The health system announced its dedicated space for innovation during the HLTH conference, with plans to support and develop new technologies and ideas to address healthcare’s biggest pain points.
Sutter Health is joining the ranks of health systems with built-in innovation incubators.
The Sacramento-based 24-hospital health system is opening an innovation center “aimed at fostering creative solutions to some of today’s biggest healthcare challenges.” Warner Thomas, Sutter Health’s president and CEO, unveiled the plan at last month’s HLTH conference and said the center should be up and running in San Francisco in early 2024.
The health system is one of at least a dozen major health systems, including UPMC, Houston Methodist, the Mayo Clinic, the Cleveland Clinic, and OSF Healthcare, who are looking to develop new technologies and ideas from within, with the goal of using their networks of hospitals and healthcare sites to test out and validate—and then potentially market—those products.
Speaking on the main stage at HLTH, Thomas said Sutter Health’s goal is to create an integrated network that enables consumers and patients to address all their healthcare needs in one place.
“Patients don’t want to go to 20 different [locations] to get healthcare,” he said. ‘They want an integrated health system.”
“We need to create an integrated experience, not a one-off experience,” he added.
Under Chief Innovation Officer Chris Waugh and chief health innovation officer Albert Chan, MD, MS, Sutter Health has built a reputation for focusing on human-centered design in healthcare. The health system recently beefed up Waugh’s team by luring two top executives from Ochsner Health: Richard Milani, MD, who was Ochsner’s chief clinical transformation officer and had led the health system’s Innovation Ochsner program for more than 11 years, is now Sutter’s chief clinical innovation officer, and Laura Wilt, who was Ochsner’s chief information officer for roughly a decade, has taken on the role of chief digital officer.
“Digital innovation is propelling healthcare into the future, and integrated systems like Sutter Health are leading the way,” Wilt said in a press release accompanying Thomas’ announcement at HLTH. “Establishing an intentional space for innovation sends a clear signal that Sutter, alongside our partners, is more committed than ever to deliver on our mission of making healthcare simpler, more engaging and deeply human.”
“We believe healthcare is at an inflection point,” added Waugh. “Sutter’s history is etched with groundbreaking innovations and partnerships that have elevated the patient experience. With the innovation center, we’re propelling our mission to new heights – igniting innovation through an unapologetically human-centric lens and ensuring a dynamic transformation that enhances the experience for both patients and providers alike.”
Thomas, who noted Sutter Health would also expand its investment strategy, said health systems are under pressure during a tight economy to be “more connected to our patients all the time.” That means investing in and supporting connected health tools and concepts that enable care management and coordination at the best time and place for both patients and their care teams.
That also means working together with other organizations to connect those care paths.
“Innovation thrives when we collaborate,” he said in the press release. “Together with innovation industry leaders, we are charting a new course to revolutionize the way care is delivered. Whether it’s in how we manage chronic diseases or provide care at home, our commitment to pushing the boundaries of what’s possible in healthcare has never been stronger. We want the work done here to have a ripple effect, transforming the entire healthcare ecosystem by benefiting both clinicians and patients. We invite visionaries who share our passion for innovation and improving the lives of patients to join us on this journey.”
At Valley Children’s Hospital, Jeremy Woods is digging into a patient’s genes and developing databases that uncover how diseases are created. “We’re no longer thinking one treatment per disease state,” he says.
Genetic testing is a relatively new and exciting concept in healthcare, giving doctors an intricate look at how diseases are created. And Jeremy Woods, MD, is developing rapid genetic tests and building databases that are changing how children are diagnosed and treated.
“We’re using data to get the patient’s best diagnosis and treatment based on their individual biology,” says the director of precision medicine at Valley Children’s Hospital in Madera, California. “We’re no longer thinking one treatment per disease state. We’re … getting real answers and providing precise treatments.”
Woods, who worked at UCLA Health before coming to Valley Children’s in 2020, is at the forefront of an innovative time in healthcare, with new and improved technology and strategies that are allowing researchers to get at the roots of disease diagnosis and treatment. Genetic testing and DNA analysis on newborns, for example, could help doctors identify and treat diseases early, saving millions of dollars in downhill healthcare costs and improving clinical outcomes—perhaps even curing patients.
