The California health system is getting $9.5 million through an HHS program aimed at tackling healthcare data breaches, and will explore innovative solutions through its new Center for Healthcare Cybersecurity.
The UC San Diego School of Medicine is getting a federal grant of almost $10 million to study how to prevent and mitigate ransomware attacks.
The $9.5 million grant comes from the Health and Human Services Department's Advanced Research Projects Agency for Health (ARPA-H) as part of its DIGIHEALS initiative, which supports innovative projects aimed at addressing hostile cyber threats. The healthcare industry saw some 344 data breaches in 2022, according to the Identify Theft Resource Center, the most of any industry.
“Healthcare systems are highly vulnerable to ransomware attacks, which can cause catastrophic impacts to patient care and pose an existential threat to smaller health systems,” Christian Dameff, MD, an emergency medicine physician at UC San Diego Health, assistant professor at the UC San Diego School of Medicine and UC San Diego Jacobs School of Engineering, and co-principal investigator, said in a press release. “Developing protocols to protect health systems, especially rural and critical access hospitals, will help save lives and make healthcare better for all of us.”
The research will target ransomware attacks, which cost health systems, on average, $11 million a year, according to IBM's 2023 Cost of a Data Breach report. Apart from the financial toll, these attacks can also affect care delivery, and can potentially cause patient harm or even death.
“During a ransomware attack, hospitals often have to switch back to inefficient pen-and-paper methods of administration, and this slows down healthcare delivery and introduces additional risks to patient safety,” Dameff said.
“When I talk about cybersecurity most people only think about protecting patient data,” he added “That’s all well and good, but we need to be just as concerned about care quality and patient outcomes. The impacts of malware and ransomware don’t stop at the digital border of a hospital.”
Jeffrey Tully, MD, an assistant clinical professor at UC San Diego School of Medicine and co-principal investigator, noted ransomware attacks can devastate small and rural health systems, with one hospital in Illinois shutting down for good.
Dameff, who in 2019 was appointed the first medical director of cybersecurity in the nation, will conduct the study through UC San Diego's new Center for Healthcare Cybersecurity, which is supported by the Joan & Irwin Jacobs Center for Health Innovation.
“Cybersecurity in healthcare is a huge problem that can affect each and every one of us, but few healthcare systems are prepared for the consequences of cyberattacks,” Christopher Longhurst, MD, chief medical officer and chief digital officer at UC San Diego Health, said in the press release. “The new center is designed to address this unmet need, and this new research is just the beginning of that effort.”
Health Systems like Essentia Health are using specially trained EMS teams to help recently discharged patients and those with chronic care needs stay out of the hospital.
One of the biggest care gaps occurs when the patient leaves the hospital. The care team can send along instructions for care management, send texts or emails or make phone calls, even schedule follow-up care, but there's no guarantee those directions will be followed.
At Essentia Health, those patients are now getting house calls from paramedics.
The 14-hospital health system covering parts of Minnesota, Wisconsin, and North Dakota has been using community paramedicine since 2014, and has seen reductions of almost 60% in 30-day readmissions, with ED visits and hospitalizations cut in half up to three months after discharge. Brendan Krupich, the health system's community paramedic program manager, says the program has reduced costly ED and rehospitalization costs while helping patients with ongoing and acute chronic conditions improve their health and wellness at home.
"They have a continuity of care that they didn't have before," he says. "We're seeing them at home now instead of [the emergency room] and helping them to stay there."
Community paramedicine programs, part of an array of outpatient services known as mobile integrated health programs, change the paradigm of providers waiting around for patients to come to them. Most health systems with MIH programs identify patients as high-risk returnees (sometimes called "frequent flyers") and schedule visits to the home after those patients have been discharged.
Healthcare organizations across the country have been launching community paramedicine programs to reduce ED and clinic traffic, cut down on hospital admissions, and take pressure off 911 services and EMS departments swamped with unnecessary or preventable calls. They're also taking aim at soaring care management costs for Medicaid and Medicare Advantage populations, many of who either avoid healthcare visits and preventive health services or wait until it's an emergency. A 2009 Institute of Medicine study indicated roughly $750 billion was being spent on preventable services, amounting to about 30% of the nation's total healthcare costs for that year.
"We were seeing a lot of people who just waited too long" to connect with their care team after leaving the hospital, Krupich says. Some, he says, are too stubborn to seek additional care, while others don’t think their concerns are serious enough to warrant a phone call or trip to the doctor. In today's economy, the sting of another medical bill hangs over the household.
