According to Damo Consulting’s 2019 Healthcare
IT Demand Survey, when it comes to spending money on information
technology (IT), healthcare executives believe AI and digital healthcare
technologies—though promising—need more development.
Damo’s report notes that 71% of healthcare providers
surveyed expect their IT budgets to grow by 20% in 2019. However, much of that
growth will be allocated to improving EHR functionality, Healthcare Purchasing News reported
in its analysis of Damo survey data.
As healthcare executives plan upgrades to their EHRs,
hospital-based medical laboratories will need to take steps to ensure
interoperability, while avoiding disruption to lab workflow during transition.
The survey also noted that some providers that are considering
investing in AI and digital health technology are struggling to understand the
market, the news release states.
“Digital and AI are emerging as critical areas for technology spend among healthcare enterprises in 2019. However, healthcare executives are realistic about their technology needs versus their need to improve care delivery. They find the currently available digital health solutions in the market are not very mature,” explained Paddy Padmanabhan (above), Chief Executive Officer of Damo Consulting, in a news release. (Photo copyright: The Authors Guild.)
Providers More
Positive Than Vendors on IT Spend
Damo Consulting is a Chicago-area based healthcare and
digital advisory firm. In November 2018, Damo surveyed 64 healthcare executives
(40 technology and service leaders, and 24 healthcare enterprise executives). Interestingly, healthcare providers were more
positive than the technology developers on IT spending plans, reported HITInfrastructure.com, which
detailed the following survey findings:
79% of healthcare executives anticipate high
growth in IT spending in 2019, but only 60% of tech company representatives
believe that is so.
75% of healthcare executives and 80% of vendor
representatives say change in healthcare IT makes buying decisions harder.
71% of healthcare executives and 55% of vendors say
federal government policies help IT spending.
50% of healthcare executives associate
immaturity with digital solution offerings.
42% of healthcare providers say they lack
resources to launch digital.
“While information technology vendors are aggressively
marketing ‘digital’ and ‘AI,’ healthcare executives note that the currently
available solutions in these areas are not very mature. These executives are
confused by the buzz around ‘AI’ and ‘digital,’ the changing landscape of who
is playing what role, and the blurred lines of capabilities and competition,” noted
Padmanabhan in the survey report.
The survey also notes that “Health systems are firmly
committed to their EHR vendors. Despite the many shortcomings, EHR systems
appear to be the primary choice for digital initiatives among health systems at
this stage.”
Some Healthcare
Providers Starting to Use AI
Even as EHRs receive the lion’s share of healthcare IT
spends, some providers are devoting significant resources to AI-related
projects and processes.
For example, clinical
pathologists may be intrigued by work being conducted at Cleveland Clinic’s Center for
Clinical Artificial Intelligence (CCAI), launched in March. The CCAI is using
AI and machine learning in pathology, genetics, and cancer research, with the
ultimate goal of improving patient outcomes, reported Becker’s Hospital Review.
“We’re not in it because AI is cool, but because we believe
it can advance medical research and collaboration between medicine and
industry—with a focus on the patient,” Aziz Nazha, MD, Clinical
Hematology and Oncology Specialist and Director of the CCAI, stated in an
article posted by the American Medical Association (AMA).
AI Predictions Lower
Readmissions and Improve Outcomes
Cleveland Clinic’s CCAI reportedly has gathered data from
1.6 million patients, which it uses to predict length-of-stays and reduce
inappropriate readmissions. “But a prediction itself is insufficient,” Nazha told
the AMA. “If we can intervene, we can change the prognosis and make things
better.”
The CCAI’s ultimate goal is to use predictive models to “develop
a new generation of physician-data scientists and medical researchers.” Toward
that end, Nazha notes how his team used AI to develop genomic biomarkers that identify
whether a certain chemotherapy drug—azacitidine (aka,
azacytidine and marketed as Vidaza)—will work for specific patients. This is a
key goal of precision
medicine.
CCAI also created an AI prediction model that outperforms
existing prognosis scoring systems for patients with Myelodysplastic
syndromes (MDS), a form of cancer in bone marrow.
