Generative AI, virtual nursing, remote monitoring: What hospital innovation leaders expect for rest of '23

From hospitals and health systems tapping into generative artificial intelligence platforms like ChatGPT to rolling out large-scale virtual nursing programs, 2023 has been a busy year for healthcare innovation already.

Becker's asked 11 health system leaders, "What are your innovation plans and predictions for the rest of 2023?" Here are their responses:

Rich Roth. Senior Vice President and Chief Strategic Innovation Officer of CommonSpirit Health (Chicago). The second half of 2023 will see the first tangible uses of next-generation artificial intelligence for health systems. While many organizations have begun testing generative AI on clinical and patient-facing use cases, the largest near-term opportunity is reducing administrative costs and eliminating unnecessary friction points between payers, providers, devices, and life sciences. 

I think we will see the first set of AI companies that co-pilot alongside administrative decision-making, reducing cost and allowing for faster decisions between multiple parties. The end benefit of this will be reductions in caregiver burden and more transparency for patients in their care journey.

Chris Coburn. Chief Innovation Officer of Mass General Brigham (Somerville, Mass.). Growing translation and outcomes from our category-leading research base of $2.3 billion will continue to be our highest focus. In this period, it is interesting to see the breakthroughs our faculty are making related to a specific disease in parallel with their success expanding indications to additional diseases. We expect to see more therapeutics in expanded applications in the coming years.

The Mass General Brigham Gene and Cell Therapy Institute will continue to drive toward improved outcomes in cancer, cardiovascular, neuroinflammation and autoimmune diseases, with significant growth forecast for regenerative medicine — all areas the institute is exploring with hundreds of researchers across MGB.

New approaches to behavioral health solutions will expand to more people via digital technologies, helping improve access and capacity issues.

The development and validation of generative AI applications will continue to accelerate for the next several years. A new study by Mass General Brigham investigators found that AI language models can accurately identify appropriate imaging services for two important clinical presentations: breast cancer screening and breast pain. Their results suggest that large language models have the potential to assist decision-making for primary care doctors and referring providers in evaluating patients and ordering imaging tests — which should further enhance utilization and ideally remove cost elements.

The full launch of the Advanced Research Projects Agency for Health, or ARPA-H, this year could be a generational game-changer. Focused, bridging investments guided by disciplined program management may yield high-impact healthcare technologies on a scale similar to the ones that have consistently emerged from Defense Advanced Research Projects Agency since its establishment in 1958. ARPA-H has the resources, know-how and nationwide standing to address systemic innovation gaps in a way never previously possible.

Drug pricing and the impact of the Inflation Reduction Act have begun to play out and will only increase over the balance of the year. It will further increase as the '24 election cycle takes hold, especially with the rise of biosimilars and their related approval pathways. A content-filled discussion on the topic was featured recently at the World Medical Innovation Forum, where Mass General Brigham also announced its list of the "disruptive dozen" technologies likely to emerge in-clinic before the end of '24. These range from obesity drugs and diabetes treatment to potential new therapies for ALS and a future blood test for Alzheimer's disease.

Charles Bruce, MD. Chief Innovation Officer of Mayo Clinic in Florida (Jacksonville). Innovation plans:

— Continue building out infrastructure to support connectivity in healthcare innovation, and expanding the Mayo Clinic Innovation Exchange reach and support for global innovation.

— Scanning the horizon for new opportunities.

— Move beyond pure technology plays to real bedside impact in healthcare.

— Think into the future of emerging technologies that have valuable applications to healthcare.

— Identify opportunities to address healthcare challenges in the face of global climate change.


— Generative AI will accelerate healthcare disruption, but we may miss other opportunities in the noise.

— A hot summer is going to bring climate change to the forefront of healthcare innovation.

Roberta Schwartz, PhD. Executive Vice President and Chief Innovation Officer of Houston Methodist. Houston Methodist has an ambitious agenda for 2023 as we roll out a greatly expanded virtual care set of offerings in the hospital setting. We continue to mature ambient intelligence in the inpatient care and the operating rooms and shortly expand inpatient vital sign monitoring from a central location, thereby reducing this burden for floor staffing.

We are beginning to see the maturity of AI tools that look through medical records and claims data to identify opportunities to improve outcomes for patients and point out to physicians that action is needed for activities such as earlier follow-up or pre-surgical optimization. Communications with patients are improving through texts at the right moment, and access is improving with additional electronic means of making and checking in for appointments. And our physician organization continues its planning for the clinic of the future.

