NYU Langone Health and the Brown University School of Public Health will conduct a five-year study on the effectiveness of OPCs, which give people dealing with substance abuse a safe and supervised place to consume drugs.
NYU Langone Health and Brown University's School of Public Health have been picked to launch a federally funded study of the value of overdose prevention centers (OPCs).
OPCs, also called supervised consumption services (SCS), are designed to provide a sanctioned, safe place for those living with substance abuse issues to consume drugs with sterile equipment under the supervision of trained staff. These centers also stock fentanyl and offer healthcare and counseling services and referrals to other resources.
There are now more than 200 OPCs in 14 countries, though their presence in the US has been met with some criticism. Some have said the centers support substance abuse while not doing enough to help people beat addiction.
The two organizations will receive grants from the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), for a five-year program to measure the impact of two of the first publicly funded OPCs in the country. No NIH money will be used to support the centers.
The project seeks to enroll 1,000 participants in what is being called the first study of its kind.
“We have an unprecedented opportunity to study the first publicly recognized overdose prevention centers in the country across two different states, as well as the impact on the communities in which they operate,” Magdalena Cerdá, DrPH, a professor in the Department of Population Health at NYU Langone, director of its Center for Opioid Epidemiology and Policy, and one of the study’s two lead investigators, said in a press release. “This research is urgently needed to inform policies that can best support public health, as more jurisdictions across the country consider implementing OPCs.”
“The overdose crisis has touched every community across America. From coast to coast and across age, gender, and race/ethnicity—people are dying,” added Brandon DL Marshall, PhD, a professor of epidemiology at the Brown University School of Public Health and the founding director of the People, Place & Health Collective at Brown University. “This groundbreaking study will help us determine whether and how OPCs are an effective public health tool as part of a more compassionate, evidence-based response to this crisis in the US.”
Through the study, investigators in New York City and Providence, Rhode Island, will:
Investigate whether enrolled participants who visit OPCs experience lower rates of fatal or nonfatal overdoses, drug-related health problems, and emergency department visits, and whether they are more likely to enter treatment for substance use disorders compared to people who use drugs but do not visit OPCs.
Examine the community impact of OPCs by assessing whether neighborhoods surrounding OPCs experience a greater change in overdoses, public disorder such as drug-related litter, arrests and noise complaints, and economic activity compared to similar neighborhood blocks that do not have an OPC.
Estimate the operational costs of OPCs and the potential cost savings to the healthcare and criminal justice systems associated with OPC use.
“Overdose prevention centers have saved lives over the past year,” Ashwin Vasan, MD, PhD, commissioner of the New York City Department of Health and Mental Hygiene, said in the press release. “Their operation in New York City also offers a unique opportunity in the years ahead to learn about their clients, the services offered, and their wider impact on the communities served. We look forward to partnering with NYU Langone, OnPoint, and the State of Rhode Island on a robust, long-term study. The findings, when they’re ready, could have national implications as we all fight the rising tide of overdose deaths in the US."
HealthLeaders Innovation and Technology Editor Eric Wicklund talks with Dr. Ruchir Shah, regional stroke director for CHI Memorial Hospital in Chattanooga, Tenn., part of the CommonSpirit health network, about how he's using new technologies to diagnose and treat patients with stroke symptoms.
A new survey finds that providers and patients see the potential in AI, but not just yet
AI tools like ChatGPT may have a place in the healthcare system of the future, but both providers and patients are wary of using them in their present form.
That's one of many takeaways from a survey of 500 healthcare professionals and 1,000 patients by Tebra, the practice management company formed in 2021 by the merger of Kareo and PatientPop. The survey shows an industry interested in the new technology, especially for improving efficiency and saving time, while also wary of the loss of human interaction.
According to the survey, one in 10 providers are now using AI technology, and roughly half have plans to adopt AI tools. Slightly more than half plan to use the technology for data entry, while 42% cited appointment scheduling, 38% listed medical research, 36% cited patient communication, and 35% picked either providing clinical notes to patients or as a virtual medical assistant.
When asked about benefits, 60% of providers surveyed cited increased efficiency, while 55% named cost savings by automating tasks and 45% noted giving time back to providers and caregivers. In describing the drawbacks, 55% cited less human interaction, half of those surveyed listed data privacy concerns, 49% noted an over-reliance on AI, and 44 % listed lack of human empathy.