Meanwhile, at Johns
Hopkins Hospital, AI applications track availability of beds and more. The
Judy Reitz Capacity Command Center, built in collaboration with GE Healthcare Partners, is a
5,200 square feet center outfitted with AI apps and staff to transfer patients
and help smooth coordination of services, according to a news release.
Forbes described the Reitz command
center as a “cognitive hospital” and reports that it has essentially enabled
Johns Hopkins to expand its capacity by 16 beds without undergoing bricks-and-mortar-style
construction.
In short, medical laboratory leaders may want to interact
with IT colleagues to ensure uninterrupted workflows as EHR functionality evolves.
Furthermore, AI developments suggest opportunities for clinical laboratories to
leverage patient data and assist in improving the diagnostic accuracy of providers
in ways that improve patient care.
Expanding healthcare services into communities is expected to increase orders for clinical laboratory tests, promote precision medicine, and lower overall costs
Clinical
laboratories continue to adapt to servicing providers in non-traditional
healthcare settings. These include freestanding urgent care centers as well as
mini-clinics in retail locations. Dark Daily has covered this trend
extensively in previous
e-briefings.
To secure a share of this new market, national retailers,
pharmacy chains, and grocery stores are increasing their health and medical
service offerings and forging partnerships with other organizations, such as
tech developers.
One such recent partnership involves Walgreens Boots Alliance Inc.
(NYSE:WBA) and the Microsoft
Corporation (NASDAQ:MSFT). In January, both parties announced a joint
venture to develop new healthcare solutions that will improve patient outcomes while
lowering cost through research and development, funding, and technology.
“Our strategic partnership with Microsoft demonstrates our
strong commitment to creating integrated, next-generation, digitally-enabled
healthcare delivery solutions for our customers, transforming our stores into
modern neighborhood health destinations, and expanding customer offerings,”
said Stefano
Pessina, Executive Vice Chairman and Chief Executive Officer of Walgreens,
in a Microsoft press
release.
Through this partnership, Walgreens plans to provide personalized healthcare (aka, precision medicine) by connecting its customers to pertinent health information through digital devices and in-store expert advice. The goal is to proactively engage patients in their own care to improve medication adherence, reduce emergency room visits, decrease hospital readmissions, and provide customers with lifestyle management solutions.
In addition, the two companies will share each other’s
market research and work with consumers, payers, providers, and pharmaceutical
manufacturers to devise solutions that improve health outcomes while lowering
costs.
“[Walgreens Boot Alliance] will work with Microsoft to harness the information that exists between payers and healthcare providers to leverage, in the interest of patients and with their consent, our extraordinary network of accessible and convenient locations to deliver new innovations, greater value, and better health outcomes in healthcare systems across the world,” Pessina said in the press release.
As part of this partnership, Walgreens will move the majority of its IT infrastructure onto Microsoft Azure, a cloud computing and artificial intelligence (AI) platform. Walgreens also will provide Microsoft 365 to more than 380,000 employees and stores located throughout the world. Microsoft 365 is a business solution which bundles Windows 10 and Office 365 with advanced security features.
Other Walgreens Collaborations That Provide Healthcare at
Retail Locations
Walgreens also announced several collaborations with other
companies to become more competitive and secure their share of the healthcare
market.
Through its partnership with Chicago-based VillageMD, a national provider of primary
care clinics, Walgreens will open five primary care clinics next to Walgreens
stores in the Houston area. These clinics, called “Village Medical at Walgreens,”
will offer customers comprehensive primary care services, pharmacists, nurses,
and social workers.
“This collaboration with VillageMD demonstrates our ongoing commitment to create neighborhood health destinations that bring affordable healthcare services to customers and provide a differentiated patient experience to the communities we serve,” stated Patrick Carroll, MD (above), Chief Medical Officer, Clinical Programs and Alliances, Walgreens, in a Walgreens press release. “VillageMD has a strong track record nationally of improving outcomes and reducing the cost of healthcare through their transformative primary care model.” (Photo copyright: Walgreens.)
Another collaboration involves Verily Life
Sciences, a research arm of Alphabet Inc. (NASDAQ:GOOG), Google’s parent company. The
agreement is for multiple projects to improve health outcomes for patients with
chronic illnesses. The two companies will be exploring the use of technology, such
as sensors, and software to help prevent, manage, screen, and diagnose disease
with the ultimate goal of deploying those technologies at Walgreens retail
locations.
