Duke Health CHIO Eric Poon says healthcare leaders can move quickly and fail fast, but they had better learn from those mistakes and adjust accordingly
The Duke University Health System is investing in roughly 80 AI products. And they're fine with the fact that not all of these tools are going to work.
"We know that not everything that we put our hands on or that comes our way is going to pan out," says Eric Poon, MD, MPH, FACMI, the health system's Chief Health Information Officer. "We don't ask for a mountain of evidence up front. Our governance philosophy is that we need to fail often and fail fast, so we provide just-in-time advice."
Welcome to what some have called the Wild, Wild West of AI in healthcare. It's a heady time to be an innovation executive these days, working with a technology that has strong potential to transform a troubled industry. But Poon, like so many of his colleagues in health systems and hospitals across the country, knows the path forward has to be managed just right. Mistakes are OK, but they had better be learning lessons.
"We openly tell our clinicians that AI is not perfect and AI is capable of making mistakes, so we as clinicians need to be responsible for everything that we take advantage of out of these products," he says. "In this case anything that we put in the chart, we need to take direct responsibility for, which means that we need to take very good care in reviewing the notes."
One example is ambient AI, in which Duke Health has partnered with Abridge to deploy a tool for physicians to capture the doctor-patient encounter. More than 1,200 clinicians in the health system are now using the tool.
Poon says clinicians have been using voice-to-text technology for some time, so the idea of capturing the doctor-patient conversation isn't entirely new. But with AI layered onto the process, the notes have more context and are more easily integrated into the medical record, potentially reducing the time spent by the doctor translating notes while enhancing opportunities to identify care pathways and coding.
Clinicians were given some training on how to use the technology, Poon says, but they were also given some freedom to integrate the tool into their own workflows.
As they become comfortable with the technology, Duke Health will look at how it can be integrated into other clinical pathways. Poon says this will include "workflows upstream and downstream from the generation of the note."
Therein lies the true benefit of working with AI. Accessing and analyzing more data gives clinicians the opportunity to better manage the patient's care journey—before, during and after the patient-doctor encounter. And while this data can unlock those opportunities to improve clinical care, clinicians have to be careful that the data being used is accurate and reliable.
The key to keeping track of the successes—and failures—is governance. Poon says AI governance was launched initially as a separate entity to technology governance, then quickly integrated when it became clear both were looking for the same things.
"We've figured out that you cannot have one single group squirreled away trying to perfect data," he says. "It needs to be a team sport, so we have a distributed data governance process and I think we in some ways take a risk-based approach."
Duke Health's approach isn't unique. While some healthcare organizations separate their AI governance, more health systems and hospitals are working those responsibilities into existing committees and workflows. Some simply don't have the time or resources to create more layers of governance, while others are recognizing that AI technology is fast becoming a part of many workflows.
Poon says healthcare executives need to understand that AI is advancing faster than many other technologies in healthcare, in part because the technology is easy to use and is being embraced just as quickly by consumers. The temptation for healthcare leaders is to move that quickly as well, which is why governance is so important.
"We've put a lot of time and effort" into responsible AI development, he says.
A new report says healthcare organizations are finding value in using ambient AI to reduce burnout and stress, but financial value is harder to assess
Ambient AI scribes may be all the rage in healthcare these days, with more than 60 different products on the market. But are they showing ROI?
A new report from the Peterson Health Technology Institute (PHTI) says AI scribes “are poised to become one of the fastest technology adoptions in healthcare history.” But as a task force convened by PHTI learned, healthcare executives may be rushing to implement these tools before determining their value.
The challenge, as always, comes in the definition of value. Many healthcare leaders who are using AI scribes report success in reducing physician stress and burnout, a key metric in today’s healthcare environment. Yet with health systems and hospitals struggling to contain costs, there’s a financial aspect to technology implementations that has yet to be realized with scribes.
According to the PHTI report, the task force launched with a question: Can a new generation of AI solutions that target administrative tasks and day-to-day workflow improvements address the previously intractable tension between increasing productivity and reducing provider burnout?
The answer is, well, complicated.
“Ambient scribes appear to reduce burnout and cognitive load and improve the patient experience,” the report stated. “The current evidence for ambient scribe improving productivity directly by reducing documentation time is mixed, though as the technology and implementation processes improve, time savings may become more apparent. Given the costs and limited evidence to date on ROI, however, there is a real risk that as ambient scribe adoption continues apace, health systems will implement solutions in ways that add to overall costs of care.”
