Health systems are learning that they need to plan carefully to give consumers access to services on a mobile platform.
Healthcare organizations are finding that an effective patient engagement strategy involves more than just opening a patient portal. A good platform not only gives consumers access to health system services and resources, but allows them to access those services on the device and at the time and place of their choosing—all without overwhelming either the consumer or the provider with unnecessary steps or tasks.
John Lock, chief transformation officer at MedStar Health. Photo courtesy MedStar Health.
The patient engagement—or patient experience—landscape has changed dramatically over the past few years, in part due to the challenges imposed by the pandemic but also because of the shift to patient-centered healthcare, a philosophy that's been around for about a decade. The advance of mHealth devices and telehealth platforms has created new channels for accessing care and given the consumer more power to choose how and where to get that care. Healthcare executives are finding that they can no longer sit back and wait for the consumer to come to them; they must be proactive, reaching out to the consumer, or that consumer will go somewhere else.
"You need to create a boundary-less experience for the consumer," says Lock, in which MedStar Health has been working on its own technologies and strategies for the past decade through the MedStar Institute for Innovation. "For us, it's part of … being on the path of becoming digital rather than just doing digital."
The challenges posed by being digital, rather than doing digital, lie in the culture shift that this creates within the health system. At healthcare organizations, new ideas and technology aren't always readily and easily embraced. Health systems need support throughout the institution to adopt new services and adapt to new ideas, and those in charge of leading that change need to make sure doctors and nurses are on board.
"Digital transformation is significant," says Lock. "The work that goes into this, when you've been doing something the same way for a long time," is extensive.
Easy to Visualize, But Difficult to Implement
Patient engagement is a tricky term, and one that might mean different things to the consumer and provider. Surveys done by different sources over recent years indicate more than half of all consumers prefer digital tools for such tasks as appointment reminders and follow ups, and about 60% want to share their health data virtually with providers. About half want to communicate with a doctor via digital channels, and 70% say they'd choose providers based on digital access.
Mobile might seem like a cool term that can be added to any service to make it more popular, but the journey from a portal to portability isn't easy.
At Atlantic General Hospital in Berlin, Maryland, Vice President and CIO Jonathan Bauer, CHCIO, said patient engagement through the portal was a top priority at the hospital when he came on board in 2017. But adding mobility to the mix took a lot of time and resources, and in 2019 hospital leadership felt the cost was too much.
Jonathan Bauer, vice president and CIO, Atlantic General Hospital. Photo courtesy Atlantic General Hospital.
COVID-19 changed that strategy. Suddenly mobility was a necessity, as the hospital needed to stay in touch with patients who were staying home. Atlantic General contracted with Allscripts to roll out the FollowMyHealth portal, along with its telehealth platform, and made use of federal grants to expand the service.
Bauer said the pandemic forced the health system to act quickly, but they knew the numbers were there to support mobility.
"Ninety-seven percent of all Americans have a cell phone and 85% have smartphones," he said in an e-mail. "We knew if we could start relying on sending text messages to patients' cellphones, we would have a better chance to reach them."
"The fact that patients no longer have to sign up or into a portal account to receive reminders, messages, and protected health information [PHI] is a huge win," Bauer added. "We are reaching more patients with less involvement from our staff. We are able to prioritize those patients who require contact and to make sure we are completing the circle of care."
Like so many other health systems, Atlantic General saw rapid support for messaging and telehealth, but ran into problems when they considered expanding into scheduling.
"The staff was very receptive to most of the deployment until campaigns like online scheduling and waitlist notification started altering their schedules," Bauer said. "This was not well received, and we are still struggling with these two campaigns as of today. We are trying to find that happy medium where the technology lets the user schedule an appointment but does not disrupt the office flow. Our deployment strategy was based on bringing the easier campaigns live first and easing into the more difficult ones."
The challenges underscore an overlooked aspect of being mobile. What's great for consumers might not be that good for providers.
"The first piece of advice would be to make sure [the providers] understand how each office is manipulating its existing schedule," Bauer says. "One of the main reasons online scheduling was not well received is the fact each office was manually manipulating its schedules to meet the provider's preference. Sitting down with each office and documenting their workflow would help understand how online scheduling and waitlists will affect them."
"The next step we are looking to take is to start using the data we are collecting. MPE [mobile patient engagement] collects a tremendous amount of data that can be used to guide decisions about care. One change we are looking at in the short term is expanding the questions that are asked after an appointment. Currently, we are getting a 6% response rate but we are only asking two questions. We want to expand that to four questions to capture more detail about the patient's encounter."
