Artificial Intelligence In Healthcare

The healthcare industry is on the brink of major transformation, thanks to healthcare-related advances in artificial intelligence. Healthcare organizations around the world, and governments, are beginning to integrate AI into their systems and processes. With AI, healthcare providers are able to improve medical diagnostics accuracy and automate administrative tasks, while improving patient care. In this blog post, we will explore how healthcare will change and the potential impact of AI on healthcare.

Advances in Medical Diagnostics

AI has the potential to revolutionize healthcare by greatly improving medical diagnostics accuracy. AI-powered tools are being used to help healthcare professionals diagnose diseases more quickly and accurately, as well as identify healthcare trends that may have previously gone unnoticed. Furthermore, AI technology can be used to monitor patient vitals in real time and detect early warning signs of disease.

Automation of Administrative Processes

The healthcare industry is full of administrative tasks that take up a considerable amount of time and resources, from filing paperwork to scheduling appointments and managing patient records. AI can automate these processes in ways that may not occur to human workers, to free up the humans to provide more focused care on the most complex cases. AI can also provide healthcare organizations with better insights into patient care and help healthcare professionals make more informed decisions.

Improved Patient Care

AI has the potential to drastically improve healthcare outcomes by providing healthcare professionals with improved data about patients, allowing them to take preemptive action or provide targeted healthcare services. AI can also be used to track healthcare trends and identify areas where healthcare quality measures could be improved.

Improved Clinician Workplaces and Opportunities

Physician offices can be made far more efficient with AI in the picture. HCC risk management is one area where AI can be used to find missed opportunities, and to strengthen Medicare reimbursement profiles. AI can often see what humans can't, either because some details just are not apparent, or because clinicians and admin personnel are overburdened with just getting through the day. In the constant struggle to keep patients as the top priority over paperwork, AI-driven systems from companies like Hindsait and MDOps can take on a share of the workload.

Caveats

From the patient's perspective, will AI depersonalize medical services? If workflow streamlining cuts the wrong corners, who will suffer? Artificial intelligence, by its very nature, is a "black box." In many cases, advanced AI is very much like a person, in that it can be difficult or impossible to understand how its "thinking" works. AI needs to develop better "talk back" capability, so that human users can interrogate the system to correct errors - to ask how it is arriving at a given conclusion, and then to correct its "thinking," much as you would reshape a human employee's perceptions to obtain the most desirable outcomes. At present, such capabilities are not present, or are not being adequately utilized by the system's handlers in some environments. Busy practitioners haven't yet "merged" with these systems such that deliberate feedback is part of the clinical workflow. This will take time, and probably a few high profile mistakes. Progress here is a bit like the early progress of the medical profession. We're just now emerging from the blood-letting phase of AI, and we must hone strategies for better control of the new tools.

As HCOs begin to adopt AI-powered tools, healthcare processes, patient care and healthcare outcomes are set to improve significantly. AI will allow practitioners to diagnose diseases more accurately, automate administrative tasks, and gain insights into healthcare trends, enabling them to provide more informed and targeted care to their patients. At the end of the day, AI has the potential to revolutionize healthcare and significantly improve patient outcomes, while the cost of progress is bound to include some failure. All stakeholders, from patients to health systems to government, need to be informed as AI involvement increases, and become girded for the journey.

$1.25 Billion in December EHR Incentives

The Centers for Medicare and Medicaid Services announced that a record $1.25 billion was paid in December to hospitals, physicians and other professionals in electronic health-record (EHR) incentive payments. The program awards healthcare providers for adopting electronic health records systems.

The December pay out is three times the size of the previous largest one-month awards total. Medicare and Medicaid awarded $255 million to physicians and other professionals, and $1 billion to hospitals. So far, EHR incentive programs have paid out $10.3 billion to improve the quality of US healthcare information technology, which for decades has lagged behind other industries.

Population Healthcare Is Health Reform

Michael Christopher
Chief Chigger, CarePrecise Technology

We have heard many people say that the Affordable Care Act is not health reform, but an attempt at health insurance reform. But a broad shift in the focus and delivery of healthcare has begun, shaped in part by the ACA, and poised to bring significant change to American healthcare. At the heart of that change is population-based healthcare.

"With the Supreme Court upholding the ACA, we all now understand that population healthcare is what we're all going to be doing going forward," says Dr. Steven Davidson, senior vice president and chief medical informatics officer for New York's Maimonides Medical Center in a June 28 Modern Healthcare article. What is "population healthcare," what does it have to do with the Affordable Care Act, and what does it mean to industry vendors?

