Kettering Health Hamilton’s Chief Medical Officer Dr. Marcus Romanello said it’s believed they are first in the region (maybe the state) to use the AI clinical platform called Regard when they launch it this month
“What we have found is that the volume of information contained within healthcare has expanded to the point where it is now humanly impossible to hold all of it in your head at one time,” Romanello said. “So our strategy is one in which we are not trying to have computers diagnose patients; what we’re trying to do is to augment the capabilities of our physicians and our medical providers ― make them superhuman, so to speak. Take our healthcare heroes and make them superheroes.”
As technology has improved the doctor’s ability to treat a patient’s ailments, and improve recovery times, Regard will assist a physician’s ability to diagnose a patient. This electronic health record (EHR)-based technology analyzes a patient’s entire medical record, then highlights possible areas of concern for the doctor to assess and consider. This artificial intelligence tool will help prevent medical errors, improve time back for physicians with patients, and improve documentation quality.
“Today’s clinicians cannot possibly read the gigabytes of data contained in one patient’s medical record,” Romanello said. “This is allowing them to collect as much information as possible, distilling it down to the key elements that they need to know, and presenting to the physician that it found something and asking if it could be relevant.”
AI has been used by the hospital for years, such as with Kettering Health’s radiology departments.
“Our radiologists, when looking at a mammogram, have software that is running in the background helping to highlight areas of concern that maybe they should take a second look at,” Romanello said. “The computer is not simply reading the mammogram by itself and spitting out a diagnosis. It’s spitting out to the radiologist, ‘Maybe this area you should take a second look.’”
Then the physician can take a different look or view, compare it to the other breast or last year’s mammography tests as “it’s helping ensure that nothing is missed when reading that image. They’re able to accomplish this through very deep statistical modeling around thousands and thousands of breast cancer cases that are in the database. And so that has been instrumental.”
This new software will also be running in the background while the doctor is seeing the patient, but scraping all possible information from the medical record for a potential diagnosis. “We found it to be faster, safer, better, and more accurate when the computer and the physician are working together,” he said.
The hospital network implemented last year the predictive software of ePRISM to determine patients’ risks for negative outcomes, such as bleeding or kidney complications before they undergo certain procedures.
Alina Joseph, executive director for Kettering Health’s Heart and Vascular Service Line, said this software takes into account a patient’s lab values, medical histories and other data points in order to calculate a unique patient risk score.
“It’s really adjusting how we treat the patient,” she said, from helping to make a determination in how much contrast is used during a procedure to the approach used specific to the risk score of that patient. “Now the care that the patients are receiving is customized specifically for them.”
Joseph said they’ve been “pleasantly surprised” with the results of the ePRISM software. The hospital system was in line with national averages, but now they are exceeding those averages. For example, with an acute kidney injury, or AKI, which can occur through infections, dehydration or medication side effects, they were seeing around seven AKI’s a month. Since March 2023, the average has dropped to 2 with the exception of November and December, when they had zero.
Additionally, Joseph said they’ve had a 38% decrease in bleeding reductions, and while many procedures are outpatients some may require a day or two hospital stay, since ePRISM’s introduction, Kettering Health has seen about a 16% decrease in the length of stay.
Practicing medicine can be very much a trial and error process at times, and AI software, whether it’s ePRISM, Regard or some other vetted technology, is helping get the right treatment faster, and on the first time.
“It allows us to understand what that risk is for that particular patient, then we’re able to adjust,” said Joseph. “When this (ePRISM) platform runs all this information ― it’s running 30-some components in the background before it produces recommendations. It gives us a risk score for AKI and a risk score for their risk of bleed and risk of mortality. We’re able to adjust the actual treatment of the patient.”
Romanello said Kettering Health Hamilton is offering these state-of-the-art and cutting-edge technologies because “we fundamentally believe our patients deserve the best we can offer. We’re not going to be able to offer every possible specialty, but the things we do offer, we’re going to offer with the utmost excellence that we can possibly imagine. So that’s where we’re focusing.”
While that means Kettering Health Hamilton may not have the subspecialists that a university hospital would employ, they have community physicians “dedicated to their patients and we’re working doubly to ensure that they’re practicing at the top of their game.”
And it’s not uncommon to find a physician who graduated from Hamilton Badin High School or Fairfield High School and returned to practice in or near their hometown.
“I think the patients are able to notice when it’s someone they can trust and that matters,” Romanello said. “Even when we recruit physicians from outside the area, we are looking for a personality type of an individual that not only has the clinical expertise but one that translates at the bedside to an individual that you can trust with your healthcare.”
And that trust goes along with when implementing an AI system, as it can be a distrust for some.
“We’ve already seen some of the prominent examples of where the AI can take us down the wrong pathway if we allow it to operate independently,” Romanello said. “We’ve seen examples where the AI can hallucinate and simply make up things. That’s why we feel the care is still overseen by your physician but the AI is functioning as an assistant.”
Kettering Health’s Chief Medical Information Officer Dr. Albert Bomnema said artificial intelligence’s ability to assimilate data and information and quickly make sense of it is a great tool for doctors.
“We just have an amazing mass of information coming to the medical professional coming from all over the place, so having that software and technical capabilities to help us make a decision or prevent harm is really timeline and it will help a lot with the information overload people are experiencing in healthcare,” he said.
But there are concerns about new AI technology, and before Kettering Health would invest in any new tool, it has to be vetted, and there needs to be anchors to the health care system and put through clinical trials. Because if the technology has the remote possibility to produce harm or won’t help improve a diagnosis, “it’s a non-starter.”
It’s also important that these AI tools won’t be automated to pre-empt a doctor’s decision because the decision must remain in the hands of a medical professional.
“Healthcare is still one person caring for another, but we’re working to ensure this is as safe as possible at the highest level,” said Romanello. “This is going to become the standard in the future. We’re confident of that, whether it’s this vendor (of Regard) in this space, or even in the future, we’re confident that the marriage between the clinical expertise and technology is going to yield better outcomes.”
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