Adding Scheduling to the Patient Portal
MedStar Health has integrated scheduling into its mHealth portal, but the process wasn't easy. One of the bigger challenges, Lock says, was moving from legacy health IT platforms to more nimble tools that have mobility baked into the back end.
Many health systems are facing that challenge now. The newest generation of digital health tools and platforms no longer sits outside the electronic health platform but integrates with existing platforms to create a seamless experience. For hospitals that have used the same platforms for a decade or two, that transition might have a few more seams than expected.
"We are moving toward interoperability," Lock says. "You're lifting data from legacy systems that you need, and you're getting data from all these new [platforms], and you're trying to make them work together."
With scheduling, Lock says the platform MedStar Health is using incorporates AI technology that can match a consumer's healthcare needs to the most appropriate care provider. This ensures not only that the consumer is being matched with the right provider, but that the provider is seeing patients that he or she should be seeing.
The process includes input and buy-in from clinicians, he said, as well as from other departments whose services will be affected. The health system even spent a year talking to patients and consumers about what should be included. Sometimes it takes a while, and a few changes and test runs to make sure the end result meets everyone's expectations.
"The business transformation that goes along with the digital transformation is significant," he says.
MedStar's portal now boasts several features, including access to records and test results, online registration, check-in and appointment scheduling, and medication reminders. It's a step-by-step process, Lock says, and the next step is to integrate specialty care.
"It's more complicated than just creating an entry point," he notes.
The future, Lock says, will lead to a more personalized platform, with itineraries tailored to the specific patient and access to more health and wellness resources. Consumers will be able to pay their bills online, and manage data from wearables and other smart devices. On the other end, clinicians will be able to use the platform to not only communicate, but collaborate with patients on care, rather than waiting for them to pick up the phone or come into the office or hospital.
The whole idea behind using digital technology, Lock says, is to reduce repetitive steps and redundant actions that push people away from healthcare until they show up in a clinic or ER with a critical health issue that needs to be addressed. The technology should be intuitive, guiding consumers directly to the care provider who can best address the issue at hand.
"We wanted to be able to [create a platform] that doesn't just say, 'Call us,' " he says.
A $2.14 million grant will be used by the University of Virginia to bolster the Wisdom and Wellbeing Peer Support Training Program, which helps healthcare workers and first responders deal with stress and burnout.
The University of Virginia is using more than $2 million in federal funding to bolster an innovative new program aimed at helping stressed healthcare workers and first responders.
A $2.14 million grant form the Health and Human Services Administration, using money from the American Rescue Plan and Lorna Breen Act, will support the Wisdom and Wellbeing Peer Support Training Program, launched by Richard Westphal, a professor at the UVA School of Nursing, and Margaret Plews-Ogan, MD, MS, chief of the Division of General Medicine, Geriatrics and Palliative Medicine at UVA’s Department of Medicine.
The program is one of many being launched or expanded across the country to deal with soaring rates of stress, depression and burnout in the healthcare ranks. In many cases they’re using new technologies or strategies to expand their reach and improve access to care and resources.
“I have been doing this work for 30 years, and it's been in the last 24 months that the world has discovered that [healthcare worker burnout] is a thing,” Westphal said in a UVA release. “We're going to be using the $2.1 million to train broadly across the entire health system — [the medical] school, nursing school, and healthcare workers in the five-county area — how to use wisdom and resilience practices to support each other.”
The program aims to take the support skills that healthcare workers and first responders are trained to use on others in distress and apply them to colleagues and peers. Westphal and Plews-Ogan note that many frontline workers who prioritize helping others fail to recognize or deal properly with stressors in their own lives.
“One good thing about [the pandemic] is that it brought absolutely front and center the stressors that the healthcare workforce was already beginning to groan under … so it actually could be dealt with,” Plews-Ogan said in the news release.
The federal money will be used, in part, to expand the program to include Charlottesville City and UVA facilities and clinics in surrounding counties. Westphal said it will now reach frontline workers in remote parts of the state that often don’t have easy access to these resources.
The Health Data Use and Privacy Commission Act, introduced earlier this month in the Senate, would create a commission to study how HIPAA can be updated to take into account new technologies, including digital health and telemedicine.
