By Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
Once while I was scrolling through the news feed on my phone, there was one specific line that really made me wonder: “There’s a 40 percent chance of gusty and blustery winds today.” Statements such as this one strongly influence people’s behavior, as they are based on evidence or data findings from years of surveying, studying, and analyzing past trends and occurrences. However, my question is “Why are we not able to make such claims in healthcare- even today?”
Can we predict the vulnerabilities a patient might face in the future or the current health risks a population segment faces?
Is risk scoring the answer we have been looking for?
Almost all kinds of care organizations have some risk scoring methodology to target care interventions. With quality, costs, and patient experience taking the center stage in healthcare, care organizations need to stratify patients based on their need for immediate intervention.
The need of the hour is to address high-risk issues that impact large groups of patients and ensure that these needs are met in a timely fashion. Often, frequent fliers among high-risk patients come into the emergency department as if it’s their second home.
What if we take the method of risk scoring to a whole new level?
Traditionally, providers and health systems have relied on claims-based risk models, such as CMS-HCC, ACG and DxCG, which were built to forecast the risk of populations/sub-populations but not for individual patients. Hence, these models give an accurate prediction of the average risk of the population but exhibit very poor accuracy if used to predict risk for individual patients.
Although risk scoring has turned out to be a key factor in addressing the needs of the patient population, this method cannot provide all the important insights that are needed to drive necessary interventions. Since healthcare already has the right data from sources such as EHRs, claims, labs, pharmacy, social determinants of health (SDoH) and others, can we predict the future cost of care instead of just stating the risk score of the patient?
The right machine learning-driven approach to predict the future cost of care for patients
It all starts with the right data. The first step is to integrate the data from multiple sources- whether it is clinical or non-clinical data, such as SDoH. The data from these sources can allow us to use the comprehensive patient’s data for multiple predictive models to predict future health cost with greater accuracy.
Partners HealthCare announced its selections for the fifth annual “Disruptive Dozen,” the 12 emerging artificial intelligence (AI) technologies with the greatest potential to impact healthcare in the next year. The technologies were featured as part of the World Medical Innovation Forum held in Boston to examine AI in clinical care including a range of diseases and health system opportunities.
Gregg Meyer, MD
“Understanding state-of-the-art medical technologies enables us to anticipate the future of clinical care,” said Gregg Meyer, MD, chief clinical officer, Partners HealthCare and 2019 World Forum co-chair. “The Disruptive Dozen technologies can offer physicians and patients a renewed sense of optimism about Artificial Intelligence and its impact on diagnosis and treatment.”
The 2019 Partners HealthCare Disruptive Dozen are:
1 Reimagining medical imaging – AI is transforming radiology and imaging, including mammography and ultrasound, to bring improvements in clinical care and diagnoses to patients worldwide. Researchers envision AI transforming mammography from one-size-fits-all to a more targeted tool for assessing breast cancer risk, and further increasing utility for ultrasound for disease detection and rapid acquisition of clinical-grade images.
2 Better prediction of suicide risk – Suicide is the 10th leading cause of death in the U.S. and the second leading cause of death among young people. AI is proving powerful in helping identify patients at risk of suicide (based on EHR data,) and also examining social media content with the goal of detecting early warning signs of suicide. These efforts toward an early warning system could help alert physicians, mental health professionals and family members when someone in their care needs help. These technologies are under development and not cleared for clinical use.
3 Streamlining diagnosis – The application of AI in clinical workflows such as imaging and pathology is ushering in a new era of AI-enabled disease diagnosis. From identifying abnormal and potentially life-threatening findings in medical imaging, to screening pathology cases according to the presence of urgent findings such as cancer cells, AI is poised to aid the diagnostic, prognostic, and treatment decisions that clinicians make while caring for patients.
