As health systems shift more care services to the patient's home, they're looking at drones to solve key supply chain challenges
Health systems and hospitals are turning to drones to address supply chain care gaps—including challenges that both providers and patients face in accessing drugs and other medical supplies.
In the latest example, the Mayo Clinic has announced a partnership with Zipline to integrate drone deliveries into its Advanced Care at Home program. The deal aims to improve care management for the home-based acute care program by giving providers quick access to medical supplies. Mass General Brigham unveiled similar plans in January when it announced a partnership with Canadian drone company Draganfly.
Just last month, Houston’s Memorial Hermann Health System announced a partnership with Zipline to deliver specialty prescriptions and medical supplies to patients’ homes beginning in 2026.
“As a system, we are continuously seeking ways to improve the patient experience and bring greater health and value to the communities we serve,” Alec King, Memorial Hermann’s executive vice president and chief financial officer, said in a press release. “Zipline provides an innovative solution to helping our patients access the medications they need, quickly and conveniently, at no added cost to them.”
Drones have been on the fringe of the healthcare space for several years, usually showing up in small pilot programs aimed at improving delivery of time-sensitive supplies between two health system sites or from a health system to a patient’s home and vice versa. The use case aims to address delays or slow deliveries caused by geography, weather, traffic, or transportation issues as well as giving patients access to tests, medicine, and vaccines in their homes rather than making them travel to a hospital or clinic.
In January, Axios called 2024 a “breakout year for delivery drones,” noting that the Federal Aviation Administration eased the rules last fall to allow some companies to fly drones beyond the visual lines of sight, called BVLOS. That opened the door to companies like Zipline, Amazon, and Wing (part of the Alphabet stable) expanding their services. The FAA is expected to create standards for BVLOS operations in the near future.
The Mass General Brigham and Mayo Clinic programs represent a different use case. Both health systems plan to use drones to transport medical supplies to and from the homes of patients in acute hospital at home programs. Those programs, which have gained traction since the pandemic, require hospitals to combine digital health and telehealth services with in-person care for patients in their homes, as an alternative to in-patient care.
The complexity of the program might mean that drones would be used almost every day to send medical supplies to the patient’s home and/or transport tests and specimens from the home back to the hospital.
“At Mass General Brigham, we are looking at the future of healthcare, and part of that vision is taking care of patients in the comfort of their homes,” David Levine, MD, MPH, MA, clinical director of research and development for the Mass General Brigham Healthcare at Home program, said in a press release. “In accomplishing this at scale, we understand that we need to continue to evolve our processes to support home-based care. These types of technological solutions allow us the opportunity to create a paradigm shift in our care delivery.”
NewYork-Presbyterian is partnering with March of Dimes to launch a mobile health vehicle targeting underserved communities in New York City where access to care is limited
NewYork-Presbyterian is going mobile to address maternal health disparities in New York City.
The health system is partnering with March of Dimes to roll out the Mom & Baby Mobile Health Center to underserved communities in The Big Apple. The mobile health vehicle will offer pregnancy, post-birth, and women’s health services to residents who can’t or don’t access healthcare services on a regular basis, regardless of insurance coverage.
Nationwide, hundreds of health systems and hospitals have launched mobile health programs aimed at addressing key population health concerns, targeting communities where access to care is difficult. Mobile maternal health programs are particularly vital given the nation’s high maternal mortality rate.
Locally, according to the March of Dimes, one out of every 18 births in NYC involves a woman who received little or no prenatal care.
"The Mom & Baby Mobile Health Center offers a bridge to care," Auja McDougale, MD, the mobile center's medical director and an obstetrician/ gynecologist at NewYork-Presbyterian/Weill Cornell Medical Center, said in a press release. "Bringing patients into the healthcare system so they have ongoing much-needed medical care is vital for healthy moms and healthy babies."
The 40-foot-long vehicle will be staffed by NYP providers and offer full obstetric and well-woman exams, prenatal and postpartum care, screenings for cervical cancer and sexually transmitted infections (STIs), breast exams, vaccination, laboratory testing, ultrasounds, contraceptive counseling, mental health screenings and referrals, and education about caring for a newborn with breastfeeding support for new mothers.