Krupich launched his program with a one-year state grant, aiming to cut 30-day readmissions in half. Patients were identified through the EMR, and scheduled for home visits from specially trained paramedics who are employed by the health system (some programs use their own paramedics, while a majority work with local EMS and ambulance departments).
"We really needed to get buy-in from home health [agencies], and that took a while," he says. "We weren't replacing what they were doing."
In fact, MIH and community paramedicine programs can supplement home health services. They also can be used in acute care at home programs, fulfilling that in-person link and giving patients a personal connection to their care management plans. The goal is to connect patients to their care plans in a more meaningful way, encouraging them to follow doctor's orders and embrace healthy habits.
Krupich says his community paramedics go into a patient's home focused on emphasizing such things as medication adherence, exercise, and nutrition. While there, they can also identify and perhaps address social determinants of health, as well as connect the patient with community health and social services resources, including behavioral healthcare.
"Honestly, that's a large part of what we're doing now," he says. "We can't claim all the successes, as there are a lot of moving parts in this."
Krupich says the program is well-received by patients and providers alike because it reinforces the human touch in healthcare, giving the health system an opportunity to get more acquainted with the people they see so often in the ED. The key, he says, is training EMS staff to make those connections and understand what patients need at home.
“I refer to them as a bit of a Swiss Army Knife,” Chris Anderson, MD, Essentia's EMS medical director, said in an August 2023 news release issued by the health system. “Their skill sets are broad and they often work under the radar because their patients interact with practitioners less frequently once the community paramedic establishes a relationship.”
"Essentia's community paramedics play an indispensable role in reducing cost of care by decreasing ED and hospital admissions," Anderson added. “Our community paramedics often develop lasting relationships with their patients, which allows patients to better understand and participate in their own care."
The challenge sustaining these efforts, Krupich says, is funding. Essentia Health has received grants to keep the community paramedicine program going, targeting expensive benchmarks for certain chronic care populations like those living with diabetes. The Centers for Medicare & Medicaid Services (CMS) does not reimburse health systems for community paramedicine visits, and recently ended a pandemic-era alternate payment model that would have reimbursed for some programs that divert care from the ED.
But the tide is shifting, as more health systems look to reduce unnecessary expenses in the ED and focus on making hospital beds available for those who need to be treated in a hospital. Krupich says the Essentia Health program has reduced unnecessary hospitalizations and readmissions, and some payers, such as Blue Cross Blue Shield, are taking notice.
"We are moving forward," he says. "I see us taking more of a proactive approach to EMS services. We've been so reactive for so long and haven't done anything to fix it."
The health system, one of the first to launch an acute care at home platform, has received federal and state approval to treat patients from three more hospitals in their own homes.
Mass General Brigham has received federal and state approval to expand its Hospital at Home program to include patients from three more hospitals.
Health system officials have announced that Newton-Wellesley Hospital, Salem Hospital, and Brigham and Women's Faulkner Hospital will join the Home Hospital program, which was launched by both Massachusetts General Hospital and Brigham and Women's Hospital in 2016 and consolidated in 2020 when the two hospitals merged.
"We are incredibly proud of the impact that Home Hospital has had on its patients, as well as our care teams across Mass General Brigham,” Heather O’Sullivan, MS, RN, A-GNP, president of Mass General Brigham Healthcare at Home, said in a news release issued earlier this month. “This expansion is an exciting opportunity to provide greater access to the integrated, high-quality care we offer to even more patients in our surrounding communities."
Acute care at home and the CMS-approved Acute Hospital at Home programs enable hospitals to provide care for patients in their own homes instead of the hospital setting. The platform combines remote patient monitoring and telehealth technology with scheduled daily in-person visits. Health systems that follow the CMS model must adhere to strict guidelines to qualify for Medicare reimbursements.
The concept gained momentum during the pandemic as a means of helping overcrowded and workforce-thin hospitals care for COVID-19 patients at home, reducing the risk of infection. During the pandemic, CMS activated special waivers to enable more hospitals to qualify for its Hospital at Home program, and more than 220 health systems have followed that model. Those waivers are scheduled to end with the 2024 calendar year, though supporters are lobbying to make them permanent.
Many health systems – including Mass General Brigham, which has treated more than 3,000 patients at home, including nearly 1,000 this year, and is considered to have one of the oldest programs in the country – have developed their own protocols to treat a wider variety of patients at home, including those with chronic care needs.
