Articles
01
The Digital Reconstruction of Healthcare
By John Halamka, MD, MS Paul Cerrato, MA
The health care delivery landscape is slowly being transformed as hospitals, clinics, and medical offices seek more cost-effective venues and processes. Many patient encounters are transitioning to a virtual setting as telemedicine, hospital-at-home programs, and remote patient monitoring devices play a larger role. That transition, which has seen a sudden increase because of the Covid-19 pandemic, is likely to continue to accelerate. Temporary measures, such as the Centers for Medicare & Medicaid Services restructuring its reimbursement regulations to allow for virtual and home-based hospital visits at the same rate as currently allowed for brick-and-mortar facilities, could be extended or made permanent. This analysis discusses the rationale for moving from brick-and-mortar to online care, the scientific evidence supporting the transition, and trends in third-party fee schedules. Finally, the authors review the essential role of artificial intelligence in making this realignment of services a viable option for health care leaders, clinicians, and patients.
02
Redesigning COVID-19 Care With Network Medicine and Machine Learning
By John Halamka, MD, MS Paul Cerrato, MA
Adam Perlman, MD, MPH
Emerging evidence regarding COVID-19 highlights the role of individual resistance and immune function in both susceptibility to infection and severity of disease. Multiple factors influence the response of the human host on exposure to viral pathogens. Influencing an individual’s susceptibility to infection are such factors as nutritional status, physical and psychosocial stressors, obesity, protein-calorie malnutrition, emotional resilience, single-nucleotide polymorphisms, environmental toxins including air pollution and firsthand and secondhand tobacco smoke, sleep habits, sedentary lifestyle, drug-induced nutritional deficiencies and drug-induced immunomodulatory effects, and availability of nutrient-dense food and empty calories. This review examines the network of interacting cofactors that influence the host-pathogen relationship, which in turn determines one’s susceptibility to viral infections like COVID-19. It then evaluates the role of machine learning, including predictive analytics and random forest modeling, to help clinicians assess patients’ risk for development of active infection and to devise a comprehensive approach to prevention and treatment.
03
Understanding the Role of Digital Platforms in Technology Readiness
By John Halamka, MD, MS Paul Cerrato, MA
State-of-the-art digital tools that take advantage of machine learning-derived algorithms and advanced data analytics have the potential to transform regenerative medicine by enabling investigators and clinicians to extract intelligence and actionable insights from published studies, electronic health records, pathology images and a variety of other sources. Used in isolation, however, these tools are not as effective as they can be integrated into a comprehensive strategy – a platform. We discuss the value of a platform strategy by summarizing several initiatives that have been launched at Mayo Clinic, including a clinical data analytics platform, a remote diagnostics and management platform and a virtual care system.
04
An FP’s guide to AI-enabled clinical decision support
By John Halamka, MD, MS Paul Cerrato, MA
To better understand the capabilities and challenges of artificial intelligence and machine learning, we look at the role they can play in screening for retinopathy and colon cancer.
05
Setting the Stage for Next-Generation mHealth
By John Halamka, MD, MS Paul Cerrato, MA
Open the pod bay doors, HAL.… I’m sorry Dave, I’m afraid I can’t do that.” To this day, those lines from Space Odyssey 2001 still elicit fear in the minds of those who worry that computers will enslave humanity. Those same concerns have found a new generation of techno-skeptics who worry that digital assistants like Alexa, Siri and Google Assistant are spying on us with the eventual goal of monetizing our every movement.
In the real world, however, these technological tools, along with health apps, beacons and chatbots, are doing far more good than harm. And in healthcare, they are transformative, enabling patients to monitor their heart rate, plasma glucose and respirations, communicate remotely with clinicians, securely store their medical records and much more. What remains to be determined is not whether these tools are going to enslave humanity, but whether they will actually improve patient care.
06
Targeting depressive symptoms with technology
By John Torous, Paul Cerrato, John Halamka
Abstract: Interest in digital mental health, driven largely by the need to increase access to mental health services, presents new opportunities as well as challenges. This article provides a selective overview of several new approaches, including chatbots and apps, with a focus on exploring their unique characteristics. To understand the broader issues around digital mental health apps, we discuss recent reviews in this space in the context of how they can inform care today, and how these apps fail to address several important gaps.
Framing apps as either tools to augment versus deliver care, we explore ongoing struggles in this space that will determine how apps are used, regulated, and reimbursed for. Realizing that many mental health apps today exist in this still undefined space and often possess no evidence, we conclude with an overview of the American Psychiatric Association (APA)’s app evaluation framework with the goal of offering a more informed approach to these digital tools.
07
AI is helping reinvent CDS, unlock COVID-19 insights at Mayo Clinic
By Mike Miliard
The technology has matured enough, and the algorithms have been honed in recent years, to the point where there are now two types of artificial intelligence: “old school AI and new school AI,” as medical journalist Paul Cerrato proposed during a recent HIMSS20 Digital Session.
For examples of the former, think DeepBlue – the chess-playing computer from IBM that beat Garry Kasparov in 1996.
For the latter, think AlphaGo, developed by Google’s DeepMind technologies, which in 2015 became the first computer to beat a human at the ancient strategic game of Go (and which now has since been succeeded by even more powerful iterations
08
Can You Make Your EHR Less Annoying?
By Paul Cerrato
Countless physicians complain that they spend so much time in front of their computers inputting information that they have little time to interact with patients. This issue continues to frustrate physicians as they try to come to grips with the digital age of electronic health records (EHRs), e-prescribing, and smartphones.
Still, there are several potential solutions, including medical transcribing services and scribes. Here are the pros and cons of each.
09
Reinventing CDS Requires Humility in the Face of Overwhelming Complexity
By John Halamka. MD
Paul Cerrato and I have created a new book, Reinventing Clinical Decision Support, our first to be published about Platform thinking.
Although it is being published during my tenure at Mayo Clinic, it is not endorsed by Mayo Clinic and represents the personal opinions of Paul and me. Below is the preface.