The AMA's CPT Editorial Board has hit a stalemate over proposed changes that would boost reimbursement for RPM, so what does it mean for its future?
A push to improve reimbursement for Remote Patient Monitoring (RPM) programs has stalled, and that could prompt health systems and hospitals to think twice about launching or expanding their platforms.
According to social media and news reports, the roadblock is coming from the American Medical Association’s 21-member CPT Editorial Panel, which hasn’t been able to agree on amendments to the CPT codes covering RPM services. The panel indefinitely suspended the proposed changes at its May meeting.
RPM was initially recognized in 2019 by the Centers for Medicare and Medicaid Services (CMS) through a small set of codes for remote physiologic monitoring services, enabling clinicians to seek reimbursement for gathering data from patients through certain medical devices outside the hospital setting. CMS has slowly amended and expanded those codes since then, adding codes for remote therapeutic monitoring.
Advocates have long argued that the codes are too restrictive on everything from what devices can be used to what conditions are covered to what data can be gathered. In all, providers can only expect to receive about $170 in Medicare reimbursements per patient per month.
At issue is the requirement that a healthcare provider collect at least 16 days of RPM data from a patient over a 30-day period to bill for Medicare reimbursement through CMS Providers and RPM advocates have long argued that the threshold is too high, that some programs don’t need 16 days of data, and that the reimbursement doesn’t cover the time and effort put into collecting the data. But a proposal before the CPT committee to create new “supply of device” codes that would have allowed providers to be reimbursed for less than 16 days of data over a 30-day period didn’t get the support to move forward.
“Since separate payments for [RPM] services were established, industry stakeholders have advocated against this 16-day requirement arguing that it is clinically arbitrary and ignores conditions where a reduced number of days would be more clinically appropriate,” Thomas Ferrante and Rachel Goodman, partners in Foley & Lardner’s Telemedicine & Digital Health Industry Team, said in a 2023 blog.
During the COVID-19 Public Health Emergency, CMS relaxed the rules, dropping the RPM threshold to two days instead of 16. But when the PHE officially ended on May 11, 2023, the 16-day threshold was returned. A bill initially introduced in 2021 and resubmitted each year by U.S. Reps. Katie Porter of California and Troy Balderson of Ohio has sought to extend that relaxed threshold for two years and prompt the U.S. Health and Human Services Department to study a long-term solution, but the bill hasn’t made it out of committee.
The issue has hampered the development of new RPM programs, as health systems and hospitals often rely on Medicare reimbursement to sustain those programs. Without that financial support, some organizations may decide against launching or expanding their platforms.
The AMA’s CPT Editorial Panel next meets on September 19-21. Whether any changes to RPM codes are on that agenda remains to be seen.
Health systems in Minnesota and Nevada are getting more than $30 million in grants to support ECMO programs, which treat patients with severe heart and lung conditions
A global philanthropy is donating more than $31 million in grants to health systems in Minnesota and Nevada to expand access to innovative life support technology that could help save lives in rural areas.
“ECMO can be a game changer for patients with severe heart and lung conditions,” Walter Panzirer, a trustee with the New York-based organization, said in a press release. “Without ECMO, hospitals have to transfer patients to other facilities, and those who are too unstable for transport could die before receiving needed care.”
ECMO provides prolonged cardiac and respiratory support for people whose heart and/or lungs are unable to provide an adequate amount of oxygen, gas exchange, or blood supply to sustain life. The technology used is similar to a cardiopulmonary bypass machine, and the device used is a membrane oxygenator, also known as an artificial lung.
As profiled in a November 2023 story in Scientific American and a March 2024 story in The New York Times Magazine, ECMO technology could be used during CPR—in a process called ECPR, or extracorporeal cardiopulmonary resuscitation—to treat patients in cardiac arrest at accident and disaster scenes and rural locations. The procedure has been in use for more than a decade in France, is being trialed in the Netherlands and was first performed in the U.S. by emergency physicians in 2019 at the University of New Mexico.
