The conference, taking place this week in San Diego, has drawn healthcare leaders, researchers, and entrepreneurs to discuss how healthcare should map out an AI strategy.
AI is having its moment. And healthcare leaders are fully invested, excited about the potential for the technology but wary of the dangers.
The technology that's on everyone's lips and in everyone's pilot programs could be used to address healthcare's key pain points, be it a shrinking workforce, surging stress and burnout rates, or care coordination and management inefficiencies. Advocates point out that AI can handle burdensome and tedious tasks that take providers away from providing care, while also gathering and analyzing data far more quickly and efficiently than the human mind.
"It's what we hear all day, every day now," said Karen Seagraves, PhD, MPH, NEA-BC, a senior healthcare consultant and former vice president of Atrium Health's Neuroscience Institute.
But while some are calling it an unguided missile, capable of causing great harm, others see it as a transformative technology poised to reinvigorate healthcare, if only healthcare would listen.
"We wouldn't have used the iPhone," points out Chip Steiner, a product manager for healthcare at Kore.ai, a digital health company focused on language-based AI technology. "We didn't know we needed it until now we do."
The good and the bad are on display at the AIMed (Artificial Intelligence in Medicine) Global Summit, taking place this week in San Diego. The brainchild of Anthony Chang, MD, MPH, MS, MBA, a pediatric cardiologist at Children's Hospital of California (CHOC) and Freddy White, a UK-based events organizer and author of Intelligence Based Medicine, the five-year-old conference boasts a registered attendance of some 1,500 healthcare executives, clinicians, researchers, and vendors.
With a high-level and international speaker list and an intimate exhibit hall ringed by track-level stages similar to the HLTH and ViVE conferences, AIMed is poised to capture the conversation. That includes heeding the concerns of those who argue for tapping the brakes on the hype.
Just remember what happened with the EHR.
"There is enthusiasm about this disruptive technology," said Jesse Ehrenfeld, MD, MPH, a senior associate dean, tenured professor of anesthesiology and director of the “Advancing a Healthier Wisconsin Endowment” at the Medical College of Wisconsin, and president-elect of the American Medical Association, while also bringing up the "horror stories" of EHR adoption caused by a provider population that clearly wasn't ready or willing to embrace the new technology. "The existing regulatory framework is clearly not equipped to handle [AI governance]."
Ehrenfeld said the healthcare community needs to make sure that AI adoption doesn't follow the same path as EHR adoption, and that healthcare executives and clinicians play an active role in shepherding the technology forward.
"They've got to include clinician voices at the front end, not as an afterthought," he said.
During a panel composed primarily of healthcare executives, the general consensus was that AI—defined as augmented intelligence rather than artificial intelligence—would help healthcare make some early gains in reducing administrative tasks and improving workflows. That's an important selling point for an industry dealing with stress, burnout, and shortages up and down the roster, from clinicians and nurses down to tech support.
'We're always asked to do more with less," said Lynn Jeffers, MD, MBA, FACS, chief medical officer at Dignity Health.
"Efficiency is at the crux of how we solve this," added Stephanie Lahr, MD, CHCIO, the former CHIME board member and CIO and CMIO at Monument Health who's now president of digital health company Artisight.
The panel even featured one of the first and few healthcare executives whose role is specifically focused on AI: Ashley Beecy, MD, FACC, an assistant professor at Weill Cornell Medical College and medical director of AI operations at New York Presbyterian Hospital. Beecy noted her role was created to bring clinical leadership to the table when discussing AI strategy, so that clinicians can be part of the process in developing, testing, and scaling AI projects.
And that's where AI should start. While Chris DiRienzo, MD, MPP, senior vice president and chief physician executive for the American Hospital Association and an adjunct professor at the Duke University School of Medicine, pointed out that AI not only can help clinicians do their work better but also do work that clinicians can't do, the inclination is to reach immediately for the stars and use the technology to, say, find a cure for cancer. Instead, he and others said, start with the low-hanging fruit and build up the small successes.
"We have to cultivate the culture," said Eric Eskioglu, MD, MBA, chief medical and scientific officer at Novant Health.
