Healthcare leaders offer perspective on AI procurement challenges
Chief Information Officers and other IT leaders at hospitals and health systems are inundated with a wide range of AI technologies and are trying to navigate a rapidly growing, high-profile market.
In fact, advice on buying artificial intelligence filled much of the morning at last week’s HIMSS AI in Healthcare Forum, where digital health leaders shared lessons on separating signal from noise.
Healthcare organizations must weigh the pros and cons of many different platforms and tools, not all of which can always deliver on their ambitious promises. At the same time, they must identify strategic partners who can help address the challenges of integrating new AI technologies into their existing networks and workflows.
Tips for approaching providers
According to Lee Schwamm, Chief Digital Health Officer at Yale New Haven Health System, digital transformation leaders especially expect AI vendors to be honest about their ingredients.
“First, you’re an AI company, and second, you’re a platform. It’s okay to be neither,” he said Friday during the panel Taming the Wild West of AI in Healthcare.
“You can say, I’m a company built on X, and we’re starting to infuse our product with some AI – that’s perfectly reasonable. That’s probably what most of you are.”
“You have to really understand how you fit into the workflow, because that’s the problem with the point solutions we have today,” said co-panelist Eve Cunningham, head of virtual care and digital health at Providence.
“Actually integrating into the workflow that we have now with the tech stack and the infrastructure that we have is an extremely complicated process,” she added. “So you can have the best point solution in the world, but if they can’t integrate, and there’s no path to integrate, and you don’t know how to speak the language of understanding that, there’s just a very low level of interest in getting involved on that front.”
It’s also important to target sales pitches appropriately and find the right decision maker, noted Dr. David Newman, chief medical officer of virtual care at Sanford Health. “Trying to get your hook in with seven people is counterproductive.”
He said he was talking to his 15-year-old daughter about his role in supplier relations and the best way for them to contact us.
“She said, ‘It’s like they’re DMing me,’ and that’s true.”
According to Newman, the most important thing for technology vendors to do is understand a provider’s mission and what problem the provider is trying to solve before reaching out to them.
“That way I can answer your email instead of skipping it,” he said.
“It’s not just about relationships and knowing someone,” but about having an objective evaluation of the technology, Cunningham added.
Many AI improvements focus on physician survival and workflow, but testing them in partnership with vendors is creating “pilot fatigue” among providers, she says.
The panelists encouraged providers to look at it from the provider perspective: Is this about improving physician productivity, or is it something revolutionary that gives health systems something they haven’t had before?
“Have you ever actually sat in a doctor’s office and watched how many clicks they do? There’s no room for one more click,” Cunningham said.
“Sometimes they’re so good that we’re willing to change our workflow to accommodate it because it’s a superpower,” Schwamm adds.
“You have a mature enough product that we’re not going to build your product for you,” Cunningham said. “We’re not your dev shop.”
Provider’s vision, costs and backlash
Schwamm says there’s no easy answer to the question of how to manage expensive product pipelines: “Maybe I want someone who really wants to work with me and build their product roadmap based on what I want to achieve.
“At the moment we’re living in now, you can’t afford to say, ‘This is going to be my system forever,’” and it can be beneficial to know that a technology module “can be broken down and replaced.”
“There’s not a lot of enthusiasm to tear down and replace, but sometimes we have to do that,” Cunningham acknowledged, such as with ambient listening technologies.
Digital health leaders need to ask themselves, “What will this look like three years from now, five years from now, seven years from now?”
In her vision of the technology-driven medical practice in five to seven years, several things are happening simultaneously.
“Maybe there’s a big screen in the room and there’s no keyboard,” she described. “I’m having a conversation with the patient. My note is being written. All the things we’re talking about, ‘Hey, you have COPD,’ and all the data from the patient’s chart that’s relevant to the COPD, comes up.
“’Hey, we need to get an order in for more PFTs for you,’ and the order is placed. ‘Hey, here’s a little bit of knowledge on the best next actions,'” she continued.
“It all happens in the room, and when I walk out of the room, all the work is done.”
