One goal of these new functions is to streamline physician workflows. However, these new EHRs may interface differently with clinical laboratory information systems
Artificial intelligence (AI) developers are making great contributions in clinical laboratory, pathology, radiology, and other areas of healthcare. Now, Electronic Health Record (EHR) developers are looking into ways to incorporate a new type of AI—called “Generative AI”—into their EHR products to assist physicians with time-consuming and repetitive administrative tasks and help them focus on patient-centered care.
Generative AI uses complex algorithms and statistical models to learn patterns from collected data. It then generates new content, including text, images, and audio/video information.
According to the federal Government Accountability Office (GAO), generative AI “has potential applications across a wide range of fields, including education, government, medicine, and law” and that “a research hospital is piloting a generative AI program to create responses to patient questions and reduce the administrative workload of healthcare providers.”
Reducing the workload on doctors and other medical personnel is a key goal of the EHR developers.
Generative AI uses deep learning neural networks modeled after the human brain comprised of layers of connected nodes that process data. It employs two neural networks: a generator [generative network] which creates new content, and a discriminator [discriminative network] which evaluates the quality of that content.
The collected information is entered into the network where each individual node processes the data and passes it on to the next layer. The last layer in the process produces the final output.
Many EHR companies are working toward adding generative AI into their platforms, including:
As our sister publication The Dark Report points out in its December 26 “Top 10 Biggest Lab Stories for 2023,” almost every product or service presented to a clinical laboratory or pathology group will soon include an AI-powered solution.
“We believe that generative AI has the potential of being a personal assistant for every doctor, and that’s what we’re working on,” Girish Navani (above), co-founder and CEO of eClinicalWorks, told EHRIntelligence. “It could save hours. You capture the essence of the entire conversation without touching a keyboard. It is transformational in how it works and how well it presents the information back to the provider.” Clinical laboratory information systems may also benefit from connecting with generative AI-based EHRs. (Photo copyright: eClinicalWorks.)
Generative AI Can Help with Physician Burnout
One of the beneficial features of generative AI is that it has the ability to “listen” to a doctor’s conversation with a patient while recording it and then produce clinical notes. The physician can then review, edit, and approve those notes to enter into the patient’s EHR record, thus streamlining administrative workflows.
“The clinician or support team essentially has to take all of the data points that they’ve got in their head and turn that into a narrative human response,” Phil Lindemann, Vice President of Data and Analytics at Epic, told EHRIntelligence. “Generative AI can draft a response that the clinician can then review, make changes as necessary, and then send to the patient.”
By streamlining and reducing workloads, EHRs that incorporate generative AI may help reduce physician burnout, which has been increasing since the COVID-19 pandemic.
“Language models have a huge potential in impacting almost every workflow,” Girish Navani, co-founder and CEO of eClinicalWorks, told EHRIntelligence. “Whether it’s reading information and summarizing it or creating the right type of contextual response, language models can help reduce cognitive load.”
Generative AI can also translate information into many different languages.
“Health systems spend a lot of time trying to make patient education and different things available in certain languages, but they’ll never have every language possible,” Lindemann said. “This technology can take human language, translate it at any reading level in any language, and have it understandable.”
MEDITECH is working on a generative AI project to simplify clinical documentation with an emphasis on hospital discharge summaries that can be very laborious and time-consuming for clinicians.
“Providers are asked to go in and review previous notes and results and try to bring that all together,” Helen Waters, Executive Vice President and COO of MEDITECH, told EHRIntelligence. “Generative AI can help auto-populate the discharge note by bringing in the discrete information that would be most relevant to substantiate that narrative and enable time savings for those clinicians.”
Many Applications for Generative AI in Healthcare
According to technology consulting and solutions firm XenonStack, generative AI has many potential applications in healthcare including:
The technology is currently in its early stages and does present challenges, such as lack of interpretability, the need for large datasets and more transparency, and ethical concerns, all of which will need to be addressed.