4 Automated malaria detection — Nearly half a million people succumbed to malaria in 2017, with the majority being children under five. Deep learning technologies are helping automate malaria diagnosis, with software to detect and quantify malaria parasites with 90 percent accuracy and specificity. Such an automated approach to malaria detection and diagnosis could benefit millions of people worldwide by helping to deliver more accurate and timely diagnoses and could enable better monitoring of treatment efficacy.
5 Real-time monitoring and analysis of brain health – a window on the brain – A new world of real-time monitoring of the brain promises to dramatically improve patient care. By automating the manual and painstaking analysis of EEGs and other high-frequency wave forms, clinicians can rapidly detect electrical abnormalities that signal trouble. Deep learning algorithms based on terabytes of EEG data are helping to automatically detect seizures in the critically ill, regardless of the underlying cause of illness.
6 “A-Eye”: Artificial intelligence for eye health and disease – Not only is AI is helping advance new approaches in ophthalmology, it’s demonstrating the ability of AI-enabled technologies to enhance primary care with specialty level diagnostics. In 2018, the Food and Drug Administration approved a new AI-based system for the detection of diabetic retinopathy, marking the first fully automated, AI-based diagnostic tool approved for market in the U.S. that does not require additional expert review. The technology could also play a role in low-resource settings, where access to ophthalmologic care may be limited.
7 Lighting a “FHIR” under health information exchange — A new data standard, known as the Fast Healthcare Interoperability Resources (FHIR) has become the de facto standard for sharing medical and other health-related information. With its modern, web-based approach to health information exchange, FHIR promises to enable a new world of possibilities rooted in patient-centered care. While this new world is just emerging, it promises to give patients unfettered access to their own health information — allowing them to decide what they want to share and with whom and demanding careful consideration of data privacy and security.
8 Reducing the burden of healthcare administration — use of AI to automate routine and highly repetitious administrative functions. In the U.S., more than 25 percent of healthcare expenditures are due to administrative costs, far surpassing all other developed nations. One important area where AI could have a sizeable impact is medical coding and billing, where AI can develop automated approaches. The goal is to help reduce the complexity of the coding and billing process thereby reducing the number of mistakes and minimize the need for intense regulatory oversight.
9 A revolution in acute stroke care — Stroke is a major cause of death and disability across the world and a significant source of healthcare spending. Each year in the U.S., nearly 800,000 people suffer from a stroke, with a cost of roughly $34 billion. AI tools to help automate the diagnostic journey of ischemic stroke can help determine whether there is bleeding within the brain — a crucial early insight that helps doctors select the proper treatment. These algorithms can automatically review a patient’s head CT scan to identify a cerebral hemorrhage as well as help localize its source and determine the volume of brain tissue affected.
10 The hidden signs of intimate partner violence – Researchers are working to develop AI-enabled tools that can help alert clinicians if a patient’s injuries likely stem from intimate partner violence (IPV). Through an AI-enabled system, they hope to help break the silence that surrounds IPV by empowering clinicians with powerful, data-driven tools. While screening for intimate partner violence (IPV) can help detect and prevent future violence, less than 30 percent of IPV cases seen in the ER are appropriately flagged as abuse-related. Healthcare providers are optimistic that AI tools will further complement their role as a trusted source for divulging abuse.
InTouch Health, ranked 2019 Best in KLAS for Virtual Care Platforms, announced the release of the industry’s first fully integrated, end-to-end virtual care platform. Solo by InTouch delivers enterprise solutions to provide scalable, patient-centric telehealth for any use case in any setting – with packages enabling compelling price points for every situation.
Joseph M. DeVivo
“We’ve spent a lot of time listening to our customers and we heard their need for a truly integrated solution that allows a physician to have a virtual, everyday interaction with patients whether they are in the home, clinic, emergency room, inpatient in a hospital – anywhere on the care continuum locally or anywhere in the world with one platform,” said Joseph M. DeVivo, InTouch Health CEO. “Coming off the heels of winning Best in KLAS for Virtual Care Platforms, we want to continue solving our customer’s problems by delivering the most comprehensive capability on the market. The latest KLAS analysis further proved that there was an industry-wide need for EHR and third-party software integrations across platforms. In order to fill that gap, we created the next generation of our software platform to provide clinicians with an intuitive, web-based interaction that allows access to all of the tools they need through a single interface.”