The Health Data Use and Privacy Commission Act, sponsored by US Senators Bill Cassidy (R-LA) and Tammy Baldwin (D-WI), would cerate a new health and privacy commission to advise Congress on “how to modernize the use of health data and privacy laws to ensure patient privacy and trust while balancing the need of doctors to have information at their fingertips to provide care.”
The proposed legislation takes aim at a 25-year-old law that was instrumental in creating guidelines for the dissemination of personal health data, but has since come under attack for being outdated. The proliferation of online resources, telemedicine and digital health platforms has given healthcare organizations new avenues for accessing, collecting and analyzing information – and opened the door to new ways that such data can be misused.
“As a doctor, the potential of new technology to improve patient care seems limitless. But Americans must be able to trust that their personal health data is protected if this technology can meet its full potential,” Cassidy said in a Feb. 9 press release. “HIPAA must be updated for the modern day. This legislation starts this process on a pathway to make sure it is done right.”
The commission would consist of 17 members, to be appointed by the Comptroller General, and would report back to Congress and the President six months after all members are appointed. That report would offer recommendations on:
The potential threats posed to individual health privacy and legitimate business and policy interests;
The purposes for which sharing health information is appropriate and beneficial to consumers and the threat to health outcomes and costs if privacy rules are too stringent;
The effectiveness of existing statutes, regulations, private sector self-regulatory efforts, technology advances, and market forces in protecting individual health privacy;
Recommendations on whether federal legislation is necessary, and if so, specific suggestions on proposals to reform, streamline, harmonize, unify, or augment current laws and regulations relating to individual health privacy, including reforms or additions to existing law related to enforcement, preemption, consent, penalties for misuse, transparency, and notice of privacy practices;
An analysis of whether additional regulations may impose costs or burdens, or cause unintended consequences in other policy areas, such as security, law enforcement, medical research, health care cost containment, improved patient outcomes, public health or critical infrastructure protection, and whether such costs or burdens are justified by the additional regulations or benefits to privacy, including whether such benefits may be achieved through less onerous means;
The cost analysis of legislative or regulatory changes proposed in the report;
Recommendations on non-legislative solutions to individual health privacy concerns, including education, market-based measures, industry best practices, and new technologies; and
A review of the effectiveness and utility of third-party statements of privacy principles and private sector self-regulatory efforts, as well as third-party certification or accreditation programs meant to ensure compliance with privacy requirements.
The bill is supported by a number of organizations, including the American College of Cardiology, Association for Behavioral Health and Wellness, Association of Clinical Research Organizations, Executives for Health Innovation, Federation of American Hospitals, Heath Innovation Alliance, National Multiple Sclerosis Society and United Spinal Association. Also supporting the bill are Teladoc, Epic, IBM and athenahealth.
In a blog posted this week, Sydney Swanson, an associate with the Morgan Lewis law firm, and W. Reece Hirsch, a partner with the firm, said HIPAA doesn’t regulate digital health companies that collect data from consumers or reference new technologies like mHealth apps and wearables. The bill, they said, “seeks to close the gap between existing protections and risk to personal health information (PHI) created by new healthcare technology that extends beyond the scope of HIPAA.”
“Recommendations based on the above studies could involve updates to HIPAA to cover a broader range of entities using PHI or new federal legislation covering health data, as the commission would be instructed to assess ‘any gaps in the privacy protections [under HIPAA] resulting from data collection and use by non-covered entities,’” they wrote. “Any such legislation might alter the Federal Trade Commission’s current authority to regulate many direct-to-consumer digital health products that are not subject to HIPAA pursuant to Section 5 of the FTC Act.”
“Proposed legislation stemming from the studies may be based on state law, such as the California Consumer Privacy Act of 2018 (CCPA), as the commission would be instructed to evaluate relevant proposed state legislation and existing state law,” Swanson and Hirsch added. “New legislation may also be inspired by General Data Protection Regulation (GDPR), as the commission would be instructed to evaluate privacy protections undertaken by foreign governments and international governing bodies.”
The American Academy of Family Physicians is looking to help primary care providers shift from a fee-for-service model to a prospective payment strategy that offers less administrative work and more time with patients.
The American Academy of Family Physicians is partnering with a digital health company to help primary care providers spend less time on administrative work and more time with patients.
The AAFP has launched an innovation lab with San Francisco-based Hint Health to study how the company’s HintOS platform can help providers with member enrollment, administration, eligibility, billing, collections, and other services. The platform, which focuses on prospective payments and value-based care, is positioned as an alternative to traditional fee-for-service (FFS) models that require extensive overhead and administrative time that pull providers away from caregiving.
