Clinicians “all alone” when integrating digital health advances: Larsen

When it comes to interoperability and linking health data and the promise of digital health, we still have a long way to go despite the continual hype, and the wholesale adoption of virtual care seen during the first year of the COVID-19 pandemic. Furthermore, many innovative breakthroughs in this area are being driven by the private sector rather than coming through the publicly funded system.

These and other provocative statements marked the first of this season’s virtual series of digital health webinars hosted by the Sandra Rotman Health Centre for Health Sector Strategy.

Attended by many of Canada’s leading experts on digital health, the session marked the end of a relatively quiet period for discussions of digital and virtual health care in Canada. The high-profile OntarioMD conference will follow later in the week with the Canada Health Infoway partner conference and Digital Health Week taking place in November.

Setting the stage for the discussion was Dr. Darren Larsen, a family physician who has had many high-profile roles coordinating digital care in Ontario and recently worked for both Accenture and Telus Health.

“There is actually no ‘there’ yet when it comes to this conversation around digital health, especially as it relates to care in the community and the work we’re doing as physicians and nurses and care providers,” Dr. Larsen said.

While 90% of physicians in the community and all doctors in hospitals now use electronic medical records (EMRs), he said, community physicians are not sharing data and have no incentive to do so. However, he said  there have been many significant advances in Ontario which allow community doctors to see what is happening to their patients in hospitals.

As for virtual care, he noted while “even though 90% of family physician offices were opened during the pandemic, there was a lot of care done virtually for so many reasons that we all understand.” But he added, the predominance of virtual care “is definitely tapering off now” because of the need to still provide in-person care for many medical services.

With reduced government funding for virtual care services, he said, much of the impetus for this type of care is being driven by the private sector and this is creating discord. What is concerning, Dr. Larsen said, is that many standalone private virtual care clinics are focused on high-volume, low complexity care which is counter to the type of high-complexity, lower volume care many primary care patients now require post-pandemic.

For digital care overall at least in Ontario, Dr. Larsen said “clinicians, sadly, are on their own when it comes to integrating digital tools in their practices. We have to bear a 100% of the cost of these things, we have to figure out if they’re going to integrate with our EMR systems or not … and the EMR companies are not very interested in tagging on products that dive there way into their databases and architecture. for so many reasons.”

“There’s very little trust, sadly, between us as providers, and some of the digital companies that are out there (with) really spectacular products.”

At this event, moderator Will Falk, in addition to peppering panelists with erudite questions played the role of the frustrated, engaged patient. He noted that as a patient, he has had to coordinate the sharing of information between his physiotherapist and his family physician and he likened it to being a telephone operator connecting different phone lines.

Dr. Larsen noted that in the current health care environment “patient expectations are changing and tolerance to private pay is changing.”

A perspective from the private sector was presented by Sonya Lockyer, president and CEO of the Lifemark Health Group, now owned by Shoppers Drug Mart, which offers community rehabilitation, workplace health and wellness and medical assessment services. She talked about organizations such as Shoppers creating (with patient consent) “micro ecosystems” including 600 affiliate primary care clinics that allow patients to see their own data and create one view of their health as well as providing insights into care.

“The real opportunity, of course, is to not just create these micro ecosystems within a high performing family health team, but also to push even broader into the public system at large,” Lockyer said.

“The private sector is willing and able to share and understand, but there isn’t a warm reception on the other side,” she said, noting that to date governments are not willing to mandate that all practitioners in a region are coordinatd in delivering care whether they work in the public or private sector.

Zayna Khayat, VP of client success and growth at Teladoc Health Canada and a senior advisor with Deloitte, said that with much of the innovation in digital health occurring in the private sector there is a need for more partnerships and innovative thinking on how care is funded and delivered.

The real promise of digital health, she comes from “really new models of care, new operating models, and new business models, which allow you to pay for things differently and have different characters do different things and get paid for it.” In fact, she said, Deloitte has estimated that 85% of everything being done in healthcare today will shift to these new models.

