Diabetes Tools Do Not Deliver, Epic Adds Ambient Listening

March 28, 2024 - The major EHR vendor Epic will introduce an ambient listening function into its EHR as the healthcare industry buzzes over the new technology.

Ambient listening tools are artificial intelligence (AI) tools that record and monitor providers' conversations with patients. The goal is to let AI take over the documentation tasks that overwhelm providers and nurses so that healthcare professionals can focus on the patients in front of them. Epic has decided to include an ambient listening feature in its EHRs.

Additionally, new research shows that some digital health diabetes tools do not improve clinical outcomes and lead to a heavier cost burden for patients. However, not all digital diabetes management tools fail to live up to their promises.

A proposed rule responds to the increasing number of cybersecurity attacks on healthcare. Ransomware attacks on healthcare organizations doubled from 2016 to 2021, according to HHS data. In light of the economic impacts these attacks can have, a bill proposed in the Senate seeks to increase the financial support for affected providers.

Lastly, Medicaid disenrollment has surpassed experts' expectations. The Medicaid unwinding started in 2023 as states implemented redetermination for the first time since COVID-19 public health emergency policies shut down this procedure. The unwinding was expected to result in at least 15 million disenrollments, but the numbers have soared past that benchmark as of March 2024.

Today's Headlines:

Healthcare can move on from certain diabetes management tools

Senate bill eyes relief for hacked providers

Medicaid disenrollment numbers exceed expectations

Epic integrates ambient intelligence into EHR

Kyle Murphy:

Hello and welcome to Healthcare Strategies | Headlines. It's been a while. I think we promised to be doing this on a weekly basis, but....

Kelsey Waddill:

Well, we were in another state.

Kyle Murphy:

Yeah. We did go to Orlando, Florida, and it was quite beautiful. Now, we're back in the studio, back at TechTarget in Newton. I'm celebrating my 12th anniversary at Xtelligent Healthcare. I'm going to stay on for 13th, at least. At least. And I want to become a teenager, and I want to get my first cell phone.

Kelsey Waddill:

Maybe start a Facebook account.

Kyle Murphy:

I think it's time. I can finally get off of YouTube Kids and I can go to YouTube proper, and I can finally watch Healthcare Strategies on YouTube.

Kelsey Waddill:

Yeah.

Kyle Murphy:

@HealthcareStrategies.

Kelsey Waddill:

Which is now possible.

Kyle Murphy:

Which is possible. I think we're 40-plus subscribers. Don't want toot my own horn.

Kelsey Waddill:

We're not going to voice that too loudly. But yeah.

Kyle Murphy:

That is two score.

Kelsey Waddill:

That is two score. And what we can say is it has increased by 200 percent [correction: 100 percent increase] in the last week alone.

Kyle Murphy:

Those stats.

Kelsey Waddill:

Those stats are unbeatable.

Kyle Murphy:

Unreal. Unbeatable stats. Glad we-

Kelsey Waddill:

We're basically viral. That is what that says.

Kyle Murphy:

As always, this is Kyle Murphy, Vice President of Editorial at Xtelligent Healthcare, and I am joined by the wonderful and creative, Kelsey Waddill.

Kelsey Waddill:

Hello.

Kyle Murphy:

Hello.

Kelsey Waddill:

Who is not at her 12th year anniversary, but--

Kyle Murphy:

Almost. We all have to start somewhere. And let's start with our first headline.

Kelsey Waddill:

Yeah. All right. That's me.

Kyle Murphy:

Yes.

Kelsey Waddill:

Healthcare can move on from certain diabetes management tools. So diabetes has been seen as a key test case for how digital health tools can improve chronic disease management, and patients have gravitated towards these tools. Unfortunately, new data shows that prevailing diabetes management technologies might not be as effective as we think.

Kyle Murphy:

WTF?

Kelsey Waddill:

A new report from the Peterson Health Technology Institute, PHTI--

Kyle Murphy:

Hey, you've interviewed them before.

Kelsey Waddill:

I have interviewed them! You can find our interview in Industry Perspectives, Season One.

Kyle Murphy:

A hundred percent.

Kelsey Waddill:

So PHTI assessed eight digital tools for diabetes. These tools fell into three categories: remote patient monitoring tools, behavioral and lifestyle modification tools, and nutritional ketosis-focused tools, which, for those who may be less familiar, monitor a patient's glycemic and ketone levels and offer nutritional guidance based on their status.

Kelsey Waddill:

So the researchers analyze these tools, specifically their economic impact and clinical effectiveness. And for the RPM and behavioral lifestyle modification categories, the digital health tools fell far from their promised outcomes in both clinical effectiveness and cost.

