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Using AI To Streamline EMR Workflow For Clinicians

Posted on May 10, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Understandably, most of the discussion around AI use in healthcare focuses on data analytics for population health management and predictive analytics. Given the massive scale of the data we’re collecting, that’s no surprise.

In fact, one could argue that using AI technologies has gone from an interesting idea to an increasingly established parto the health IT mix. After all, few human beings can truly understand what’s revealed by terabytes of data on their own, even using well-designed dashboards, filters, scripting and what have you. I believe it takes a self-educating AI “persona,” if you will, to glean advanced insights from the eternity of information we have today.

That being said, I believe there’s other compelling uses for AI-fueled technologies for healthcare organizations. If we use even a relatively simple form of interpretive intelligence, we can improve health IT workflows for clinicians.

As clinicians have pointed out over and over, most of what they do with EMRs is repetitive monkey work, varied only by the need to customize small but vital elements of the medical record. Tasks related to that work – such as sending copies of a CT scan to a referring doctor – usually have to be done in another application. (And that’s if they’re lucky. They might be forced to hunt down and mail a DVD disc loaded with the image.)

Then there’s documentation work which, though important enough, has to be done in a way to satisfy payers. I know some practice management systems that integrate with the office EMR auto-populate the patient record with coding and billing information, but my sense is that this type of automation wouldn’t scale within a health system given the data silos that still exist.

What if we used AI to make all of this easier for providers? I’m talking about using a predictive intelligence, integrated with the EMR, that personalizes the way data entry, documentation and follow-up needs are presented. The AI solution could automatically queue up or even execute some of the routine tasks on its own, leaving doctors to focus on the essence of their work. We all know Dr. Z doesn’t really want to chase down that imaging study and mail it to Albany. AI technology could also route patients to testing and scans in the most efficient manner, adjusted for acuity of course.

While AI development has been focused on enterprise issues for some time, it’s already moving beyond the back office into day-to-day care. In fact, always-ahead-of-the-curve Geisinger Health System is already doing a great deal to bring AI and predictive analytics to the bedside.

Geisinger, which has had a full-featured EMR in place since 1996, was struggling to aggregate and manage patient data, largely because its legacy analytics systems couldn’t handle the flood of new data types emerging today.

To address the problem, the system rolled out a unified data architecture which allowed it to integrate current data with its existing data analytics and management tools. This includes a program bringing together all sepsis-vulnerable patient information in one place as they travel through the hospital. The tool uses real-time data to track patients in septic shock, helping doctors to stick to protocols.

As for me, I’d like to see AI tools pushed further. Let’s use them to lessen the administrative burden on overworked physicians, eliminating needless chores and simplifying documentation workflow. And it’s more than time to use AI capabilities to create a personalized, efficient EMR workflow for every clinician.

Think I’m dreaming here? I hope not! Using AI to eliminate physician hassles could be a very big deal.

A Look At The Role Of EMRs In Personalized Medicine

Posted on January 19, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

NPR recently published an interesting piece on how some researchers are developing ways to leverage day-to-day medical information as a means of personalizing medical care. This is obviously an important approach – whether or not you take the full-on big data approach drug researchers are – and I found the case studies it cited to be quite interesting.

In one instance cited by the article, researchers at Kaiser Permanente have begun pulling together a dashboard, driven by condition types, which both pulls together past data and provides real-life context.

“Patients are always saying, don’t just give me the averages, tell me what happened to others who look like me and made the same treatment decisions I did,” said Dr. Tracy Lieu, head of Kaiser’s research division, who spoke to NPR. “And tell me not only did they live or die, but tell me what their quality of life was about.”

Dr. Lieu and her fellow researchers can search a database on a term like “pancreatic cancer” and pull up data not only from an individual patient, but also broad information on other patients who were diagnosed with the condition. According to NPR, the search function also lets them sort data by cancer type, stage, patient age and treatment options, which helps researchers like Lieu spot trends and compare outcomes.

Kaiser has also supplemented the traditional clinical data with the results of a nine-question survey, which patients routinely fill out, looking at their perception of their health and emotional status. As the article notes, the ideal situation would be if patients were comfortable filling out longer surveys on a routine basis, but the information Kaiser already collects offers at least some context on how patients reacted to specific treatments, which might help future patients know what to expect from their care.

Another approach cited in the article has been implemented by Geisinger Health System, which is adding genetic data to EMRs. Geisinger has already compiled 50,000 genetic scans, and has set a current goal of 125,000 scans.

According to Dr. David Ledbetter, Geisinger’s chief scientific officer, the project has implications for current patients. “Even though this is primarily a research project, we’re identifying genomic variants that are actually important to people’s health and healthcare today,” he told the broadcaster.

Geisinger is using a form of genetic testing known as exome sequencing, which currently costs a few thousand dollars per patient. But prices for such tests are falling so quickly that they could hit the $300 level this year, which would make it more likely that patients would be willing to pay for their own tests to research their genetic proclivities, which in turn would help enrich databases like Geisinger’s.

“We think as the cost comes down it will be possible to sequence all of the genes of individual patients, store that information in the electronic medical record, and it will guide and individualize and optimize patient care,” Ledbetter told NPR.