Perhaps for those reasons, some 42% of providers surveyed said they were "not excited" about the integration of AI at this point, while 26% said they were excited and one-third said they were "moderately excited."
That's similar to how patients see the use of AI in healthcare, at least at present. While 80% of those surveyed say the technology has the potential to improve quality, reduce costs, and boost accessibility, only a third said they are moderately comfortable with a provider using AI to diagnose and treat a medical condition. Some 31% said they are slightly comfortable and 18% are not comfortable at all with AI being used in that fashion, while 12% a very comfortable and 4% are extremely comfortable.
When asked about the benefits of AI, patients mirrored the thoughts of their care providers. Some 63% cited increased efficiency, while 56% selected cost savings by automating tasks, 53% noted improved diagnosis and treatment, 45% cited research and development assistance, and 43% noted increased accessibility.
One area in which AI, and in particular ChatGPT, may have a more immediate impact is in behavioral health, which is struggling due to a surge in people needing help combined with a shortage of care providers. Some 25% of patient surveyed said they would be more likely to talk to an AI chatbot instead of attending therapy, and of those who have already used ChatGPT for therapy advice, 80% said that advice was an effective alternative to attending in-person treatment.
Roughly one-quarter of patients surveyed, meanwhile, went so far to say they wouldn't visit a provider who refuses to embrace AI technology.
Finally, 52% of the patients surveyed said they'd place their trust in the technology for faster care, while 47% said they'd visit a provider using AI to reduce the risk of human error in medical decision-making, 42% selected either telemedicine and more accurate diagnoses, and 41% said they'd go to a provider using AI for more access to advanced medical technologies.
When asked what would keep them away from AI in the doctor's office, 53% said a belief that AI technology can't fully replace the experience of seeing a doctor in person, while 47% cited concerns about reliability in diagnoses and treatments, 43% said they preferred the human interaction with a care provider, 42% cited data privacy and security concerns, and one-third of those surveyed see a concern with biased algorithms leading to unfair or discriminatory treatment.
The Mayo Clinc Platform, the health system's innovation base, is adding Israel's Sheba Medical Center, Brazil's Hospital Israelita Albert Einstein, and Canada's University Health Network to its distributed data network, which already includes Missouri's Mercy health system.
The Mayo Clinic is expanding its AI-based data sharing network on a global scale.
The health system's innovation base, Mayo Clinic Platform, announced today that its distributed data network, called Mayo Clinic Platform_Connect, will include Hospital Israelita Albert Einstein in Brazil, Sheba Medical Center in Israel, and University Health Network in Canada. They join the Missouri-based Mercy health system, which joined the platform in 2022.
The announcement adds an international flavor to a fast-developing segment of healthcare. Those within the Mayo Clinic network will be able to use de-identified clinical data on the Data Behind Glass platform to test AI-enhanced solutions for clinical care.
"We describe the data needed for fair, equitable AI as having depth (types of information), breadth (number of patients) and spread (heterogeneity)," Mayo Clinic Platform President John Halamka, MD, said in a press release. "To transform healthcare globally, we must expand our distributed data networks to every continent. We must protect privacy, adhere to international laws and regulations, and incorporate knowledge from every language."
Officials said the partnership will initially focus on:
Information Collaboration. "Secure cloud-based use of Data Behind Glass allows each collaborator to base decisions on a wider range of clinical outcomes gathered over time," officials said. "The information will help scientists analyze patterns of effective disease treatment and, more importantly, disease prevention in new ways, based on reviews of incremental clinical patient data over time."
Solution and Algorithm Development, Validation, and Deployment. "The resulting AI-based solutions will provide proven treatment paths based on years of patient outcomes, representing the next generation of proactive and predictive medicine that can be used by care providers around the world," the press release noted.
The Mayo Clinic has been on the front lines of integrating AI into healthcare, and is a member of the Coalition for Health AI (CHAI), launched just last month. In 2021, the health system launched the Remote Diagnostics and Management Platform (RDMP), designed to aid AI and clinical diagnostics opportunities in remote patient monitoring programs.
This latest announcement pushes the platform out into the global healthcare market, with partnerships with three health systems known for their innovation.