That's going to take some time. When asked to predict the future for AI acceptance in healthcare, some foresaw 10 failures for every success and a gradual annoyance of the ChatGPT craze. But mixed with that was an understanding that healthcare leaders would move slowly to embrace more AI applications in healthcare, primarily because consumers and clinicians will be learning how to use the technology and will be pushing for more opportunities to use it.
Chang sees the landscape remaining unsettled for another one or two years, then a gradual understanding of what can and can't be done in three to five years.
"I do think there is more hope than ever before," he said.
The health system is using Epic's Cheers tool to connect with patients to discuss health and wellness
Customer relationship management (CRM) is a relatively new concept for healthcare organizations that have long thought little of the patient until they show up in the hospital or doctor's office. But with the shift to patient-centered care and increasing competition in the healthcare marketplace, it's become more important for healthcare providers to listen to what the patient wants.
Health systems are now using CRM tools to get in front of their patients on topics such as vaccinations, wellness visits, screenings, and chronic care management. And they're finding that a technology platform that offers personalized messages at preferred times and channels not only boosts engagement, but can improve clinical outcomes as well.
"Once you have this tool, the value is immediately apparent," says Rachel Everhart, MS, PhD, director of research for Denver Health, which has been using Epic's Cheers CRM tool for more than a year and is seeing large increases in engagement for vaccinations and other services. "It's a different way to think of patient care, and one that is working very well."
CRM tools have been a staple in other industries for many years, but healthcare has been slow to catch on to the value. That has changed with the advent of technology that can capture more data on patients inside and outside the healthcare system, giving providers more information and opportunities to affect health and wellness.
Modules like Cheers enable providers to analyze all that data, identify who needs what specific services or reminders, and even tailor the message for the patient.
"This helps health systems to understand the complete patient journey," says Sam Seering, Epic's product manager for Cheers, who notes more than 200 health systems are currently using at least one aspect of the CRM tool. The technology, he says, "wraps around a connected health insight layer to identify and address gaps in care."
That's an important resource to have at a time when consumers are ignoring or skipping healthcare tasks or failing to follow through on a doctor's recommendations. Health concerns that could be caught early through a screening, test, or even a simple visit to the doctor are festering and turning into much more dangerous issues.
According to Epic, health systems using Cheers in the first few months after the product's launch scheduled more than 3,900 preventative health visits for patients over the age of 40—a key time to check out all those nagging little concerns before they become serious. They also scheduled close to 1,300 mammograms, and in four instances those tests led to a cancer diagnosis.
Denver Health used Cheers in a campaign to improve the rate of parents scheduling annual wellness visits for their children, which had dropped significantly during the pandemic. The health system transitioned from what Everhart calls a home-made CRM tool built on the Microsoft platform.
She says Cheers was "wildly successful" in connecting with parents and convincing them to schedule wellness visits, prompting Denver Health to quickly turn around and set up the platform to address COVID-19 vaccinations.
"Without this, we were relying on front-office staff—when they had the free time—or medical assistants to comb through the records, then pick up a phone and call people," she says. "We would end up leaving a lot of voicemails and really not getting a lot of calls back."
Everhart says the CRM tool pulls providers out of their comfort zone, which has long been to "focus only on the patient in front of you," and think more about value-based care, which centers on a patient's health journey and long-term clinical outcomes. This in turn enables patients to feel that the health system is looking after them, which makes them more receptive to following doctor's orders and scheduling various health and wellness visits.
"It's still a bit of a challenge for us," she admits. "We're talking about new ways of communicating with patients, and we don't want to overburden them. We have to think carefully about how often we send those messages," as well as what channel they're sent on.
Seering says Cheers has also helped health systems increase patient use of the MyChart portal, with the Yale New Haven Health System seeing more than 9,000 portal activations in five months as a result of messages sent through the Cheers tool.
Everhart says Denver Health is currently only using one function in the Cheers toolkit, and is looking forward to adding new functions, such as bi-directional communication and screening assessments for social determinants of health and other factors. Each new tool. She says, will enrich the experience for the patient and give the health system more opportunities to manage care.