The procedure has the support of the National Institutes of Health, which ended a 2020 clinical trial at the University of Minnesota early, saying it would be unethical to deprive eligible people of the treatment, after it was reported that ECPR resulted in a survival rate of 43%, compared to 7% in traditional care. Other studies haven’t been so positive, including one published in 2023 in the New England Journal of Medicine, which compared ECPR with standard care across 10 medical centers in the Netherlands and found little difference in survival rates.
In Minnesota, the Helmsley trust has given $19.7 million to the University of Minnesota to expand and sustain a mobile ECPR program launched in 2022 with a van specially fitted with ECMO technology.
In Nevada, the trust is granting more than $5.1 million to the St. Rose Dominican Health Foundation to launch an ECMO program at Dignity Health-St. Rose Siena Hospital in Henderson. The grant will be used to add four dedicated ICU rooms and an adjacent sleep room for patients suffering from acute respiratory distress, recovering from cardiac arrest, or awaiting a heart or lung transplant.
(The foundation is also getting a $1.7 million grant to help renovate the hospital’s four cardiac catheterization labs and upgrade vascular disease imaging services for patients with coronary artery and structural heart diseases.)
Another $3.5 million will go to the Renown Health Foundation to establish an ECMO program at Renown Regional Medical Center in Reno, the first such program in the northern part of the state.
A $1.2 million grant to University Medical Center of Southern Nevada, initially made in 2023, helped to create a program with four ECMO machines, and the health system plans to add another seven machines in the near future.
The Arizona-based health system is rolling out to all 33 hospitals across 6 states a new tool designed to help clinicians ease their documentation burden
One of the nation’s largest health systems is scaling an AI tool across the enterprise in hopes of giving doctors more time in front of their patients.
Arizona-based Banner Health is giving clinicians in all 33 of its hospitals across six states access to a tool within the EHR that summarizes clinical notes. The technology, developed by Regard, is designed to reduce the clinician’s time spent in front of a computer and facilitate easier access to decision support for care management.
The project is indicative of a trend in healthcare, with health systems and hospitals across the country putting AI to work handling back-end and administrative tasks that otherwise would be done by doctors or nurses. Industry leaders see these projects as “low-hanging fruit” that prove AI’s value and offer immediate ROI.
“We are looking for multiple ways to take tasks away from clinicians and replace that with time they have in front of the bedside,” says Susan Lee, DO, MBA, CP, the health system’s Physician Executive for Hospital Based Medicine. “We want to be AI-enabled.”
“The more that we can envision these tools as enhancers and not replacers, I think organizations will successfully adopt them,” she adds.
Lee says the health system, which tested the tool at Banner Thunderbird Medical Center in 2022, took the unusual step of asking that each clinician be trained one-on-one, rather than via video or in a classroom. The idea is to personalize the clinician’s use of AI and make it more meaningful.
“I think for this tool, the ability to impact such a broad swath of clinical care in a meaningful way made us want to pursue the more personal route,” she says.
This also helps with buy-in, as clinicians come to understand that AI can augment their workflows rather than replacing them. Lee points out that clinicians need to select the tool in the EHR, review the summary, and act on it.
“There’s also a human at the end of the AI loop,” she says. “The physician is still making all the clinical decisions. This tool is helping the physician sort through information in a more rapid way and is also sorting through a very large portfolio of information that the physician could manually sort though, [but] it just does it a lot faster.”
Whether the tool actually improves documentation or care management remains to be seen. Lee says the health system will at first keep tabs on how many clinicians are using it and how often. They’ll also look at whether the tool captures all the information a doctor needs and whether that summary is accurate.
It’s also important to see how this tool evolves. As with any AI technology, the platform becomes more sophisticated as more data is introduced. Lee says Banner Health’s clinicians have been and will continue to offer feedback on the tool, giving Regard more insight into what works for clinicians and what doesn’t. That feedback should help in how the technology evolves, while also giving clinicians the confidence to use a tool they they had a hand in developing.
“Banner is looking to be a front-runner in many of these scenarios,” Lee says of the opportunity to influence a tool’s development. “We do want to be influencers. I think everybody should try playing with it.”
The health system is getting feedback from the front lines to make sure its Virtual Nursing program will meet expectations and become a permanent part of patient care
Virtual nursing programs require careful planning. And no one knows that better than the nurses.
