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CNIOs Go Strategic

October 20, 2016
by Heather Landi
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In a survey by Chicago consulting firm Witt/Kieffer, 51 percent of respondents said their organizations have a CNIO in place, an 82 percent increase from a similar survey in 2011.
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As more healthcare delivery organizations undergo clinical transformation processes, the demand for senior nursing informatics leaders continues to gain momentum—and along with new needs, the role of the chief nursing informatics officer (CNIO) is evolving forward, maturing and becoming more complex. Many CNIOs are finding themselves increasingly involved in organization-wide performance improvement and management processes even as they successfully let go of direct nursing management and other responsibilities.

Several years ago, a number of surveys and articles came out that pointed to the rise of the CNIO as an emerging role to support clinical transformation, as healthcare organizations began to move past initial electronic health records (EHR) implementations, and into EHR optimization and beyond. Indeed, the CNIO role has quickly gained traction in the past five years as healthcare executives recognize the importance of aligning clinicians’ workflow with health IT systems.

While in the past, senior nursing informaticists acted mainly as liaisons between IT and nursing in their organizations, the CNIO role has been blossoming into greater scope and complexity, with CNIOs in large health systems and integrated delivery networks (IDNs) in particular, ascending to positions of organization-wide leadership. And while the CNIO role has become increasingly established at large academic medical centers and large IDNs, leaders at a range of patient care organizations nationwide are increasingly recognizing the need for these skilled professionals.

“The nursing informaticists have such a unique role and their ability to blend clinical practice and how best to leverage technology is what really makes it a powerful role,” Sue Atkinson, R.N., associate principal with The Chartis Group (Chicago), says. Atkinson, who is based in Aspen, Colorado, is a leader at The Chartis Group’s clinical performance excellence practice. “Those are important skills to have—the clinical expertise and the IT knowledge and the ability to bring the two together to make the most of technology to ultimately focus on improving patient care.”

According to a recent survey of nursing informatics executives and their peers released by Chicago-based consulting firm Witt/Kieffer, 51 percent of respondents said their organizations have a CNIO in place, an 82 percent increase from a similar survey Witt/Kieffer conducted in 2011. In that survey from five years ago, 28 percent of respondents said they had a CNIO in place. Additionally, one-fourth of respondents (24 percent) in this year’s survey indicated the role was on the corporate radar.


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“I think a good surprise from the survey results is that the role is becoming more mainstream and we’re seeing more organizations either have hired CNIOs or are thinking about hiring them, more so than five years ago,” says Chris Wierz, R.N., an Oak Brook, Ill.-based principal with Witt/Kieffer, and co-lead of the firm’s IT practice. Wierz notes that her initial nursing title in healthcare IT was the computer nurse, “so we’ve come a long way,” she says.

Chris Wierz, R.N.

In the Witt/Kiefer survey, 14 percent of respondents currently hold the title of CNIO, compared to 4 percent in the 2011 survey, a 250 percent increase. The prevalence of the title Director of Clinical Informatics also grew, from 4 percent of respondents in 2011 to 14 percent in this year’s survey. Wierz says this indicates the informatics role is gaining credibility while making its way into the C-suite.

Terri Gocsik, R.N., a Detroit-based consultant and associate principal with The Chartis Group, sees a number of healthcare trends elevating the role of nursing informatics, including the persistent merger and acquisition activity in healthcare. “We’re seeing the existence of large IDNs and clinical integrated network (CIN) formation, and those organizations are seeing that they have disparate, decentralized processes for informatics and there’s a need to pull that together into a more organized, centralized format. So, we’re starting to see that leadership role, and it may not necessarily be a CNIO, it may be at the director level, so there’s different titles. We’re starting to see an increase of the recognition of the need for nursing clinical leaders to organize their work.”

The 2015 HIMSS “Impact of the Informatics Nurse Survey” indicates that informatics nurses were widely seen as bringing value to the use of clinical systems and technologies at their healthcare organizations. Respondents to that survey indicated that informatics nurses bring greatest value to the implementation phase (85 percent) and optimization phase (83 percent) of clinical systems process. Informatics nurses also were viewed as having a direct positive impact on the quality of care patients receive.

