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At Conference, Experts Address Implications of Intelligent Automation in Healthcare

September 13, 2017
by Heather Landi
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In order to address transformative issues in the healthcare industry, healthcare provider organizations, payers and life sciences companies need to be agile, need to drive disruption utilizing technology, and need to be more analytically driven, according to a panel of healthcare industry leaders. During a panel discussion at New York City-based consulting firm KPMG’s Annual NY Health and Life Sciences Summit, which took place at KPMG’s Manhattan office, healthcare industry thought leaders tackled the impact of disruptive technologies, such as intelligent automation and robotics, in healthcare.

Joe Parente, principal at KPMG, kicked off the summit by offering a general overview of the current moment in healthcare and the role that intelligent automation, and even artificial intelligence (AI) and machine learning, can play to address the most pressing challenges in healthcare. Parente noted that healthcare provider organizations are challenged with tremendous operating pressures with rising costs and shrinking reimbursements. “What will tomorrow’s successful healthcare organization look like? Agile,” he said, noting that adaptability will be critical moving forward.

“This is a time of uncertainty, with regard to legislation, regulations, increasing competition, driving the focus on cost reduction, along with an ongoing shift from volume to value, and improving quality of care and optimizing reimbursement,” he said. To face these challenges, healthcare organizations will need to see disruption as an opportunity, not a threat, and should drive the disruption, he said. “Organizations can use analytics to find variance in clinical process, re-engineer those processes and then use automation to be more efficient,” he said.

During the panel discussion, Lita Sands, an independent and industry consultant, Dusty Majumdar, chief marketing officer at IBM Watson Health and Paresh Shah, M.D., vice chair of quality and innovation in surgery at New York City-based NYU Langone Health gave their perspectives on the current adoption of intelligent automation, robotics and AI in the healthcare space.

Providing the vendor perspective during the panel discussion, Majumdar with IBM Watson noted that AI in healthcare is “red hot.” “In terms of where we see traction, we see a significant amount of traction in imaging. Radiologists, in our experience, they want something like Watson to help them detect that legion or to characterize a nodule that’s in the early stage of cancer. We do see it across imaging, see it across oncology, in terms of being able to stratify the patient with the right clinical trial, and we see it in genomics in terms of linking the mutation profile to the right clinical trial and the right treatment and also some advanced ways of looking at the genomic profile,” he said.


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Majumdar’s comments come a week after Stat News published an investigative piece on IBM Watson’s shortcomings, contending that the artificial intelligence supercomputer as not lived up to its potential. As Healthcare Informatics Managing Editor Rajiv Leventhal noted in a news story about the Stat News report, the piece examined Watson for Oncology’s use, marketing, and performance in hospitals across the world, from South Korea to Slovakia to South Florida. The in-depth article included interviews with doctors that have deployed Watson at prominent healthcare institutions as well as other healthcare experts—many of whom seem far from thrilled about the results Watson has delivered so far.

Offering the healthcare provider perspective on where intelligent automation and AI are gaining traction, Shah said, “At the very granular, foot-solider level, that’s where it’s the hardest to get some traction because they are so consumed with the day-to-day of what they are doing. Interestingly enough, when a provider sees a tangible benefit, they are ready to adopt it. The hurdle is just getting it to them, to show them that it’s added value. Once they see it, they will take it on,” he said, adding, “Things like decision support, such as, if I’m a radiologist sitting in front of a screen, and I see something, if I could push a button and have it verify what I’m seeing, or push a button and have it give me three ideas that I haven’t even thought of, they love that.”

Shah continued, “Or, if I’m an internal medicine doctor, and I may or may not know what is the best option for treating diabetes for this particular patient. When I graduated medical school, there were only four drugs, outside of insulin, that were used to manage diabetes. Now, there’s a couple of dozen drugs. One of the challenges is that, at the provider level, the actual quantity of the information has expanded so exponentially giving providers a tool or vehicle in which they can access, categorize and curate that information, that is really valuable.”