“Being able to have that kind of vantage point, you can ensure greater health and safety of a patient as you’re tailoring their care plan to their personal environment,” Stephen Dorner, MD, MPH, MSc, chief clinical and innovation officer for Mass General Brigham Healthcare at Home, said in the release.
According to David Levine, MD, MPH, clinical director of research and development at Mass General Brigham Healthcare at Home, the program has shown benefits in a number of clinical outcomes, which Levine and his colleagues have reported on in studies. Levine says those outcomes include clinical quality measures, "enhanced patient and employee experiences, and increased capacity and access to inpatient care, [as well as] greater visibility into a patient’s socioeconomic needs and offers additional resources to support their care."
Mass General Brigham's program includes daily in-person or virtual visits from a nurse practitioner, physician assistant, or physician, as part of a larger care team that includes paramedics, nurses, therapists, and home health aides. According to the press release, "services provided include intravenous fluids and medications, laboratory testing, oxygen, radiology studies, electrocardiograms, and ultrasounds directly in the home. All of this is supported by a 24/7 continuous remote patient monitoring platform that transmits a patient’s vital sign readings to their clinicians as well as a two-way text and video communication pathway that ensures continual access to a patient’s clinical team."
The health system currently is approved to care for 33 patients at home and is expanding to serve up to 45 patients. Officials say they expect to shift 10% of inpatient care at Mass General, Brigham and Women's, Newton-Wellesley, Salem and Women's Faulkner to the home setting within the next five years.
Joneigh Khaldun, MD, MPH, FACEP, sees the national pharmacy chain as an integral part of a new healthcare ecosystem that uses data and technology to overcome barriers to care.
CVS Health's first-ever chief health equity officer says the national pharmacy chain is placing itself at the front of the health equity movement because it has the name-brand recognition to help underserved communities.
"People see us as a trusted brand," says Joneigh Khaldun, MD, MPH, FACEP, who also serves as vice president of the Rhode Island–based company, which includes among its many subsidiaries CVS Pharmacy, MinuteClinic, CVS Caremark, Aetna, Osco Drug, and Oak Street Health. "Nowadays people are more likely to go to their neighborhood pharmacists than a primary care provider."
Khaldun, who joined CVS Health in late 2021 and is also an Emergency Department physician for the Detroit-based Henry Ford Health System, has the background to address health equity. Prior to joining CVS Health, she was Michigan's chief medical executive and chief deputy director for health for the state's Health and Human Services Department, where she oversaw public health, Medicaid, behavioral health, and aging services. She also spearheaded Michigan Gov. Gretchen Witmer's COVID-19 response strategy and was appointed in 2021 to President Joseph Biden's COVID-19 Health Equity Task Force.
Khaldun says health equity is a long-standing issue, affecting underserved populations long before COVID-19 cast a spotlight on the topic. But with the glare of public perception came a new interest in addressing the issue with innovative technologies and strategies.
Health equity "has become a buzzword, but health disparities aren't new at all," she says. "What is exciting is the energy around addressing the root causes. The entire healthcare ecosystem has changed, and it has given us new opportunities" to level the playing field for consumers who have problems accessing the care they need.
Part of that change comes from the expansion of the healthcare marketplace, and the introduction of new and more diversified participants, such as Amazon, Microsoft, Google, Walmart, Walgreens, and CVS Health. Traditional healthcare organizations are working hard to stay competitive, often by using consumer-friendly technology and strategies to keep their patients.
Khaldun won't talk about whether CVS Health is competing with or partnering with health systems, but she does say the CVS network can address one aspect of health inequity: Lack of trust in the healthcare industry. Underserved populations often feel disenfranchised from local health systems due to barriers in accessing care. Having them access care through CVS Health helps to break down those barriers and put more faith in healthcare providers, she says.
Khaldun has a three-pronged approach to addressing health inequity: Empowering people to take charge of their own care, using data to identify each person's unique healthcare journey, and using technology to take action. Consumers often encounter care gaps, she says, when they don't have the data they need to make the right healthcare decisions.
"To understand the disparities and inequities, you have to have the right information," she says. "That’s what we can do."
Khaldun also says virtual care "is going to be an important part of our healthcare ecosystem," enabling CVS Health to link consumers to the care providers they need to see no matter where they're based. That will go a long way toward breaching the barriers to care caused by lack of access, she says, and open the door for new opportunities in care management.