The task force noted that healthcare technology market has often evolved faster than the effort to produce meaningful results, and this is certainly true in AI. Healthcare providers are jumping on the bandwagon and piloting new tools and services well before they have a good idea about ROI—or, in many cases, governance.
This experience is also causing healthcare leaders to step back and assess what value means to them. Faced with a declining workforce and pressures to reduce workflows to keep the people they have, some executives are pointing out that a tool that can improve a clinician’s work-life balance and reduce stress does produce positive ROI, and financial savings will show up in reduced turnover and hiring and training costs, not to mention morale. And that, in turn, will positively affect clinical outcomes.
But that will take time. And that seems to be the one factor that many overlook.
“There are many other areas of health system administration ripe for transformation with AI-enabled technologies,” the task force concluded. “AI in RCM is likely to be the next significant area of at-scale solution deployment, and task force members anticipate significant progress in AI for call centers, quality and regulatory reporting, inbox management, and CDS in the coming years. “
“The promise of AI in each of these areas is compelling but the ability to deliver on that promise will take time, enhanced technological sophistication, and organizational maturation,” the report said. “The experiences of early adopters can inform the broader industry on whether the investment in these technologies is warranted, how to measure impact and track progress, and which technologies are delivering outsized returns.”
In small towns where the doctor is a neighbor and the hospital is the biggest employer, new ideas like AI and telehealth face a much tougher path to adoption.
Rural critical-access hospitals are struggling, and they're looking at innovative ideas like telehealth and AI to keep the doors open. But what works in the big city won't necessarily work in a small community.
And that's what makes innovation such a hard sell in rural America.
"We're very cautious when the word 'partnership' comes into the conversation," says Susan Gutjahr, HIT Director at Sparta Community Hospital, a 25-bed hospital in Sparta, Illinois, a city of roughly 4,000 residents in the southern part of the state. "We don't want to lose our local connection. That's who we are."
For small hospitals like Sparta, new technology offers the promise of improving care, but it can also rob the organization of its identity—a valuable commodity in rural communities where the hospital is often the biggest employer and the doctor is a neighbor. Hospital leaders looking to keep their hospital afloat have to understand that the promise of innovation doesn't apply equally to every organization.
"What can new technology really bring to us?" asked Gutjahr, who attended the HIMSS 25 conference and exhibition earlier this month in Las Vegas "to physically see everything that I get e-mails about." For hospitals that are often the lifeblood of a rural community, the idea of buying things just to keep up with the big guys isn't always best.
Different Communities, Different Priorities
During a panel on rural healthcare challenges at the ViVE 25 conference this past month in Nashville, Rachelle Schultz, President and CEO of Winona Health, an independent community health system based in southeast Minnesota, said she has to balance new ideas with specific workforce demands.
"Our challenge is to really rethink the work," she said. "It's a very different landscape today. … Our really experienced people have retired, and the incoming people have different expectations," she said.
Schultz said her hospital had to invest in a simulation lab because some of their new hires are ill-prepared for the hospital. Some nursing and allied health programs are cutting out clinical rotations in order to get more students out the door and into health systems, resulting in a new wave of hires that need more training on basic patient care.
"In a lot of cases they've never laid hands on a patient," she said. "This puts a burden on our supervisors and our managers [to use the lab} to reinforce the education and the training."
As a result, she said, there's less money to spend on other technology.
"We need new technology probably more than most folks do," added Ryan Thousand, Fractional Chief Information Officer at Dahl Memorial Healthcare, a critical-access hospital in Ekalaka, Montana that's more than two hours away from the next healthcare facility. "It's something that we really have to be on the innovative edge of, but unfortunately we don't have anyone to feed and water that after we put it in."
Thousand said he has to focus on using whatever he has and "creating that vanilla base layer that allows us to innovate." That means avoiding a new EHR or virtual care platform and focusing on base-line technology just to be connected.
"My IT team could fit in the trunk of a Prius," he said. "And I can't go out and buy that shiny new car. I would love to have Epic Connect. I have Dwight, but he's 65 years old and he drives a tractor every day to my office" just to see a doctor.
Telehealth Is a Bad Thing?
Scott McEachern, CHCIO, Chief Information Officer at Southern Coos Hospital & Health Center in Bandon, Oregon, said they invested heavily in the Epic Community Connect EHR to tackle interoperability challenges. He said it was crucial that his small health system create a platform to try and hold onto patients who, through telehealth, have more options for care.
That struck a chord with Mountain.
"People talk about telehealth like it's the best thing that ever happened; it's the worst thing that ever happened," he said. "They can now get their care from their house [instead of coming] into my facility."
