A new tool assesses coronary inflammation, which is often overlooked in measuring the risk of a heart attack. One doctor says this test could detect problems years in advance and save lives.
An AI tool that can detect inflammation in the coronary artery could help clinicians diagnose heart disease much earlier, even decades before the patient shows any outward signs of distress.
CaRi-Heart Technology, developed by Connecticut-based Caristo Diagnostics, was recently given its own Category III CPT code by the American Medical Association’s CPT Editorial Panel, an important step in the path to adoption after FDA approval and, just as important, payer reimbursement. The technology has also shown promising results in trials conducted in 2024 at five National Health Service hospitals in the UK, where reports indicate more than half of patients analyzed by the AI tool had their treatments changed.
To clinicians, the tool could be a critical step forward in the diagnosis and treatment of heart disease, the leading cause of death in the country.
“Cardiology disease is very different than other diseases in terms of how we treat it,” says Stephen Bloom, MD, MSCCT, FASNC, FAHA, FACP, FACC, a cardiologist with Midwest Heart and Vascular Specialists in Overland Park, Kansas, part of the HCA Midwest Health System. “We do mammograms before people have breast cancer. We do colonoscopies before people have colon cancer. And then in cardiology, we wait until they have symptoms, and then we do our best to treat our patient, now with established disease. It doesn't even make sense.”
AI has the potential to analyze data from tests, such as a CT scan, more quickly and with more detail than the human eye. While traditional imaging can identify visible plaques that cause narrowing and blockages, the CaRi-Heart tool zeroes in on perivascular fat, or coronary inflammation, which is overlooked in assessing someone’s heart health.
And since acute MIs occur when non-calcified plaque ruptures, any method for detecting non-calcified plaque better and earlier would save lives.
“[AI] could actually look at each coronary [artery], each segment, if you break it down to three, and [it] can actually summarize not only how much calcified plaque you have, but also non-calcified vulnerable plaque, which has more of a tendency to rupture and cause a heart attack,” Bloom says.
Bloom notes that inflammation can be present in many diseases and measured by a blood test (c-reactive protein (CRP)). However, this blood test is not specific for the heart and less sensitive.
But with coronary CT with AI, clinicians can drill down further than they’ve been able to in the past. Bloom says doctors often use stress testing, but these tests only become positive for heart disease when the patient has a coronary blockage greater than 70%. This can create a false sense of security. Analyzing inflammation with plaque analysis from a CT could create a much better definition of a patient’s cardiac risks.
And it could be done long before any signs of heart disease are evident.
“We can take patients even before they have symptoms and diagnose whether or not they have early coronary disease and treat them with appropriate medication as well as a change in their diet [and] exercise,” Bloom says.
The challenge, as always with new technologies, is reimbursement. Most payers currently don’t cover tests like nuclear cardiac stress testing, MRI stress scans or even coronary CTs unless there are symptoms. Bloom is hoping that the results of the UK tests and the newly approved CPT code will prod payers to cover the CaRi-Heart test.
“The good thing is it’s simple [and] it’s painless and less expensive than nuclear and other tests like MRI, and so it could be the gatekeeper to reducing heart disease by finding it early and treating the patient in the early stages,” he says.
“The next five years will probably dramatically change the way we treat our patients with coronary disease,” Bloom adds, adding that plaque analysis from a CT has only been approved for reimbursement this past year. As more clinicians use these new tools with coronary CT and gather data on its effectiveness, they’ll build a better argument for coverage.
“We will be able to diagnose and treat coronary disease well before symptoms occur and finally reduce heart disease as the number one cause of death today ”.
MedStar Health SVP and Chief Innovation Officer Bill Sheahan says AI will meet its potential to transform healthcare when it improves clinical outcomes. And that will take some time.
As AI programs reach maturity, so, too, will their value. Early-stage tools that are under the spotlight now for cost will succeed in the long run if they also improve clinical outcomes.
That, says Bill Sheahan, senior vice president and chief innovation officer at MedStar Health and executive director of the MedStar Institute for Innovation, is where AI will be truly transformative. And that's how healthcare executives have to think about the future.
