In today’s healthcare environment, the volume of patient data generated by medical devices is so vast that it’s not realistically possible for clinicians to analyze and act on all of it, especially in real time. In addition, the continuum of care is expanding beyond the walls of the traditional health system, with trends such as hospital-at-home gaining momentum. Capturing comprehensive data about a patient throughout the entire treatment journey can be difficult, as can turning those data into actionable insights that can be used to improve patient care.
Becker’s Hospital Review recently spoke with Harsh Dharwad, President, and CEO of Nihon Kohden Digital Health Solutions, about these challenges. He shared how technology can improve patient care and the clinician experience by making data from patient monitoring devices more actionable.
The future of healthcare is digital.
Nihon Kohden Corporation is a leading Japanese medical device manufacturer that is known for its best-in-class monitoring products. The company recognized long ago, however, that digital health represents the wave of the future and began investing in innovative products to advance the healthcare field.
Nihon Kohden’s Digital Health Solutions (NKDHS) wants to make clinicians’ lives easier and improve patient care,” Mr. Dharwad said. “Not only do we want to provide world-class medical devices, but we have also developed a digital health ecosystem to enhance the patient care workflow in hospitals."
Around the clock, medical devices generate large volumes of data, as well as many alarms and alerts. It’s impossible for clinicians to gather all the information about a patient that is generated by different monitoring devices, consume and interpret these data, and make improved care decisions. “On top of that, most hospitals and health systems are struggling with shortages of nurses, technicians, and doctors,” Mr. Dharwad said. “The healthcare sector is ripe for the technological and digital advancements that have occurred in other industries.”
AI-based technologies and tools serve as a second set of eyes for clinicians. Solutions powered by artificial intelligence can continuously review all data generated by various monitoring devices in real time to identify patient-specific trends that precede physiological deterioration. This information can be used to inform clinicians proactively and to enable intervention prior to a clinical event.
Clinicians need actionable information, not just data
Rather than simply providing alarms and alerts that are often ignored, NKDHS has conducted considerable research to identify the actionable information clinicians actually need. “This approach helps solve the challenges of alarm fatigue, the overwhelming volume of patient data, and healthcare talent shortages,” Mr. Dharwad said.”
NKDHS’s CoMET® (Continuous Monitoring of Event Trajectories) solution provides an innovative visual display to clinicians that represents the three-hour trajectory of a patient’s risk for future adverse events. “The comet-shaped alerts are a simple and intuitive way of showing whether a patient is progressing toward higher or lower risk,” Mr. Dharwad said. “We analyze a great deal of data to provide risk indications for eight to ten different future clinical events, such as sepsis, emergency intubation and hemorrhage."
“Many other industry solutions use static lab data and discrete vital sign data to evaluate patient risk. Depending on the hospital and its clinical workflow, however, labs and vital sign data about a patient may be gathered just once or twice a day. As a result, the accuracy and effectiveness of such risk indicators are significantly limited by the low frequency of data collection.
“NKDHS believes that subtle changes can occur in a patient’s physiological parameters prior to a catastrophic clinical event,” Mr. Dharwad said. “What differentiates CoMET from almost every other risk indicator in the industry is that it continuously monitors patient waveform data, which creates more accurate and timely risk indications.”
One compelling use case for CoMET is sepsis — a lifethreatening complication of infection that affects approximately 1.7 million adults in the United States each year and has high patient mortality rates. To address this problem, NKDHS recently worked with healthcare organizations to introduce CoMET for early identification of patients at risk for developing sepsis. The application frequently indicated a higher risk for sepsis up to six hours before diagnosis. This expeditious identification of risk supports early clinical action, which is associated with a reduction in mortality.
“Every 15 minutes, the risk information in CoMET is updated, so clinicians can see the progression of that risk,” Mr. Dharwad explained. “As the CoMET visual alert becomes larger and redder, it's clear that the patient has increasing risk for a critical event. That visual indicator enables clinicians to take a closer look and to order additional tests."
Unifying data across different clinical events generates valuable patient insights Selecting the Right Partner is Everything
In the hospital setting, several different monitoring devices and applications may be utilized in the care and treatment of a single patient. For example, one device may be used to review the patient's brain waves, while a second is used to evaluate cardiac conditions, and a third may be used for treating the lungs. Today, the data produced by these different devices often exist in silos and are not integrated to provide a comprehensive view of the patient.
"There is a strong belief in healthcare that when something happens in one part of the body, it affects other areas," Mr. Dharwad said. "Yet previously, no platform existed that unified data originating from multiple body systems that span different clinical events. When you unify information from the body's physiological systems, you uncover new insights."
Nihon Kohden's Digital Health Platform (DHP) is designed to address this challenge by providing a holistic view of each patient. It collects information from multiple devices and provides it to real-time applications, such as CoMET, for use in Al algorithms and models. DHP is device-agnostic, so it can pull together information from Nihon Kohden devices, as well as from the monitoring devices of other manufacturers. Regardless of source, DHP can capture and integrate real-time patient information so that it can be used to provide a complete view of each patient.
Cloud-based platforms support patient care in the home and other non-hospital settings
More and more health systems are adopting hospital-at-home programs and remote patient monitoring to reduce the length of hospital stays and to provide better care to patients after they are discharged. In addition to providing better post-discharge care, a goal is to reduce costly readmissions.
The earlier discharge and home-based care trends introduce unique challenges, however. After clinicians send a patient home, it can be difficult for them to know what is happening if something goes wrong. If that patient later returns to the hospital, the same tests are often repeated. Additional costs are incurred, and payers penalize hospitals for these readmissions. Nihon Kohden's Digital Health Platform, and applications like CoMET, are cloud-based, so patients can be monitored at home with simple, non-invasive devices that measure and collect relevant information. "Those data are sent to the platform in the cloud, where we run models and ping the doctor if a patient doesn't seem to be doing well," Mr. Dharwad said.
Technology that supports a true continuum of care is good for patients, and it's also good for hospitals. "We're trying to build solutions that will support hospital-at-home, but also the prehospital space," Mr. Dharwad said. "The home-to-ambulance-to hospital portion of the care continuum is also very important."
Collaborative partnerships and explainable Al are keys to successful technology adoption
“As Nihon Kohden builds new clinical care models and algorithms to cover more of the clinical landscape, it needs access to physicians and patients. "What physicians look for varies for every clinical condition," Mr. Dharwad said. "To address that challenge, we are collaborating with research and academic centers worldwide and interfacing with like-minded physicians who understand that it's possible to do better than the status quo."
Nihon Kohden brings in its technology and infrastructure and leverages the expertise at partner sites. The Ni hon Kohden team conducts studies inside hospitals, monitors the results, and develops Al models that will eventually be commercialized.
When it comes to clinician acceptance of this new generation of tools, explainable Al and technology are critically important. When Ni hon Kohden builds Al models, the company shares and publishes the models in peer-reviewed journal articles.
"There's no black-box Al happening," Mr. Dharwad said. "We provide physicians and clinicians with published, peer-reviewed papers that explain how the system works. That's the first step when building credibility with institutions. As we build credibility, trust grows, and clinicians use our solutions more. It's an important element that's too often left out. If you simply say, 'Trust the black box and do what it says,' I don't think many people will adopt that."
Conclusion
Nihon Kohden delivers value to hospitals and health systems through high-quality medical devices and through its Digital Health Platform, which collects and continually analyzes data generated by medical devices from all manufacturers.
"With our Al-based tools, we can provide clinicians with the insights needed to intervene before a catastrophic event occurs," Mr. Dharwad said. "Our infrastructure supports the complete continuum of care from the hospital to the home."