The panelists also acknowledged that organizations need a structure around technology adoption in order to effectively prioritize projects. During an earlier keynote address, Shah discussed NYU Langone Health’s plans to leverage intelligent automation and robotics, particularly in its new Kimmel Pavilion, which will feature TUG robots to distribute food and medications, digital wayfinding tools for patients and families and Brainlab, an audiovisual medical communications system for the surgical and procedure rooms. He also detailed some of the health system’s deep learning IT initiatives to utilize data analytics and machine learning to reduce clinical variability and improve quality of care while reducing costs.

“For us, it started with our transformation to value, that was the primary driver and the mission that enabled us to prioritize different projects,” Shah said. “It was really around moving from volume-based to a value-based system. And, the first simple pass of that was around cost reduction, waste elimination, with the objective being wanting to improve care quality and reduce the cost at the same time. From an operational perspective, that’s how we looked at it. Some of that was easy and some of that turned out to be quite hard, and required some really in-depth analytics to understand it. And now we’re moving to the next generation of quality improvement, which is thinking beyond just what we currently do better, but thinking about how we can actually change how we do it.”

Shah provided an example of how the health system’s Value-Based Management (VBM) program, which serves as the oversight for many of these projects, leverages technology to address problems. Health system leaders found that many hospital patients are readmitted because they get dehydrated. “The current mechanism to handle that in our system is those patients come through the ER, because in the physician office, due to regulatory issues, you can’t start an IV, even though the physician’s office is in building with the hospital,” Shah said. “So, in order to understand how big the problem was, we used our data warehouse and we applied intelligent analytics to look at what the scope of the problem was, not just episodes of reoccurrence, but looking at what the true cost was, what that translates into, and how do we act on it?” The insights derived from that analytics work motived the health system to set up a process to provide patients with hydration in the outpatient setting to avoid patients being readmitted due to dehydration.

As Healthcare Informatics’ Leventhal addressed in a recent article on the opportunities for artificial intelligence in healthcare, one of the key concerns among clinicians is that AI and machine learning will eventually replace doctors. IBM Watson Health’s Majumdar addressed this issue, referring to it as a “myth” around AI. “Our belief is that it will augment humans. If we can augment the oncologist, with the right data at the right time, based on 7,000 cancer-related publications per day, based on the explosion of genomic data, based on all the different publications around treatment that are out there and around drugs, we think we can augment the oncologist, the pathologist, the surgeon to take the right steps.”

He added, “There are some more subtle challenges in radiology. It’s not just about recognizing a tumor, but the characteristics of it. We’re just beginning to get there with machines; it’s going to be a long time before a machine can actually replace the critical judgment of the radiologist who has seen 10,000 similar tumors. You need a lot of data, a few million tumors, for the machine to learn from. We believe that we are, at this point, augmenting radiologists, oncologists, in a big way with cognitive intelligence, what we call cognitive capabilities, and this is a journey. In my opinion, it’s at least a couple of decades’ long journey before we can think of machines completely replacing physicians.”

Shah also noted that adopting technology with cognitive capabilities is as much as process issue as a technology issue. “It’s a process, and an evolution. As you build trust in this technology and as the technology demonstrates enough reliability to engender that trust, you will allow it more freedom. We’re not at the point of cognitive independence; and nor are we trying to get there. We’re trying to maximize the existing potential. With radiologists, for example, if you get yourself lulled into this sense of confidence, or even complacency, around what it’s spitting out at you, you run the risk of propagating error, rather than reducing error. That’s true to everything we’ve done to now. That isn’t new to AI. That’s a process issue more than a technology issue. I think you build processes to protect against that, and you train and educate around that.”

On the subject of disruptive technologies in healthcare, the panelists also discussed the impact of new entrants into the market, such as Verily, Amazon and Apple. Sands, a consultant in the life sciences space, says there is an opportunity for these technology companies, as well as payers, to leverage technology to change consumers’ behavior and, subsequently, have a profound impact on population health. “You have some payers trying to reinvent itself themselves. For example, the CEO of Aetna has gone out there and said, ‘We’re going to take the perspective that we need to move from the exam table to the kitchen table.’ You probably read they made a big investment with Apple watch, using this data to help people change behavior. That’s a great example of a player that’s being innovative.”

