The ongoing COVID-19 pandemic has taken a toll on many healthcare systems across the World. So, it was not at all surprising this was the answer when Dr. Arlen Meyers, President and Chief Executive Officer (CEO) of Society of Physician Entrepreneurs asked Dr. David H. Berger, CEO of University Hospital Of Brooklyn and Peter Horne, Director of System Delivery at the Southampton City Clinical Commissioning Group at the recent AIMed webinar, what keeps senior healthcare executives up at night.
Wellbeing of healthcare workers, the critically ill, and hospitals turning obsolete
Dr. Berger said there were many discussions around ventilators and hospital beds in the early days of COVID-19. Yet, the real issue was how to keep healthcare workers healthy to take care of the large volume of patients. “How can we monitor the exposure of these workforce, keep them from getting infected and keep them from infecting our patients, that’s really a concern of mine,” he says.
From a general healthcare perspective, Dr. Berger cited a recent article by Regina Herzlinger of Harvard Business School on how hospitals might become obsolete in the coming years. “As we have seen in COVID-19, there is a de-emphasis on hospitals as entities as more and more healthcare is taking place in the communities and more and more digital health and telehealth are being used. As I newly appointed CEO of a university hospital, am I taking a job in an industry that in five years that probably won’t exist in any significant extent?”
Echoing Dr. Berger’s comment, Horne said there were three things that would keep him awake at night. First, it is the similar concern around managing the hospital systems and keeping the workforce going. He has to ensure healthcare workers are not going fatigue and having burnout in view of the wintery season, a possible second wave of infection and UK leaving the European Union. At the same time, Horne is also worried about the critically ill but non-COVID-19 related patients and a potential missed opportunity around health and equality.
Horne believed in the next couple of years, the focus at the national and international levels will be on treatment and addressing those who are on the lists awaiting for interventions. “So, if we don’t talk about prevention and early intervention, we may end up adding to the existing problems rather than solving the problems,” Horne says. Dr. Berger added to Horne’s input by highlighting the “COVID neglect syndrome” – people who are afraid to seek medical attention during the pandemic ended up with much worse health problems.
“We have seen, even though the volume of our emergency department declines by more than 40%, there is a 25% increase in mortality from stroke and cardiac arrest… There is also an article on people are not getting recommended screening. Really, we are neglecting other illnesses because of the focus on COVID-19”.
Technology: The changes and the challenges
Nevertheless, both speakers agreed technology had assisted them in the rapid generation of critical care capacity. They were able to convert areas of the hospitals to take in more respiratory patients and change the overall ratio of staff to support patients in intensive care.
Horne mentioned technology has also supported shielding and protecting people from getting infected in the very first place. “Necessity is the mother of invention… there was a force to sort of support the patient population outside the hospitals, so they will not get the disease and overloading the system”. The most profound change, as Horne pointed out was they managed to get General Practitioners (GPs) or primary care to interact with their patients again.
However, Dr. Berger believed challenges remained. Most hospitals limit visitations so facilitate communications to ensure families understand what is going on with their loved ones, particularly if they are critically ill, has been difficult. Often, these additional responsibilities were shouldered by the nursing staff, which resulted in a huge physical and emotion burden.
As such, Horne thought this is one of the areas he wished to have done differently after knowing what he doesn’t know prior to the pandemic. He hoped there are more digital solutions to support the healthcare workers and also people who are at home, especially nursing homes. Besides, he thought technology could be deployed to better manage elective care, so outpatient consultations can be conducted online and make it more convenience for the patients.
On the other hand, Dr. Berger would like to have efficient contact tracing and testing to be in place early. “I think that will be game changing. When COVID-19 first started, we have up to a 100 Patient Under Investigation (PUIs) in the house every day and we were burning Personal Protective Equipment (PPEs) and stuff all the time. Once we have testing in place and figure out who has COVID-19 in a more rapid manner, it quickly eliminates the challenge”.
The role of artificial intelligence (AI)
Interoperability is still challenging hospital administration when it comes to AI. Dr. Berger said it is hard to pick out something with real value since there are so many digital and AI solutions but there is no cohesive and coordinated suite to get them in place. “You may have a great solution but if you don’t have a solid implementation plan, it is not going to work. Hospitals have very tight margin; we do not necessarily have an army of people to implement and manage all these digital solution”.
Dr. Berger felt that this can be done as one of the hospitals which he served previously already had AI in place. What he looked out for is to have more important implications in place. For examples, vital signs should be continuously reported and not at an interval of four, eight or twelve hours. Information coming from the electronic health records (EHRs) and vital signs should be consolidated to identify which patients are deteriorating so that help can be provided in advance. Ultimately, Dr. Berger’s goal is to marry EHRs into the operations, to prioritize who, what and when medical interventions or procedures should be administered so patients can get through the whole process faster.
Horne said it would definitely be a march forward if interoperability can be achieved across all the systems; from GPs to hospital to social care, that’s probably when they can start experimenting with more complex AI solutions or have them to run in parallel with the existing ones. However, the UK National Health Service (NHS) has got a history of not doing well with technology, given the way the public health system is configured in the political dimension, there are going to be some significant barriers for interoperability.
At the end of the day, AI will fail without doubt if it is being thrown into a healthcare system full of fundamental challenges and process issues. Dr. Meyers, Horne, and Dr. Berger will be joining fellow C-suite executives, healthcare leaders, clinical and technical experts in the upcoming AIMed Healthcare Executives virtual event taking place on 29 September. Please click here to receive more information about the event or to receive a copy of the agenda. You may also revisit this AIMed webinar here.