"That's a conversation we haven't had yet," she says. "We're very focused right now on what we can do, rather than what we would like to do. We need to plan very carefully where this can go."
The implication is that targeted messaging campaigns can affect clinical outcomes, though there hasn't been enough research done yet to confidently make that point. Everhart says Denver Health is tracking engagement rates as well as clinical actions triggered by the messages, and will be looking to tie in data from those actions and any follow-up care in the future.
Ideally, the tool will engage more patients to schedule appointments with their provider, which in turn will enable Denver Health to catch more health concerns early and develop better care management plans. This will lead to fewer crises and more healthy patients down the road, alongside a much better doctor-patient relationship.
'We already see this as being very successful," she says. "It's so much better than what we had done before."
Hoag is the first West Coast health system to use the technology, which produces a full-body 3D avatar of a patient within minutes and allows doctors to identify, measure, and track suspect lesions.
A southern California health system is offering whole-body 3D scans to patients at high risk of developing skin cancer.
Hoag, a Newport Beach-based health system consisting of two hospitals, 15 urgent care facilities, and 10 health and wellness centers, is reportedly the first West Coast provider to offer the VECTRA WB360, a walk-through machine that uses 92 separate cameras to capture a patient's entire skin surface. The system generates a 3D avatar of a patient and maps out all moles and legions.
The process takes about eight minutes, officials say, whereas traditional imaging methods would take up to 90 minutes.
Designed specifically for dermatology, the platform includes software that allows clinicians to tag, measure, and track lesions, organize the images in a secure and accessible image management system, and allow for better monitoring over time.
“In sunny Southern California, melanoma remains a prevalent problem, and nothing is more powerful than prevention or early detection,” Burton Eisenberg, MD, FACS, executive medical director of the Hoag Family Cancer Institute and the institute's Grace E. Hoag Medical Director Endowed Chair, said in a press release. “With this advanced noninvasive technology, our physicians will be able to detect changes in high-risk patients at the earliest possible stage.”
“This highly innovative imaging system will allow our dermatologists to monitor suspicious lesions and track changes over time,” added Steven Q. Wang., MD, Hoag’s program director of dermatologic oncology. “More importantly, this powerful tool can help dermatologists detect skin cancer at the earliest stage, while avoiding unnecessary skin biopsies."
The imaging technology was developed by Canfield Scientific, a global firm with headquarters in New Jersey, and was piloted at Memorial Sloan Kettering Cancer Center in New York and the University of Queensland in Australia. It's now being used by roughly 13 health systems in the US, along with about two dozen in Europe, two in China, and a handful in Australia.
The state is one of the first to fully sanction veterinary telemedicine, a growing trend since the pandemic that has shown to benefit not only the pet but the pet's owners.
Arizona Governor Katie Hobbs has signed legislation allowing residents to use telemedicine to access care for their pets.
SB 1053, which drew almost unanimous support from both the Senate and the House, was supported by a strong coalition of animal rights groups, veterinarians, and farming advocates. Among other things, the bill amends current law to allow pet owners and veterinarians to create a relationship via virtual care rather than first meeting in person.
While the industry is overseen by the American Veterinary Medical Association, state veterinary medicine boards are responsible for establishing telehealth guidelines and rules. The most common uses are for initial diagnoses, to determine whether the pet needs to be brought into the office, for consults with specialists such as radiologists, and for the care and treatment of farm animals and livestock.
Most states require that a veterinarian-client patient relationship (VCPR) be established in a face-to-face meeting before moving to telehealth, with the exception of an emergency. And many states and the AVMA oppose the use of telemedicine for remote consulting offered directly to the public in the absence of a VCPR – in other words, direct-to-consumer telehealth for new clients.
Support for veterinary telemedicine soared during the pandemic, when pet owners sought a means of getting care for their pets without visiting a veterinarian. Some 19 states, including Arizona, passed legislation to enable veterinarians to conduct virtual visits during the COVID-19 crisis, and Arizona is one of the first to make that practice permanent.
