The executive vice president and chief information & innovation officer at Children's Hospital & Medical Center is committed to an innovation strategy that will keep the Omaha-based hospital on the cutting edge of children's care.
Healthcare innovation might seem like a slow and steady process, marked by methodical pilots that gather data and lead to system-wide adoption.
Jerry Vuchak would like you to know that isn't the case in pediatric care.
"We frequently want to go faster than [technology vendors] want to go," says the executive vice president and chief information & innovation officer at the Omaha, Nebraska–based Children's Hospital & Medical Center. "We're moving forward at a pace that they're not used to."
There's a reason for that. Roughly $22 billion was raised globally in 2020 for digital health innovation, according to StartUp Health's annual report, yet only $167 million, or less than 1%, was set aside for children's digital health. And a quick online search of "children's hospitals" and "healthcare innovation" finds that many of the 250 or so children's hospitals in the U.S. are actively trying to raise funds that they aren't getting from the National Institutes of Health or other resources.
Whatever the reason for this lack of representation, Vuchak is quick to point out that innovation is alive and well at Children's Hospital & Medical Center. That's because so many care pathways and treatments for children can be made better.
Consider, for example, alarms within the hospital. They're vital to alerting care teams when patients are in distress, yet in children's hospitals they can also be distressing to patients, many of whom are scared to be in a hospital. With that in mind, Vuchak, says, Children's is working on designing new alarms that can alert providers without adding to a patient's discomfort.
Jerry Vuchak, executive vice president and chief information & innovation officer at Children's Hospital & Medical Center. Photo courtesy Children's Hospital & Medical Center.
"Innovation is our first value," he points out. "And it's not just words on a page. We're always thinking about how we can do things better because it's in our culture. It has a huge impact on our patients and their families."
Vuchak's view is shared by many innovation executives at pediatric hospitals across the country. Because so much of the activity in healthcare innovation is geared toward the adult patient, pediatric-based health systems are forging their own paths, creating innovative tools and strategies that apply directly to their young and fragile patients and their families.
This, in turn, makes pediatric healthcare innovation a dynamic arena.
"It's much harder in the pediatric environment," Vuchak says, noting the hospital has even had to build pediatric content into its EHR platform. "But that also makes it much more rewarding."
In many cases, children in pediatric hospitals and their parents are eager to embrace innovation. That's seen in Children's Hospital & Medical Center's digital front door. While national estimates place the number of patients using digital health tools to access care at between 30% and 40%, Vuchak says more than 70% of their patients are digitally active.
"Consumer engagement and experience is [a key factor to] our digital front door strategy," he says. "So it's very important to us that we know if we're thinking about the right things. That's how we'll build our roadmap out beyond 2023."
This roadmap includes mobile health apps that give care providers access to the latest information on chronic diseases like asthma, as well as up-to-date information on the patient, including medications and other treatments; and remote patient monitoring programs that ease the transition from the hospital to the home. One such program focused on young children who've had heart surgery within their first six months. The program boosted clinical outcomes 10%–20% by giving providers access to data that enabled them to intervene more quickly when a patient started trending downwards.
"We're prioritizing access to services," Vuchak says, meaning both how patients and their families can access healthcare and how providers can access resources to improve care. "We have a strategy council, and we have more ideas than we can actually take on."
Aside from augmented and virtual reality, in which Vuchak says "we're just scratching the surface," Children's Hospital & Medical Center is exploring how AI can be integrated into both provider workflows and care programs, and how wearables might be used in pediatric care—a challenge, again, because so many wearables are designed for adults.
Vuchak says he's surprised that so many companies in the healthcare technology space don't have a good innovation strategy. That's why he'll look far and wide for partners that have the right philosophy, and who will pivot quickly and adjust to meet specific and important patient needs.
As with all areas of healthcare innovation, the pandemic was a driving force in the adoption of new ideas and technologies, especially virtual care. For Children's Hospital & Medical Center, there was another unexpected benefit: the shift to working from home opened up 10,000 square feet of space within the health system, which is now being turned into a center for innovation.
This, he says, will help Children's to develop tools and platforms that address not only the patient, but the surrounding support team, including family, friends, and providers. It will also help as the hospital dives into the challenges around social drivers of health and the myriad causes of health inequity and outcomes, which healthcare organizations are now finding ways to address.
"You don't want to slow down because there's so much that can be done," Vuchak says. And that's both an important skillset and a challenge to working in pediatric healthcare.
