AI enhances physician-patient communication, study reveals
UC San Diego Health, as one of the initial health institutions in the United States to integrate generative artificial intelligence (GenAI) into the Epic Systems electronic health record system, is at the forefront of digital health innovation. This integration facilitates the drafting of replies to patient inquiries, marking a significant step forward in medical communication.
The findings from a recent study conducted by the University of California San Diego School of Medicine, published in the Journal of the American Medical Association’s Network Open on April 15, 2024, reveal that while AI-generated drafts did not shorten the time physicians took to respond, they significantly reduced the mental effort required by doctors by providing an initial empathetic draft. This allows physicians to refine the message rather than composing one from scratch.
This pioneering study represents the first randomised prospective evaluation focused on AI-drafted messages within physician-patient communication, highlighting its potential to alleviate some of the cognitive demands on healthcare providers.
Christopher Longhurst, MD, the senior author of the study and a leading figure at UC San Diego Health, emphasised the utility of AI in addressing challenges within health systems, notably the surge in patient communications contributing to physician burnout. He pointed out that the lengthier AI-drafted messages suggest enhanced quality and that physicians have expressed appreciation for the assistance, which lessens their cognitive load.
The research underscores the role of GenAI in improving the quality, efficiency, and engagement of digital healthcare interactions. By reducing the workload on physicians, AI allows them to concentrate on the more intricate aspects of patient care, thereby aiming to mitigate burnout.
Ming Tai-Seale, PhD, MPH, the lead author and a professor at UC San Diego School of Medicine, described generative AI as a collaborative tool that assists physicians, who may receive around 200 messages per week, in overcoming writer’s block by providing a foundation for crafting empathetic responses to patients.
The enduring high demand for digital communication between patients and physicians, amplified by the COVID-19 pandemic, has led to the widespread use of patient portals like MyUCSDChart. These systems facilitate direct emails to doctors but also increase the pressure for timely responses, a demand that many physicians struggle to meet efficiently.
In response, UC San Diego Health initiated a pilot program with Epic Systems in April 2023 to employ GenAI for drafting responses to non-urgent patient queries. The AI-generated drafts include a disclaimer to inform patients of the AI’s involvement before the messages are reviewed and personalised by the responding physician.
Despite not reducing response times, the AI helps compose more detailed and compassionate replies, which are valued by patients. According to Marlene Millen, MD, another co-author and chief medical information officer for ambulatory care at UC San Diego Health, the AI’s ability to maintain consistent performance, regardless of the time of day, provides significant support in drafting empathetic messages that integrate relevant patient information.
While the study did not find time savings in message drafting, the qualitative benefits suggest a potential shift in healthcare communication practices. Further research is needed to evaluate patient perceptions of the enhanced empathy and detail in AI-assisted replies.
Since May 2023, UC San Diego Health and the Jacobs Center for Health Innovation have been rigorously testing GenAI models, exploring their safe and innovative applications in healthcare settings, thereby paving the way for future advancements in the field.
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Pioneering AI tool developed by NHS teams to transform patient care
A ground-breaking artificial intelligence (AI) tool, designed to forecast patient health trajectories, has been developed by a collaboration of healthcare researchers within the NHS. Dubbed “Foresight,” this innovative tool is poised to revolutionise clinical decision-making processes, enhance monitoring in healthcare environments, and bolster clinical trials.
The development team is composed of specialists from two NHS foundation trusts in London—King’s College Hospital and Guy’s and St Thomas’—as well as academic experts from King’s College and University College London. Utilising the Cogstack platform, which is renowned for its capability in information retrieval and extraction, Foresight leverages natural language processing to efficiently mine data from NHS electronic health records. This allows the tool to be trained on vast amounts of healthcare data, employing a deep learning methodology to identify intricate patterns within both structured and unstructured data sources.
A critical evaluation published in The Lancet Digital Health illustrates Foresight’s effectiveness: the tool successfully predicted the next ten possible health disorders in a patient’s timeline with impressive accuracy rates—68% at King’s College Hospital, 76% at Maudsley NHS Foundation Trust, and an outstanding 88% with the US-based MIMIC-III dataset.
The tool’s utility was further underscored through a practical test where five clinicians created 34 hypothetical patient timelines based on simulated scenarios. An impressive 93% of the predictions made by Foresight were deemed clinically relevant, affirming their practical applicability in real-world settings.
