The New York-based health system is using telemedicine to triage calls from three outlying hospitals so that ED doctors can assess patients with burn injuries and either treat or transport them to a burn center.
Northwell Health has launched a telemedicine program aimed at helping care providers triage burn victims.
The teleburn program connects specialists at Staten Island University Hospital's Regional Burn Center to three outlying hospitals in the New York City area to help providers determine whether a patient can be treated on site or transported to the burn center.
“With this technology we can tell pretty quickly the different depths of burns, how large the burns are and what the treatments should be,” Michael Cooper, MD, the burn center's director, said in a recent press release. “This information is vital to provide the most accurate assessment of a burn injury which can lead to the best outcome for the patient.”
The program is the latest example of a hub-and-spoke telemedicine platform, which connects specialists at the central hospital to providers in distant, more remote locations, such as hospitals, clinics and health centers. The model gives providers in outlying areas the clinical decision support they need to either care for their patients or schedule an emergency transport, reducing the time spent on consults and speeding up the time to treatment.
“With this technology, we can have a quick evaluation by a physician who is miles away and who can help us make decisions about care and whether we need to transfer a patient to that site,” Christopher Calandrella, DO, chair of emergency medicine at Long Island Jewish Forest Hills, one of the three spoke hospitals piloting the program, said in the press release.
When a burn patient is brought into Long island Jewish Forest Hills in Queens or Long Island Jewish Valley Stream and Long Island Medical Center, both in Long Island, ED providers can open an audio-visual telemedicine link with a specialist at the burn center to assess the severity of the burns. If the wounds are deemed severe, or if the hospital doesn't have the inpatient capacity or staff on site to treat other injuries like sever smoke inhalation, an ambulance or helicopter transport can be ordered.
Other examples of hub-and-spoke telemedicine networks include telestroke services, telpsych consults and school-based telehealth networks.
Memorial Sloan Kettering Cancer Center is replacing an often manual process with a tech platform that streamlines data transfer and verification from its EHR to platforms used by clinical trial sponsors.
Memorial Sloan Kettering Cancer Center (MSK) is embracing new technology designed to enable clinical trial sponsors to quickly and easily pull relevant patient data from MSK's EHR.
The New York City health system is partnering with IgniteData, a UK-based developer of electronic data transfer solutions, to provide data integration between MSK's EHR platform and the platforms used by two major clinical trial sponsors. The company will deploy its Archer technology through the MSK Innovation Hub.
The goal is to streamline and improve what is often a manual process of pulling and verifying data from sometimes different EHRs to support cancer research, boosting the efficiency of these trials, improving the process for selecting and monitoring participants, and eventually leading to better outcomes.
The technology is designed to enable research staff to quickly transfer regulatory grade data such as vital signs and labs—which typically account for as much as half of the data needed—into the sponsor's study database, reducing data entry errors and source data verification and query resolution times.
“Today, a typical phase 3 oncology study generates an average of 3.6 million data points," Dan Hydes, IgniteData's co-founder and CEO, said in a press release. "More than half of this eSource data already exists in patients’ electronic medical records, yet it is still being painstakingly transcribed into study databases, burdening research staff and creating inefficiencies and delays."
“This collaboration aspires to automate the routine tasks performed by our research teams and quicken the pace of clinical trial execution, driving us toward our ultimate goal of changing how the world treats cancer through research," added Joseph Lengfellner, MSK's senior director of clinical research informatics.
Once the process is worked out, officials said they would expand interoperability to other clinical trial platforms.
Researchers in Pittsburgh found that an AI tool outperformed the three most common practices for analyzing ECGs of patients being treated for chest pain, reclassifying one of every three patients.
An AI tool used in three Pittsburgh hospitals was able to diagnose and reclassify 33% of patients being treated for chest pain, improving on the standard practice for identifying heart attacks and potentially saving lives.
The technology, developed by researchers in Toronto, analyzes ECG readings for subtle clues that are often overlooked, leading to delays in detection and treatment. Researchers from the University of Pittsburgh compared the model against the three gold standards for assessing cardiac events and found that the AI tool performed better than all three.