"We believe that the real transformative potential of AI will come from integrated, systemwide adoption," Sheahan, a participant in the HealthLeaders Mastermind program for AI in clinical care, said in a recent e-mail Q&A. "Much like the building of a new hospital within a health system, the long-term impact of AI across our health system will be measured in patient outcomes and margins, not millions."
In a HealthLeaders story last December, Sheahan described how the Maryland-based health system was taking a slow and steady approach to AI, with a particular focus on change management. That process has continued with governance.
"Over the past year, MedStar Health's AI governance has matured from a more exploratory, ad-hoc process into a structured and proactive system," he said. "We launched an AI review process involving experts across the enterprise in innovation, legal, compliance, equity, quality and safety, information security, operations, and beyond. Leaders at MedStar Health are empowered to explore and propose AI tools to address their needs and bring them forward for evaluation."
"The overall volume of new AI products and features being added across all areas of the organization, along with a better understanding of the complexity of integrating AI into clinical care, necessitated different approaches to governance and strategy," he added. "AI that is impacting clinical decision-making or that is patient-facing is typically higher-risk and more complex, requiring more internal expertise from our AI COE (Center of Excellence) than what are typically lower-risk clinical administrative or broader business applications (e.g., coding and billing)."
With that process in place, Sheahan says they're now looking ahead.
Bill Sheahan, senior vice president and chief innovation officer at MedStar Health. Photo courtesy MedStar Health.
"As we further establish our governance processes and opportunities, we increase our focus on strategic imperatives in areas with significant transformational potential that are not yet fully addressed within our current vendor ecosystem, either due to product fit or pricing constraints," he says. "Within these areas, we often buy a solution if offerings in the market are more robust and well-defined, while prioritizing an internal build/partnership model in more nascent areas."
Sheahan and others in the Mastermind program have said it's important to point out that AI isn't exactly new. Traditional machine-learning and predictive modeling have been around for quite some time. The addition of large language models, however, has given a boost to generative AI capabilities.
"In the generative AI space, we are integrating various tools throughout our software stack to support a wide range of application areas, ranging from our safety event tracking system to human resources and informatics," Sheahan says. "Exploration of EHR data is under way, utilizing internal tools to extract and code notes and radiology reports to drive workflows for incidental findings and quality."
"We will also soon roll out an internally-built ‘chat' program in phases across our system," Sheahan adds. "This internal alternative to widely-available tools aims to protect data, improve understanding of usage patterns, and support administrative and clinical staff in searching for system-specific information (e.g., human resources policies). More complex future iterations are expected to integrate patient-level clinical information to allow reasoning over both internal and national clinical guidelines."
Sheahan says the large-scale data warehouses that power large language models are also enhancing the value of traditional predictive modeling.
"Currently, we are implementing a next-generation sepsis algorithm and workflow, with plans to expand to pressure ulcers, fall prediction, and other critical events," he says. "We anticipate that older clinical ‘scores,' such as risk prediction calculators involving only a few simplified variables (e.g., falls, readmission, sepsis, etc.) to inform diagnoses and decision-making, will gradually be replaced with more accurate and fully-automated algorithms. We are also expanding our radiology portfolio to increase the number of findings that tools can detect and use for triaging radiologist review."
At this point in the AI curve, however, ROI is still elusive. There have been some great stories about AI tools that have reduced administrative burdens and workflows and helped both doctors and nurses spend less time on the computer and more time in front of their patients. Sheahan says it will take time for the long-term benefits to show.
"Many of these applications still have limited validation, whether for clinical outcomes or ROI," he says. "As an example, ambient dictation offers the advantage of personal scribes at a fraction of the cost, and providers and patients find it improves the quality of their interactions; however, many health systems are still working to fully quantify and capture the impact needed to secure long-term investment in these products."
"Many of the most promising products are enormously challenging to validate for clinical accuracy or safety as well given current tools, such as large language model products that summarize charts or aid clinicians in reaching diagnoses," Sheahan concludes. "These products otherwise have substantial potential to transform clinical care. Improved frameworks and accepted validation models will be necessary to address safety and outcome questions, leading to greater refinement and broader deployment."
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Nursing executives at the nation’s largest rural health system, participating in the HealthLeaders Virtual Nursing Mastermind program, say that ‘extra set of eyes’ is a crucial component to inpatient virtual care.
