Everyone's talking about gen AI, but how is it actually being used?
While Hollywood may be all abuzz at the quickly rising fortunes of Barry Keoghan, generative Ai is seeing a similar ascendancy in healthcare. But will both avoid the bombs and tabloid headlines and fulfill their potential?
As ViVE 2024 kicks into gear today at the Los Angeles Convention Center, AI is on everyone’s minds. And while the past year has seen stories ad infinitum on the promise for large language models and gen AI to rid healthcare of its biggest headaches, the talk on the floor is that it’s time to show everyone what it really does.
“Every health system is investing a great deal in AI solutions,” says Harjinder Sandhu, chief technology officer for Microsoft’s Health and Life Sciences Platforms and Solutions, a partner for many health systems putting AI to the test. “You have to. There’s really no choice. But readiness really depends on the complexity of the use case and the risk of the use case.”
“What I see is a lot of caution,” he adds. “[Health systems] are being very tentative in thinking about these use cases. I see a lot more confusion than I see jumping too fast right now.”
Sandhu, who will be part of a ViVE panel this week discussing AI readiness, says healthcare leadership is understandably cautious in moving forward with projects that carry a lot of risk, especially as the industry is still trying to figure out governance. But that doesn’t mean they haven’t come up with plenty of ideas.
“I’ve literally been in sessions where, over a four-hour period, you’ll have a group that puts Post-It notes on a board with, like, 300 use cases,” he says. “And [they’ll] say ‘Here’s all the different areas we want to be able to impact.’”
Some of the biggest, brightest Post-It notes are focused on using gen AI to capture conversations and turn them into valuable clinical information in the EHR. At a time where every healthcare organization is dealing with a shortage of clinicians and a surge in stress and burnout, it’s those tasks that are causing the most conflict. Those in the know call it “pajama time,” as in the time spent by clinicians each evening at home going over their notes from the day’s patient encounters and translating them into information they can use for care management.
Microsoft and Nuance recently rolled out DAX Copilot, which integrates directly into the Epic EHR. It’s one of several tools from a number of AI vendors aimed at that particular pai n point.
“It’s probably one of the fastest growing products that we have witnessed in terms of how quickly physicians are taking to it and adopting it,” Sandhu says of the market in general. “It is starting to make an enormous difference in how physicians view their work and their work-life balance.”
This particular tool captures the conversation right after it has taken place, giving clinicians their notes immediately after the patient encounter, while the conversations are still fresh. They can review those notes for accuracy, then submit them into the EHR.
That review process is crucial. The technology is still relatively new, and still liable to make mistakes. That’s why practically any use of AI in healthcare at this time needs a “human in the loop” to review and sign off on the final product.
“You have to approach [AI tools] always with a hint of skepticism,” Sandhu points out. “Be a little bit skeptical about what they produce and double-check and triple-check.”
But the benefits are significant. Any tool that can integrate easily into a clinician’s workflow and reduce translational tasks—especially during nights and weekends—pulls time away from the computer and puts it back where it should be: In front of the patient or the family. Sandhu says those tools should see the lion’s share of adoption over the next year or two, especially as clinicians test them out and vendors work to fine-tune the process. It’s worth noting that gen AI is designed to learn as it goes along, so that a tool will learn a clinician’s habits and language and become better at transcribing.
Beyond that, Sandhu says healthcare decision-makers are keen to apply gen AI to another crucial pain point: Nursing workflows. Nurses are struggling just as much, if not more than, any other healthcare provider, and they need AI to reduce that overload and put them back in front of patients. But they also need technology that is designed for them.
Even farther out, Sandhu sees an expanding market for gen AI technology that can capture and, more importantly, analyze conversations. Consider a tool that that study the patient encounter for signs of mental health distress, enabling specialists or even primary care providers to identify patients in need of help just by how they talk to someone.
“We’re kind of in this new age of literacy with AI,” he says.
So at this point, as the attendees at ViVE settle in under a crisp California sun, a lot of talk will be about what’s on stage now, and how it’s playing in the market, and not so much about that next big thing or the future blockbuster. It’s nice to see where this will all go, but there’s a view among the executives that new ideas have to show ROI now, not later. Healthcare needs help now.