“When a patient comes into the hospital with chest pain, the first question we ask is whether the patient is having a heart attack or not," Salah Al-Zati, PhD, RN, an associate professor in the Pitt School of Nursing and of emergency medical and cardiology in the School of Medicine, said in a press release issued by UPMC. "It seems like that should be straightforward, but when it’s not clear from the ECG, it can take up to 24 hours to complete additional tests. Our model helps address this major challenge by improving risk assessment so that patients can get appropriate care without delay.”
Al-Zaiti was part of the team that tested the technology on 4,026 patients treated for chest pain at the Pittsburgh hospitals and co-authored the results of the study, which was recently published in Nature Medicine. Those results were independently validated with 3,287 patients from a different health system.
The study compared the technology against experienced clinician interpretations of an ECG, commercial ECG algorithms, and the HEART score, which factors in age, risk factors, and other considerations prior to diagnosis. The model outperformed all three standards, reclassifying one of every three patients into low, intermediate, or high risk.
The study has implications not only for ED treatment, but for those who are first on the scene to treat patients with chest pain.
“This information can help guide EMS medical decisions such as initiating certain treatments in the field or alerting hospitals that a high-risk patient is incoming,” Christian Martin-Gill, MD, MPH, chief of the Emergency Medical Services division at UPMC and co-author of the study, said in the press release. “On the flip side, it’s also exciting that it can help identify low-risk patients who don’t need to go to a hospital with a specialized cardiac facility, which could improve prehospital triage.”
Martin-Gill and his team are testing that concept in the next phase of their research. They're working with the City of Pittsburgh Bureau of Emergency Services to deploy the model through the cloud to hospital command centers, which can direct risk assessments back to EMS teams in the field for more timely diagnosis and treatment.
EHR platforms are complex and costly and require a lot of planning to make sure they're a good fit for a health system. Here are 8 recommendations for organizations looking to transition from one EHR to another.
Electronic Health Records platforms have been around since the first EHR was unveiled by the Regenstrief Institute in 1972. And while there are just as many horror stories related to EHRs as successes, there's little doubt that the technology is integral to a health system's growth and development.
As with any technology, EHRs have evolved considerably since their first iteration, with new tools and capabilities that can address key healthcare pain points, both administrative and clinical, and address new capabilities like interoperability, virtual care, and even AI. The market has also grown, with new companies that can tailor EHRs to specific specialties.
With that in mind, health systems need to think carefully about their EHR investment, whether they're purchasing a new platform or transitioning from one to another. It's an expensive undertaking, not only for the initial software purchase but also in staffing, training, and workflow adjustment, as well as down time and the inevitable problems that come with a new tech installation.
Many health systems are now considering switching EHRs, either because they've outgrown the legacy platform they started with or they're not satisfied with the product.
"Such a transition requires a substantial investment in planning, preparation, and execution," says Ezio Castellani, vice president of healthcare and life sciences at IT consultancy company DataArt. "The prices of purchasing the new system, hiring additional staff, and providing training increase, and healthcare organizations’ budgets may not have room for large-scale IT projects. Furthermore, it will likely significantly impact patient care and the hospital's financial performance, so the decision needs thorough consideration and budget planning."
Key to that transition is data migration. Health system leaders need to develop a reasonable timeline for the transition, he says, with the understanding that this will be time-consuming. Aside from integrating all of a health system's technology, from software platforms to devices, into the new system, they also have to adjust workflows and train everyone on the new system.
"Rushing the switch to a new system can lead to errors and negatively impact patient care, while prolonged transition can increase costs and frustrate staff," Castellani says.
For healthcare organizations considering this move, Castellani offers eight recommendations:
Develop a detailed plan before beginning. Include detailed timelines, roles, and responsibilities for everyone involved, and be sure to build in contingency plans and time considerations for the inevitable unexpected issues and delays.
Consider outsourcing integration assistance. Not all health systems have the technical expertise on hand to manage a project this complex. A third-party system integrator can assist with or even handle many of the tasks associated with the transition, from project management to data migration to customizations. It's vital that this be considered early on in the process, so that time spent reviewing vendors and associated costs are included in the budget.
Get everyone involved. Key stakeholders, including physicians, nurses, and IT staff, need to be part of the process from the planning stages, so that everyone understands the transition and can offer input on how it will affect their departments. There are plenty of stories about new technologies that have failed because the end-user wasn't included in the planning process.