Virtual nursing programs have seen early success in helping floor nurses reduce time spent in the EHR and doing other administrative tasks. But at Sanford Health, nursing leadership wanted a more interactive platform.
Erica DeBoer, SVP, CNO for the health system that spans 56 hospitals and seven states across the upper rural Midwest, says leadership was intent on using an audio-visual platform from the start, and using the virtual nurse to “be another set of eyes and ears”that nurses in the patient’s room might not notice.
That might include vital signs or pain reassessment that need to be checked haven’t been collected, or a medication that needs to be taken. It also might be a patient showing subtle signs of mental distress, or someone at risk of falling, or a tense situation between a patient and a nurse that needs backup.
“Can we prevent some escalation of patient behaviors,” DeBoer says, “[and] get additional help to the patient room to support our team on the floor?”
That’s not a concern unique to Sanford Health, but it does underscore the value of a virtual nursing platform in providing support to floor nurses. Since the COVID-19 pandemic, health systems and hospitals have been dealing with high rates of nurse stress and burnout and a declining workforce, and they’ve been putting a premium of technologies and processes that improve the nurse’s workload and attract new nurses.
“It’s a recruitment and retention tool, knowing that our workforce is looking for forward-looking organizations that leverage technology to support care and safety,” DeBoer notes.
For the nation’s largest rural health system, keeping and attracting nurses is critical. And that begins with supporting them at the bedside.
DeBoer says the program, which is expanding to 40 more beds and integrating technology through the in-room television, is staffed from within. Nurses can be scheduled for two shifts on the floor and one shift as the virtual nurse, so that both patients and floor nurses know who’s at the other end of the audio-video feed.
As a result, those virtual nurses are also well-attuned to the tasks of the floor nurse, and they’re more apt to spot something that needs to be done. Instead of waiting for the floor nurse to ask for help, they can offer help when they see that need. This shifts the focus of the virtual nurse from a task-oriented workflow to one of observation and support.
It also reduces the friction between floor and virtual nurse, DeBoer says, and facilitates a team-based approach to care.
Advocates say virtual nursing can help providers address another trend: Hospital patients are becoming sicker, and their hospital stays are becoming more complex. That’s putting even more pressure on nurses.
“It’s not uncommon for our patients to travel anywhere from 30 minutes to four hours to receive care in an inpatient setting.” DeBoer says. “By the time they need hospital care, they’re there for a reason. They’re acutely ill in many cases and need to be admitted and require care.”
And while virtual nursing will improve the inpatient experience, DeBoer sees a future outside the hospital as well. Rural health systems like Sanford rely on a network of sites and providers to span long distances and keep remote residents is small communities connected to care. With resources at a premium, that might mean using virtual nurses in skilled nursing and rehab facilities, maybe even the home.
“Our philosophy is that we have the technology, we have the platform, now how can we scale it?” DeBoer says. “Let’s try to see what’s going to work, knowing that a mile saved from being on the road means reduced time away from work, school and the comfort of their own homes.”
In rural communities, that also means expanding the platform to include more care providers, from doctors and specialists to social workers.
“We are focusing on nursing, but the technology doesn’t prevent us from having multiple individuals leverage it to help care for patients in new ways,” she adds.
DeBoer says there’s plenty of agreement among nurses and administration that virtual nursing will stay.
“Our teams are trusting us that this is what the future holds,” she says.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights into excelling your virtual nursing program. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Atrium Health’s Levine Children's Hospital has launched the first Hospital at Home program in the country that focuses on children and their families.
Few would argue that the hospital is no place for a child. But can the Hospital at Home strategy work for children who would otherwise be stuck in a hospital bed?
Levine Children’s Hospital, part of the Atrium Health network, is putting that theory to the test. The 247-bed hospital in Charlotte, North Carolina, launched the nation’s first program to deliver acute-care services to children at home earlier this year.
Stefanie Reed, medical director of the Pediatric Hospital at Home Program, says the program is modeled after Atrium’s Health’s Hospital at Home program, one of hundreds across the country following the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home (AHCAH) model. That model establishes protocols for home treatment of patients who would otherwise be admitted to a hospital, with a mixture of daily in-person and telehealth visits and remote patient monitoring.
But where those programs focus on adult patients, Levine is targeting a very different population.
