Monthly Roundup: ChatGPT and CDS, virtual specialty care and payers, unified financial platforms

Takeaways from articles about research, case study spotlights, and industry trends this month.

Using AI-generated suggestions from ChatGPT to optimize clinical decision support

I found this paper interesting because it offers a fresh perspective on applying AI and large language models (LLMs) to clinical decision support (CDS). Led by Siru Liu at Vanderbilt University Medical Center (VUMC), the study uses ChatGPT to generate suggestions for refining the logic (rather than the content) of CDS alerts. This approach is intriguing because it integrates AI into an existing human-driven process, making it a practical and potentially beneficial application in the near term for healthcare provider organizations.

To understand why this approach is significant, let’s first consider the “anatomy” of traditional CDS systems. These systems have a “backend” comprising clinical data, a knowledge base, and logic, and a “frontend” that includes the user interface and subsequent action. When we talk about integrating AI into CDS systems, it’s crucial to specify which part of this anatomy we’re optimizing. Often, the focus is on training the AI, but the intentional design of the CDS system is equally important.

An example of a set of logic for a CDS system to alert providers to avoid live virus immunizations for immunocompromised patients.

Source: Liu et al. JAMIA 2023

While AI is often touted as a potential replacement for knowledge bases and logic, the reality is that current machine learning models fall short in being able to be applied to CDS at scale. Yet, there remains a need to change how CDS systems are built; the process of creating and maintaining these knowledge bases is time consuming, involving synthesis and translation of expert knowledge into discrete knowledge artifacts and rules. This is a task that seems well-suited for a large language model.

The study at VUMC provides a great example of this intentional design led approach to applying AI to CDS. The researchers used seven alerts from the Epic EHR system and transformed the documented alert logic into ChatGPT prompts. They then mixed LLM-generated suggestions with those previously generated by clinical informaticians, randomizing the order of suggestions. The suggestions were rated by a group of physicians and pharmacists on eight different perspectives, including understanding, relevance, and usefulness.

The results of the study were promising. LLM-generated suggestions scored high in understanding and relevance, suggesting that AI can provide valuable insights that can enhance the effectiveness of CDS alerts. However, the study also highlighted some challenges with AI-generated suggestions, including lack of knowledge management and implementation understanding. These findings underscore the need for further research and refinement of LLMs for CDS optimization.

Looking ahead, the integration of AI into CDS optimization could pave the way for more dynamic, responsive, and effective CDS systems. As we continue to explore this opportunity, it is clear that the journey is just as important as the destination.

Reference: https://academic.oup.com/jamia/article/30/7/1237/7136722

Aetna and Oshi collaborate to provide virtual care for digestive disorders

This is news back from April, but it recently caught my eye. In a move towards vertical integration into specialty care, Aetna announced a value based collaboration with Oshi Health, a virtual digestive health provider. Oshi’s digital care model in involves connecting patients with specialized providers via telehealth visits, and continuously adapting and refining care plans based on monitoring of symptoms, food intake, and bowel movements with the support of health coaches and nutritionists. Early results presented in a clinical study look promising in terms of member satisfaction and cost savings. The partnership will provide Aetna commercial members with in-network access to Oshi’s services. It is unclear whether/how Aetna is building in any features to “navigate” its members towards these virtual care options versus traditional specialty referrals.

This partnership follows its recent acquisitions of Signify Health (home health), and Oak Street Health. At $8 billion and $10.6 billion, respectively, these are much more aggressive and higher conviction moves than the partnership with Oshi. However, the trend and strategy is clear: CVS/Aetna is betting on vertical integration of its payer business with virtual first provider capabilities, which now includes not just supportive and primary care, but specialty care services.

To those in the health technology space, this presents unique opportunities and problems to be solved, ranging from referral optimization, care coordination, and even clinical decision support at a very different scale than with traditional provider organizations. The breadth and depth of products (and the data that will drive these products) will be different. I’ll be keeping my eye out for products and companies that emerge in this space.

Reference: https://www.cvshealth.com/news/virtual-care/aetna-and-oshi-collaborate-to-provide-virtual-care-for-digestive-disorders.html

79% of Consumers Want to Pay All Medical Bills From Single Digital Platform

A survey of 2,034 consumers in the United States revealed that participants by and large prefer a unified digital platform to help with financial transactions related to healthcare, including payment of medical bills, financing options, and HSA investment options.

Of note, this study was conducted by a healthcare fintech company Lynx and Pymnts, a fintech news outlet, so I cannot speak to its degree of bias and validity. Nevertheless, it highlights two interesting trends that I believe those of us in health IT should continue to track closely: 1) the experience of paying for healthcare is a major pain point, and 2) patients are looking for more control and convenience over the process, rather than deferring it to the provider organizations.

Managing their own healthcare becomes an arduous labyrinth for patients juggling multiple providers, health systems, and pharmacies, each with its unique policies, paperwork, and billing processes; a mounting frustration that only exacerbates the stress of navigating their medical problems. I think the sentiment from this survey represents a desire for a future state towards a model where patients manage healthcare transactions on their terms — not just the payment process, but also financing, access to tax deductible investment accounts, and I would also guess price transparency (which is not explicitly mentioned in the survey).

This may also imply a shift in preferences in the tradeoff between privacy and convenience. Traditionally, privacy has been a paramount concern in healthcare. Still, the growing demand for a simplified and unified payment system may cause consumers to compromise on this front.

Patients are expressing their frustration with legacy health systems and processes, and as health IT professionals, we need to be listening. The desire for control and convenience is redefining the way we must think about our systems, processes, and the products that we are building for the future. Perhaps patients are telling us something a bit more nuanced about the tradeoffs that they are willing to make: while they undoubtedly value their privacy, their increasing desire for convenience, control, and an integrated healthcare experience suggests that they might be open to a more flexible model of data management where transparency, security, and user-friendliness coexist.

Reference: https://www.pymnts.com/healthcare/2023/79percent-of-consumers-want-to-pay-all-medical-bills-from-one-digital-platform/