Valley Children’s is part of Project Baby Bear, a consortium of California children’s hospitals launched in 2018 and funded by the state of California to develop rapid whole genome sequencing (rWGS) for ICU infants. In the first 18 months of the program, the genetic codes of 178 critically ill babies at five hospitals were sequenced, with some 43% receiving a diagnosis of their condition within three days and about a third receiving changes in treatment.
“This was a watershed moment in genomic medicine,” says Woods. “There are more than 3 billion pieces of information in the human genome, and it used to cost millions [of dollars] to sequence it. Now it costs about $200 and we can [provide results] in about a week, sometimes a day. The rate of innovation over the past three to five years has been stupendous.”
Jeremy Woods, MD, director of precision medicine, Valley Children's Hospital. Photo courtesy Valley Children's.
Woods says he treats about 2,000 patients per year, many with rare diseases.
“I deal with a disease that I had probably never heard of every day,” he says. “There are so many genetic variants that we don’t understand properly. That’s why collecting and analyzing all this data is important.”
And that has produced results. Using a database of genetic sequences that he developed, Woods was able to identify a rare genetic disorder, called Zellweger Syndrome, and trace its roots back to indigenous farmers from central Mexico. Although currently uncurable, Woods and his colleagues were able to send detailed information back to OB-GYNs in Mexico so that they could begin early screening to catch and treat the condition more quickly.
While this is an example of how data can be analyzed to produce meaningful, value-based outcomes, Woods says there’s not enough analyzing being done right now. Health systems need the technology, including AI, to take all that data coming in and curate it. And they need EHR platforms that can integrate that data.
“Many people [undergo genetic screening] and get their results in a PDF, which they forget about,” Woods says. “That’s why it’s so important” that the data is embedded into the EHR, where it can prompt doctors to take a closer look and have discussion with their patients.”
With that data, he says, healthcare providers can also identify populations that exhibit a prevalence of a specific disorder, then design community outreach programs that support screening, identification, and early treatment. And it can be used by genetic counselors to support—or rule out—expensive lab tests and new treatments.
On another level, Woods sees the continued development of pharmacogenomics, or programs that study how a person’s genetic makeup reacts to medications. This, in turn, would help the pharma industry develop more effective medications, while giving clinicians more insight into what drugs will and won’t work for specific patients.
Woods says support for precision medicine and genetic testing is slowly gaining steam. Payers, including some Medicare and Medicaid programs, are now covering genetic testing when it’s recommended by a patient’s doctor. And the technology will someday be refined so that genetic tests can be sequenced at the patient’s bedside, in less than an hour, and inputted directly into the EHR.
Precision medicine “is still a somewhat nebulous concept,” he says. “The biggest challenge right now might be education.”
The provision, included in the final 2024 Medicare Physician Fee Schedule, enables health systems to bill Medicare for telehealth services delivered from the doctor’s home.
A key Medicare reimbursement for health systems the deploy telehealth services has been extended through the end of 2024, along with a measure that gives physicians who work from home some privacy and security.
The Centers for Medicare & Medicaid Services has included in its final CY 2024 Medicare Physician Fee Schedule (PFS) Medicare reimbursement for providers who use virtual care at home to treat patients. In addition, the provision states that providers will not be required to list their home address as a practice location.
“Clinicians, their loved ones, and other stakeholders can breathe a sigh of relief – at least until the end of 2024 – that Medicare providers will not be required to publicly report their home address as their practice location,” Kyle Zebley, senior vice president of public policy for the American Telemedicine Association (ATA) and executive director of ATA Action, said in a press release. “This reprieve will help to maintain the safety and privacy of physicians and removes a significant roadblock to access to care.”
Supporters have argued that enabling physicians to bill Medicare for telehealth services delivered from their homes will give health systems more leeway to develop virtual care programs that cater to the needs of both patients and providers. This, in turn, would create better, more sustainable and scalable platforms and encourage providers to give the technology a try.
“Allowing appropriately licensed and credentialed providers to practice telehealth from their home improves patient access to healthcare services, reduces healthcare costs, while maintaining and meeting patient demand for care,” the letter stated. “This was necessary during the height of the COVID-19 pandemic and remains just as important today amidst provider workforce shortages and burnout, given that 78 percent of health care practitioners agree that retaining the opinion to provide virtual care from a location convenient to the practitioner would ‘significantly reduce the challenges of stress, burnout, or fatigue’ facing their profession and eight in 10 indicate that this flexibility would make them more likely to continue providing medical care.”