Stephen Dorner, MD. Chief Clinical and Innovation Officer of Mass General Brigham Healthcare at Home (Boston). 2023 is going to continue to see a blend of aggressive moves to right the financial hardships hospitals and health systems have faced coming out of the pandemic, coupled with exploration of the home-based and virtual space afforded by the temporary regulatory and financial frameworks of post-pandemic legislation. I think for the pioneering hospital/health system, shifting from "exploration" to "commitment" will prove to be a sound investment on both fronts.

What we typically refer to as "modern" medicine was built around the notion that clinics, hospitals, and health systems were the most effective and efficient way to deliver medical care. However, the strain of the COVID pandemic on hospitals, healthcare workers, and patients' ability to access care demonstrated that the facility-based model of healthcare delivery is unsustainable and the notion of what "modern" medicine looks like needs to evolve.

The future of healthcare will be home-based rather than facility-based, delivering a more patient-centered rather than hospital-centered delivery model. Hospitals will one day be sites of emergency, short-stay observation, operative, and intensive care as we transition the site of more healthcare from hospital floors to patients' homes. Virtual care, remote monitoring and automated medication dispensing will be part of the home-based ecosystem with sophisticated last-mile delivery, logistics and AI platforms.

Physicians, nurses, physical therapists — all clinicians — will evaluate, monitor and treat patients in their home environment, accounting for the factors that contribute to their health and well-being and structuring care plans accordingly. That future will be more satisfying, comfortable, and safer for patients, while substantially decreasing the costs of healthcare delivery. The future of medicine will be a reversion to the house calls of yore, enhanced by modern medical advancements for managing and treating disease and the truly modern technological capabilities that make home-based care delivery possible.

Justin Meade. Assistant Director of Entrepreneurship and Innovation for Texas Children's Hospital (Houston). Three of the themes/trends we are expecting to continue:

1. Consumerism in healthcare — not only have patients' expectations shifted towards convenience and experience, so have our providers' and staff's.

2. Pressures both external and internal are driving changes in how we work in both clinical and nonclinical areas.

3. The shift towards value-based care ideals is being enabled by rapidly evolving technology. We don't want to deploy technology for the sake of saying we've done it — we want to make sure we deploy innovative tech that prevents and predicts, personalizes care experiences, removes inequalities, and improves outcomes.

Although we are in the midst of transformation, I don't anticipate many major changes over the next six months. I think we will continue to see what we are already seeing:

1. Certain areas of the digital health and wellness bubble that saturated the market with point solutions during the pandemic will continue to burst. However, those with viable business models, high-value add and convenient workflows will continue to transform how patients engage with us and continue to close the gaps between the hospital and the home.

2. Provider and operational workflows will continue to be augmented and optimized with technology to decrease burden, enrich experiences and improve outcomes.

3. Clinical AI will continue to demonstrate value for early-risk identification, predictive insights and improved efficiencies for those organizations that have the right infrastructure and assets to properly deploy them.

4. The ChatGPT and generative AI hype cycle will continue, and we will start to get clarity on who has real solutions vs. vaporware and which problems actually make sense to be solved using these tools vs. other AI or automation. We plan to be at the front of this and have cross-functional teams who are actively exploring and using GPTs, large language models and generative AI tools in our own safe and secure innovation environments. The learnings are being shared with other teams, providers and end users to help inform strategies, internal policies and roadmaps in real time.

Omkar Kulkarni. Vice President and Chief Transformation and Digital Officer of Children's Hospital Los Angeles. Our focus continues to orient around leveraging technology to enable people to more efficiently and conveniently achieve their goals. We are expanding the use of telehealth into local public schools in Los Angeles, making it easier for patients and families to connect with their providers. We're looking to expand the use of Moxi, our delivery robot, within the hospital to allow nurses, pharmacists and other care providers to focus on clinical tasks. We're optimizing the use of robotic process automation to save our staff time in some of their repeatable revenue cycle processes. We are leveraging digital forms and text messaging to make the appointment-scheduling process more convenient and transparent for patients and families.

We strive to introduce solutions that our patients, families and team members love to use because they are adding value and benefit to them.

Jeffrey Guterman, MD. Chief Research and Innovation Officer of Los Angeles County Department of Health Services. 1. Self-service analytics for population health. Though many use the term population health, it is clear that we are not describing the same thing. One characteristic that is a critical differentiator of population health management is an identified care team responsible for the person, whether or not they sought care from the named provider.

That seemingly simple statement trips up most transaction-focused data systems. The questions raised by population health management are not answered by traditional EHR transaction reports.

We developed a sophisticated data model that includes the entire population, as well as the health and sick care transaction information for persons who have also become patients.