Kyle Murphy:

So they were supposed to improve quality and cost?

Kelsey Waddill:

And they did neither.

Kyle Murphy:

Oh my God.

Kelsey Waddill:

The economic impact of these tools is expected to grow over the next one to three years. So people are going to be paying more for these tools despite the fact that the RPM and behavioral lifestyle modification tools have demonstrated few clinical benefits.

Kyle Murphy:

Few.

Kelsey Waddill:

So based on these results, the executive director of PHTI, Caroline Pearson, actually recommended moving away from these tools and moving toward more innovative solutions, which is a pretty big shift in the conversation up to this point. So in contrast, however, there is a bright spot: nutritional ketosis-focused tools did achieve clinical benefits, significant clinical benefits, and they went so far as to carry patients into remission for diabetes. So we may have an innovative next step to move toward.

Kyle Murphy:

Holy smokes.

Kelsey Waddill:

Yeah. So yay for data. And Kyle, we heard a lot about different digital tools when we were in HIMSS down in Orlando, and I just was curious, what do you think about this trend toward chronic disease management with digital health?

Kyle Murphy:

One of the things that I feel like we're afraid of doing in the healthcare space, if I can pretend to be in the healthcare space, is to fail at something. Sometimes failure is actually good because now we can move away from investing in the wrong things and hopefully shift resources to the right things. There's no shortages of things to try, but what we always have to do is prove that they work. And maybe sometimes the goals are not something that you should say upfront. You should actually prove it out.

Alright, talk about more fun stuff. Senate bill eyes relief for hack providers. You may have heard, Kelsey, that Change Healthcare had an issue.

Kelsey Waddill:

Yeah, I heard.

Kyle Murphy:

So Senator Mark Warner introduced the "Healthcare Cybersecurity Improvement Act of 2024," aimed at providing financial support to healthcare providers affected by cyber incidents contingent on meeting specific cybersecurity standards. The proposed legislation responding to the increased cyber threats exemplified by the recent Change Healthcare cyber attack, proposes modifications to the Medicare Hospital Accelerated Payment Program and the Medicaid Part B advanced payment program. These modifications would enable advanced and accelerated payments during cybersecurity crises--crises plural, because they are that common....

Kelsey Waddill:

That's where we're getting to.

Kyle Murphy:

Providers and potentially affected vendors must adhere to minimum cybersecurity standards set by the Department of Health and Human Services Secretary to qualify for these payments.

The initiative reflects growing concerns on the Hill for healthcare cybersecurity. The Act, if passed, seeks to incentivize, enhance cybersecurity measures among healthcare providers and vendors with provisions set to become effective two years post enactment. It would be really nice if this Congress could actually pass things. That'd be wonderful.

Kelsey Waddill:

In general.

Kyle Murphy:

And just in general. Anything.

Kelsey Waddill:

Anything.

Kyle Murphy:

Just please. Kelsey, we did some talking at HIMSS. You did some talking at HIMSS with some cybersecurity folks. Top of mind obviously was Change Healthcare. We know that there's more to be done, but it seems like relief, like this financial relief, is necessary.

Kelsey Waddill:

Yes. It's getting to the point where hospitals are, and we talked about this last episode, small and rural hospitals are starting to border on or already shuttering. And HHS has actually really pointedly been talking to payers specifically about directing more relief to those sorts of institutions. But this kind of a bill to bring more widespread relief to really put structure to that kind of relief and put some obligation to it, not just out of the kindness of their hearts, would be pretty essential because...I don't think there's a really good track record of payers doing things out of the kindness of their hearts. I'm sure the people in those companies would, but the businesses themselves don't operate that way and aren't incentivized to.

Kyle Murphy:

Just to make an Easter pun, if we're going to put all of our eggs in the technology basket, we sure as hell better have some kind of fail-safe so when the technology can't work, doesn't work. So it stands to reason, but reasonable people don't seem to be in charge these days.

Kelsey Waddill:

Yeah. And we'll see where this bill goes. It's just been proposed, it's not--

Kyle Murphy:

I propose a lot of things and then the next day I don't do them. All right, what else we got?

Kelsey Waddill:

Medicaid disenrollment numbers have exceeded expectations. Usually when we talk about things exceeding expectations, that's a good thing. In this case, it's a bummer.

More than 18 million Medicaid beneficiaries have been disenrolled from Medicaid, which surpasses the HHS's projections of 15 million who would lose coverage.

Texas has disenrolled the highest number of beneficiaries, 2 million Texans have been disenrolled from the program. And then on the other end of the spectrum, Wyoming has disenrolled 5,300 enrollees, which is the smallest share of disenrollments in any state. States are at varying points in the redetermination process. A lot of them started at different times. So there's a lot of variation on that point. Among the completed redeterminations, Utah has the highest share of disenrollments with 57 percent of its finalized redeterminations resulting in disenrollment. Whereas Maine is on the other end of that spectrum with the lowest share of disenrollments among completed redeterminations at 12 percent.

