Your Daily digest for Health Tech | Fierce Healthcare Daily Digest (Unofficial)

Tue Jul 23 10:31:40 PDT 2024

Health Tech | Fierce Healthcare Daily Digest (Unofficial)

(https://www.fiercehealthcare.com/regulatory/advocates-meet-white-house-urge-inclusion-stimulants-upcoming-telehealth-prescribing) Advocates to White House: Allow virtual stimulant prescriptions
Jul 23rd 2024, 13:31

Mental health advocates met with the White House’s Office of Management and Budget this month to urge the administration to include schedule IIN non-narcotic stimulants in its proposed telehealth prescribing rule set to air in September. 
If the pandemic prescribing flexibilities lapse—or the Drug Enforcement Administration leaves out Schedule IIN drugs in its upcoming telehealth prescribing rule—patients may be required to see providers in person to receive their medications. 
Over half of counties lack local qualified prescribers. 

The American Psychiatric Association presented at the White House meeting and told the administration it should not create a blanket in-person visit requirement for the prescription of controlled stimulant medications like Adderall, Concerta and Ritalin. It also urged it to deliver the proposed telemedicine rulemaking before there are more complications for practices. 
“Any further delay in the rule could pose challenges for a lot of practices and organizations,” a member of APA's Committee on Telepsychiatry and practicing psychiatrist, Shabana Khan, told Fierce Healthcare.
Schedule IIN substances were not included in the last version of the proposed telehealth prescription of controlled substances rulemaking, which the DEA put out in March 2023. In response to a near-record-breaking 38,000 comments from providers, patients and other stakeholders, the DEA held public listening sessions in September 2023 and announced it would propose a new rule. 
The new proposed rule is likely to be a version of a special telehealth registration system. The agency has skirted the creation of a telehealth registration system despite its requirement to do so in the 2008 Ryan Haight Act Online Pharmacy Consumer Protection Act. 
“For ADHD, [Schedule IIN substances are] the first line treatment. Our patients often have comorbidities, so it's not just ADHD,” Khan told Fierce Healthcare. “They may have a mood disorder. They may have OCD, anxiety, depression …  If we can't prescribe a first line, evidence-based treatment for one psychiatric condition, then we can't pick and choose. We do want to provide comprehensive care for our patients.”

APA also urged the administration to continue to pursue telehealth providers that are overprescribing the medication and to prevent diversion and misuse of non-narcotic stimulants. Khan and others penned a letter to the DEA in June asking for the inclusion of Schedule IIN controlled substances in the rule. 

Khan said her practice has been in conversations with patients about the possible return to in-person visits to obtain controlled substance prescriptions for the last year and a half amid the regulatory uncertainty following the end of the COVID-19 public health emergency. Other practices stopped accepting new telehealth patients. 
Khan said patients have mixed reactions to the news. More-resourced patients might not have an issue switching care modalities and seeing Khan’s team in-person. Patients in rural and underserved areas may struggle to find a local in-person psychiatrist from whom to get their prescriptions. Khan said 55% of counties do not have a psychiatrist and 70% do not have a child psychiatrist. Pediatricians in rural and underserved areas are already overburdened as well. 
“Ultimately, we can try to find someone locally, try to look into resources, but even if we do that, there may not be that option locally,” Khan said. “Ultimately, it has been a call on patients to be able to find that care.”
Scheduling telehealth visits has also been a challenge for Khan’s and other APA members’ practices due to the regulatory uncertainty. Practices also feel mixed about continued investment in their telehealth infrastructure because of the possible end to virtual stimulant prescribing. 
Khan emphasized that there are safeguards in place such as state prescription drug monitoring programs (PDMPs), state medical laws and malpractice insurance to protect the integrity of virtual prescribing of controlled substances without an in-person visit requirement.  

(https://www.fiercehealthcare.com/ai-and-machine-learning/abridge-teams-epic-mayo-clinic-develop-gen-ai-tools-nurses) Abridge, Epic and Mayo Clinic collaborate on gen AI for nurses
Jul 23rd 2024, 13:31

Abridge has spent the last six years building generative AI tools to help doctors with medical documentation and is now putting that technology in the hands of hospital nurses. 
In collaboration with Mayo Clinic and health IT giant Epic, Abridge rolled out a generative AI ambient documentation workflow for nurses. Abridge's new product integrates into existing Epic inpatient nursing workflows, according to the company.
The product was developed as part of Abridge's participation in the (https://www.fiercehealthcare.com/health-tech/epic-launches-new-showroom-website-3rd-party-apps-services) Epic Workshop program, which was announced last year. The Workshop program features third-party vendors who are co-developing technology with Epic. 

Nurses at Mayo will help design and test the solution and prioritize the workflows where the AI tool will have the highest impact, according to Shiv Rao, M.D., CEO and founder of Abridge.
"Nurses are the scaffolding of the healthcare system. Being able to serve them now with cutting edge technology that can unburden them to focus on the thing that actually gives them energy, which is patient care," Rao, a cardiologist, said in an interview. "I'm excited about these coming weeks, but also these coming months as we start to not only measure the impact of this technology, but hopefully also scale across the healthcare system."
The company, one of Fierce Healthcare's (https://www.fiercehealthcare.com/special-reports/fierce-healthcares-fierce-15-2024) Fierce 15 of 2024 honorees, uses AI to increase the speed and accuracy of medical note-taking, leveraging a proprietary data set derived from more than 1.5 million medical encounters. The company's AI converts a patient-clinician conversation into a structured clinical note draft in real time and integrates it seamlessly into the EMR.
Abridge was founded on the premise that clinician-patient conversations are at the core of all healthcare, Rao said in a previous interview with Fierce Healthcare. His family's own journey through the healthcare system also made him aware of the need for better communication, and he saw an opportunity to use technology to improve the gap between healthcare conversations and what happens next. Motivated by personal and professional experiences, Rao worked together with Florian Metze, Ph.D., and Sandeep Konam to launch Abridge in 2018.