According to a report from the NIHR Maudsley Biomedical Research Centre, Foresight’s capabilities are not limited to forecasting; it can also emulate clinical trials, facilitate longitudinal research, generate synthetic datasets, and simulate interventions to study disease progression. Professor Richard Dobson, a leading figure in medical informatics at King’s College London and the senior author of the study, expressed enthusiasm about the multitude of applications for Foresight. He highlighted its potential in creating digital health twins and advancing medical education, among other uses.
Professor Dobson emphasised the importance of employing high-quality data to refine AI models and expressed a vision for expanded collaboration. His aim is to involve more hospitals in the development of “Foresight 2,” an iteration that promises even greater accuracy through enhanced language models.
This initiative has garnered substantial support, receiving funding from the NHS AI Lab, the National Institute for Health and Care Research, and Health Data Research UK (HDRUK). Professor Andrew Morris, director of HDRUK, noted that the success of such innovations hinges on the quality and representativeness of the data used. He advocated for continued investment in the UK’s data infrastructure to ensure these advancements can be realised in a manner that is both secure and respectful of patient privacy.
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World Health Organisation unveils new Global Digital Health Initiative to transform healthcare
In a significant step towards advancing global health care through technology, the World Health Organisation (WHO) unveiled its Global Initiative on Digital Health (GIDH) on Tuesday (20th of February, 2024). This initiative represents a coordinated network managed by WHO, aimed at bolstering and harmonising resources to support the digital transformation of health care led by countries around the world.
The GIDH is set to fortify collaboration and knowledge sharing, serving as a critical mechanism for the execution of the Global Strategy on Digital Health for the period 2020-2025. Its objectives include evaluating and addressing the digital health requirements of member countries to ensure sustainable transformation, enhancing capacity building, and unifying efforts to promote the local development, maintenance, and adaptation of digital health technologies in response to evolving health care needs.
An executive summary released alongside the GIDH’s launch highlighted that over 120 WHO Member States have formulated national digital health policies or strategies. However, many of these strategies lack detailed financial planning or comprehensive architectural designs. Moreover, the rapid progression of digital health transformation faces hurdles such as fragmented resource allocation, inconsistent definitions, and varying quality levels of digital solutions.
A pivotal concern among countries is the transition from product-centric digital health initiatives to the establishment of a national digital health infrastructure. This transition necessitates reliable, high-quality technical support to meet national digital health priorities effectively, with governments leading the charge.
To combat challenges like effort duplication and product-focused digital health transformation, the GIDH is structured around four foundational pillars. These pillars are designed to ensure that digital health investments align with national priorities through a country needs tracker, identify both conventional and innovative funding opportunities via a country resource portal, enhance country capacity and autonomy through a transformation toolbox, and promote robust collaboration and knowledge sharing across digital health networks globally, regionally, and nationally.
A particular focus of the GIDH is on data sharing and enhancing patient access to digital health tools. Mathias Cormann, secretary general of the Organisation for Economic Cooperation and Development, emphasised during a webinar that the initiative could significantly contribute to improving data sharing and patient access to digital tools. He pointed out the underutilisation of health-related data, which, despite constituting 30% of the world’s data, sees less than 1% used in healthcare decision-making. Cormann also highlighted the introduction of public application programming interfaces (APIs) for health data by at least 14 OECD countries, which could serve as valuable models for similar efforts worldwide.
Improving patient access remains a priority, with 23 out of 27 OECD countries reporting that patients can view their electronic health records. Nevertheless, the accessibility of this data to all patients and health providers is limited, and functionality issues persist.
Dr Tedros Adhanom Ghebreyesus, WHO’s director-general, warmly welcomed the GIDH, underscoring WHO’s longstanding commitment to leveraging technology to enhance health. He mentioned the establishment of the Department of Digital Health and Innovation at WHO and the creation of a global digital health certification network. This network facilitates the bilateral verification of digital records and health certificates across over 75 countries. Additionally, WHO recently introduced guidelines for member states on regulatory considerations for artificial intelligence, marking another stride towards assisting countries in achieving their digital transformation ambitions.
Dr Tedros highlighted the challenges of fragmentation and overlap in the digital health sphere, exacerbated by the proliferation of new digital tools lacking common standards. He advocated for a digital health future characterised by interoperable systems, reducing the workload on health care providers and improving service delivery to the public. The emphasis is on governments having access to quality-assured digital tools and resources necessary for the local production and ownership of digital health solutions.
This initiative builds on WHO’s recent policy brief on digital health data, including new guidelines on “person-centred” HIV strategic information, reinforcing its dedication to shaping a future where digital health tools are integral to global health care enhancement.