“The
continued rise in chronic diseases today can be costly to patients as well as
to our healthcare system,” Pessina told Business
Wire. “Working with Verily, we’ll look at how we can best support
integrated and value-based care to meet our patients’ needs, as well as
opportunities to address other chronic conditions over time.”
Service Agreements with LabCorp and Quest
In 2018, Walgreens
announced a significant expansion of their collaboration with LabCorp, to increase the number of patient
service center (PCS) locations within Walgreens stores. The two companies
agreed to open at least 600 additional LabCorp-at-Walgreens facilities across
the US over the next four years. At the time of the announcement, LabCorp operated
17 facilities at Walgreens in Florida, Colorado, North Carolina, and Illinois.
Along the same lines, Quest
Diagnostics (NYSE:DGX) also has opened hundreds of patient-serviced centers
within various food and drug retail stores throughout the US, which Dark
Daily reported in 2017.
“Healthcare is too complicated, too big, and if I can say, a
little too messy,” Pessina told Digital
Commerce 360. “We cannot be helpful to our patients if we don’t team up
with many, many different, practically all, the players in this industry.”
CVS HealthHubs Offer Blood Testing, Health Screenings,
and Other Services
To remain competitive, CVS also is trying new ways to
capitalize on the growing healthcare market.
In February, CVS announced
the creation of three newly designed stores in the Houston area as pilot
projects. These stores, called HealthHubs,
will include expanded health clinics with medical laboratories for blood
testing and health screenings. They’ll also feature dieticians, respiratory
specialists, and dedicated space to assist customers with the management of
some chronic health conditions, as well as wellness rooms for yoga classes and
health seminars.
“We’re pleased and surprised pleasantly with the ecosystem
of healthcare that we’ve created here and how approachable it is, how much
people are interested in it, and there are certain things we can take to all
stores,” Kevin
Hourican, Executive Vice President, CVS Health and President, CVS Pharmacy,
told Becker’s
Hospital Review.
With more retailers
adding an ever-increasing number of healthcare services to their offerings, the
number of medical laboratory tests available at those locations will likely
also increase. Although this trend may boost competition for clinical
laboratories, it could also benefit them by creating new opportunities to
provide value-added services to their clients.
Clinical laboratories could soon have new tests for determining how fast a patient’s digestive system is aging as part of a precision medicine treatment protocol
When it comes to assessing human age and longevity, much research has focused on telomeres in recent years. Now clinical laboratory managers and pathologists will be interested to learn that provocative new research demonstrates that the human microbiome may also contain useful information about aging. Microbes that can be diagnostic biomarkers may be one result of this research.
From preventing weight loss to improving cancer treatments to stopping aging, human microbiome—especially gut bacteria—are at the heart of many near miraculous discoveries that have greatly impacted clinical pathology and diagnostics development. Dark Daily has reported on so many recent studies and new diagnostic tools involving human gut bacteria it’s a wonder there’s anything left to be discovered. Apparently, however, there is!
Using artificial intelligence (AI) and deep-learning algorithms, researchers at Insilico Medicine in Rockville, Md., have developed a method involving gut bacteria that they say can predict the age of most people to within a few years. Located at Johns Hopkins University, Insilico develops “artificial intelligence for drug discovery, biomarker development, and aging research” notes the company’s website.
According to a paper published on bioRxiv, an online biomedical publications archive operated by Cold Spring Harbor Laboratory, the Insilico scientists have “developed a method of predicting [the] biological age of the host based on the microbiological profiles of gut microbiota” as well an “approach [that] has allowed us to define two lists of 95 intestinal biomarkers of human aging.”
“This microbiome aging clock could be used as a baseline to test how fast or slow a person’s gut is aging and whether things like alcohol, antibiotics, probiotics, or diet have any effect on longevity,” Alex Zhavoronkov, PhD (above), one of the study’s authors and founder of Insilico Medicine, told Science. (Photo copyright: Insilico Medicine.)