To gauge where healthcare providers are currently in their AI implementation, HIMSS Market Insights recently conducted a study that explored the positive impact of AI within healthcare organizations, and the challenges they face in integrating AI into their workflows and existing technologies.
Nicole Ramage, senior market insights manager at HIMSS, sat down with Schwamm to discuss the questions surrounding AI and insights from the report.
While nearly half of the organizations surveyed this spring were larger organizations with 7,500 or more employees, the data unsurprisingly showed that “smaller organizations are likely to be less advanced in their AI implementation journey,” Ramage said.
“I think your data shows very well that it is a capital-intensive process, and it also requires the ability to think about the workflows that you want to pursue” and the leadership structure needed to do that, Schwamm said — noting that hospitals are “seriously underwater from the devastating impact of COVID plus changes in our age and population,” and that ROI is deteriorating.
“It’s a continuous downward trend, and costs are a continuous upward trend,” he said. “So that’s not a great formula.”
Ramage asked Schwamm what he sees as the greatest opportunity for AI transformation in patient care and operational efficiency over the next three to five years.
“The easiest things to pursue from a transformational perspective are operational workflows or back-office things, because they don’t touch patients,” he said. “They’re very risk-free and relatively unregulated.”
According to Schwamm, the biggest financial opportunities currently lie in back-office activities, but there is also growing resistance among employees to the potential replacement of humans by AI.
There are four ways to achieve ROI, he noted.
“You either renegotiate a contract for a lower price or cancel a contract,” he said. “You make it easier to do the same thing and do it at a lower cost, or you reduce your labor.”
AI will radically change healthcare and its workforce.
“Whether you agree with it or not, it will be your next member,” said Sunil Dadlani, Chief Information and Digital Officer of Atlantic Health System.
Fellow panelist Charles Jaffe, CEO of HL7, meanwhile, said he worries about the politicization of the process. “The promise of AI is not a threat to anyone,” he said. “It’s a challenge to make their jobs easier.”
Small organizations, however, are in a very vulnerable position, Schwamm said. They cannot afford to fall behind.
Ramage asked Schwamm what approaches he recommends smaller organizations take to effectively advance AI adoption while maintaining employee engagement.
“If I were in a small organization, I would be limited in my capital. I am overwhelmed by it,” he said.
Because they lacked the expertise and financial resources to hire consultants, he advised smaller organizations to partner with organizations they did not compete with, so they could divide up the technologies and explore them as a partnership.
“You have a group of five or six health systems, about your size, from different parts of the country, there’s no competition between you, and you say, ‘Hey, Jones Regional Hospital, how about you take on the back-office issue and we take on the patient navigation issue?’” Schwamm suggested.
“And then maybe even collective bargaining, right? Think about group purchasing opportunities.”
Data Footprints and the Law of Subtraction
From a leadership perspective, the biggest challenge is who owns AI data, Schwamm says.
“If I worked with you before and gave you data so you could process a transaction for me, at the end of the contract you either destroyed my data or gave it all back,” he said.
When data is used to train an AI model, returning my data does not give me back the intellectual property rights you extracted from my data.
When integrating AI into specific domains, “most mature health systems will eventually end up with a change management function that is specifically focused on AI, because it is such a large part of those change management projects and it has such resource-intensive implications.”
According to Dadlani in the panel on ethics, healthcare accounts for a third of all data in the world, and the amount is growing, doubling every 46 days.
“So you need more and more technology and interoperability principles to really make smarter decisions about patient outcomes, patient safety and the transition to the next generation of that,” he said.
This is where the laws of addition and subtraction come into play.
“When you try to add more and more technologies, you have to think about and take a platform approach. Where can we simplify the process?” Dadlani asked.
As an organization continues to add technologies, complexity increases, which, he said, means higher administrative costs, more data errors and more data breaches. If it’s a point solution and can’t integrate with other technologies, “it doesn’t make sense,” he said.
Andrea Fox is Editor-in-Chief of Healthcare IT News.
Email address: afox@himss.org
Healthcare IT News is a publication of HIMSS Media.