She continued, “And then of course, we’ve been reading a lot about Amazon, and I think they call their division 1492, and they are going into the pharma space. With Amazon moving into the space, I’m enthusiastic about it; it’s an opportunity to remove barriers. You could extend it into all sorts of avenues in terms of being able to do clinical studies in the home.” What’s more, Sands said she sees opportunities for technology companies in the life sciences and pharma space to put together claims data with behavioral data, “which is where the nirvana is. “Once you have that, and then use AI, you can now start to create tailored, clinical pathways and we can quickly monitor and adjust a medication. It’s been proven that with access to data, insights and action-driven behavior, you can dramatically change your health,” she said.

Moving forward, Sands says life sciences companies need to change their strategy and become more analytically-driven to succeed in this new, disruptive world. “We’re moving into the world where data is the new currency; data and insights, we have to come to the table with that, it’s not just our drugs, it’s about the whole patient. If that’s what the model looks like and we’re discovering that personalized data from technology impacts human behavior, let’s go to the beginning; let’s start with zero and change how we do our clinical trials, augmented with technology, let’s not be afraid of this,” she said.

The panelists also offered their perspectives on lessons learned from early adopters of these technologies.

IBM Watson’s Majumdar said partnership is a key to success. “IBM doesn’t do anything on their own in healthcare,” he said. And, he also noted, “As we are applying AI to imaging, we have to remember that the imaging technology is not sitting still, it’s also evolving. The MRI machines, and each of these advancements in CT or MRI, are improving the specificity, the accuracy of diagnosis. The key is to tie advancements in AI with the changes and advancements in imaging.”

Shah reiterated the need for provider organizations to have a strategic plan to help prioritize technology-driven projects. “The second lesson is, fail fast,” he said. “One of the biggest challenges is that there is so much out there. Provider organizations are inundated with vendors, of all sizes and shapes, giving you these sexy, appealing ideas, but you’re going to engage with something, make sure that your pilot is able to demonstrate its true value quickly, and if not, then cut and run and move on.” Shah also added, “You have to a have a clinical champion. It can’t be something that’s dictated from on high from the C suite. There needs to be a ground level clinician who wants this to happen; because that’s the person who is going to help you with change management and help you with the clinical case as well as the business case.”



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VCU Health Motto: ‘In God We Trust; Everyone Else Must Bring Data’

October 19, 2018
by David Raths, Contributing Editor
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CMIO Colin Banas, M.D., talks about winning 2018 HIMSS Davies Enterprise Award

VCU Health System in Virginia was recently named a 2018 HIMSS Davies Enterprise Award recipient for leveraging health IT to improve outcomes. Colin Banas, M.D., the health system’s chief medical information officer, said the organization prides itself on using data to improve patient outcomes. “I am reminded of a quote from one of our senior leaders,” he said. “She even puts it at the bottom of her meeting minutes. It says, ‘In God we trust. Everyone else must bring data.’”

HIMSS cited three use cases that demonstrate VCU Health’s commitment to using data and technology to improve outcomes. The first is an Enhanced Recovery after Surgery (ERAS) protocol that improved colorectal surgery outcomes.

As VCU redesigns processes such as this, technology is always one of the last steps.   “When you sit in on these meetings, they are not going to talk about tech solutions for the first two months,” Banas said. “We stress the mantra of people, process and then technology. In a 7-stage flow chart, you don’t see technology until stage six and seven.” Once a team is identified and a standard of care is spelled out, then they turn back to IT and figure out how to hard-wire the changes into the electronic health record.

Because the VCU mascot is a ram, Banas said, the “ninja swat team” that works on process improvement projects is called the RAM Care team. RAM stands for reliable, appropriate and measurable. “We try to remind people that the RAM Care team is not just implementing order sets,” he said. There are five stages of people and processes first and then technology, including decision support and dashboards. “The way to drive variation out of a lot of these care processes is to be data-driven and consensus-driven,” he said. “That is what RAM Care really does – it is all about reducing variation.”