“We are going to continue to see the role and use of technology expand in healthcare and the demand for nurses with informatics training will grow in parallel. As clinicians further focus on transforming information into knowledge, technology will be a fundamental enabler of future care delivery models and nursing informatics leaders will be essential to this transformation.” Joyce Sensmeier, R.N., vice president of informatics at HIMSS North America, says.

Joyce Sensmeier, R.N.

According to Atkinson, the CNIO role is now growing in smaller IDNs as well. “I think there is measured growth for CNIOs right now. It’s somewhat slowed, with the focus now on what they are doing at their organizations. There is some growth in those smaller IDNs that are trying to achieve value with their technology investments.”


An Evolving, Maturing, Collaborative Role

The CNIO role is evolving as the requirements and responsibilities expand, and at the same time, there are ongoing efforts by nursing IT leaders to formalize and better define the position.

“A couple of years ago, we spent a lot of time trying to figure out what the role is for the CNIO and what the role was for a nursing informaticist, and to a certain extent, we still grapple with that,” says Mary Beth Mitchell, R.N., CNIO at Texas Health Resources, a 29-hospital health system based in Arlington, Texas. Mitchell led clinical informatics in a director role at Texas Health Presbyterian Hospital Dallas for 10 years and was named CNIO at Texas Health Resources six years ago.

“In my role, at least, we’ve moved past that and have said, ‘Okay, I’ve got my role defined and here is what I’m doing’ and I work more with clinicians and spending a lot of focus on quality outcomes and how we can use technology to support our patient care, our strategic initiatives, our quality,” Mitchell says. “Certainly, the documentation that nurses do and the EHR is becoming more visible, and as we have really gotten better at reporting and developing outcomes and analytics and dashboards, I think we’re having to really pay attention to the quality of documentation, and not just how they are using the EHRs, but are they using it well.”

Mary Beth Mitchell, R.N.

Some healthcare organizations have created new CNIO positions, while others have modified existing jobs to incorporate the title and scope. “Every CNIO I know has created their own job,” Mitchell says, adding that healthcare leaders need to strategically consider where the CNIO role fits organizationally. “Is it in IT or nursing? Is it a matrix position, as most CNIOs want to be clearly aligned with nursing. And, where do I sit at the table?”

In an effort to formalize the CNIO role, the HIMSS Nursing Informatics Community recently developed a CNIO job description to provide a standardized job description that can be referenced for needed competencies. The CNIO job description provides recommendations for a C-suite level CNIO position and outlines a broad set of responsibilities under the key categories of strategy and leadership, quality, patient safety, policy and procedure and technology.

“The bulk of the CNIO responsibilities fall under strategy and leadership, which is interesting, as it’s not just about technology, it’s about applying technology to patient care and the health of individuals, and technology is a small component,” Sensmeier says.

Nursing informatics leaders see their work expanding to initiatives focused on achieving value, patient care improvement, patient safety improvement, workflow adoption and optimization and they are also pushing into population health initiatives. Writing in the American Organization of Nurse Executive (AONE) publication Voice of Nursing Leadership, Patricia Sengstack, R.N., CNIO at the Marriottsville, M.D.-based Bon Secours Health System and past president of the American Nursing Informatics Association, said CNIOs can be key strategic partners in providing informatics expertise in the planning and implementation of new care delivery and payment models, such as accountable care organizations (ACOs), patient-centered medical homes (PCMHs), bundled payment programs and remote care via telemonitoring,

“Now that we have EHR systems implemented, I’m thinking that the CNIO role is important now more than ever as we try to manage how we use our technology to improve patient care and improve the clinician experience,” Mitchell says. As the nursing IT leader at Texas Health Resources, Mitchell focuses on the use of predictive tools for nursing. “One of the things that I work on is how can we make the EHR functionality more predictive and how can we put information more at nurses fingertips, so I put a lot of emphasis on interoperability and integration,” she says.

As an example of an integration project, this past year Mitchell led an effort to integrate IV infusion pumps across all the health system’s hospitals, which significantly reduces manual tasks and reduces errors. “I think CNIOs bring a different push and thought into how they approach the use of the technology,” she says.

