Updated: 5 days ago
Can AI contribute to the solution of some of the challenges faced by the US healthcare system, enhance the access and quality of care for patients, and help the daily work of nurses, doctors, and administrative staff? At Titan Intake, we think it can.
September 29, 2023
Senior Software Developer and NLP Lead at Titan Intake Inc
Understanding AI: More Than Just a Hype
Artificial Intelligence (AI) encompasses a wide range of fields including search, logic and reasoning, knowledge representation, machine learning (ML), computer vision (CV), natural language processing (NLP), planning, agents, and robotics, among others. While each of these fields has witnessed significant progress, the advancements in machine learning—especially deep learning—in the last decade have opened up numerous opportunities in computer vision and natural language processing that many believed would take decades to realize.
But why are these subfields so crucial? Simply put, NLP empowers computers to comprehend and produce human language, CV enables machines to interpret visual data, and ML allows us to address complex tasks with computers and data without needing explicit programming. Underpinning these fields are core concepts from calculus, linear algebra, probability, optimization, numerical methods, and algorithms from computer science.
What's truly remarkable is that while the field of AI itself is thrilling and still has a long way to go, its current applications are genuinely transformative. At Titan Intake, we are firm in our belief that AI can augment human capabilities. The most impactful advancements in healthcare AI will emerge when grounded in a deep, patient-centered understanding of the intricacies involved in care and treatment pathways.
Pain Points of the US Healthcare System
The U.S. healthcare is renowned for its innovation ecosystem, yet it has several challenges. These include the high cost of healthcare, ensuring health equity, navigating a complex interoperability landscape, transit
ioning to value-based care, and addressing provider shortages, to name a few. In the subsequent sections, we will delve into each of these pain points and explore how the use of AI could potentially alleviate some of these burdens.
Arguably, the high cost of the US health care system is its biggest weakness. In the US, national expenditures on health care goods and services were approximately $4 trillion in 2020, accounting for an estimated 18% of gross
domestic product. It has been stated that more than 45% of American adults say it’s difficult to afford health care, and more than 40% have medical debt. However, according to McKinsey, 25% of health care spending stems from administrative activities, such as billing, scheduling, and insurance filing. In fact, administrative costs are estimated by Kocher et al at $2500 per person per year. Interestingly, some of these expenses can be reduced by automating repetitive tasks, establishing or adopting better communications protocols and platforms, and improving reporting. Below are some areas where AI can make a notable impact:
NLP can assist nurses in specialty clinics by quickly processing faxed referrals from other medical practices to extract essential patient information. This efficiency not only accelerates appointment scheduling for patients but also liberates nurses from time-consuming tasks. Ultimately, this reduces the potential for complications and curtails costs for the healthcare system.
Automated Billing and Claims Processing
AI algorithms can analyze billing and insurance claims data in real-time, flagging errors and inconsistencies that could lead to costly delays or denials. These systems can even predict which claims are likely to be rejected and suggest corrective action, reducing the burden on administrative staff and accelerating the reimbursement process.
Optimizing Staff Allocation
AI-powered predictive analytics can forecast patient inflow, allowing hospitals and clinics to allocate their staff more efficiently. By predicting busy periods or foreseeing staff shortages, healthcare providers can better plan their resources, resulting in fewer overtimes and better patient care, thereby saving costs.
Virtual Health Assistants for Scheduling
Advanced chatbots and virtual assistants can handle routine scheduling tasks such as setting up patient appointments, sending reminders, or processing cancellations. This automation frees up human resources to focus on more complex, value-added tasks, improving efficiency and reducing overheads.
Streamlined Supply Chain Management
AI can optimize supply chain processes in healthcare, predicting the need for medical supplies or medications and automatically reordering as needed. This level of automation ensures that healthcare providers maintain optimal stock levels, reducing wastage and emergency orders that come with high costs.
Automated Medical Coding
AI can automate the cumbersome task of medical coding, where every diagnosis and procedure must be assigned specific codes for billing and records. AI can sift through medical records and allocate the appropriate codes more quickly and accurately than human coders, reducing the risk of costly errors.
Enhanced Customer Service
AI can also be employed to improve patient experience and service delivery, from automated symptom checking to personalized health reminders, which indirectly can reduce the costs associated with poor customer service such as lost revenue from dissatisfied patients or the cost of resolving complaints.
Regulatory Compliance and Reporting
Compliance with an ever-growing list of healthcare regulations is a significant administrative burden. AI can help by automatically flagging potential compliance issues in real-time, suggesting corrective actions, and even auto-generating necessary compliance documentation, thereby saving administrative time and avoiding financial penalties.