"We are thrilled to be part of this historic alliance to transform the future of health," Eyal Zimlichman, MD, chief transformation officer and chief innovation officer at Sheba Medical Center and director and founder of ARC Innovation at Sheba Medical Center, said in the press release. "Creating a truly global network that will break down language barriers and enable the inclusion of diverse populations, we are unlocking the potential of AI solutions to revolutionize health care worldwide. This is not just a game-changer, but a visionary leap toward data-driven healthcare."
HealthLeaders editor Jay Asser sits down with Angela Hunt, principal of quality clinical documentation improvement at Vizient, to discuss the connection between quality, clinical documentation, and coding departments, and how they can better coordinate to improve patient outcomes.
Reacting to a wave of complaints against its earlier proposed revision of rules for prescribing controlled substances via telemedicine, the DEA is changing course yet again.
The US Drug Enforcement Administration is revising proposed regulations for the prescription of controlled substances via telemedicine after receiving thousands of complaints.
A statement issued today by DEA Administrator Anne Milgram says the DEA, coordinating with the Health and Human Services Department, is submitting a draft temporary rule to the Office of Management and Budget for the "Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Substances."
Details of the new rule will be released when it is published in the Federal Register.
"The Drug Enforcement Administration received a record 38,000 comments on its proposed telemedicine rules," Milgram said in her statement. "We take those comments seriously and are considering them carefully. We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities while we work to find a way forward to give Americans that access with appropriate safeguards."
The use of telemedicine in prescribing controlled substances has long been stringently regulated by the federal government. Passed into law in 2008, the Ryan Haight Online Pharmacy Consumer Protection Act severely restricts the prescription of controlled substances, and requires an in-person exam by a qualified provider before those drugs can be prescribed via telemedicine. Enforcement is handled by the DEA.
The DEA had eased its rules during the pandemic to allow healthcare providers to prescribe controlled substances via telemedicine without the need to first conduct an in-person exam. With the COVID-19 public health emergency scheduled to end on May 19, the agency unveiled a proposed revision in February that would have expanded some telemedicine uses but also established a new set of guidelines.
The FDA's proposed rules would allow providers to use telemedicine to prescribe 30-day supplies of Schedule III-V non-narcotic controlled medicationsand buprenorphine, the latter specifically for the treatment of opioid abuse disorder, for new patients and without the need for an in-person evaluation..
"Leading professional associations, respected think tanks, and experienced clinicians submitted compelling and noteworthy comment letters explaining how the proposed rule will result in limitations on access to care, harm patients in rural and urban areas alike, and likely result in otherwise avoidable overdoses and deaths when patients are denied access to their medically-important medications," several lawyers from the Foley & Lardner law firm wrote in a blog.
Nathaniel Lacktman, a partner in the firm and chair of its national Telemedicine & Digital Health Industry Team, and his colleagues produced a legal guidebook shortly after the proposed rules were unveiled, and submitted a 15-page letter picking apart various aspects of the rules on March 30. Others submitting critical comments (the Foley & Lardner team called it a "tsunami of criticism") include the American Telemedicine Association, the Alliance for Connected Care, and a group composed of members of the Brookings Institution, Harvard Medical School, David Geffen School of Medicine at UCLA, and Harvard T.H. Chan School of Public Health.
Healthcare organizations across the country are launching RPM programs aimed at monitoring specific patient populations outside the hospital.
As healthcare organizations look to improve care management for patients outside the hospital setting, they're embracing remote patient monitoring in droves. New programs launched across the country are using everything from digital health tools and wearables to smart home technology and telehealth to connect patients to care teams.
"It's truly a new service model," says Karie Ryan, clinical transformation lead for connected care at Philips, who has been watching the growth of programs for the healthcare technology giant. "A lot of hospitals know it's the right thing to do and know it has value, but they don't know how to do it."
Ryan says large health systems "are well-positioned to own RPM" because they can use the platform as a population health tool, but smaller hospitals might not have the numbers to achieve sustainability and are looking at outsourcing to an RPM provider.
"There are many different ways" to develop an RPM program, she says. "None of them are wrong, but hospitals have to be very careful in planning these programs. We've seen many that were implemented during COVID that were never meant to be long-term solutions."
To that end, Ryan says she's worried that some health systems "jumped on the bandwagon" before plotting a sustainable use case, and they’re either just barely hanging on or dropping the program and giving RPM a black eye.
