September 25, 2020, 1:35 pm Cindy Borgmeyer -- It’s been less than two years since the AAFP Board of Directors approved a 42-month special informatics project focused not just on easing the burdens posed by EHRs, but on shaping the very future of health IT for family physicians by leveraging new technologies.
Led by AAFP Vice President and Chief Medical Informatics Officer Steven Waldren, M.D., M.S., the Academy has made substantial progress toward that goal. In March 2019, the AAFP partnered with the Center for Medicare and Medicaid Innovation and the Laura and John Arnold Foundation to launch the CMS Artificial Intelligence Health Outcomes Challenge. The challenge engages with innovators from all sectors – not just health care – to harness AI solutions that can predict health outcomes for potential adoption by and use in CMMI’s payment and service delivery models.
Waldren also spearheaded the establishment of an Innovation Laboratory last year to drive innovation using the latest proven, advanced technological platforms and tools: cloud, AI/machine learning, and voice and mobile technologies. By working with a wide swath of industry associates, the Innovation Lab can offer AAFP members and their practices opportunities to assess existing and emerging tech solutions and share feedback and recommendations for implementation in family medicine practices.
The first such tool -- a digital assistant for physicians that combines AI and voice-enabled technology -- achieved proof of concept earlier this year. That tool, Suki, has entered the second stage of the pilot process, with dozens of family physicians across the country currently evaluating its performance in practice.
Now, a second opportunity is opening up for family medicine practices to evaluate an AI-driven platform, thanks to a collaboration between the AAFP and Navina, a leader in the digital health space. Designed to enhance clinical workflow by automating data capture and analysis, Navina’s signature product integrates multiple types of patient data from multiple sources (tabular, numerical, time-series, images, text) in real time and restructures it into intuitive, actionable summaries called “Patient Portraits.” Navina’s goal is to ensure that what's most important is immediately clear, diagnostically linked and contextually surfaced, based on the entirety and complexity of each patient’s data and history.
“One of the challenges that our members have is just wading through all the content inside the medical record and the concern that there’s something in there that may have been missed,” Waldren told AAFP News. “So, having a product that can do a lot of the heavy lifting to look through the chart and pull data forward to present a summary” could greatly streamline the patient visit.
How the data retrieved is presented is a key element of the Navina product, said eHealth Innovation Strategist Paul Dow. “Navina puts it into just a one- or two-page document for your review prior to walking into the room so you’re able to plan a little more effectively,” he explained. “You’re able to say, ‘Here are the three things we need to address’ before the patient inevitably gets to the ‘one more thing’ as you have your hand on the doorknob to leave.”
“Family docs using this product are seeing value in it in saving time and clicks and finding issues that need to be addressed,” Waldren noted. “They feel they have a better view of their patient before they start doing their previsit planning and visit with their patient.”
AAFP member Lindy Gilchrist, M.D., of Denver, is one of those physicians. About a year ago, she and her practice partner, Lynn Joffe, M.D., M.S.P.H., began working with Navina to assess how their practice, DTC Family Health in Greenwood Village, Colo., could benefit from using Navina.
After spending a number of days observing the practice’s patient flow and the kinds of challenges that arose, Navina’s team customized their product to suit the practice’s needs. “They launched it using us as a test site,” she told AAFP News, and the product has continued to advance since that time.
Navina’s point-of-care model allows Gilchrist and her colleagues to mine patients’ data in real time to optimize diagnosis and ICD coding processes. That enables them to ensure they have identified all pertinent diagnoses and provided appropriate care based on those diagnoses, she said. It also helps them increase risk-adjustment factor scores for reimbursement “because often we found that we were doing the work, but if we didn’t code properly or if we didn’t accurately identify the diagnosis, we were leaving money on the table.”
“So, although the primary focus was on quality care, the bonus has been increasing our revenue stream just by coding properly; you do all the work, you may as well be paid properly.”
For Gilchrist, the benefits from Navina’s ability to summarize multiple data points from the patient record start well before she ever walks into the exam room, although she acknowledges that some of her office colleagues don’t use the system in the same way she does.
“My particular practice style is that I look at the charts in advance; I like to know what I’m seeing when I go in,” she explained. “I go through all the charts, and then I go to the (Patient Portrait) and make sure that I have updated all the information that Navina has provided.
“If I’ve missed a diagnosis and Navina alerts me to it, then I’m able to add that to my problem list.”
Another plus, according to Gilchrist: “At the point at which I am looking in the chart, I am able to give feedback immediately to Navina to say this was helpful, this was not.”
One aspect of the tool Gilchrist would like to see enhanced is its ability to integrate with her practice’s EHR, Athena, so she doesn’t have to toggle between the chart and the Patient Portrait to review or add information.
“Ultimately, as Athena users and Navina supporters, our hope is that communication between the two systems will become seamless, so that information from Navina pops up into the EMR immediately saying this diagnosis has not been addressed or this RAF score is whatever,” Gilchrist said.
Given that Navina is still a fairly new company, “This gives us a great opportunity to help mold the product even further to the needs of family medicine,” said Waldren. Another benefit of working with a start-up like Navina, he added, is the rapid development of new and better capabilities, such as improvements they have made in integrating with EHRs.
If you’re interested in becoming one of the physicians who provides that input, you may be in luck. The Innovation Lab is looking for about a dozen family physicians from two or three broad-scope family medicine practices to trial the platform from now through the end of the year.
There’s no cost to participate. Interested AAFP members who want to submit information about their practice for consideration are invited to email eHealth@aafp.org.