“We do things a little bit differently,” Reed says, pointing out that whereas adult-level care focuses on the patient, pediatric care often envelops the whole family. The program aims to bring “wrap-around care” to the patient and family, bringing in a much larger mix of care providers, including pediatric hospitalists, certified nurses and pharmacists as well as specially trained paramedics, child life case management and discharge managers and other specialists.
That’s a different dynamic, she says, focusing on team-based care rather than individual visits or services.
Stephanie Reed, medical director of the Pediatric Hospital at Home Program at Atrium's Health's Levine's Children's Hospital. Photo courtesy Levine Children's Hospital.
“It’s important for us to make sure that we really support families and team members throughout the hospitalization by being really, really available to them in ways that probably you don't need to be on the adult side,” Reed says.
A unique program with unique protocols
In many ways, providing home-based care for pediatric patients is more complex. Aside from the use of specialists, Reed says they’re tracking more metrics. Alongside the basic data on care quality, readmission rates, hospital flow and patient safety, they’re taking a closer look at patient experience with care teams and technology. Among the questions being asked: Is this an easier and better way of doing things than in the hospital?
They’ve also built in some “extra checks and balances,” Reed says. Clinicians are asked to visit more than once a day with families. And a clinician--doctor, nurse or paramedic--is online or at the home every time a medication is administered or the child is interacting with technology.
“Even in these early days there are some really positive things,” she says. “We are definitely seeing a lower readmission rate and revisit to the ED rate. We are certainly seeing our patient satisfaction rates off the charts. I've yet to have a family that that said, ‘You know this was no fun.’ Every single family has said, ‘Thank goodness we could do this.’”
Since the program was launched in February, Reed says 40-50 kids have received care at home, and those numbers are growing.
An effective Hospital at Home program, of course, begins in the hospital. Pediatric patients and their network of caregivers need to be screened well in advance of moving care into the home. Reed says the program runs on an “inclusion/exclusion basis,” meaning anyone from infancy up to age 17 can be eligible. That said, the range is currently limited to the Charlotte area, and children in intensive care or with complex care needs aren’t eligible at this point in time.
Reed says they’ve treated everyone from newborns with jaundice to teens dealing with flu or dehydration—and, most importantly, their families.
“We always start with family-centered care,” she points out. “Families should feel engaged and [be able to] participate in the care of the child from the moment that they come into our care.”
“I joke all the time,” she adds. “I've met more aunties and grandmas and pets because I'm in the house and I can really talk to them about the support that this mom needs.”
Assessing the home environment
They also take a close look at the home, assessing social determinants of health (SDOH) like food, transportation and family dynamics. Social workers and case managers play a role in this evaluation.
“We really want to elevate that environment,” she adds. “We know if we can do a good job, whether they're with us in a brick and mortar [setting] or they're discharging from hospital at home, if we've set that groundwork, then you have a healthier child and the likelihood of them needing to come back to an emergency room drops dramatically.”
Even then, when all the boxes are checked, things crop up, and the care team sometimes has to react on the fly. Reed says one family assured them that they had transportation, but when a paramedic visited the home he found that the car battery was dead. So he stayed around to recharge the battery and make sure the care was working.
The program is entirely voluntary, Reed says. And there are times when the hospital is a better place for care than the home.
“If a family is not ready, if the home environment is not ready, if they need our support in a different way, that's OK,” she says. “We will be there and we can reapproach it [later if necessary].”
Reed says the program can be an important bridge from the hospital to the home for both children and their families.
“It’s hard to leave the hospital and go home, even when you’re ready to go home,” she says. “Having someone there, holding your hand, so to speak, making sure you really, truly have what you need, someone that you can call anytime of the day or night is a value in a support system in itself.”
A new project in Illinois aims to connect at risk mothers-to-be with a remote patient monitoring platform that includes a Fitbit, a phone, and an AI assistant named Nurse Avery.
Google and digital health company Drive Health are launching a remote patient monitoring project in rural Illinois to connect expectant mothers with an AI bot to guide them through their pregnancy.
In a partnership with state officials, selected women in Cook County will receive Google Pixel phones, Fitbit devices and access to the Google Cloud to connect with Nurse Avery, an agentic AI health assistant developed by Drive Health. The Healthy Baby program is expected to engage more than 56,000 women over the next few years.