Not lost in the equation is the impact that pharmacies can have on care delivery. Advocates say pharmacists can and should play a more active role in care management because they often have access to the data needed to link consumers to effective treatments and are often the best resource to address an ineffective treatment or identify new care plans.
"That's why CVS Health is certainly a healthcare innovation company," she says. "Pharmacists have an incredibly important role to play in this."
The digital health company launched by former Allscripts and Livongo executive Glenn Tullman is touting partnerships with 10 health systems across the country.
Ten major health systems are joining forces with a digital health company to create a nationwide concierge medicine platform targeted at large employers.
Transcarent, launched just two years ago with $200 million in investments by former Allscripts and Livongo executive Glenn Tullman, aims to push the value-based care model by incentivizing health and wellness and offering competitive prices for services.
“Our close collaboration with these ten leading health systems will allow us to better design care pathways, provide higher-quality care, and faster access," Tullman said in a press release issued today. "By aligning with health systems who can guarantee both quality of care and competitive pricing, we can reduce administrative burden, and just as important, demonstrate true measurable value for the people who pay for care - employers and their employees. We’ll also more closely integrate the digital experience with hands-on care."
The Transcarent National Independent Provider Ecosystem includes:
Advocate Health
Atrium Health
Baylor Scott & White Health
Corewell Health
Hackensack Meridian Health
Intermountain Healthcare
Mass General Brigham
Memorial Hermann Health
Mount Sinai Health System
Virginia Mason Franciscan Health
The model builds on the idea of a direct-to-consumer healthcare platform by linking in well-known healthcare systems to offer primary and specialty care services, including second opinions. Officials say the platform will offer in-person and virtual care, including telehealth-based physical therapy, orthopedic consultations and a pharmacy marketplace.
The attraction for businesses lies in a network of known healthcare entities offering care at scale.
"By directly contracting for rates upfront with our health systems and guaranteeing same-day payment, which no one else does, we can also guarantee our employer clients very cost-effective outcomes," Transcarent officials said in the press release.
The New Hampshire health system is using a virtual health program to train rural providers to handle difficult births, while also plugging in a robust telemedicine network to offer on-demand access to specialists.
Rural hospitals are closing their labor and delivery (L&D) units at alarming rates, forcing more expectant parents to give birth in an ill-prepared emergency room or other location, like the back of an ambulance.
At New Hampshire's Dartmouth Health, officials are combining virtual learning and a hub-and-spoke telemedicine platform to address difficult and emergency births. This includes STONE (Simulation Training for Obstetric and Neonatal Emergencies) training delivered on a virtual platform to rural healthcare providers such as emergency department personnel and paramedics, as well as an around-the-clock Tele-ED platform offering on-demand access to specialists to assist in emergency births.
"Sometimes babies come fast," Kevin Curtis, MD, MS, medical director of connected care and the Center of Telehealth at Dartmouth-Hitchcock Medical Center, said during a presentation at the Northeast Telehealth Resource Center's annual meeting this month in Nashua, New Hampshire.
In New Hampshire, 11 of 27 hospitals, or 40% of the state's hospitals, have shut down their L&D units since 2011. All but one are in areas designated by the U.S. Health Resources and Services Administration (HRSA) as rural service areas. Nationwide, 217 hospitals have closed their L&D departments, creating more maternity care deserts, where access to services is strained.
Many rural hospitals are closing L&D units because of the cost of staffing and keeping open a unit that doesn't see a lot of activity over the course of a year, but the consequences are dire, especially for expectant parents experiencing a difficult birth, requiring a C-section, or needing immediate care by neonatal intensivists. On top of that, most rural EMS units and emergency departments don't have quick access to those specialists. The result is an increase in difficult births and a resulting surge in babies and mothers experiencing health problems, including death.
That's true in New Hampshire, a decidedly rural state in northern New England with one teaching hospital (Dartmouth-Hitchcock Medical Center) and a network of smaller hospitals and clinics overseeing a population of roughly 1.4 million. Aside from lack of access, residents also must contend with rough terrain and snowy winters, making travel difficult.
The lack of resources for pregnant families "is projected to get worse, and it's happening all over the country," says Curtis. "We're seeing these [complicated births] more often, and even bedside teams are asking for our help."
Dartmouth Health's answer is two-fold. Using a one-year HRSA grant, the health system created a virtual STONE program, and has seen more than 120 rural providers and EMS personnel go through the program so far. The program gives providers the education they need to handle difficult births and uses simulation to guide those providers through various scenarios.