Within healthcare delivery, there is a convergence of trends pushing the scope of nursing informatics leaders across disciplines and also across the continuum of care. CNIOs represent and advocate for the largest group of healthcare workers—nurses—and increasingly, these health IT leaders also represent other ancillary departments as well.

“With the informatics evolution there is now a broader focus on nursing informatics that touches not just nursing but also they really are becoming a bridge to the physicians and workflows that cover both, and linking in other ancillary services, like respiratory therapy,” Atkinson says. “Knowing that it takes a team to provide excellent patient care, we’re starting to see that move from focusing on just nursing tools to tools that link the various disciplines to focus on the optimal patient care.”

Sue Atkinson, R.N.

At the same time, many CNIOs work at large IDNs and health systems that are comprised of multiple hospitals, ambulatory practices, home health agencies and long-term care facilities, so communication with system end users across and throughout organizations increasingly has become an area of focus, Sengstack says.

CNIOs also are challenged with communicating real-time patient care information in an ever mobile environment across these organizations. In her article, Sengstack wrote, “The patient’s data is often contained in different clinical systems or databases. Attempting to tell the patient’s complete story and providing the necessary clinical data to the right care provider, at the right time no matter the location, is frustrating. We struggle with enabling patients’ data to follow them across care settings.”

As physician practices increasingly move to join health systems and IDNs, nursing informatics leaders will be expected to expand their focus to the ambulatory side, Atkinson says. “Up until now, there was not a need for oversight from a technology perspective for those nursing resources at those practices. Now, with population health, nurses need to have a purview across a full continuum—into the long-term care, into home health and the oversight of applied strategy to telehealth initiatives—to have a bigger impact as all that can drive value and prevent readmissions and acquired conditions,” she says.

Looking ahead, Mitchell is focused on nursing IT initiatives around analytics and “the quality of the nursing data,” she says, with an emphasis on “how do we make sure our nurses are documenting correctly, not just for the correct care of the patient, but also documenting in the right place, in the right way, so it is correctly reflected in our analytics, especially as we get to electronic clinical quality measures (eCQMs) and e-measures.”

It’s perhaps interesting to note that the Witt/Kieffer survey from this year asked respondents to rank the skills that could be considered success factors for CNIOs. Collaboration and consensus building as well as knowledge of nursing informatics topped the list as “essential” skills, yet people management also ranked high, along with skills such as vision and creativity.

Mitchell says she is not surprised by the latter skills cited in the survey. “It can be hard to transition from being operationally focused to being strategically focused. I really try to push the envelope as far as innovation. The technology changes so fast that we always have to be thinking ahead,” she says. As an example, Mitchell is working on an initiative for early detection of sepsis that involves getting vital signs from all patients in non-critical care settings every four hours. “I’m looking at ways to automate that process to do vital sign integration, but that still requires the nurses to go in every four hours to take the vitals. So then what about patient wearables that continuously monitor their vital signs so a nurse doesn’t have to take vitals every four hours? That’s what I mean by pushing the envelope. I want the integration, but what I really want is the patient wearable and still have the same outcome, which is early detection of sepsis,” she says.

Having a Seat at the Executive Table

There is a general consensus that CNIOs are gaining a strategic seat at the table alongside chief medical informatics officers (CMIO). As the CNIO role has matured and evolved, the reporting structure within healthcare organizations also has evolved. According to the Witt/Kieffer survey from this year, 42 percent of respondents said the CNIO reports to the chief nursing officer (CNO) and 24 percent said the position reports to the CIO, with 16 percent reporting to the CMIO. The duel CIO/CNO reporting structure was cited by 12 percent, followed by CEO and chief medical officer (CMO) among the “other” category with 3 percent. In the 2011 survey, many respondents selected the “other” option and, because the role was not at the C-suite level, the reporting structure was matrixed among C-suite leadership or connected to the top with a dotted line. “There seems to be less ambiguity now,” Wierz says.

“Overall, we’re seeing a move to have the informatics leader report through the operational side to really focus on the clinical needs and operational ownership of the technology resources,” Gocsik says.

Terri Gocsik, R.N.