Telehealth may allow small hospitals to connect patients with specialists and services that aren't available in a rural facility, Mountain noted. But it also gives patients an opportunity to see what they can access elsewhere—to the detriment of a small, local hospital that needs those patients to survive.
"Now you're sending them off for that additional care and you're just praying that they come back," he said.
Schultz, whose health system has used a Cerner/Oracle EHR since 1989, said she's encouraged by the integration of AI into the EHR, which would improve what she called "the bane of our existence as providers."
"There is no Amazon-like experience with our current EMR systems," she said. Adding AI, however, "is what I would consider breakthrough technology."
Mountain was less optimistic.
"AI is not going to work for me right now," he said. "I've got gravel roads. At the end of the day if you bring a blade in that's made for asphalt, it's not going to work. And that's where I'm at. The emerging technologies for us are still the shiny objects that are out there, and we're just trying to get to those less-emerging [technologies]."
Community Comes First
The challenge with bringing in new technology, the panelists said, is that it affects not only the hospital, but the entire community.
"Most of us are the largest employers in our community, so we're critical not only for healthcare but … for the economy of the cities that we're in as well," said Linda Stevenson, Chief Information Officer at Fisher-Titus Medical Center in Norwalk, Ohio.
"In rural areas technology is a force-multiplier when it comes to your economy," Mountain said. "I'm the largest employer in town, and that's not a good thing. For the hospital to be the largest employer in town is kind of scary. So at the end of the day, If I take a job away from somebody and I start bringing in AI, that's all they start talking about. They don't care about the efficiencies."
Mountain suggested attracting new technology like AI into the community, but having it develop in other businesses first, rather than the hospital. The community would see the benefits economically in new and better businesses, and then the hospital could embrace the technology to improve care.
At the end of the day, how a rural community embraces technology is far different than how an urban city looks at innovation.
"We have kiosks, and we have people who come in who will not use kiosks," noted Schultz, adding that Winona Health doesn't use patient portals because some patients want to call their doctors instead of messaging them online.
"I think we have to be careful that we're not interrupting what is really a valued relationship that people have with their doctors, their nurses, their therapists, and so forth, and make it too techy," she said. "Because at the heart of it, it is the connection of people."
"We can swing too far if we're not paying attention," she added.
That's what concerns Gutjahr, at Sparta Memorial Hospital. For a rural hospital, a partnership might just mean giving patients new opportunities to seek care elsewhere. With that in mind, she was at the HIMSS conference to look at new technologies and ideas to improve patient engagement and staff retention.
"We need help to hang on to what we have," she said, noting clinicians will come to Sparta to get their foot in the door, then move on to bigger and better paying opportunities. "That's a real challenge.
Hospitals are testing AI in the Emergency Department, where clinicians face high rates of burnout and need tools to help them create a better medical record.
Generative AI is proving it's value in the doctor's office, where the doctor-patient encounter is usually structured and quiet. Now healthcare leaders want to apply that technology to the Emergency Department, where very little is controlled.
At Atlanta's Emory Healthcare, ED clinicians are using Abridge Inside for Emergency Medicine, a generative AI tool designed to organize, maintain and update the patient's medical record through the disjointed and often interrupted journey from admission to discharge.
Tricia Smith, MBBS, MPH, FACEP, an emergency physician at Emory University Hospital Midtown, says the technology has the potential to reduce time spent gathering disparate patient data, giving clinicians a more efficient path to diagnosis and treatment.
And that's a critical pain point in a hospital's most stressful environment.
"If you have a complete story on the first encounter that you have with the patient, you're able to streamline your workflow," Smith says. "It seems like a minute here, a minute there, but those things really add up in a chaotic environment."
Emory is one of a handful of health systems that have integrated the AI tool into the Epic EHR platform for ED use over the past three months. Abridge officials say the technology taps into Epic's ASAP module to capture the salient points of the conversation, identifying key words and different speakers, and create a medical record that a clinician can drop into and out of as needed.
One of the bigger challenges of the ED is the disparity of the information needed to treat a patient, especially one who may not be conscious or able to communicate. Clinicians in this environment are gathering data from paramedics and EMTs, family members, visual exams and whatever they can find that's already in the EMR. They're developing a medical record out of these unstructured pieces of data, while also stepping in and out of the room to deal with other concerns.
Smith says that workflow extends to the end of this journey as well, when the patient is either discharged or admitted. That medical record needs to be complete for the next care provider, either in the hospital or at home, as well as the patient's insurer and the hospital's revenue cycle department. And AI can help organize that process.
