Response by Kristin Simonini, vice president of product, Applause.
Healthcare has long been looked at as a laggard when it comes to adopting digital services. Part of that is due to the stringent regulations of the industry and the sensitivity surrounding personally identifiable information. Part of the blame, however, falls on healthcare providers themselves. As more and more providers in the industry start to embrace digital innovation, a number of key trends emerged over the past decade including:
The embrace of mobile technology for scheduling appointments and other routine tasks
Telehealth patients accessing doctors for consults, education, and certain outpatient treatments across a variety of fields
The IoT explosion (Fitbits and other wearables) providing customers health information to drive the healthcare they receive
Healthcare’s focus on patient experience means bringing a critical eye to current digital experiences. Ease-of-use and inclusivity must be considered to ensure high-quality digital experiences across all touchpoints, particularly on smartwatches, tablets, and smart speakers
In terms of predictions for 2020, we expect use of voice technology will continue to grow and empower the healthcare industry in new ways, including supporting patients. The benefits that voice brings to healthcare can be seen in medical record transcriptions, chatbots sharing the work, sharing knowledge, voice-user interface, and connecting clinics to customers.
In addition, AI will continue to impact the healthcare industry in numerous ways. As healthcare embraces AI, it will also need to address issues of bias. All types of AI – from virtual assistants learning how different users ask for the same thing, to healthcare apps identifying potential health issues from uploaded photos – have been hampered by the same challenge: sourcing enough data to teach the machine how to interpret and respond, and then testing the output at scale to ensure the results are accurate and human-like when necessary. To mitigate bias concerns, healthcare will need to make AI more representative of patients.
Baystate Health, the premier integrated health system serving more than 800,000 patients in western New England, announced a partnership with Life Image, the largest medical evidence network providing access to points of care and curated clinical and imaging data, to develop novel artificial intelligence tools that would help advance technical innovations in radiology, neurology and oncology.
Specifically, TechSpring, the innovation arm for Baystate, will work with Life Image to evaluate a number of AI solutions including those that promise to improve speed and accuracy in diagnosing blood clots in stroke patients; improve clinical pathways for physicians treating or diagnosing a patient by finding and comparing clinical criteria against a group of de-identified patients with similar clinical characteristics; and identify potential patient matches to oncology clinical trials in order to advance cancer research, as well as give western New England residents better access to potentially life-saving treatments.
Baystate and Life Image began working together 10 years ago when the health system became one of the company’s first customers. Life Image created the image exchange category when it developed solutions more than a decade ago to help solve the many technical and structural barriers that prevented the seamless exchange of medical images.
With its beginnings in image exchange, Life Image is now a global medical evidence network that offers ‘living’ datasets of novel imaging data that’s linkable to other clinical information and provides network access to points-of-care to enable improved care delivery, novel research and innovation.
It’s no secret that cyberattacks are escalating, rising in tandem with the growing sophistication of technology. One industry that has taken a massive hit by cyberattacks in recent years is the healthcare industry. The healthcare industry is increasingly reliant on technology and data connected to the internet, such as patient records, lab results, radiology equipment and hospital elevators. Now imagine if a cybercriminal encrypted an entire hospital’s data with a nasty ransomware. Doctors would be unable to pull up a patient’s medical records, or worse, utilize equipment connected to the internet to make a proper diagnosis.
Unfortunately, this is the reality that healthcare industry professionals are facing today. And while 92% of healthcare organizations are confident in their ability to respond to cyberattacks, there is a plethora of malicious activity that poses a great threat to their networks. Here are the main cybersecurity challenges faced by the industry today:
The Rise of Ransomware
You might recall the WannaCry attack of 2017, the ransomware worm that attacked hospitals as well as other industries by exploiting a weakness in Windows machines. This worm infected thousands of computers around the world and threw the United Kingdom’s National Health Service into chaos. This resulted in the Health Care Industry Cybersecurity Task Force to conclude that healthcare cybersecurity was in critical condition.