With prominent healthcare leaders projecting that upwards of 50 percent of care can be delivered virtually, Solo by InTouch powers the first of its kind platform that healthcare providers can leverage for every type of user and use case, including direct-to-consumer, direct-to-patient, provider-to-provider, clinics, worksites, EDs, and more.
“Healthcare providers are facing an immense amount of pressure to retain and attract new patients from both inside the system and the external, new market entrants,” said Steve Cashman, chief commercial officer at InTouch Health. “Virtualizing their practices as appropriate creates an opportunity for providers and patients to connect in ways that can meaningfully improve quality, access, and cost. Solo by InTouch is the first of its kind integrated platform that considers health systems’ large investments in EMR systems and can offer capabilities to every user from simple follow ups, to ambulatory clinics, to emergent care.”
The new software platform runs through the proactively monitored InTouch Network and will provide the same clinical reliability InTouch customers know and trust. It will include an updated user interface for seamless virtual visits, IT integration capabilities designed for interoperability, and end-to-end care coordination, with newly-scaled pricing. Additional capabilities will also allow for the basic audio/video connections clinicians need to facilitate telehealth for low-acuity interactions, such as post-op follow-up with a patient and getting a second opinion from a colleague during a virtual visit. These new capabilities are designed to deliver the flexibility for all healthcare providers — from small practices to large health systems — to scale their telehealth services across basic, low-acuity interactions to life-saving, emergent consultations.
Cambia Health Solutions and Pager announced a strategic partnership to improve care coordination and delivery for millions of consumers. Pager’s proprietary care navigation platform combines advanced chat-technology with real human clinical services to enable a trusted, personalized and convenient experience for people throughout their care journeys.
Laurent Rotival
“A complex array of care delivery options is available today and consumers are struggling to understand and navigate these fragmented services,” said Laurent Rotival, senior vice president strategic technology solutions and chief information officer, Cambia. “Partnering with Pager allows us to innovate with a like-minded, consumer obsessed, team to deliver best-in-class end-to-end experiences.”
Through a combination of human touch and technology, Cambia is transforming the industry and the way people engage with the health care system. The company is a national leader for innovation, technology and digital experience for consumers.
“Cambia and Pager have a shared vision to deliver a seamless consumer experience for how people access their health care,” said Walter Jin, CEO, Pager. “As our collaboration grows, we are confident that people are going to have an experience that will transform the way they engage with their health care. This is a significant milestone in Pager’s history and I can’t wait to share more as we progress.”
Syapse announces that the Syapse Oncology platform has achieved certified status for information security by HITRUST. This certification audits healthcare-specific security, privacy and regulatory requirements including HIPAA, NIST, ISO and COBIT, as well as industry best practices and provides a single evaluation framework that is designed for the unique needs of Syapse’s health system customers.
“Syapse is scaling one of the largest global networks of health systems and we are committed to building secure and resilient infrastructure for powering precision medicine solutions in cancer care. Our health system partners are under immense pressure to meet complex compliance requirements and through certifications like HITRUST CSF we are helping them solve the technical and process elements of best practices in information security,” said Vinod Subramanian, senior vice president, cloud operations at Syapse. “Syapse is proud to demonstrate its deep commitment to security by achieving the high bar set through HITRUST CSF certification. It’s a validation of our team’s threat awareness and our growing investment in protecting customer data.”
The precision medicine solutions that Syapse provides to its health system customers are developed with a comprehensive understanding of the risk environment and the corresponding needs they identify. For example, every health system working with Syapse retains all access and usage rights to their organization’s data. In addition to the HITRUST CSF certification, Syapse has instituted safeguards, policies, and procedures to protect health system data in compliance with federal health laws such as the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH), as well as various state data privacy laws across the country.