Just as important is the ruling that providers don’t have to include their home addresses as a point of care. Increasing numbers of doctors have been targeted by angry consumers, hate groups, and even people looking for some means of accessing opioids, putting the lives of themselves and their families in danger.
Zebley says CMS’ actions have also set the stage for a very busy 2024, telehealth-wise.
“With nearly all of the flexibilities established during the COVID-19 public health emergency (PHE) extended until the end of 2024, we can expect a telehealth policy ‘Super Bowl’ at the end of next year,” he said. “We have the unprecedented opportunity to impact transformative changes to how healthcare is delivered.”
The study finds that pharmacists could save millions of lives and more than $1 trillion in healthcare costs if they were given more leeway to help patients with chronic care management and coordination.
As pharmacies struggle to find their footing in a hard economy, a study out of Virginia Commonwealth University makes the argument that pharmacists could save millions of lives and cut healthcare costs significantly if they were allowed to help manage patients with chronic conditions.
The study, published today in the Journal of the American Medical Association (JAMA), finds that pharmacists who are given more leeway to help patients living with hypertension could prevent more than 15 million heart attacks, roughly 8 million strokes, and more than 4 million cases each of angina and heart failure and save $1.1 trillion over 30 years, or more than $10,100 per patient.
The study supports a long-running argument that pharmacists should be allowed to perform more care management and coordination services, and it could help the likes of Walgreens, CVS, and Rite Aid as they seek to reverse losses and redefine themselves as community healthcare hubs.
“Pharmacists’ role as healthcare providers tends to be underused in the community, and this is really about how pharmacists can provide for their communities in a way that improves access to care for hypertension,” Dave Dixon, PharmD, corresponding author of the study and the Nancy L. and Ronald H. McFarlane Professor of Pharmacy and chair of the Department of Pharmacotherapy and Outcomes Science at the VCU School of Pharmacy, said in a story provided by VCU.
“Although pharmacists currently have some type of prescribing privileges in 49 states and Washington, D.C., they are not recognized as providers under the Social Security Act,” he added. “This is one of the major barriers to implementing these life-saving – and cost-saving – measures for patients.”
According to the study, pharmacists could trigger these outcomes by becoming more active members of a patient’s care team, including offering advice on health and wellness, helping patients adhere to their medication regimen, and assisting in prescribing certain medications. This would be especially impactful in underserved communities, whose residents have much higher rates of death due to hypertension and where the pharmacy is visited more often than a doctor’s office or clinic.
According to a 2022 study published in the Journal of the American Pharmacists Association, more than 95% of Americans live within five miles of a community pharmacy, and they visit pharmacies 12 times more often than a primary care provider. With the nation in the midst of a shortage of healthcare professionals, advocates say pharmacies could support local health systems by taking on more services that a PCP would normally provide.
In addition, Dixon and his colleagues found that the improved outcomes that result in interventions by pharmacists could give patient more than 30 million “quality-adjusted life years,” or years where one’s quality of life is better than it would have been had those care management steps not been taken.
“Being that hypertension affects so many Americans – we’re talking about over 100 million people in the U.S. – I think the impact is tremendous because everybody knows somebody with high blood pressure,” said Dixon. “It’s one of the leading causes of heart disease and kidney failure in the world.”
At issue is a 2022 bulletin that prohibits HIPAA-covered entities from using technology that captures the IP address of people visiting public-facing websites.
Healthcare organizations are pushing back against a federal rule restricting hospitals from using tracking technology to collect data from consumers visiting their web portals.
The American Hospital Association (AHA), Texas Hospital Association, Texas Health Resources, and United Regional Health Care System have filed suit against the federal government, charging that the Health and Human Services Department has exceeded its statutory authority in preventing providers from collecting the IP addresses of people visiting public-facing websites.
The lawsuit calls for the elimination of “an unlawful, harmful, and counterproductive rule that has upended hospitals’ and health systems’ ability to share healthcare information with the communities they serve, analyze their own websites to enhance accessibility, and improve public health.”