"The Healthy Baby pilot represents a critical step in maternal healthcare, showing how AI can help deliver personalized, proactive health support directly to underserved mothers," Chris Hein, field chief technology officer for Google's Public Sector division, said in a press release. "Using the AI agent, Nurse Avery, and delivering it through Google Pixel phones and Fitbit devices, the program provides real-time support – managing appointments, monitoring vitals, and offering health guidance directly, aiming to make essential resources more readily available."
The program isn't entirely unique. Health systems and state health departments have been trying to use telehealth and digital health for years to connect with at-risk mothers-to-be and monitor them up to and through childbirth. They're driven by maternal mortality rates that place the U.S. well down the list, among developing nations.
In Illinois, that problem is acute. Roughly one-third of all counties in the state struggle with access to maternal care providers, and more than 90% of hospitals lack adequate mental health resources. Among Medicaid populations nationally, 40% of pregnant women have an undiagnosed or untreated mental health concern.
The Health Baby project takes a multi-pronged approach to connecting with at-risk women. The Fitbit device will be used to track participants' activity as well as monitoring heart and sleep data. That information will be collected on Drive Health's platform on participants' Google Pixel phone, from which they can access personalized health recommendations – and Nurse Avery.
This is where digital health outreach meets AI, offering participants are more personal, interactive platform. According to Drive Health executives, Nurse Avery bridges "the gap between providers and patients," answering questions, prompting care plan adherence and providing information on a variety of health concerns, including nutritional support and folic acid intake coordination, vaccination updates, genetic risk assessment, mental health and stress management, and chronic disease management.
As with any RPM program, the key to success will lie in patient engagement. Will expectant mothers be comfortable with using the devices and interacting with an AI assistant? And will the state see improvements in maternal health outcomes as a result? According to officials, they'll be looking for reduced mortality rates, improved birth weight and more full-term pregnancies, as well as reduced costs tied to better access to timely care.
Houston Methodist is now using virtual nursing across eight acute care campuses, and handling some 500 admits and discharges per day. Many of those nurses are even working from home.
While virtual nursing programs typically begin with one or a few specific functions and outcomes, scaling those programs means creating a comprehensive platform that can handle many services.
Houston Methodist, which launched its virtual nursing program in 2022, is now using the platform to facilitate more than 500 admits and discharges a day across eight acute care campuses, says Steve Klahn, the health system's clinical director for virtual medicine. And at its newest location, Houston Methodist Cypress, that experience is much more immersive.
"The team is piloting care delivery in a more comprehensive fashion with remote virtual nurses," Klahn, a participant in the HealthLeaders Virtual Nursing Mastermind program for the second year, said in a recent e-mail exchange. "This pilot includes rotating bedside nurses through a local virtual operations center and supporting bedside nurses' care for their patients by increased remote documentation assistance, multi-disciplinary rounds participation and virtual consenting."
Steve Klahn, clinical director for virtual medicine at Houston Methodist. Photo courtesy Houston Methodist.
As noted in a 2024 story on the program, Houston Methodist is in it for the long run. That means understanding where the platform can evolve and where executives need to take a step back and evaluate their priorities.
"Maintaining flexibility to all the great ideas [that] come in, while being able to remain standardized in the approach so as to not have to re-educate and change workflows too frequently," is crucial to the program's growth, Klahn says. "We also aim to ensure programmatic efficiency with minimization of wait times, while maintaining 24x7 services with safe and fiscally responsible staffing solutions."
One glimpse of the future might be seen in their staffing strategy. Several participants in the Mastermind program have indicated they're looking at enabling nurses to work from home—a key incentive to retaining current nurses and attracting new ones. At Houston Methodist, which now has 50 RN FTEs dedicated to the program, Klahn says the idea is being pushed along out of necessity. Some 70% of the health system's virtual nurses now work from home, and the gaol is to get that number up to 90%.
"We are currently shifting more of our teams to remote work, as space in our virtual operations center is at a premium," he says. "Our strategy remains for direct hire exceptional staff nurses (no-outsourcing to contracted teams), as well as supporting nurses in times of short-term light-duty assignments."
Klahn says the program is gradually integrating new services as well, including dual medication signoffs, remote witnessing of controlled substance wasting, and VTE prevention rounding.
He says the program's success is due to how well it has been received by both patients and nurses.