“We see it as a translation tool,” Lindemann told EHRIntelligence. “It’s not a panacea, but there’s going to be really valuable use cases, and the sooner the community can agree on that, the more useful the technology’s going to be.”
Since generative AI can be used to automate manual work processes, clinical laboratories and anatomic pathology groups should be alert to opportunities to interface their LISs with referring physicians’ EHRs. Such interfaces may enable the use of the generative AI functions to automate manual processes in both the doctors’ offices and the labs.
“The SDPR will consolidate geographically fragmented EMR, PAS, and LIMS systems to create a detailed lifelong patient record and deliver cost savings,” NSW Health said in a news release.
NSW Health is the largest public health system in Australia with more than 220 public hospitals, 16 Local Health Districts, and three Specialty Networks. NSW Health Pathology operates more than 60 pathology laboratories (clinical laboratories in the US) and has 150 patient service centers.
“While this initiative will provide untold benefits to all the patients of NSW, we are excited about its potential for improving the health outcomes of our regional patients,” said Andrew Montague (above), former Chief Executive, Central Coast Local Health District in a press release. “By enabling greater collaboration across all local health districts and specialty health networks, the Single Digital Patient Record will provide clinicians with even better tools to keep the patient at the center of everything we do.” This project is more market evidence of the trend to bring clinical laboratory test results from multiple lab sites into a single data repository. (Photo copyright: Coast Community News.)
Cloud-based Realtime Access to Patient Records
Australia has a population of about 26 million and New South Wales, a state on the east coast, is home to more than eight million people. Though the scale of healthcare in Australia is much smaller than in the US, this is still a major project to pull patient data together from all the NSW hospitals, physicians’ offices, and other healthcare providers such as clinical laboratories and pathology practices.
With the change, NSW clinicians will benefit from a cloud–based system offering up real-time access to patients’ medical records, NSW Health Pathology Chief Executive Tracey McCosker told ITnews.
“Patients and our busy staff will benefit from clinical insights gained from the capture of important new data. Our work in pathology is vital to the diagnostic process and developing a statewide laboratory information management system will ensure we provide the best possible services,” McCosker told ITnews.
The KLAS Research report, “US Hospital Market Share 2022,” states that Epic, located in Verona, Wisconsin, has the largest US electronic health record (EHR) market share, Healthgrades noted. According to KLAS:
NSW Health’s decision to engage Epic came after a process involving 350 clinicians, scientists, and technical experts, Zoran Bolevich, MD, Chief Executive of eHealth NSW and NSW Health’s Chief Information Officer, told ITnews.
NSW Health’s Goal for Statewide Digital Patient Record
It was in December 2020 when NSW Health announced its plan to create the SDPR.
“Our vision is to be able to provide a single, holistic, statewide view of every patient—and for that information to be readily accessible to anyone involved in the patient’s care,” Bolevich said in the news release.
The SDPR, according to NSW Health, will address the following:
Challenges:
Current systems not connected statewide.
Inaccessible patient data.
Duplicative data collection.
Gaps in decision-making.
Goals:
Improve health outcomes.
Create patient centricity.
Leverage insights.
NSW’s government has already invested more than $106 million in the SDPR, Healthcare IT News reported.
Other Large EHR Rollouts
NSW Health is not the only large organization to take on such an ambitious project of creating a large-scale digital patient record. And not always to a successful conclusion.
The US Department of Veterans Affairs (VA)—also intent on EHR modernization—recently announced it is suspending roll-out of the Oracle Cerner EHR at VA centers until June 2023 to address technical issues affecting appointments, referrals, and test results.
Four VA centers in Washington, Oregon, and Ohio already went live with the system in 2022.
“We are delaying all future deployments of the new EHR while we fully assess performance and address every concern. Veterans and clinicians deserve a seamless, modernized health record system, and we will not rest until they get it,” said Deputy Secretary of Veterans Affairs Donald Remy, JD, in a news release.
For its part, Oracle Cerner wrote federal lawmakers noting the importance of continuing the project, which will move the VA away from its former VistA health information system.