“Including those bedside nurses [in planning] is the most important thing you can ever do,” says Laura Gartner, DNP, MS, RN, RN-BC, NEA-BC, Associate CNIO for Jefferson Health. “Because if you just try to [drop] a program into their unit without taking what they think is important, it’s not going to be successful because it’s not going to fit into their day or what they would value.”
Gartner is one of the point people for the Philadelphia-based health system’s Virtual Nursing program, which is entering its second iteration after a 90-day pilot in 2023 on two floors of one hospital. They’ve sharpened their focus now, she says, with funding for a more durable model and clear goals for sustainability and scalability.
“We’re not calling it a pilot any more because we’re not piloting this,” she says. “We know we’re moving forward with it.”
Jefferson Health is one of a handful of health systems across the country taking part in the HealthLeaders Virtual Nursing Masterminds program, a series of virtual meetings capped off by an in-person event in June. The program is taking a deep dive into virtual nursing strategies with perspectives from some of the top health systems and executives in the country.
Gartner says involving nurses in every phase of the program is crucial, because they know what will work and what won’t. And as Jefferson Health moved beyond the pilot and began to map out a more permanent program, those nurses helped to point out that the bedside nurse and the virtual nurse are two different roles requiring unique skillsets.
“A lesson we learned is that talking to a person through a computer is much different than talking to a person where you can, say, touch their shoulder,” Gartner says. The bedside nurse has always had that in-person connection to patients that influences every task from care delivery to communication. Simply taking a nurse, putting him or her in front of a computer in a separate room and telling him/her to continue being a nurse won’t cut it.
“That’s a little bit of a different conversation and skill set,” she notes, adding that Jefferson Health is working with a local nursing school to plot how to teach “webside” manner.
Gartner says the health system “threw out a broad net” in coming up with goals for the pilot, and has since narrowed its focus.
“With that first phase pilot, use cases came out of the woodwork,” she notes. “But if you focus on everything, do you really make a difference on anything?”
Where they do want to make a difference is on stress, which affects everything from nurse turnover to quality and safety.
That’s why it’s important, Gartner says, to create a partnership between the floor and virtual nurse, so that they’re working together on patient care. And that involves making sure both nurses are comfortable in their roles and their environments.
“I do hope that goes beyond just assigning the tasks to someone, so more of that working in concert with each other, being part of that care team, like you were there on the floor.”
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexceling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
The House Ways and Means Committee has approved a bill that would extend CMS pandemic-era telehealth waivers another two years and the Acute Hospital Care at Home waiver another five years
While prospects look dim for making pandemic-era telehealth waivers permanent, a bill before Congress could at least extend some flexibilities and one popular program beyond the end of this year.
The House Ways and Means Committee has voted to advance the Preserving Telehealth, Hospital and Ambulance Access Act (HR 8261), which would, among other things, continue pandemic-era Medicare waivers enacted by the Centers for Medicare and Medicaid Services (CMS) for telehealth access and coverage through 2026 and extend the CMS Acute Hospital Care at Home waiver for an additional five years, to the end of 2029.
Those waivers had been set to expire with the end of the COVID-19 Public Health Emergency but were continued to the end of this year.
With regard to telehealth waivers, the proposed legislation would waive geographic and originating site restrictions on telehealth delivery, enable federally qualified health centers (FQHCs) and rural health clinics (RHCs) to use telehealth, expand the list of providers able to use telehealth, allow providers to use audio-only telemedicine platforms, such as the phone, and enable behavioral health providers to treat patients via telehealth without a required initial in-person evaluation.
In addition, the bill would give health systems five more years to seek reimbursement from Medicare for Hospital at Home programs that meet the requirements of the AHCaH waiver. More than 300 health systems are currently running programs that meet the CMS requirements.
Supporters say the House committee’s markup and approval of the bill is good news at a time when positive steps forward are hard to find. A number of bills before Congress have sought to make the telehealth and Hospital at Home waivers permanent, but despite seeing widespread support on both sides of the aisle, none of those bills appear to be going anywhere this year.