Dov Klein, VP of value-based care at Ontario Health, and the final speaker on the panel talked of the desire in Ontario to develop a system focused more on outcomes and in preventing patients from requiring acute-care services. He also hinted as changes to come for the Ontario Health Teams providing primary care in the province.

Ontario’s family doctors getting guidance on best use of AI

Artificial Intelligence (AI)-assisted scribes are at the front of the queue when it comes to tools using AI being assessed to help Ontario family physicians in their practices.

OntarioMD is partnering with the Ontario Medical Association (OMA) and the eHealth Centre of Excellence to evaluate the value of clinical AI scribes to reduce the administrative burden in primary care.

This work is part of a comprehensive process that has been undertaken by OntarioMD to assess the potential role for AI in primary care. Ontario MD is a subsidiary of the OMA funded by the province to deliver digital health solutions to clinicians.

At the recent e-Health conference in Toronto, the organization hosted a lunchtime session led by Dr. Chandi Chandrasena, chief medical officer, to brief delegates on its work on AI. Underlying OntarioMD’s focus in this area is a belief that use of AI tools could help move physicians away from transactional tasks and allow them to focus more on patient care. If such tools are integrated seamlessly into physician workflows, Dr. Chandrasena said, they have the potential to help physicians avoid burnout.

Work that has been done by OntarioMD resulted in several key observations about the AI’s potential in family medicine as detailed at the session by Simon Ling, executive director for products and services at OntarioMD.

Ling noted the AI market is growing rapidly in Ontario. An initial environmental scan undertaken by OntarioMD showed Canadian vendors are active in all areas where AI may have potential uses of community-based physicians.

In tracing patient interactions with community physicians, OntarioMD detailed how AI solutions could assist in the pre-visit, visit, and post-visit stages. During the patient visit, the organization noted that AI could assist during the patient visit with documentation (AI scribe), diagnostic support, as a virtual assistant (e.g. with scheduling and prescription writing), and clinical decision support.

The OntarioMD presentation detailed how two major vendors in Ontario – TELUS Health and WELL Health have stated their strong commitment to developing AI solutions for physicians.

However, Ling said there is currently a lack of integration between existing AI solutions and EMRs being used by Ontario family physicians as well as the absence of a “coherent blueprint” connecting AI solutions with healthcare needs. In addition, OntarioMD feels there is still limited information on the accuracy of AI models used in healthcare as well as data on the effectiveness of AI solutions.

While AI scribes top the list of tools being assessed by OntarioMD, speakers at the lunchtime session also talked of the potential for AI solutions to help prepare patients to visit their physicians and to provide them with guidance after these visits.

In another presentation at the e-Health conference, Dr. Kaveh Safavi, senior managing director of global health for Accenture shared to-date unreleased data on which tasks  Canadian physicians, doctors and nurses think will become automated. Topping the list in 2022 poll were:

• 82% Patient registration (check-in)
• 82% Service billing and remuneration
• 77% Inventory management
• 76% Scheduling for providers
• 75% Patient scheduling and follow-ups

It’s a medical practice, Jim – but not as we know it

Image: Dr. Kaveh Safavi

Artificial intelligence (AI) – whether old school AI algorithms using “big data” or new normative models using large language models (such as chat GPT) – is already fundamentally changing how some Canadian physicians work and will impact the very nature of medical practice itself.

But whether changing approaches to diagnosis and management augmented by AI are actually going to make practice more satisfying and combat the smoldering fires of burnout driven by increasing demands placed on physicians is still very much an unknown.

As with any conferences focusing on health technology right now, recent Canadian health care conferences such as the major e-Health conference held in Toronto last week had the role of AI has a major topic of discussion.

Speakers at both #ehealth2023 and the CADTH annual symposium that preceded it in Ottawa provided tangible examples of how major Canadian healthcare institutions are already using AI to improve care delivery. But arguably the most provocative and thought-provoking presentation was the opening plenary at e-Health from Dr. Kaveh Safavi, senior managing director of global health for Accenture.