According to the Veterinary Virtual Care Association, only Idaho, Virginia, and New Jersey allow virtual care for pets without restrictions, while roughly 33 states require either an in-person exam or some sort of prior relationship before switching to telemedicine. Only New York bans any use of telemedicine for veterinary care.
Arizona's approval of a veterinary telemedicine bill drew support from the Goldwater Institute, a conservative and libertarian think tank based in Phoenix.
"A chronic shortage of veterinarians has created veterinary deserts throughout the United States," Mark Cushing, founder and CEO of the Animal Policy Group, wrote earlier this month on the organization's website. "Pet owners of all ages don’t hesitate to seek veterinary advice and care, but such care is often available only through digital tools. Veterinary trade associations resist these changes, ignoring the key principle that telemedicine requires an informed choice by the veterinarian and pet owner to proceed without an in-person examination of the pet."
While aiming to improve access to care and clinical outcomes for pets, veterinary telemedicine is also showing up on the radar for health plans, self-insured businesses, and private payers, who see pet care as an important part of member engagement and satisfaction. Pets are also being considered a social determinant of health, with research showing that pet ownership has a positive impact on the owner's health.
Pet care companies like Chewy and Petco Health have been expanding into telemedicine service, with the latter estimating the value of the service at $119 billion in 2021. And just last month, Walmart signed a deal with pet telehealth company Pawp to offer its members access to veterinary services via video or text without an appointment.
Four health systems are testing out a generative AI tool through the Epic EHR platform that provides answers to commonly asked and time-sensitive e-mails sent by patients to their doctors.
Four health systems across the country are piloting a generative AI tool within their Epic EHR platform to generate answers to certain patient messages.
The project aims to reduce workload stress for clinicians, particularly during their off hours, by sorting through their e-mail in-box and providing answers to commonly asked and time-sensitive questions. The answers are reviewed by the clinician before they're sent to the patient.
North Carolina's UNC Health, UC San Diego Health, Wisconsin-based UW Health, and Stanford Health Care are taking part in the project, along with Epic and Microsoft. A small number of physicians from each health system will be testing the tool, which runs on Epic's EHR and Microsoft's Azure cloud platforms.
“A good use of technology simplifies things related to workforce and workflow,” Chero Goswami, chief information officer at UW Health, said in an April press release from Microsoft announcing the project. “Integrating generative AI into some of our daily workflows will increase productivity for many of our providers, allowing them to focus on the clinical duties that truly require their attention.”
“We are incredibly excited that UNC Health’s work to build strong foundational IT systems and our existing use of AI tools has established us as a national leader helping drive the future of AI in healthcare,” Brent Lamm, UNC Health’s SVP and chief information officer, said in a separate release put out by the health system last week. “For us, the goal is to find ways we can thoughtfully and safely use AI to improve our teammates’ experience and help them focus on patients.”
According to UNC officials, who rolled out the tool to between five and 10 physicians, the project began with "a small subset of more administrative-type messages, similar to how your phone can suggest responses to texts." The answers aren't designed to replace a clinician's judgment, but rather save that clinician the time and effort involved in reading multiple e-mails.
The platform also incorporates natural language processing.
“Our exploration of OpenAI’s GPT-4 has shown the potential to increase the power and accessibility of self-service reporting through (Epic's self-service reporting tool) SlicerDicer, making it easier for healthcare organizations to identify operational improvements, including ways to reduce costs and to find answers to questions locally and in a broader context,” Seth Hain, senior vice president of research and development at Epic, said in a press release.
A partnership between the University of Texas and telehealth provider MDLIVE will give roughly 11,200 students between 10 and 18 on-demand access to psychiatricts or therapists through a telehealth platform at school, an mHealth app, or a phone call.
Close to a dozen school districts in Texas will have access to virtual behavioral health services for their students through a partnership between the University of Texas and telehealth company MDLIVE.
The new program will offer some 11,200 students between the ages of 10 and 18 on-demand virtual access to MDLIVE licensed psychiatrists or therapists, either from a dedicated telehealth platform at the school or through an mHealth app or phone call. Students can also request a provider that aligns with their gender and ethnicity.