Beyond training rural providers to handle difficult births, Curtis and Patricia Lanter, MD, MS, associate professor of emergency medicine at Dartmouth-Hitchcock's Geisel School of Medicine and associate program director of the emergency medicine residency program, saw an opportunity to integrate the health system's robust telehealth network. Dartmouth Health Connected Care, which launched 11 years ago, now offers eight different telemedicine services across the state through its hub at Dartmouth-Hitchcock Medical Center in Lebanon, including TeleEmergency care at 13 hospital EDs and TeleICN (neonatal intensive care) services at 11 sites.
Through the Lebanon hospital, the health system's telehealth team can connect providers in distant and remote locations with ED doctors or OB-GYN or TeleICN specialists to handle difficult births and resulting in care for both the mother and baby.
Lanter says rural healthcare providers "are scared to death" of having to handle complicated births and are eager to have experts on a real-time audio-visual platform helping them. It's also important, she says, to have those specialists on hand to help providers when something goes wrong, such as the death of a baby or mother.
Curtis says the Tele-ED program has assisted in roughly five OB emergencies since the program was launched in May, while the TeleICN platform has been called in, on average, five times a month to help with infant care. And he expects those types of emergencies to become more frequent and complicated as rural healthcare sites struggle to stay open and difficult pregnancies and births increase.
But while the program is no doubt saving lives, it's also expensive. Curtis says the price tag to keep the hub manned 24 hours a day every day is prohibitive, particularly in a region where there aren't that many emergencies.
"TeleEmergency [care] still isn't pervasive at all in this country," he says.
Curtis and Lanter say they'll look for ways to make the STONE program sustainable. As for the Tele-ED platform, Curtis says that will remain open, as it's part of the health system's core mission. They charge a subscription rate to each hospital in the network, he says, but that doesn't cover the overall costs.
"It's very expensive," he says. "We couldn’t offer a break-even price because no one could afford it."
OSF HealthCare is one of several health systems launching a virtual nursing program aimed at improving nurse workflows and addressing workforce shortages.
When OSF HealthCare encountered problems hiring nurses for its med-surg units, executives decided to launch a virtual nursing program to fill the gaps and improve nurse morale and efficiency.
"That's one of the hardest positions to fill," says Kelly George, the Illinois-based health system's vice president of performance improvement. "And we were seeing that a lot of our nurses [were dealing with] a heavy workload. We decided that we would try anything we could do to better support the staff that we have."
With workforce shortages across the board, from nurses to doctors to IT and support staff, health system leaders are leveraging a number of strategies to improve the workplace, reduce stress and turnover, and entice more people into the industry.
HealthLeaders is convening a select number of the industry's top decision-makers next week in Nashville to address clinical and financial approaches to workforce shortages. The two-day HealthLeaders Teams Exchange will feature panel discussions on four topics: Strategic workforce planning, recruiting and retaining clinical talent, workforce innovation and technology, and physician alignment and partnerships (including nurse staffing and scheduling).
Workforce stabilization, especially in the nursing ranks, is top-of-mind for many healthcare executives. According to a survey of about 780 healthcare professionals conducted in April by Joslin Insight on behalf of telehealth company AvaSure, the two most important metrics for chief nursing officers using virtual nursing platforms are nurse satisfaction and retention (86%) and improving the workload for current staff (82%).
OSF HealthCare is one of several health systems across the country to explore virtual nursing platforms to stabilize the workforce (among them are Jefferson Health in Philadelphia, Michigan-based Trinity Health, and Nashville's Vanderbilt Health, all of which recently announced new programs). George says OSF looked to other health systems for guidance and found that many are at the same stage of development.
"It's still very early for everyone," she says.
Indeed, inpatient telemedicine programs were popular during the pandemic, as health systems sought to separate infected patient populations from doctors and nurses to curtail the spread of the virus. Virtual platforms were also effective in monitoring multiple patients, rooms, or even departments from one location, like a nurse's station, giving hospital administrators a means of doing more with a depleted staff.
The challenge for healthcare decision-makers with these platforms is ROI. Telemedicine programs aren't exactly inexpensive, and CEOs and CFOs need to see the hard benefits to a new program before signing off.
At the Medical University of South Carolina (MUSC) in Charleston, officials tested a virtual nursing service about a year ago, says Emily Warr, MSN, RN, administrator for the health system's Center for Telehealth. That program was geared toward helping new nurses learn the ropes.