“While we prefer Medicare telehealth flexibilities be made permanent, we understand the dynamics and applaud the Committee for a two-year extension of many of the critical flexibilities without arbitrary and unnecessary guardrails such as in-person requirements,” Kyle Zebley, senior vice president of public policy for the American Telemedicine Association and executive director of ATA Action, said in a press release.
Zebley pointed out that the committee’s markup and approval of the bill isn’t a guarantee that Congress will pass or even vote on the bill. He also noted that some proposals, including one that would ease rules around the use of telehealth to prescribe controlled substances, were left off the passed bill.
“This is not over yet,” he said. “There will be additional markups and other committees need to weigh in, as we continue to push for telehealth permanency.”
A UCSF study has found that a ChatGPT-4 LLM can prioritize Emergency Department patients for treatment with 89% accuracy
Healthcare organizations looking for help prioritizing patients in the Emergency Department could benefit from an AI tool developed by researchers at the University of California San Francisco (UCSF).
Researchers tested the ChatGPT-4 large language model (LLM) on 10,000 sets of patients seen at the UCSF ED between 2012 and 2023, and found that the tool accurately assessed clinical acuity in 89% of the cases. A subset of 500 cases evaluated by a clinician as well as AI found that AI outperformed the clinician, 88% to 86%.
The study, which appears this week in JAMA, could give health systems a valuable tool for triaging ED patients, particularly during times of heavy traffic or staff shortages. By assessing severity more quickly, the hospital could direct ED staff to those patients in need of emergency care and speed up time to treatment, eventually improving clinical outcomes.
“Imagine two patients who need to be transported to the hospital but there is only one ambulance, or a physician is on call and there are three people paging her at the same time, and she has to determine who to respond to first,” Christopher Williams, MB, BCHir, a UCSF postdoctoral scholar at the Baker Institute and lead author of the study, said in a UCSF press release.
Using data from more than 250,000 ED visits, Williams and his colleagues used an AI model to extract data from clinical notes and determine the severity of the injury. They then compared that analysis to the patient’s score on the Emergency Severity Index (ESI), which rates patients on a scale of 1-5 and is used by ED nurses to prioritize care delivery.
The ESI “uses an algorithm to categorize patients arriving at the ED, estimating the severity of their condition and anticipated future resource use,” Williams and his colleagues said in the study. “The ESI is assigned based on a combination of initial vital sign assessments, the patient’s presenting symptoms, and the clinical judgment of the triage clinician, who is often a trained registered nurse. By capturing clinical acuity at triage, the ESI can be used as a surrogate marker to evaluate, at scale, whether LLMs can correctly assess the severity of a patient’s condition on presentation to the ED. This can be achieved by providing the LLM with patient clinical histories documented in ED physician notes, prompting the model to compare histories to determine which patient has the higher acuity, and evaluating the model output against the ground truth as determined by ESI score.”
While proving the value of the AI tool, Williams pointed out that the technology shouldn’t be introduced to an ED just yet. An incorrect assessment could cause delays in treatment that could harm the patient or even lead to death. In addition, AI tools could reflect biases caused by the data used to train the model, further expanding care gaps for underserved populations.
“It’s great to show that AI can do cool stuff, but it’s most important to consider who is being helped and who is being hindered by this technology,” William said in the press release, while calling for more clinical trials and research. “Is just being able to do something the bar for using AI, or is it being able to do something well, for all types of patients?”
The South Carolina health system, part of the HealthLeaders Virtual Nursing Mastermind series, is learning to measure ROI in specific, actionable tasks, such as communication
A key component to launching an effective Virtual Nursing program is communication. How will the virtual nurse communicate with the floor nurse, as well as with the patient?
“Clear delineation of roles and communication is going to be really important,” says Emily Warr, administrator for the Center of Telehealth at the Medical University of South Carolina (MUSC), which launched a second iteration of its Virtual Nursing program about six months ago and is now monitoring the program in five hospitals.
Warr says it’s critical to identify specific KPIs in evaluating the success of a Virtual Nursing program, and to focus on small, measurable actions rather than larger concepts. For example, it’s great to say such a program will reduce time spent on admissions and discharge, but there are many factors that go into those processes that Virtual Nursing won’t affect.