The program seeks to address the growing behavioral health crisis in schools, with schools struggling to find the healthcare resources needed to treat students and students facing barriers to accessing those care options.
The pandemic exacerbated that crisis, making it even harder for students to get in front of care providers. According to research by MDLIVE parent company Evernorth, there has been a 14% increase in suicide-related diagnoses in children and adolescents since the start of the pandemic, accounting for 35% of all patients with these health concerns.
“This initiative will help address the alarming rise in mental health issues among young people today and provide essential resources to students who would otherwise have limited access to quality mental healthcare," Matt Orem IPSI's associate director, said in a press release. "It was not only the size and quality of MDLIVE’s network of providers and suite of behavioral health services that led us to choose them as our partner, but also the flexibility of their care delivery platform to meet the unique needs of this program.”
The collaborative, funded by the National Science Foundation, brings together close to a dozen colleges and universities to focus on the use of AI in healthcare diagnostics and treatment.
Almost a dozen colleges and universities in South Carolina are joining a federally funded collaborative aimed at using AI technology to improve healthcare diagnostics and treatment.
Clemson University is leading the program, called Artificial Intelligence-Enabled Devices for the Advancement of Personalized and Transformative Health Care in South Carolina (ADAPT-SC). The effort is being funded by a five-year, $20 million grant from the National Science Foundation.
“Health innovation has long been a strength at Clemson, and we continue to build a strong platform in AI research," Tanju Karanfil, Clemson's vice president for research and a principal investigator for the program, said in a press release issued earlier this month. "ADAPT will bring these two critical fields together to improve the quality of care and life in South Carolina. Ultimately, patients and their families will be the beneficiaries of what we believe will be life-saving research.”
The program is split into three parts:
First, researchers will be working to develop research capacity in AI-enabled biomedical devices to improve the state's healthcare network, especially in underserved regions.
Second, the program will work to expand and improve education and workforce development in the state to create a more diverse talent pool in biomedical AI.
Third, the program will support interdisciplinary collaborations and academic-industrial partnerships that foster research, education, and technology-transfer integrated programs.
“Healthcare providers face numerous challenges diagnosing disease, or monitoring infections from traumatic injuries, or predicting likely outcomes of various treatment plans," Bruce Gao, ADAPT-SC's scientific lead and the South Carolina SmartState Endowed Chair of biofabrication engineering at Clemson, said in the press release. "It is an incredibly difficult job, but AI can remove some of those challenges. In particular, AI can provide expedient information that will help physicians create a care of plan specific to each patient’s condition and medical history.”
Along with Clemson, other members of the program are the Medical University of South Carolina (MUSC), the University of South Carolina, Benedict College, Claflin University, South Carolina State University, the College of Charleston, Francis Marion University, The Citadel, Winthrop University and Tri-County Technical College. The group will also work with SC Bio, a statewide economic development organization and life sciences industry association comprised of some 200 members.
The grant from the Helmsley Charitable Trust will help NYC Health + Hospitals' innovative HoPE program expand its reach to expectant mothers who are experiencing homelessness or imprisoned.
A program launched last year in New York City to address high maternal mortality rates among minorities is getting a $2 million cash infusion to expand its reach to homeless and incarcerated mothers-to-be.
The funding will help the program expand doula care services to expectant mothers who are homeless or facing housing insecurity, as well as those in prison.
“Right now, New Yorkers experiencing homelessness or incarceration are twice as likely as their housed peers to experience negative birth outcomes,” Tracy Perrizo, the program officer for the Helmsley Charitable Trust’s New York City Program, said in a press release. “At Helmsley, we look for solutions that reduce barriers to care for those with complex needs and limited access to quality services. Expanding doula services for those who are sheltered or incarcerated can improve birth experiences. With continued support from doulas who understand their challenges and needs, we are optimistic that this program can enhance participants’ overall engagement with healthcare and promote long-term well-being for themselves and their children.”
The program is one of hundreds across the country that aim to improve access to care for pregnant women, as well as those who have recently given birth and the children. Through community-based programs as well as telehealth and digital health channels, health systems are offering services and access to resources to those who either can't or won’t seek the care they need.