HealthLeaders Innovation and Technology Editor Eric Wicklund talks with Dr. Mafuzur Rahman, CMIO at SUNY Downstate Health Sciences University, about how the Brooklyn hospital is integrating AI tools into its patient discharge process to improve engagement and care coordination with patients who recently visited the ER or had a hospital stay.
The Midwest health system has developed new algorithms to help its nurse navigators manage their workflows, reducing stress and burnout and improving care management for cancer patients.
OSF Healthcare has designed an AI platform that improves care management for cancer patients by monitoring and adjusting the workflows of nurse navigators.
The Illinois-based health system developed an algorithm that combs through the electronic health record platform and other data sources to map out each cancer patient's journey for the coming week, including new patients. The technology then assigns the new patients to nurse navigators according to characteristics like cancer specialty and a care navigator's existing workload.
The platform not only improves care management for patients by ensuring they're matched with the most appropriate navigator, but also reduces stress and burnout among navigators by helping them manage their workloads.
"Our cancer patient nurse navigators are highly dedicated, and their workload can sometimes be overwhelming," Jonathan Handler, a senior fellow in innovation for OSF Healthcare, said in a press release. "They never want to shortchange the patient, so they shortchange themselves, working extra hours and sacrificing their own well-being to help patients. We hope our system can even out those workloads and improve their work-life balance."
The technology was developed by a team that consisted of researchers from OSF Healthcare and the OSF Innovation group, the University of Illinois College of Medicine Peoria, the University of Illinois Urbana-Champaign, and the Northwestern University Feinberg School of Medicine. It was funded by a grant from Jump ARCHES (Applied Research for Community Health through Engineering and Simulation), a collaborative that includes OSF Healthcare, the University of Illinois College of Medicine at Peoria, and the University of Illinois Urbana-Champaign.
The team's work was recently published in the American Society of Clinical Oncology's Journal of Cancer Informatics (JCO). That report noted that this may be the first time a project like this focused on the individual—including anticipated patient needs, navigator experience, and existing workload--rather than shifts, and the model they created "significantly outperforms the random distribution approach that approximates our current distribution methodology."
"Better workload management may reduce CPN burnout and lead to more effective and efficient navigation assistance for patients with cancer, allowing greater scalability of this vital resource to all oncology patients in need, regardless of geography," the study concluded.
The health system will next introduce the technology into its cancer care program through its OSF Community Connect workflow automation platform.
The proposed Transitional Coverage for Emerging Technologies (TCET) pathway is designed to facilitate Medicare coverage for new treatments that usually need time to develop data proving their value.
Federal officials are proposing an expedited pathway for Medicare coverage of new medical technologies.
In a notice posted in the Federal Register, the Centers for Medicare & Medicaid Services (CMS) is proposing a voluntary Transitional Coverage for Emerging Technologies (TCET) pathway for designated Breakthrough Devices. Officials say the new pathway, developed in a partnership with the Agency for Healthcare Research and Quality (AHRQ), should speed up the process to bring new treatments to Medicare beneficiaries while ensuring those treatments still meet rigorous review guidelines.
"As part of our commitment to fostering innovation and ensuring patient-centered care, CMS created the TCET pathway to provide a mechanism for coverage for certain new, innovative technologies with limited or developing evidence in the Medicare population using a transparent and predictable evidence generation framework that, when appropriate, not only develops reliable evidence for patients and their physicians to make healthcare decisions but also provides safeguards to ensure that Medicare beneficiaries are protected and continue to receive high-quality care," the agency said in a press release.
Officials said the new pathway was developed through feedback from a wide range of sources and based on requests "for CMS to utilize a more agile, iterative evidence review process that considers fit-for-purpose study designs, including those that make secondary use of real-world data."
Candidates for the TCET pathway will include devices that are:
Certain FDA-designated Breakthrough Devices;
Determined to be within a Medicare benefit category;
Not already the subject of an existing Medicare NCD; and
Not otherwise excluded from coverage through law or regulation.
Key elements to the TCET pathway include an evidence preview, or focused literature review, and an evidence development plan (EDP), which would be drafted by the developer to address any evidence gaps spotted in the evidence preview.
Once a treatment has qualified for this pathway, Medicare coverage will remain in place "only as long as needed to facilitate the timely generation of evidence that can inform patient and clinician decision making," along with an additional year to allow manufacturers to finish their analysis. CMS would then launch its updated evidence review.
Public comments on the proposal will be accepted for the next two months.