"I have to write these words in this order in this context so the patient can understand exactly what I mean, so the insurer can understand exactly what I mean," Smith points out. And right now we haven't hit that sweet spot for emergency care to make sure that the note has all of those check buttons matched just yet."
Smith says it's likely the technology will need to be fine-tuned as it spends more time in the ED, encountering as many different distractions and roadblocks as possible. That includes making sure the technology is really helping clinicians—burnout rates for this group are among the highest in the hospital setting, running from 50% to 70% in several recent studies.
Smith says ED clinicians face unique challenges, exacerbated by the environment. There are many different points of pressure on their cognitive workload, and it can easily be more difficult to gather and organize the right information than to make a diagnosis. The right tool for them isn't necessarily the one that will help make the diagnosis, but will help them on the path to that diagnosis.
After hearing all the stories about how AI is helping the clinician capture the patient conversation, Smith says she's grateful the C-Suite is looking beyond the doctor's office and into the ED.
"To be quite frank, we felt a little bit left out of the AI conversation," she says. "The majority of these generative AI tools that were being developed were developed for clinic settings, for office settings, where you have a 15-minute encounter. There's a back and forth and there's a neat and tidy conclusion all wrapped up within 15 minutes. But in the ED you're trying to make order out of chaos."
At HealthLeaders’ Virtual Nursing Mastermind event this week in Atlanta, chief nursing executives discussed how the health system of the future will use technology to reinvent the care team.
As healthcare organizations look to transform care delivery, their innovation plan had better begin with the nurse.
Virtual nursing is one of the more popular concepts in healthcare these days, with health systems and hospitals trying out a wide variety of technologies and strategies focused on reinventing care delivery. And at a recent HealthLeaders Virtual Nursing Mastermind live event, it became clear that this is where healthcare leaders want to start when they talk about the health system of the future.
For the roughly 10 nursing executives attending the Mastermind event this week in Atlanta, the path to transformation begins with the nurse, who is most often closest to the patient, and any meaningful change that reduces waste and cost and boosts outcomes has to focus on improving the patient’s healthcare journey.
The challenge, then, is figuring out how a nurse should fit into the patient’s care journey, and how today’s healthcare ecosystem gets that wrong. Beginning with inpatient care, from the ED to the hospital room, nurses are currently called on to do many things they really don’t have to do. Technology like AI can take on those tasks and give nurses back the time they need and want to care for patients.
That new nursing workflow, Mastermind participants said, should be part of a much larger reinvention of the care team.
Indeed, a growing number of health systems don’t even want to call the platform virtual nursing, and are instead focusing on care coordination and management, a strategy that pulls in all the members of the care team, from clinicians to specialists to pharmacists to technicians.
In that model, technology becomes the foundation upon which each member of the care team can do the tasks they were meant to do—clinicians providing care to patients, and others providing support or handling education and administrative duties. A virtual care platform would then be more like a call center, handling incoming requests and directing them to the right care team member.
According to the Mastermind participants, as healthcare leaders develop the hospital of the future, that virtual care platform will extend outside the hospital, coordinating services that extend to other healthcare sites, even the home. But this platform will only work if the technology sits in the background, gathering and assessing data and handling the tasks that would normally put nurses and other care team members in front of computers instead of patients.
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Congress has extended telehealth and Hospital at Home waivers through September. This may be the healthcare industry’s last chance to prove their value.
But the six-month extension isn’t making things any easier for healthcare execs looking to plot long-term strategies. And while supporters are taking heart in the fact that Congress has consistently kept these programs in view, they also know that the cycle of kicking the can down the road has to end. Either Congress or the Centers for Medicare & Medicaid Services (CMS) makes these waivers permanent, or they end them once and for all.
This gives healthcare leaders the summer to make their case for permanent CMS support of telehealth flexibilities and the Acute Hospital Care at Home (AHCAH) program. That means finding and showing data that proves these flexibilities are saving money, reducing complexity and improving clinical outcomes.
Are we ready for the Summer of Telehealth?
Supporters, beginning with the American Telemedicine Association (ATA) and extending to the hundreds of advocacy groups, healthcare organizations and lawmakers that have signed so many letters calling for waiver permanence, have long lobbied for a multi-year extension of anywhere between two and five years. That time frame, they argue, is necessary for healthcare leaders to conduct their studies and pilots and gather the data they need to support these programs.