Why was the healthcare industry so impacted by this cyberattack? Many hospitals struggle to keep up when it comes to upgrading their operating systems due to the sheer volume of devices on the network. However, much of the software in a medical-specific device is often custom made, making system upgrades difficult. Additionally, manufacturers tend to avoid prematurely pushing out modifications that could potentially impact patient safety. For these reasons, medical machines continue to exist with outdated software, putting them at greater risk of cyberattacks such as ransomware.
Lack of Investment
Many organizations within the healthcare industry suffer from a lack of investment in cybersecurity solutions. Despite the number of breaches that occur, healthcare is behind other sectors when it comes to taking security measures. Only 4-7% of healthcare’s IT budget is allocated to cybersecurity, while other sectors allocate about 15% to their security practices. However, the finances associated with a cyberattack if these solutions aren’t put in place can take an even greater toll on an organization. Some hospitals and healthcare insurers see estimates of over $5 billion in costs as the result of cyberattacks on their systems. On top of the costs incurred finding a solution to fix these breaches, healthcare organizations then have to deal with fines from the Department of Health and Human Services Office of Civil Rights.
Securing Connected Devices
With the growing adoption of IoT, more and more devices are being connected and used in healthcare systems. However, as connected medical devices become more powerful and widely adopted, they become greater targets for malicious actors to exploit. According to the Cybersecurity in Healthcare report, over 16% of IT professionals can’t patch their own operating systems, leaving the network wide open for attack. Now imagine if a cybercriminal gained access to just one medical device on the exposed network. This could lead to the theft of sensitive patient data or even unauthorized access to an implanted device that could cause physical harm to the user.
Artificial intelligence (AI) has two faces in healthcare.
One face sings the praises of AI as the tonic that will enable healthcare to
deliver better clinical outcomes at a lower cost and the second face is full of
skepticism and raises barriers to adoption at every turn. It is heartening to
see that a third face is emerging, the thoughtful and appropriate use of AI to
predict adverse health events; to identify and stratify patients in need of
health, social, and human services; and the application of AI in the automation
of tasks, activities, and processes.
To understand the likely evolution of AI-based automation,
it’s important to evaluate the interaction of humans and machines across these
five levels. At each level of automation, the following questions must be asked
and answered:
Who produces insights? – Does the human
or the machine (AI) analyze data and deliver insights from such analysis? Does
the human or the machine describe what something is, how it trends, why
something is happening, and what might happen next?
Who decides and how? – Once all relevant
analysis has been conducted, does the human or the machine make the decision
based on the derived insights?
Who acts based on the decision? – Finally,
a decision should lead to an action by either a human or a machine? The action
can be in the digital or physical environment.
Based on the responses to these questions, IDC has
identified the following five levels of AI-based automation:
Human Led – At the first level, it is
the human who analyzes the data using limited technology, such as tools for
only descriptive analytics; it is the human who makes the decision based on the
analysis (or experience); and it is the human who acts based on the decision.
Human Led, Machine Supported – At the
second level, the human continues to lead data analysis, decision making, and
action steps but is now more reliant on the machine across these steps.
Machine-led, Human Supported – At the
third level, it is the machine that is using a wide range of analytic and AI
techniques to conduct the analysis and produce insights. These insights are
reviewed by humans. The human still makes the decision based on machine’s
recommendations, and it is the human who acts based on the decision. However,
at this level, the machine acts to provide oversight over human decision making
and execution.
Machine Led, Human Governed – At the
fourth level, the machine analyzes data and produces insights without the need
for human review. At this level, the machine decides based on the analysis of
all available data and a framework of human-developed governance policies and
procedures. At this stage, it is also the machine that acts based on the
decision under the governance of humans.