“A virtual nurse, as one member of the team, cannot carry all of the factors that impact, say, an HCAHPS score on a unit,” she points out. A more effective way of measuring value would be to focus on single factor, such as how communication between nurses affects admissions or discharge times.
MUSC is one of a handful of health systems across the country that are taking part in the HealthLeaders Virtual Nursing Masterminds program, a series of virtual meetings capped off by an in-person event in June. The program is taking a deep dive into virtual nursing strategies with perspectives from some of the top health systems and executives in the country.
MUSC launched its first version of a Virtual Nursing program about two years ago, with a focus on mentoring new nurses. Warr said that program didn’t produce the ROI needed to be sustainable, so the health system looked for more “hard outcomes.” That led to a discussion about how to identify meaningful outcomes and understand the KPIs that go into defining a program’s value.
“We needed to focus on something that we felt we could impact and choose to measure,” she says, such as “very specific, task-oriented things.”
In the six months that version 2.0 has been in play, Warr says they’ve learned a few things about those tasks. During the first two months, as everyone was getting used to the new approach, the virtual nurse would often reach out to the floor nurse to take tasks. But as time has passed, the floor nurse is reaching out more often tp the virtual nurse to hand off tasks. In other words, the two nurses are communicating more freely (and equally) about their workflows.
Warr anticipates those conversations will lead to a smoother or more seamless collaboration between floor nurse and virtual nurse, which in turn will lead to better administrative outcomes and, eventually, improved clinical outcomes.
“We’re still learning and evolving (in) what we’re tracking … and where we’re able to make a measurable impact,” she says. But the results so far are truly encouraging.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexceling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
The health system will be launching a new platform this month to improve care management for patients in cancer treatment
As health systems across the country look for small but significant ways to use AI, Intermountain Health is putting the technology to work improving care management for patients in cancer treatment programs.
The Salt Lake City-based health system is partnering with San Francisco’s Memora Health on a care management platform designed to reduce the workload on nurses and give patients quick and seamless access to the resources they need.
"The moment a person is diagnosed with cancer, their life changes,” Derrick Haslem, MD, Intermountain’s senior medical director for cancer care, said in a March press release announcing the partnership. “Being able to provide consistent communication with patients to address questions and concerns about their care is critical and very important to us, Memora's technology helps our busy care teams with daily tasks and empowers them to focus on what matters most: delivering high-quality care to our patients."
Phil Wood, program director for Intermountain Ventures, says the health system is looking for ways to insert AI into care management pathways that typically take a lot of time and effort. By using the technology to handle messaging, which is primarily and administrative task, Intermountain is freeing up its nurses and clinicians to focus on clinical work.
“It doesn’t change the messaging,” Wood points out. “Clinicians want to have control over the patient’s care. This [creates] a more effective way of communicating … and gives nurses back their time to focus on more acute and urgent cases.”
The platform uses AI to help patients with their care plan once they’ve left the hospital or doctor’s office, answering patient questions and guiding them to online resources. When a question or concern is complex, the system connects the patient with the care team for follow-up.
Wood, noting Intermountain hopes to have the program up and running by the end of this month, says success hinges on whether the patients engage with the platform and feel comfortable with the technology. Early KPIs will focus on engagement surveys and patient satisfaction scores, while other benchmarks will target whether patients follow their care plans, especially in medication adherence, and whether operational workflows are improved.
As health systems look to adopt consumer-facing technology, healthcare leadership will need to focus on those questions. Where can technology replace a clinician and where might it interfere with the relationship between doctor (or nurse) and patient? And can the platform (and the health system) adjust to patients uncomfortable with the technology and preferring more in-person interactions?
Wood says the oncology space is the ideal space to test the platform because of the importance of communicating with patients at home. Once this program is established and the value proven, he expects to expand it to other surgical services, and perhaps eventually into chronic care management. At the same time, Intermountain will be looking for new opportunities for EHR integration as the health system continues its switch from Cerner to Epic.
“Having an easy way for the patient to interact with the health system” is crucial to improving patient engagement and clinical outcomes, he says.