Clinical Laboratories
Might Be Able to Use AI and Gut Bacteria to Predict Age
To perform the study, the researchers collected 3,663 gut bacteria samples from 10 publicly available data sets containing age metadata and then analyzed the samples using a machine learning algorithm. The samples originated from 1,165 healthy individuals who were between the ages of 20 and 90. The individuals used for the study were from Austria, China, Denmark, France, Germany, Kazakhstan, Spain, Sweden, and the US.
The researchers divided the samples equally among three age
groups:
20 to 39 years old (young);
40 to 59 years old (middle aged); and,
60 to 90 years old (old).
The samples were then randomly separated into training and
validation sets with 90% of the samples being used for training and the
remaining 10% making up the validation set.
The scientists trained a deep neural network regressor to predict the age of the sample donors by looking at 95 different species of bacteria in the microbiome of the 90% training set. The algorithm was then asked to predict the ages of the remaining 10% of the donors by looking only at their gut bacteria.
They discovered that their computer program could accurately
predict an individual’s age within four years based on their microbiome. They also
were able to determine that 39 of the 95 species of bacteria examined were most
beneficial in predicting a person’s age.
In addition, the researchers found that certain bacteria in
the gut increase with age, while other bacteria decrease as people age. For
example, the bacterium Eubacterium
hallii, which is associated with metabolism in the intestines, was found to
increase with age. On the other hand, one of the most plentiful micro-organisms
in the gut, Bacteroides
vulgatus, which has been linked to ulcerative colitis,
decreases with age.
Understanding
Microbiome’s Link to Disease
The human microbiome consists of trillions of cells
including bacteria, viruses, and fungi, and its composition varies from
individual to individual. Scientific research, like that being conducted at
Insilico Medicine, expands our understanding of how gut bacteria affects human
health and how diseases such as inflammatory bowel disease, arthritis, autism, and obesity, are linked to the
microbiome.
This type of research could be used to determine how the
microbiomes of people living with certain illnesses deviate from the norm, and
possibly reveal unique and personalized ways to create healthier gut bacteria.
It also could help researchers and physicians determine the best interventions,
drugs, and treatments for individual patients dealing with diseases related to
aging. Such advancements would be a boon to precision medicine.
“Age is such an important parameter in all kinds of diseases.
Every second we change,” Zhavoronkov told Science. “You
don’t need to wait until people die to conduct longevity experiments.”
Further research is needed to develop these findings into
diagnostic tests acceptable for use in patient care. However, such tests could
provide microbiologists and clinical laboratories with innovative tools and
opportunities to help physicians diagnose patients and make optimal treatment
decisions.
Mobile technology continues to bring clinical-grade medical laboratory testing into patients’ homes, as more do-it-yourself kits receive FDA approval
Recently, the federal Food and Drug Administration (FDA) approved a smartphone-based at-home urine test that enables patients with chronic diseases, urinary tract infections, or high-risk pregnancies to monitor their health using a testing method that’s as easy as taking a smartphone selfie.
This latest breakthrough is another example of how technology is making it possible to move clinical laboratory testing closer to patients—in this instance into their homes. But it’s also taking away some of the urine testing being performed by medical laboratories.
The Dip.io urinalysis test system from Israeli-based Healthy.io received FDA 510(k) clearance for prescription home use. The test is for the semi-quantitative detection of glucose, specific gravity, blood, pH and protein, as well as the qualitative detection of nitrite. Special conditions also mandate in vitro diagnostic use only, according to the 501(k) Substantial Equivalence Determination Decision Summary.
In 2016, the Dip.io testing kit received CE marking, a certification mark that indicates health, safety, and environmental protection standards for products sold within the European Economic Area. And it has International Organization for Standardization (ISO) 13485 certification, making it commercially available in the European Union and the United Kingdom.
“We are incredibly proud of [achieving] this landmark ruling,” Healthy.io Founder and CEO Jonathan (Yonatan) Adiri (above) told MobiHealthNews. “It’s the highlight in a year that has seen us achieve so many of the key tasks we set out to achieve. With seven leading medical partners worldwide, including the UK National Healthcare System [sic] and a growing product portfolio, we’re set to meet 100,000 patients this year.” (Photo copyright: CNBC.)
Smartphone app with backend cloud-based server; and,
User manual.
Combining a urine sample kit and testing strips with color recognition, computer vision, and artificial intelligence (AI) has enabled Healthy.io to offer patients the ability to take what it calls a “medical selfie.” The test kit achieved more than 99% usability across age groups from 18 to 80.