That’s particularly true of the Hospital at Home movement. Close to 400 health systems and hospitals across the country are following the CMS model, which qualifies them for Medicare reimbursements but is quite complex. Others are forgoing reimbursements to develop their programs to treat patients with acute care needs at home (or, in some cases, a SNF or rehab center).
Stephen Dorner, MD, MPH, MSc, Chief Clinical and Innovation Officer of Mass General Brigham’s Healthcare at Home program, says the regulatory uncertainty is slowing down growth, and he worries what will happen if the waivers are ended. But at the same time, the fact that so many healthcare organizations have invested in this strategy means it does have value.
“We’re in this journey to build out the whole continuum of care in the home” he said at the recent HIMSS 2025 conference and exhibition in Las Vegas.
Dorner is part of a Hospital at Home program that’s widely considered to be one of the best in the country, with services that impact a growing number of patient populations, from those with chronic care concerns to veterans. Supporters point to the published studies by the health system showing how the program saves money and improves clinical outcomes; critics, meanwhile, note those studies are small and hyper-focused, and there’s no guarantee the program can be scaled and sustained.
Dorner says the industry needs time to prove its value—and to tinker with the model to find the right mix of efficiency and outcomes.
“I don’t think that the way it’s structured now is necessarily that way it will be structured forever,” he said. “We need more of a critical mass of information” to prove what works and what doesn’t.
The same goes for the collection of pandemic-era waivers on telehealth expansion and use. Virtual care comprised a small percentage—roughly 15%--of all healthcare interactions before the COVID-19 crisis, at which point providers scrambled to put as many services as possible onto a telemedicine platform to help overcrowded hospitals and enable patients and providers to connect and isolate at the same time.
With the end of the pandemic, many patients expressed a desire to see their providers in person again, swinging the telehealth pendulum in the other direction. Some mistakenly assumed this would be the end of telehealth, but the technology had done enough to reduce access pain points and improve outcomes that patients still asked for it and providers found a way to integrate virtual and in-person care. As a result, the waivers were continued.
Which brings us back to the road ahead. With the waivers extended until September 30, the healthcare industry has the summer to prove the value of these flexibilities. They know the extensions won’t go on forever, and with each passing Congressional action the drumbeat is growing to end them and move on.
Supporters can’t keep recycling thank you notes to Congress and the White House for these extensions and vow to continue working to make them permanent. They’ve been doing that for the last two years, and nothing has changed.
Today’s healthcare innovation landscape is chaotic, and the C-Suite needs to adjust to keep up. Are we ready for a Chief Storyteller or Chief Collaborator?
The chaotic pace of innovation is forcing CIOs to become a jack-of-all trades.
During a recent CHIME panel at ViVE 25 in Nashville, Andy Crowder, CHCIO, CDH-E, SVP, Southeast Region CIO and Enterprise Chief Digital Officer for Advocate Health Care, traced the evolution of the CIO back to the pandemic, when virtual care was all the rage and health systems were scrambling to be innovative.
“I think the role of the CIO or Chief Digital Officer … has been [as] a strategic advisor, part of the C-Suite, tied to strategy,” he said. “We put our feet on the accelerator, and nobody’s taken that off.”
“Because of those disruptions and because of that focus, now you’re a force-multiplier,” added Aaron Miri, MBA, FCHIME, CHCIO, Baptist Health Jacksonville’s EVP and Chief Digital & Information Officer. “It changed the lexicon of CIOs to be talking more like a CFO, or a COO, or a Chief Human Resources Officer. I spend part of my day looking at recruitment, part of my day looking at P&L [profit and loss], part of my day looking at futuristic digital transformations and what we can do [to be] disruptive, as well as strategically, where are we going as a health system?”
With the promise of AI on the doorstep and against a backdrop of declining workforces, quality and cost problems, razor-thin margins and an uncertain federal response, CIOs and their colleagues are in a tough spot. And many are eager to accept the challenge.
“We want to be that first-stop shop” for innovative ideas, Miri said. “We want to help you co-develop, and more importantly, imagine the art of the possible.”
At a time when healthcare organizations are looking to cut costs, and in some cases culling their C-Suite, the idea of a fluid job description for the CIO might seem like job security. But at a time when innovation needs a hard and fast ROI, it’s incumbent upon CIOs, Chief Transformation Officers, Chief Digital Health Officers and Chief Strategy Officers to gain a better understanding of what it takes to push through a good idea.
And it’s not limited to CIOs. CFOs and those in Revenue Cycle Management need to better understand the clinical side of the organization to develop tools and strategies that benefit both the patient and the purse strings. CMOs want to work with CNOs—and vice versa—to create better relationships between doctors and nurses.
