Tech in Medicine: Innovating to Improve Patient Engagement

From improved medical records systems to drone delivery systems to artificially intelligent (AI) health care companions, Nebraska medical organizations are helping shape the future of patient care.

Methodist Health System recently debuted its Methodist Care Innovation Center, according to Kent Sona, vice president and chief information officer.

“This is a new space in our information technology department where physicians and other staff can explore new concepts and innovation efforts,” he said.

Methodist has implemented Medigate — Healthcare Internet of Things (IoT), which has improved the system’s remote monitoring capabilities and enhanced its visibility, allowing it to improve security and operational efficiencies. The organization has also converted from paper faxing to Cerner Work Queue Monitor, which allows patient documents to be identified, labeled and uploaded directly into the electronic medical records (EMR).

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Nebraska Medicine has made major enhancements to its backup and recovery infrastructure, allowing it to quickly back up multiple terabytes of data in minutes rather than hours and recover systems in hours rather than days, according to Ron Carson, executive director of enterprise applications. A major security enhancement was completed by creating one identity across multiple systems and provision access based on user role.

“This lays the groundwork to automate the provisioning process, which will be transformational in ensuring the right people have the right access to systems when they join Nebraska Medicine or when they change roles within the health system,” he said. “To increase patient safety, we integrated infusion pumps with the electronic health record. We also invested in the infrastructure to keep patient data moving quickly and securely. Many wireless access points were upgraded, and we further built out micro-segmentation to ensure data moves securely across the network.”

Boys Town has expanded capabilities in the Boys Town National Research Hospital and related clinics, according to Christopher Wren, senior vice president of information technology.

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“We inaugurated the Institute for Human Neuroscience, which is revolutionizing child and adolescent brain research with a cutting-edge neuroscience research facility housing two next-generation MEG (magnetoencephalography) systems.”

To support the growth of its health care initiatives, Boys Town overhauled its technology infrastructure in 2021, including the implementation of the Epic EMR system and the first phase of the Workday Enterprise resource-planning system.

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Advancing Technology

Since Encounter Telehealth president and CEO Jen Amis took over the firm in late 2015, both hardware and software have improved, and prices have dropped. Back then, the firm sent desktop computers to each senior living community it partnered with.

“Now we send them all iPads, so residents don’t have to go into a specific clinical room,” Amis said. “A staff member can take the iPad directly to wherever that resident wants to be seen.”

States continue to open the practice environment for nurse practitioners, allowing them to diagnose, treat and prescribe like the medical doctors.

“We collaborate closely with all medical directors at the senior living communities, but this gives [the nurse practitioners] the authority to prescribe without requiring the MD’s time,” Amis said.

Insurance also has changed dramatically over the past seven years, with COVID-19 driving part of this change. Originally, Encounter Telehealth was restricted to Medicare recipients only in skilled nursing facilities, hospitals or designated rural areas. Now the firm can see all Medicare recipients regardless of their location, including assisted and independent living communities.

The stigma surrounding mental health has been reduced, thanks in part to the pandemic.

“So many people had depression or anxiety, understandably so because it was a really scary time,” Amis said. “With so many celebrities, professional athletes and politicians talking about their own struggles with mental health issues, there’s a greater acceptance of mental health care.”

Seven years ago, Encounter Telehealth had its EMR system on a physical server in its office.

Today the EMR is cloud-based, which is less expensive. The organization also uses a cloud-based video solution.

“We’re developing our own platform that will integrate this video with the scheduling from the EMR component and also customize it a bit more specific to our workflow as a national telehealth company,” Amis said.

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Future of Health Care

“Microservices will have a major impact on health care and our technology strategy for both the near and long term,” Carson said. “The proliferation of application programming interfaces (APIs) and the ability to connect disparate systems together is going to enable new levels of care that were not previously possible.”

In the past, data contained in each of Nebraska Medicine’s niche systems would have stayed in that system or would require manual copying to get the data into the firm’s enterprise systems.

Now this is being automatically transferred using APIs and Smart on Fast Healthcare Interoperability Resources (FHIR) interfaces.

“It’s much easier to get that niche data into our enterprise systems to serve as knowledge and information for caregivers at the bedside,” Carson said.