“The Department of Health and Human Services’ new rule restricting the use of critical third-party technologies has real-world impacts on the public, who are now unable to access vital health information,” AHA President and CEO Rick Pollack said in a press release “In fact, these technologies are so essential that federal agencies themselves still use many of the same tools on their own webpages, including Medicare.gov, Tricare.mil, Health.mil, and various Veterans Health Administration sites. We cannot understand why HHS created this ‘rule for thee but not for me.”
The suit targets a bulletin issued in December 2022 by the HHS Office for Civil Rights (OCR) highlighting the use of online tracking technologies by Health Insurance Portability and Accountability Act (HIPAA) covered entities and business associates. The bulletin states that regulated entities such as hospitals “are not permitted to use tracking technologies in a manner that would result in impermissible disclosures of PHI to tracking technology vendors or any other violations of HIPAA Rules.”
According to the AHA and others supporting the lawsuit, that interpretation of HIPAA rules would prevent hospitals “from using commonplace web technologies to analyze use of their websites and communicate effectively with the populations they serve.”
“Simply put, OCR’s new rule harms the very people it purports to protect,” Pollack said. “The federal government’s repeated threats to enforce this unlawful rule tie hospitals’ hands as trusted messengers of reliable healthcare information.”
The suit alleges that common technologies used by healthcare organizations such as analytics software, video technologies, translation and accessibility services, and digital maps would be rendered ineffective without access to IP-address information.
“That statute allows hospitals to rely on third-party tools that capture IP address information because that information cannot reasonably be used to identify an individual whose healthcare relates to the webpage visit,” the AHA says. “By restricting use of these common tools on public-facing webpages on this basis, OCR violated HIPAA and has acted without legal authority. In addition, the suit alleges that OCR unlawfully issued this Bulletin without providing any reasoning supporting its novel legal assertions, without acknowledging the government’s own use of implicated third-party technologies, and without following required notice-and-comment rulemaking processes.”
Healthcare organizations and tech companies say the President's Executive Order is a good first step toward establishing AI policy, but will actions support the words?
The order "directs the most sweeping actions ever taken to protect Americans from the potential risks of AI systems," a fact sheet accompanying the order states. But there's little detail about how it would affect healthcare organizations or technology companies working with them.
Across all industries, Biden's order seeks to balance regulations with encouragement, establishing guidelines for controlling risk while giving the green-light to grants and other funding models to support research.
Specifically for healthcare, the President is giving the U.S. Health and Human Services (HHS) Department six months to draft a strategy to determine whether AI meets the standards for delivering healthcare, and he asks HHS to create a task force within the year to create a plan for responsible AI use.
In addition, the order calls on companies developing generative AI tools to notify the government when they are testing those tools and to share the results of those tests.
Through HHS, Biden's order envisions grants that would cover, among other things:
Developing AI-enabled tools that create personalized immune-response treatments.
Improving the quality of data used in AI tools.
Addressing administrative tasks that improve efficiency and contribute to stress and burnout.
Improving care for veterans and developing nationwide "AI Tech Sprint" competitions to support start-ups and small healthcare tech companies.
Reaction to the announcement was, for the most part, positive, with health system executives and industry analysts praising the administration for taking action. But at the same time, many noted that the nation is lagging behind Europe in developing AI policy, and many healthcare organizations are already testing and even using AI tools.
"While many general principles of AI ethics apply across industries, the healthcare sector has its own set of unique ethical considerations," he noted. "This is due to the high stakes involved in patient care, the sensitive nature of health data, and the critical impact on individuals and public health."
"It is critical that AI in healthcare benefit all sectors of the population, as AI could worsen existing inequalities if not carefully designed and implemented," he added. "It's also critical that we ensure AI systems in healthcare are both accurate and reliable. Ethical concerns arise when AI is used for diagnosis or treatment without robust validation, as errors can lead to incorrect medical decisions."
To that end, many of the tech giants developing AI tools—sometimes in partnerships with health systems—pledged at a July meeting at the White House to adhere to a set of voluntary guidelines, including allowing independent experts to assess tools before public debut, researching societal risks related to AI, and allowing third parties to test for system vulnerabilities.