The term refers to "the ability to assess the health needs of a specific population; implement and evaluate interventions to improve the health of that population; and provide care for individual patients in the context of the culture, health status, and health needs of the populations" according to the Association of American Medical Colleges. Population healthcare is a broadening of focus to see beyond the individual patient to the broad context of that patient's health issues, and to understand the issues of the patient's population to better serve both the individual patient and broader communities of patients.

This perspective becomes ever more critical when cost efficiencies are taken seriously into account, as they must be in an "affordable care" paradigm. In a Tufts Managed Care Institute's white paper on population health, we find

"Population-based care involves a new way of seeing the masses of individuals seeking health care. It is a way of looking at patients not just as individuals but as members of groups with shared health care needs. This approach does not detract from individuality but rather adds another dimension, as individuals benefit from the guidelines developed for the populations to which they belong.* Members with a particular disease must be prioritized so that disease management interventions are targeted toward those members most likely to  cost-effectively benefit.**"

The Affordable Care Act package as it now stands places the emphasis on results, rather than on specific means to obtain results. Despite what has been said by opponents, providers are given wide freedom in achieving improved quality and reach of care, and are provided with new resources, such as advanced electronic health records, paid for in part by the taxpayer. Population healthcare is a strategy for deploying these resources and creative latitudes, in a package of practical tactics and achievable objectives, and at scale.

When viewed through the lens of health reform's quality focus, public health data collection and bringing the technologies that enable collection to every point of care, population healthcare is seen as a key - if not the key - strategy for both implementing the provider side of health reform, and rewiring its financial backbone of health insurance.

* Boland P., editor. Redesigning Heath Care
Delivery. Boland Health Care, Berkeley,
1996. pp. 159-163.
** Zeich R. Patient identification as a key to
population health management. New
Medicine. 1998;2:109-116.

Now We Know: Time to implement the Affordable Care Act

As the Tennessee Medical Association puts it, there is now a "certain finality" to the Affordable Care Act following the Supreme Court decision upholding the law. A huge win for the Obama administration, the decision yesterday was like kicking a hornet's nest among conservatives. The Christian Medical Association said the decision "sounds an alarm across the country to people with faith-based and pro-life convictions" and called on Congress to repeal the law.

An article in Modern Physician characterizes the response among physicians as "mixed," but the vast majority of our MD, DO, PA and RN contacts have come down strongly in favor of the law, in one case saying "The government did something right... 50 million healthier Americans is going to look pretty good here in a few years."

Whichever political side one is on, it is now clear that work can move forward on implementing the law. The Tennessee Medical Association's statement concluded "Today's decision allows us to make more definitive plans regarding reforms to our healthcare system in Tennessee." The sentiment seems to be fairly widespread through the provider side of the industry.

Some states - among them our own Oklahoma - elected to refuse federal funding ($54 million in Oklahoma's case) to establish health insurance exchanges. The decision, taken on the part of Governor Mary Fallin, appears to have been politically motivated, but Oklahoma is, in fact, developing an exchange, without the federal dollars. An agency head, speaking with an Oklahoma radio station, said "It would have been good to have the money, so we could have a more user friendly and effective system, but we'll have something, anyway."

The justices struck down provisions in the law that would empower the federal government to force states to comply with the planned Medicaid expansion or lose all of their Medicaid funding. Now states will be eligible for basic Medicare funding even if they choose not to accept the additional dollars to provide expanded care. Numerous states have sworn to refuse expanded Medicaid funding, but it remains to be seen whether any will ultimately deny this added coverage for hundreds of thousands of their citizens. The federal dollars are being offered with no required match for three years. Medicaid is often one of the biggest lines in states' budgets, and that share is growing as healthcare costs continue to rise.

Medical Data Breaches Unnecessary

The problem of breaches involving healthcare data is getting worse, not better. As more medical information is stored electronically, the risk of unauthorized access grows. But a significant portion of the risk could be reduced to near zero if the primary users of the data - practitioners, healthcare information technology staff and contractors, administrative staff - would take one simple step. One simple and completely free step. Really; it costs nothing, and places nearly zero burden on the user.

We made this same recommendation about six years ago, when reports of stolen laptops first began coming in. But it seems as though no one in the industry has applied our simple fix. In January of 2012, a contractor copied the records of 34,000 patients of Howard University Hospital, containing SSNs, birthdates, and diagnosis-related information, onto a laptop. The data was not encrypted; the laptop, of course, was stolen from the contractor's car. This same scenario has been reported numerous times. Data, laptop, car, repeat.

