AI and Digital Medicine Provide Real-Time Data to Improve Patient Care

August 3, 2018

In the Lab

// By Sheryl S. Jackson //

Sheryl JacksonThe drama of a “code team” racing to a patient’s bedside is a frequent scene in the myriad of hospital-based television shows that are popular today, but the innovationOchsner team has plans to replace the emphasis on teams that respond after a cardiac arrest.

What if you could predict a potential event in the next four hours and, by doing so, avoid having it occur in the first place?

An artificial intelligence (AI) tool developed by the innovation team at Ochsner Health System — using Epic’s machine learning platform and powered by Microsoft Azure — produced a predictive model that continually monitors patient data to identify subtle changes in a patient’s condition.

Richard V. Milani, MD, FACC, FAHA, medical director of innovationOchsner

Richard V. Milani, MD, FACC, FAHA, medical director of innovationOchsner

This is one of many projects Ochsner Health System’s innovation lab, innovationOchsner, is tackling. Founded in 2015, the goal of innovationOchsner is to improve the experience for patients and healthcare providers, says Richard V. Milani, MD, FACC, FAHA, medical director of innovationOchsner and chief clinical transformation officer and vice chairman of the cardiology department. The group’s technology-based initiatives are being implemented on both the inpatient and outpatient sides of healthcare.

In our latest In the Lab article, we get an inside look at how transformation happens at Ochsner Health. Developing tools that make a nurse’s or physician’s job more efficient, and allow them to provide better care to patients, can be accomplished with technology and a fresh look at workflow, Milani says.

Preventing a Code Event

In addition to the traditional “code” teams that hospitals have in place, Ochsner now also has specialized teams trained to evaluate the patient based on an alert sent to providers through the AI tool. This team requires a different type of training from a team responding to a code, Milani points out. Rather than trying to “fix” a problem, the team is trying to prevent it from occurring, he says: “It’s an entirely different mindset and training. We’re doing this to get the best possible outcomes for our patients.”

Outcomes based on the AI tool and early-warning alerts are positive, says Milani: “We’ve been able to intervene and reduce these events by 44 percent.” With the pilot project completed, plans to expand the program include rolling it out across multiple hospitals in the system.

Plans also call for identification of other health events, in addition to cardiac arrest, that can occur throughout the hospital. Milani points out that the value of AI is that it can be applied to multiple events that can take place during hospitalization anywhere in the hospital, with the use of mobile technology.

The Optimal Hospital Project

In addition to AI and predictive analytics to enable intervention before cardiac arrest, an innovation wing of the hospital houses medical-surgical patients but uses technology to evaluate new approaches to hospital care. Patients are randomly admitted to the unit, just as they would be to any medical-surgical unit, and the nurses and physicians are the same, but innovative workflows and new technology are used throughout the patient’s care.

The Optimal Hospital Project combines the use of passive vital sign monitoring, delay of morning phlebotomy, reduction of nighttime noise as well as access to daily health information through an inpatient portal to give patients more control of their health information and decisions, and to help maintain a normal sleep-wake pattern. Results of the project reported in the American Journal of Medicine show that length of stay for patients on the innovation unit was 8.6 hours less than on a traditional unit; 30- and 90-day readmission rates were 16 percent and 12 percent lower, respectively; and self-rated emotional or mental health was higher — 69.2 percent compared to 52.4 percent.

For example, Milani points to the task of collecting vital signs throughout the hospital. “We have now a wireless device that does not have a cuff. It sits on the wrist — you don’t even feel it — and it’s continuously measuring all vitals every minute,” he says. Results are sent directly into the medical record and if the readings are outside parameters set for the patient, an alert message is sent directly to the nurse on a smartphone that says, “Mr. Jones in Room 123 has this blood pressure reading.” Patients are not constantly awakened for vital sign readings, and caregivers are receiving information when they need it, he explains.

Impacting Death and Dollars

On the outpatient side of Ochsner’s services, a number of digital medicine programs address what Milani calls “the biggest problem in healthcare from a death and dollars perspective.” Noting that 86 percent of all healthcare dollars spent in the U.S. every year are related to chronic disease, he says that digital medicine programs can give clinicians a more holistic and real-time look at a patient’s ongoing condition. This ongoing versus episodic care can result in improved outcomes, he adds.

Diabetes and heart failure are two chronic conditions that can be addressed with digital medicine, says Milani. “Your body is changing daily, so a great blood sugar today doesn’t guarantee you have a great blood sugar in a day or two or three,” he says. “If we’re sampling you when you show up in the office maybe once or twice a year, how successful do you think we’re going to be in managing those things?”

Digital medicine for high blood pressure has several thousand patients enrolled, says Milani. Using wireless blood pressure cuffs at home, patients take weekly readings that are automatically shared with the digital care team and logged into their electronic health record. Patients in the diabetes digital medicine program use a wireless glucometer, and patients in the heart failure program weigh daily with a wireless bathroom scale. As results are reviewed, medications can be adjusted or advice on exercise or diet changes can be shared via smartphone. Patients and physicians can review monthly reports that show trends, enhancing education and patient engagement in their care.

“We’ve shown that we can double or triple control rates over standard care with very high levels of patient satisfaction and better outcomes,” explains Milani. “And we do this all virtually, so patients don’t have to come into the office; in fact, that’s the piece of the program that they enjoy the most — the convenience.”

The Connected Mom

Another very successful digital medicine program does not address a chronic illness but provides the same convenience and continual monitoring that diabetic and heart failure patients appreciate. The Connected MOM (Maternity Online Monitoring) program monitors expectant mothers throughout their pregnancy. Blood pressure, weight, and urine protein results can all be transmitted digitally, so the expectant mother can go to the doctor only for scheduled visits for pelvic exams, ultrasounds, or if the transmitted results warrant follow-up.

“If someone is developing preeclampsia, we’re able to catch it sooner than we would with the traditional visit schedule because we’re capturing more frequent data points from home,” says Milani.

Recent Developments

A digital medicine program for head and neck cancer patients was recently launched, and programs in development for the near future include peripheral arterial disease, liver transplant, and oncologic chemotherapy. 

Physician Advocates

Doctors refer their patients to digital medicine programs if they meet specific program requirements, one of which is that they own a smartphone, says Milani: “We’ve actually had some primary care doctors that are so adamant about [the need for patients to be in] our diabetes or high blood pressure programs that they’re telling patients to go get a smartphone.”

Sheryl S. Jackson is a writer and editor specializing in marketing, leadership and management topics for the healthcare, education, construction, and supply chain industries. You can reach her at sherylsjackson@bellsouth.net.