As the story points out, we might be getting ahead of ourselves if we all got analyses of our genetic information, as doctors don’t know how to interpret many of the results. But it’s good to see institutions like these getting prepared, and making use of what information they do have in the mean time.

Patients Want Access To Physician Notes Despite Privacy Concerns

Posted on October 4, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While privacy concerns remain, patients’ desire to access their medical records online seems to outweigh those concerns, according to a study reported in iHealthBeat.

The study, which was published in the Journal of Medical Internet Research, included 3,874 primary care patients at Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center. Each of these institutions implemented OpenNotes, a portal which allows patients to read the notes written by their doctors following office visits, e-mail correspondence and phone calls. The patients were able to view the notes via the portals where other parts of their medical records are stored.

Researchers interviewed patients at baseline, prior to their using the OpenNotes portal. They were interviewed again after a one year period during which they were able to use the OpenNotes portal to review the notes doctors made during their visits.

Privacy remained a concern throughout the study period, iHealthBeat noted. At the study’s outset, about 33 percent of OpenNotes project participants reported having concerns about privacy;  meanwhile, almost 37 percent said they were concerned about privacy after the one year period of using the portal.

After using the portal  for a year, 15.5 percent of patients said they were more concerned about privacy, while 12.7 percent said they were less concerned about privacy.

That being said, study participants were still very enthusiastic about having access to the notes. In fact, at the study’s end, 99 percent of participants said they wanted continued access physician notes, despite their initial privacy concerns.

In April of last year, when I first wrote about this project, I  predicted that patients would become very attached to the level of intimacy OpenNotes would offer with their providers.  It seems that this has come to pass. If 99 percent of patients want to continue with the project despite having privacy concerns, that’s a ringing endorsement of the concept. Now, I’m curious as to whether other institutions will get on board.

Geisinger Opens Doctors’ Notes To Patients

Posted on May 15, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Geisinger Health System is kicking off a new program under which more than 100,000 patients will have access to their doctors’ notes. Patients will access the notes through the secure MyGeisinger online patient portal, reports Healthcare Informatics.

The initiative grows out of a pilot, funded by a $1.4 million grant from the Robert Wood Johnson Foundation. The OpenNotes project, which lasted 12 months, brought together 105 primary care doctors with more than 19,000 of their patients, in an effort to see how both patients and physicians were affected by the sharing of doctors’ notes after each encounter, according to Healthcare Informatics.

The study group included 24 Geisinger primary care docs and 8,700 patients.  The rest of the patients and doctors  were drawn from Harborview Medical Center, Seattle, Wash., and Beth Israel Deaconess Medical Center.

Results from the pilot, which were published in the October 2012 Annals of Internal Medicine, showed that patients strongly favored seeing their physician’s notes.  Also, tellingly, no doctors asked to opt out at the study’s end.

Findings showed that patients did indeed read their notes and felt more a part of the care process when they did. Roughly 11,200  patients (or about 82 percent) opened at least one note found in their EMR.

Of patients who opened at least one note, 77 to 87 percent across the three study sites said that OpenNotes made them feel more in control of their care.  Doing so also helped them adhere to their medication regimens, the magazine said. Only a few patients reported higher levels of worry, confusion or offense due to seeing the notes.

Patients liked having the notes access so much that 85 percent reported that it would influence their choice of providers in the future.

It seems that opening up a patient portal isn’t quite the pandora’s box that some thought it could be.

Will “Open Notes” Change EMR Design?

Posted on April 26, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Today I read about a very interesting project focused on improving relationships between physicians and patients. I suspect the concept would make some doctors’ skin crawl — anytime you’re asked to give up over control of information, it smarts a bit — but I suspect we’re seeing a glimpse of the future.

The  OpenNotes project, which is being conducted at Beth Israel Deaconess Medical Center, Geisinger Health System and Seattle’s Harborview Medical Center, lets patients review the notes, e-mails and phone calls primary care doctors make after their medical appointment. Patients access the information via a secure Web interface.

In July 2010, researchers published baseline findings prior to the OpenNotes kickoff in the Annals of Internal Medicine. Since then, the project seems to have attracted a lot of interest, with more than 100 doctors and 20,000 patients participating.   It’s also gotten a lot of support from foundations;  the group has received grants from the Robert Wood Johnson Foundation Pioneer portfolio, the Drane Family Fund, the Koplow Family Foundation and the Katz Family Foundation.

Wondering how participants feel about this level of medical intimacy? Check out the OpenNotes site, where you’ll find a video  offering impressions from patients and doctors on how they feel about their level of communication.  As you’ll see, OpenNotes volunteer patients seem to enjoy having a closer relationship with their doctor, and more importantly, feel empowered to comment or even contradict the doctor if they see something that seems to be out of line.

“You can look at the comments that Bob writes down and sometimes you agree with him and sometimes you don’t,” says one patient. “Sometimes we clash on it, but then we work things out.” (Note the familiar title “Bob” the patient uses to address his doctor, which I doubt he would have otherwise.) Sounds like a better working relationship than I have with most of my providers!

Of course, there’s always questions as to whether approaches like these would work outside the confines of a grant-funded, academically-minded group of institutions and doctors.  Certainly that’s hard to tell. But it seems clear that at minimum, something worthwhile is going on here that might force vendors to think about patient facing data more deeply.  I’m impressed by what I see here and hope that we continue to learn from these efforts.