“Modernization requires change and some short-term pain for the long-term benefits of a modern technology infrastructure,” noted Oracle Cerner Executive Vice President Ken Glueck in the letter, Becker’s Health IT reported. “A modernization project of this scale and scope necessarily involves time to untangle the decades of customized processes established in support of VistA, which inevitably involves challenges.”
NSW Health’s goal is to build a single repository of health information—including lab test results from multiple clinical laboratory sites. When finished NSW Health expects that sharing patient data will contribute to producing better healthcare outcomes.
However, the VA’s experience—and several other similar attempts at large-scale electronic patient record installations—suggest the work ahead will not be easy. But for NSW Health, it may be worth the effort.
Retail giant now has primary care clinics at stores in five states, but the rollout has not gone smoothly
Healthcare is increasingly being driven by consumerism and one clear sign of this trend is Walmart’s ambitious plan to open health clinics at its retail locations. The retail giant set its plans in motion in 2019 with its first primary care site in a suburban Atlanta store, however, the rollout since then has presented certain challenges.
Nevertheless, the trend of placing nearly full-service primary care clinics in retail locations continues. Clinical laboratories in these areas need strategies to serve customers accessing healthcare through these new channels, particularly as Walmart and the national retail pharmacy chains continue to expand the clinical services offered in their retail stores.
“Consumer engagement is a huge part of healthcare, [yet it is also a] gap for us in healthcare,” cardiologist and Walmart VP of Health and Wellness Cheryl Pegus, MD, told Modern Healthcare. “Healthcare is incredibly complicated,” she added. “And where we are in healthcare today is not in having great treatments. It’s not in having evidence-based medicine. It’s understanding how we engage consumers.”
The company also entered the telehealth business with last year’s acquisition of multispecialty telehealth provider MeMD.
“Telehealth offers a great opportunity to expand access and reach consumers where they are and complements our brick-and-mortar Walmart Health locations,” said Pegus in a Walmart new release announcing the acquisition. “Today people expect omnichannel access to care and adding telehealth to our Walmart healthcare strategies allows us to provide in-person and digital care across our multiple assets and solutions.”
Currently, Walmart Health centers only operate in Georgia, Florida, Illinois, and Arkansas. But telehealth enables Walmart “to provide virtual healthcare across the country to anyone,” Pegus said. With both offerings, “we’re really attempting to allow people to get healthcare the way they need it without disrupting the rest of their life.” Many users of these services are Walmart “associates,” she added, using the company’s term for its retail employees.
“In this country, about 25% of people don’t have a primary care physician,” cardiologist Cheryl Pegus, MD (above), Walmart’s VP of Health and Wellness, told Medscape. “So, your options for being able to solve in real time something that will help you, they’re quite limited. What we’re trying to do is give those options. We’re not trying to take away emergency rooms, or healthcare systems, or existing primary care. We’re asking, how do we expand that infrastructure so that people get care when they need it?” And this includes clinical laboratory testing, radiology, and telehealth services as well. (Photo copyright: Walmart.)
Large Portfolio of Healthcare Offerings
Pegus joined Walmart (NYSE:WMT) in December 2020 to oversee a portfolio that now includes more than 4,700 pharmacies and 3,400 Vision Centers, in addition to the telehealth operation and the Walmart Health centers. She was previously chief medical officer at Walgreens and Cambia Health Solutions and worked in private practice as a cardiologist.
The retail giant opened its first Walmart Health center in Dallas, Ga., an Atlanta suburb, in September 2019, followed by additional centers in Georgia, Arkansas, and Illinois.
Earlier this year, it opened five new clinics in northern and central Florida with plans for at least four more in the Jacksonville, Orlando, and Tampa areas, according to a press release. Each health center is adjacent to a Walmart retail location.
These centers offer a range of primary care medical services, including:
physicals,
injury care,
immunizations,
radiology, and
care for chronic health conditions.