“The HITRUST CSF has become the information protection framework for the healthcare industry, and the CSF Assurance program is bringing a new level of effectiveness and efficiency to third-party assurance,” said Ken Vander Wal, Chief Compliance Officer, HITRUST. “The HITRUST CSF Certification is now the benchmark that organizations required to safeguard protected health information are measured against with regards to information protection.”
With a recent study revealing a substantial rise in heart attacks among younger women, developers of cardiac medical technology are seeking to help reverse this trend. The study, published in the journal Circulation, examined the incidence of heart attacks in women ages 35 to 55, finding: From 1995 through 1999, this population accounted for 21 percent of reported heart attacks among all women; and from 2010 through 2014, that number increased to 31 percent of reported heart attacks among women.
That’s an increase of nearly a third in just 10 to 15 years – a huge jump in epidemiology terms for a cardiovascular condition that is not known to be communicable. It’s especially disconcerting because the incidence of heart attacks among men in the same age group barely budged during that time.
Heart disease in women often goes undetected or un-diagnosed. Then, when a cardiac event finally strikes, it is much more lethal:
Younger women have worse heart attack outcomes than men of a similar age.
Ages younger than 45 is a known predictor of 30-day survival for men, but not for women.
Gender differences in cardiac events
There are a number of reasons for these poor outcomes. Because the symptoms of a heart attack are different for women than men, women often attribute their symptoms something far less serious. But even when younger women experiencing heart attack symptoms do seek medical treatment, doctors themselves have struggled to get to an accurate and timely diagnosis.
Women are less likely to experience dramatic chest pains. Instead, they are more likely to experience fatigue, nausea, dizziness/lightheadedness and vomiting – symptoms that can cause doctors to mistakenly diagnose women with other conditions, thus delaying treatment.
The difficulty is compounded by the fact that spontaneous coronary arterial dissection (SCAD) – a form of heart attack that overwhelmingly affects women – is not as highly correlated with known heart attack precursors such as diabetes and hypertension. Unlike myocardial infarction, SCAD often strikes healthy women, with an average onset age of about 42 – with reported cases as young as 14.
These relatively healthy and active women are not thought of as high risk for a heart attack when they present, and so are even less likely to receive important diagnostic procedures like CT angiograms, coronary calcium scans and remote cardiac monitoring.
According to a study from the University of Leeds, women who had a final diagnosis of ST-elevation myocardial infarction (STEMI) were initially misdiagnosed 59 percent more often than men, while women who had a final diagnosis of non-ST elevation myocardial infarction (NSTEMI) were initially misdiagnosed 41 percent than men.
Early misdiagnosis predictably led to substantially higher mortality among young women experiencing their first heart attack. Even when women do seek treatment, and get a cardiac event diagnosis, they are less likely to receive the same treatments that men do:
A study published in the International Journal of Cardiology showed that both younger and older women with acute coronary syndrome are less likely to receive reperfusion.
Women with blocked coronary arteries were 34 percent less likely than men to receive stents or bypass surgery.
Women were 24 percent less likely to be prescribed statins.
Women with known heart issues were also 16 percent less likely to be put on an aspirin regimen.
Medical technology advancements
Fortunately, new technology can play an important role in the fight to track and diagnose cardiac events earlier and faster. Advances in data storage and management, deep learning, artificial intelligence and secure telecommunications are helping to make cardiac monitoring and diagnosis easier, faster, less invasive, more convenient and more economical for patients and doctors alike.
Healthcare technology is advancing quickly and this is precisely why executives need to be aware of all new technologies that can make their healthcare organisation more efficient and more impactful. This may seem difficult – staying on top of things and implementing new technologies always is, but it brings immense benefits and great results. While many technology advancements come with all that fame that is often not necessary, it can make patient satisfaction better. It can also improve cost savings and this is really important for the future of your organisation.
So, in this spirit, here are some of the most amazing tech advancements that can help your healthcare organisation become better and take another step towards the future.