This data model is wrapped around a user interaction design that allows for multivariate person and patient cohort selection. We give those whose programming skills are limited to "point and click" the ability to do sophisticated data and information discovery from a new population health perspective in a manner of minutes, not weeks of waiting for IT to build a single report.

2. Using nurses for medication titration in select chronic illnesses. The U.S. healthcare system does an abominable job of disease control for those with chronic common illnesses. Management of blood pressure, dyslipidemia, and glycemic control are for the most part done haphazardly and variably based on the patient and provider. For hypertension, only 25 percent of patients are at goal. It has been clearly shown that pharmacists who have a specific medication titration focus perform better than usual care, where medication adjustment is one component of a provider interaction.

However, pharmacists are expensive and in relatively short supply compared with the nursing workforce. We have successfully implemented a nurse titration clinic that has demonstrated positive results for blood pressure control for patients with simple primary hypertension.

Clinical inertia is an underappreciated, yet important contributor to the cost of sick care. Medication titration can be done effectively by pharmacists, and now with our work and the work of Kaiser Permanente, there is a growing body of literature that suggests that nurses are also very effective at medication titration. This is really just an expansion of how we think about the patient-centered medical home team, and another place where we can expand the availability of the physician by ensuring that clinical decision-making that can be done well by others does not take up physician time.

3. Prediction: Many will rush into implementing ChatGPT 3.5 with unbridled enthusiasm unprepared for the backlash of negative interactions when the system routinely hallucinates.

Two years from now, ChatGPT version 814 has replaced human interaction for prior authorization requests, reviews, determination and appeals. This has increased the speed by which each party receives and acts upon in the prior authorization process. The typical prior authorization request and its associated denials and appeals now generate an average of 1,400 pages per patient event in less than one minute.

One thing that has not changed, clearly demonstrated by the research team at Rand Corp. and UCLA, is that the new massive documents have the same measurable impact on improving the quality of care delivery. Absolutely none.

Jay Lawrence, MD. Senior Vice President and Chief Transformation and Innovation Officer Southcoast Health (New Bedford, Mass.). Our innovation focus for the rest of this year is aimed at driving operational excellence and reducing unit cost by marrying AI and natural language processing with time-driven activity-based costing in care model redesign.

Amy Graham. Chief Strategy and Innovation Officer of FirstHealth of the Carolinas (Pinehurst, N.C.). FirstHealth is implementing a virtual nursing system to supplement its workforce, which will allow staff to spend more time with patients. We plan to expand our work around using drone technology for deliveries on and off our hospital campuses. We are also exploring the use of AI to streamline workflows, increase efficiencies, and use predictive modeling to analyze market data. There are so many ways to use AI that we have just scratched the surface for how it can benefit our processes.

Kelly Hollinger. Chief of Staff of Vibra Healthcare (Mechanicsburg, Pa.). In the realm of innovation for healthcare services, 2023 represents a critical year for aligning AI capabilities with core objectives. Organizations still need to comprehend what AI signifies for care delivery and back-office productivity. In our context, we aim to address this by focusing on the following areas:

1. Grassroots innovation and feedback channels: We believe the best insights can often come from those in the trenches daily. Therefore, we're implementing more open lines of communication and feedback channels that enable care providers and staff nationwide to share ideas for optimization and improvement. This democratization of innovation allows us to harness the collective intelligence of our organization.

2. Piloting and scaling AI-driven clinical decision support systems: We foresee further integrating AI-driven clinical decision support systems. By piloting and subsequently scaling these systems, we aim to provide our healthcare professionals with more comprehensive and precise data, which, in turn, will facilitate better-informed decisions.

3. Integrating AI in administrative tasks: Leveraging the power of AI can significantly simplify administrative tasks. In 2023, we plan to educate our team on utilizing generative AI to reduce administrative workload, enabling our healthcare professionals to concentrate more on providing quality care.

4. Robust evaluation metrics: It is essential to have evaluation metrics to quantify the return on investment and the impact of AI initiatives on care delivery and back-office operations. This involves establishing benchmarks, continually monitoring the progress, and analyzing the data to assess the efficacy of AI applications in the healthcare workflow.

5. AI and remote care delivery: With the increasing trend of remote healthcare delivery, our innovation plans for 2023 also involve leveraging AI to optimize telehealth and remote patient monitoring systems.

In conclusion, integrating AI in healthcare is a multifaceted endeavor that requires a cohesive strategy. Through open communication, pilot projects, and a focus on care delivery and administrative efficiency, we are taking steps in 2023 to ensure that AI is leveraged in a manner that is both innovative and grounded in practical application.

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