The other efforts HIMSS highlighted involved new tools that streamlined the patient discharge process and automated documentation tools that reduced catheter-associated urinary tract infections (UTIs).

Banas says it is an exciting time to be a CMIO. “We are getting out of the doldrums of regulatory reform and meaningful use, and ICD-10 sucking up all the oxygen, and we are starting to get better tools and better interoperability platforms to start doing innovative things,” he said.  He pointed to SMART on FHIR and open APIs as allowing users to do new things.

VCU Health is a client of Cerner, which has an Ignite API engine. “We have one SMART on FHIR app, Visual DX, and we have just signed the paper to allow the Apple health record beta for VCU Health, so our patients will be able to link their portal data to the native Apple experience,” he said. Cerner is creating its own app store. “Some are free and others have a cost, but it is exciting,” Banas said. “A lot of these people are solving things that have really bugged us and Cerner for quite some time, and they have done it way better. Kudos to Cerner for opening up and allowing other people in this space. They openly acknowledge that some of the things people are developing are in direct competition to core functionality they try to sell to their clients. Competition is good.”



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How a Data-Driven Approach Can Bolster the Fight Against Opioid Abuse

October 12, 2018
by Steve Bennett, Ph.D., Industry Voice
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I want to tell you about Andy. Andy’s mom, Pam, is a colleague of mine. Growing up an only child, Andy was a happy kid. He was a straight-A student, loved to play the violin, and spent a year as an exchange student in Europe. Andy had two loving parents. But Andy suffered an injury in college, and needed to have some minor surgery performed to repair his sinuses. Following that surgery, his doctor prescribed opioid pain medication for him, to which he became addicted. Despite several years of effort, Andy was unable to shake the addiction, and tragically lost his life to a heroin overdose two years after his surgery. This was a normal kid with a normal family, like mine, and like yours.

Andy’s story is an important story. The opioid epidemic has led to the deadliest drug overdose crisis in the history of the United States, killing more than 64,000 people in 2016 alone – the last year numbers were available. This is a true national epidemic, and one that continues to get worse. For the first time in nearly 60 years, life expectancy for Americans has dropped for two years in a row due to the opioid epidemic.

The opioid crisis has been so difficult to curtail, in part, because of the inability to integrate data from various stakeholders and systems. With so many players and data sources, today’s information is partial, fragmented, and often not actionable.

While this disconnect applies directly to the opioid epidemic it is a systematic problem that affects the healthcare community at large. Better data and analytics can help develop better treatment protocols for a wide array of medical and public health challenges that affect the general public. For opioids, that could be to develop better pain management programs or for better, more-targeted remediation and rehabilitation for those that become dependent on drugs.

A Data-Driven Healthcare Approach: Making Information Real


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Ample data has been collected on the opioid epidemic, but disparate sources are not communicating with one another. Addressing this disconnect and lack of communication is something that can provide researchers, lawmakers and the public with improved insights.

Data-driven healthcare can help provide this guidance by using available data and analytics to help create programs that can make a tangible difference on population areas that need the most help. By looking at the data, lawmakers, hospital administrators and doctors can begin to make impactful changes throughout the system.

While much can be learned from this data, most of it is not being analyzed in a way that brings true benefits. It has been put in a silo and/or it is not organized in a way that is interoperable with other data systems.

The 21st Century Cures Act, which established the Health Information Technology Advisory Committee, shows the commitment of national leaders to improving healthcare information sharing. Analytics can take this data and turn it into something real. Subsequent visualization of this analyzed data presents the information in a way that can truly tell a story, making sense of data that analysts sometimes miss. Analytics can arrange and organize data in different ways and pick up previously undetected trends or anomalies. This information can be turned into real programs that produce real outcomes for those affected.

The data management and integration process can also help us understand where our knowledge gaps are, revealing flaws in data quality and availability. Organizations may learn that they lack sufficient data in a certain area where they want to learn more, but are currently limited. They can then make changes to data collection efforts or seek out different sources to fill these larger gaps. They can resolve data quality issues across systems and arrive at a consistent, reliable version of the truth.

