Baptist Health Adopts Innovative AI Solutions, Cutting-Edge Research to Address Complexities of Care

Artificial neuron in concept of artificial intelligence: © ktsdesign - stock.adobe.com

The rapid pace of advancements in oncology coupled with the growing complexity of cancer cases and treatment options as well as rising costs makes the delivery of high-quality, comprehensive care a challenge, even for the most experienced cancer programs. That increased demands for cancer care have put a burden on medical facilities everywhere is not a new issue. A 2013 Institute of Medicine report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, indicated the problems of complexities of care, the aging population, and rising costs constituted a “crisis in cancer care delivery.”¹ Approximately 1.9 million individuals are newly diagnosed with cancer in the United States each year, and that number is expected to grow to 2.3 million by 2030. In addition, we now have an estimated 18 million cancer survivors.²

Current approaches to cancer care, discovery, and education will fall short in meeting our obligation to patients and society without careful planning at this critical time of change. Our caregivers are overburdened with recordkeeping and nonclinical/academic duties such as making authorization requests, staying up-to-date while working to provide the latest evidence-based practices, and engaging in research and education. They must care for ever-increasing numbers of patients, address needs of survivors, and practice in a manner that is also financially responsible, delivering high value with a focus on patient-centered outcomes.

Articulating the Goal: Objectives and Tactics for Success

True north at Baptist Health Cancer Care―Miami Cancer Institute and Lynn Cancer Institute―and for all of us must be the highest quality of care for our patients. Our patients and our community deserve top-quality cancer care. It is the idea of true north that has enabled Baptist Health Cancer Care to very quickly become Florida’s largest cancer program, contributing to its placement in the top 10% in the nation for treating the most complex cancer cases in the 2023-2024 U.S. News & World Report Best Hospitals rankings. And it is the focus on true north that drove investments in recruiting top clinicians and researchers with operations services such as clinic concierge and large nurse navigator programs that resulted in a score in the 90th percentile for “patient’s likelihood to recommend” Miami Cancer Institute to those in need. As we consider how to proceed while addressing limitations and obstacles in planning and in daily practice, it is true north that guides us. We have done so with strong financial performance metrics through focus on a disciplined approach to mission-consistent margin generation.

The Role of Research

Our investment in research as a society has led to some truly fantastic accomplishments by our scientific community and very rapid advancements in cancer care in the last decade. There are cures and amazing new therapies that I could not have even imagined when graduating from medical school. Offering clinical trials and advancing a robust research program, however, is neither simple nor inexpensive. Not all cancer care facilities will engage in primary research, but we must be sure that our institutes such as Miami Cancer Institute and our academic centers continue to be funded and supported in a manner that will advance discovery and teach the next generation.

Why Collaboration and Culture Go Hand in Hand

With such rapid developments in the oncology field, including emerging data on novel agents and immunotherapeutic approaches,it is very difficult to keep up, let alone be a leader in applying the breakthroughs that are making even more targeted and personalized care possible. The more complex cancer care becomes, the more crucial it is to break down silos and work in a multidisciplinary setting.

On a global scale, industry groups and medical societies are pulling together, creating task forces of the world’s leaders to develop standards of care and discuss complex problems. Horacio Asbun, MD, Miami Cancer Institute’s director of hepatobiliary and pancreatic surgery, was instrumental in developing the first international evidence-based guidelines on minimally invasive pancreas resection surgery, a joint initiative of 9 surgical societies and 70 pancreas experts from 20 countries, for example.

Within our own organization, it has been critical to have a deeply inclusive culture recognizing that all team members’ engagement is key to success. Cancer centers must nurture their culture. As I outlined in “Flip the Org Chart,”³ many of the best ideas come from the front lines, and our dedicated employees are the direct contact with our patients. It’s a matter of assuring by systems design that every team member has a voice and knows that they are valued. Is there a team-based thought process and shared decision-making? Are mentors actively engaging with newer employees? Do your physicians and staff come together to plan and evaluate daily metrics, in times of uncertainty and crisis, and for camaraderie and fun? Are there mental health programs easily accessible to address stress, anxiety, work, and personal demands? Is there recognition, reward, and shared success? Does your organization have a true north, and does everyone know what that is?

Addressing Disparities in Care

We are fortunate in Miami to have an extremely diverse population, which makes us a very attractive partner in clinical trials. Yet like the rest of the world, we are grappling with the issues surrounding health care inequities among minorities and underserved populations. Baptist Health South Florida is committed to advancing care and research in broad collaborations to help identify social determinants of health and improve access to clinical trials. Access to optimal care for all should top every cancer center’s list of priorities.