Ryan Davies' career has been defined by taking risks. His newest company is taking on one of healthcare's biggest challenges.
The biotech industry isn't for the faint of heart. And that's why Ryan Davies jumped at the chance to lead CancerVax, a high-stakes, pre-clinical biotech partnering with UCLA to develop immunotherapy cancer treatments that use the body’s immune system to fight cancer.
CancerVax's mission is to develop a breakthrough universal cancer vaccine. That, Davies says, is more than just hairy and audacious.
It's "big," "high-risk," and "unique," he says. And right up this serial entrepreneur's alley.
"This opportunity really spoke to me," he says. "I like taking risks. I love diving in and achieving difficult goals. CancerVax is an exciting chance to make a difference."
A risk-taker by nature, Davies' entire career has been entrepreneurial. As a young man, he had anticipated a career in business management, but he began founding companies straight out of college. He established companies in e-commerce, technology, and software, and worked in energy and investments, before he fell in love with the challenges of biotech.
Ryan Davies, CEO of CancerVax. Photo courtesy CancerVax.
"My first company was a software ecommerce company, and I sold it and then started and sold another one. And then started and sold another one, until I ended up in the venture capital space," he says. "While there, we found a really cool technology being developed between the biology and chemistry departments at a major university. We licensed it and built a company around this crazy idea for developing a new class of antibiotics. I was put in as the interim CEO with no science experience. I was a business guy. But I absolutely fell in love with the biotech space."
The company was Curza, which he led for seven years, educating himself with For Dummies books about cell biology and attending organic chemistry classes. The 'crazy idea' developed into the CZ-02 platform of antibiotics for the treatment of drug-resistant bacterial infections. The CZ-02 platform represents a novel class of antibacterial agents with a unique mode of action.
The science learning curve in this experience was "tricky," Davies says, but not knowing everything upfront was also an advantage.
"One of the reasons that I've had success in the biotech space is because I don't know what I don't know," he says. "In the beginning, we were renegades. We didn't know that there was a very specific way of developing a drug, so we went down avenues and did things that were very atypical and very different. And I actually think that worked to our advantage."
Davies' biotech background has grown. He has co-founded several biotech companies, including wound-care company Advanox and medical device company Purgo Scientific.
One of the biggest challenges facing an "outsider" in the industry, he says, was learning to shift gears to align with the slower pace of drug development.
"I remember going straight from the business world into a partnership with a major university on the first biotech that I worked on, and how frustrated I was at the slow pace of academia," he said. Later, during a meeting with the US Food & Drug Administration (FDA), a staffer told him that the government process was going to be frustrating because the FDA wheels grind slow.
"'We're not fast like academia,' he said to me, and I nearly fell off my chair," Davies says.
He says he had to reframe his mindset to a more realistic view of the speed of the development process.
"I looked at other biotech companies and compared how long it took them to get to market," he says, "and as long as I'm moving at a pace that's a little quicker than what some of these companies have done historically, then I'm OK with that."
Davies took the reins at CancerVax in 2022 and is already applying his entrepreneurial skills to its two leading programs. CancerVax is focused on a novel universal cancer vaccine targeting multiple cancers, and a single disease immunotherapy targeting Ewing sarcoma.
According to Bloomberg Business, the cancer immunotherapy market is expected to grow to $196 billion by 2030. Davies believes immunotherapy drugs like Merck's Keytruda and Opdivo from Bristol-Myers Squibb, which started out as niche products and became blockbusters with multiple cancer indications, are proof that not only is immunotherapy a growing and successful market, but also an opportunity for hope for cancer patients.
The newer cancer vaccine program involves creating a methodology that only targets cancer cells and leaves healthy cells alone.
"What is unique about cancer cells is there are markers specific to the cancer cells that healthy cells don't have," he says. "But most immunotherapy treatments today overlap between the cancer cell and the healthy cells, and a lot of healthy cells get killed. We're trying to correct that."
Davies cautions that this is not a preventative vaccine. Rather, it's a proactive approach to treatment.
The second disease-specific immunotherapy program is targeted at treating Ewing sarcoma, a rare and deadly bone and soft tissue cancer that affects children and young adults. There are currently no treatment options available for the disease, which has a high mortality rate and is diagnosed in only 200 to 250 patients a year.