The HoPE program was launched in a partnership between Elmhurst and Queens hospitals and two doula organizations, Ancient Song Doula Services and the Caribbean Women's Health Association, and is part of a larger program launched in 2018 known as the New York City Partnership.
“With the support from Helmsley, we can better assist our community members who have historically faced disproportionately high adverse childhood experiences, chronic health challenges, limited support during the critical perinatal period, and poor maternal and child health outcomes," Sheela Maru, MD, MPH, an attending physician at NYC Health + Hospitals/Elmhurst and assistant professor of global health and obstetrics, gynecology, and reproductive science at the Icahn School of Medicine, said in the press release. "Community-based doula care offers us a way to change this trajectory.”
“With funding from Helmsley, the HoPE program will give our patients the opportunity to work with doulas who can support them both in jail and after they return to the community," added Rebecca Giusti, MD, Medical Director of NYC Health + Hospitals/Correctional Health Services' Complex Care and Special Populations division. "I expect that the relationships they build will improve birth experiences and outcomes and further strengthen continuity of care between CHS and H+H hospitals.”
University of Iowa Hospitals and Clinics is using technology in the OR to study how surgical procedures are done, with a goal of improving efficiency, reducing workflows, and improving clinical outcomes
Hospitals are turning to technology to get a good look at how their operating rooms, well … operate. And the results are not only improving OR efficiency but boosting clinical outcomes as well.
"These things turn out to be very important in patient outcomes," says John Cromwell, MD, FACS, associate chief medical officer and the director of surgical quality and safety at University of Iowa Hospitals and Clinics. "The amount of data we're getting will help us see things that we never would have seen before."
UIH launched its "data-driven surgery" program in July 2021 in a partnership with Caresyntax, one of several digital health companies developing technology platforms to improve operational and clinical efficiency in different parts of the hospital. The hardware and software program taps into connected devices and platforms throughout the OR while capturing audio and video recordings of the procedure.
John Cromwell, MD, FACS, associate chief medical officer and director of surgical quality and safety at University of Iowa Hospitals and Clinics. Photo courtesy University of Iowa Hospitals and Clinics.
Using that data, Cromwell says, administrators can gain a better understanding of how surgical procedures are done, as well as how the different members of the surgical team work individually and as a team.
"It's surprising how many variations we can find in processes," Cromwell says. For example, review teams can look at surgery outcomes based on the time of day, the day of the week, workflow patterns, even fluctuations in the weather.
While the platform acts as a kind of audit, Cromwell says it's not used to evaluate anyone's skills or performance.
"There are always concerns when you start collecting this type of data," he says, adding that it's not used for HR purposes or "gotcha moments." The data, he says, that's collected is federally protected and stored behind a strong firewall.
What it is used for, Cromwell says, is to examine how surgical procedures are conducted, with an eye toward, for example, how devices and supplies are used and where surgical team members are placed. Administrators can then look for more efficient workflow adjustments that might save time or reduce wasteful processes or the use of supplies.
By leveraging EHR data, Cromwell, says, review teams can also take into account clinical outcomes.
"You can do some really interesting things [with the data] that are not always obvious," he says, such as identifying when and where infections might occur, due to fluctuations in temperature, changes in a patient's vital signs, or processes that open up opportunities for an infection.
Cromwell says the health system has used this technology to make some short-term improvements in OR procedures, mainly affecting efficiency and room turnover rates. Shaving 5-10 minutes off of a procedure "can be an enormous amount of time saved," he says, when played out over 50 or more OR rooms.
As administrators learn how to train the technology on specific aspects of a surgical procedure, he says, they'll be able to identify processes that can affect clinical outcomes (such as infections) and make improvements.
"This is a new way of doing things," he says. "There's really no other way of doing this. We can't really put people in the OR to watch over everything and tell [the surgical team] to do this or that. It's the technology that is really enabling us to get a better look and see where things can be improved."
He says surgeons are interested in the data as well and are often curious as to how they can improve their skills.
Cromwell sees other areas of the hospital where this technology could help, such as the emergency department. He sees the technology playing a part in credentialling and training programs, especially as healthcare organizations move into value-based care and gain a better understanding of how clinical services affect the revenue cycle.