Among the factors that health system leaders need to address in developing an RPM program:
Identifying the right patients to be monitored at home;
Assessing the patient's home environment to ensure an RPM program will work;
Understanding what data needs to be collected, and how to collect it;
Identifying the technology needed, both at home and at the health system;
Identifying participating members of the care team and developing or adjusting workflows to monitor patients at home;
Establishing parameters and protocols for interventions, including emergency consults and hospitalizations;
Setting parameters for the length a patient participates in an RPM program, and how to return technology once that participation has ended;
Setting benchmarks for a program's success, sustainability, and scalability; and
Incorporating other care providers into the program to address SDOH.
Among the more common reasons for launching an RPM program is to monitor patients living with chronic care needs, or helping patients recover and rehabilitate at home after a hospital stay. The more common goals are reduced hospitalizations or adverse health events, a reduction in healthcare costs and in-person visits, and improved clinical outcomes.
Ryan says the RPM model will evolve as the technology becomes more sophisticated and health systems understand more about how they want to collaborate with patients at home. She says the platform could also be used in advance of a hospital stay, to prepare patients for scheduled treatments such as surgeries.
To gauge how RPM is evolving, HealthLeaders spoke with three different health systems about their programs.
Using RPM for Chronic Care Management
Community Health Systems opted to partner with Cadence in 2022 to launch an RPM program covering hypertension and congestive heart failure, and has since added diabetes to the roster. Through this partnership, the Tennessee-based, 79-hospital network relies on care teams employed by Cadence to handle daily monitoring duties, with more urgent cases handled by CHS providers.
"We had had physicians that had tried [to launch RPM programs] and they were just overwhelmed by all the data," says Lynn Simon, MD, MBA, the health system's president of clinical operations and chief medical officer. "So we had to focus on reducing that burden on our physicians. Once we had the process down, it became very easy."
Lynn Simon, MD, MBA, president of clinical operations and chief medical officer, Community Health Systems. Photo courtesy CHS.
Simon says CHS wanted to focus on chronic conditions that would show improvement with regular monitoring and adjustments to the care plan, alongside a patient population that could manage using devices at home to gather data for the care team. The health system looked at more than a dozen RPM vendors before choosing Cadence, opting for a company that would help the health system's primary care providers with enrollment and monitoring. and loop in clinicians when necessary.
"We did a lot of work to select the right partner and make sure our doctors were on board," she says. "We didn't want it to feel like we were handing our patients off to another company, and that [Cadence care teams] were part of our care team. We also wanted to make sure there is still that connection to the primary care providers."
Simon says CHS held webinars and meetings to educate its providers on the value of an RPM program, and used a handful of early adapters to highlight the partnership with Cadence.
CHS has enrolled more than 2,300 patients in its programs to date, with plans to give another 700-800 providers access to the program and scale up to more patient populations. So far, she says, only about 1% of the RPM encounters has had to be elevated to a physician intervention.
"I thought it would be a little more challenging to get enough information back," she says. "But that hasn't been the case. And we're hearing anecdotal information [and] some good stories about how we've been able to avoid hospitalizations."
Targeting a High-Risk Population
At Kentucky-based Baptist Health, officials launched an RPM program in late 2021 to address care management for high-risk patients living with CHF. The health system partnered with Current Health, the healthcare arm of Best Buy, to launch the program with plug-and-play technology, which includes a tablet, blood pressure cuff, and a wearable.
Steven Heatherly, MD, the nine-hospital health system's medical director of heart failure and pulmonary hypertension, says Baptist Health specifically targeted an at-risk population that is 18% more likely to be rehospitalized and/or develop acute health concerns. These patients, he says, have an average age in their 70s, and often have problems following doctor's orders in between visits.
Through the RPM program, care teams gather data from patients three times a day and connect with patients via phone when necessary.
Steven Heatherly, MD, medical director of heart failure and pulmonary hypertension, Baptist Health. Photo courtesy Baptist Health.
"We decided not to do routine phone calls," Heatherly says, noting nurses would call if they weren't getting data from the devices in the patient's home or if that data indicated a health concern. "We didn't get excessive amounts of workflow out of this. It worked very well for us and didn't overwhelm" the care providers.
In the first 10 months of the program, he says, the health system did see an increase in clinic visits—not exactly a surprise, given the patients' ages and their acute conditions. But only one patient was rehospitalized, for an unrelated medical concern, and only two patients died. In addition, the patients in the program paid more attention to their care plans.