Abridge says its technology can now support more than 14 languages and 50+ specialties. In February, the company picked up a (https://www.fiercehealthcare.com/ai-and-machine-learning/abridge-clinches-150m-build-out-generative-ai-medical-documentation) $150 million series C financing round, which includes a strategic investment from NVIDIA. The company has raised $212.5 million to date.
Abridge's generative AI-powered platform has been deployed at the University of Vermont Health System, (https://www.fiercehealthcare.com/ai-and-machine-learning/christus-health-deploying-abridges-generative-ai-tool-aid-clinician) Christus Health, UChicago Medicine, (https://www.fiercehealthcare.com/ai-and-machine-learning/sutter-health-taps-abridge-roll-out-generative-ai-tech-physicians-and) Sutter Health, Yale New Haven Health System, UCI Health, Emory Healthcare, The University of Kansas Health System, UPMC, and dozens of other health systems.

Abridge designed the new product to fit nurses' unique workflows, which often encompass a fast-paced, continuous and wide-ranging scope of activities, potentially involving several patients and hundreds of tasks.
"As a doctor, when I see a patient, I might have a conversation and then I write a note that is really a narrative; I'm capturing the story of the patient," Rao said. "The nurses have to capture narratives, but they also have to do so much more. They're capturing vital signs, for example, they are documenting work that they have to do from a safety perspective, like turning a patient in an ICU. There's so much that they have to do that also goes into different spots in the medical record. There are flow sheets, but there's notes that they write and vital signs that they might capture on a patient. There's a unique complexity to their workflows. That amounts to a new user experience that we're working backwards from."
A nurse's day-to-day tasks can involve patient and team-based communication, clinical notetaking and data capture.
Mayo Clinic nursing staff are at the center of the collaboration, said Ryannon Frederick, M.S., R.N., chief nursing officer at Mayo Clinic. “We are engaging them directly in the development of this technology to ensure its use meets the unique needs of nursing and patient care workflows along with regulatory requirements for ambient solutions. We are thrilled to bring the knowledge and expertise of our nursing staff to help shape the future of documentation, where documentation could happen automatically and organically," Frederick said in a statement.

Rao noted that developing the product with Epic was critical to integrate into its EHR and inpatient nursing workflows.
"I think that the complexity, in some ways, is greater from an integration perspective than the complexity of integrating a doctor's note into the medical record. Nurses do all the things, they take histories, they take vital signs, they perform actions, so there's just so many different workflows that we need to account for," he said. "Now certainly, we need to focus and prioritize, but being able to get that data back into the medical record, being able to really be fluid and be a seamless part of those workflows, we would not be able to do that without these incredible partners."
Rao did not specify how many nurses at Mayo Clinic would initially test out the technology. "The way Mayo is thinking about this is to be responsible in the way we deploy this, but also be prepared to scale this quickly at the right time," he said.
Mayo Clinic's goal is to get the tool into the hands of nurses before the end of the year, noted Edwina Bhaskaran, M.S.N., R.N., chief clinical systems and informatics officer at Mayo Clinic, in a press release.
The AI-based nursing product will help address the growing administrative burden on nurses, Rao noted.
"I think over the years, there have been a number of ways that folks have thought about building tools for nurses in the voice space. I'd say a lot of those tools probably have to do with dictation-oriented technologies, with voice commands. We're thinking from a first principles perspective around what kind of user experience and underlying AI technology will unburden the those nurses the most and what will allow them to really focus on the patient in front of them. That's a high bar to be able to meet," Rao said.
He added, "We're making this announcement with Mayo and Epic and we're very, very bullish. What's so exciting about this moment is being able to bring the most cutting-edge technology to the folks who could really use it the most. Often, we see that it takes a longer time for technologies to reach those folks. This is a moment to really recognize that we need to to expedite these technologies or prioritize the people who can benefit the most and where nurses are at the top of our list."
The collaboration combines Abridge's AI tech, Epic's development and Mayo Clinic's nursing practice expertise and will enable the health system to "develop and iterate on the technology to meet the nursing workforce and patients' needs," Bhaskaran said. "This technology will be shaped using the expertise of nurses that care for patients every single day."
Many nurses are experiencing burnout and surveys have found that job dissatisfaction is high among nurses. The industry also is facing critical nursing shortages.
A (https://www.fiercehealthcare.com/providers/nearly-third-nurses-looking-exit-survey-shows-heres-what-health-systems-can-do-reverse) 2023 survey revealed that nearly one-third of nurses (30%) say they are likely to leave their career due to the pandemic, up seven points since 2021, according to AMN Healthcare data published Monday.
Healthcare career marketplace Incredible Health surveyed more than 3,000 nurses this year, in March, and found (https://www.fiercehealthcare.com/providers/nurses-struggling-wages-staffing-shortages-incredible-health-report-finds) nearly a quarter of nurses say they are very likely to leave their role this year. Though nurses are slightly less dissatisfied with current staffing levels compared to 2023, 88% believe that patient care is being negatively impacted by staffing shortages.
Only 11% of nurses have used AI in their roles, according to that survey. Most (70%) don’t see AI impacting their roles in the next year, though 64% believe AI will negatively impact their employment overall. And 65% think the technology will impact the industry negatively overall. 
Some do recognize the positive impacts of AI, like supporting technological education and making processes more efficient, Incredible Health found.

Forwarded by:
Michael Reeder LCPC
Baltimore, MD

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