Atkinson adds, “I think a key aspect of the reporting relationship has to do with the CNIO having someone who gets the importance of informatics in general and the CNIO role specifically, and can support their development and help them to focus on work that is meaningful to the organization and make sure that they are strategically aligned,” Atkinson says.

Additionally, in the Witt/Kieffer survey, 69 percent of respondents cited direct day-to-day collaboration with the CMIO on clinical IT matters as a top responsibility for the CNIO, the third highest responsibility after EHR and clinical IT system implementation and optimization and IT strategy as it relates to nursing.

At Texas Health Resources, Mitchell reports to Chief Health Information Officer Ferdinand Velasco, M.D., as does the CMIO, Luis Saldana, M.D., with a “dotted line” to the chief nurse executive. Sensmeier with HIMSS has high praise for the collaborative relationship between Mitchell and Saldana at Texas Health Resources, noting that the clinical informatics leaders “work together to look at the organizational requirements and use their areas of expertise to provide guidance to the organization.”

What was once viewed as a “grassroots role,” according to Sensmeier, nursing informatics leaders now have educational resources such as informatics programs to help further formalize the CNIO position. The HIMSS CNIO job description recommends that health system and hospital leaders require the CNIO to have a Master’s in Informatics or a Master’s in Nursing degree, and it is preferred that CNIOs have a Ph.D. in nursing or informatics or a Doctor of Nursing Practice (DNP) degree. Nurses serving in the CNIO role also should be board certified by the American Nurse Credentialing Center (ANCC) in Nursing Informatics, according to HIMSS.

Sengstack, who has a D.N.P. degree, asserts that nurses serving in CNIO positions should possess a doctorate degree. “This puts them in a position to serve at a partner level, as equals to other disciplines that may be at the corporate table. It prepares them as leaders to navigate the healthcare system at the highest level and gives them the skills to lead teams strategically through clinical transformation using technology,” she wrote in Voice of Nursing Leadership.

Outside of their healthcare organizations, CNIOS also are raising their profiles and establishing credibility by taking on external leadership roles on task forces at HIMSS and other professional organizations as well as serving on advisory boards.

Challenging Landscape for CNIOs

CNIOs at health systems and hospitals are confronting a number of challenges, both strategically and operationally. Nursing IT leaders say budget constraints and funding issues are a significant barrier to more rapid growth of the CNIO role among healthcare organizations, particularly small and medium-sized hospitals. Limited resources also may be impacting compensation levels for CNIOs or hindering efforts to expand informatics teams.

The Witt/Kieffer survey of nursing IT leaders revealed that compensation levels for CNIOs are generally lower than similar IT and medical leadership positions. Three-fourths of CNIOs report salaries between $150,000 and $200,000, and from $200,000 up, the percentages dropped significantly.

“The salary range still seems low and that was a disappointment to us,” Wierz says of the survey findings. Considering the multidisciplinary reach of the CNIO, simple compensation parity with similar nursing leadership positions may not be enough, she adds. Organizations that are committed to successful informatics initiatives need to review their compensation packages for CNIOs and ensure parity with similar medical leadership positions in order to attract and keep the best talent, she says.

Notably, the Witt/Kieffer survey found that 57 percent of respondents answered “no” to the question, “is the role of the CNIO understood and respected within your organization?” This may stem from a lack of understanding about information technology strategy and informatics.

Sensmeier says, “A big challenge for CNIOs is defining the role and executive leadership giving them the decision-making power and partnership that’s needed. If organizations are ignoring this role, it may come back to hurt them later. There’s a gap in understanding the nursing perspective, and also the patient perspective, and nurses are the closest to the patients."

Many industry leaders expect that as healthcare transformation accelerates, more healthcare organizations will recognize the importance of clinical informatics expertise and will carve out space for nursing informatics leaders.

“There are organizations that don’t see the value of IT, and when they don’t see IT as a strategic partner in moving the organization forward,  then no doubt those organizations wouldn’t see the value in that CNIO role. It’s only when organizations see IT as an overall strategic value will this role become more important to them,” Wierz says.


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Have CIOs’ Top Priorities for 2018 Become a Reality?

December 12, 2018
by Rajiv Leventhal, Managing Editor
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In comparing healthcare CIOs’ priorities at the end of 2017 to this current moment, new analysis has found that core clinical IT goals have shifted from focusing on EHR (electronic health record) integration to data analytics.