Heatherly says Baptist Health is now expanding the RPM program to other patients, including those with COPD and hypertension, and will be using the platform to follow patients after they've been discharged from a hospital. They're also opening the program to more hospitals and clinics.
"We've seen how it works with high-risk patients, so now we know what we can do," he says. "There are a lot more patients that can benefit from this.
Heatherly also wants to track data on quality of life and medication adherence, among other factors. And they'll be talking to payers about the benefits of the program.
'Even I was skeptical at first," he says. "But the results so far have been very good."
Continuing Care From the Hospital to the Home
The Beacon Health System launched its first RPM program earlier this year with a focus on patients with complex chronic conditions who'd been recently discharged from a hospital. The Indiana-based health system is partnering with Biofourmis on the population health program, using a platform that includes digital health tools and a mobile dashboard for clinicians. Biofourmis also assists in monitoring patients for the health system, primarily overnight and on weekends.
Roughly 80% of the patients chosen for the program are monitored episodically, with data gathered at specific times during the day or week; the other 20% are monitored continuously.
"We're really looking at the patients who need the most intervention to stay stable in the ambulatory space," says John Bruinsma, Beacon Health's manager of care coordination and population health. "These are high-need, high-cost patients who go through a cyclical pattern of needing multiple readmissions."
John Bruinsma, manager of care coordination and population health, Beacon Health System. Photo courtesy Beacon Health.
Bruinsma says the health system pulled in staff from care coordination, population health, IT, health information management, and finance to plan out the program, which was initially funded by COVID-19 funding from the CARES Act.
He says one of the biggest challenges was designing a process that matched the right care providers with the right patients after they went home.
"It took a lot of talking with the key stakeholders, but we're very optimistic about the answers that this program will provide up front," he says. "This is another tool we can use to help patients who are struggling to manage their symptoms at home or to interpret their symptoms."
Bruinsma says Beacon Health is looking at long-term outcomes with this program, as well as identifying and addressing social determinants of health that may be affecting access to care from the home. They're also tracking ED visits, rehospitalizations, adherence with scheduled doctor's appointments, and medication management and adherence.
He anticipates that patients might spend up to 30 days in the program before transitioning out.
"We might integrate with in-person visits, maybe look at a Hospital at Home program," he says. "We've looked at it, and we decided to start in the middle for now. Factoring in long-term care management might be the next step."
Researchers say their AI algorithm can analyze clinical data and images of a patient's heart and calculate the probability of cardiac arrest and other concerns over several years.
Researchers at Cedars-Sinai have developed an AI algorithm aimed at predicting heart attacks before they happen.
A team led by Piotr Slomka, PhD, the hospital's director of innovation in imaging and a research scientist at the Smidt Heart Institute's Division of Artificial Intelligence in Medicine, created a tool that collects and sifts through climical data and images of a patient's heart to identify cardiac concerns and determine the likelihood of a heart attack, requirement for an invasive cardiovascular intervention (such as a stent or bypass surgery) or even death over several years.
“This general patient data, together with heart imaging, is what the deep-learning platform uses to make cardiac health predictions,” Slomka said in a press release. “Doctors and patients can use these graphs to track how risk changes over time and to identify individual risk factors. They can also interactively modify certain risk factors to see how it impacts a patient’s particular risk.”
“AI algorithms of this nature could enable physicians to communicate more personalized information regarding potential timing of imminent heart disease events, allowing patients to engage more meaningfully in the shared decision-making process,” added Sumeet Chugh, MD, director of the Center for Cardiac Arrest Prevention in the Smidt Heart Institute and director of the Division of Artificial Intelligence in Medicine and the Pauline and Harold Price Chair in Cardiac Electrophysiology Research. “Even more importantly, this tool has the potential to lend data-led, appropriate urgency to heart disease prevention efforts by both patients and providers.”
The results of the project were recently published in NPJ Digital Medicine. It's being touted as the first study to "evaluate prediction at multiple time points of multiple events in a large multi-site registry of cardiovascular imaging data that also explicitly takes advantage of time-to-event data during model training."
"The model relies on the combined predictive potential of the clinical features, stress test data, and direct image analysis, similarly to the way clinicians try to integrate all available information to provide the most accurate study interpretation," the research team wrote in its study. "Moreover, this approach also leverages time-to-event data to provide more robust risk estimation over time, which could potentially be applied to a broad range of AI tasks."