Pictured above is one of the first health clinics established by Walmart. This location is in a western Atlanta suburb. Note that the services advertised include more than just primary care. Also offered are “labs and X-ray,” along with dental, hearing, optometry, and counseling. Clinical laboratory managers and pathologists may want to monitor whether consumers embrace primary care delivered from clinics located in retail stores. (Photo copyright: Georgia Health News.)
As Dark Daily reported in May 2020, the Walmart Health centers also offer clinical laboratory testing at cut-rate prices, such as:
$10 for a lipid test,
$10 for Hemoglobin A1c, and
$20 for a strep test.
On the Walmart Health website, patients can enter their Zip code to view a list of Walmart Health clinics in their area, including links to price lists.
Walmart’s Expansion into Healthcare Not Without Problems
However, the company’s expansion into healthcare has not gone smoothly. In 2018, the Walmart board signed off on a plan to open 4,000 health centers by 2029, Insider reported. By the end of 2021, Walmart expected to have 125 health centers in operation, but as of June 2022, the Walmart Health website listed only 25 locations, mostly in Georgia.
Citing anonymous sources, Insider reported problems that include “leadership changes, competing business priorities brought on by the coronavirus pandemic, and the complexity of scaling a massive healthcare operation.”
In Sept. 2021, Insider further reported that the clinics were experiencing operational difficulties including hidden fees and billing problems. One culprit, the story suggested, was the company’s electronic health record (EHR) software. That same month, Walmart announced it would adopt the Epic health records system, beginning with the opening of new clinics in Florida locations.
Pegus’ arrival at Walmart appears to be part of a management shakeup. In January 2022, Insider reported that she had assembled a new executive team, with David Carmouche, MD, Senior VP, Omnichannel Care Offerings, overseeing the health centers and telehealth operations. By then, the original executives leading the rollout of the health centers had all left, Insider reported. Carmouche was previously an executive VP with Ochsner Health in New Orleans.
Partnership with Quest Diagnostics
Meanwhile, in January, Walmart announced a deal with Quest Diagnostics that allows consumers to order more than 50 lab tests through The Wellness Hub on Walmart.com, which is separate from the Walmart Health website. The tests cover “general health, digestive health, allergy, heart health, women’s health, and infectious disease,” according to a press release announcing the partnership.
Consumers can order at-home test kits for certain conditions or set up appointments for tests at Quest Patient Service Centers. The tests on the Walmart/QuestDirect website include:
COVID-19 Active Infection ($119+)
COVID-19 Antibody Test ($69)
Cholesterol Panel ($59)
Complete Blood Count ($59)
Comprehensive Metabolic Panel ($49)
CRP Inflammation Marker ($59)
Diabetes Management ($69+)
Diabetes Risk ($99+)
Food Allergy Test Panel ($209)
Chickenpox ($59)
The website also offers a combined Basic Health Profile with CBC, CMP, cholesterol panel, and urinalysis for $149. “Each purchase is reviewed and, if appropriate, ordered by a licensed physician,” the press release states.
What does all this mean for clinical laboratories? “They need to recognize that the Millennials and Gen Zs are driving a consumer revolution in healthcare,” said Robert Michel, Publisher and Editor-in-Chief of Dark Daily and its sister publication The Dark Report.
“Walmart was early to recognize and respond to this, in part because it employs 1.3 million Americans, many of whom are Gen Y and Gen Z and quick to use telehealth and similar virtual health services,” he added.
Clinical laboratory leaders need to understand this trend and develop strategies to attract and serve new patients who are willing to access healthcare virtually, while still needing to provide blood and other specimens for the lab tests ordered by their providers.
Faulkner was surpassed on Forbes’ list only by roofing material magnate Diane Hendricks, co-founder of ABC Supply Co., whose net worth of $11 billion puts her squarely in the top spot.
Richest Self-Made Women in Healthcare
Becker’s Hospital Review highlighted the seven richest “self-made” women who ran healthcare-related companies. They include:
Judith Faulkner, founder and CEO of Epic, ranked 2nd, net worth $6.5 billion.
Alice Schwartz, co-founder of Bio-Rad Laboratories, ranked 10th, net worth $2.9 billion.