Probably not, but next week’s conference will bring together an impressive list of C-Suite decision-makers to discuss how some of the newest and most innovative strategies and technologies are being put to use
From overstressed nurses to overeager AI enthusiasts, next week’s ViVE 2024 conference in Los Angeles aims to take on some of the biggest issues in healthcare innovation.
The annual event, co-produced by HLTH and the College of Health Information Management Executives (CHIME), targets the healthcare industry C-suite in innovation and technology with an agenda that’s heavy on panels and presentations. Topics of discussion will include disruptors in the healthcare space, AI, data management and interoperability, policy, sustainability, and digital health.
In keeping with a growing theme in healthcare conferences this year, ViVE has created a special program for nursing leaders. Faced with high rates of stress and burnout, nursing execs are looking for strategies and technologies that not only improve workflows and wellness, but also take advantage of the nurse’s unique skills and front-line care duties. This includes everything from new ideas for nurse education and training to the adoption of Virtual Nursing programs.
The conference comes at a crucial time for the industry. With tech companies like Apple, Google, and Microsoft and retail giants like Amazon, Walmart, and Walgreens applying new ideas to the healthcare space and a current economy that puts a premium of reducing costs and finding an immediate ROI, health systems and hospitals are under a lot of pressure to do better. That may be why the agenda features an impressive number of healthcare executives, including panels with as many as three execs from different health networks.
Specifically, they’ll be talking about topics like the rapid rise of Generative AI, VC investment in health system ownership, consumer-facing and retail strategies in care delivery, remote patient monitoring and home-based care, challenges with scaling and sustaining telehealth and virtual care platforms, and data management and analysis (a wide-ranging topic that includes interoperability, cybersecurity, and patient access to data).
As with many conferences, the value to C-suite executives will be in seeing where these concepts are already being put to use, and whether they’ve proven their value. Decision-makers want to see that value now, rather than in a few years, and they’ll be looking for programs already in place, with clear benchmarks and outcomes.
And while any event like this shines the spotlight on new technology, like AI and VR, the industry is shifting its perspective to look for value not in point or niche solutions, but tools and platforms that can be integrated into larger, enterprise-wide programs. Returning attendees often make it a point to see which vendors from previous conferences are still exhibiting and which “shiny new objects” have dulled and been pushed aside.
And if that isn’t enough, there will also be a Billy Idol concert.
The agency is warning that no devices have been approved that can accurately measure a user’s blood glucose without piercing the skin
Federal regulators are hitting the pause button on digital health advancements for diabetes care management.
The U.S. Food and Drug Administration (FDA) has issued a safety alert indicating that smartwatches or smart rings that claim to measure a user’s blood glucose levels without piercing the skin should are not reliable and should not be trusted.
“The FDA has not authorized, cleared, or approved any smartwatch or smart ring that is intended to measure or estimate blood glucose values on its own,” the agency said.
Some 38.4 million Americans live with diabetes, according to a 2021 report from the American Diabetes Association (ADA), and experts say that population is the fastest growing chronic care population in the nation. Care management includes monitoring blood glucose levels throughout the day and taking immediate action (such as injecting insulin) when those levels are out of particular range. A trending high or low blood glucose level could lead to serious health issues, including coma and death.
Digital health advances have greatly improved care management for diabetes over the past two decades, including wearable sensors that can track blood glucose and administer doses of insulin when needed and AI-enhanced tools that can identify trending blood glucose levels before they become dangerous or are even noticed.
While the industry has been working on wearables that can accurately measure blood glucose without pricking the skin, that technology hasn’t yet been perfected.
“The FDA routinely monitors the medical device market and became aware of unauthorized products being marketed to consumers,” the agency said in its alert. “The agency is working to ensure that manufacturers, distributors, and sellers do not illegally market unauthorized smartwatches or smart rings that claim to measure blood glucose levels. Additionally, the FDA is alerting consumers about this issue and making the public aware that smartwatches and smart rings should not be used to measure blood glucose levels.”
The New Jersey health system is partnering with care.ai to scale a pilot program in one med-surg unit to all of its hospitals
Virtua Health is partnering with an AI company to scale a new Virtual Nursing program across the enterprise.