Blockchain
Blockchain can make interoperability ai reality. You can solve many problems between healthcare organisations and it’s a solution that healthcare industry has been looking for for many years. It can decentralize the record systems and have multiple locations that can be shared with more stakeholders. This will help the healthcare system immensely and it can operate within different stakeholders in the healthcare systems. Instead of having a single client database, you can include both clinical and financial data on one server and in an independent, transparent database.
“Blockchain technology can share data in a safe system and put the clients and their needs at the center of the attention. Still, healthcare industry is a decade away from implementing blockchain in a meaningful way,”says Ingrid Fulton, a tech editor at Draft beyond and ResearchPapersUK.
Artificial intelligence
Artificial intelligence can help with better oncology. Veterans Affairs is helping with this as a part of their precision oncology program which supports patients that have stage 4 cancer and that have tried all other methods of getting better. They are using AI to help use cancer data in the treatment of these patients. They are also veteran.
They treat more than 3.5 percent of patients in the US and this is the largest group of patients with cancer within any healthcare groups. This includes veterans from rural areas where it has been hard for them to implement better technology, especially something of this value.
Patient is not a word typically used to describe the current generation of tech savvy, time saving, health conscious millennials – and it shows in their healthcare decisions, too. Fewer individuals choose to see their primary care physician, and more are turning to quick clinics or urgent care offices for care. According to a survey by NPR, one in five respondents reported going to an urgent care facility at least once in the last two years for common ailments because of the lack of available appointments at their primary care provider. And typically, urgent care offices can guarantee same day appointments, with short wait times of 30 minutes or less.
Although patients are commonly turning to these solutions to meet their needs, most still prefer being treated by their own doctor who knows them and their medical history. Ask patients why they opted to go to the urgent care center, or even more cumbersome, the emergency room for a non-emergent issue and the answer generally boils down to convenience. Primary care physicians are finding a solution through telemedicine that not only provides their patients with additional options for care but can increase practice revenue.
Telemedicine provides patients with the opportunity to meet with their doctor regarding common yet non-life-threatening conditions. Some of the conditions that are most commonly treated through telemedicine in a primary care setting are a cough, runny nose, sore throat, musculoskeletal pain, pink eye or urinary symptoms that do not warrant a physical exam to diagnose. Additionally, lab reviews, medication refills, and managing widespread chronic conditions including diabetes and hypertension can be effectively handled through virtual visits.
By seeing these patients virtually in addition to in-office visits, these physicians can maximize their time by increasing the number of patients they see in a day while still maintaining a quality level of care. Happier patients, and increased revenue? Who could ask for better.
Here are some of the most common conditions that Dr. Kaufmann of the Kaufmann Clinic, one of the primary care practices that uses ExamMed’s technology, treats virtually through telemedicine:
Cough/Sore Throat: Many patients see the provider for a sore throat unknowing if it’s strep throat, allergies or a cold. A virtual appointment can determine if in-person testing and/or antibiotic treatment is needed.
Urinary Symptoms: Urinary infections are extremely common. Although a less common condition for men, according to the National Institute of Health, 50 percent to 60 percent of women will experience a UTI in their lifetime. Urinary infections can easily be managed virtually, including diagnoses and treatment.
Follow-up Appointments: Many follow-up appointments do not require a physical examination. Rather than taking the time to travel to a doctor’s appointment to discuss a new medication, patients can talk with their doctor virtually.
Pink Eye: A highly contagious infection, pink eye is diagnosed in more than three million people each year. Rather than potentially exposing others to the germs, pink eye can be easily diagnosed, treated and reevaluated through virtual appointments.
While telemedicine is not the solution for all appointments, it is a great addition to couple traditional, in-person visits. Virtual care enhances a practice’s capabilities, improves patient outcomes and offers a convenient option. Blending telemedicine services into a medical practice is a strategic move that will benefit both patients and providers long-term.
Syapse