In December 2017, hospitals CIOs said they planned to mostly focus on EHR integration and mobile adoption and physician buy-in, according to a survey then-conducted by Springfield, Va.-based Spok, a clinical communications solutions company, of College of Healthcare Information Management Executives (CHIME) member CIOs.

The survey from one year ago found that across hospitals, 40 percent of CIO respondents said deploying an enterprise analytics platform is a top priority in 2018. Seventy-one percent of respondents cited integrating with the EHR is a top priority, and 62 percent said physician adoption and buy-in for securing messaging was a top priority in the next 18 months. What’s more, 38 percent said optimizing EHR integration with other hospital systems with a key focus for 2018.

Spok researchers were curious whether their predictions became reality, so they analyzed several industry reports and asked a handful of CIOs to recap their experiences from 2018. The most up-to-date responses revealed that compared to last year when just 40 percent of CIOs said they were deploying an enterprise analytics platform in 2018, harnessing data analytics looks to be a huge priority in 2019: 100 percent of the CIOs reported this as top of mind.

Further comparisons on 2018 predictions to realities included:

  • 62 percent of CIOs predicted 2018 as the year of EHR integration; 75 percent reported they are now integrating patient monitoring data
  • 79 percent said they were selecting and deploying technology primarily for secure messaging; now, 90 percent of hospitals have adopted mobile technology and report that it’s helping improve patient safety and outcomes
  • 54 percent said the top secure messaging challenge was adoption/buy in; now, 51 percent said they now involve clinicians in mobile policy and adoption

What’s more, regarding future predictions, 87 percent of CIOs said they expect to increase spending on cybersecurity in 2019, and in three years from now, 60 percent of respondents expect data to be stored in a hybrid/private cloud.

CIOs also expressed concern regarding big tech companies such as Apple, Amazon and Google disrupting the healthcare market; 70 percent said they were somewhat concerned.

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How One Community Hospital is Leveraging AI to Bolster Its Care Pathways Process

December 6, 2018
by Heather Landi, Associate Editor
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Managing clinical variation continues to be a significant challenge facing most hospitals and health systems today as unwarranted clinical variation often results in higher costs without improvements to patient experience or outcomes.

Like many other hospitals and health systems, Flagler Hospital, a 335-bed community hospital in St. Augustine, Florida, had a board-level mandate to address its unwarranted clinical variation with the goal of improving outcomes and lowering costs, says Michael Sanders, M.D., Flagler Hospital’s chief medical information officer (CMIO).

“Every hospital has been struggling with this for decades, managing clinical variation,” he says, noting that traditional methods of addressing clinical variation management have been inefficient, as developing care pathways, which involves identifying best practices for high-cost procedures, often takes up to six months or even years to develop and implement. “By the time you finish, it’s out of date,” Sanders says. “There wasn’t a good way of doing this, other than picking your spots periodically, doing analysis and trying to make sense of the data.”

What’s more, available analytics software is incapable of correlating all the variables within the clinical, billing, analytics and electronic health record (EHR) databases, he notes.

Another limitation is that care pathways are vulnerable to the biases of the clinicians involved, Sanders says. “In medicine, what we typically do is we’ll have an idea of what we want to study, design a protocol, and then run the trial and collect the data that we think is important and then we try to disprove or prove our hypothesis,” he says.


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Sanders says he was intrigued by advances in machine learning tools and artificial intelligence (AI) platforms capable of applying advanced analytics to identify hidden patterns in data.

Working with Palo Alto, Calif.-based machine intelligence software company Ayasdi, Flagler Hospital initiated a pilot project to use Ayasdi’s clinical variation management application to develop care pathways for both acute and non-acute conditions and then measure adherence to those pathways.

Michael Sanders, M.D.

Flagler targeted their treatment protocols for pneumonia as an initial care process model. “We kicked around the idea of doing sepsis first, because it’s a huge problem throughout the country. We decided to use pneumonia first to get our feet wet and figure out how to use the tool correctly,” he says.