While the promise of AI in healthcare extends to many sectors, its capacity to substantially reduce administrative costs is particularly compelling. By automating routine tasks, optimizing resource allocation, and enhancing data analytics, AI technologies not only cut costs but also allow healthcare professionals to focus on what really matters: providing high-quality patient care. As the healthcare industry continues to evolve, leveraging AI for administrative efficiency will become not just an option, but a necessity for maintaining a sustainable, high-quality healthcare system.
Overall, there are significant differences in health outcomes among various groups depending on the environmental influences, as they play a substantial role in a person's health and well-being. Referred to as social determinants of health, these environmental factors encompass various elements such as where a person
lives, their racial or ethnic background, the quality of air and water in their environment, and availability of employment, housing, education, transportation, and healthy food options, among others. When people from underprivileged backgrounds face a health emergency, the costs for treatment often escalate, frequently necessitating hospital stays or emergency room visits. AI presents an opportunity to make significant strides in addressing the challenge of health equity.
AI can sift through vast sets of data to determine which populations are most at risk for certain diseases based on social determinants of health. For instance, machine learning algorithms can analyze data from electronic health records to predict who might be at a higher risk for conditions like diabetes or hypertension. By identifying at-risk populations early on, healthcare providers can implement preventive measures tailored specifically to those groups, reducing overall healthcare costs and improving outcomes.
Telemedicine and Remote Monitoring
AI-driven telehealth platforms can make healthcare more accessible for people living in remote or underserved areas, thereby leveling the playing field. Advanced AI algorithms can assess patient data in real-time, providing healthcare practitioners in rural or underprivileged regions with the same level of diagnostic capability available in sophisticated urban healthcare systems.
Streamlined Administrative Processes
AI can reduce the administrative burden on healthcare systems, allowing for a more efficient allocation of resources. For example, AI-powered chatbots can handle routine queries, freeing up administrative staff to focus on more complex tasks. This improved efficiency can translate into more time for patient care, which is particularly beneficial in underfunded and understaffed healthcare settings.
Enhanced Community Outreach
AI can also improve community health initiatives by pinpointing exactly where interventions are most needed. Using algorithms that can analyze a wide range of data, from census data to medical records, AI can help public health officials understand the unique needs of different communities and adapt their health programs accordingly.
Real-time Translation Services
Language barriers often contribute to healthcare disparities. AI-driven real-time translation services can help healthcare providers communicate more effectively with patients who speak different languages, thereby improving the quality of care and patient satisfaction.
Social Determinants and Predictive Analytics
AI can analyze social determinants of health to not only predict individual health outcomes but also to guide interventions on a community level. By understanding how factors like zip code, education level, and employment status interact to affect health, AI can help create more effective, targeted public health campaigns.
By leveraging these AI capabilities, we can take significant steps toward reducing disparities and improving health equity. It's not just about making healthcare more efficient but also about making it fair and accessible for everyone. Through its ability to process large sets of data, facilitate telemedicine, and improve both administrative efficiency and community outreach, AI is uniquely positioned to address the inequities in the U.S. healthcare system. Therefore, investing in AI technologies isn't just an investment in innovation; it's an investment in a healthier, more equitable future for all.
Complex interoperability landscape
Health care is now data-dependent, but to what extent? Even before the COVID-19 pandemic, a single patient was producing as much as 80 megabytes of data each year, including medical images and electronic medical records. Beyond the sheer volume of data generated, the diverse types of data also present a challenge. This data encompasses not only patient background information, lab results, medication histories, and radiological images, but also financial and insurance details.
However, the primary concern isn't storage; it's about sharing this information across different healthcare systems and making sense of it. This is where interoperability comes into play. Interoperability in healthcare refers to the ability of healthcare providers and various records systems to electronically share patient information. Achieving interoperability presents several challenges, including managing inconsistent information from multiple sources, inconsistent data, a lack of standardized data structures, a lack of skills and resources, and an absence of interoperability standards and infrastructure. These challenges can lead to poor health outcomes and increased costs. To overcome these challenges, healthcare providers must ensure their data is "liquid" and accessible to all stakeholders, invest in consumer-mediated, voluntary identity standards, and agree on standards-based approaches that unite their efforts. Here are some of the ways in which AI can contribute to alleviating the difficulties in achieving a seamless, interoperable healthcare landscape:
AI algorithms can automate the process of data harmonization by learning the patterns and structures of data from different sources. With the help of natural language processing (NLP), machine learning models can read and interpret clinical notes, radiology images, and other types of health records to create a unified data structure. This uniformity is critical for sharing information across different healthcare systems and platforms.