In partnership with CancerVax, the Ewing Sarcoma Program at the UCLA Jonsson Comprehensive Cancer Center has made positive progress toward developing a treatment. This was CancerVax's first partnership with UCLA; the company has raised $2 million of seed funding to date and plans to raise an additional $10 million to further the development of these two programs.
Sluggers and Success
The Utah-based father of eight is a huge baseball fan. And surprisingly, given his location, his favorite Major League team is the Boston Red Sox.
"I love the strategy and the statistics behind baseball and my wife is a fan as well," he says. "We enjoy traveling and hearing live music, but we also like going to Major League ball games. It's something we like to do together."
He says baseball is not all that different from biotech in terms of strategy. Like legendary Red Sox sluggers Ted Williams and Carl Yastrzemski, biotech leaders need to position themselves for the big wins without swinging too fast or too hard out of the gate.
Since the onset of sports analytics, building a baseball team has changed dramatically, as has research that uses healthcare data to fine-tune the development of medicine. Some days you win, and some days you don't.
"Biotech is high-risk," Davies says. "It's an expensive business and it takes a long time to get established. But there's a lot of different areas to pursue, so if we fail in one area, there are 100 different ways that we can pivot."
The organization is issuing almost $590,000 to nine healthcare organizations who will study how EHRs can be used to reduce stress and burnout, improve workflows, and boost value-based care.
Nine healthcare organizations have been tagged by the American Medical Association to study how EHRs can be used better.
The organizations will receive grants from the AMA's Electronic Health Record Use Research Grant Program, which supports research into how EHRs can help "prevent clinician burnout and turnover, enhance high-quality patient care, and improve workflows, teamwork, and resource allocation at the practice level."
“The EHR Use Research Grant Program allows the AMA to work with researchers who are leading efforts to expand insight into EHR systems and measure the technologies’ capacity to support or undermine the delivery of efficient and effective clinical work,” AMA Vice President of Professional Satisfaction Christine Sinsky, MD, said in a press release.
More than $2 million has been doled out by the AMA since 2019 to support 26 studies aimed at giving the often-criticized EHR a better reputation and highlighting capabilities and advancements that have made the technology more beneficial.
That research is particularly important now, as healthcare organizations are struggling with high rates of burnout and stress and dwindling workforces and need their technology platforms to step up. Backed by the emergence of AI, health systems are hoping that EHRs can be used to not only improve workflows, but also reduce expenses and boost clinical outcomes.
“Burdensome EHR systems are a leading contributing factor in the physician burnout crisis and demand urgent action as outlined in the AMA’s Recovery Plan for America’s Physicians," Sinsky said in the press release. "The research supported by the AMA grant program builds the evidence base to help change EHR technology into an asset to medical care, and not a demoralizing burden.”
The organizations receiving funding from the $589,000 grant program are:
AllianceChicago, which plans to use EHR event log data to explore both the prevalence and the facilitators of relational continuity among patients, physicians, and care teams in primary care.
Brigham and Women’s Hospital, which will investigate factors that influence the amount of time spent using an EHR and the impact of inbox messages on EHR burden, all in a primary care setting.
MedStar, which will study primary care physician EHR inbox prioritization.
The Stanford University School of Medicine, which will use EHR event log data and other information to evaluate the frequency of text messaging in the inpatient setting and the relationships between team stability and inbox message frequency, as well as whether higher text message interruptions during order entry is associated with increased order entry errors.
The University of California San Francisco, which will study the impact of e-visit billing on clinician EHR inbox time, work on the EHR after patient scheduled hours and overall EHR burden.
The University of Colorado School of Medicine, which will investigate whether inpatient EHR-based audit log data can serve as a useful tool in identifying when work design and workloads are leading to physician burnout and patient harm.
The University of Wisconsin-Madison, which will use EHR event log data to study any links between team support for medication orders and physician time spent on order entry and time on inbox in primary care.
The Wake Forest University School of Medicine, which will analyze time spent in the EHR by primary care physicians during paid time off.
The Yale University School of Medicine, which will expand on previous research into physician retention, clinical productivity, and patterns of EHR use in the emergency department.
The 23-member task force will develop recommendations to make pharmacists a more integral part of healthcare and give them guidelines for prescribing and managing digital therapeutics and other services.
Federal officials have launched a task force aimed at making pharmacies a more integral part of healthcare.
The Pharmacy Interoperability and Emerging Therapeutics Task Force was unveiled by Tricia Lee Rolle, a senior advisor for the Health and Human Services Department's Office of the National Coordinator for Health IT (ONC), during a June 15 meeting of the ONC's Health Information Technology Advisor Committee (HITAC).