"We continue to appreciate high levels of satisfaction with patients, bedside nursing teams, physicians/providers and hospital administrators," he says. "The team does an amazing job of ensuring focused high-quality completion of the clinical support they do on a daily basis."
"The biggest surprise to me is how fast the program grew with the strategy our organization acted upon," Klahn adds. "It was amazing to see how quickly the bedside teams embraced this new approach to patient care, and we were able to quickly deliver on the requests for services to each of our hospitals. The future is very bright for VN programs and we look forward to much more growth in the space."
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on excelling your virtual nursing program. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
The Cleveland Clinic is the latest to partner with a developer of ambulatory surgery centers to take minimally invasive procedures out of the hospital.
Health systems are taking a step toward the hospital of the future by outsourcing minor surgeries.
The latest to do so is the Cleveland Clinic, which announced a partnership this week with Tennessee-based Regent Surgical to build a number of ambulatory surgery centers across the country. These centers are designed to handle minimally invasive procedures, which require little to no hospital stays and shorter recovery times, much of which can be handled at home or in clinics.
As hospitals struggle with workforce shortages and look to reduce costs and their patient census, leadership is looking for alternatives to expensive and resource-intense hospital care, with the idea of saving the hospital for those who need acute care services and will spend several days there.
As a result, the ambulatory surgery market is growing. Fortune Business Insights reports the market size was valued at almost $44 billion in 2022 and projected to grow to more than $75 billion by 2030. There are currently more than 6,000 such centers in the U.S.
Arizona-based Banner Health joined forces with Select Medical in 2018, and now has a network of four private rehabilitation hospitals and outpatient physical therapy programs and services at dozens of Banner Physical Therapy Centers. Mark Garvin, the health system’s SVP of Partnership & Venture Development, says the partnership is part of Banner’s strategy to grow beyond its extensive hospital footprint and provide value-based care where it’s most convenient.
“These are people that wake up every single day and this is what they worry about,” he said in a recent HealthLeaders interview. “They’re experts. They know how to operate. They know how to develop. They know how to grow. It is their wheelhouse.”
Garvin says health systems and hospitals have the advantage over disruptors because of the name brand and the expertise in providing healthcare services.
“We can play in this space differently than the Amazons, differently than other retail organizations, simply because we’ve created these clinically integrated networks,” he says.
Cleveland Clinic, which is internationally known for outsourcing second opinions through The Clinic by Cleveland Clinic, a partnership with telehealth provider Amwell, is banking on new efficiencies with the Regent Medical deal.
“Ambulatory surgery centers provide an important setting for health systems to expand access to surgeries, and to be more efficient in the delivery of services,” Cleveland Clinic CEO and President Tom Mihaljevic, MD, said in a press release. “Regent's capabilities in managing and operating ambulatory surgery centers will enable us to focus on continuing to provide the highest quality care for our patients and will enhance our ability to grow and offer that care to more patients.”
AI can help clinicians manage complex conditions and relationships, says the CMIO of Stanford Medicine Children's Health
Pediatric healthcare is a complex undertaking. The doctor-patient experience is far more complicated, involving not just patients of various ages but parents, grandparents, siblings, other caregivers, maybe even a pet or two, real or imaginary. The old standard ‘How are you doing today?’ usually doesn’t do the job in this environment.
“So much of pediatric care is about connection, and about preventative medicine, and about ensuring that you understand the complex interactions between the child, the parent and the provider, and so, so much of that kind of subtle nuance about what is the child doing during the evaluation,” she says. “So much of what we’re assessing is the child’s behaviors [and] the child’s interaction with other people in the room, the child’s body motions. And if you're sitting at a computer and typing the whole time, you're missing all of that very rich data.”
Children’s hospitals have a rich history of embracing innovation, often because the tried-and-true ways of care management for adults don’t necessarily work for kids. Clinicians often have to take new ideas and technology designed for adults and modify them for their own patients.
That’s also true of AI, which, Pageler says, needs to evaluated differently.
Natalie Pageler, MD, CMIO of Stanford Medicine Children's Health. Photo courtesy Stanford Medicine Children's Health.
Take ambient scribes, which are designed to capture the doctor-patient encounter for the medical record.
