Trustworthy Augmented Intelligence in Health Care

Augmented Intelligence (AI) systems have the power to transform health care and bring us closer to the quadruple aim: enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers. Earning physicians' trust is critical for accelerating adoption of AI into patient care. As technology evolves, the medical community will need to develop standards for these innovative technologies and re-visit current regulatory systems that physicians and patients rely on to ensure that health care AI is responsible, evidence-based, free from bias, and designed and deployed to promote equity. To develop actionable guidance for trustworthy AI in health care, the AMA reviewed literature on the challenges health care AI poses and reflected on existing guidance as a starting point for addressing those challenges (including models for regulating the introduction of innovative technologies into clinical care).

The Role of Electronic Medical Records in Reducing Unwarranted Clinical Variation in Acute Health Care: Systematic Review

Background The use of electronic medical records (EMRs)/electronic health records (EHRs) provides potential to reduce unwarranted clinical variation and thereby improve patient health care outcomes. Minimization of unwarranted clinical variation may raise and refine the standard of patient care provided and satisfy the quadruple aim of health care. Objective A systematic review of the impact of EMRs and specific subcomponents (PowerPlans/SmartSets) on variation in clinical care processes in hospital settings was undertaken to summarize the existing literature on the effects of EMRs on clinical variation and patient outcomes. Methods Articles from January 2000 to November 2020 were identified through a comprehensive search that examined EMRs/EHRs and clinical variation or PowerPlans/SmartSets. Thirty-six articles met the inclusion criteria. Articles were examined for evidence for EMR-induced changes in variation and effects on health care outcomes and mapped to the quadruple aim of health care. Results Most of the studies reported positive effects of EMR-related interventions (30/36, 83%). All of the 36 included studies discussed clinical variation, but only half measured it (18/36, 50%). Those studies that measured variation generally examined how changes to variation affected individual patient care (11/36, 31%) or costs (9/36, 25%), while other outcomes (population health and clinician experience) were seldom studied. High-quality study designs were rare. Conclusions The literature provides some evidence that EMRs can help reduce unwarranted clinical variation and thereby improve health care outcomes. However, the evidence is surprisingly thin because of insufficient attention to the measurement of clinical variation, and to the chain of evidence from EMRs to variation in clinical practices to health care outcomes.

Lifestyle Medicine and Economics: A Proposal for Research Priorities Informed by a Case Series of Disease Reversal

Chronic disease places an enormous economic burden on both individuals and the healthcare system, and existing fee-for-service models of healthcare prioritize symptom management, medications, and procedures over treating the root causes of disease through changing health behaviors. Value-based care is gaining traction, and there is a need for value-based care models that achieve the quadruple aim of (1) improved population health, (2) enhanced patient experience, (3) reduced healthcare costs, and (4) improved work life and decreased burnout of healthcare providers. Lifestyle medicine (LM) has the potential to achieve these four aims, including promoting health and wellness and reducing healthcare costs; however, the economic outcomes of LM approaches need to be better quantified in research. This paper demonstrates proof of concept by detailing four cases that utilized an intensive, therapeutic lifestyle intervention change (ITLC) to dramatically reverse disease and reduce healthcare costs. In addition, priorities for lifestyle medicine economic research related to the components of quadruple aim are proposed, including conducting rigorously designed research studies to adequately measure the effects of ITLC interventions, modeling the potential economic cost savings enabled by health improvements following lifestyle interventions as compared to usual disease progression and management, and examining the effects of lifestyle medicine implementation upon different payment models.

Oral Appliances for OSA Treatment: Meeting the Quadruple Aim

ABSTRACT Introduction In order to better treat obstructive sleep apnea (OSA) in a more efficient and cost-effective way, a joint program between dental clinics and the sleep medicine clinic was piloted at Fort Hood, Texas. Obstructive sleep apnea negatively affects soldier readiness and deployability, leading to the need to establish a successful and proven workflow to treat these patients with oral appliance therapy (OAT). Materials and Methods We performed a retrospective review of a de-identified data set which included 288 patients from July 2016 to July 2020. Projected cost data were obtained from routinely collected sleep clinic positive airway pressure (PAP) data. Data were analyzed to determine treatment success and potential cost savings using OAT versus continuous positive airway pressure (CPAP). Patient workflow including successes and challenges with the program is summarized. Results About 85.5% of patients met criteria for successful control of their OSA using OAT as treatment. Five patients did not tolerate OAT and switched back to CPAP. A higher (less severe) O2 nadir on diagnostic polysomnography is moderately correlated with OAT success. Diagnostic Apnea–Hypopnea Index was inversely and weakly correlated with success. Two of the major challenges noted in the program were (1) loss of follow-up and (2) the length of time from oral appliance referral to fitting the oral appliance. If this program was successfully implemented at other Defense Health Agency (DHA) medical treatment facility (MTF) markets nationwide, a potential cost savings of over $500,000/year/MTF could be achieved. Conclusions Oral appliance therapy has the potential to increase both readiness and deployability for active duty soldiers. Using baseline O2 nadir can help predict success with OAT patients, determining which patients will benefit from this joint program between the dental and medical sleep clinics. Future studies can aim to establish an evidence-based pathway for clinic testing and follow-up. If this patient workflow is implemented properly, there can be significant cost savings army-wide. This all helps The United States Medical Command (MEDCOM) align with the DHA’s Quadruple Aim of increased readiness, better health, better care, and lower cost.