"In addition to informing the physician about the rationale behind model predictions, the visualization of factors contributing to increased risk of adverse events might serve as a powerful tool in shared decision-making after the exam, utilizing all available information," the team concluded. "When discussed with the patient, a special focus might be given to modifiable risk factors such as high BMI, hypertension, diabetes, and dyslipidemia, leading to optimal, goal-directed medical therapy of these risk factors. That could be a starting point for a discussion on how these factors can be targeted through lifestyle modifications and medications. Such an approach could be an important step towards patient empowerment and could improve adherence to physicians’ recommendations."
The State-level Mobile Unit Capacity Building grant program, overseen by the Leon Lowenstein Foundation, recognizes community health centers that have launched mobile health clinics to address challenges to healthcare access among underserved populations, including social determinants of health. The $12,500 grants are awarded in three categories: policy (improving sustainability and/or operational effectiveness); training and technical assistance for mobile unit growth and development; and technical assistance for emergency preparedness.
“For those who are unhoused, young people, those in active addiction, people in rural and urban areas alike, and many others in disenfranchised communities, mobile healthcare delivery is an essential service that increases access to healthcare,” Stewart Hudson, executive director of the Leon Lowenstein Foundation, said in a press release. “The Leon Lowenstein Foundation continues to be an engaged partner and funder to support the National Association of Community Health Centers (NACHC) in their efforts to build capacity for mobile units at health centers. These units are an important part of the work toward health equity in the US.”
Wilson, an Air Force veteran who has advised the Congressional Black Caucus on issues like health equity, talks about the evolution of diagnostic and imaging services.
HealthLeaders recently caught up to Cedric Wilson, MBA, RT, an executive director at Stanford Medicine Children's Health, for a virtual chat about the evolution of diagnostic and imaging services and the role that innovation plays in this segment of the healthcare industry.
Wilson served more than 20 years in the Air Force, and he has spoken with and supported the Congressional Black Caucus on issues ranging from health equity to opportunities for minorities in healthcare.
Q. You're leading the Diagnostic Imaging Innovations effort at Stanford Medicine--tell me a little bit about that. What do you focus on?
Wilson: My role is an incredibly rewarding one. I am the executive director of diagnostic and imaging services at Stanford Medicine Children’s Health. At its core, it constitutes leading diagnostic testing and imaging strategies, navigating the evolving continuum of care surrounding chronic diseases, and moving to preventative approaches in healthcare.
All of this is underpinned by research. I oversee about 180 or so experts that cover all facets and all modalities of radiology, as well as developing a leadership team. As an aside, I also spent more than 20 years in the United States Air Force, and in that role as a senior leader and superintendent, [in] the Pacific as well as Europe. This, along with my background, drives a large part of my service mindset and work promoting health equity, healthcare education and policy strategy in my work as a speaker at the Congressional Black Caucus.
Q. How have new technologies and strategies changed diagnostic imaging?
Wilson: Radiology in a children’s hospital differs from that in the adult setting. The majority of patients who receive MRIs, for example, are adults, so the equipment on the market and tools developed reflect that. Those are not always best for children or young adults. Sticking with the MRI example, children find it harder to sit still, they are smaller, they breathe faster, and more. This makes clear imaging challenging.
Cedric Wilson, MBA, RT, executive director of diagnostic and imaging services, Stanford Medicine Children's Health. Photo courtesy Stanford Medicine Children's Health.
Recent innovations in MRI equipment were a must. We’ve collaborated with engineers at UC-Berkeley to produce new designs and methods for smaller equipment. Flexible, lightweight MRI signal-receiving coils that increase imagery for children and lower scan times. Adding to this are advancements in image-reconstruction algorithms. Motion-correction sharpens images and artificial intelligence reduces scan times by using computer technology to reconstruct MR images with less raw data. We’re seeing large time savings across cardiac and oncologic examples, for example, with scans now able to be completed in 10 or so minutes versus an hour.
Q. What are the biggest challenges or barriers faced by radiology providers?
Wilson: A major challenge that has risen to prominence over the past few years is disparity in education and understanding of radiology among diverse populations. This didn’t happen overnight; it was passed from generation to generation.