"We learned from that endeavor that it's not enough," Warr says. "It has to be much more complex and bring more value."
So MUSC pivoted, creating a platform designed not only to remotely monitor patients in their rooms but to help with administrative tasks, from charting in the EMR to onboarding and discharges. That program will debut soon in four of the health system's rural hospitals, where the nursing ranks are especially strained.
"This program can't just focus on workforce economics or quality [of care]," she says. "One is not enough. There has to be a quality component. We've got to impact patient care."
At OSF HealthCare, George says the virtual nursing program will be closely watched by executives, and that clinical outcomes have to be included in the ROI, alongside nurse retention and satisfaction.
"We recognize that we have to be able to show the value," she says.
Kelly George is a contributor to the HealthLeaders Teams Exchange Community. HealthLeaders Exchange isan executive community for sharing ideas, solutions, and insights. Please join the community at https://www.linkedin.com/company/healthleaders-exchange/. To inquire about attending a HealthLeaders Exchange, email us at exchange@healthleadersmedia.com
A pilot program in Maine is proving the value of a telemedicine network that links remote primary care providers with specialists.
An eConsult program launched in Maine last December has improved care management and coordination for several small, rural primary care providers, while reducing expensive and time-consuming trips to a specialist.
The Maine eConsult Network, a one-year pilot program developed by the non-profit MCD Global Health, now encompasses eight primary care organizations across the predominantly rural state. More than 500 specialist consults have been conducted through the virtual network in the past six months, officials say, with 70% of those eConsults resulting in continued care by the patient's PCP, just 25% leading to an in-person visit with the specialist, and 5% needing more information.
The program addresses a care gap plaguing healthcare organizations across the country. Access to specialist consults is difficult owing to the declining numbers of specialists and high demand for their services. In rural areas those specialists are few and far between, requiring patients to travel long distances for in-person visits. Urban areas may have more specialists, but scheduling an appointment can often take months.
An eConsult platform enables a primary care provider to send patient information through a telemedicine portal to a specialist, who reviews the case and can ask for more information, request an in-person visit or determine that the PCP can handle the case, perhaps even offering clinical decision support. The platform is designed to reduce unnecessary in-person visits and the stress they put on patients, while speeding up the treatment process and improving clinical outcomes. It also helps PCPs treat more of their patients, a key business metric.
Since eConsults are relatively new, many payers don’t reimburse for the service. That includes CMS, which this year began offering Medicare and Medicaid coverage in specific circumstances and is seeking data on the overall value of the platform. MCD received funding from the state's Department of Health and Human Services to set up the program, and an evaluation will be done by the Maine Rural Health Research Center at the University of Southern Maine.
Daren Anderson, MD, was one of the first to explore the value of eConsults with the Connecticut-based Community Health Center and the Weitzman Institute, where he served as director. He's now president of ConferMED, an eConsult company serving federally qualified health centers (FQHCs) in several states and the platform for the Maine eConsult Network.
“With traditional specialty consultations, complicated logistics, and tracking combined with limited access, especially for patients in rural areas, can result in delays and worse clinical outcomes," he said in a press release issued by MCD. "As an alternative, eConsults provide advice and guidance from specialists quickly and easily and reduces the need for face-to-face visits. This results in better care for patients and a better process for everyone. For most cases, it takes far more work to coordinate and track face-to-face visits than simply getting an eConsult from a specialist, and the eConsult often provides all that is needed.”
In Maine, specialty consults can be especially challenging. At Mount Desert Island Hospital (MDI) in Bar Harbor, doctors treat patients on several nearby islands as well as small communities along the rugged coastline.
“I work on an island, but sometimes, it feels like I’m an island and I don’t have specialty resources,” Natasha Neal, DO, MPH, a family medicine provider at MDI, said in the MCD press release. “Knowing that I can place this consult and have this conversation with a specialist makes us less isolated and better equipped to serve patients, especially when they otherwise will wait months to learn more.”
“It is often possible, via eConsults, to get guidance on what tests to order, help interpret results, and recommend medication,” added Jennifer Monti, MD, a cardiologist based in southern Maine who is part of the Maine eConsult Network. “These three core functions reduce the amount of time it takes for care plans to be executed, which means more efficient, less expensive care for patients, and the face-to-face visit with the specialist, if needed, can be more nuanced and higher value because the patient will be present with relevant testing already performed.”