The New Jersey-based health system is collaborating with care.ai to integrate its virtual care technology throughout Virtua Our Lady of Lourdes Hospital in Camden following a pilot program launched late last year in one med-surg unit. Virtua executives say the platform will eventually be scaled out to all hospitals in the health system.
"By embracing the transformative potential of artificial intelligence and ambient intelligence, Virtua is pioneering a new era in patient care," Tarun Kapoor, MD, MBA, Virtua Health’s senior vice president and chief digital transformation officer, said in a press release.
The partnership is part of a nationwide trend of health systems and hospitals adopting virtual nursing platforms for one or more of three primary reasons:
Many are using virtual care technology to address staffing shortages and reduce stress and burnout by assigning virtual nurses administrative tasks and allowing on-site nurses to focus on care management.
They can also target improved administrative and clinical outcomes through round-the-clock patient monitoring and data entry and analysis.
Some are also using the platform to mentor newer nurses and give older nurses a new opportunity to stay in the workforce.
Virtua executives say the platform aims to streamline patient care “from routine admit and discharge activities to documentation, fall prevention, and clinician safety.” It enables floor nurses to focus on patient interaction while the virtual nurse handles other tasks, while ambient AI sensors in the rooms keep an eye on patients at all times.
“Our focus is not just on integrating cutting-edge technologies, but on enhancing the human aspects of healthcare,” Michael Capriotti, Virtua Health’s senior vice president of integration and strategic operations, said in the press release. “By swiftly adopting optical cameras and ambient sensors, we’re poised to markedly enhance the patient and care team experience, ensuring a safer, more efficient, and empathically connected healthcare experience.”
A recent OIG audit of evaluation and management (E/M) services provided by telemedicine during the pandemic found that providers generally followed the rules for Medicare reimbursement. But they did make some documenting errors
Healthcare providers who use telemedicine often rely on reimbursements to support the platform. And according to a recent audit, they did a pretty good job documenting those virtual encounters during the pandemic.
The report, prepared by the Health and Human Services Department’s Office of the Inspector General (OIG), analyzed $10.3 billion in E/M services billed to Medicare between March and November of 2020, of which $1.4 billion, or about 14%, were conducted by telemedicine. The OIG found that providers “generally complied with Medicare requirements” to a point that the agency made no recommendations for changing or improving the coding and reimbursement process.
That being said, the OIG audit identified five common errors in documenting for an E/M visit conducted via telemedicine. They are:
Documenting how a service was provided. Some providers didn’t document whether the service was done in person or through either an audio-only or audio-visual telemedicine visit.
Documenting the location of the telemedicine visit. Some providers did not document where the provider or patient were located during the encounter.
Identifying the telemedicine product used. Some providers documented the use of audio-visual telemedicine for an E/M visit but didn’t identify the platform used (such as Zoom, Microsoft Teams, or a telemedicine vendor). The federal government relaxed both CMS and HIPAA guidelines during the pandemic to enable providers to use more telemedicine platforms, including public-facing products. Now that the pandemic and the public health emergency have passed, the government is again cracking down on telemedicine products that don’t meet rigid privacy and security guidelines and pushing providers to use platforms that are secure.
Clarifying the telemedicine modality. Some providers documented that they used audio-only telemedicine for the E/M encounter but used an audio-visual telemedicine CPT code, which is different from the audio-only CPT code. The government expanded the use of audio-only telemedicine during the pandemic to expand access to healthcare services but has been pulling back since then to focus on more secure audio-visual telemedicine platforms.
Documenting problems with the technology. Some providers reported that there were problems with the technology during a telemedicine visit, such as an unreliable internet connection or issues using video. They therefore conducted the visit via audio-only telemedicine but documented the visit as an audio-visual visit.
According to the OIG report, the problems weren’t big enough to indicate the need to take action, but they point to areas of concern that could affect future telemedicine policy. For example, CMS may wish to issue guidance in the future on how providers should deal with technology issues and how they should document the encounter.
The Delaware health system now has school-based health centers in 25 schools, with a goal to give students better access to a variety of primary care services.
The Delaware-based health system now operates school-based health centers in six elementary schools and 19 high and middle schools. The latest wellness centers were launched through a partnership with the Delaware School-Based Health Alliance, the schools and school districts and local government, with funding from the American Rescue Plan Act.