The 23-member task force is charged with developing new ideas to integrate pharmacies and pharmacy services with clinical care, including creating protocols to support the prescribing and management of new technologies and treatments, such as digital therapeutics, and direct-to-consumer (DTC) services.
The group's co-chairs are Hans Buitendijk of Oracle Health and Shelly Spiro of the Pharmacy Health Information Technology Collaborative. Some of the members were appointed by Congress, while others were selected by the Government Accountability Office and the HHS Secretary.
The task force has two short-term goals: To identify standards and data needs for pharmacists to participate in emergency use interventions, and to determine if there are actions that the ONC can take to enable data exchange to support public health emergency use cases.
Long-term goals consist of:
Recommending ways to integrate pharmacy systems and data for public health surveillance, reporting, and interventions;
Identifying opportunities to improve interoperability between pharmacies to promote pharmacy-based clinical services and care coordination;
Identifying standards to support the prescription and management of emerging therapies, such as digital therapeutics, specialty medications, and gene therapies; and
Identifying technology and policy requirements for DTC services.
The task force will have a November 9 deadline to return its recommendations.
The CONNECT For Health Act has been filed again in both the Senate and House, and supporters say the groundswell for expanded telehealth coverage and services could finally give the bill the momentum it needs for passage.
A bill that aims to improve and expand Medicare coverage for telehealth is back for a fifth time before Congress.
The CONNECT for Health Act of 2023, filed this week by US Senators Roger Wicker (R-Mississippi), Cindy Hyde-Smith (R-Mississippi), and Brian Schatz (D-Hawaii), continues a lengthy campaign by telehealth advocates to address the Centers for Medicare & Medicaid Services' restrictive rules around who can use telehealth and what services are reimbursable.
A companion bill has been introduced in the House by US Reps. Mike Thompson (D-California), Doris Matsui (D-California), David Schweikert (R-Arizona), and Bill Johnson (R-Ohio).
Eliminate geographic restrictions on telehealth use and expand the list of allowed "originating sites" to include the home and other sites;
Allow federally qualified health centers and rural health clinics to provide telehealth services;
Expand the list of eligible healthcare providers to use telehealth;
Eliminate the in-person visit requirement for telemental health services;
Allow for a waiver of telehealth restrictions during future public health emergencies; and
Mandate studies on how telehealth is used, how it impacts quality of care, and how it can be improved to support patients and providers.
The bill, first introduced in 2016, has a long list of supporters—some 60 senators are supporting this latest version—but has been unable to cross the finish line. Several provisions of previous versions of the CONNECT for Health Act were signed into law through separate bills or adopted by CMS, including actions to improve telemental health and telestroke care and integrate telehealth in home dialysis programs.
Supporters say the rapid and successful use of telehealth during the pandemic should give this bill a better chance of success.
“The pandemic showed us just how valuable telehealth is to ensuring folks receive care, but telehealth’s use goes far beyond navigating public health emergencies,” Hyde-Smith said in a press release announcing the bill's reintroduction this week. “Mississippians and Americans face many obstacles accessing healthcare, whether it’s living in rural areas, old age, or mobility issues. This legislation would be key to providing them with the quality, affordable care they need and deserve. It’s time to get this done.”
“While telehealth use has skyrocketed these last few years, our laws have not kept up," added Schatz, a well-known telehealth advocate. "Telehealth is helping people in every part of the country get the care they need, and it’s here to stay. Our comprehensive bill makes it easier for more people to see their doctors no matter where they live.”
Many of the flexibilities sought in this bill are in place through the end of 2024, thanks to an omnibus spending bill passed by Congress in December. Supporters say these provisions need to be made permanent to that healthcare organizations can map out long-term telehealth strategies and programs and consumers can access them without fear that they would be eliminated in a few years.
Among the many organizations supporting the bill is the American Telemedicine Association.
“Since originally introduced in 2016, the CONNECT for Health Act has envisioned a world where Medicare beneficiaries have access to virtual care services where and when they need them," Kyle Zebley, the ATA's senior vice president of public policy and executive director of ATA Action, said in a press release. "Today, our esteemed policy champions in Congress reintroduced an updated version of the CONNECT Act, including new and revised provisions that will help more people access telehealth services.”