Aalpen Patel, chairman of the radiology department at Geisinger, explains how point-of-care ultrasonography (POCUS) technology is revolutionizing imaging operations and improving both business and clinical outcomes.
Healthcare organizations are moving away from the bulky ultrasound machines of years past and embracing digital health platforms that make imaging more mobile and integrate directly with the EHR to improve care management and workflows.
One of those health systems is Geisinger, which today announced a partnership with medical imaging and software company Exo to streamline the mobile ultrasound process. The Pennsylvania health system is using point-of-care ultrasonography (POCUS) in its women's health, emergency, and sports medicine departments and plans to expand to more than a dozen other locations in the future.
The streamlining of inpatient services is on every executive's to-do list as healthcare organizations seek to reduce workflow stress on staff and clinicians, reduce hefty medical costs, and boost clinical outcomes through better data access and analysis. Medical imaging costs are a significant burden on a hospital's bottom line and an area ripe for innovation.
"POCUS is perhaps the single most revolutionary technological advancement in medicine in the last 30 years," says Aalpen Patel, MD, MBA, FSIR, chairman of the Geisinger's radiology department, in an e-mail conversation with HealthLeaders. "Its scope spans almost every specialty and exponentially extends the clinician's ability to make rapid diagnoses and guide many procedures safely."
"Historically, ultrasound was performed in radiology or cardiology, where in-depth, time-consuming studies performed by techs were then interpreted by a physician (not at the bedside). This often required the patient to be transported to another area of the hospital, which is problematic, especially if the patient is unstable. POCUS has significantly extended the bedside clinician's ability to rapidly answer important clinical questions about the patient and narrow their differential."
Aside from improving workflows and care coordination, the technology also impacts clinical outcomes.
"POCUS allows clinicians to rapidly diagnose or exclude life-threatening conditions at the bedside," Patel says. "It is also used for procedural guidance, making procedures significantly safer for patients. Having the ability to archive images and generate reports in a streamlined workflow allows other members of the healthcare team to view this data and make clinical decisions."
According to Patel, hospitals are turning to this technology for several reasons.
"First and foremost, using an enterprise POCUS workflow can improve the quality of care for patients," he says "It allows the ability to perform quality assurance on images. This data can be used for assessing clinician competency, helping with credentialing and privileging, and providing quality feedback for continuous POCUS skill improvement and education."
"It also allows health systems to collect previously uncaptured revenue for POCUS studies," Patel adds. "Creating a POCUS workflow and archive also provides a database for quality review and helps mitigate medicolegal risk. And it can improve ED and hospital throughput, decreasing procedural complications and high-end radiology utilization such as CT, MRI or Interventional Radiology."
On the other side of the ledger, there are challenges to adopting this technology. And in this turbulent economy the biggest barrier may be the cost. Imaging systems aren't cheap, and it's up to the CIO or radiology department head to connect the dots for the CEO and CFO between expenses and ROI.
"Sometimes it can be difficult to convince leadership that a standardized POCUS workflow is needed to ensure that POCUS is performed properly and safely," Patel says. "However, demonstrating the quality and safety benefits along with the positive ROI from both soft and hard revenues gained by investing in an enterprise POCUS workflow solution can help overcome this barrier."
Ther's also the challenge of integrating new technology into the workflow.
"Clinicians are extremely busy, and every extra click they are asked to make takes them away from direct, patient-facing care.," Patel says. "Ensuring that the POCUS workflow is streamlined and seamlessly integrated in the EMR can help overcome this barrier. These exams allow the clinician more time at the patient's bedside, and [the technology] has been shown to improve patient satisfaction and experience scores."
"Another challenge is the ability to standardize a POCUS workflow across multiple departments," he adds. "Different specialties have different needs and expectations from a POCUS workflow. Providing a flexible workflow with customizable reports can help overcome this challenge."
And finally, Patel says, it's important to have resources on hand to educate staff about how to use the technology.
"Some specialties have POCUS education embedded in their residency and fellowship training curriculum, but others do not," he says. "Providing attending clinicians with educational and training resources including internal courses, didactics, image review sessions, and hands-on training sessions and simulation can help overcome this challenge. Fortunately, POCUS is being incorporated into not only residency and fellowship training but in many medical school curriculums."
A lot of the potential around this technology lies in its mobility. As health systems look to move more services outside the hospital and closer to the patient—be it in the home, a community health center, a remote clinic or doctor's office or even an accident scene—mobile ultrasound platforms are showing their value for providing on-demand care.