For example, for many minorities or culturally diverse patients and families, there’s a fear of going to the doctor or of having diagnostic tests. This runs the gamut from X-Rays to MRIs and many tests in between. It hinders the industry’s ability to catch diseases early or provide optimal care plans. Many radiology departments, including ours at Stanford Medicine Children’s Health, deal with some of the most critically ill and rare cases from around the world. We’re working hard to lead the industry in dispelling myths and promoting education around radiology. This extends to engaging our patients in new ways to understand their unique cultural behaviors. This will empower healthcare to better care for increasingly diverse patient populations. It remains a core component to an equitable health future.
Q. How can these new technologies or strategies improve clinical outcomes?
Wilson: One of the goals of technology in radiology is to limit (or, in some cases, eliminate) a child’s exposure to radiation. Another is to improve diagnostic capabilities.
A good example of this is how we’ve developed a way to test for vesicoureteral reflux, a kidney condition that impacts approximately one in 10 children, without the use of radiation. Another would be pioneering the use of PET/MRI instead of PET/CT scans in pediatrics. This strategic approach limits radiation exposure and eliminates the need for separate appointments — and because it provides more information to our experts in relatively the same amount of time, it enables a more accurate diagnosis and faster time to providing the right treatment options. Our team also participates in the Image Gently campaign, which seeks to reduce radiation exposure in pediatric imaging across the nation.
Q. How can these new technologies or strategies improve provider workflows and reduce stress?
Wilson: Any radiology innovation must be considered as supplemental to a diverse, multidisciplinary care team that accounts for the holistic well-being of patients. The high-acuity, critically ill patients we work with are children or young adults. They are growing and experiencing trauma during transformative years of their lives. There’s a lot more that goes into caring for them than simply treating an ailment or disease. So new imaging technologies and techniques capture images with increasing levels of detail, clarity, and speed. It gets the right people in the room earlier on in the process. This shares the load when it comes to caring for patients and puts experts in a position to maximize their impact.
Q. Is there a shortage of qualified technicians for this field? What steps might be taken to ensure the stability of the workforce?
Wilson: On the theme of health equity and how that impacts radiology, a lack of education also extends to the opportunities to work or build a career in radiology.
Radiology is quite unique in that so much of the profession is driven by technology--and how to then empower caregivers with information to better care for patients. I have spent a lot of time over the past few years explaining my journey to people and educating others to the modalities in radiology. Two reasons: First, there are non-traditional ways into radiology, and we need to be open to inviting all types of talent into our field. Second, the industry doesn’t do a good enough job of highlighting the computer science elements of our work. Behind the bench and bedside care that upholds radiology is an intricate and innovative layer of computing and imaging systems. Do you like technology? Then wonderful, there’s potential in radiology. You’re looking at a future in artificial intelligence, machine learning, or cloud computing systems? We offer that, too.
Q. How will radiology fit into the hospital of the future?
Wilson: Radiology will remain critical in the hospital of the future.
The earlier and more specifically imaging can identify potential illness or disease, the more opportunity that opens up to provide the right care. I believe it will fundamentally change how we care for patients across the healthcare continuum. For example, we are currently planning imaging around enamel to assess brain function at a younger age. This information can be used to better predicted disease before the child ages, leading to earlier treatment potential.
Radiology is also moving into care models that enable multidisciplinary approaches to healing. This includes not only the AI, ML, or advanced technology applications we’ve discussed earlier, but also broader conversations around systems, operations, and education. For multidisciplinary or holistic care strategies, we’ll see radiology play a critical function in care, accompanied by providers from other specialties or domains. Think mental health, physical health, emotional health, and more.
Q. What new technologies or strategies are on the horizon? How will this field evolve?
Wilson: I am glad that you mentioned strategy within this question. Often in pediatrics, strategy is just as important as research and technology innovation.
Here’s an example that shows how strategies are evolving to provide better care to patients. Years ago, we discovered that children who needed an MRI for orthopedic indications had a slow and cumbersome experience with the healthcare system. The child and parents would take a day off from school/work to see a specialist, who then requests an MRI. Then the families go home, wait for insurance pre-authorization, and then take another day off to come for the MRI.
So the radiology and imaging team worked together to innovate a new process that leverages our understanding of MRI physics and uses high-performance computing to enable the MRI to be done in under 10 minutes. That, coupled with a new process that waives insurance pre-authorization, allows immediate walk-in MRIs. Instead of care taking days or weeks, now we can take just a single visit to set a child on the path to recovery.