“The pandemic showed us that we need to use technology to deliver care when and where it is needed," added Rene Quashie, vice president of digital health for the Consumer Technology Association, the driving force behind the annual CES show in Las Vegas, in an e-mail to HealthLeaders. "Extending telehealth access for Medicare beneficiaries will help bridge gaps in distance, accessibility, and availability of crucial health services in communities across the nation. The CONNECT for Health Act is a step in the right direction to modernize our health care system, and CTA is proud to endorse it.”
The recent AIMed Global Summit painted a positive picture for the technology in tackling healthcare's biggest pain points, but a scramble to govern and regulate AI could make things tricky.
While healthcare organizations are scrambling to understand how and where AI can best fit in, there's a mad rush to figure out policy and regulations as well.
During the recent AIMed Global Summit in San Diego, Alya Sulaiman, a partner in the McDermott Will & Emery law firm who focuses on digital health, described an active landscape in which federal agencies like the Health and Human Services Department's Office of the National Coordinator for Health Information Technology (ONC), the U.S. Food and Drug Administration and the Federal Trade Commission were competing with the likes of state attorneys general to regulate the technology.
The ONC, for instance, recently floated a proposal to create new transparency and risk management expectations for artificial intelligence and machine learning technology that aid in decision-making in healthcare, including any technology that integrates with EHRs.
"There's an increasing [number] of very specific health AI [bills]," she said, that would add regulations and chains of approval to any health system using the technology within a specific state's borders.
Sulaiman also noted that AI may soon be referenced in lawsuits in which a health system might be held liable if it doesn't use available AI technology.
"That's a real example that we're starting to see in [potential] litigation," she said. "AI is being interjected into the standard of care."
In this fast-moving landscape, the three-day conference offered an opportunity to highlight how the healthcare industry is approaching AI—sometimes called augmented intelligence, rather than artificial intelligence, to focus on the idea of technology assisting clinicians and other healthcare staff rather than replacing them or acting on their behalf.
The conference featured a number of keynotes and panel discussions on the challenges and benefits of using AI in healthcare, which is still very much in its infancy. It included a 'Shark Tank' styled main stage event in which several start-ups in search of investment funding pitched their business plans to a board of investors. The start-ups encompassed a wide range of AI-in-healthcare ideas, including wound care analytics, drug discovery trials, consumer-facing search engines, identifying and addressing a patient's risk of falling in a hospital, heart health, oxygen therapy, and identifying and addressing mental health issues in high school students.
David Higginson, executive vice president and chief innovation officer at Phoenix Children's Hospital and a participant in more than one panel at the event, said healthcare organizations are moving slowly but steadily forward with AI. They're launching small programs that address care gaps or "low-hanging fruit" to score easy wins, then scaling up and out to tackle bigger issues.
"It's good to know we're getting there," he said. "We have to take those chances."
At the same time, healthcare leaders need to be aware of the shifting policy and regulatory landscape.
On a state level, 23 attorneys general have submitted a letter to the National Telecommunications and Information Administration (NTIA), a part of the U.S. Department of Commerce, calling for transparency and accountability with AI technology. They also argued that AGs "should have concurrent enforcement authority in any Federal regulatory regime governing AI."
“AI is increasingly a part of our lives, influencing transactions and decisions big and small," California Attorney General Rob Bonta said in a June 14 press release announcing that he'd joined the coalition. "We need policies governing this technology that prioritize transparency, audits, and accountability, and that put consumer protection front and center.”
At the same time, the American Medical Association—whose president-elect, Jesse Ehrenfeld, MD, MPH, gave a keynote at the AIMed conference—addressed AI during its recent Annual Meeting. The organization's House of Delegates announced plans to "develop principles and recommendations on the benefits and unforeseen consequences of relying on AI-generated medical advice and content that may or may not be validated, accurate, or appropriate."
“AI holds the promise of transforming medicine," AMA Trustee Alexander Ding, MD, MS, MBA, a practicing physician and assistant professor at the University of Louisville School of Medicine, said in a press release issued by the AMA. "We don’t want to be chasing technology. Rather, as scientists, we want to use our expertise to structure guidelines, and guardrails to prevent unintended consequences, such as baking in bias and widening disparities, dissemination of incorrect medical advice, or spread of misinformation or disinformation.”
“We’re trying to look around the corner for our patients to understand the promise and limitations of AI," he added. "There is a lot of uncertainty about the direction and regulatory framework for this use of AI that has found its way into the day-to-day practice of medicine.”
