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Advancing clinical decision support and telehealth in times of crisis

Article-Advancing clinical decision support and telehealth in times of crisis

Virtual HIMSS 2020 put the spotlight on telehealth

The Healthcare Information and Management Systems Society (HIMSS) had to cancel its annual health IT conference due to growing concern over the novel coronavirus (COVID-19) outbreak, which was quickly becoming a pandemic. This marked the first time in nearly 60 years that the conference has been cancelled and as we have seen since, not only has every other conference been cancelled or postponed, but entire cities are now under quarantine. To salvage as much of the conference as possible, many of the scheduled on-site meetings carried on remotely. During the meetings, vendors highlighted technology that could potentially ease the strain for which many healthcare systems are now experiencing, including the following examples.

AI for the clinician

Omdia spoke with Tim Butler, Sr. Director of Acute Care Strategy and Marketing at GE Healthcare about a new collaboration with Roche called Graffiti.

Graffiti™ is a clinical virtual assistant with artificial intelligence (AI)-enabled skills designed to help simplify access to patient data and inform critical thinking from a mobile device. It enables clinicians to conversationally query the medical record while better coordinating patient care through real-time collaboration. While the tool was developed completely in-house, as a platform it utilises Amazon Web Services (AWS) and was trained on ‘tens of thousands of utterances.

Building on GE’s in vitro and Roche’s in vivo capabilities, Graffiti is designed to help heighten the situational awareness of clinical teams especially as they care for patients susceptible to deterioration, including sepsis. Graffiti may also prove valuable in situations where triage is needed. When asked about the U.S. Federal Drug Administration (FDA) approval, Butler noted that notifying based on changes in a patient’s condition will require FDA approval, but it is not required for the current version. Graffiti is being tested in one healthcare system with two more pending.

The radiology command centre

Omdia spoke with Dale Wiggins, General Manager of Philips HealthSuite Digital Platform, and Sham Sokka, Global Marketing and Ventures Leader in Precision Diagnosis at Philips Healthcare, about new ventures that the company has been investing. Among these are teleradiology, telepathology, and command centre capabilities for remote image acquisition. Within an integrated delivery network, this command centre can manage acquisition across the entire system, even remote locations. AI aids in the acquisition process, including patient positioning, patient throughput, and workforce management—cameras are also incorporated.

Philips Healthcare can have a remote imaging location set up and running within one week, and the company uses a multi-vendor approach concerning scanner hardware. This combination of AI and imaging centres closer to patients can prove useful in deploying triage in rapidly developing situations. Philips Healthcare is currently testing the command centre with two large radiology chains in the U.S., the teleradiology platform is now used by 400 hospitals, with 120 radiologists, doing 1.2 million exams per year.

AI-powered ambient clinical intelligence and the smart exam room

Peter Durlach, Senior Vice President, Healthcare Strategy and New Business Development at Nuance Communications, noted that the company has been fighting physician burnout with its conversational AI in products such as Dragon Medical and PowerScribe (speech recognition for clinical documentation). Now Nuance is taking the technology a step further with the Dragon Ambient eXperience (DAX)—exam rooms that are equipped with 14 microphones connected to software in Microsoft Azure cloud.

The DAX system can interpret and document up to six people speaking conversationally. The system can pull information from any health record and all documentation happens without further input from the clinician, this benefits revenue cycle management, as well as clinical decision support as more accurate and complete documentation of patient information, leads to better management of the care pathway. Microsoft had previously been working on PowerMD for this purpose but found it beneficial to partner with Nuance for the new service, which launched two weeks ago. It is in use with a few early adopters (including Novant Health, Rush University Medical Center, and SSM Health).

Preliminary findings show an 88 per cent improvement in physician satisfaction. The ability to capture examination details from an entire care team and patient simultaneously, while reducing physician burnout, may prove to be an enabler of high case throughput in times of crisis. Further to crisis management, Nuance is assisting its clients to quickly enable clinicians to work remotely. They are also helping to facilitate quick moves toward scaling telehealth services with their patient and clinician portal products. An example of this occurred last week as a healthcare system needed to scale from a few hundred connected physicians to several thousand within less than three days due to the recent COVID-19 outbreak.

Also concerning telehealth, the Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors, without having to travel to a healthcare facility. These policy changes build on regulatory flexibility provided under President Trump’s emergency declaration. The CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

Under this new waiver, Medicare can pay for office, hospital, and other visits furnished through telehealth services across the country and including in patient’s places of residence. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. Additionally, the Health and Human Services (HHS) Office of Inspector General is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programmes. Prior to this waiver, Medicare could only pay for telehealth on a limited basis such as when the patient is in a designated rural area and when they leave their home and go to a medical facility.

Incentivising better patient behaviour

‘Patientology CRM’ is one of the patient management tools from Welltok, designed to help providers improve margins through better patient management and facilitates one-on-one connections with patients. Chris Cosgrove, Market President at Welltok, noted that the platform can reinforce provider relationships to increase referrals and activate certain patient behaviours that support health. While the goal is to aid healthcare system clients realise the long-term value of each patient, it may also enable the rapid dissemination of critical and timely information at times of crisis. Welltok uses a proprietary consumer database of 275 million people and 800 variables, applying predictive analytics and AI to identify individual needs. Welltok integrates with the electronic medical record (EMR) and cost accounting systems and is in 50 healthcare systems in the U.S.

As of today, healthcare systems in much of the world continue to brace for rising incidences of the COVID-19 virus. There are widespread concerns over staff, bed, and device shortages, which have already become problematic in some of the hardest-hit cities. While public cooperation is essential to curbing the pandemic through sanitation and social distancing, there is a significant role that technology can play now and in future crisis. This includes applying cloud computing and AI to pharma development.

For instance, IBM has just announced that it will help coordinate an effort to provide massive computing power to scientists researching COVID-19. As part of a newly launched consortium known as the COVID-19 High Performance Computing (HPC) Consortium (which includes the White House Office of Science and Technology Policy, the U.S. Department of Energy, MIT, Rensselaer Polytechnic Institute, Lawrence Livermore National Lab, Argonne National Lab, Oak Ridge National Laboratory, Sandia National Laboratory, Los Alamos National Laboratory, NASA, the National Science Foundation, Microsoft, Google, Hewlett Packard Enterprise, and Amazon), research teams will have access to 16 systems with a combined 775,000 processor cores and 34,000 GPUs.

IBM anticipates that this massive capacity will be used to develop algorithms that assess how COVID-19 is progressing and to model potential therapies in pursuit of a vaccine. Further, in another effort to speed vaccine development, Lenovo and Intel have provided a large high-performance computing cluster that can be used to process high-throughput data from a genome sequencing system developed by China-based life sciences company BGI.

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