Heather Hasson and Trina Spear, co-founders and co-CEOs of FIGS (direct-to-consumer healthcare apparel and scrubs), ranked 50th and 52nd, net worth $625 million and $600 million respectively.
Also listed by Forbes was Anne Wojcicki, CEO and founder of 23andMe, a personal genomics and biotechnology company. Wojcicki’s net worth of $1.1 billion puts her in the 25th position, according to Forbes.
In “Genetic Test Company 23andMe Completes Merger with Richard Branson’s VG Acquisition Corp., Stock Now Trades on NASDAQ,” Dark Daily noted that since the Sunnyvale, Calif. direct-to-consumer (DTC) genetic testing company will now be filing quarterly earnings reports, pathologists and clinical laboratory managers will have the opportunity to learn more about how 23andMe serves the consumer market for genetic types and how it is generating revenue from its huge database containing the genetic sequences from millions of people.
Judith Faulkner (left), founder and CEO of Epic Systems Corp., and Alice Schwartz (right), co-founder of Bio-Rad Laboratories, ranked 2nd and 10th respectively in Forbes’ list of the top 100 richest self-made women. In healthcare, Faulkner ranks 1st and Schwartz 2nd. Clinical laboratory personnel will likely be familiar with Epic Beaker, which, according to Healthcare IT Leaders, “is Epic’s laboratory information system (LIS) for hospitals, clinics, patient service centers, and reference labs. The software supports common workflows for clinical pathology (CP) labs as well as anatomic pathology (AP) labs.” (Photo copyrights: HIT Consultant/Science History Institute.)
“I always liked making things out of clay. And the computer was clay of the mind. Instead of physical, it was mental,” Faulkner, who is 77, told Forbes.
Company milestones noted by Forbes include:
Inking a deal in 2004 with Kaiser Permanente for a three-year, $400-million project.
Moving in 2005 to a corporate campus in southern Wisconsin—an “adult Disney World” with the largest underground auditoriums and more “fantastical” buildings.
More recently, AdventHealth of Altamonte Springs, Fla., contracted with Epic for a $650 million remote build and installation.
“Epic’s system has tentacles that go out through amazing networks. You can actually help a person get the care they need wherever they need to get it,” AdventHealth’s CEO Terry Shaw told Forbes.
“I think that what will happen is that a few of them will do very well. And the majority of them won’t. “It’s not us as much as the health systems who have to respond to the patient saying, ‘Send my data here,’ or ‘Send my data there,’” Faulkner told Forbes.
Bio-Rad’s Alice Schwartz an IVD ‘Pioneer’
As Faulkner rose to prominence in healthcare IT, Alice Schwartz of Bio-Rad Laboratories found massive success in the in vitro diagnostics industry.
She and her late husband, David, started Bio-Rad with $720 in 1952 in Berkeley, Calif. They were intent on offering life science products and services aimed at identifying, separating, purifying, and analyzing chemical and biological materials, notes the company’s website.
“They were at the right place and at the right time as they became pioneers in the industry,” International Business Times (IBT) stated.
Bio-Rad Laboratories (NYSE:BIO and BIOb) of Hercules, Calif., offers life science research and clinical diagnostic products. The company’s second quarter (Q2) 2021 net sales were $715.9 million, an increase of about 33% compared to $536.9 million in Q2 2020, according to a news release. Its Clinical Diagnostics segment Q2 sales were $380 million, an increase of 34% compared to 2020.
Norman Schwartz, the founders’ son, is Bio-Rad’s Chairman of the Board,
President, and CEO. However, at age 94, Alice Schwartz, the oldest person on Forbes’ richest self-made women list, “has no sign of stopping soon,” IBT reported.
Lists are fun. Medical laboratory and diagnostics professionals may admire such foresight and perseverance. Judith Faulkner and Alice Schwartz are extraordinary examples of innovative thinkers in healthcare. There are others—many in clinical laboratories and pathology groups.