In discussing the future of healthcare and the potential roles for AI, Dr. Safavi noted “we are fundamentally changing the nature of how we do work, and it will be different in half a decade or a decade for now.” Using technology to replace tasks in healthcare will mean redistributing remaining tasks and essentially changing the healthcare workforce to a combination of “fixed and adaptive workers”, he said.

Dr. Safavi also challenged the widely held believe that using AI to help relieve physicians and nurses of the administrative burdens they currently face will allow them to focus on more complex tasks and make reduce burnout. Doctors complain bitterly about doing administrative tasks but complain even more when these tasks are being taken away because it means they must work at peak capacity continuously, he said.

Interestingly at the very same conference other speakers maintained that allowing physicians to focus on patient care and deal with complex cases and patient care would do exactly what Dr. Safavi said it will not – namely improve physician well-being and reduce burnout.

For AI to be used productively in healthcare, Dr. Safavi said, practitioners will need to know how to ask the right questions of the AI tools and interact with them. A panel discussion focused specifically on the role of AI in healthcare at e-Health agreed that medical schools needed to integrate effective use of AI into medical education.

“When we think about how we train clinicians today and you look at medical schools and nursing schools, I think we’re a little behind the curve,” said Aloha McBride, global health sector leader with EY Consultants, adding basic training about AI needs to be incorporated into undergraduate and postgraduate curricula.

“Clinicians especially need to be able to understand why it is that this particular algorithm is presenting them with this particular recommendation. And probably more importantly, they need to be able to explain it to their patients.”

Another speaker on the same panel, Rachel Dunscombe, former CEO of the National Health Service (NHS) Digital Academy said that within the NHS in the UK, senior clinical leaders are already being provided with such training.

As noted, speakers at both e-Health and the CADTH meetings showed how AI is already being integrated into care delivery at major Toronto hospitals.

In the closing session at CADTH, Dr. Muhammad Mamdani, vice president of data science and advanced analytics at Unity Health Toronto said much of healthcare is data driven and AI can assist in using data better for diagnosis, prognosis and treatment. He described how a predictive AI algorithm is being used at Unity Health to monitor internal medicine patients to assess risk and that this is reducing mortality rates.

At e-Health, Dr. Bradly Wouters, executive vice president of science and research at the University Health Network in Toronto described how clinicians at Princess Margaret Cancer Centre are implementing use of an AI algorithm to quickly and accurately develop a treatment plan for use of radiation therapy.

Other examples were also given about the impact of combining big data with machine-learning to develop clinical support tools.

(This is part 1 of a 2-part series dealing with discussions of AI at e-Health. The second part will discuss how AI could best benefit community-based family physicians)

 

“Data can save lives” The 2022 @Infoway Partnership Conference

One in five clinicians spend more than an hour daily beyond what they think they should be spending in looking for patient information either within or outside their own patient record system.

This finding comes from the Canadian Interoperability Landscape survey conducted by Canada Health Infoway in April with 808 clinicians of whom half were either general practitioners or specialists. Results were released in early November and further discussed as part of the Infoway Partnership conference held in Montreal this week – the first time the conference had been held in person since 2019.

The findings underscore the ongoing challenges physicians can face in accessing the patient data they need even with the prevalence of electronic medical records (EMRs) and was a main theme underlying the Infoway meeting. While the conference focused heavily on the success of recent Infoway initiatives, physicians will be encouraged to hear many speakers over the course of the meeting acknowledged the profession’s concerns.

Four years ago, at the same meeting Infoway positioned itself as an advocate for building a coalition committed to promoting “a future where all Canadians have access to their health information through the availability and use of digital health tools and services, which will empower patients and improve health outcomes.” The whole initiative was branded under the banner ACCESS 2022.

That initiative has now morphed into an emphasis on Connected Care (the more user-friendly term for interoperability) and the need to give all Canadians to ability to access and share their health information while at the same time improving the flow of better and timely data to increase care coordination and help system planning and improved performance.