"POCUS technology and workflow is evolving at light speed," Patel says. "In the last 10 years these machines have transformed from large, clunky, cart-based machines with suboptimal image quality to compact and handheld units that can be taken to almost any environment inside or outside the hospital. Many newer machines are equipped with Wi-Fi capabilities, wireless technology, significantly improved imaging quality, and various Doppler technologies. Many of the newer devices have built in AI/machine learning [capabilities] that allow for auto-labeling and auto-calculations, and they can direct novice learners to the correct scanning plane and beam angle. And POCUS workflow reporting from various vendors allows mobile reports to be generated on iPhones, iPads, and android devices with a few swipes of the finger."
The recent flurry of collaborations between healthcare organizations and Big Tech is a good sign that health systems are finding their footing in AI development.
Healthcare organizations are joining forces with some of technology's heaviest hitters to push AI projects out of the planning stages and into the hospital.
The announcements are, in part, an effort to get in front of the AI hype machine and demonstrate that health systems are putting this technology to work to improve critical issues like workforce stress and administrative overload. The industry doesn't want to repeat the missteps of the EMR rollout, when news stories about bad experiences overwhelmed talk of the positives and hindered EMR adoption and development.
In just the last month:
Mass General Brigham announced the rollout of an AI algorithm for radiology "that will help increase operations' effectiveness and productivity." The technology was developed in a partnership with GE HealthCare, which agreed to a 10-year collaboration in 2017 "to explore the use of AI across a broad range of diagnostic and treatment paradigms."
HCA Healthcare announced that its partnership with Google, forged in 2021, had led to the pilot of an AI platform to document emergency department conversations between doctors and patients, and that the two were now testing an AI tool to facilitate nurse handoff reports.
"Everyone's trying to get ahead of it," says Avishkar Sharma, MD, CIIP, director of AI at Jefferson Einstein, part of the Philadelphia-based Jefferson Health network, which has been working with Aidoc in the radiology space for several years and is considered a leader in that space. "It's an ever-present conversation [in every health system boardroom]."
At the AIMed Global Summit this past June in San Diego—as well as other healthcare conferences like ViVE and HIMSS—the focus on AI was around what many call "low-hanging fruit." To wit, healthcare organizations are looking to use the technology to handle administrative tasks that consume time and energy for staff, including doctors and nurses.
"That's the immediate benefit," says Stephen Motew, MD, MHA, FACS, executive vice president and chief of clinical enterprise at the Virginia-based Inova Health System. "Where are the small, value-added opportunities in our day-to-day operations … that can be made more efficient?"
Indeed, while questions remain around AI governance and policy, health system executives who want to get their foot in the door are launching small programs that use tightly controlled, non-PHI data, finding the benchmarks and the benefits, then moving on to more ambitious projects.
Sharma fits AI adoption into the Gartner Hype Cycle, which charts the maturity, adoption, and social application of technologies. The five stages of that cycle are Innovation Trigger, Peak of Inflated Expectations, Trough of Disillusionment, Slope of Enlightenment, and Plateau of Productivity. He says AI has moved beyond that first stage and sits between the second and third, with health systems looking to find meaningful value beyond the hype and potential.
"We're very much in that turbulent phase," he says.
And that's why these recent announcements are important. They show that health systems are putting skin in the game and moving forward with pilot projects.
Motew says these partnerships are also important at a time when operating margins are thin and health system leaders are hesitant to take on new ideas. Few health systems have the IT talent on hand to make these moves on their own or scale them out to the enterprise.
Furthermore, these partnerships support health systems who are moving their data into the cloud and need help with cloud management.
"This is what everyone is trying to figure out now," he says. "And we want a seat at that table."
Sharma says partnerships are essential to developing and scaling AI programs across the enterprise, but they also have to be nimble. Owing to the evolving nature of the technology, an AI program created now that will use a specific subset of data to address a specific pain point won't be the same program in, say, a year's time. The technology, the data, and the governance around it will mature dramatically.
"You have to build relationships that are ongoing," he says.
Lastly, AI programs coming down the pipeline need to be guided by clinicians. Both Motew and Sharma also say that while the C-suite needs to set safeguards and parameters for AI use, the true value of the technology will be found by those using it.
"We encourage our teams to play around with it," Motew says. "The best ideas are going to come from the people using it every day."
"Clinicians very much need to be in the conversation and in the driver's seat," adds Sharma.