“The family medicine experience is based on a deeply personal physician-patient interaction, but today’s fee-for-service (FFS) model and many technologies used in practice have eroded the experience rather than enhanced it,” Dr. Steven E. Waldren, the AAFP’s vice president and CMIO, said in a press release.
As part of the innovation lab, the AAFP surveyed 10 physician practices who used the HintOS platform. All reported that the technology gave them “ample time” with their patients, increasing those visits from an average of 15 minutes to about 45 minutes, and allowed them to expand their patient base to include more underinsured or uninsured patients.
Primary care physicians have been struggling to balance patient care with the administrative demands of running a practice, a responsibility that figures considerably into soaring rates of stress, anxiety and burnout. Tech vendors like Hint Health offer a variety of services aimed at outsourcing or automating those tasks so that doctors can practice medicine.
“HintOS addresses the operational requirements of the DPC prospective payment model, which frees physicians from the FFS treadmill and enables them to focus on their patients,” Waldren said in the press release. “Through this process, we further validated myriad benefits, including that DPC offers improved access and time with physicians and is an avenue to expand needed primary care services. The impact of this study suggests that prospective payment, such as seen with DPC, may be the ideal model for family physicians.”
The partnership with the AAFP comes as Hint also expands its reach. The company recently launched Hint Connect, a nationwide network aimed at giving employers a single point of access to independent primary care providers, in Texas, with plans to expand to Florida, Arizona, Colorado and Oklahoma in the next three months.
The University of Alabama at Huntsville is studying how drones can be used to ferry medications and other medical supplies to rural healthcare sites and facilitate critical tests.
Researchers at the University of Alabama in Huntsville (UAH) say a recent simulation test has proven the value of drones in delivering critical medications and other supplies to rural residents.
The UAH team, comprised of members from the College of Nursing and the UAH Rotorcraft Systems Engineering and Simulation Center (RSESC) Unmanned Aircraft Systems (UAS) Program, created a scenario in which a rural hospital receives a pregnant woman at risk for preterm labor. Nurses at the hospital perform a focused preterm labor assessment and receive a prescription for fetal fibronectine (fFN) and betamethasone – but neither are available at the hospital or anyplace nearby.
This is where a drone comes in handy. An urban clinic or hospital uses the drone to send the medicine and an fFN testing kit (fFN is a protein produced during pregnancy that’s used to predict risk for preterm delivery and betamethasone is vital for maturing fetal lungs in the event of preterm birth) to the hospital. The nurses use that kit to perform a test, then send the results back to the urban location via the drone.
“This simulation was designed to promote creative and viable decision-making by nurses,” Darlene Showalter, RN, CNS, a clinical associate professor and DNP program coordinator at UAH who led the simulation, said in a UAH press release. “We are equipping our students to collaborate and think through real-life issues that serve as obstacles to healthcare equity.”
The project is the latest of several conducted by UAH that focuses on using drones for healthcare services, and one of several healthcare organizations around the country that are testing or using drones in both urban and rural areas. Utah-based Intermountain Healthcare recently launched a program to deliver prescriptions and other medical supplies in and around Salt Lake City; others testing the idea include WakeMed Health & Hospitals in North Carolina, Kaiser Permanente (which is using drones to deliver prescriptions to a retirement community in Florida) and the Rady Children’s Institute for Genomic Medicine in San Diego.
At UAH, Azita Amiri, PhD, MSN, RN, an associate professor of nursing at UAH who has been leading the research program with RSESC research engineer Casey Calamaio for about two years, says the latest simulation is a step toward using drones throughout healthcare.
“This simulation model can also be used as a pilot for medical services delivery in our hospital systems in Huntsville,” she said in the press release. “Our team is now working on a simulation where we have a case of an overdose in a rural area, and a drone is used to deliver the life-saving medication naloxone to reverse the effects of opioids.”
“This demonstration provided a simple scenario to test unmanned aerial delivery solutions in a campus environment,” Calamaio added. “We also had a chance to identify areas with radio frequency interference in urban environments, considerations for UAS traffic management, and to discuss effective ways to introduce UAS in the local medical community.”
While drone services are closely regulated by the Federal Aviation Authority and currently restricted to package delivery, healthcare organizations are working with the federal agency to develop and launch pilots and programs.
“Significant coordination with the FAA to safely implement a rural UAS delivery system is required,” Calamaio said. “Challenges in assured operational safety and regulatory compliance need addressing before UAS are used as delivery mechanisms on the scale to tilt the medical supply chain in a significant way.”
