and the Administration on these critically important efforts.”   

Those organizations have pledged to:

• Develop AI solutions to optimize healthcare delivery and payment by advancing health equity, expanding access, making healthcare more affordable, improving outcomes through more coordinated care, improving patient experience, and reducing clinician burnout.
• Work with their peers and partners to ensure outcomes are aligned with fair, appropriate, valid, effective, and safe (FAVES) AI principles.
• Deploy trust mechanisms that inform users if content is largely AI-generated and not reviewed or edited by a human.
• Adhere to a risk management framework that includes comprehensive tracking of applications powered by frontier models and an accounting for potential harms and steps to mitigate them.
• Research, investigate, and develop AI swiftly but responsibly.

The administration is also highlighting pledges secured earlier this year from more than a dozen technology companies, including Microsoft and Google, to toe the line on developing and using AI responsibly.

“We must remain vigilant to realize the promise of AI for improving health outcomes,” Brainard, Tanden, and Prabhakar wrote. “Healthcare is an essential service for all Americans, and quality care sometimes makes the difference between life and death. Without appropriate testing, risk mitigations, and human oversight, AI-enabled tools used for clinical decisions can make errors that are costly at best—and dangerous at worst. Absent proper oversight, diagnoses by AI can be biased by gender or race, especially when AI is not trained on data representing the population it is being used to treat. Additionally, AI’s ability to collect large volumes of data—and infer new information from disparate datapoints—could create privacy risks for patients. All these risks are vital to address.”

As outlined in Biden’s Executive Order, the federal government’s efforts to govern AI are being led by the Health and Human Services Department. Alongside HHS, other departments have taken action on AI concerns, including the National Institutes of Health (NIH), US Food and Drug Administration (FDA), Office for Civil Rights (OCR), and Centers for Medicare & Medicaid Services (CMS).

“The private-sector commitments announced today are a critical step in our whole-of-society effort to advance AI for the health and wellbeing of Americans,” the three advisors wrote. “These 28 providers and payers have stepped up, and we hope more will join these commitments in the weeks ahead.”