According to Infoway, a savings of $350 million annually could be gained by having health care providers access complete patient information in one place thereby allowing them to spend more time with patients.

Despite seeing the normalization of virtual care delivery during the COVID pandemic, Dr. Rashaad Bhyat, a Brampton family physician and clinician leader at Infoway told the meeting fragmented and siloed information systems have worsened physician burnout. For example, the Interoperability survey found that more than half of the specialists polled (54%) and 36% of family physicians said they continue to rely on faxes as one of the means of receiving patient summaries from outside their practices.

Other speakers noted that ongoing frustration with digital tools and the administrative burden of maintaining EMRs continues to feed physicians’ ambivalent or negative attitude towards digital care.

In addition to the challenges facing physicians in easily accessing the patient data they need, speakers from OntarioMD noted the majority of primary care physicians currently do not capture data in their EMRs in a codified or structured format that can uploaded to benefit the system and they do not have incentives to do so.

“Health data can save lives” federal health minister Jean-Yves Duclos bluntly told the conference in backing the call for a national framework to better share health data. His fireside chat at the meeting came just days after provincial and territorial health ministers rejected an offer for more healthcare funding from the federal government in part in exchange for supporting a national health data system.

While the whole Infoway conference focused on the need for more health data to be shared more effectively, it was acknowledged during a session on cybersecurity that such increased sharing would likely lead to more cyberattacks on hospitals and other healthcare organizations. The same session heard just how challenging it can be for those schooled in using electronic systems to revert to using paper if electronic systems are unavailable due to a cyberattack.

In the US, physicians push hard for ongoing support for virtual care

Changes instituted because of the COVID-19 pandemic that relaxed the regulatory and payment environment for virtual care appear to have strengthened the support of US physicians for the use of digital health technologies.

The survey is being used by the American Medical Association (AMA) to bolster advocacy efforts calling on the US Senate to follow the House of Representatives and continue to flexibilities around Medicare payments for telehealth and regulations supporting telehealth, until the end of 2014.  Earlier this week, dozens of US medical associations (including the AMA), academic centres and insurers also sent a letter to the Senate also urging extension of measures introduced because of COVID-19.

The situation has been mirrored somewhat in Canada where medical associations have been negotiating to extend changes in the fee schedule to support virtual care as well as advocating for regulatory changes to make it easier to offer such services.

The new survey by the AMA involving 1300 physicians shows the number who feel there is an advantage in using digital tools for patient care has risen from 85% in 2016 to 93% now. This has been accompanied by a growth in the number of doctors using virtual care from 14% to 80% over the same period.

The letter sent to the Senate states “…patients now expect and often prefer telehealth as a key component of our health care system,” said the letter, adding “virtual care is now a fundamental part of the U.S. health care system, and it will improve patient access to high quality care and strengthen continuity of care well beyond the COVID-19 pandemic.”

“Virtual care is now a fundamental part of the U.S. health care system,” the letter goes on, adding “…many of the most compelling clinical use cases for virtual care are only now emerging, more communities than ever have experienced the powerful impact telehealth has had in bridging gaps in care … without statutory certainty for remote care the hard work of building infrastructure, trust, and relationships with these communities is beginning to stall.”

Interestingly, the AMA survey indicates physicians feel improved clinical outcomes and work efficiencies rather than improved patient engagement are the main motivators for using digital health tools. In fact, the ability of digital tools to give consumers greater access to their clinical data dropped in importance between 2019 and now in the eyes of physicians as an important reason for using digital tools.

More than three-quarters of physicians polled (76%) feel that digital health tools can help reduce stress and burnout up from 69% in 2019.

The survey also shows US physicians are starting to adopt more advanced digital technologies in their practices. Eighteen percent now say they are using augmented intelligences for practice efficiencies and another 76% said they plan to do so in the future. Similarly, 18% say they are using augmented intelligence for clinical purposes with another 36% saying they are planning to do so within the next year.