Test, then test again. Technology installations rarely go as planned. Putting the new platform through repeated tests enables everyone involved to see how the technology will work and spot potential issues or pain points. This includes testing data migration, user interfaces, functionality, and customizations.
Don't skimp on training. Make sure everyone who will use the new platform gets the training needed to understand how it works, including instruction on what to do when something goes wrong. A fully prepared workforce reduces the lag time when the new platform is launched and improves the chances of a smooth transition.
Ensure data integrity. Perhaps the most important aspect of the transition is ensuring that all data moves from one platform to the other, and that it can be located and used accurately and consistently in the new system. This is not only a functionality issue, but a patient safety issue as well. Have protocols in place to ensure that all data has migrated, with no gaps or errors, and have procedures in place for data backup and recovery.
Keep an eye on the EHR. Once the new platform is up and running, it's essential to monitor how it's working and how it's used. Establish processes and protocols that will enable management to quickly spot and address any issues before they become much larger problems.
Create a support network. Establishing a help desk and/or technical support team ensures that anyone using the EHR knows who to contact in an emergency. This will cut down on a lot of the stress and frustration associated with using the technology and ensure that problems are quickly addressed.
"Changing EHRs can be challenging and require extensive planning, preparation, and execution," Castellani points out. "Healthcare organizations must carefully consider the challenges and potential risks of transitioning to a new system before deciding to do so. Adequate planning, training, and budgeting can help mitigate potential risks and ensure a successful transition."
The agency says the innovative program that allowed EMS providers to seek alternative care pathways instead of the routine ED transport didn't get enough participants or interventions.
An innovative alternative payment model for emergency transports is ending early due to a lack of participants and interventions.
The Centers for Medicare & Medicaid Services (CMS) has announced it will shut down the Emergency Triage, Treat, and Transport (ET3) Model at the end of this year, two years earlier than planned.
"Current and projected number of interventions are lower than the number anticipated when the Model was designed," the agency said in a notice to participants. "This affects the cost of operating the Model relative to its expected benefits, the ability of CMS to conduct a robust quantitative evaluation of the Model’s impact, and the Model’s ability to achieve the estimated Medicare savings in the Model’s design. For these reasons, CMS has determined that it is not in the public interest to test the Model in Performance Year 4 (Calendar Year 2024) through Performance Year 5 (Calendar Year 2025) and has good cause to unilaterally amend the Agreement to modify its Performance Period."
Unveiled in 2021, the five-year project was designed to give EMS providers more flexibility in addressing the emergency care needs of their patients. Participants, ranging from EMS and healthcare providers to local governments, were encouraged to identify alternatives to the standard ED transport, such as urgent care centers, physician offices, and telehealth.
In March of 2021, CMS unveiled a list of 184 public and private ambulance providers and suppliers selected to take part in the program, as well as plans to seek $34 million in funding to support the model.
Participating ambulance providers and suppliers are paid by Medicare based on the level of service provided— Basic Life Support (BLS-E) or emergency Advance Life Support, Level 1 (ALS1-E) rate—plus mileage and quality adjustments. The qualified healthcare practitioner is also paid the current Medicare rate if the practitioner can treat the beneficiary in place.
The model had been delayed by one year due to the pandemic, and CMS adjusted the model to include more locations for transports during the public health emergency (PHE).
CMS' decision doesn't affect participation in the model or the ability to bill for ET3 interventions or receive performance-based payments through the end of this year.
"Emergency Medical Services remain an area of focus for CMS, and we believe that the lessons learned from the ET3 Model can aid in the development of potential future initiatives," the agency said.
The executive vice president and chief information & innovation officer at Children's Hospital & Medical Center is committed to an innovation strategy that will keep the Omaha-based hospital on the cutting edge of children's care.
Healthcare innovation might seem like a slow and steady process, marked by methodical pilots that gather data and lead to system-wide adoption.
Jerry Vuchak would like you to know that isn't the case in pediatric care.
"We frequently want to go faster than [technology vendors] want to go," says the executive vice president and chief information & innovation officer at the Omaha, Nebraska–based Children's Hospital & Medical Center. "We're moving forward at a pace that they're not used to."
