Literature Review

AI And Health Insurance Prior Authorization: Regulators Need To Step Up OversightHealth Affairs; by Carmel Shachar Amy Killelea Sara Gerke; 7/24Artificial intelligence (AI)—a machine or computer’s ability to perform cognitive functions—is quickly changing many facets of American life, including how we interact with health insurance. AI is increasingly being used by health insurers to automate a host of functions, including processing prior authorization (PA) requests, managing other plan utilization management techniques, and adjudicating claims. In contrast to the Food and Drug Administration’s (FDA’s) increasing attention to algorithms used to guide clinical decision making, there is relatively little state or federal oversight of both the development and use of algorithms by health insurers.

Exploring AI-powered music therapy as a solution to chronic pain management and the opioid crisisNeurologyLive; by Neal K. Shah; 8/6/24While the opioid crisis continues to ravage communities across America, many with chronic pain are in dire need of solutions. As a result, healthcare providers and researchers are urgently seeking alternative treatments for chronic pain management. One innovative solution is the use of music therapy, particularly when enhanced by artificial intelligence (AI) and neurotechnology. This combination could offer a powerful, non-pharmacological intervention to help millions of Americans suffering from chronic pain while potentially reducing opioid dependence.

End-of-life decisions are difficult and distressing. Could AI help?MIT Technology Review; by Jessica Hamzelouarchive;8/1/24Ethicists say a “digital psychological twin” could help doctors and family members make decisions for people who can’t speak themselves. End-of-life decisions can be extremely upsetting for surrogates, the people who have to make those calls on behalf of another person, says David Wendler, a bioethicist at the US National Institutes of Health. Wendler and his colleagues have been working on an idea for something that could make things easier: an artificial-intelligence-based tool that can help surrogates predict what patients themselves would want in any given situation. The tool hasn’t been built yet. But Wendler plans to train it on a person’s own medical data, personal messages, and social media posts. He hopes it could not only be more accurate at working out what the patient would want, but also alleviate the stress and emotional burden of difficult decision-making for family members.

Empowering patient access, protection, and choice: The 21st Century Cures Act eight years on Healthcare Business Today; by David Navarro; 7/26/24 The 21st Century Cures Act, signed into law in December 2016, marked a significant shift in the healthcare landscape by focusing on patient empowerment through enhanced access to medical records, stringent privacy protections, and increased choices in healthcare options. Eight years later, this landmark legislation continues to revolutionize the interaction between patients, providers, and the healthcare system. Recently, The U.S. Department of Health and Human Services (HHS) issued an updated ruling to the Act to establish penalties for healthcare providers who engage in information blocking. This rule, aims to deter practices that prevent or discourage the access, exchange, or use of electronic health information (EHI).

Following the CrowdStrike outage, healthcare stresses the importance of prevention HealthCare Brew; by Cassie McGrath; 7/25/24... [The recent CrowdStrike outage] affected millions across all sorts of industries, from healthcare to travel. ... However, amid the chaos, what has largely gone untold are stories of the companies that emerged unscathed. And within those unaffected companies lies a lesson for others, according to Andrew Molosky, president and CEO of Tampa-based Chapters Health System. ... “We’ve really focused on business continuity, redundancies, safety nets, and understanding of the difference between cybersecurity as a task and cybersecurity as a cultural commitment of your organization,” Molosky said. ... These investments, Molosky said, included protocols for documenting on paper, using a backup application that provides patient information when electronic medical records and other systems are offline, and allowances for bringing in personal devices to use if company devices go down. 

Baptist Health taps 3 vendors to build a population health system that works Healthcare IT News; by Bill Siwicki; 7/26/24With help from Oracle, Innovaccer and Salesforce, the South Florida provider is scoring big population health wins, including a 7% increase in coding gap closure rate and a 17% increase in annual wellness visit completion rates. Baptist Health South Florida operates a network of 11 hospitals covering four counties. It also includes numerous ambulatory facilities, urgent care centers and emergency departments to provide comprehensive healthcare services across the region. ... "One of our primary issues was the fragmented nature of patient data across multiple provider organizations and electronic health record systems," said Milady Cervera, vice president, population health and physician integrated networks, at Baptist Health South Florida. "This lack of interoperability made it difficult to gain a comprehensive view of our patients' health status, care history and ongoing needs. ..."