Among health systems, Duke Health announced the launch of an AI and Innovation Lab and Center of Excellence in a five-year partnership with Microsoft "aimed at responsibly and ethically harnessing the potential of generative artificial intelligence (AI) and cloud technology to redefine the healthcare landscape."
Among those weighing in on the President's order was Bill Gassen, president and CEO of Sanford Health, who attended Biden's press conference at the White House.
“We believe that emerging AI technologies have the potential to positively transform the future of care delivery [and] advance rural health equity and are key to the industry's long-term sustainability," he said. "While we need to be appropriately cautious in our adoption of these technologies, we are supportive of the development of frameworks and guidelines that would enable healthcare providers to responsibly and safely use AI-enabled technology so that we can address some of the most pressing challenges in healthcare today related to our workforce, access to care and quality improvement for all."
"It will be critical that the guidance strikes the right balance between setting appropriate guardrails but is not unnecessarily stifling so we do not impede innovation and progress where it’s needed most," he added. "We look forward to collaborating with industry leaders, elected officials and the Administration on these efforts to ensure we can harness these technologies in the best interest of our patients and caregivers.”
One organization taking advantage of the hype surrounding Biden's Executive Order was the American Telemedicine Association, which published its guidelines for responsible use of AI in telemedicine programs.
"With today's Executive Order issued by President Biden to ensure the safe, secure, and trustworthy use of artificial intelligence, our timely release of the ATA's AI Principles can help chart the way forward as the administration works to create new standards for AI's potentially game-changing capabilities," Kyle Zebley, the ATA's senior vice president of public policy, said in a release. "AI is already being used in telehealth and its future potential is endless, especially to harness the reams of data that our healthcare system produces, including data collected from virtual care technologies, to improve healthcare delivery."
Several AI companies also chimed in, praising the administration for starting the conversation.
"Overall, the executive order is a great start and begins to lay a policy foundation to harness the benefits of AI, while addressing key challenges," Rajeev Ronanki, CEO of Lyric, said in a message to HealthLeaders. "By integrating it with ethical frameworks, liability, training/upskilling, AI literacy, oversight & auditing, data interoperability, and transparency, policy-makers can create a more comprehensive framework for AI."
But the question is whether HHS or another government entity has a plan—or the muscle—to go after a vendor or health system that runs afoul of the guidelines, and whether they can step in before serious damage is done. How will healthcare executives feel about HHS oversight? And will there be enough guidance from the government to help health systems map out and execute reliable and effective AI strategies?
The proposed penalties, if made final, could be levied on healthcare organizations that knowingly and unreasonably interfere with the access, exchange, or use of electronic health information.
Federal officials are proposing penalties for healthcare organizations accused of information blocking.
The Health and Human Services Department has released a proposed rule that would establish three specific “disincentives” for healthcare providers found by the HHS Office of the Inspector General (OIG) to have knowingly and unreasonably interfered with the access, exchange, or use of electronic health information except as required by law or covered by regulatory exception. Public comments on the proposal will be accepted through January 2, 2024.
The proposed rule complements information blocking penalties established by the OIG in June for other parties, such as health information technology vendors, health information exchanges, and health information networks. Companies found by the OIG to have violated the rule can be fined as much as $1 million per violation.
With that penalty in place, HHS is now targeting health systems.
“HHS is committed to developing and implementing policies that discourage information blocking to help people and the health providers they allow to have access to their electronic health information,” HHS Secretary Xavier Becerra said in a news release. “We are confident the disincentives included in the proposed rule, if finalized, will further increase the appropriate sharing of electronic health information and establish a framework for potential additional disincentives in the future.”
The disincentives, coordinated through the Centers for Medicare & Medicaid Services (CMS) are as follows:
Under the Medicare Promoting Interoperability Program, an eligible hospital or critical access hospital (CAH) would not be a meaningful electronic health record (EHR) user in an applicable EHR reporting period. The impact on eligible hospitals would be the loss of 75 percent of the annual market basket increase; for CAHs, payment would be reduced to 100 percent of reasonable costs instead of 101 percent.
Under the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS), an eligible clinician or group would not be a meaningful user of certified EHR technology in a performance period and would therefore receive a zero score in the Promoting Interoperability performance category of MIPS, if required to report on that category. The Promoting Interoperability performance category score typically can be a quarter of a clinician or group’s total MIPS score in a year.