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U.S. healthcare industry powers toward digital future
In an era marked by rapid technological evolution, the healthcare industry in the United States is making significant strides towards a digitally-enhanced future. A recent study conducted by Information Services Group (ISG), a prominent global technology research and advisory institution, sheds light on this transformative journey. The findings, encapsulated in the 2023 ISG Provider Lens™ Healthcare Digital Services report, underscore a concerted move by healthcare providers and insurers towards embracing digital health tools, aiming to bolster the efficiency, accessibility, and quality of healthcare services.
At the heart of this digital shift are integrated electronic health records (EHRs) and patient-centric applications. These innovations are enabling healthcare organisations to monitor patients with greater precision, facilitate seamless data exchange among healthcare professionals, and offer tailored wellness advice directly to patients. The implications of such advancements are profound, enhancing patient care and operational efficiencies across the board.
Bob Krohn, a healthcare partner at ISG, highlights the transformative impact of this trend. He points out that as the industry gains a deeper understanding of the social determinants of health, there is a growing emphasis on utilising technology to promote health equity and outcome-focused care. This modernisation wave is not only about adopting new technologies but also about rethinking approaches to healthcare to ensure it is more inclusive and outcome-oriented.
A critical aspect of this transformation is the collaboration between providers and insurance companies. This partnership is pivotal in identifying and supporting the most vulnerable segments of the population. By integrating technology with a deep understanding of the social factors influencing health, the sector aims to foster behavioural changes that could lead to significant improvements in public health. Technologies such as EHRs, machine learning, and predictive analytics are at the forefront of these efforts, enabling a more personalised, holistic approach to healthcare.
The report also highlights a shift towards more cost-effective healthcare services, particularly under Medicare, through partnerships between providers and insurance companies. This move towards value-based care, which prioritises quality over quantity, is not just improving patient outcomes but is also presenting providers with new growth and competitive opportunities.
Furthermore, Generative AI (GenAI) is identified as a burgeoning technological wave poised to redefine the healthcare industry. With many organisations planning substantial investments in GenAI solutions over the next five years, there is anticipation of significant impacts on healthcare technology and economics. ISG predicts that GenAI will prompt a reevaluation of current projects, with technology service providers ready to guide enterprises through these transitions.
The exploration of healthcare technology trends extends to integrated health platforms and the increasing need for electronic medical record migration services. Moreover, the report delves into challenges such as talent shortages and the integration of new technologies with existing systems, offering insights and recommendations for addressing these issues.
The 2023 ISG Provider Lens™ Healthcare Digital Services report evaluates 39 providers across three categories: Payer Digital Transformation Services, Provider Digital Transformation Services, and Healthcare Platform Implementation Services. It recognises leaders in the field, including Accenture, Cognizant, and HCLTech, among others, for their outstanding contributions across various segments. Additionally, companies like CitiusTech and Persistent Systems are acknowledged as Rising Stars, indicating their promising potential in the healthcare digital services landscape.
This comprehensive report, available for subscribers or through a one-time purchase, offers an invaluable resource for understanding the dynamic changes underway in the U.S. healthcare sector and the digital innovations driving these changes forward.
UCSD Health study reveals AI’s potential in reducing sepsis mortality
Sepsis, a critical and often fatal response to infection that causes widespread inflammation and organ damage, is a major health concern, claiming the lives of approximately 350,000 Americans annually. Timely detection is crucial for effective treatment, involving prompt administration of antibiotics and intravenous fluids to stabilise the patient.
Researchers at UC San Diego Health have been exploring the potential of artificial intelligence (AI) to enhance early sepsis diagnosis. Their internally developed AI system, named COMPOSER, utilises machine learning and is trained on over 100,000 digital patient records from previous sepsis cases. A recent study published in the journal npj Digital Medicine has demonstrated the potential of COMPOSER in reducing mortality rates.
COMPOSER operates by analysing electronic health records of emergency patients at UCSD every hour. It evaluates various parameters, including medication histories and recent vital statistics, to identify individuals who may be in the initial stages of sepsis. This approach is particularly beneficial in ambiguous cases, where symptoms do not distinctly indicate sepsis.
Dr. Gabriel Wardi, a co-author of the study and a specialist in emergency medicine and sepsis, highlights the algorithm’s significance in situations where diagnostic clarity is lacking. The system acts as an additional tool for medical professionals, suggesting further examination of patients at risk of developing sepsis, thereby facilitating timely intervention.