As organizations get better at assembling and managing the data, automating processes to generate standard reports and file exchanges can ease the burden on analysts. Streamlining the user interfaces for prescription drug monitoring programs and other systems allows analysts and medical informatics staff to spend less time working on the data itself and more time enabling and encouraging the use of predictive modeling and “what-if” scenario capabilities.

Helping to Solve a Problem

The national opioid epidemic is a terrible and complex issue. It is not something that can be solved with just one action, approach or program. It is a layered issue that will require systematic changes to how patients are treated and how the healthcare system operates. Some of the nation’s best continue to work on providing operational solutions to these problems, but as the statistics show, they need more help.

A data-driven approach can be that help. Using data analytics to find better and deeper insights into the root problems of this epidemic can help decision-makers make real change. While opioids are the focus now, there will come a day when a new problem emerges. Having data and analytic solutions in place can prepare these organizations to tackle these future challenges as well.

64,000 people died in 2016 as a result of opioid abuse. But 64,000 is more than a large number – it’s also Andy and his family. With analytics and a data-driven approach, government and healthcare leaders can make better decisions that can help people in need.

Steve Bennett, Ph.D., is the director of SAS' global government practice. He is the former director of the National Biosurveillance Integration Center within the Department of Homeland Security

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DOJ Approves CVS-Aetna $69B Merger, On Condition Aetna Divest Part D Business

October 10, 2018
by Heather Landi, Associate Editor
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The Department of Justice (DOJ) has approved a $69 billion merger between mega-pharmacy retailer CVS Health and health insurer Aetna, after Aetna entered into an agreement with the DOJ to divest is Medicare Part D prescription drug plan business.

According to a statement released by the DOJ on Wednesday, the settlement, in which Aetna will sell off its Part D business, was a condition of the merger’s approval and resolves the DOJ’s “competition concerns.”

The deal is the latest in a wave of combinations among healthcare companies, including many pharmacy benefit manager (PBM) and insurer integrations. Last month, the Justice Department approved Cigna’s $67 billion takeover of Express Scripts.

CVS Health announced in early December 2017 its intention to acquire Aetna in a $69 billion-dollar merger, marking the largest ever in the health insurance industry. Woonsocket, R.I.-based CVS operates the nation’s largest retail pharmacy chain, owns a large pharmacy benefit manager called Caremark, and is the nation’s second-largest provider of individual prescription drug plans, with approximately 4.8 million members. CVS earned revenues of approximately $185 billion in 2017. Aetna, headquartered in Hartford, Connecticut, is the nation’s third-largest health-insurance company and fourth-largest individual prescription drug plan insurer, with over two million prescription drug plan members. Aetna earned revenues of approximately $60 billion in 2017.

Following news of the deal back in December, there was speculation that antitrust regulators might not approve the deal. Back in January 2017, a federal judge blocked a merger that would have resulted in Aetna acquiring Louisville, Ky.-based insurer Humana, which at the time was the largest acquisition of its type in the history of health insurance in the U.S., reported at $37 billion. At the time, U.S. District Judge John D. Bates in Washington said that proposed deal would “violate antitrust laws by reducing competition among insurers.” Similarly, a proposed combination of two other health insurers, Anthem and Cigna, was also shot down last year.


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According to the DOJ’s statement issued today on the CVS-Aetna deal, the Justice Department’s Antitrust Division had significant concerns about the anticompetitive effects of the merger with regards to the Medicare Part D businesses. CVS and Aetna are significant competitors in the sale of Medicare Part D prescription drug plans to individuals, together serving 6.8 million members nationwide, according to the DOJ.

In a press release issued today, CVS Health said, “DOJ clearance is a key milestone toward finalizing the transaction, which is also subject to state regulatory approvals, many of which have been granted.” CVS Health's acquisition of Aetna remains on track to close in the early part of Q4 2018, the company said.