Physicians will have good opportunities to view the digital health landscape in Canada this fall as both OntarioMD and Canada Health Infoway hold major conferences with updated assessments of the situation.

Safety not convenience needs to guide use of virtual care: CMPA

CMPA Panel on Virtual Care

Safety not convenience should determine when to offer virtual care, according to a new white paper from the Canadian Medical Protective Association (CMPA). The CMPA document places a strong emphasis on the need for the development of clear and consistent professional and clinical guidelines and standards for delivering virtual care.

The document was released in conjunction with CMPA’s annual meeting which hosted an information panel of experts discussing the medical-legal realities of offering virtual care emerging from the COVID-19 pandemic.

In its white paper, the association called on guideline development to be done by specialty societies and by regulatory authorities who should “adopt consistent licensure requirements for virtual care delivered from another province or territory.”

“Physicians must be allowed to continue to use their professional judgment about whether virtual care is appropriate in the circumstances of each patient,” states the white paper. “However, guidelines and standards can help physicians make these decisions in a way that enhances both access to, and safety of, care and minimizes medico-legal risk.”

The report details some of the ongoing challenges with rolling out virtual care in Canada:

• the fragmented approach across the country with respect to interprovincial licensure requirements;
• an inconsistency in standards and guidelines for the reasonable to use virtual care;
• lack of proper infrastructure and training about the various modalities of virtual care; and
• lack of access to secure virtual care platforms.

While the decision when to offer virtual care rests in the hands of the physician, the CMPA also notes patient preference and autonomy should be respected.

It was CMPA CEO Dr. Lisa Calder who perhaps most accurately summarized the panel discussion and current state of virtual care in Canada in her remarks after the panel when she noted the lack of clear focus and direction for the appropriate use of virtual care.

Speakers in the panel session such as CMA President Dr. Katharine Smart and College of Physicians and Surgeons of Ontario CEO Dr. Nancy Whitmore noted the huge advances made in the use of virtual care made necessary by the COVID-19 pandemic. Dr. Smart also suggested that if regulatory hurdles could be overcome then virtual care could help address the current crisis in healthcare staffing.

“The reality is we know there’s areas that are very well resourced and areas that aren’t and and I think there’s some potential for virtual care to bridge that,” she said, “(and) I think there are also opportunities to be providing virtual supports in places that don’t necessarily have a physician.”

Cautionary notes were struck by CMPA panel representatives who noted the impact of the huge increase in the use of virtual care on the medico-legal landscape is still not clear. “I think many of us intuitively think there are risks (but) we haven’t seen the hard data to confirm that at this point in time,” said Dr. Pamela Eisener-Parsche, executive director of member experience.

“The judgment that physicians need to bring to deciding how they implement virtual care in their practices is actually different today, than it was in April or May of 2020 when many of us were in lockdown,” said Dominic Crolla, senior legal counsel for CMPA. “Although we’re in Western Canada (the CMPA meeting was being held in Vancouver), it’s not the Wild West. Virtual care, for physicians at least, has real, ethical, legal and professional standards.

Another cautionary note was struck by one physician in the audience who commented “I’m seeing virtual care being used for the convenience of physicians, and not in small ways.” However, Dr. Smart countered that when it comes to virtual care “the vast majority of people are going to do a great job and the right job and make good decisions.”

While Dr. Smart spoke enthusiastically about the positive impact of virtual care on her pediatric practice in Whitehorse it was her comment that “there is no substitution still in medicine for a good history and physical exam” that seemed to resonate most with those commenting on the session through Twitter.

Discussion during the panel also touched on the need for appropriate remuneration, the problematic nature of virtual walk-in clinics offering only episodic care, the important role of equity in delivery of virtual care services and the toll providing virtual care has taken on some physicians.

#AI: Risks and Challenges (June 2022 edition)

Last week’s virtual e-Health conference and tradeshow featured some intriguing examples of how AI and machine learning are being used in the Canadian healthcare context – from developing a screening blood test for breast cancer to helping public health officials to manage the COVID-19 pandemic.