The study involved 6,217 emergency patients at UCSD’s Hillcrest and La Jolla emergency departments. Comparing the outcomes of 5,000 patients treated before the implementation of COMPOSER with 1,152 patients during its active phase, researchers observed a reduction in sepsis mortality from 11.39% to 9.5%. While these results are promising, they represent correlations rather than direct cause-and-effect, due to the non-randomised nature of the trial.
Karin Molander, director of the Sepsis Alliance, acknowledges the potential benefits of AI in healthcare, particularly in continuous monitoring without human limitations. However, she emphasises the importance of verifying AI-generated recommendations.
The implementation of COMPOSER required careful calibration to minimise false alerts, ensuring that it aids rather than burdens healthcare providers. The system, while capable of predicting sepsis, cannot replace medical professionals, who are responsible for all patient care decisions.
Shamim Nemati, a co-author and UCSD associate professor, notes the challenges in training the algorithm to differentiate between sepsis and similar conditions. The ongoing development of COMPOSER includes enhancements to request additional diagnostic tests when necessary.
UCSD is expanding the use of COMPOSER to include patients admitted to the hospital, and its application is expected to extend to the new East Campus. The integration of advanced wearable sensors and large-language models like ChatGPT into the system is also underway, aiming to improve data accuracy and reduce false alarms.
UC San Diego Health is actively incorporating AI into various aspects of patient care, having appointed its first chief AI officer and collaborating with Microsoft Inc. to utilise AI technologies like ChatGPT in routine patient communications. This initiative is part of a broader strategy to centralise data integration and maximise the benefits of AI in healthcare.
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Mayo Clinic teams up with Cerebras Systems to advance healthcare AI
The Mayo Clinic, a renowned non-profit medical institution based in Rochester, Minnesota, announced a strategic partnership with the Silicon Valley-based startup Cerebras Systems on Monday (15th of January, 2024). This collaboration aims to harness the power of artificial intelligence (AI) in enhancing healthcare services.
With significant presences across three major campuses in the United States and additional facilities in the United Kingdom and the United Arab Emirates, the Mayo Clinic is set to utilise cutting-edge computing chips and systems supplied by Cerebras. The collaboration will delve into the Mayo Clinic’s extensive archive of anonymised medical records and data, laying the groundwork for the development of bespoke AI models.
According to Matthew Callstrom, Mayo’s Medical Director for Strategy and Chair of the Radiology Department, these AI models are poised to revolutionise various aspects of medical record management and diagnostics. Some models are being designed to interpret and summarise extensive medical records for new patients, streamlining the patient onboarding process. Additionally, other models will focus on identifying intricate patterns in medical imagery and genome data, patterns that might elude even the most experienced medical professionals. However, Callstrom emphasised that these systems are intended to augment medical decision-making, not replace it. The human expertise of doctors remains paramount in the clinical decision-making process.
“The integration of AI is about enhancing the decision-making process for each patient, considering the multitude of factors and drawing upon extensive experience,” Callstrom explained.
The Mayo Clinic’s collaboration with Cerebras is anticipated to yield results that will be accessible via the Mayo Clinic Platform. This platform is a comprehensive data network already utilised by various healthcare systems such as Mercy in the U.S., the University Health Network in Canada, and other systems in Brazil and Israel.
While the pricing model for the AI technology developed through this partnership has not been finalised, Callstrom indicated that the Mayo Clinic intends to disclose further details about this venture during a presentation at JPMorgan Chase’s healthcare conference in San Francisco.
Andrew Feldman, CEO of Cerebras, described the deal as a multi-million-dollar agreement spanning several years, though he refrained from disclosing specific financial details. Cerebras, aspiring to compete with industry leaders like Nvidia, will provide both the necessary hardware and software development expertise as part of the agreement. This collaboration marks a significant step in integrating advanced AI capabilities into the healthcare sector, aiming to enhance patient care through technological innovation.
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Vietnam and Australia join forces to accelerate digital health transformation
A pivotal conference in Hanoi, sponsored by the government, has recently brought together health authorities and experts from Vietnam and Australia. This gathering focused on exploring collaborative opportunities to enhance Vietnam’s digital healthcare infrastructure and capabilities.
The conference saw participation from the Vietnam Military–Civil Medicine Association, the Health Strategy and Policy Institute under the Vietnamese Ministry of Health, and the Iverson Health Innovation Research Institute at Swinburne University of Technology in Australia.
The significance of this event lies in addressing the urgent need for Vietnam’s health sector to secure resources for its digital transformation. Deputy Minister of Health, Dr Tran Van Thuan, emphasised the importance of such advancements in improving patient access to medical services. He highlighted the potential role of international cooperation and assistance in achieving these goals.