The AI tools from Ayasdi revealed new, improved care pathways for pneumonia after analyzing thousands of patient records from the hospital and identifying the commonalities between those with the best outcomes. The application uses unsupervised machine learning and supervised prediction to optimally align the sequence and timing of care with the goal of optimizing for patient outcomes, cost, readmissions, mortality rate, provider adherence, and other variables.

The hospital quickly implemented the new pneumonia pathway by changing the order set in its Allscripts EHR system. As a result, for the pneumonia care path, Flagler Hospital saved $1,350 per patient and reduced the length of stay (LOS) for these patients by two days, on average. What’s more, the hospital reduced readmission by 7 times—the readmission rate dropped from 2.9 percent to 0.4 percent, hospital officials report. The initial work saved nearly $850,000 in unnecessary costs—the costs were trimmed by eliminating labs, X-rays and other processes that did not add value or resulted in a reduction in the lengths of stay or readmissions.

“Those results are pretty amazing,” Sanders says. “It’s taking our data and showing us what we need to pursue. That’s powerful.”

With the success of the pneumonia care pathway, Flagler Hospital leaders also deployed a new sepsis pathway. The hospital has expanded its plans for using Ayasdi to develop new care pathways, from the original plan of tackling 12 conditions over three years, to now tackling one condition per month. Future plans are to tackle heart failure, total hip replacement, chronic obstructive pulmonary disease (COPD), coronary artery bypass grafting (CABG), hysterectomy and diabetes, among other conditions. Flagler Hospital expects to save at least $20 million from this program in the next three years, according to officials.

Finding the “Goldilocks” group

Strong collaboration between IT and physician teams has been a critical factor in deploying the AI tool and to continue to successfully implement new care pathways, Sanders notes.

The effort to create the first pathway began with the IT staff writing structured query language (SQL) code to extract the necessary data from the hospital’s Allscripts EHR, enterprise data warehouse, surgical, financial and corporate performance systems. This data was brought into the clinical variation management application using the FHIR (Fast Healthcare Interoperability Resources) standard.

“That was a major effort, but some of us had been data scientists before we were physicians, and so we parameterized all these calls. The first pneumonia care path was completed in about nine weeks. We’ve turned around and did a second care path, for sepsis, which is much harder, and we’ve done that in two weeks. We’ve finished sepsis and have moved on to total hip and total knee replacements. We have about 18 or 19 care paths that we’re going to be doing over the next 18 months,” he says.

After being fed data of past pneumonia treatments, the software automatically created cohorts of patients who had similar outcomes accompanied by the treatments they received at particular times and in what sequence. The program also calculated the direct variable costs, average lengths of stay, readmission and mortality rates for each of those cohorts, along with the statistical significance of its conclusions. Each group had different comorbidities, such as diabetes, COPD and heart failure, which was factored into the application's calculations. At the push of a button, the application created a care path based on the treatment given to the patients in each cohort.

The findings were then reviewed with the physician IT group, or what Sanders calls the PIT crew, to select what they refer to as the “Goldilocks” cohort. “This is a group of patients that had the combination of low cost, short length of stay, low readmissions and almost zero mortality rate. We then can publish the care path and then monitor adherence to that care path across our physicians,” Sanders says.

The AI application uncovered relationships and patterns that physicians either would not have identified or would have taken much longer to identify, Sanders says. For instance, the analysis revealed that for patients with pneumonia and COPD, beginning nebulizer treatments early in their hospital stays improved outcomes tremendously, hospital leaders report.

The optimal events, sequence, and timing of care were presented to the physician team using an intuitive interface that allowed them to understand exactly why each step, and the timing of the action, was recommended. Upon approval, the team operationalized the new care path by revising the emergency-department and inpatient order sets in the hospital EHR.

Sanders says having the data generated by the AI software is critical to getting physicians on board with the project. “When we deployed the tool for the pneumonia care pathway, our physicians were saying, ‘Oh no, not another tool’,” Sanders says. “I brought in a PIT Crew (physician IT crew) and we went through our data with them. I had physicians in the group going through the analysis and they saw that the data was real. We went into the EMR to make sure the data was in fact valid, and after they realized that, then they began to look at the outcomes, the length of stay, the drop in readmissions and how the costs dropped, and they were on board right away.”