“Through the opening of these three new school-based health centers, these children now have convenient access to medical services, behavioral health services and wraparound social care,” Erin Booker, LPC, the health system’s chief bio-psycho-social officer, said in a press release. These centers can improve their health and education and set them on a lifelong path of wellness.”
The centers will provide, at no cost, comprehensive medical and mental healthcare, ranging from treatment to education. This includes screenings, women’s health, treatment of minor injuries, immunizations, nutrition and weight management, crisis intervention and suicide prevention, tobacco cessation, and substance abuse treatment and referrals. They won’t offer hospitalizations, x-rays or complex lab tests, or ongoing treatment for more complex medical and psychiatric problems.
“School-based health centers are the connection of whole-child health and education,” Priscilla Mpasi, MD, FAAP, assistant medical director for the Clinically Integrated Network and Delaware Medicaid Partners, part of the ChristianaCare network, said in the press release. “As we all know, early intervention is the key to wellness. Children can learn better when they are happy and healthy and know they have a safe place to go when they need care.”
The health centers aim to improve care management for children who might face barriers to accessing care. The Children’s Health Fund estimates that 20.3 million children in the U.S., or about 28% of the total population of children, face barriers to accessing essential healthcare. And according to the Centers for Disease Control and Prevention (CDC), some 40% of school-aged children and teens are living with at least one chronic health condition, such as asthma, diabetes, obesity, or behavioral health problems.
Sharp HealthCare has launched the Spatial Computing Center of Excellence, a new research hub aimed at turning VR technology like the Apple Vision Pro into a clinical tool
While many health systems see the new Apple Vision Pro as a consumer device, executives at Sharp HealthCare are taking a close look at what it can do for clinicians.
The San Diego-based health system recently opened the Spatial Computing Center of Excellence, an innovation center aimed at studying the healthcare applications of AR and VR technology. The center, launched in a collaboration with Epic and Elsevier, is the latest initiative to come out of the year-old Sharp Prebys Innovation and Education Center.
“This is a completely different form factor that opens up a lot of opportunities in healthcare,” says Brian Lichtenstein, Sharp’s associate chief medical informatics officer. “In the spatial realm, we have a chance to move beyond the limitations of the EHR.”
While AR and VR technology has long been focused on gaming, other industries are starting to see the value. Healthcare is no different, as health systems like Cedars-Sinai and Boston Children’s have, for the last few years, developed AR and VR programs to address health concerns like pain management, childbirth, mental health issues, and pediatric care. Cedars-Sinai, which hosts a virtual medicine conference called vMed, recently debuted an AI-enhanced app for mental health treatment designed exclusively for the Apple Vision Pro headset.
At Sharp HealthCare, though, the interest for now is solely on the clinician ranks, which are dealing with stress and burnout associated with overflowing workflows and seeing their numbers decrease. This is where Lichtenstein and his colleagues hope the technology can ease workflow pressures and make life easier for doctors and nurses.
“We’re looking at a new way of enabling humans to interact with computers,” says Dan Exley, Sharp’s vice president of clinical systems.
The new research center is closely aligned with Apple and has purchased 30 Vision Pro headsets to get the ball rolling. The latest iteration of the VR technology was initially teased in a video last June and made available to the public at the beginning of February—at a price of $3,500.
Michael Reagin, MBA, CHCIO, Sharp’s SVP and chief information and innovation officer, says Apple has been a longtime partner of the health system, and that partnership gives Sharp clinicians and engineers an opportunity to work not only with top-line technology but a consumer-facing device that has made a considerable impact in the public space. That understanding of consumer needs will be important as the health system looks at how this technology can be used in healthcare.
“We have to be at the forefront of developing these resources,” he says.
Tommy Korn, MD, an ophthalmologist and digital health innovator with the Sharp Rees-Stealy Medical Group, says the timing is right because the health system is undertaking a major transition from four separate EHR platforms down to one Epic platform. This gives them the opportunity to develop projects that integrate better with the new platform.
He, Lichtenstein, and Exley all envision using the Apple Vision Pro to give doctors and nurses a new way of working with data, visualizing healthcare delivery, and interacting with their patients. Where clinicians now often labor to work with an EHR through a computer or laptop, a spatial computing app could create a 3D EHR, giving clinicians and patients a different look at healthcare conditions and how treatments affect the human body.