Perhaps more significant was a panel discussion on “practicing responsible” AI which noted that while AI has the potential to expand health services in underdeveloped regions globally, it also creates risks of creating “data poverty” by not properly including populations in the databases used to create the algorithms running clinical programs driven by AI.

A just published report by the European Parliament Panel for the Future of Science and Technology provides more of a deep-dive into the risks and ethical and societal impact of AI and machine learning touched on in the panel discussion at e-Health.

The European report was based on “a comprehensive interdisciplinary (but non-systematic) literature review and analysis of existing scientific articles, white papers, recent guidelines, governance proposals, AI studies and results, news articles and online publications.”

The report notes that “AI has progressively been developed and introduced into virtually all areas of medicine, from primary care to rare diseases, emergency medicine, biomedical research and public health. Many management aspects related to health administration (e.g. increased efficiency, quality control, fraud reduction) and policy are also expected to benefit from new AI-mediated tools.”

In the clinical setting specifically, the European report authors state the potential of AI “is enormous and ranges from the automation of diagnostic processes to therapeutic decision making and clinical research.”

The report goes on to identify and elaborate upon 7 main risks associated with the use of AI in medicine healthcare:

• patient harm due to AI errors
• the misuse of medical AI tools
• bias in AI and the perpetuation of existing inequities
• lack of transparency
• privacy and security issues
• gaps in accountability
• obstacles in implementation

“Not only could these risks result in harms for the patients and citizens, but they could also reduce the level of trust in AI algorithms on the part of clinicians and society at large,” the authors state. “Hence, risk assessment, classification and management must be an integral part of the AI development, evaluation and deployment processes.”

Even with large-scale datasets with sufficient quality for training their AI technologies, the report says there are still at least three major sources of error for AI in clinical practice.

1. Having AI predictions significantly impacted by noise in the input data during the usage of the AI tool. Eg. Scanning errors when using AI in ultrasound scanning.
2. AI misclassifications due to dataset shift that occurs when the statistical distribution of the data used in clinical practice is shifted, even slightly, from the original distribution of the dataset used to train the AI algorithm.
3. Predictions can be erroneous due to the difficulty of AI algorithms to adapt to unexpected changes in the environment and context in which they are applied.

The report authors outline the potential for misuse of medical AI tools and potential mitigating factors in the chart below:

From: European Parliament : Artificial Intelligence in Healthcare

When it comes to the know well demonstrated potential for bias in AI, the report suggests mitigating these risks by:

• Systemic AI training with balanced and representative datasets
• Involving social scientists in interdisciplinary approaches to medical AI
• Promoting more diversity and inclusion in the field of medical AI

The report notes accountability is key to the greater acceptance of AI in the field of medicine. “…clinicians that feel that they are systematically held responsible for all AI-related medical errors – even when the algorithms are designed by other individuals or companies – are unlikely to adopt these emerging AI solutions in their day-to-day practice. Similarly, citizens and patients will lose trust if it appears to them that none of the developers or users of the AI tools can be held accountable for the harm that may be caused.” For this reason, the report authors state: There is a need for new mechanisms and frameworks to ensure adequate accountability in medical AI …”

Of course, the European report is far more comprehensive than the summary above and also provides detailed suggestions for mitigating the risks it identifies – some specific to the European policy environment and others not.

Building the health data system Canada needs (#VCAHSPR22 #Ehealth2022)

From: Expert Advisory Group Report 3: Toward a world-class health data system

Canada may be in desperate need of a world-class, person-centric health data system but the drive to implement such a system certainly isn’t making headlines … even though patients are being harmed and sometimes dying without one.

A month ago, the Pan-Canadian Expert Advisory Group (EAG) released its third and final report on developing such a system, to what can only be described as a total lack of media attention. The EAG was established in the fall of 2020 under the chairmanship of Dr. Vivek Goel with support from the Public Health Agency of Canada.

While Canadians may badly need and strongly support the set of common principles outlined in a Canadian Health Data Charter – endorsement of which was the first recommendation of the advisory group – it’s hardly a topic to knock Ukraine or even  the Ontario election of the front pages of newspapers.