“DOJ clearance is an important step toward bringing together the strengths and capabilities of our two companies to improve the consumer health care experience,” CVS Health president and CEO Larry J. Merlo, said in a statement. “We are pleased to have reached an agreement with the DOJ that maintains the strategic benefits and value creation potential of our combination with Aetna. We are now working to complete the remaining state reviews.”

Merlo also said, “CVS Health and Aetna have the opportunity to combine capabilities in technology, data and analytics to develop new ways to engage patients in their total health and wellness. Our focus will be at the local and community level, taking advantage of our thousands of locations and touchpoints throughout the country to intervene with consumers to help predict and prevent potential health problems before they occur. Together, we will help address the challenges our health care system is facing, and we'll be able to offer better care and convenience at a lower cost for patients and payors.”

Following the close of the transaction, Aetna will operate as a standalone business within the CVS Health enterprise and will be led by members of its current management team.

The American Medical Association (AMA), an industry group that has been opposed to the merger, issued a statement saying the agreement that Aetna divest its Part D business doesn't go far enough to protect patients.

"While the AMA welcomes the U.S. Department of Justice (DOJ) requiring Aetna to divest its Medicare Part D drug plan business, we are disappointed that the DOJ did not go further by blocking the CVS-Aetna merger," Barbara L. McAneny, M.D., president, American Medical Association, said in a statement. "The AMA worked tirelessly to oppose this merger and presented a wealth of expert empirical evidence to convince regulators that the merger would harm patients. We now urge the DOJ and state antitrust enforcers to monitor the post-merger effects of the Aetna acquisition by CVS Health on highly concentrated markets in pharmaceutical benefit management services, health insurance, retail pharmacy, and specialty pharmacy."

Agreement with DOJ Resolves “Competition Concerns”

Late last month, Aetna agreed to sell its Part D business to WellCare. According to a Securities and Exchange Commission (SEC) filing from WellCare Health Plans last month, WellCare entered into an asset purchase agreement with Aetna to acquire the company’s entire standalone Medicare Part D prescription drug plan business, which has 2.2 million members. According to the agreement, Aetna will provide administrative services to and retain the financial risk of the Part D business through 2019. In that filing, it states that Aetna is divesting its Part D business as part of CVS Health’s proposed acquisition of Aetna.

“Today’s settlement resolves competition concerns posed by this transaction and preserves competition in the sale of Medicare Part D prescription drug plans for individuals,” Assistant Attorney General Makan Delrahim of the Justice Department’s Antitrust Division, said in a statement. “The divestitures required here allow for the creation of an integrated pharmacy and health benefits company that has the potential to generate benefits by improving the quality and lowering the costs of the healthcare services that American consumers can obtain.”

In its statement, the DOJ referred to WellCare as “an experienced health insurer focused on government-sponsored health plans, including Medicare Part D individual prescription drug plans.”

The Department’s Antitrust Division, along with the offices of five state attorneys general, today filed a civil antitrust lawsuit in the U.S. District Court for the District of Columbia to enjoin the proposed transaction, along with a proposed settlement that, if approved by the court, would fully resolve the Department’s competitive concerns. The participating state attorneys general offices represent California, Florida, Hawaii, Mississippi, and Washington.

In a complaint filed to the U.S. District Court, DOJ attorneys argued that without the divestiture, the combination of CVS, which markets its Medicare Part D individual prescription drug plans under the “SilverScript” brand, and Aetna would cause “anticompetitive effects, including increased prices, inferior customer service, and decreased innovation in sixteen Medicare Part D regions covering twenty-two states.” DOJ attorneys also argued that the loss of competition between CVS and Aetna would result in “lower-quality services and increased costs for consumers, the federal government, and ultimately, taxpayers.”

Under the terms of the proposed settlement, Aetna must divest its individual prescription drug plan business to WellCare and allow WellCare the opportunity to hire key employees who currently operate the business.  Aetna must also assist WellCare in operating the business during the transition and in transferring the affected customers through a process regulated by the Centers for Medicare and Medicaid Services (CMS).


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