Drones are an upcoming technology that can complete simple tasks and remove the burden from caregivers. Drones could deliver medications to the patients’ doorsteps, and specimens can be delivered securely to the lab. Drones could pull supplies for surgery, deliver them on time for surgical start times and the same drone could restock shelves.

“I foresee that in the future, drones could be part of the first responder team delivering patients to emergency departments and bypassing traffic congestion,” Carson said. “These types of advancements will increase the quality of care being delivered and make health care accessible to everyone.”

“We’re seeing an increasing number of systems and devices generating data and becoming interconnected,” Wren said. “In areas like neuroscience, that’s giving us the ability to do more data analysis to discover patterns and help focus areas of research, leading to better patient outcomes.”

The data coming out of these systems will need AI on top of it to raise actionable information to clinicians caring for patients. Nebraska Medicine uses AI to proactively find patients at risk for developing sepsis for early medical intervention.

“The use of AI will only grow and will be used for everything from ensuring patients have access to care to clinician-aided identification of abnormalities in imaging,” Carson said.

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Continuing Research

Nebraska Innovation Campus (NIC) has several companies that are involved in research and development (R&D) in the health care arena, according to Executive Director Daniel J. Duncan.

Companies that have opened offices at Innovation Campus include Synbiotic Health, PraesensBio, Tyreos and Virtual Incision.

“Innovations range from vaccine development, food products that promote health microbiome functions in humans to a company making a surgical robot,” Duncan said. “[MatMaCorp] was doing R&D on NIC and has since relocated to another area of Lincoln. They make molecular diagnostic equipment.”

Coming in the near future is monitoring of human vital signs using wave radar, a contactless method of monitoring vitals, with applications for both hospitals and home health.

“Imagine being able to sleep the whole night in the hospital without being woken up every four hours for a vitals check,” Sona said.

Another anticipated advancement is AI powered health care companions for the home.

“The AI companion could learn about the patients, ask them questions, engage them, detect if something is wrong and notify the family or caregivers accordingly,” Sona said.

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Digital Health Care

Methodist Health System is currently exploring patient monitoring and remote rounding, which gives its physicians the ability to monitor several patients remotely, reducing falls and assisting with dementia patients.

“Remote rounding can assist clinical staff with seeing patients via a video visit within the room using the same platform, discharge orders, nurse call, can increase patient satisfaction and help gain efficiencies for staff,” Sona said.

This type of monitoring can take place in the home.

“Remote patient monitoring for key patients allows us to monitor cardiovascular or diabetic patients, for example,” Sona said. “Ability to automatically update the EMR and alert clinicians if certain values seem off. Improved outcomes for patients, reduce re-admissions, stay ahead of possible issues.”

Methodist is eyeing expansion of telehealth, leveraging AI — AI physician assistants, AI care coordination, AI staffing support — to assist with providing care to aid in operational efficiencies and improve outcomes for patients.

Digital health care tools can help medical professionals focus on the personal touch so they can spend all of their time truly engaging with patients rather than spending a good deal of time in the systems.

“Similar tools can be used for patients to engage with their medical providers when they are outside of the facility, information sharing, education, check-ins, allowing the patients to become more engaged in their care for better outcomes,” Sona said.

Biometric monitoring devices are continuing to proliferate and can empower patients with information about their bodies.

“We have a long history of success with glucometers in our remote patient monitoring program,” Carson said. “We also used pulse oximeters at home to check patients during the height of the pandemic to ensure respiration issues didn’t develop post-discharge. Pedometers at the bedside are an effortless way to ensure patients are getting up and walking post-surgery, which we know helps speed recovery.”

An estimated 30 million people — about the population of Texas — are walking around with a device that can take a single lead ECG and detect falls. These devices enable powerful insights into a patient’s health and well-being.

Technology can be a big part of the solution to clinician burnout in health care.

“We’re currently working on an ambient documentation experience,” Carson said. “A microphone listens to the provider/patient interaction then, using AI, transforms the recording into a clinical note stored in the electronic health record. We’ve seen this decrease the amount of time clinicians spend documenting while increasing the quality of the notes. This is just the beginning of what is possible and how technology will be an aid to our clinicians.”