The AMA also adopted a policy regarding the use of AI in one of the more controversial topics in healthcare: Prior authorizations. This follows a ProPublica report claiming that Cigna denied more than 300,000 claims over two months through a process that used AI, enabling doctors to spend an average of 1.2 seconds on a claim.
"The use of AI in prior authorization can be a positive step toward reducing the use of valuable practice resources to conduct these manual, time-consuming processes," AMA Board Member and Pennsylvania physician Marilyn Heine, MD, said in an AMA press release. "But AI is not a silver bullet. As health insurance companies increasingly rely on AI as a more economical way to conduct prior authorization reviews, the sheer volume of prior authorization requirements continues to be a massive burden for physicians and creates significant barriers to care for patients. The bottom line remains the same: we must reduce the number of things that are subject to prior authorization.”
Regardless of the challenges around regulation and policy, the mood at the AIMed conference was that healthcare stands in good position to benefit from the technology as long as researchers and providers move slowly and steadily and don’t rush forward expecting to solve all of healthcare's problems within a few months, or even years.
Healthcare is "a complex system," Robert Groves, MD, executive vice president and chief medical officer for Banner | Aetna, said in a keynote on the last day of the event. "There are just so many boxes to select, so many things to do … [but] complexity is the nature of advancement."
The key, said Groves and several others, is to understand that AI can help as long as it's used as a tool and not a replacement. At the end it's important, Groves said, to "value caring over curing."
In a Q&A, Joann Ferguson, the health system's VP of revenue cycle, explains how the technology saves time and money and improves revenue cycle and clinical processes.
Among the many uses for AI technology in the healthcare space is in medical coding, which affects both clinical and revenue cycle processes.
Detroit-based Henry Ford Health recently expanded its collaboration with CodaMetrix to include patient bedside visits, where abstraction takes an average of 40 minutes per patient and accounts for 20% of the health system's overall coding costs.
"Inpatient hospital stays due to serious medical conditions, injuries, surgical procedures, and medical emergencies such as strokes, heart attacks, broken bones and burns, routinely require bedside physician consultation," the health system said in a press release announcing the CodaMetrix deal. "Evaluations and management of patients at the bedside, by hospitalists and other specialists, as well as bedside procedures, need to be abstracted into medical codes for reimbursement. Depending on health systems’ policies, the coding function is usually performed by physicians, medical coders, or both. In scenarios where physicians are responsible for coding, not only is it an extra burden, but it increases the number of missed opportunities for accurate reimbursement."
To learn how AI can be integrated into the bedside procedures, HealthLeaders spoke virtually with Joann Ferguson, RN, BSN, MBA, CRCR, vice president of clinical revenue cycle at Henry Ford Health.
Q. How does Henry Ford use AI to improve the coding process?
Ferguson: As one of the nation’s premier academic and integrated health systems, Health Ford Health has more than 110,000 inpatient visits per year across five hospitals and 2,300 staffed beds. We hold ourselves to a high standard not just in our care, but operationally as well. We’re always looking for the best ways to support our teams, from our doctors and nurses to our coding and billing departments in their everyday workflows.
Joann Ferguson, RN, BSN, MBA, CRCR, vice president of revenue cycle, Henry Ford Health. Photo courtesy Henry Ford Health.
We began exploring new technological options across our revenue cycle operations because we were dealing with many of the same issues that are putting pressure on healthcare providers and employers across the country, including attrition via retirement and difficulty filling open positions. We needed to improve efficiency in our workflows, resulting in lower costs, reduced backlogs, and enhance patient and provider experiences.
After an extensive review of our internal work streams and technologies we decided to pursue implementing an AI coding solution for our bedside professional services. With more than 700,000 inpatient bedside services performed each year, it’s one of our highest volume specialties. We needed an alternative solution to keep up with rising volumes and to reduce backlogs.
AI improves our bedside medical coding process in several ways. First, it automatically codes the simplest procedures, taking that work off our coders’ plates. By 'simplest,' we mean the procedure notes that match closely or exactly with how the ICD codes themselves are written. It does this by bringing together all the complex information required to identify, understand, and code a bedside professional charge. It then predicts and assigns charges and diagnosis codes, automating cases directly to billing.
For bedside procedures where the AI platform does not reach our confidence level threshold, AI gives our coders an optimized view of the information required to code a case and pre-populates code suggestions for non-automated cases. The coder can then validate and edit from a selection of probable codes rather than start from scratch.
Additionally, before a coder releases the case for further processing, the case is checked against standard edits. This means the original coder resolves the edits rather than them being sent along to a standalone edit team, streamlining the process.