The Borowy Family Children’s Critical Care Tower will offer not only the latest in digital health technology, but a glimpse into the future of healthcare innovation—for adults as well as children.
As Baptist Health opens the Borowy Family Children's Critical Care Tower today at the Baptist Medical Center Jacksonville and Wolfson Children's Hospital campus, visitors will marvel at the sleek design and complex technology that combine to make the seven-story tower a shining example of the evolution of pediatric healthcare.
But the real evolution won't be evident. It'll be contained inside the technology, showing up on mobile devices and dashboards, giving healthcare providers new and precise data to improve care and clinical outcomes for the health system's smallest and most fragile patients.
"This is really where the future is," says Michael Aubin, FACHE, president of Wolfson Children's Hospital and chief philanthropy officer for the Baptist Health Foundation. "We're making sure that we give our staff the tools they need to maximize outcomes."
The three-year, $224 million project puts Wolfson Children's Hospital at the pinnacle of pediatric care, offering a look not only at the latest in healthcare innovation but a glimpse of where these technology platforms and services will be going. The hospital serves a roughly New England—sized swath of northern Florida, home to more than 1.1 million children, and sees well over 1,000 admissions a year.
The seven-story, 127-suite tower, which opens today, consists of three floors devoted to neonatal intensive care patients, including a unit for micro preemies, or babies born on or before 26 weeks; two floors housing pediatric critical care patients; a neuro ICU; a cardiovascular ICU; and two beds devoted to severely burned or wounded patients.
Michael Aubin, FACHE, president of Wolfson's Children's Hospital and chief philanthropy officer for the Baptist Health Foundation. Photo courtesy Baptist Health.
Each patient bed is connected to a digital health platform developed by Philips, with sensors and AI technology that can capture and translate at least 138 key elements of data. That data is critical to patient care, Aubin says, because most of these patients are too small or underdeveloped to support traditional wearables or sensors.
Making Use of Machine Learning Technology
This, in fact, is where a lot of the innovation is focused these days in the digital health space. Health systems and hospitals are poised to embrace new technology that captures key patient data, both inside the hospital and at home, but they want to make sure that technology analyzes and sorts that data, giving it specific value for providers. It's one thing to track and collect key physiological data, and quite another to make it meaningful.
Aubin points out that many young babies, especially those in neonatal care, present similar data, even as each baby is completely different, with different needs and concerns. A monitoring platform must recognize those differences and drill down to specific data points, identifying trends that are important but might not set off traditional alarms.
"It's very specific," he says. "And when two or three [data sets] are going in the wrong direction, we have to know about that immediately."
Those AI capabilities, Aubin says, are "the holy grail of healthcare" these days, particularly in pediatric care. And healthcare organizations that focus on pediatric care, he says, must be careful selecting those platforms.
"It's all about the software now," he says. "There are lots of innovative ideas out there right now, and there are systems that do predictive analytics but they're very niche. It's still an evolving field for pediatric ICUs."
Beyond that, it's also important to establish the right atmosphere for doctors and nurses, especially in a high-pressure area like the neonatal ICU, where stress is constant and burnout is a concern. Aubin says the potential for sensors and AI technology is great, but management must present these platforms not as a replacement for care providers but an assistant, another set of eyes and ears that allows them to improve care management and coordination.
"First of all, we don't want the machine to be telling us what to do," he says. "The first step is to make sure that [doctors and nurses] know they're not being told what to do. The machine is giving them the information they need to make those decisions and giving them all the data they've been looking for."
Innovations in Imaging
Another important innovation included in the new tower is an MRI system developed by Aspect Imaging, enabling the hospital to include imaging in the new tower instead of transporting them to another part of the hospital campus. Aubin notes that many infants in the neonatal ICU are in extremely delicate condition and can't be wheeled down to another part of the hospital for an MRI.
The Embrace Neonatal MRI platform offers several benefits, including continuous thermal support, quiet operation, continuous visual monitoring of the baby during the MRI and a fully shielded magnet, which allows caregivers and parents to be nearby during the MRI. The machine, which is housed on the fourth floor and offers easy access to the NICUs above and below, is one of only four in the world and three in the United States (the others are located at Brigham and Women's Hospital and Yale New Haven Children's Hospital).