Collaboration has become a necessity, as health system and hospital leadership looks for new ideas that address more than just one pain point or niche problem.
During the CHIME panel, Tressa Springman, SVP and Chief Information & Digital Health officer for LifeBridge Health, said CIOs can’t just sit at their own desks and wait for things to come to them. They have to be storytellers, understanding the environment and the competitive landscape of vendor relations, looking beyond the shiny new toys and hype to assess whether something really will transform healthcare.
“I see myself as the educator,” she said. “I am the person who is the glue in the organization. I am constantly educating my peers on what their peers are doing.”
“I spend most of my day thinking about, OK, how am I going to improve this business function, how are we going to partner to make this improvement, and will technology help that particular function or not?” she added.
This is where HealthLeaders is headed with its new Chief Digital Executive Exchange, scheduled to take place December 4-5 in Washington DC. Designed to bridge the gap between CIOs and their counterparts, this event aims to give digital and information executives the knowledge they need to collaborate and give new ideas the best chance for sustainability and scalability.
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In Alaska, where access to specialist care is challenging and emergency transfers can be harrowing, providers are using AI to speed up diagnosis and improve treatment
Healthcare access and treatment issues in rural and remote areas can mean the difference between life and death for people suffering a stroke. Every delayed minute of care costs roughly 2 million brain cells.
That’s why a consortium of healthcare providers in Alaska is investing in AI to improve the diagnosis and treatment of strokes, which kill about 140,000 people a year.
“There's a lot of time that gets lost and a lot of time that is essentially burned unnecessarily because the standard way that we're used to doing things in medicine is very linear,” says Lucy He, MD, FAANS, a neurosurgeon with Anchorage Neurosurgical Associates and physician sponsor of the Alaska Stroke Coalition, a non-profit established in 2023 to boost care coordination and outcomes in the nation’s most rural state.
In late 2024, the coalition partnered with digital health company RapidAI to launch the Rapid AK Project, a three-year initiative aimed at integrating AI technology at six of the state’s largest hospitals (four other hospitals already have the technology installed). On this platform, specialists at these hospitals can more quickly analyze data sent in by rural providers on stroke victims, improving a care process that saves lives.
Lucy He, MD, FAANS, a neurosurgeon with Anchorage Neurological Associates and physician sponsor of the Alaska Stroke Coalition. Photo courtesy Anchorage Neurological Associates.
According to He, when someone in a remote part of Alaska—about 97% of the state qualifies as remote—suffers a stroke, care providers send CT images to the nearest hospital with stroke diagnosis and treatment capabilities. That process of sending roughly 1,500 images takes about 45 minutes. Specialists then review the images to determine whether the patient needs to be transferred to the hospital for treatment, which usually involves the administering of tissue plasminogen activator (tPA).
In Alaska, that transfer may involve an ambulance, helicopter, and/or fixed-wing aircraft and take hours. Flight crews have 30 minutes to accept the transfer and another 30 to file a flight plan and receive clearance to fly. And after the patient is transported to the hospital, another round of CT images is taken to make sure the patient is still a good candidate for treatment.
Throughout this lengthy process, the patient’s health is declining, reducing the chances that tPA can halt the effects of the stroke and preserve brain function. In some cases, a patient who initially could be saved with tPA might not be saved by the time he or she reaches the hospital.
AI can improve that process, He says, by enabling CT scans to be sent in real time and helping specialists review the images.
“All of a sudden you’ve got an hour that’s been saved,” she points out.
Through the RapidAI platform, she says, care providers and specialists can collaborate and share data more quickly and effectively, analyzing a patient’s chances of recovery and giving everyone – care teams, specialists, transport teams and the patient’s family – a more accurate time frame.
“There's nothing worse than transferring a patient … and then they get here and it's like, no, they're not going to be a candidate,” He says. “Now this patient is far from their family [and] their family still has to fly on their own money down to Anchorage. So it's really about identifying the right patients in a timely manner to make a decision whether it's transfer or stay.”
From Hours Down to Minutes
According to Jeremy Hunter, CMO and CMIO of the Alaska Native Tribal Health Consortium (ANTHC), one of the participating healthcare networks in the Alaska Stroke Coalition, the coalition sees roughly 150 stroke activations a year. Since joining the project, the amount of time needed to assess and begin treatment has dropped from about four hours to roughly 45 minutes.
Those are telling numbers for a population that can be hundreds of miles from the nearest hospital.