Exley, calling VR an “infinite canvas connected to infinite computing power,” says Epic has already developed an app for the Apple Vision Pro, and he envisions early uses for the technology in places like radiology and surgery. In addition, he says, the Spatial Computing Center of Excellence can draw on recent advances in AI technology and cloud computing to improve use cases.
“We want to see content that is driven by context,” Lichtenstein adds.
A collaboration between Rochester University Medical Center and Five Star Bank is putting telehealth kiosks in bank branches, offering new insights into how to improve access to care in rural regions
In a partnership with Five Star Bank, Verizon, and digital health companies Higi Health and Dexcare, URMC is co-locating telehealth stations in Five Star branches across the western part of the state. The model aims to improve access to care for rural residents, especially those on Medicaid and Medicare, who face geographical and technological barriers.
Michael Hasselberg, PhD, URMC’s chief digital health officer, says the health system came out of the pandemic seeing measurable benefits in a telehealth platform for rural residents, but most were using a phone to access care. In order to include Medicare and Medicaid reimbursements, URMC needed to establish an audio-visual telemedicine link.
“We thought, rural communities, what do you have?” he said. “You’ve got a traffic light, you’ve got a Dollar Store, and you’ve got a bank. What about banks?”
In singling out banks, Hasselberg identified a challenge facing health systems and hospitals looking to expand their telehealth networks. Many programs have focused on putting kiosks or telehealth stations in community centers, libraries, barber shops and hair salons, malls, and other retail locations. In most cases that means working with a different party at each location.
A patient uses a URMC telehealth kiosk at a Five Star Bank in New York. Photo courtesy URMC.
Banks, however “are in these branch distribution models, so they’re scalable,” Hasselberg noted. “I can’t scale a library, or a barber shop, or a community center because I, as a health system, have to negotiate with every single [site]. But if you negotiate with a bank, you have, potentially, access to all their branches across the region.”
In addition, and just as important, the costs of launching the program are reduced.
“The organizations partnering to make this pilot a success have all offered generous, in-kind support,” Hasselberg said. “Verizon Business is contributing the necessary telecommunications infrastructure. DexCare and Higi are providing leading-edge telehealth software and Smart Health Stations, respectively, to connect rural residents with UR Medicine physicians. And Five Star Bank is volunteering private space in its bank branches to create a healthcare access point for its neighbors in a familiar, trusted, community location. UR Medicine is not funding the Five Star Bank space.”
Addressing Key Gaps in Care Delivery
The program, which is currently in three branches, gives consumers and patients an opportunity to track key biometric markers, such as blood pressure, obesity, and blood sugar, through connected devices and an app managed by Higi. Through DexCare, visitors can connect for a virtual visit with a physician in the health system for treatment or to schedule an in-person visit.
“We already had an on-demand telemedicine service line that is staffed by our primary care doctors,” Hasselberg noted, “So we just kind of built off of that.”
The program addresses a number of care gaps that health systems face in serving rural regions. According to Hasselberg, roughly three-quarters of the health system’s rural patients live at least 10 miles from the nearest brick-and-mortar care site, but more than half live within three miles of a Five Star bank.
And studies have shown that consumers are often reluctant to visit a doctor’s office or clinic for a minor or nagging health concern unless or until they really need urgent medical care, often postponing care and running the risk of developing a more urgent health issue later. Co-locating a telehealth station in a bank, often located near other community services, gives the consumer an opportunity to combine a few errands in one trip, or to consider a virtual visit while out running other errands.
In a unique example, Hasselberg noted that one of the telehealth kiosks is located in a community with a sizable Amish and Mennonite population (the bank even has a drive-through for customers using a horse and buggy). Providing easy, convenient healthcare access for a population that traditionally keeps to itself and eschews most technology at home could go a long way toward improving care and outcomes for that group of people.
Unique Benefits to Telehealth
Hasselberg noted that many rural residents, particularly those with limited incomes, have higher rates of no-shows, cancellations, and ED visits and tend to skip or avoid filling prescriptions. All of those issues, he said, were improved significantly through the use of telehealth during the pandemic. And many don’t have or can’t afford broadband services in their homes, which a telehealth kiosk addresses.