There's a reason for that. Roughly $22 billion was raised globally in 2020 for digital health innovation, according to StartUp Health's annual report, yet only $167 million, or less than 1%, was set aside for children's digital health. And a quick online search of "children's hospitals" and "healthcare innovation" finds that many of the 250 or so children's hospitals in the U.S. are actively trying to raise funds that they aren't getting from the National Institutes of Health or other resources.
Whatever the reason for this lack of representation, Vuchak is quick to point out that innovation is alive and well at Children's Hospital & Medical Center. That's because so many care pathways and treatments for children can be made better.
Consider, for example, alarms within the hospital. They're vital to alerting care teams when patients are in distress, yet in children's hospitals they can also be distressing to patients, many of whom are scared to be in a hospital. With that in mind, Vuchak, says, Children's is working on designing new alarms that can alert providers without adding to a patient's discomfort.
Jerry Vuchak, executive vice president and chief information & innovation officer at Children's Hospital & Medical Center. Photo courtesy Children's Hospital & Medical Center.
"Innovation is our first value," he points out. "And it's not just words on a page. We're always thinking about how we can do things better because it's in our culture. It has a huge impact on our patients and their families."
Vuchak's view is shared by many innovation executives at pediatric hospitals across the country. Because so much of the activity in healthcare innovation is geared toward the adult patient, pediatric-based health systems are forging their own paths, creating innovative tools and strategies that apply directly to their young and fragile patients and their families.
This, in turn, makes pediatric healthcare innovation a dynamic arena.
"It's much harder in the pediatric environment," Vuchak says, noting the hospital has even had to build pediatric content into its EHR platform. "But that also makes it much more rewarding."
In many cases, children in pediatric hospitals and their parents are eager to embrace innovation. That's seen in Children's Hospital & Medical Center's digital front door. While national estimates place the number of patients using digital health tools to access care at between 30% and 40%, Vuchak says more than 70% of their patients are digitally active.
"Consumer engagement and experience is [a key factor to] our digital front door strategy," he says. "So it's very important to us that we know if we're thinking about the right things. That's how we'll build our roadmap out beyond 2023."
This roadmap includes mobile health apps that give care providers access to the latest information on chronic diseases like asthma, as well as up-to-date information on the patient, including medications and other treatments; and remote patient monitoring programs that ease the transition from the hospital to the home. One such program focused on young children who've had heart surgery within their first six months. The program boosted clinical outcomes 10%–20% by giving providers access to data that enabled them to intervene more quickly when a patient started trending downwards.
"We're prioritizing access to services," Vuchak says, meaning both how patients and their families can access healthcare and how providers can access resources to improve care. "We have a strategy council, and we have more ideas than we can actually take on."
Aside from augmented and virtual reality, in which Vuchak says "we're just scratching the surface," Children's Hospital & Medical Center is exploring how AI can be integrated into both provider workflows and care programs, and how wearables might be used in pediatric care—a challenge, again, because so many wearables are designed for adults.
Vuchak says he's surprised that so many companies in the healthcare technology space don't have a good innovation strategy. That's why he'll look far and wide for partners that have the right philosophy, and who will pivot quickly and adjust to meet specific and important patient needs.
As with all areas of healthcare innovation, the pandemic was a driving force in the adoption of new ideas and technologies, especially virtual care. For Children's Hospital & Medical Center, there was another unexpected benefit: the shift to working from home opened up 10,000 square feet of space within the health system, which is now being turned into a center for innovation.
This, he says, will help Children's to develop tools and platforms that address not only the patient, but the surrounding support team, including family, friends, and providers. It will also help as the hospital dives into the challenges around social drivers of health and the myriad causes of health inequity and outcomes, which healthcare organizations are now finding ways to address.
"You don't want to slow down because there's so much that can be done," Vuchak says. And that's both an important skillset and a challenge to working in pediatric healthcare.
The Midwest health system has developed new algorithms to help its nurse navigators manage their workflows, reducing stress and burnout and improving care management for cancer patients.
OSF Healthcare has designed an AI platform that improves care management for cancer patients by monitoring and adjusting the workflows of nurse navigators.