Under the Medicare Shared Savings Program, a health care provider that is an Accountable Care Organization (ACO), ACO participant, or ACO provider or supplier would be deemed ineligible to participate in the program for a period of at least one year. This may result in a health care provider being removed from an ACO or prevented from joining an ACO.
The proposed rule is set ty be published in the National Register on November 1, after which the public comment period will be set for 60 days. The Office of the National Coordinator for Health Information Technology (ONC) and CMS will host an information session on the proposed rule within the next few weeks.
The health system is using a federal grant to analyze how a virtual care platform can be used to coordinate care after ICU discharge and reduce negative health outcomes.
Vanderbilt University researchers are using a $3.6 million federal grant to explore how health systems can use virtual care to improve care coordination and management after an ICU discharge.
The study, funded by the National Institute on Aging, focuses on post-intensive care syndrome (PICS), which can affect as much as 80% of discharged patients and leads to reduced clinical outcomes, poor quality of life, and rehospitalizations. Researchers led by Leanne Boehm, PhD, RN, ACNS-BC, FCCM, an assistant professor of nursing, will study how hospitals can coordinate care after ICU discharge with primary care physicians to reduce PICS and boost care management.
“Following ICU discharge, patients have problems lasting months to years that often go unaddressed,” Boehm said in a press release. “Primary care providers—and even ICU clinicians taking care of these patients—do not know much about PICS.”
“Only recently have we started to characterize what PICS assessment and management looks like across ICU recovery clinics,” she added. “We’re seeing so much variation in what clinics are doing. This made us wonder which screening intervention elements were the most important in ICU recovery clinics.”
The results of the study could help healthcare organizations develop new strategies for collaborating with PCPs and other resources, including caregivers, to improve the patient’s journey from the hospital to the home or other care site, such as a skilled nursing facility. This includes using virtual care and perhaps remote patient monitoring platforms to track patients more closely and identify and address care gaps before they become serious.
While large health systems often have ICU recovery clinics to help with the transition, smaller and rural health systems often don’t have that resource. The research could not only help ICU recovery centers refine their strategies for connected care, but give those smaller hospitals and networks the guidance they need to improve care and reduce rehospitalizations.
This study follows research recently done by Boehm and others on the value of a telehealth-based multidisciplinary ICU recovery clinic. That research identified the health concerns that accompany an ICU discharge and the value of care coordination and management in reducing negative clinical outcomes.
PICS consists of a variety of physical and mental health problems that remain after critical illness, and affects one-third of patients on ventilators, half of all patients admitted with sepsis, and as many as half of those patients who stay in an ICU for at least a week. One-third to half of those patients develop ICU-acquired dementia, which the NIH now classifies as Alzheimer’s Disease or Related Dementia.
Boehm will be partnering with Carla Sevin, MD, director of Vanderbilt’s ICU Recovery Center and co-chair of the Critical and Acute Illness Recovery Organization’s (CAIRO’s) post-ICU clinic collaborative, and James Jackson, PsyD, director of behavioral health at the ICU Recovery Center, on a telehealth-based model to assess how interdisciplinary teams may be used to transition patients from the hospital and monitor them as they recover from an ICU stay.
“Providers will talk with the patient about their assessment, care plan, what they can expect and the resources to help them in their journey,” Boehm said. The interdisciplinary team, consisting of a physician and/or nurse practitioner, psychologist or psychiatrist, social worker, and pharmacist, “have a multidisciplinary view of ICU-started problems and serve as a bridge in the transition of care from the ICU to their PCP or specialists.”
“Our primary aim is to see if this intervention can improve cognition, mental health, physical function, their social network, and patient activation,” she added.
Health systems are just beginning to develop digital models of everything from organs to people to whole neighborhoods to improve and personalize patient outcomes.
A technology first used by NASA to map out space travel is now giving healthcare providers a better look at how to treat patients.
Digital twin technology creates a digital model of a person, object, system, or process, which can be used to simulate the real thing for testing, monitoring, and other processes. Healthcare has only recently caught on to the potential for digital twins, which can be used to map out complex surgeries, test the efficacy of a treatment, and anticipate the progress (including possible side-effects and setbacks) or a care plan.