“We did a rigorous evaluation of how that affected the interaction for children and families, because most of it was developed in the context of a single provider and a single patient,” Pageler says. “Of course, in pediatrics, it's often the patient, a couple parents, a couple kids running around the room screaming. We really wanted to do that evaluation to understand [whether] it could have the same impact for children and families.”
The potential value of these tools for pediatric clinicians is clear. In that busy exam room, a doctor or nurse needs to be attentive to the children as well as the parents, picking up on subtle clues and interactions that could play an important role in diagnosing and treating underlying health concerns.
“We need to make sure they are addressing the true needs of the patient and the family,” Pageler notes.
Just as important, she says, is the connection between the clinician, the patient and the patient’s family, a key dynamic in any healthcare experience but critical to those working with children. Pageler says AI is helping to take the technological barriers out of the exam room and making children and their parents feel more comfortable.
“We’ve had several patients walk out of the room and say, ‘Wow, my provider looked at me the whole time and we got to really talk about this complex challenge I'm having with my child's behavioral issue,’” she says.
Pageler says some doctors have even decided to use AI instead of having a scribe in the room or listening to the conversation from another location. In some cases, she says, Ai is less intrusive to parents and children who want to talk about personal issues and don’t want another person listening to that conversation.
Aside from ambient listening opportunities, Pageler says AI can be a valuable support tool for doctors who are treating patients as young as infants and as old as teens. Different ages often call for different treatments, and the technology can help clinicians gather the information they need to guide their conversations with children, adolescents, parents and other caregivers.
“The relationships are so complex,” she notes. Clinicians have to be “extremely thoughtful” in how they share information with different patients and family members.
Pageler expects clinician decision support to be the next wave of AI innovation, helping clinicians find and use the right data to improve care management and coordination. That’s especially true as healthcare organizations set their sights on health and wellness and prevention opportunities.
As she sums up the value of AI in the pediatric care space, Pageler says the technology enables doctors and nurses to interact with patients, their families and others without the intrusive presence of computers and scribes.
“AI should make care more human, not less,” she says. It will “allow for more humanity” in care management.
A bill introduced in both the Senate and House would Improve Medicare reimbursement for rural providers using RPM technology.
While adoption rates are growing for remote patient monitoring (RPM), rural and remote providers are holding back, due in large part to low Medicare reimbursement. A new bill before Congress aims to change that.
The Rural Patient Monitoring Access Act, introduced this week by U.S. Senators Marsha Blackburn (R-Tennessee) and Mark Warner (D-Virginia) in the Senate and by U.S. Reps. David Kustoff (R-Tennessee), Mark Pocan (D-Wisconsin), Troy Balderson (R-Ohio) and Don Davis (D-North Carolina) in the House, would set a geographic payment floor for RPM reimbursement, enabling rural providers to recoup expenses from Medicare at the same rate as their urban and suburban counterparts.
Supporters say the bill would also ensure that providers are capable of responding to health concerns detected by RPM and that the RPM technology can promptly transmit biometric data at the EHR. It would also give the Centers for Medical & Medicaid Services (CMS) a pathway for reporting data to the Health and Human Services Department (HHS) to evaluate costs savings generated by RPM.
The proposed legislation has a number of supporters, including Marshfield Clinic, Lifepoint Health, SSM Health, Ascension, the University of Virginia Center for Telehealth, the American Telemedicine Association (ATA), the National Rusal Health Association, HIMSS, and the Alliance for Connected Care.
According to a summary of the bill, RPM reimbursement via Medicare is lowest in areas where the prevalence of heart disease, hypertension and diabetes are above average and where access to care providers is problematic.
“Patients in rural and underserved communities deserve the same opportunity to manage their health as those in more resourced areas,” Christ Frost, Lifepoint Health’s CMO and Chief Quality Officer, said in a press release. At Lifepoint, we’ve seen firsthand how high-quality remote patient monitoring can help bridge long-standing access gaps and drive meaningful clinical improvement, especially for chronic conditions like hypertension and diabetes.
The bill comes just two weeks after the Peterson Center on Healthcare released a study that called for improvements to RPM reimbursement, including coverage that aligns with specific services that have shown the most value, improved access to high-impact RPM services and improved data collection from RPM devices.
The study also found that hypertension, diabetes and heart failure are the most common conditions being monitored through RPM.