The Illinois-based health system developed an algorithm that combs through the electronic health record platform and other data sources to map out each cancer patient's journey for the coming week, including new patients. The technology then assigns the new patients to nurse navigators according to characteristics like cancer specialty and a care navigator's existing workload.
The platform not only improves care management for patients by ensuring they're matched with the most appropriate navigator, but also reduces stress and burnout among navigators by helping them manage their workloads.
"Our cancer patient nurse navigators are highly dedicated, and their workload can sometimes be overwhelming," Jonathan Handler, a senior fellow in innovation for OSF Healthcare, said in a press release. "They never want to shortchange the patient, so they shortchange themselves, working extra hours and sacrificing their own well-being to help patients. We hope our system can even out those workloads and improve their work-life balance."
The technology was developed by a team that consisted of researchers from OSF Healthcare and the OSF Innovation group, the University of Illinois College of Medicine Peoria, the University of Illinois Urbana-Champaign, and the Northwestern University Feinberg School of Medicine. It was funded by a grant from Jump ARCHES (Applied Research for Community Health through Engineering and Simulation), a collaborative that includes OSF Healthcare, the University of Illinois College of Medicine at Peoria, and the University of Illinois Urbana-Champaign.
The team's work was recently published in the American Society of Clinical Oncology's Journal of Cancer Informatics (JCO). That report noted that this may be the first time a project like this focused on the individual—including anticipated patient needs, navigator experience, and existing workload--rather than shifts, and the model they created "significantly outperforms the random distribution approach that approximates our current distribution methodology."
"Better workload management may reduce CPN burnout and lead to more effective and efficient navigation assistance for patients with cancer, allowing greater scalability of this vital resource to all oncology patients in need, regardless of geography," the study concluded.
The health system will next introduce the technology into its cancer care program through its OSF Community Connect workflow automation platform.
The proposed Transitional Coverage for Emerging Technologies (TCET) pathway is designed to facilitate Medicare coverage for new treatments that usually need time to develop data proving their value.
Federal officials are proposing an expedited pathway for Medicare coverage of new medical technologies.
In a notice posted in the Federal Register, the Centers for Medicare & Medicaid Services (CMS) is proposing a voluntary Transitional Coverage for Emerging Technologies (TCET) pathway for designated Breakthrough Devices. Officials say the new pathway, developed in a partnership with the Agency for Healthcare Research and Quality (AHRQ), should speed up the process to bring new treatments to Medicare beneficiaries while ensuring those treatments still meet rigorous review guidelines.
"As part of our commitment to fostering innovation and ensuring patient-centered care, CMS created the TCET pathway to provide a mechanism for coverage for certain new, innovative technologies with limited or developing evidence in the Medicare population using a transparent and predictable evidence generation framework that, when appropriate, not only develops reliable evidence for patients and their physicians to make healthcare decisions but also provides safeguards to ensure that Medicare beneficiaries are protected and continue to receive high-quality care," the agency said in a press release.
Officials said the new pathway was developed through feedback from a wide range of sources and based on requests "for CMS to utilize a more agile, iterative evidence review process that considers fit-for-purpose study designs, including those that make secondary use of real-world data."
Candidates for the TCET pathway will include devices that are:
Certain FDA-designated Breakthrough Devices;
Determined to be within a Medicare benefit category;
Not already the subject of an existing Medicare NCD; and
Not otherwise excluded from coverage through law or regulation.
Key elements to the TCET pathway include an evidence preview, or focused literature review, and an evidence development plan (EDP), which would be drafted by the developer to address any evidence gaps spotted in the evidence preview.
Once a treatment has qualified for this pathway, Medicare coverage will remain in place "only as long as needed to facilitate the timely generation of evidence that can inform patient and clinician decision making," along with an additional year to allow manufacturers to finish their analysis. CMS would then launch its updated evidence review.
Public comments on the proposal will be accepted for the next two months.
The organization is issuing almost $590,000 to nine healthcare organizations who will study how EHRs can be used to reduce stress and burnout, improve workflows, and boost value-based care.
Nine healthcare organizations have been tagged by the American Medical Association to study how EHRs can be used better.
