Coming through the pandemic, healthcare organizations are ramping up their use of digital technology as they redefine healthcare delivery. The rapid adoption of telehealth in crisis demonstrates their ability to go further.

There have been accelerated shifts toward other emerging healthcare models, along with the investments and technologies they require. One quickly growing technology in healthcare is artificial intelligence.

Time-pressured decisions have highly consequential outcomes on a minute-by-minute basis. Using rules-based systems and machine learning algorithms, automation can facilitate process execution, drawing on specific patient histories to improve treatment.

By applying AI to these functions, organizations can expedite prior authorization, identify fraud and waste, and automate billing, coding and patient scheduling.

Sashi Padarthy is assistant vice president at Cognizant Healthcare Consulting, and leads digital strategy and transformation services. Healthcare IT News sat down with him to get his expert views on these aforementioned subjects and on the accelerated use of AI in healthcare overall.

Q. How has the use of artificial intelligence in healthcare been accelerated in recent years, including by COVID-19?

A. AI as a technology and its overall adoption have significantly advanced over the last few years and will continue to accelerate. In the last 15 months we have seen computational biology coming to the forefront.

To be fair, computational biology has been rapidly developing over the last decade as the healthcare industry has gotten access to large datasets, more advanced analytical capabilities, and modernized data ecosystems, enabling us to conduct faster and more efficient drug discovery and research to create precision drugs and treatments. COVID-19 vaccinations (Pfizer and Moderna) are clear examples of that.

As the medical community has seen the capabilities of AI to help drive this research and shorten the amount of time it takes to develop new treatments, the trust and reliance on AI is growing.

Computational medicine – the use of AI, machine learning and other technologies for early detection and diagnosis of disease – has been in the works for nearly a decade. The next milestone is to bring computational medicine to the bedside to be able to identify patient-specific treatments and drugs and provide them to the bedside clinician in almost real time to significantly enhance patient care.

AI as a technology has advanced in three ways: 1) pattern recognition (computer vision), 2) natural language understanding, and 3) natural language generation.

With these advances, a variety of healthcare challenges can be addressed. Here are some examples:

More than 150,000 deaths in the U.S. are related to lung cancer, making it one of the leading causes of death. There are now deep learning algorithms that can detect as well as, or sometimes better than, a radiologist can.

Provider burnout and the desire to remove some of the administrative burden has led to clinicians embracing AI. Many providers are now using AI to assist them in creating clinical documentation. AI listens to a patient and doctor's conversation and creates a clinical document, which the doctor reviews and edits before signing off the chart. This saves clinicians a lot of time and increases the accuracy of documentation.

Finally, clinicians are being asked to integrate a tremendous and ever-growing amount of data from various EHRs and patient-generated data into clinical practices. Until recently we really haven't had the tools to harness that vast quantity of information in a meaningful way to help patients. AI helps solve that problem. We are selectively using AI now to forecast the spread of different flu strains and other contagious diseases a week in advance, with more than 90% accuracy.

Even though AI promises many benefits, we still need to ensure there isn't any algorithmic bias. Bias is not new in the industry or in healthcare, but, because of its ability to scale, AI can amplify the impact of bias. Therefore the application of AI in a clinical setting will require significant clinical trials to create an evidence base and physician buy-in.

Q. Time-pressured decisions have serious outcomes on a minute-by-minute basis. What are a couple of examples of these decisions in healthcare where AI can help?

A. AI has been proven for many use cases and is able to assist clinicians in making critical patient-care decisions. AI is not replacing the clinician, nor is it making the decision for the clinician. AI is generating insights for clinicians from data sources traditionally unavailable to a provider at the point of care.

One such example is the use of an AI algorithm to predict psychiatric diagnoses using data from Facebook. The AI algorithm was able to predict psychiatric diagnosis comparable to that of a standard clinical PHQ-9 survey given to a patient to assist the clinician in diagnosing, quantifying or monitoring symptoms and severity of symptoms of depression.

The significance being that the questionnaire may have high false-positive rates in primary care settings. Specifically, one meta-analysis found that only 50% of patients screening positive had major depression (Levis 2019). The algorithm, however, has access to large volumes of data that may span days, months and years, and is objective in its analysis.

Another example: Vocal biomarkers for prediction of psychiatric diagnosis – another AI-driven diagnostic tool for clinicians that can be used by the patient to track and analyze over longer periods of time to aid in diagnosing or assessing the severity or change in symptoms of depression.

Access to data outside the EHR, coupled with EHR and claims data, are more traditionally available. They are shining a light on use cases that allow the prediction of disease risk, as opposed to diagnosis of an active disease process.

By leveraging AI to analyze larger datasets that include both clinical and social data, clinicians can predict a patient's risk of developing specific conditions, disease processes or suffering a major medical event. It also allows clinicians to develop a patient-specific treatment plan based on the specific health disparities that patients face.

AI algorithms can provide insights to the clinician alerting them that a patient has an elevated risk of developing cardiovascular disease. The algorithms can also provide insight into the challenges the patient faces in mitigating their risk, such as the walkability of their physical environment, access to healthy foods or the quality of care within the geographical area available to the patient.