Kyle, we knew that this was going to be a chaotic process. What are you projecting? Are we going to get worse before it gets better?

Kyle Murphy:

Am I supposed to be diplomatic or am I supposed to be empathetic? I don't really know what the right pathway--

Kelsey Waddill:

Yeah, I kind of set you up with that. Sorry.

Kyle Murphy:

I think it will get a lot worse because Medicaid, the program has been politicized as some kind of government handout. Now, we all pay for uncompensated care. We had to pay for it upfront, or we pay for it after the fact. So one would say that this redetermination process, this disenrollment process is step one, and then part two should be very aggressively to get these folks who need it, because Medicaid covers a very marginalized part of the population with severe health risks that really need to be addressed. And the only way to address them is giving people healthcare coverage who can't afford it, who can't have jobs because of their health condition or their financial status.

So I think it will get worse. I think as you see in Texas, and as you're likely to see in Florida, you're going to see the politics of these particular states leading to people being disenrolled, and therefore somebody else is going to pay. All right, I think we're going to end on a high note.

Kelsey Waddill:

Great.

Kyle Murphy:

And it has to do with Epic. Epic is integrating ambient intelligence into its EHR. Epic has integrated ambient intelligence into its EHR system revolutionizing--that might be a strong word--clinical documentation by swiftly drafting notes from patient-provider conversations. I know this sounds innovative.

Kelsey Waddill:

Innovative.

Kyle Murphy:

Innovative. This advancement is aimed at reducing clinician burnout--which is not as cool as it sounds--due to extensive EHR documentation time was developed in partnership with Nuanced Communications.

Kyle Murphy:

Ambient intelligence, which involves responsive technology that covers the human presence, the interaction in an exam room, will enable clinicians to focus more on the patient rather than the computer during visits. With the capability to record conversations with consent and produce draft notes for review within seconds, this technology not only is likely to enhance patient experience through increased engagement, but also significantly decrease after hours work, commonly referred to as "pajama time." That's why you got to have pajamas so you can document at night. Pilot users, not airplane pilots, pilot users report reduced burnout, improved documentation quality, and increased patient throughput... Treating patients like objects... Over 150 health systems are adopting this transformative approach, pointing towards a future where ambient intelligence is an expected element of clinical care workflows.

Kyle Murphy:

Kelsey, we've heard a lot about burnout, so now we're hearing about another tool that is supposed to solve it.

Kelsey Waddill:

In fact, we have a whole episode of Industry Perspectives on YouTube right now about provider burnout.

Kyle Murphy:

So what are you thinking? Are you more encouraged or disheartened by increasing the amount of technology in the exam room?

Kelsey Waddill:

I think it's more complex than support or deny, because--this is a sneak peek, one of the conversations that is publishing on audio-only on our podcast this week--

Kyle Murphy:

For people with ears.

Kelsey Waddill:

For people only with ears, not people with eyes.... Is a conversation with Rich Birhanzel from Accenture about the complexity of introducing ambient technology into the clinic. And I'm going to try not to spoil it, but the short version is: it's complicated because you're changing a workflow again.

Kyle Murphy:

But isn't this workflow going back to what the--

Kelsey Waddill:

So it's weird, right? Because you're like, "Oh, it's going back to what we had historically before we had all the documentation." But it's still a shift and it's still adding a layer that we didn't have pre-EHRs. Anytime we add a new technology, it can have a lot of benefits and a lot of drawbacks. But the thing that's always consistent is that it requires a change of workflow usually.

Kyle Murphy:

People love change, don't they?

Kelsey Waddill:

Oh, everybody loves completely reshaping the way that they think about a patient interaction. No, I think that it's shown a lot of benefits, clearly, from what we just read there are pilot users who have flown this plane and decided it can fly.

Kyle Murphy:

Wow, look at you. That's a metaphor for you.

Kelsey Waddill:

But that doesn't mean that it's the best plane that we've got in the fleet.

Kyle Murphy:

I'll start with a paper airplane on a nice, calm day where there's not a lot of wind. I think it can happen.

Well, Kelsey, as always, it's been a pleasure.

Kelsey Waddill:

It has.

Kyle Murphy:

And this has been Healthcare Strategies Headlines. Like, subscribe, follow, and also find us on YouTube.

Kelsey Waddill:

Healthcare Strategies on YouTube.

Kyle Murphy:

Take care everybody. Bye.

Kelsey Waddill:

Bye.