The organizations will receive grants from the AMA's Electronic Health Record Use Research Grant Program, which supports research into how EHRs can help "prevent clinician burnout and turnover, enhance high-quality patient care, and improve workflows, teamwork, and resource allocation at the practice level."
“The EHR Use Research Grant Program allows the AMA to work with researchers who are leading efforts to expand insight into EHR systems and measure the technologies’ capacity to support or undermine the delivery of efficient and effective clinical work,” AMA Vice President of Professional Satisfaction Christine Sinsky, MD, said in a press release.
More than $2 million has been doled out by the AMA since 2019 to support 26 studies aimed at giving the often-criticized EHR a better reputation and highlighting capabilities and advancements that have made the technology more beneficial.
That research is particularly important now, as healthcare organizations are struggling with high rates of burnout and stress and dwindling workforces and need their technology platforms to step up. Backed by the emergence of AI, health systems are hoping that EHRs can be used to not only improve workflows, but also reduce expenses and boost clinical outcomes.
“Burdensome EHR systems are a leading contributing factor in the physician burnout crisis and demand urgent action as outlined in the AMA’s Recovery Plan for America’s Physicians," Sinsky said in the press release. "The research supported by the AMA grant program builds the evidence base to help change EHR technology into an asset to medical care, and not a demoralizing burden.”
The organizations receiving funding from the $589,000 grant program are:
AllianceChicago, which plans to use EHR event log data to explore both the prevalence and the facilitators of relational continuity among patients, physicians, and care teams in primary care.
Brigham and Women’s Hospital, which will investigate factors that influence the amount of time spent using an EHR and the impact of inbox messages on EHR burden, all in a primary care setting.
MedStar, which will study primary care physician EHR inbox prioritization.
The Stanford University School of Medicine, which will use EHR event log data and other information to evaluate the frequency of text messaging in the inpatient setting and the relationships between team stability and inbox message frequency, as well as whether higher text message interruptions during order entry is associated with increased order entry errors.
The University of California San Francisco, which will study the impact of e-visit billing on clinician EHR inbox time, work on the EHR after patient scheduled hours and overall EHR burden.
The University of Colorado School of Medicine, which will investigate whether inpatient EHR-based audit log data can serve as a useful tool in identifying when work design and workloads are leading to physician burnout and patient harm.
The University of Wisconsin-Madison, which will use EHR event log data to study any links between team support for medication orders and physician time spent on order entry and time on inbox in primary care.
The Wake Forest University School of Medicine, which will analyze time spent in the EHR by primary care physicians during paid time off.
The Yale University School of Medicine, which will expand on previous research into physician retention, clinical productivity, and patterns of EHR use in the emergency department.
The 23-member task force will develop recommendations to make pharmacists a more integral part of healthcare and give them guidelines for prescribing and managing digital therapeutics and other services.
Federal officials have launched a task force aimed at making pharmacies a more integral part of healthcare.
The Pharmacy Interoperability and Emerging Therapeutics Task Force was unveiled by Tricia Lee Rolle, a senior advisor for the Health and Human Services Department's Office of the National Coordinator for Health IT (ONC), during a June 15 meeting of the ONC's Health Information Technology Advisor Committee (HITAC).
The 23-member task force is charged with developing new ideas to integrate pharmacies and pharmacy services with clinical care, including creating protocols to support the prescribing and management of new technologies and treatments, such as digital therapeutics, and direct-to-consumer (DTC) services.
The group's co-chairs are Hans Buitendijk of Oracle Health and Shelly Spiro of the Pharmacy Health Information Technology Collaborative. Some of the members were appointed by Congress, while others were selected by the Government Accountability Office and the HHS Secretary.
The task force has two short-term goals: To identify standards and data needs for pharmacists to participate in emergency use interventions, and to determine if there are actions that the ONC can take to enable data exchange to support public health emergency use cases.
Long-term goals consist of:
Recommending ways to integrate pharmacy systems and data for public health surveillance, reporting, and interventions;
Identifying opportunities to improve interoperability between pharmacies to promote pharmacy-based clinical services and care coordination;
Identifying standards to support the prescription and management of emerging therapies, such as digital therapeutics, specialty medications, and gene therapies; and
Identifying technology and policy requirements for DTC services.
The task force will have a November 9 deadline to return its recommendations.