Help Is Arriving: The Growth of Artificial Intelligence

Success in our ever more complicated environment requires the knowledge that large-scale application of past experience and data provide. Traditionally, these have been kept within the consciousness of master clinicians and leaders using organized reference sources. Now we have the technologies that have the potential to provide far more.

Much has been written about artificial intelligence (AI). Fundamentally, AI provides an ability to take vast amounts of historical information and current knowledge and apply it to aid us in addressing complex situations. We see this in our everyday lives―in Amazon, banking, and many other business applications. AI is in its infancy in all domains but is a newborn in medicine. As with any newborn, we have only a glimpse of what it may become in the years ahead.

With the ability to analyze very large historic and real-time data, we have information that will help provide clinical decision support, streamline administrative tasks, improve operational efficiencies, and enhance the patient experience. In the past few years, the study and early stages of implementation of AI within medicine are already having an impact. Some early examples are as follows:

• AI in the diagnosis of breast cancers: At Baptist Health Cancer Care, dedicated breast radiologists use AI to assist in finding cancers on mammograms that are undetectable to the human eye and help them read more studies in a shorter amount of time.
• An AI scheduling system for anesthesiologists at Ochsner Medical Center in New Orleans, Louisiana: The new technology substantially reduced staff time spent on scheduling and increased anesthesiology engagement scores from 3.3 to 4.2 out of 5 within 6 months.⁴
• A University of Pennsylvania study on communication regarding end-of-life preferences: A machine-learning algorithm identified cancer patients at highest risk of death within 6 months and sent reminders to clinicians about talking to these patients about end-of-life care preferences. The program increased these types of conversations from 3.4% to 13.5% and decreased the use of chemotherapy and targeted therapies in the last 2 weeks of life.⁵
• A Tulane University report on AI for the detection of colorectal cancer: Researchers first reported in 2021 that AI could detect colorectal cancer accurately from tissue scans.⁶
• The move from a manual scheduling system to an AI-driven program for the infusion suite at Hartfield Healthcare: The change resulted in a decrease in infusion wait times of 27.3% to 35% and an average daily scheduled volume increase of 9.1%.⁷

We are expecting AI to deliver solutions that will support the ever more complex duties of our clinicians and administrators helping move clinicians from behind a computer screen to where we want to be―in front of our patients, having meaningful conversations. As an emergency medicine physician for 3 decades, I know firsthand how onerous electronic medical record documentation can be, and I am expecting AI to provide suggested courses of action as well as eventually take over documentation duties.

In addition, AI can improve the efficient utilization of patient-needed and revenue-generating assets such as radiology suites and chemotherapy chairs and align patient visits so that they can be seen expeditiously. These can be hugely complex scheduling issues―more than what a human alone can manage―and require AI solutions to achieve maximal efficiency and patient-centered scheduling options. On the business side, if high-cost assets sit idle or empty, the financial ramifications are substantial. We are also exploring the use of AI to assist with care authorizations, a process that is very time-consuming and expensive and hampers a patient’s access to care.

This is a critical time for careful analysis and planning in cancer care. Success in these complex times requires discipline, given the constraints, and vision, given the opportunities.

REFERENCES:

1. Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population, Board on Health Care Services, Institute of Medicine. Levit LA, Balogh EP, Nass SJ, Ganz PA, eds. Delivering high-quality cancer care: charting a new course for a system in crisis. National Academies Press; 2013. https://bit.ly/3ZLMcwH. Accessed October 1, 2023.

2. American Cancer Society. Cancer facts & figures 2022. 2022. https://bit.ly/3PQaiS9. Accessed October 1, 2023

3. Blackman M. A prescription for operational success: 3 ways to ‘flip the org chart.’ HealthLeaders. May 25, 2023. https://bit.ly/3LRVe5v. Accessed October 1, 2023

4. Jerich K. AI-powered scheduling can boost clinician engagement, reduce burnout. Healthcare IT News. February 4, 2022.https://bit.ly/3LUYJYL. Accessed October 1, 2023

5. Manz CR, Zhang Y, Chen K, et al. Long-term effect of machine learning-triggered behavioral nudges on serious illness conversations and end-of-life outcomes among patients with cancer: a randomized clinical trial. JAMA Oncol. 2023;9(3):414-418. doi:10.1001/jamaoncol.2022.6303

6. Sumler L. Tulane University study uses artificial intelligence to detect colorectal cancer. November 2, 2021. https://bit.ly/3trsomd. Accessed October 1, 2023

7. Gao H, Ukpebor O. How AI/ML helped Hartford Healthcare optimize infusion scheduling. November 14, 2021. https://bit.ly/3FtKjeR. Accessed October 1, 2023