Machine Led – At the fifth level, the
world has likely achieved general AI. At this stage, there is a full AI-based
automation without the need for human involvement. At this level, we need to
think of machines that set their own goals and understand all mathematical,
economic, legal, and other external constraints. Most AI academics and experts
in labs of commercial enterprises predict this level of AI to arrive no sooner
than in about 50 years.
In
recent years, one of the shortcomings in the commercial sphere of AI has been
the misrepresentation of the scope of possible automation. Too often, we hear
claims of AI systems automating end-to-end processes and predictions of massive
labor losses, this does a disservice to organizations trying to plan for the
appropriate level of investment in AI. There is a need for a pragmatic
framework that decision makers across industries can use to assess
opportunities and risks of AI-based automation. The levels of AI-based
automation must also be viewed in the context of the scope of automation. We
define this scope where:
Task is the smallest possible unit of work
performed on behalf of an activity.
Activity is a collection of related tasks to be
completed to achieve the objective.
Process is a series of related activities that
produces a specific output.
System (or an ecosystem) is a set of connected
processes.
IDC’s AI automation framework was developed to help wade through the hyperbole associated with AI. Our goal is to help provide a planning tool and key piece of vendor evaluations processes to fully understand the role AI is playing in software and guide strategic decision making.
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.
Non-clinical factors can account for up to 80 percent of the health outcomes for patients. Such factors, including socioeconomic conditions, healthy behaviors, and physical environment, may vary drastically for each patient and can significantly impact health outcomes such as poor medication adherence, frequent visits to the ED, and more. Thus, it is essential to consider these factors while creating care plans to ensure that the specific needs of patients are addressed.
Additionally, healthcare’s transition to value-based care is pushing organizations to lead more efficient population health management programs that address every clinical and social need of the population in which they serve. The challenge, however, is that organizations don’t usually have the means to capture the social needs of the patients or address them beyond the four walls of a hospital to ensure that no care gaps remain unplugged.
To help healthcare organizations gain richer insights into social determinants of health (SDOH), Innovaccer Inc. announces the launch of its SDOH Management solution tailored to capture SDOH data and leverage it to deliver enhanced care, powered by its Data Activation Platform.
Innovaccer offers to assist healthcare organizations in a stepwise approach, starting with surveys for patients to complete in order to evaluate their social needs, such as access to food, housing situations, or economic conditions. Additionally, Innovaccer’s solution allows care teams to send as many surveys as needed with multiple language support. Based on the answers received from the survey, the solution helps care teams find suitable community resources to assign to the patient from a pre-built national database.
The solution’s AI-assisted closed-loop referral process to community resources enables care teams to ensure patient-centric care, even after an encounter is over. This closed-loop referral process gives physicians and social workers complete visibility into the social needs of their patients, which allows them to refer their patients to the most relevant community resources. In fact, patients are also kept in the loop in such a way that they can track their referrals, give feedback, and coordinate with their providers at any time, all through a single mobile application.
Innovaccer’s primary aim with this solution is to empower physicians and care teams with visibility into the social needs of their patients, right in the moment of care. The solution also triggers automated and real-time alerts to care teams if a patient’s needs are found to be urgent, such as high social risk or missed follow up. Additionally, the insights from the survey are available to the physicians right at the point of care within their EHR workflows, ensuring that they have a holistic picture of their patients.
“For organizations under value-based contracts, establishing a culture of wellness is a priority to keep their business model financially viable. Social determinants of health are a gamechanger in this regard and organizations who leverage them put themselves in the driver’s seat,” said Abhinav Shashank, CEO at Innovaccer. “We hope that our solution is instrumental to healthcare organizations as they tie their efforts to address social determinants of health and create similar strategies to maximize care and cost outcomes.”
Only recently, Innovaccer also launched its first-ever in-house research authored by Dr. David Nace, CMO at Innovaccer, around the social vulnerabilities of the population across the US. The research paper named “From Myth to Reality- Revolutionizing Healthcare with Augmented Intelligence and Social Determinants of Health” discusses a revolutionary way of leveraging advanced algorithms to determine the social vulnerability of the zip code-level population.