However this week the EAG did have an opportunity to give a comprehensive account of its work and the issues involved at the annual meeting of the Canadian Association of Health Services and Policy Research (#CAHSPR22).

Serendipitously, the e-health 2022 Virtual Conference & Tradeshow (#ehealth2022), occurring at the same time, featured a panel discussion in which representatives from Canada’s main players in the digital health space – Canada Health Infoway, the Canadian Institutes for Health Information (CIHI) and Digital Health Canada – discussed how they were collaborating to address interoperability of health systems. As those working in digital health have know for years, interoperability is one of the key facilitators needed to overcome some of the barriers spelled out by the EAG in its reports.

As part of the EAG presentation, Eric Sutherland noted that the currently health data in Canada is “as protected as possible and as open as necessary” and a radical culture shift is required to flip this paradigm. Dr. Ewan Affleck, another member of group, made a strong case for core principles in a Data Charter to make this happen. “We have a moral obligation to do this because we are failing Canadians if we do not,” said Dr. Affleck.

While there is not space here to outline all that the EAG proposes for such a charter, the highlights include the need for:

• Person-centric health information design to ensure that health data follow the individual across points of care to support individual, clinical, and analytical access and use.
• The quality, security and privacy of health data to maximize benefit and reduce harm to individuals and populations.
• Literacy regarding health data and digital methods for the public, decision-makers and the health workforce.
• Harmonization of health data governance, oversight, and policy.
• Support for First Nations, Inuit and Metis Nation data sovereignty.

As for implementing the strategy, the EAG calls for endorsement of the principles in the charter as a first step with other incremental advances being made towards implementation of the full strategy in a decade. The EAG also acknowledges the importance of collaboration among key players, including levels of government and the public, to bring about the strategy.

The full text of the EAG’s third report can be accessed here.

For their part the e-Health panel noted that the availability of health data in a common, standardized and structred format is the key to interoperability. Abhi Kalra, VP, Portfolio Management, Virtual Care Programs, Canada Health Infoway acknowledged, the journey to interoperability has taken some time but key organizations are now leveraging their assets and working collaboratively to bring it closer to reality.

 

 

 

Clinicians express views on the digital future at #HIMSS22

The majority (56%) of clinicians participating in a large, global survey believe that “the majority” of their clinical decisions in the future will be made with tools using artificial intelligence (AI)

However, in the poll of about 3000 physicians and nurses conducted in 111 countries (including Canada) by Ipsos for Elsevier Health,  the majority of respondents expressed concern that medical and nursing school training was not keeping up with the need to educate them properly with the knowledge and skills needed to use modern technologies.

Findings from The Clinician of the Future study were released during the Health Information and Management Systems Society (HIMSS) annual meeting here and discussed during a sponsored session by Dr. Ian Chuang, chief medical officer for Elsevier Health.

Meanwhile results from HIMSS own State of Healthcare survey conducted at the end of last year and including 359 physicians from five countries was also releasee and discussed at the meeting. That report confirmed clinicians feel digital transformation is well underway with 90% of respondents identifying ongoing digital initiatives within their own organizations.

Interestingly, while many health system leaders polled in the HIMSS survey had reservations about the pace of digital transformation within healthcare, 16% of US clinicians said they felt their organizations had completed the transformation process and about half felt the process was well underway.

According to U.S.-based clinicians, tools that do not fit into clinical workflows, lack of proper training and lack of clear communication within the health organization are impeding transformation efforts. However, UK clinicians identified lack of clear communication as the top barrier to digital transformation.

While 88% of clinicians in the HIMSS survey reported their digital skills have improved over the past year and 79% reported choosing to use digital health tools on their own initiative, respondents in the Elsevier survey were less confident of their skills in using new digital technologies.