Automated Verification and Validation
Incorrect data can have significant consequences in healthcare. AI algorithms can automatically verify the consistency and validity of the data coming from multiple sources, making it easier for healthcare providers to trust the shared data.
Patient-Mediated Data Exchange
AI can empower patients to take control of their healthcare data, making it easier for them to share it among different providers and to understand it. Through AI-powered apps and platforms, patients can have real-time access to their data and can grant permission for its use in a secure, convenient way.
By integrating AI into the complex interoperability landscape, healthcare providers can break down the barriers that hinder the effective sharing of information. Think of data as the new electricity, but what’s the point of electricity if you don’t have “transmission lines” to share it?
Movement towards value-based care
In the past, healthcare providers in the United States primarily followed a fee-for-service (FFS) approach where billing was based on each service rendered, using specific billing codes. Currently, the healthcare industry is shifting towards a value-based care (VBC) model. In this new paradigm, Medicare and insurance companies reimburse healthcare providers based on patient outcomes rather than services rendered. This encourages hospitals to reduce readmission rates and focus on minimizing medical and surgical errors. Though VBC aims to elevate overall public health and reduce the incidence of hospital admissions and illnesses, it complicates the billing process. To address this, healthcare administrators are embracing value-based administration (VBA) and adopting new payment and billing technologies that can accommodate this patient-centric approach. Artificial Intelligence (AI) can be a game-changer in the push towards value-based care for several reasons:
Real-time Monitoring and Analytics
AI can process real-time patient data, providing immediate insights that can lead to timely interventions, potentially preventing complications and hospital readmissions. This ability directly aligns with the objectives of VBC, which emphasizes outcome over service.
Personalized Treatment Plans
Through machine learning algorithms, AI can assist in the development of personalized treatment plans by taking into account a wide array of variables, from medical history to genetic factors, thus ensuring more effective treatments and better outcomes.
AI can automate many administrative tasks, such as billing and coding, which become more complicated under VBC. This frees healthcare professionals to focus more on patient care rather than administrative duties, enhancing the value of the services provided.
By integrating AI into the value-based care model, healthcare systems can significantly enhance the efficiency and efficacy of patient care, providing better outcomes while bringing down the overall cost of healthcare.
The United States is projected to face a shortage of up to 124,000 physicians by 2034 as the demand outpaces supply, according to the Association of American Medical Colleges. The shortage of healthcare workers is not limited to physicians but also includes other healthcare professions such as home health aides and nurse practitioners. AI offers promising avenues to help mitigate this issue. Here there are some ways AI can be utilized to address the shortage:
Telemedicine and Remote Consultations
AI can facilitate telemedicine by acting as the first point of contact, triaging patients and helping to decide whether an in-person consultation is necessary. This allows healthcare providers to focus on patients who need more immediate and intensive care, effectively increasing their reach.
AI algorithms can help in the diagnostic process by analyzing medical images, pathology slides, and even genetic data more quickly and often more accurately than human professionals. While not replacing human expertise, AI can serve as a reliable second opinion and help speed up the diagnostic process, allowing providers to see more patients in the same amount of time.
Routine and Administrative Tasks
Virtual Health Assistants
AI-driven virtual health assistants can provide basic medical advice for common conditions, helping to alleviate the demand on primary care providers. These virtual assistants can perform functions such as symptom checking, medication reminders, and even mental health support.
Training and Simulation
AI-driven simulation programs can provide medical professionals with realistic scenarios to practice, thereby speeding up their training process without compromising on the quality of education. This can help produce a greater number of qualified healthcare providers more quickly to address the shortage.
Expanding the Role of Nurse Practitioners and Physician Assistants
AI can support nurse practitioners and physician assistants in diagnosing conditions and recommending treatments, thereby expanding their roles and freeing up physicians to focus on more complex cases.
By integrating AI into various aspects of healthcare, the U.S. can have another tool to address the anticipated provider shortage more proactively. This can result in more efficient and effective healthcare delivery, better patient outcomes, and a more manageable workload for the existing healthcare workforce.
The road ahead
While we have witnessed remarkable advancements in machine learning, natural language processing and computer vision over the past decade, and especially in the last year, artificial intelligence algorithms are still in their early stages. However, this doesn't prevent them from being employed to alleviate some of the challenges faced today by the U.S. healthcare system. As part of this effort, it is crucial to ensure that the collected data flows smoothly and securely among the various stakeholders in the system, to be leveraged for the benefit of patients. At Titan Intake, we are actively working on some of the issues outlined in this blog. Although the challenges are formidable, the gratification of contributing to the solution of a problem that impacts millions of patients annually is immensely rewarding.