Last month, federal prosecutors charged a worker at the same hospital with selling hospital data. She's set for a plea hearing on June 12. Clearly, this is a different situation, and would not have been mitigated by encrypting the data, since the worker was entrusted with full access. But you can be sure that Howard University Hospital wishes that the stolen laptop had not preceded this incident. Patients and regulators are rightly outraged.

Simply put, had the data been stored on an encrypted drive partition on those laptops, it would have been safe from prying eyes. How difficult is it to do that? If a free, open source program like TrueCrypt is installed on the computer, it's as easy as typing in a password to open the protected drive, copying the data onto it, and using the data just as though it were on any ordinary drive. After so many minutes of idleness, or when the computer sleeps, hibernates or is shut down, the program can be set to close the protected drive, rendering its contents completely unusable until the password is given again.

Along with encryption, passwords must be strong, which means hard to guess. But they don't have to be hard to remember and type. A good rule is to have 20 or more characters, but a simple phrase can be easy to remember. Stop thinking pass word, and think pass phrase instead. Here's an extremely strong password: Theylike2bheld/theseKitties ("they like to be held, these kitties"). Easy to remember and type, but it has upper and lower case letters, a numeral and a punctuation character, and totals 27 characters in all. That's one strong password. It works in TrueCrypt and virtually all other encryption programs. And it even has kittens!

Some encryption software, including TrueCrypt, offer an additional important feature.  Let's say you are carrying extremely valuable data, being mugged, and are forced to enter your password to start the computer. Let's go so far as to say that the mugger is savvy enough to search the computer for an encrypted file, and finds it. TrueCrypt actually lets you use a different password when you mount the protected drive, which opens a phony data trove on which you've stored some bogus data. Plausible deniability saves you and your data.

There is simply no reason not to require all staff members and contractors to use encryption for all medical and other personal data. Essentially zero ownership cost, and it doesn't slow anybody down. No excuses.

Encryption and strong passwords. Take these two pills and sleep better tonight.

TrueCrypt is a free open source project, available at http://www.truecrypt.org/

Hospital Spending To Grow

A new survey conducted by L.E.K. Consulting indicates a predicted rise in spending and aggressive supplier negotiations by hospitals during 2012. The study, which surveyed 200+ hospital executives, found that 61% expect budgets to grow through the year, in such areas as healthcare I.T. (57%), facilities and major medical devices (35%), and many expect growth in infection-fighting disposables. In fact, budgets are expected to rise through the coming five year period.

But the study also revealed that hospitals can be expected to drive ever harder bargains for their purchasing. Eighty percent stated that they will continue or step up pressure on suppliers to cut costs, while the number that anticipate greater use of purchasing organizations grew from 52% to 62% over last year.

The investigators cited the Affordable Care Act as a driver for the increase in hospital spending. CarePrecise healthcare provider data contains 31,270 hospital records as of February 29, 2012, representing 5,755 hospitals with 942,000 beds and total 2011 expenditures of $751 billion.

Health IT Talent at a Premium, or Take 2 Aspirin and Call Me a Headhunter

It's hardly news that the pool of qualified healthcare information technology professionals is drying up as providers and vendors race to meet tech deadlines associated with federal HIT funding programs. For HIT folk like us, this rocks! Except, of course, when we're trying to flesh out project staff and we learn that the talent is beginning to know what it's worth.

At stake is the $25 billion allocated in 2009 by the American Recovery and Reinvestment Act for EHR and other health IT outlays. Providers can be compensated for costs if they jump through the hoops by certain dates, with several important deadlines coming through the next several months. July 3 is the last day for hospitals to begin the 90-day reporting period in which they must demonstrate Meaningful Use for the Medicare EHR incentive program for federal FY 2011.

Oct. 3, 2011 is the last day for physicians to begin their Meaningful Use reporting period for EHR, and November 30 the curtain drops on general and critical access hospitals registering for payments. And that's just a handful of the headaches.

In addition to all of this activity, ICD-10 and 5010 implementations are also looming. If you're in HIT and you haven't asked for a raise, as my daddy used to say, "What's wrong, cat got your tongue?" (Apologies to our CIO friends.)