“Without a road system, without reliable connectivity in some places, some without running water in villages, it's fascinating delivering care up here,” he says.
Hunter says the AI platform gives local providers more confidence in assessing patients. He can use an app to more quickly share data with specialists. An AI interpretation of a scan, he says, can give emergency care providers some vital information on the severity of a stroke within minutes.
“With stroke medicine, I think it's definitely improving morbidity,” he says. “Even if there isn't an absolute mortality reduction, it's going to be hard to argue that we are not lowering morbidity significantly.”
Using innovative technology to improve stroke assessment and care isn’t exactly new. Health systems and hospitals across the country, from Chicago to Mississippi, have been using telemedicine and digital health tools for years to improve the process, establishing telestroke networks that connect rural care teams with specialists, even using specially equipped EMS vehicles in large cities to improve emergency diagnosis and care.
But while those advances get patients in front of specialists more quickly, AI tools are helping providers see the data they need to see to make critical decisions.
He says AI can drastically reduce the maddening gaps that affect stroke care, improving the chances that a patient will survive and reducing brain damage caused by those delays. He says AI can help providers understand how much of a patient’s brain has been affected by stroke and what can be saved through intervention. This includes a better understanding of whether a patient can be saved by intervention—a literal pain point when a provider has to decide whether to set up an expensive and stressful emergency transfer for a patient in the throes of a stroke.
An Ongoing Path to Better Care
But the technology also gives providers more data, enabling them to understand what causes a stroke and how different treatments work. This can fuel stroke prevention education and resources as well as fine-tuning stroke treatment protocols.
“Really, prevention ultimately is what needs to happen,” she says.
And then there’s cost. Healthcare organizations have little resources to spare on new tech, hence the formation of the coalition and the three-year grant to keep it going. Both Hunter and He say there’s an ongoing effort to sustain this partnership.
“We'll have financial conversations, but I think it is such a vital tool for improving stroke care that unless it's an astronomical number that we just simply can't afford, I don't see how we can go back to not having it,” Hunter says.
He agrees, saying the ROI for this technology should be measured not only in lives saved and emergency transport and ER costs justified, but in education and other resources that help people reduce their stroke risk and providers understand preventive care, diagnosis and treatment.
A continuing resolution now before Congress would extend pandemic-era telehealth and Hospital at Home waivers for six months.
The up-and-down battle over Medicare telehealth and Hospital at Home waivers is on the upswing again, as a proposed bill to fund the government through September includes extensions for both.
But in typical good news-bad news fashion, those proposed extensions would only run to September, leaving health systems and hospitals wondering whether to keep those programs going or shut them down.
According to the American Telemedicine Association (ATA) and several others, the proposed Continuing Resolution unveiled on March 8 keeps in place pandemic-era waivers on key telehealth coverage and the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home (AHCAH) program through September 30. Advocates say this would give Congress more time to negotiate a long-term deal, such as a five-year extension supported by the ATA and others.
“We appreciate Congress taking action to prevent a lapse in these vital telehealth flexibilities,” Kyle Zebley, Executive Director of ATA Action, the ATA’s lobbying arm, said in a press release. “While we would have preferred a longer extension, this step ensures uninterrupted access to telehealth services for patients and clinicians, as we continue working toward permanent solutions that reflect the needs of modern healthcare.”
But “uninterrupted access” is a bit of a misnomer. Many health systems and hospitals are relying on the waivers and using Medicare reimbursements to keep these programs going, and the constant battle over extensions is forcing executives to rethink their long-term strategies. Some have already rolled up certain telehealth programs, while others are delaying or cancelling plans to expand their virtual care platforms, figuring the money being put into those services could be best used elsewhere.
As with the stopgap funding bill passed by Congress last December, the new proposed bill would extend to September 30 the following telehealth flexibilities:
Waiving geographic restrictions on telehealth coverage and use;
Expanding the list of providers able to bill Medicare for telehealth services;
Allowing audio-only telehealth services;
Easing originating site restrictions on telehealth so that the patient can receive treatment at home;
Waiving the in-person requirement for telemental health treatment;
Enabling telehealth service for hospice care; and
Enabling Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to use telehealth.
In addition, the bill would extend the CMS waiver for its AHCAH program, enabling the more than 350 health systems following the CMS model to receive Medicare reimbursement.
And like the December bill, several telehealth flexibilities supported by the advocates didn’t make the cut. They include:
First dollar coverage of High Deductible Health Plans (HDHPs) and Health Savings Accounts (HSAs);
Support for virtual care providers in the Medicare Diabetes Prevention Program;
Improved coverage for digital health in home-based cardiology and pulmonary rehab programs; and
The SPEAK Act (HR 6033), which paves the way for accessible telehealth services.