“As we adopt exciting, new technologies that extend care beyond the walls of the doctor’s office, we need to design payment models that align with clinical benefits for patients,” Caroline Pearson, executive director of the Peterson Center on Healthcare, said in a press release. “That means ending ‘forever codes’ that incentivize long-term billing of ineffective care and instead designing payments that reimburse providers for the periods of time they should be actively monitoring and managing their patients’ diseases.”
Jefferson Health, a participant in the HealthLeaders Virtual Nursing Mastermind program, is strategically expanding its program as it looks for sustainability
Jefferson Health launched its virtual nursing program in 2023, and is expanding its strategy to broaden the virtual observation footprint and include inpatient provider consults. They’re also exploring opportunities to integrate other care team connections, such as diabetes educators.
“For nursing specifically, we completed a second pilot, applied key learnings, and officially launched a formal program with a dedicated, permanent team,” Laura Gartner, DNP, MS, RN, RN-BC, NEA-BC, the health system’s Nursing Informatics Officer and a second-year participant in the HealthLeaders Virtual Nursing Mastermind program, said in an e-mail Q&A. “We have refined the virtual nurse’s core tasks and workflows to enhance support for bedside teams and have collaborated closely with our vendor to optimize the technology. In addition, we have identified other areas across our system where virtual care can further improve patient support and clinical workflows. As we continue to expand, our goal is to integrate virtual care more seamlessly into inpatient operations to enhance efficiency and patient outcomes.”
This includes using the virtual platform for more care team functions. Beyond the first use cases for provider consults, Gartner says they want to expand inpatient consults to help hospitals access specialists in other locations and reduce the need for transfers, which can be stressful and time-consuming. They’re also working to integrate this and other virtual functions into their EHR platform, so that virtual nursing isn’t an added function that complicates nursing workflows.
These additional services cost time and money, though, which is a tough sell in this economy.
Laura Gartner, AVP and Nursing Informatics Officer at Jefferson Health. Photo courtesy Jefferson Health.
“One of the biggest challenges we’ve faced with the virtual nursing program is securing sustainable funding,” says Gartner. “There is strong interest in implementing virtual nursing across various units, as the benefits—such as improved workflow efficiency and enhanced patient support—are widely recognized. However, integrating a virtual nurse into staffing models requires a financial investment, and identifying consistent funding sources has been a barrier. Aligning financial priorities with program expansion remains a key focus.”
To prove that ROI, Gartner says they’re tracking process metrics such as average number of virtual nursing sessions per shift, overall number of sessions, time per session and overall, and the reason for accessing a virtual nurse. They’re also tracking outcomes, including the 30-day readmission rate, falls, falls with injury, HCAHPS scores, voluntary nurse turnover, discharge times, LOS, and incidental overtime, among others. To date, she says, they’ve seen improved HCAHPS scores, shorter LOS times, a decrease in incidental overtime and reduced discharge times.
They’re also on track, she says, to double the use of their meds to beds program, which aims to improve patient education and medication management.
The program also has value that can’t be measured in a metric. Gartner says virtual nursing has had a positive effect on the nurse-patient relationship.
“One of the best parts [of the program] has been hearing the virtual nurses connect with patients,” she says. “These are truly incredible nurses, and through this program, they’re able to spend more focused time with patients than they often could at the bedside. It’s been rewarding for both the nurses and the patients, and a great reminder of the value of meaningful interactions in care.”
Gartner says she was surprised by how nurses were initially apprehensive about the program.
“Even though virtual nursing has a benefit of reducing bedside staff workload, it’s still a big change from how things have traditionally been done,” she says. “Some nurses were worried that we were taking a nurse away from the unit, rather than adding support.”
In fact, the health system has changed its staffing strategy as the program evolves. Where Jefferson Health first used two enterprise resource nurses on temporary assignment, Gartner says, they’ve now switched to two permanent staff members and have plans to add more.
“I’ve found that building trust and understanding takes time, and that’s been a valuable reminder of the importance of clear communication, collaboration, and involving frontline nurses early and often,” she added. “What’s been most encouraging is that, as nurses see the impact firsthand and hear positive feedback from peers, acceptance and enthusiasm grow organically. It’s a journey, but one that’s already showing great promise.”