The Embrace points to another ongoing innovation in healthcare: The development of more compact, sometimes mobile devices that enable providers to move around and deliver services to the patient, rather than requiring the patient to come to the hospital for those services. Portable MRIs may be rare now, but the growing use of portable ultrasound platforms points to the future of mobility in healthcare.
As for Wolfson, Aubin says the Embrace Neonatal MRI system gives clinicians an opportunity to capture images that couldn't be done before, thus greatly improving care for delicate newborns. The system is FDA-approved for brain scans at present, he says, with the hope that it will soon be approved for body scans.
He's also hopeful of advances in Bluetooth-enabled wearable technology that will allow the hospital to use smaller and more discrete sensors that attach to patients or their clothing, thus gradually eliminating the connected and wired devices that are so common these days in neonatal ICUs and that keep patients literally tethered to their beds.
"I'm looking to disconnect these kids from everything except the IVs that they have to have," Aubin says.
And he's especially eager to see the development of rapid genomic processing, which could lead to the quick development of treatments for sepsis and other infections which too often become fatal.
"There's a lot out there right now that will help us in the future," he says.
A Comfortable Place for Patients and Their Families
While clinical outcomes are the focus of much of this innovation, Aubin isn't forgetting about comfort —not only for the patients, but their families as well. The 127 patient suites in the new hospital are nicer than most hotel suites, with private bathrooms, wardrobes, couches that pull out into beds, kitchens and laundry facilities, and separate TVs for the kids and their parents. Considering the average length of stay for a pediatric patient is almost four weeks, it's important to make that stay as comfortable for the patients as for their often stressed-out family members, he says.
Comfort and sound suppression are important, Aubin says, not only because his patients need to be in environments that maintain sound levels at 45 decibels or lower, but because the hospital complex sits right next to I-95 (thus making access easy). Both the windows and the doors are specially designed to cut down on sound, and iPads and TVs in the room are connected to Bluetooth earbuds. The iPads and TVs are linked to a wide-ranging platform developed by the GetWell Network, offering digital patient engagement services that include entertainment, communications, and access to educational resources.
That's an important and often overlooked resource because the goal of pretty much any hospital is to send those patients home. Creating a comfortable environment for the parents and caregivers, Aubin says, gives them more time to not only be with their children, but access resources and learn what they need to know to care for their children at home.
The American Medical Association and Manatt Health have teamed up to release a new report outlining how behavioral healthcare providers can use digital health tools and platforms to improve access and outcomes.
The American Medical Association has released a new report highlighting the value of digital health technologies in addressing the nation’s behavioral healthcare crisis.
In collaboration with Manatt Health Strategies and a group of healthcare experts, the AMA is highlighting several strategies, including telehealth and digital health tools, that it feels can improve access to behavioral healthcare services at a time when demand is high and care providers are in short supply.
“The demand for behavioral health services is significant and rising, but so is the potential for digital technology to support the integrated delivery of physical and behavioral health services,” AMA President Gerald Harmon, MD, said in a press release. “The AMA is committed to accessible and equitable treatment for behavioral and physical health needs, and appropriate use of digital health technology can drive behavioral health integration, particularly at time of increased psychological distress and trauma.”
The report, titled “Accelerating and Enhancing Behavioral Health Integration Through Digitally Enables Care: Opportunities and Challenges,” examines how technology platforms can be used alone and in hybrid models of care to enhance access and improve treatment outcomes. It also lays out the benefits for a wide range of stakeholders, including providers, health plans, policymakers, employers, and privately or publicly funded behavioral health companies.
Finally, the report lays out a value framework for introducing or integrating digital health platforms and tools, a model that the AMA has been highlighting recently through its “Return on Health” campaign for healthcare organizations.
Researchers from Brigham and Women's Hospital and Massachusetts General Hospital say AI technology could be used in a hybrid platform that improves how clinicians communicate with patients and their families about serious illnesses and palliative care.
AI technology is starting to show up in care management and coordination platforms as an avenue for interpreting data and communicating with patients, usually through chatbots, but is it appropriate for dealing with patients in palliative care?
In a recent article in NPJ/Digital Medicine, researchers from Brigham and Women’s Hospital and Massachusetts General Hospital say the platform could help care providers with serious illness communication (SIC) by smoothing over what is often a difficult process. But the technology needs to be integrated carefully in a hybrid platform.
Patients with serious illness often experience delayed SIC because clinicians are poor at prognosticating life expectancy for terminally ill patients, usually erring on the side of optimism,” says the January 27 article, authored by Isaac S. Chua and David W. Bates of Brigham and Women’s and Christine S. Ritchie at Mass General. “Moreover, systematic methods to identify patients with palliative care needs are lacking.”