“The process for the user is very simple,” Adiri told VentureBeat. “We like to say ‘If you can text, you can test.’ The user simply opens the app and is walked through the process step by step—aided by our chatbot nurse named Emily.”
According to Adiri, “the user opens the kit, fills the cup,
dips the stick, and, places it on our patented color-board. After waiting for
60 seconds (timed within the app) both the color-board and dipstick are scanned,
similar to how a QR code is scanned. The image is normalized and data points
are sent to our cloud, where they are classified into the correct clinical
result.”
Adiri notes that one significant aspect of the Healthy.io
device is it uses a standard urinalysis dipstick.
“It is important to first note that we haven’t tampered with the standard urine dipstick,” Adiri told VentureBeat. “It has been a tried and tested diagnostic tool for decades and is well established across many clinical pathways. We test for ketones, leukocytes, nitrites, glucose, protein, blood, specific gravity, bilirubin, urobilinogen, and pH. These indicators span a wide range of pathologies, from urinary tract infection to ketosis, kidney disease, health in pregnancy, and bladder cancer.”
The Healthy.io app integrates Dip.io (above) into the clinical process by automatically sending results to the patients’ electronic health records for physician review. The results may necessitate a follow-up clinical laboratory urine culture test to determine whether bacteria or other organisms are present in the urine. (Image copyright: Science and Enterprise.)
Adiri told VentureBeat that his company will be bringing an albumin-to-creatinine ratio (ACR) test to market as well. He says the test is “critical” for as many as 76 million Americans with diabetes, hypertension, and other medical issues who undergo urine testing looking for signs of chronic kidney disease. Healthy.io is also planning to release a skincare test.
“We see a leap forward in smartphone hardware that happens
roughly every four years. Our urinalysis product would not have been possible
five years ago because the image quality of smartphone cameras simply wasn’t
good enough,” he noted.
Other Clinical Lab
Grade Urine-testing Kits
Healthy.io received the FDA’s 510(k) approval on July 18,
2018. And as of February, 2019, the company has raised $18 million in venture
capital funding, according to VentureBeat, which reports that
100,000 patients in Europe and Israel are already using Dip.io.
“We know that most patients with kidney disease and protein in their urine are untested and therefore go undiagnosed,” Josef Coresh, MD, PhD, professor of epidemiology, medicine, and biostatistics at Johns Hopkins Bloomberg School of Public Health, and head of Healthy.io’s clinical advisory board, told VentureBeat. “[This] technology—[which] directly [connects] patients at home with the medical system—is a gamechanger addressing a big need.”
According to mHealth Intelligence, Dip.io is reportedly one of the first Class II medical devices the FDA has approved for use with optical equipment designed by a third party, such as a smartphone.
But it’s not the only at-home clinical-grade urine testing kit in the market. California-based inui Health, formerly known as Scanadu, announced the launch of its own clinical-grade home urine analysis platform last year. Its FDA-approved kit includes a dippable paddle that measures five key biomarkers (protein, glucose, leukocytes, nitrites, and ketones) in urine and uses a smartphone app to provide results directly to patients within one minute. Results may be shared with providers via a HIPAA compliant system.
As more diagnostic tests become available for home-use, anatomic
pathology and clinical laboratories should work closely with healthcare
providers to ensure patients who use these new tools receive the proper interpretation
guidance and follow-on diagnostic or monitoring tests they need.
The flood of new diagnostic technologies undergoing research
and moving toward regulatory approval should motivate medical laboratory
managers and clinical pathologists to rethink their lab’s business and clinical
strategies. The goal would be to identify ways to offer these new diagnostic
tools so that labs can deliver more value to physicians, patients, and
payers—value for which clinical labs can be reimbursed under new payment
models.
Leveraging the user base of its existing Rally mobile wellness platform, UnitedHealth Group plans to expand its new electronic health records system to 50 million benefited members and one million healthcare providers by the end of 2019 Before the end of 2019, UnitedHealth Group plans to introduce an electronic health records (EHR) system that it developed internally. It has a ready market for such a system because of its 50 million beneficiaries and one million providers. But this EHR may...