The majority of Flagler physicians are adhering to the new care path, according to reports generated by the AI software's adherence application. The care paths effectively sourced the best practices from the hospital’s best doctors using the hospital’s own patient groups, and that is key, Sanders notes.

“When we had conversations with physicians about the data, some would say, ‘My patient is sicker than yours,’ or ‘I have a different patient population.’ However, we can drill down to the physician’s patients and show the physician where things are. It’s not based on an ivory tower analysis, it’s based on our own data. And, yes, our patients, and our community, are unique—a little older than most, and we have a lot of Europeans here visiting. We have some challenges, but this tool is taking our data and showing us what we need to pursue. That’s pretty powerful.”

He adds, “It’s been amazing to see physicians rally around this. We just never had the tool before that could do this.”

While Flagler Hospital is a small community hospital with fewer resources than academic medical centers or larger health systems—for example, the hospital doesn’t have a dedicated data scientist but rather uses its in-house informatics staff for this project—the hospital is progressive in its use of advanced analytics, according to Sanders.

“We’ve been able to do a lot of querying ourselves, and we have some sepsis predictive models that we’ve created and put into place. We do a lot of real-time monitoring for sepsis and central line-associated bloodstream infections,” he says. “Central line-associated bloodstream infections are a bane for all hospitals. In the past year and a half, since we’ve put in our predictive model, we’ve had zero bloodstream infections, and that’s just unheard of.”

Sanders and his team plan to continue to use the AI tool to analyze new data and adjust the care paths according to new discoveries. As the algorithms find more effective and efficient ways to deliver care that result in better outcomes, Flagler will continue to improve its care paths and measure the adherence of its providers.

There continues to be growing interest, and also some hype, around AI tools, but Sanders notes that AI and machine learning are simply another tool. “Historically, what we’ve done is that we had an idea of what we wanted to do, conducted a clinical trial and then proved or disproved the hypothesis, based on the data that we collected. We have a tool with AI which can basically show us relationships that we didn’t know even existed and answer questions that we didn’t know to ask. I think it’s going to open up a tremendous pathway in medicine for us to both reduce cost, improve care and really take better care of our patients,” he says, adding, “When you can say that to physicians, they are on board. They respond to the data.”


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At RSNA 2018, An Intense Focus on Artificial Intelligence

November 29, 2018
by Mark Hagland, Editor-in-Chief
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Artificial intelligence solutions—and discussions—were everywhere at RSNA 2018 this week

Artificial intelligence solutions—and certainly, the promotion of such solutions—were everywhere this year at the RSNA Conference, held this week at Chicago’s vast McCormick Place, where nearly 49,000 attendees attended clinical education sessions, viewed nearly 700 vendor exhibits. And AI and machine learning promotions, and discussions were everywhere.

Scanning the exhibit floor on Monday, Glenn Galloway, CIO of the Center for Diagnostic Imaging, an ambulatory imaging center in the Minneapolis suburb of St. Louis Park, Minn., noted that “There’s a lot of focus on AI this year. We’re still trying to figure out exactly what it is; I think a lot of people are doing the same, with AI.” In terms of whether what’s being pitched is authentic solutions, vaporware, or something in between, Galloway said, “I think it’s all that. I think there will be some solutions that live and survive. There are some interesting concepts of how to deliver it. We’ve been talking to a few folks. But the successful solutions are going to be very focused; not just AI for a lung, but for a lung and some very specific diagnoses, for example.” And what will be most useful? According to Galloway, “Two things: AI for the workflow and the quality. And there’ll be some interesting things for what it will do for the quality and the workflow.”

“Certainly, this is another year where machine learning is absolutely dominating the conversation,” said James Whitfill, M.D., CMO at Innovation Care Partners in Scottsdale, Ariz., on Monday. “In radiology, we continue to be aware of how the hype of machine learning is giving way to the reality; that it’s not a wholesale replacement of physicians. There have already been tremendous advances in, for example, interpreting chest x-rays; some of the work that Stanford’s done. They’ve got algorithms that can diagnose 15 different pathological findings. So there is true material advancement taking place.”