SIC is a both complicated and delicate process. Providers first have to determine whether a patient is in need of palliative care services, then talk to that patient and his or her family about everything from life expectancy to end-of-life care.
The traditional SIC delivery process consists of a series of conversations where gathering, interpreting, and integrating SIC data occur within a clinical encounter followed by manual clinician documentation in the electronic health record (EHR) post-visit,” Chua, Bates and Ritchie write. “This process can be broken down into the following steps: determining patient eligibility for SIC; gathering and interpreting information (e.g., eliciting and clarifying the patient’s illness understanding, hopes, and worries); conducting a therapeutic conversation (e.g., counseling and supporting the patient on coping with life-threatening illness) with the goal of shared decision-making; documenting the conversation; and making SIC documentation accessible to others in the HER. However, each step is a potential bottleneck because the ability to initiate SIC or make forward progress depends heavily on the clinician’s ability, skill, and judgement.”
The researchers point out that many clinicians lack SIC training, and there are no clear standards to document how the process should be conducted or how the EHR facilitates documentation. This might lead to inaccurate or uncertain diagnoses and timelines, awkward and infrequent conversations and more anguish for patients and their caregivers.
“In addition to training more clinicians to be competent in SIC, a novel workflow that addresses these barriers will be necessary to ensure that all seriously ill patients receive timely and effective SIC that informs their care in real time and naturally results in documentation of patients’ goals and preferences that is visible to others,” the article suggests.
That workflow, Chua and his colleagues write, should by a hybrid strategy that combines AI tools in the background with in-person services that should always be the backbone of SIC. The technology would be used to gather and interpret data to ensure and accurate diagnosis and timeline, and to give clinicians the information they need to have those conversations with patients.
“AI can also streamline the SIC documentation process and potentially improve the quality of SIC documentation via natural language processing (NLP)—a form of machine learning designed to understand, interpret, or manipulate human language,” the article continues. “Missing or incomplete documentation in the EHR regarding patient preferences for life-sustaining treatment is common and contributes to medical errors related to end-of-life care.”
“NLP also has the potential to address barriers resulting from poor EHR design that prevent or inhibit the extraction and flow of meaningful advanced care planning information across the care continuum,” Chua and his colleagues continue. “In its current state, identifying SIC documentation in the EHR typically involves a manual chart review that possibly includes a keyword search or utilization of note filters. NLP-enabled software that identifies free text SIC documentation would likely reduce the time and effort clinicians spend looking for this information and prevent inadvertent oversight of patient preferences leading to goal-discordant care. AI-assisted chart reviews have demonstrated higher accuracy and shorter time for extracting relevant patient information compared with standard chart reviews.”
Finally, the AI platform could also be helpful in giving clinicians feedback on their communication skills, a critical component of discussing SIC with distraught patients and family members.
Chua, Ritchie and Bates conclude by noting AI technology can greatly benefit SIC, but some of those benefits aren’t there quite yet. A hybrid approach that integrates data analysis and NLP with in-person services would be an ideal platform, improving accuracy and eliminating gaps in care while giving clinicians more information and guidance to handle challenging and often delicate conversations. But the technology hasn’t been tested enough or isn’t developed far enough to be put to use in clinical situations.
“This proposed paradigm still requires that clinicians undergo some SIC training to capitalize on the assistance provided by AI, as well as additional research to avoid unintended consequences of AI implementation,” they write. “That said, a semi-automated approach to SIC delivery holds tremendous promise and would likely improve current SIC workflow by optimizing clinical manpower and efficiency while increasing the likelihood that these critically important conversations will occur effectively and in a timely fashion.”
Vanderbilt University Medical Center is joining forces with Carnegie Mellon University and Cornell University on a Defense Department-funded project to create an artificial lung that can be used by patients at home.
Three universities are joining forces to develop an artificial lung platform that can be used by patients at home.
Vanderbilt University Medical Center, Carnegie Mellon University and Cornell University are sharing a four-year, $87 million grant from the Department of Defense Congressionally Directed Medical Research Program (CDMRP) to create the platform, which would allow patients with incurable lung disease who can’t wait for a lung transplant or who aren’t viable candidates.