New Way to Market to Healthcare Providers

The international PR firm Ogilvy has just released a study prescribing a shift in healthcare marketing from the exploitation of clinical breakthroughs to something Ogilvy calls "sustainability." They're not talking about the sort of sustainability we in healthcare usually mean, such as the sustainability of a health information exchange's business model. Instead, they're suggesting that we start selling green.

Companies with strong environmental competencies will rule the market in the coming years, say the investigators, Jeff Chertack and Monique da Silva. In an op-ed by Chertack, he says that "[the new] value will be delivered by new healthcare products and delivery systems that help society adapt to and thrive in changing climate and disease patterns."

CarePrecise Technology made a move in the past year toward eliminating a large part of its carbon footprint by shifting even our largest file deliveries from physical (DVD disks) to virtual. All new product sales are now 100% virtual, and as subscribers renew, their deliveries will be virtual as well. Not only has the shift reduced fuel and materials consumption, but products are now delivered in less than half the time. In a business where the freshness of data is crucial, every hour counts. CarePrecise's NPI directory unit, NPIdentify, has produced state NPI directories in electronic form only since 2007.

CarePrecise's data center is a shared environment, utilizing hyper-efficient cloud computing resources. Except for certain mission-critical operations performed on in-building platforms, all front-end operations and many back-office computing tasks have been moved to the cloud, dramatically reducing office space utilization and fuel consumption.

Whether the healthcare industry in specific, and the broader business community in general, will effectively turn environmental competencies into profits is still an open question. Certainly, entities like hospitals make huge impacts and consume enormous resources (think about all those disposables and all those sheets washed after 30 minutes of use, pillows, trays and pitchers discarded after each patient...), and spectacular improvements could be made. Vendors who help these organizations green up are offering a new way to compete for patients. The competitive advantage offered by corporate carbon consciousness could be tomorrow's marketing edge for providers and their vendors.

Flaw in CMS Logic Causes Cost

When the NPI Final Rule (and all of its after-final rules) created the National Plan and Provider Enumeration System, there were many unknowns: Which datapoints would be released for the industry to use? loomed large. But another issue has come home to roost.

Organizations (Type 2 providers under the rule) were permitted to have as many NPI numbers as they liked, and they could structure their assignment of NPIs any which way. For instance, one hospital might get separate NPI numbers for each of its business units, while another got and NPI for each of its physical locations, another for each of the cluster of corporations, while some clever hospitals got an NPI for each reimbursement channel. And then of course, some hospitals got just one.

No problem with that -- the various business optimization strategies are interesting to observe, and surely make sense in their various contexts. The problem is that there is no primary NPI number per hospital or health system. That is to say, there is no way to know from the NPPES records which if any of the NPI records is a parent, and which is a child. Oh, of course, an army of human analysts can pore over the records and find 37 hospital NPI records each identifying, say, Mayonaise Health System as its parent. But a computer finds that task a bit difficult, since it will find many variations in the records, e.g.,

• Mayonaise Hospital
• Mayonaise Health System
• Mayo Hospital
• Mayo Hospitals
• Mayonaise Hospitals
• Miracle Whip Health
• and on an on

Thus, it becomes essentially impossible to say how many hospitals there are, even though we are looking at the complete set of federal records on hospitals. Had there been a primary or master NPI required for each General acute care hospital -- regardless of how many business units and other NPIs are involved, it would be possible to perform much more significant research on hospital service areas, densities, availability of care, duplication of services, and much more. (We've just started putting state-by-state physician and hospital counts on our home page at CarePrecise.com, but for now, we are able only to show the total of all hospital records -- 29,946 at present -- which is far more than the roughly 5,000 actual hospitals to whom all those records belong.)

The coyness built into the NPPES was more or less deliberate. American hospitals are a contentious lot, engaging in constant competition, and they did not want any more known about them than absolutely necessary. Coy data costs everyone money, and adds opacity to the healthcare system. Still, with the HospitalCompare project and our subsequent mining of all of these data sources, much can be learned, and the reach of each hospital organization can ultimately be published. Stay tuned.

New Hospital Admin Education Website

Hannah Anderson's goal was to compile an unbiased and updated list of every school that offers a hospital administration degree in the US.  She felt that the existing lists were not comprehensive, easy to find, and many websites have outdated information and links. www.HospitalAdministration.org is a valuable new resource for hospital administration students, and for seasoned administrators when we're asked to make recommendations. All the schools are listed on the front page and lead directly to each program, and can be viewed state-by-state. Thanks, Hannah!