Meanwhile, Dr. Whitfill said, “At the same time, people are realizing that coming up with the algorithm is one piece, but that there are surprising complications. So you develop an algorithm on Siemens equipment, but when you to Fuji, the algorithm fails—it no longer reliably identifies pathology, because it turns out you have to train the algorithm not just on examples form just one manufacturer, but form lots of manufacturers. We continue to find that these algorithms are not as consistent as identifying yourself on Facebook, for example. It’s turning out that radiology is way more complex. We take images on lots of different machines. So huge strides are being made,” he said. “But it’s very clear that human and machine learning together will create the breakthroughs. We talk about physician burnout, and even physicians leaving. I think that machine learning offers a good chance of removing a lot of the drudgery in healthcare. If we can automate some processes, then it will free up our time for quality judgment, and also to spend time talking to patients, not just staring at the screen.”


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Looking at the hype cycle around AI

Of course, inevitably, there was talk around the talk of the hype cycle involving artificial intelligence. One of those engaging in that discussion was Paul Chang, M.D.., a practicing radiologist and medical director of enterprise imaging at the University of Chicago. Dr. Chang gave a presentation on Tuesday about AI. According a report by Michael Walter in Radiology Business, Dr. Chang said, “AI is not new or spooky. It’s been around for decades. So why the hype?” He described computer-aided detection (CAD) as a form of artificial intelligence, one that radiologists have been making use of for years.

Meanwhile, with regard to the new form of AI, and the inevitable hype cycle around emerging technologies, Dr. Chang said during his presentation that “When you’re going up the ride, you get excited. But then right at the top, before you are about to go down, you have that moment of clarity—‘What am I getting myself into?’—and that’s where we are now. We are upon that crest of magical hype and we are about to get the trench of disillusionment.” Still, he told his audience, “It is worth the rollercoaster of hype. But I’m here to tell you that it’s going to take longer than you think.”

So, which artificial intelligence-based solutions will end up going the distance? On a certain level, the answer to that question is simple, said Joe Marion, a principal in the Waukesha, Wis.-based Healthcare Integration Strategies LLC, and one of the imaging informatics industry’s most respected observers. “I think it’s going to be the value of the product,” said Marion, who has participated in 42 RSNA conferences; “and also the extent to which the vendors will make their products flexible in terms of being interfaced with others, so there’s this integration aspect, folding into vendor A, vendor B, vendor C, etc. So for a third party, the more they reach out and create relationships, the more successful they’ll be. A lot of it will come down to clinical value, though. Watson has had problems in that people have said, it’s great, but where’s the clinical value? So the ones that succeed will be the ones that find the most clinical value.”

Still, Marion noted, even the concept of AI, as applied to imaging informatics, remains an area with some areas lacking in clarity. “The reality, he said, “is that I think it means different things to different people. The difference between last year and this year is that some things are coming to fruition; it’s more real. And so some vendors are offering viable solutions. The message I’m hearing from vendors this year is, I have this platform, and if a third party wants to develop an application or I develop an application, or even an academic institution develops a solution, I can run it on my platform. They’re trying to become as vendor-agnostic as possible.”

Marion expressed surprise at the seemingly all-encompassing focus on artificial intelligence this year, given the steady march towards value-based healthcare-driven mandates. “Outside of one vendor, I’m not really seeing a whole lot of emphasis this year on value-based care; that’s disappointing,” Marion said. “I don’t know whether people don’t get it or not about value-based care, but the vendors are clearly more focused on AI right now.”

Might next year prove to be different? Yes, absolutely, especially given the coming mandates coming out of the Protecting Access to Medicare Act (PAMA), which will require referring providers to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services—CT, MR, nuclear medicine and PET—for Medicare patients. The federal Centers for Medicare and Medicaid Services (CMS) will progress with a phased rollout of the CDS mandate, as the American College of Radiology (ACR) explains on its website, with voluntary reporting of the use of AUC taking place until December 2019, and mandatory reporting beginning in January 2020.

But for now, this certainly was the year of the artificial intelligence focus at the RSNA Conference. Only time will tell how that focus plays out in the imaging and imaging informatics vendor space within the coming 12 months, before RSNA 2019 kicks off one year from now, at the conference’s perennial location, McCormick Place.



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