“The need for helping people with chronic lung disease is just so apparent, because it’s literally millions,” Matthew Bacchetta, MD, MBA, MA, a professor of surgery and adjunct professor of biomedical engineering at Vanderbilt who’s leading that research team, said in a press release issued by the university. “Transplant is obviously the only outlet for those patients. If you can’t get a transplant, you are stuck living with chronic lung disease. The need is quite great, and there is little out there that addresses it.”
The portable device would take the place of ECMO (Extracorporeal Membrane Oxygenation) system, a platform housed in a hospital’s ICU that can temporarily takes over the functions of the body’s heart and lungs.
More than 12 million people suffer from chronic lung disease, often in the form of chronic obstructive pulmonary disease (COPD). The Defense Department is spearheading the research because veterans are roughly three times more likely to develop COPD.
Vanderbilt’s team will focus on designing and testing the modes of vascular access and the ergonomics of the device as well as developing the gas exchange mechanism. The Cornell team will work on coating technology to make the platform more biocompatible. The Carnegie Mellon team will work with the Vanderbilt group on the gas exchange mechanism and develop the telemedicine platform that will allow patients to use the device at home while being monitored by caregivers.
“The intent is that this could potentially be used for years,” Bacchetta said in the press release. “It’s a very different design approach from ECMO, [which] is temporary and limited to an ICU setting. That’s not our design intent. We’ve completely erased that drawing board and created a new drawing board that is focused on management of chronic lung disease in a durable and enduring fashion, really as a destination therapy.”
The Pennsylvania health system is pointing to a recent survey that shows the digital health tool, which is now marketed by a company spun out of Penn Medicine, improves real-time care coordination.
Penn Medicine is touting the results of a study showing the value of a digital workflow tool, developed at the health system, that allows providers to better coordinate care between teams.
The tool, called CareAlign, pulls data from the electronic health record and allows multiple providers to access from different locations and schedule services, such as tests and specialist consults. It’s designed to give the patient’s care team real-time access via mHealth devices to the patient’s care management plan as it’s designed and updated.
According to a study recently published in Applied Clinical Informatics, the digital health tool saw widespread use across three hospitals in 2016, and has been positively reviewed by clinicians in surveys taken in 2016 and 2018, with steady use over at least four years.
Penn Medicine has since spun the service into a digital health company called CareAlign, which markets the tool to other health systems.
“This demonstrates that there is a definite need for clinician-facing platforms that build on to the investment health systems have made in electronic health records to help clinicians be more efficient, improve communication and streamline documentation,” Subha Airan-Javia, MD, an adjunct associate professor of Medicine in Penn’s Perelman School of Medicine and a former associate chief medical information officer at Penn Medicine who launched the company and now serves as its CEO, said in a recent press release.
The project points to a growing interest among healthcare organizations to develop their own digital health solutions to address long-standing gaps in care management and coordination, particularly as the technology becomes more sophisticated. Several health systems – including Penn Medicine – have set up their own digital innovation labs, and some have launched companies out of those labs to market their products.
It also highlights the need for innovative digital health solutions that can address gaps in care, particularly in inpatient settings where a patient with complex healthcare needs is being managing by a team of care providers not always in the same room, or even the same building. Through virtual care platforms and mHealth devices, those providers now have opportunities to collaborate and coordinate online.
According to executives, CareAlign was developed in 2014 in the health system’s Center for Health Innovation after Penn Medicine Chief Medical Information Officer C. William Hanson II, MD, asked Airan-Javia to design a tool that would “make the workflows around patient care easier and more efficient to manage.” The platform was originally designed to address hand-offs, then expanded to include overall care coordination, including digital rounding.
Airan-Javia and her team then introduced the tool to clinicians in Penn Medicine’s three Philadelphia hospitals. By 2020, they said, it had been adopted by 159 out of a possible 169 primary inpatient services.
“One way to interpret this finding is that users of this system are now able to review data to satisfy clinical questions more often, whereas, before, the accessibility of data made it more challenging,” Jacqueline Soegaard Ballester, MD, a surgical resident at Penn Medicine who served as lead author for the study, said in the press release. “Another interpretation is that with increasingly accessible data, more users are learning to incorporate this information into their work more often and in new ways. Increasing access to data may, in turn, help providers make more informed decisions and progress patient care more quickly.”
“Anything we can do to reduce clerical burden in healthcare is a step in the right direction,” she added. “That frees up clinicians to dedicate more time to non-clerical tasks and/or care for more patients. This is especially important given the increasing rates of burnout in the medical profession and the challenges we are facing amid the COVID-19 pandemic.”