“We know the technology is capable of great things,” says Steve Levine, senior director of virtual human modeling for San Diego–based Dassault Systèmes, which drew large crowds with an exhibition at the CES 2023 show in Las Vegas last January. “Many medical centers are only recently becoming digitized, so the adoption curve is going to be long.”
Digital twin technology was first used by the American space program in the 1960s to model spacecraft development and simulate the moon landing. Since then, it has been used to design buildings and other structures such as dams, roadways, theme parks, automobiles, planes, planned communities, and a wide range of manufactured products.
The concept first entered the healthcare lexicon roughly 10 years ago with the launch of the Living Heart Project, a collaboration between Dassault Systèmes and the U.S. Food and Drug Administration (FDA) to gather cardiovascular researchers, medical device developers, cardiologists, educators and others to “develop and validate highly accurate personalized digital human heart models.”
Levine, who founded the project and serves as its chief strategy officer, says the goal is to create a 3D model that replaces animal testing, reduces the cost and complexity of clinical trials, helps guide medical device makers in designing cardiac technology, and can be used to plan out surgeries, treatments, and other procedures.
“Simulations are extremely expensive, limited, and not personal,” Levine says. “This will give us a much better model of the human heart.”
Levine says several organizations are using lessons learned from the Living Heart Project to develop digital twin models for other parts of the body, including the brain, liver, kidneys, lungs, and musculoskeletal system. In addition, Boston Children’s Hospital is partnering with Dassault Systèmes on applications of the technology for pediatric care, and Johns Hopkins is exploring the potential for digital twins in remote surgery and treatment.
“Ten years ago, no one had heard of digital twins,” he says. “Now [healthcare organizations] are interested in it and are looking at how they can use it. The pandemic raised a lot of awareness around the need for working virtually, so the focus on this technology has accelerated phenomenally over the past few years.”
Several health systems are testing the technology, including the University of Miami Miller School of Medicine, which is using funding from the National Institutes of Health (NIH) to create a digital twin, or MILBox, of a patient through data gathered from wearables and sensors.
“We want to demonstrate that this kind of individualized data capture can spur a new line of research and personalization in healthcare,” Azizi Seixas, PhD, founding director of the Media and Innovation Lab (TheMIL), and associate director for the Translational Sleep and Circadian Sciences Program at the Miller School of Medicine, said in a press release. “With the capacity to discover everything we can about the individual, we can change the relationship between people and their health.”
“Eventually, such digital twins could comprise sufficient detail about an individual so that a computer could test different treatment or wellness options against that model to predict which are most likely to produce the best outcomes for that person,” school officials said. “Instead of prescribing treatments based on a statistical model of outcomes across a large population, this new approach would provide each patient with a personalized recommendation calculated to produce the best outcome for them.”
This past January, the NIH awarded a $3.14 million grant to the Cleveland Clinic and MetroHealth to design entire “digital twin neighborhoods” based on the electronic health record data of 250,000 patients, to analyze how environmental, economic, and social factors create healthcare disparities.
“Where a person lives or works can shape their health outcomes, including life expectancy and risk of developing diseases like cancer or diabetes,” Jarrod Dalton, PhD, director of the Center for Populations Health Research at the Cleveland Clinic, said in a press release. “Americans from socioeconomically disadvantaged communities are more likely to have heart attacks and stroke, and are expected to live 10 fewer years than wealthier Americans. Our goal is to design an approach to help health systems, governments and organizations collaborate and strategize ways to address clear disparities.”
“This project aims to chart a new course for understanding place-based population health strategies and improving health outcomes,” added Adam Perzynski, PhD, of MetroHealth’s Population Health Research Institute (PHRI). “Evaluating technology like digital twins in the research space can make it easier for organizations to take a data-backed approach to public health interventions. Instead of building these models from scratch, other health systems and organizations can adapt the framework for their own needs.”
Levine, who is now working to develop a playbook on digital twin technology in healthcare, says the evolution of digital twin technology will move from designing models to using AI and predictive analytics to map out outcomes, both good and bad.
“We’ll move on from what does it look like to how does it perform to what it can and will do,” he says.