The ATA’s Zebley said the inclusion of the telehealth and Hospital at Home extensions indicate that Congress “has listened” to the intense lobbying effort by the organization and others. But he also acknowledged that “the path forward remains uncertain.” There’s no guarantee that Congress will approve a final bill that includes those provisions.
Tech companies and healthcare providers flocked to Las Vegas this week to talk about the latest innovative tools and strategies. But amid shifting definitions of value, uncertain signals from Washington and increasing pressure to reduce costs and improve outcomes, are healthcare leaders struggling to just stay the course?
The almost frantic pace at HIMSS 25 this week hints at an industry struggling to keep up with the times.
The exhibit hall at the Venetian teemed with people rushing from one event or meeting to the next, making deals or looking to make deals. Technology vendors announced new partnerships, programs and product upgrades at a rate almost bordering on desperation.
Fueled by the advances of AI – in the consumer world as well as healthcare – and digital health, health system and hospital executives are dealing with a rapidly evolving industry. They're being forced to embrace change at a faster rate than they're used to, and in some cases struggling to connect the dots on innovation and ROI. Everybody knows that AI is a transformational tool, and no one wants to be left out.
But healthcare organizations are struggling on several fronts. Everyone is feeling the workforce shortage and looking for ways to keep who they have, attract whoever is out there, or use technology to supplement the workforce. Money is tight, so there's little to spend on new ideas or technology and a strong push to reduce costs and inefficiency.
For Susan Gutjahr, HIT Director for Sparta Community Hospital, the urgency is there to find technology that can help the 25-bed critical access hospital in Sparta, Illinois stay open. The hospital epitomizes the small, rural facility in farming and mining country struggling to keep up with the big boys in Chicago, several hours to the northeast, and St. Louis, 50 miles to the northwest.
"It's hard to find [technology] for us," she says, noting the hospital has had the same EMR since 1997. "We really need to get our foot in the door."
Gutjahr says hospital leadership is eager to find tools to improve patient engagement, an important strategy for small, rural hospitals that are often the linchpin of the community. She says they received federal funding during the pandemic, which they used to boost their virtual platform and reward stressed out staff, but that money is gone now and there's no indication that they'll be getting anything from Washington.
"We need to ask some hard questions about what this [technology] could really bring us," she says.
At the other end of the spectrum is the University of Texas MD Anderson Cancer Center, a well-known health system looking to expand its innovation strategy. Lavonia Thomas, BSN, DNP, MSN, RN, the health system's Chief Nursing Informatics Officer, led a team of nine nurses to HIMSS with the goal of finding the right technology that nurses will actually value and use.
"What are the problems that nurses at MD Anderson have that [can be addressed] here?" she asks. "We want to know what the nurses think. We know that the nurses using [this technology] will determine its return on investment for us."
And that may be the key to HIMSS' sustainability, which took a hit during COVID-19 but seems to be rebounding quite well. The healthcare C-Suite may not be in Las Vegas in big numbers this week, but many have sent executives and, just as importantly, clinicians in their place to get a good look at what's available.
Thomas points out that nurses require different things from new technology than doctors, so they need to check out the tools themselves. An ambient AI tool that's winning rave reviews from doctors for capturing the patient encounter won't address nursing needs.
So while the pressure is on providers to find the technology that works best for them, there's also an increasing amount of pressure on the technology industry to give health system and hospital executives the tools they need.
Srinivas (Sri) Velamoor, President and Chief Operating Officer of NextGen Healthcare, sees an industry in a certain amount of turmoil, looking to keep up with a technology that's being embraced by consumers just as quickly as other industries. The rush to create AI tools that meet the demands of providers is daunting, as are the needs to validate data, monitor on a continual basis, and even share risk with providers.
There's no doubt that AI will transform healthcare, he points out, and some of the larger, more established players in the healthcare technology ecosystem may have to tear themselves down and completely rebuild to meet new demands. Others are changing how they sell their products, especially to not-for-profits, rural hospitals and clinics that have limited resources but need that technology to survive.
So amid all the popcorn, puppies, happy hours and magic tricks on the HIMSS25 show floor this year, there's also a certain amount of desperation. Jump on the bandwagon now or risk being left in the dust. Try out a new tool, forge a new partnership, make a new deal, and look for those KPIs and benchmarks quickly. The clock is ticking.