Can Artificial Intelligence speak for incapacitated patients at the end of life? JAMA Internal Medicine; by Teva D. Brender, MD; Alexander K. Smith, MD; Brian L. Block, MD; 7/22/24 Viewpoint: Imagine meeting with the daughter of a critically ill patient. The patient (her mother) had a cardiac arrest, is in multiorgan failure, and cannot communicate. The daughter is uncomfortable making decisions because they are estranged and never discussed what her mother would want in this type of situation. The patient has no advance directive or alternative surrogate. Now imagine this meeting taking place in a future where the mother’s medical visits have been audio recorded. Furthermore, you have access to an artificial intelligence (AI) algorithm that can identify and play excerpts of the mother talking about what mattered most to her. You and the daughter listen to these recordings together. Then you share that another algorithm, trained on 7 million patient records, predicts that the mother’s chance of walking again is less than 5%. ...

Keeping staff members safe and sound by optimizing security technology Security; by Paul Sarnese; 7/12/24 Nobody wants to invest in technology, only to have it go the way of the stationary bike that sits unused in the corner of a room. That holds true for healthcare organization leaders who are looking to invest in staff safety alarm systems that can help avert potentially dangerous situations. With workplace violence against caregivers increasing 115% since 2021, many healthcare organizations are, indeed, looking to protect workers from harm — and to shield their organizations from resultant financial distress.Editor's Note: Workplace violence and staff safety continues to trend as a root cause for nursing and other healthcare strikes across the nation. Examine your organization's Incident Reports and QAPI initiatives. What needs to be addressed?

6 guidelines from ASCO on AI, cancer care Becker's Hospital Review; by Ashleigh Hollowell; 6/25/24 Leaders at the American Society of Clinical Oncology published a formal document June 25 that outlines what the group deems as the most appropriate use of artificial intelligence when it comes to clinical oncology care. ... When considering AI technology for oncological care, the American Society of Clinical Oncology says clinicians should keep the following principles in mind to guide their use: 

Why nurses are protesting AIHealthcare Brew; by Tom McKay; 6/26/24Continuous data collection and analysis is hardly a replacement for knowledge, nursing unions say, and sometimes gets in the way of care. The largest nursing union in the US, National Nurses United (NNU), is sounding the alarm about the use of AI in healthcare. In April, the union’s affiliate California Nurses Association (CNA) protested an AI conference helmed by managed care consortium Kaiser Permanente. Like workers in other sectors who are worried about AI encroachment, the nurses fear that the tech is contributing to the devaluation of their skills amid what they say is already a “chronic” understaffing crisis, nurses reported in an NNU survey of 2,300 registered nurses and members in early 2024. But the NNU, which represents approximately 225,000 nurses across the country, also claims healthcare operators are using AI hype as a pretext to rush half-baked and potentially harmful technologies into service, says Michelle Mahon, NNU’s assistant director of nursing practice.

AMA Advocacy 2024 efforts American Medical Association; by AMA; Updated June 2024, 6/27/24 There are far too many everyday practice challenges interfering with patient care. That’s why the American Medical Association is advocating to keep physicians at the head of the health care team, reform the Medicare physician payment system, relieve the burdens of overused prior authorizations and so much more. [Key advocacy efforts include:]

Hospice charity’s online community ‘at huge risk’ after Meta ban ThirdSector, United Kingdom; by Emily Harle; 4/26/24The charity says it has been unable to fully access to its Facebook and Instagram accounts after the admin was banned for posting a hospice advert.  Lewis-Manning Hospice Care has lost access to its Meta Business Manager account, saying the unexpected ban has left it unable to access analytics, fundraising tools and at risk of losing its entire online community. The charity, which offers palliative care for people with life-limiting illnesses and their families across east Dorset, has been left unable to fully manage its Facebook and Instagram accounts for more than a year after an admin was banned by Meta. Olivia Girling, head of marketing and communications at Lewis-Manning Hospice Care, told Third Sector the ban was imposed on the charity’s former marketing manager’s advertising account, after she posted a fundraising advert. Girling said Meta, which owns Facebook and Instagram, told the charity the ad had “violated community guidelines,” but she insisted it was a “generic hospice marketing post.” When pressed for its reasoning behind the ban, Meta would not give any further explanation, she said.Editor's Note: Click on the title's link for this important information, conflicted outcomes, and horrific bans from being able to manage one's own hospice Facebook and Instagram accounts.