The biggest obstacle at present, he says, is unfamiliarity with the technology, alongside the reluctance among health system decision-makers to invest in something new.
“We need the pioneers to take on the work,” he says. “Once we start getting the qualitative assessments and the data … you’ll see a lot more interest [and engagement]. It’s going to happen.”
The HLTH conference reinforced the idea that collaboration may be a key element in the healthcare ecosystem of the future.
Healthcare’s disruptors are finding out that delivering healthcare isn’t as easy as selling retail goods or managing bank accounts or travel plans.
This theme became apartment at the recent HLTH conference in Las Vegas, where disruptors gather and conversations center around redefining healthcare. But amid the hype around AI, the potential of the growing ‘Food as Medicine’ movement, and the U2 show at the Sphere, much of the talk in the Las Vegas Convention Center was on the idea that disruption is not about competition but about collaboration.
A prime example during the event was General Catalyst’s announcement about its Health Assurance Transformation Corporation (HATCo) and to mold a “clicks and mortar” platform. HATCo’s co-leader Marc Harrison said the platform will combine technology with in-person care, mostly through partnerships with other health systems, to improve access and outcomes and reduce costs, especially waste.
The three projects are rooted in value-based care, but critics of the General Catalyst announcement at HLTH were quick to question how that value will be determined.
As the global law firm Sheppard Mullin noted in a recent JD Supra post: “For HATCo and Risant Health, data analytics and value-based care will go hand-in-hand, as their use of data analytics may help health systems unlock major care delivery and patient population insights that drive better care and better outcomes, ultimately lowering total costs of care, which is precisely the goal of value-based care.
“Bottom line: Sophisticated technology, including AI-driven data analytics, combined with deeper collaboration across health systems, may be the new capstone of health system transformation,” the firm wrote.
And while the concept isn't new, the focus on provider partnerships struck a chord with HLTH attendees. The idea that health systems can collaborate to improve care management and coordination takes aim at the long-standing issue of siloed care and competition. It also addresses the idea that companies like Amazon, Google, Microsoft, Walgreens, and Walmart aren’t necessarily competitors in the healthcare space but partners in redefining how care is delivered.
At HLTH, Walgreens announced the launch of a virtual primary care service, with Tracey Brown, the company’s EVP, president of retail and chief customer officer, saying the way forward requires “creating the partnerships that are required, the technology and the data, so that we can create personalized, effective care to improve the overall health and well-being for people in this country.” This came shortly before the company announced plans to slash $1 billion in costs and close 60 VillageMD clinics in the coming year.
To create those partnerships, healthcare executives are seeking expertise they don’t have. For example, HCA Healthcare earlier this year announced an alliance with Google Cloud and Augmedix to develop AI programs. Augmedix, the San Francisco company once known for developing smartglass applications, is now producing digital health tools that use natural language processing (NLP), large language models (LLM), and structured data sets to give clinicians on-demand support summarizing conversations and medical notes.
At the Augmedix booth on the HLTH floor, Augmedix CEO Manny Krakaris said the focus is now on finding the right partners to create a comprehensive platform that helps providers save time, reduce workflow stress, and improve clinical outcomes. It’s a lot like putting together a puzzle, with each vendor and each health system holding different pieces.
That’s what health systems are looking for now, and so a lot of the chatter at HLTH was among companies looking to complement other companies, creating platforms that address a number of needs rather than one pain point. A vendor with a unique app might see some initial success, but the company won't survive unless that app can integrate with other solutions across the enterprise.
Healthcare executives are also wary of taking on new projects, primarily because they don’t have the money to spend—but also because solutions to healthcare pain points are found in change management and workflow strategies. New technologies won't necessarily solve problems that are baked into standard operating procedure.
“It's not something you can just throw money at any more,” said Kimberly King Webb, senior vice president and chief human resources officer for CHRISTUS Health, during a session on new ways to address stress and burnout, still one of the biggest issues in healthcare.
This is perhaps HLTH’s biggest takeaway: Health systems can no longer just spend money on new technology to solve the industry’s most pressing problems. True disruption begins with an understanding that change is tough, and change management is vital. Instead of seeing competitors and looking to get ahead of everyone else, healthcare decision-makers should be recognizing opportunities to collaborate and forging partnerships that identify and affect value.