The platform also gives URMC a visible presence in rural regions where brick-and-mortar sites are few and far between, at a time when disruptors like Walmart, Walgreens, Google and Apple are looking to stake a claim in the busy primary care space.
“What we have found is healthcare is local, especially in these small, rural communities,” Hasselberg said, adding the disruptors are doing more to improve healthcare than create competition. “Having a trusted health system to deliver care, and that understands these communities … is really, really important.”
“Our [goal] wasn’t to make money,” he added. “We needed to create access…. We’re not going to be looking at this through the lens of, are we generating enough volume to make a profit?”
Tackling Social Determinants of Health
In addition, co-locating a telehealth station in a bank gives URMC an opportunity to address several social determinants of health.
“Financial health is so closely tied to physical health,” noted Hasselberg, who said a patient could be referred to the bank right after the telehealth visit for help understanding, planning for, and paying medical bills. “We might be able to affect healthcare access and financial instability at the same time.”
Hasselberg sees plenty of opportunities to expand the program, not only to other bank branches and potentially other banks, but to assisted living and skilled care facilities, which struggle to connect their patients to the care they need. In addition, he sees more services being available through the kiosks, including chronic care management and follow-up care. They could even be used as access points for resident sot connect with local primary care physicians.
“We all went into this going, ’This may be a nothing-burger,’” he said. “And patients [may] go, ‘I don’t know about getting healthcare in a bank.’ But what if it does work? That’s the really exciting part. Because if this does work, it could be transformative. It could be replicated across other health systems and across other banks across the country.”
The CommonWell Alliance and Kno2 are the sixth and seventh organizations to qualify to exchange healthcare information under the federal TEFCA framework
The U.S. Department of Health and Human Services’ Office of the National Coordinator of Health IT (ONC) announced last week that the CommonWell Health Alliance—a nonprofit alliance of healthcare and technology associations—and healthcare connectivity company Kno2 are the sixth and seventh QHINS, joining the eHealth Exchange, Epic Nexus, Health Gorilla, KONZA, and MedAllies.
"These additional QHINs expand TEFCA's reach and provide additional connectivity choices for patients, health care providers, hospitals, public health agencies, health insurers, and other authorized healthcare professionals," ONC chief Micky Tripathi, PhD, said in a press release.
The Sequoia Project, the federally Recognized Coordinating Entity (RCE) for TEFCA management, is reviewing comments on a second version of TEFCA, which was unveiled last month. The group’s CEO and RCE lead, Mariann Yeager, said she expects the QHINs to begin implementing version 2 by the end of March.
“The most important thing for people to understand is that version 2.0 was revised to support FHIR-based exchange,” she told HealthLeaders in a recent interview. “There are new use cases to support healthcare operations and public health. The other thing is it does permit health systems that participate in TEFCA-based exchange to connect to multiple QHINS, to the extent that they support multiple data sources.”
TEFCA isn’t the only framework for health data exchange, but it does have the backing of the federal government and builds off of the expertise of the Sequoia Project. Each QHIN goes through a rigorous process to achieve the designation and must adhere to federal standards.
TEFCA actually become operational in December 2023, when the first five QHINS were announced.
UnityPoint Health is scaling its remote patient monitoring program out to new populations. Here’s its game plan for success.
For many health systems, remote patient monitoring (RPM) Is still a challenge. It’s not easy to find the right patient population, match those patients to the right devices, and develop a process that meets clinical goals and doesn’t put a strain on clinician workflows.
Health systems like UnityPoint Health are addressing those challenges by partnering with digital health companies who act as the middleman. The Iowa-based, three-state network has collaborated with HealthSnap over the past two years to build out RPM and chronic care management (CCM) programs that now collectively serve more than 25,000 patients through 94 primary care clinics and involving more than 400 physicians.
“Logistics are not something that healthcare organizations are typically good at,” says Dawn Welling, chief nursing officer at UnityPoint Clinic. By partnering with someone to handle the technology, she points out, the health system can focus on care management and clinical oversight.
Outsourcing the Tech
That strategy, of course, involves careful planning on the part of healthcare leadership. Executives have to balance the cost of outsourcing against the financial and clinical outcomes of the program.
