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      Closing the Loop in AI, EMR, and Provider Partnerships: The Key to Improved Population Health Management?

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          Abstract

          The capabilities of and interest in artificial intelligence (AI) in healthcare, and more specifically, population health, have grown exponentially over the past decade. The vast volume of digital data or ‘big data’ in the form of images generated by an aging population, with an ever-increasing demand for imaging, amassed by radiology departments, provides ample opportunity for AI application and has allowed radiology to become a service line leader of AI in the medical field. The screening and detection capabilities of AI make it a valuable tool in population health management, as organizations work to shift their services to early identification and intervention, especially as it relates to chronic disease. In this paper, the clinical, technological, and operational workflows that were developed and integrated within each other to support the adoption of AI algorithms aimed at detecting subclinical osteoporosis and coronary artery disease are described. The benefits of AI are reviewed and weighed against potential drawbacks within the context of population health management and risk contract arrangements. Mitigation tactics are discussed as well as the anticipated outcomes in terms of cost-avoidance, physician use of evidence-based clinical pathways, and reduction in major patient events (e.g. stroke and hip fracture). The plan for data collection and analysis is also described for program evaluation.

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          Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

          Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). Methods: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year’s worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year’s edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. Results: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. Conclusions: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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            Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

            PURPOSE Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non–face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. METHODS We conducted a retrospective cohort study of 142 family medicine physicians in a single system in southern Wisconsin. All Epic (Epic Systems Corporation) EHR interactions were captured from “event logging” records over a 3-year period for both direct patient care and non–face-to-face activities, and were validated by direct observation. EHR events were assigned to 1 of 15 EHR task categories and allocated to either during or after clinic hours. RESULTS Clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2%). Inbox management accounted for another 85 minutes (23.7%). CONCLUSIONS Primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout. Direct time-motion observations validated EHR-event log data as a reliable source of information regarding clinician time allocation.
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              The rise of artificial intelligence in healthcare applications

              Big data and machine learning are having an impact on most aspects of modern life, from entertainment, commerce, and healthcare. Netflix knows which films and series people prefer to watch, Amazon knows which items people like to buy when and where, and Google knows which symptoms and conditions people are searching for. All this data can be used for very detailed personal profiling, which may be of great value for behavioral understanding and targeting but also has potential for predicting healthcare trends. There is great optimism that the application of artificial intelligence (AI) can provide substantial improvements in all areas of healthcare from diagnostics to treatment. It is generally believed that AI tools will facilitate and enhance human work and not replace the work of physicians and other healthcare staff as such. AI is ready to support healthcare personnel with a variety of tasks from administrative workflow to clinical documentation and patient outreach as well as specialized support such as in image analysis, medical device automation, and patient monitoring. In this chapter, some of the major applications of AI in healthcare will be discussed covering both the applications that are directly associated with healthcare and those in the healthcare value chain such as drug development and ambient assisted living.
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                Author and article information

                Journal
                TMT
                Telehealth and Medicine Today
                Partners in Digital Health
                2471-6960
                10 October 2022
                2022
                : 7
                : 10.30953/tmt.v7.370
                Affiliations
                BHSH Spectrum Health West Michigan, Grand Rapids, USA
                Author notes
                Corresponding Author: Alexis Kurek, Email: alexis.kurek@ 123456spectrumhealth.org
                Author information
                https://orcid.org/0000-0002-5997-9327
                Article
                370
                10.30953/tmt.v7.370
                77704545-6f18-4631-92de-5730a53dd22c
                © 2022 Alexis Kurek et al.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, adapt, enhance this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 12 July 2022
                : 27 July 2022
                Categories
                OPINIONS, PERSPECTIVES, AND COMMENTARY

                Social & Information networks,General medicine,General life sciences,Health & Social care,Public health,Hardware architecture
                osteoporosis,artificial intelligence,coronary artery disease,population health

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