Today initial diagnosis comes with high levels of accuracy: Dr. John Danaher

There are full suite of solutions that we are bringing to India and we believe it can lead to more accurate diagnosis and better care being delivered.

Today initial diagnosis comes with high levels of accuracy: Dr. John Danaher Shahid Akhter, editor, ETHealthworld spoke to Dr. John Danaher, President, Clinical Solutions, Elsevier, to know what role artificial intelligence plays in healthcare and how Elsevier plans to improve diagnostic outcomes by way of AI and machine learning.

Clinical errors and role of AI and health analytics
There are three examples. The first one is making an initial diagnosis. What can be achieved with artificial intelligence, machine learning and actual language processing is the ability to assist doctors to make more accurate initial diagnosis.

Second is the work being done in the area of image recognition with radiology and pathology. Here, those same cognitive technologies are being applied to provide augmented intelligence to allow radiologists to more accurately determine what the images are on a study.

The third example is how data analytics and artificial intelligence is being used to look at patient data, to run analytics to see which drugs work and which therapies are more effective.

Clinical decision tools to reduce medical errors
Probably, the most advanced used case of clinical decision support is in the United States. The reason for this was the Affordable Care Act, which provided a tremendous stimulus to hospitals to encourage implementation of electronic medical records (EMRs). In the US, you have approximately 100% penetration with electronic medical records. When you have EMRs, what happens is that then the hospitals buy the software for referential and workflow standardization and the results of clinical decision support have been absolutely remarkable.

There have been 60% improvements in the accuracy of the initial diagnosis with use of clinical decision support, 70% increased performance in terms of using the right drugs and therapies and 40% improvement in the implementation of the right imaging studies.

In the US, there are regulations, for example, the regulation of Centers for Medicare and Medicaid Services called PAMA, which encourages for reimbursement and the use of clinical decision support in the area of radiology.

Clinical error: Solutions available
We're bringing many solutions, which we will deploy throughout the world to India. We have a broad range of solutions and there are things such as helping with the primary care efforts in ensuring that issues around public health and population health management are addressed. We have solutions, which address more rural and underserved areas and we also have solutions for hospitals and the software, which is running and generating there.

These are things such as when physicians make orders or nurses do coordinated care in the hospital and then the treatment of difficult diseases such as oncology. Therefore, what we have is a full range, which addresses the needs of the citizens of India and of the healthcare practitioners. We are also interested in nursing and medical education and also focused on certifications and upskilling. Additionally, we are also working on pilot projects, which is linked with fraud and abuse in terms of billing and claims. Hence, there are full suite of solutions that we are bringing to India and we believe it can lead to more accurate diagnosis and better care being delivered.

Elsevier Solutions provided
We are partnering with Piramal Foundation in terms of the project that we're doing such as addressing the infant needs and maternal needs of underserved populations. We are also partnering with other NGOs in terms of reaching to some of the underserved.

Certainly, we're targeting and working with private and public hospitals to deploy and roll out our tools.
We are looking at some innovative partnerships with other companies, which serve other parts such as pharma, medical devices, etc. to address the healthcare needs in India.

Universal Health Coverage and the role of technology
There is a tremendous infrastructural needs, people processes and technology, which can be deployed to address some of the persistent problems in terms of infant mortality rates and in terms of improving the entire population.
In our meeting with a hospital system, we discussed how we could deploy our content or decision support localized for their catchment business for the patients and how we can deploy localized solutions and handheld devices and put those devices into the hands of the healthcare workers. This would consist of a standardized way of doing data capture and of some very fundamental things such as height, weight, immunization status, etc. and then be able to use that information for population management.

Rolling out a data infrastructure will be very helpful not just in treating for specific diseases such as tuberculosis or malnutrition, etc, but also being able to collect a multitude of data points and to do longitudinal tracking of patients over time. Certainly, the call to being able to do clinical decision support in the in-patient or the hospital setting requires an electronic medical record for these order sets and care plans to be automated pathways.

The ability with universal healthcare and rolling the blueprint for rolling out the electronic health record is going to be able to automate this type of decision support to collect that information. Hence, technology in both in the national EMR and being able to collect this data for population health management is going to be a key for successfully rolling out UHC.

Elsevier’s research and clinical decision tools
One of the things that I'm most excited about is that we have a business called ClinicalPath and it's an oncology pathways. We have 54 institutions around the world, US, China, Italy and also other countries. This is something, which we look forward to bringing in India. These pathways standardize the delivery of care associated with difficult cancer conditions.These pathways are automated into the electronic records.

We see strong adherence of the oncologist to these pathways. They have been staying on these pathways and following recommendations. We have over an 85% adherence.

We've seen with our solutions that patients are enrolled in clinical trials at two and a half times more often than before the implementations of these pathways and we are also taking this patient data, running analytics and being able to drive those insights.

There are a number of other things such as we've got products in the area of radiology decision support. We have a product available here in India, called STATdx, which helps radiologists at the point of care and make a more accurate diagnosis.

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