“There is a financial play in this,” Welling says. While the short-term benefits, such as identifying unhealthy trends and reducing hospitalizations offer “bread-and-butter fee-for-service crisp ROI,” she says, the long-term benefits should also come into play, especially as the industry moves toward value-based care. A program that reduces hospitalizations now is great, but one that encourages healthier trends and cuts down the chance of many more healthcare events down the road is even better.
“Are we keeping people healthier?” she asks. “That takes longer to figure out. You definitely see fee-for-service [benefits] faster, but that’s not the only [measurable outcome.]”
Reimbursement is also important. The Centers for Medicare & Medicaid Services (CMS) has been slow in embracing RPM, which it calls remote physiological monitoring and remote therapeutic monitoring, but does offer some codes for Medicare coverage of data capture at home. Recently CMS expanded that coverage to include rural regions.
“That was big,” says Welling, who notes UnityPoint is moving quickly to expand its RPM program to rural communities in Iowa. “You have to have that up-front investment for those long-term gains I think we all know will come.”
Identifying the Right Tools for the Right Patients
CCM and RPM are in fact two different programs, each addressing a different patient population (though some patients are enrolled in both programs at the same time). CCM is more selective, focusing on patients with chronic health conditions and relying on a patient’s ability and willingness to manage their care at home. RPM, meanwhile, matches a patient’s health concern with a specific device aimed at tracking a key metric and relaying that data back to the care team.
According to Welling, UnityPoint developed its RPM program by creating a protocol to match patients with certain health concerns with a specific device that would be sent to them (unless they were using a device on their own). For patients living with more than one health concern, the clinician must choose what device that patient gets.
This process, she says, needs to be integrated with the patient flow process, so that patients get their devices at the appropriate time at home, along with whatever training is needed. Without that structure in place, patients could get their devices before they’re ready to use the technology, in some cases even affecting their willingness to use the devices.
“If you don’t do that well, you will frustrate your care teams,” she says.
Healthcare leaders also have to plan ahead for more complex patients. In some cases, Welling says, a physician could prescribe more than one device for a patient if the physician felt that strongly about multiple devices, even though Medicare reimbursement is limited to one device per patient.
“We didn’t automate that in any way, shape, or form,” she says. “There isn’t an algorithm for that. That is truly a physician and patient decision.”
That type of exception could become more commonplace as more patients present with multiple health concerns. Welling says this could also lead UnityPoint Health to develop more intricate and integrated RPM programs, adding resources such as behavioral health and home health care.
Episodic Vs. Continuous Care
Welling says it’s also important to understand how data from devices reflects a patient’s health. A single reading can capture a patient’s health at a specific moment, but it doesn’t accurately capture the patient’s continuous health journey. For that reason, the RPM program charts seven readings at the beginning of monitoring, allows some time for the patient to get used to the program, then captures seven more data points.
“It takes some time to get into [a] normal lifestyle,” she points out. And while that information is gathered by HealthSnap and included in quarterly reports, a physician can ask to look at a specific patient’s data at any time.
Understanding how that data is used goes a long way toward determining the ROI for an RPM program—and helping reluctant physicians buy into the program.
“This is not easy – it’s a big change,” she says. “Some [physicians] run towards it; they love it. Others see it as relinquishing control.”
And both physicians and patients have had concerns about having a technology vendor in the loop. Both are used to the concept of episodic care, where a patient visits a doctor for treatment, everything is done in that visit or in subsequent follow-ups, and that’s it. RPM, on the other hand, understands that a lot of healthcare happens outside the doctor’s office, with patients and doctors connecting via the device to keep patients on a care path.
Welling says the health system is still learning the intricacies of RPM, and that should be the strategy for the program that needs to adjust continuously to the ebb and flow of its patients. It’s important, she says, for the physicians in the program to know they can check on their patients at any time, guiding each patient rather than waiting for the next scheduled doctor’s visit. And patients in the program are encouraged by knowing that a care team is monitoring them, helping them get through the ups and downs of healthcare management.
She expects both the RPM and CCM programs to continue evolving. She also sees the platform branching out to address behavioral health concerns, which play a role in many care pathways. As well, the program could link in pharmacies.
“In time, we will think that what we’re doing before was just silly,” she says.