Vietnam currently faces several challenges in its journey towards healthcare digitalisation, notably its underdeveloped IT infrastructure, which hampers the support for Electronic Medical Records (EMR). Additionally, there is a notable scarcity of funding to integrate new health technologies in medical facilities across the country.
Dr Tran Quy Tuong, chairman of the Vietnam Health Informatics Association, pointed out further obstacles, such as the shortage of IT skills and manpower and the lack of standardised protocols and guidelines for integrating data across various medical information systems.
The Iverson Health Innovation Research Institute from Swinburne University of Technology, which participated in the conference, is actively engaging in collaborations with governments and industry stakeholders. Their focus includes the management of patient health records among other digital health areas. However, there has been no formal announcement regarding a partnership between the research institution and the Vietnamese government.
In the broader context, Vietnam is aiming to establish smart healthcare by 2025 as part of its National Digital Transformation Programme. This initiative encompasses three key areas: smart disease prevention, smart medical examination and treatment, and smart health administration.
Vietnam commenced its healthcare digitalisation foundation in 2019 with the nationwide implementation of Electronic Health Records (EHRs). While all public hospitals have adopted Health Information Systems (HIS), there is still progress to be made in integrating PACS, RIS, and LIS systems.
International collaborations have been crucial in introducing advanced technologies in Vietnamese healthcare. Earlier this year, IT giant Microsoft entered its first technology partnership in Vietnam, teaming up with VinBrain, a local AI healthcare company supported by Vietnam’s leading conglomerate Vingroup. Their collaboration focuses on three primary AI healthcare areas: data sharing, cross-product validation, and research and development.
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NHS England’s controversial £330m data deal with Palantir draws mixed reactions
NHS England’s recent decision to award the £330 million Federated Data Platform (FDP) contract to US data analytics firm Palantir, in collaboration with Accenture, PwC, NECS, and Carnall Farrar, has elicited a spectrum of reactions. This announcement marks a significant step in NHS’s digital transformation efforts, with the FDP designed to connect and streamline access to healthcare data across the NHS.
Matthew Taylor, CEO of the NHS Confederation, acknowledged the FDP’s potential in enhancing care delivery by freeing up clinical time and fostering efficient, safer patient care. However, he emphasised the need for substantial efforts to garner public support for the initiative.
Contrasting opinions emerged from within the NHS. Paul Jones, Chair of the Digital Health Networks CIO Advisory Panel, expressed disappointment at NHS England’s decision to proceed despite reservations from trust digital teams and the financial constraints on other NHS digital budgets.
Nick Wilson, CEO at System C, recognised the wealth of experience within the NHS and technology companies in digital transformation but voiced disappointment over the contract not being awarded to a British consortium. He also highlighted concerns about the exclusion of GP data from the FDP, stressing the complexities of interoperability in health and social care and urging Palantir and Accenture to learn from past challenges.
The decision faced criticism from those who had campaigned against Palantir’s involvement. The Good Law Project, a not-for-profit campaign organisation, is preparing legal challenges to ensure proper handling of sensitive NHS data, focusing on maintaining privacy.
Cori Crider, Director of Foxglove, a legal advocacy organisation, raised questions about the FDP’s effectiveness, citing unsuccessful hospital trials of Palantir’s technology. Dr David Nicholl, spokesperson for Doctors’ Association UK, echoed these concerns, questioning the scrutiny around the deal and the preliminary results of NHS trials with Palantir’s technology.
David Davis, MP for Haltemprice and Howden, expressed reservations about Palantir’s suitability for handling sensitive data, citing their background in espionage and concerns about data protection.
In response to these varied perspectives, NHS England has garnered support from several organisations, including the NHS Confederation, National Voices, and the Academy of Royal Medical Colleges. National Voices CEO Jacob Lant and Dr Jeanette Dickson, Chair of the Academy of Medical Royal Colleges, acknowledged the FDP’s potential in driving digital innovation and enhancing data connectivity in the NHS.
To address public concerns, NHS England is developing an engagement portal for the public to learn more about the FDP and submit queries. Additionally, Dr Nicola Byrne, National Data Guardian, and Dr Nicola Perrin of the Association of Medical Research Charities have joined the independent Check and Challenge Group for the FDP, overseen by NHS England.
Furthermore, NHS England has assured that data sharing under the FDP will not commence until new ‘Privacy Enhancing Technologies’ (PET) are developed and implemented, expected by April 2024. Details on these technologies, being developed by a separate supplier, are anticipated to be released later in the year.
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