Q. How did the health system approach this process prior to using AI?
Ferguson: We had built a custom access database, which we used to aggregate coding information and look for charge gaps. Unfortunately, it was cumbersome to use and almost impossible to scale and maintain.
Q. What are the benefits to using AI in coding? What specific improvements are you seeing?
Ferguson: Inpatient bedside visit coding accounts for 20% of our overall coding costs. By implementing AI, we will increase workflow efficiency by reducing errors, missed charges, billing backlogs, and claim denials while lowering costs.
The platform also creates a nuanced understanding of our patient journey and can identify potential charge gaps where services were likely provided but there is no documentation. Once identified and routed to coders for follow up with providers, these estimated charge gaps can equal as much as 8% of overall bedside revenue that was previously left unbilled.
Workforce challenges are addressed, too. Because staffing is at a premium, by automating our bedside visit coding, we can shift resources to other areas of need. Regarding the big picture on the people side of Henry Ford Health, it reduces the daily workloads on physicians, medical coders, and billing administrators, driving better financial and operational performance while improving our coders’ job satisfaction.
Finally, Al improves the patient experience by reducing denials.
Q. What are the concerns or challenges to using this technology?
Ferguson: As with onboarding any new technology, the biggest challenges we face are overcoming staff nervousness about learning and using a new system, training staff to then use that system correctly, and ensuring the AI is coordinated with our other systems. However, we find we can get around some of the roadblocks and hesitation that come with using new technology by taking time to highlight the short-term and long-term benefits to employees’ everyday workloads, while also laying out how it helps the organization as a whole. When people see the benefits on both ends of the spectrum, we’ve found they’re very willing to make the leap to AI.
We also build trust with our coders by using a 'glass-box' AI partner. That means our team can see the evidence behind every code and every case, so we are not asking them to blindly trust the AI’s recommendations.
Q. How do you ensure accuracy and reliability with this technology?
Ferguson: The AI system we use through CodaMetrix is being built to learn and adapt over time based on the feedback provided by our medical coding teams, so it’s constantly improving. That’s the power of machine learning, which keeps the system from becoming brittle when new ICD and CPT codes are released throughout the year.
We are in constant contact with CodaMetrix in every step of the build process to ensure we have a successful launch of the technology. We set our own quality standards for coding accuracy, giving us an additional layer of control of the AI. Through our partnership we are both committed to quality on Day 1 of implementation, having immediate access to prediction and automation information. This will keep Henry Ford Health’s revenue cycle running smoothly, while improving how we operate the system.
Q. What has surprised you, good or bad, about this technology or the outcomes you're seeing?
Ferguson: We like the level of control we have. We set the quality thresholds, which means we can use the coding AI to our standards rather than those set by someone outside of the organization. We also look forward to the transparency with which the platform operates. We’re able to see 'under the hood' at all times, so our medical coding team does not have to guess why CodaMetrix chose a particular code for a specific case. This helps build our team’s confidence in the AI solution, which we anticipate will speed ramp-up.
Q. How do you see this technology evolving? How and where else would you like to use it?
Ferguson: AI has been infiltrating the healthcare industry for years now, but recently it’s seemed to hit a critical mass. It’s already working its way into doctors’ notes and diagnoses via new products from Google and Microsoft, and it doesn’t seem like it will be long before AI is providing meaningful assistance to doctors making complicated decisions about the best way to treat their patients. It’s amazing to see everything unfold in real time and be at the center of it.
Regarding coding, as the technology matures and becomes more adaptable, I would like it to spread into new specialties and departments. Each hospital specialty has its own medical coding team, so the first step would be using AI across the entire hospital and patient billing departments. The same goes for billing and doctors’ notes, which all layer into a well-run revenue cycle. To have AI that makes revenue cycle management easier across the board via accurate automation is a big win.
Q. What advice would you give to another health system considering using this technology? What, in your opinion, would they be most likely to do wrong?
Ferguson: When it comes to using AI in medical coding, make sure to do your due diligence. Going for the quick fix or using last year’s technology because it’s cheaper will only make change more painful in the future. That means finding a partner who understands rev cycle operations and AI, and what your team needs to be successful.
AI products that will grow and can keep pace with the breakneck speed of tech innovation in healthcare are a must, not a 'nice to have.' Check out what the best and most innovative hospital systems are using; they’re usually at the vanguard of the industry and often choose the best practices.