To learn more about Innovaccer’s SDOH Management solution, click here.
By Abhinav Shashank, co-founder and CEO, Innovaccer.
Abhinav Shashank
U.S. healthcare is nowhere near what technology made us dream of a decade back. Healthcare technology was meant to act as a means of reducing costs, eliminating burnout, and making care delivery patient-centric. Cut to today, where a broken leg can cost a patient as much as $7,500, seven out of 10 physicians do not recommend their profession to anyone, and we rank poorly among other developed countries in terms of the number of preventable deaths.
Why did technology fail?
While disruptive technology solutions did flood healthcare in the last couple of decades, many of them required physicians to go the extra mile to comprehend those sophisticated systems. Today, physicians are still crunching large data files day in and day out, nurses are doubling up as technical executives, and patients are perplexed by the fact that their providers hardly have time for them.
It’s time for technology to care
If a technology solution is not assisting organizations in improving care quality, reducing costs, and optimizing utilization levels, then its very relevancy is questionable. Healthcare organizations need technologies that can help them actuate their data, realize their strategic goals, and bring patients closer to their providers.
Health IT solutions should make the lives of providers easier. Any health IT solution that puts an additional burden on providers is unjustified and unacceptable. Providers are not data analysts, and expecting them to train tirelessly to understand an IT system and spend a couple of hours each day navigating through complex interfaces can drastically reduce physician-provider time and pave the way for physician burnout.
In with ultimate integration. We need to bring together EHRs, PHMs, payer claims and HIEs and put it all in the palm of the providers’ hands. Whether it’s quality management or data management, it should be simple.
In with relevant insights right at the point of care. Providers are tired of wading through complicated EHRs and excel sheets. What we need now is to seize the nanosecond and realize truly automated care delivery that helps boost the clinical outcomes.
In with 100 percent transparency and bi-directional interoperability. Healthcare providers are often forced to access bits and pieces of electronic healthcare analytics and referrals on disparate applications. Physicians need to capture real-time care gaps, coding opportunities, patient education opportunities, and more; the only problem is that they don’t know how exactly to accomplish this. Providers should be able to capture the gaps in patient care right when they need to and enhance the patient experience of care.
In with true patient-centric care. Healthcare is not just providing episodic care to patients, it is about building relationships with them. In a world where the quality of care directly influences the financial success of an organization, providers should look forward to aligning the needs of their patients to their treatment procedures.
Healthcare of the 2020s needs reliable data activation platforms
“If you can’t explain it simply, you don’t understand it well enough.” — Albert Einstein
Buzzwords like innovation, intelligence, and analytics make sense in today’s time; however, unless the user experience is seamless, the charisma of back-end development does little good for healthcare professionals.
We’re moving into an age of intelligence, and in this age, successful organizations do one thing right- they know the worth of their data. This is the same thing that we need to do in healthcare. Organizations have to switch from a makeshift approach to engage patients and find a concrete strategy that is suited to their advantage, but this needs to be done with the support of data.
It’s no secret that cyberattacks are escalating, rising in tandem with the growing sophistication of technology. One industry that has taken a massive hit by cyberattacks in recent years is the healthcare industry. The healthcare industry is increasingly reliant on technology and data connected to the internet, such as patient records, lab results, radiology equipment and hospital elevators. Now imagine if a cybercriminal encrypted an entire hospital’s data with a nasty ransomware. Doctors would be unable to pull up a patient’s medical records, or worse, utilize equipment connected to the internet to make a proper diagnosis.
Non-clinical factors can account for up to 80 percent of the health outcomes for patients. Such factors, including socioeconomic conditions, healthy behaviors, and physical environment, may vary drastically for each patient and can significantly impact health outcomes such as poor medication adherence, frequent visits to the ED, and more. Thus, it is essential to consider these factors while creating care plans to ensure that the specific needs of patients are addressed.