Of those responding to the survey, 69% feel the widspread use of digital health technology will be a challenging burden on clinician responsibilities if clinicians are not appropriately supported. In addition, 83% felt training needs to be overhauled to keep pace with intro of new technologies. Dr. Chuang said there is a sense that it is not just new information that needs to be taught but rather a shift in the whole medical education paradigm. As one US clinician quoted in the report said: “There’s no time spent separately to learn technology. That education needs to be instilled into the system to ensure all doctors are educated.”

The survey also found that 69% of clinicians globally felt overwhelmed with the current volume of data they had to deal with. While 38% of the clinicians felt receiving training and education in order to remain current will be the top educational priority over the next decade, a similar percentage believe training in the effective use of digital health technologies to assist in the delivery of patient care remotely will be the second priority

#HIMSS22 – Battling burnout with technology

Orlando, FL — Can the technological beast that has made many physician lives so miserable by drastically increasing the administrative work required to support electronic medical records be tamed and used to help reduce burnout?

That possibility was raised at several sessions here at the annual meeting of the Health Information and Management Systems Society (#HIMSS22).

The issue was first addressed in an Executive Forum held as one of a series of pre-conference symposia where speakers raised the prospect that both better analytics and the expanded use of virtual care could help with workforce retention and also in reducing burnout.

In a panel discussion, Mikki Clancy, chief digital officer at Premier Health in Ohio noted how the hospitals in her network have started using AI to reduce the administrative burden facing nurses, automating more tasks that previously had been done manually and using predictive analytics to help support more flexible working conditions. In the same discussion, Albert Marinez chief analytics officer at Intermountain Healthcare said that many clinicians have become burned out during the current pandemic and want to stop providing direct patient care in a hospital environment. For some of these physicians, he said, the broader opportunities now offered in virtual care offer an alternative which can allow them to still interact with patients in a more flexible environment.

It’s not just hospital-based physicians who are feeling more burdened today as a result of the pandemic and the requirements of maintaining electronic medical records. To quote the American Association of Family Physicians (AAFP): “The family medicine experience is based on a deeply personal physician-patient interaction that requires support from technology. But many technologies used in practice today have eroded the experience rather than enhancing it.” 

It was in part to address this that AAFP created its Innovation Laboratory  in 2018 to partner with technology companies to rigorously test new technologies such as AI and voice and mobile technologies to eliminate or decrease burnout by reducing the administrative burden on family physicians.

At a HIMSS session, Dr. Steven Waldren, VP and chief medical informatics officer at the AAFP, discussed two successful pilot projects AI Digital Assistants:

• Suki (suki.a) is an AI-powered digital assistant that allows physicians to minimize documentation/charting time.
• Navina (Navina.ai) integrates with the practice’s EHR and automates data aggregation and analysis to create a comprehensive patient portrait for physician review. Dr. Waldren said this tool can not only save time, it also helps ensure that no relevant information is missed.

An AAFP document states both tools “use voice recognition, natural language processing, and artificial intelligence to provide physicians with an AI assistant that continually listens, learns, and adapts to a physician’s documentation patterns and needs. The vision is for the AI assistant to be similar to a medical assistant or nurse who understands a physician’s preferences, anticipates their needs, and completes their charting for them.” 

With both of these tools, AAFP first demonstrated proof of concept with a small group of physicians and then tested the tools with groups of more than 100 practising family physicians.

With the documentation reduction tool, physicians who completed the 30 day trial saw a 72% reduction in their median documentation time per note for an estimated time saving of 3.3 hours/week. Participating physicians also expressed satisfaction with the quality of notes prepared as being more meaningful and professional. “We conclude that an AI assistant for Documentation is an

essential innovation for all family physicians who have documentation burden and experience burnout,” the report on the trial stated.

Initial results of the tool used to create patient summaries, found use of the tool reduced by 70% the time taken by a physician to prepare for a patient visit.

Numerous other sessions at HIMSS promoted a variety of technological tools and systems with the promise of helping to reduce burnout  These included:

• APIs (Application Programming Interfaces)
• Next-Gen Community Platforms
• AI-optimized staffing schedulers