Cerner and Epic are the industry’s revenue leaders, though smaller vendors remain popular with physician groups
Sales of electronic health record (EHR) systems and related hardware and services reached $31.5 billion in 2018. And those sales will increase, according to a 2019 market analysis from Kalorama Information. This is important information for clinical laboratories and anatomic pathology groups that must interface with the EHRs of their physician clients to enable electronic transmission of lab orders and test results between doctor and lab.
Kalorama’s ranking includes familiar big EHR manufacturer names—Cerner (NASDAQ:CERN) and Epic—and includes a new name, Change Healthcare, which was born out of Change Healthcare Holding’s merger with McKesson. However, smaller EHR vendors remain popular with many independent physicians.
“We estimate that 40% of the market is not in the top 15 [in total revenue rankings],” said Bruce Carlson, Kalorama’s publisher, in an exclusive interview with Dark Daily. “There’s a lot of room. There are small vendors out there—Amazing Charts, e-MDs, Greenway, NextGen, Athena Health—that show up on a lot of physician surveys.”
“The EHR is really important,” noted Bruce Carlson (above), Publisher at Kalorama. “Since there are a variety of systems—sometimes different from the LIS [laboratory information management system]—you want to make sure you know the vendors and the space.” Carlson says opportunities remain for new entrants in the 700-plus competitor space, which is expected to see continued mergers and acquisitions that will affect clinical laboratories and their client physicians. (Photo copyright: Twitter.)
Interoperability a Key Challenge, as Most Medical
Laboratories Know
Interoperability—or the lack thereof—remains one of the
industry’s biggest challenges. For pathologists, that means seamless electronic
communication between medical laboratories and provider hospitals can be
elusive and can create a backlash against EHR vendors.
Kalorama notes a joint investigation by Fortune and Kaiser Health News (KHN), titled, “Death by a Thousand Clicks: Where Electronic Health Records Went Wrong.” The report details the growing number of medical errors tied to EHRs. One instance involved a California lawyer with herpes encephalitis who allegedly suffered irreversible brain damage due to a treatment delay caused by the failure of a critical lab test order to reach the hospital laboratory. The order was typed into the EHR, but the hospital’s software did not fully interface with the clinical laboratory’s software, so the lab did not receive the order.
“Many software vendors and LIS systems were in use prior to
the real launching of EHRs—the [federal government] stimulus programs,” Carlson
told Dark Daily. “There are a lot of legacy systems that aren’t
compatible and don’t feed right into the EHR. It’s a work in progress.”
Though true interoperability isn’t on the immediate horizon, Carlson expects its arrival within the next five years as the U.S. Department of Health and Human Services ramps up pressure on vendors.
“I think it is going to be a simple matter eventually,” he
said. “There’s going to be much more pressure from the federal government on
this. They want patients to have access to their medical records. They want one
record. That’s not going to happen without interoperability.”
Other common criticisms of EHRs include:
Wasted provider time: a recent study published in JAMA Internal Medicine notes providers now spend more time in indirect patient care than interacting with patients.
Physician burnout: EHRs have been shown to increase physician stress and burnout.
Not worth the trouble: The debate continues over whether EHRs are improving the quality of care.
Negative patient outcomes: Fortune’s investigation outlines patient safety risks tied to software glitches, user errors, or other flaws.
There’s No Going Back
Regardless of the challenges—and potential dangers—it appears EHRs are here to stay. “Any vendor resistance of a spirited nature is gone. Everyone is part of the CommonWell Health Alliance now,” noted Carlson.
Clinical laboratories and pathology groups should expect
hospitals and health networks to continue moving forward with expansion of
their EHRs and LIS integrations.
“Despite the intensity of attacks on EHRs, very few health systems are going back to paper,” Carlson said in a news release. “Hospital EHR systems are largely in place, and upgrades, consulting, and vendor switches will fuel the market.”
Thus, it behooves clinical laboratory managers and
stakeholders to anticipate increased demand for interfaces to hospital-based
healthcare providers, and even off-site medical settings, such as urgent care
centers and retail health clinics.