With added insights into the challenges a patient faces, the provider can work proactively with the patient to determine the most appropriate treatment plan for that individual patient in order to mitigate the patient's risk factors. Limited to just the information available within the EHR, providers are not able to garner the same level of insights that allow them to provide whole-person care.

Another use-case for AI enabling providers to make faster and better-informed decisions is supporting the decision-making process for medically or surgically complex patients. By using deep learning AI and machine learning, a provider could weigh the risks and benefits of treatment options.

Patients with complex care needs typically have a long medical history, multiple diagnoses and multiple comorbidities, which make synthesizing all the information and determining a treatment plan based on the best possible outcome difficult and time-consuming. A provider could save time and determine a better statistical analysis of the risk or benefit of a treatment option that is based on the unique history, diagnosis and comorbidities of an individual patient.

AI brings more information to a provider in real time to assist with making difficult and complex medical decisions. Providers can leverage key insights at the point of care from multiple data points that are not traditionally available to help patients achieve better outcomes.

Q. Using rules-based systems and machine learning algorithms, automation can enable process execution, drawing on patient histories to improve care. Would you elaborate?

A. AI provides the ability to scan across spaces and places of care to identify the information that is most relevant to a provider at any given time. Many patients see multiple providers prior to getting to the correct specialist for a specific medical problem. This means that their care and the documentation of that care may exist across various clinics, hospitals or health systems.

It is challenging and time-intensive for a specialist to have to review various encounter notes, diagnostic testing results and other documentation to help them care for the patient. AI can remove that burden and learn to identify the specific types of information that a particular provider searches for and uses and help develop a perspective about the patient based on information from multiple sources.

An example: Cognizant's Cognitive Computing and Data Sciences Lab tackled the challenge of diagnosing diabetic retinopathy (DR) for patients in India who did not have coverage or access to quality eye care. Cognizant partnered with a Bangalore-based clinic, Vittala International Institute of Ophthalmology, to help patients who did not have access to quality equipment and specialists.

Cognizant and VIIO developed deep learning algorithms that could identify DR 90% of the time, even in low- to poor-quality images. Clinicians upload images and the software uses the deep learning algorithm to identify DR. This provides increased access because patients no longer must travel to see a specialist or pay the additional cost of seeing a specialist.

With new models of care coming to the market and the tendency for healthcare consumers to shop around, patients will be receiving care across multiple spaces and places of care. AI can help create a more unified, seamless experience for the provider and patient.

Q. By applying AI to healthcare clinical and business functions, provider organizations can expedite prior authorization, identify fraud and waste, and automate billing, coding and patient scheduling. Please explain how this can be done with AI.

A. AI can remove some of the administrative burden surrounding prior authorization, billing and coding. AI is better at identifying patterns than a human being. Where a rules-based engine requires updating and changes to maintain accuracy, AI learns and can get smarter and more efficient at recognizing patterns for billing and fraud.

AI can not only identify the patterns of fraud faster, but can also help to prevent it. It is capable of sorting through much larger amounts of data and identifying patterns of upcoding, whether appropriate documentation exists for a service a patient was billed for and other things that seem out of place. 

Like using AI in clinical care and clinical decision-making, it is not a replacement for a comprehensive fraud detection program, but a tool to alert a team sooner to patterns that seem out of place.

Natural language processing and natural language understanding are being used to assist clinicians with generating clinical documentation by listening to their interaction with a patient and turning what it heard into a clinical note. Using this type of AI, a more complete and more comprehensive document in a narrative style is created for the provider.

These clinical documents created using NLP and NLU are able to show the thought process of the provider more clearly and better demonstrate the medical decision-making process a provider went through. 

With CMS finalizing the 2021 Physician Fee Schedule with updated E/M codes, this will better enable providers to code and bill for the additional time spent with and more involved medical decision-making for complex patients.

AI can remove some of the administrative burden of documenting the necessary information to show the complexity of the patient's problems and medical decision-making for the new billing coding requirements. This also leads to better coding, fewer denials and fewer rejected claims.

Like using AI across spaces and places of care to help providers gather the most pertinent information, it can also be used to harvest the appropriate information for prior authorizations and allow for automatic approvals. This removes the burden on the provider or their staff to have to manually fill out or input the information for prior authorization.

AI-enabled scheduling software can make both a patient's and the medical team's lives much easier. AI is able to determine the scheduling preferences of a patient by analyzing their past scheduling patterns and either auto-schedule or suggest the most appropriate date and time, location, and provider. 

It can also help to create an optimized schedule for a patient who is seeing multiple providers or receiving multiple treatments in the same day. This reduces the amount of time spent by both the patient and the scheduling staff to get the next appointment or series of appointments created.

AI is also able to recognize the complexity of a patient and can be used to determine the appropriate visit length for the next appointment. A standard wellness visit for a patient with multiple diagnosis takes longer than one for a patient who has continually been healthy. 

A provider's schedule can be optimized with this approach because the time allocated to each patient is more customized based on their needs and [it] allows the provider to spend the necessary time with each patient without feeling rushed or falling behind in their clinic schedule.

AI is able to make processes that are task-heavy or time-consuming for humans much easier by reducing the overload.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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