"It's limitless in what we can do with the technology," he says. "And it'll become a standard of practice in the future as [we] figure out what we can learn from it."
The Pennsylvania health system has eliminated redundant processes and reduced the time and number of people involved in a discharge while boosting patient satisfaction scores.
Patient discharge can be a particularly nasty pain point for hospitals, involving several people from several departments and data from a variety of sources. That, in turn, might make it less than appealing for patients, thus affecting both satisfaction and engagement metrics.
Recognizing the logjams that can occur when leaving the hospital, UPMC has launched a new patient discharge process that consolidates decision-making under one clinical care coordinator and creates a platform for data gathering. The process has shaved 3–4 hours off patient discharge times, improved consult and referral protocols, and boosted HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores by almost 10%.
"Our people have become a blended team … with a new boss," says Tami Minnier, MSN, RN, FACHE, FAAN, the Pennsylvania health system's senior vice president of health services and chief quality & operational excellence officer, and the driving force behind the new strategy. "There's a lot that we've been able to improve, and I really think we're only scratching the surface of what we can gain."
Minnier says the patient discharge process had grown cumbersome over time, adding in a variety of check-offs and approvals that built up like gravel gathering along the edges of a streambed. Add in the necessary steps to transfer a patient to a rehab or skilled nursing facility or send a patient home, perhaps with remote patient monitoring services or scheduled follow-up appointments, and patients weren't seeing daylight until late afternoon.
Tami Minnier, MSN, RN, FACHE, FAAN, senior vice president of health services and chief quality & operational excellence officer at UPMC. Photo courtesy UPMC.
"We had created many, many, many different siloed roles around discharging patients from the hospital," she says. "It could take six, seven, eight, nine, 10 people to get just one patient out the door."
Aside from the excessive use of staff and resources, the process also leaves patients and their families waiting to leave the hospital, reducing their satisfaction and, perhaps, causing them to question or avoid post-discharge instructions and follow-up care. Those delays also keep cleaning staff on hold and leave hospital rooms out of commission for longer periods of time.
Minnier's solution was to create one single, accountable, patient discharge manager who oversees a discharge process that involves fewer people. While that might sound easy, it affected more than 700 people within the health system and involved a good deal of change management.
"Change management and culture were the biggest challenges," she says, describing a system that included some "embedded and entrenched" habits and attitudes that needed to be changed. "Getting people to think differently about what they do isn't easy."
"First of all, we had to recognize that anyone can be a good manager," she adds. "The first thing was to say, 'We are all equal,' and then create an integrated care team that understands situational leadership and how to be accountable. Not everything can or has to be delegated."
As part of the process, UPMC developed a new clinical leadership ladder and standardized nursing roles, giving everyone a more streamlined approach to the patient discharge process. The health system also redesigned its weekend compensation program, which reduced on-call costs by more than 50%. Again, the idea was to reduce the number of steps and people involved in getting a patient out the door and back home or wherever they were going next.
"We found a lot of redundant work, [such as] unnecessary consults," Minnier says, estimating the new process cleaned up roughly 157 hours a month of extraneous consults. "We also added cellphones to improve communications, and embedded referrals. We saved hundreds of hours a month there."
They also took a closer look at pending order sets, and reduced labs and other tests (which reduced needle sticks for the patients). They also fine-tuned the protocols for placing patients in rehab and SNFs, with an eye toward reducing the number of times that a patient has been ready for discharge but isn't ready to be received at the next care site.
Minnier says the new process is working well, and the health system is getting ready to publish a study and will present it at major healthcare conferences.
But there's also more to be done. She looks at the network of SNFs, rehab facilities, and other sites that are included in the patient's journey and wants to "build better bridges" with them, so that the transition is smooth and data is shared quickly and efficiently. This would include strengthening communications with health plans, outpatient clinics, and other resources, such as transportation services, behavioral health providers, and social services.
And with the trend of moving more hospital services into the home, Minnier would also like to strengthen the transition for patients to remote patient monitoring and acute care at home programs.
