Ep. 102: care.ai and the Smart Hospital

Health care transformation is starting to move from the realm of concept to reality. One example is a platform called care.ai, which brings together virtual care and artificial intelligence to create “smart hospitals” and “smart care teams.” It's already in action at such luminary health care providers as Vanderbilt University Medical Center in Nashville and Henry Ford Health in Detroit — and coming soon to Nemours Children’s Health. 

care.ai President Bruce Brandes and Nemours Children’s Chief Nursing Executive Jane Mericle stepped up to the podcast mics during the 2024 American Academy of Pediatrics Experience National Conference in Orlando to talk about care.ai and the solutions it brings to myriad issues faced in today’s crucial care setting.

Guests:
Bruce Brandes, President, care.ai
Jane Mericle, DNP, MHS-CL, BSN, CENP, Executive Vice President, Enterprise Chief Nursing Executive and Patient Operations Officer, Nemours Children's Health

Host/Producer: Carol Vassar

Views expressed by guests do not necessarily reflect the views of the host or management.

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Transcript

Announcer:

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Carol Vassar, podcast host/producer:

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Music:

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Bruce Brandes, President, care.ai:

I think too often in healthcare we've been slow and the status quo has been acceptable to us, and I think for the first time now we have a real great opportunity for transformation.

Carol Vassar, podcast host/producer:

That's care.ai President, Bruce Brandes, like so many, eager to bring transformation to healthcare across the nation. For Brandes though, transformation is becoming reality through the care.ai platform, which brings the best of virtual care together with artificial intelligence to create smart hospitals and smart care teams. If it sounds a little futuristic, then the future is now. care.ai is already in action at such luminary healthcare providers, as Vanderbilt University Medical Center in Nashville, Henry Ford Health in Detroit, and coming soon to Nemours Children's Health.

Bruce stepped up to our podcast mics at the 2024 American Academy of Pediatrics Experience National Conference in Orlando to talk about care.ai and the solutions it brings to myriad issues being faced in the critical care setting today. Joining the conversation is Jane Mericle, Nemours Executive Vice President, Enterprise Chief Nursing Executive, and Patient Operations Officer. We started our conversation by asking Bruce to describe the problems for which care.ai has been designed as a solution.

Bruce Brandes, President, care.ai:

Of all the challenges that we as an industry have, I think that there are two overarching existential threats that we believe we can help to address. One is, increasingly what we ask of our bedside caregivers has become humanly impossible. And unfortunately, that's one of the reasons why we don't have enough of them. And sadly, too often the technology we've brought to bear has actually made their lives harder, not easier. And we can unpack that a little bit as well.

And then secondly, even if we had all the labor we needed, the underlying costs of our current acute and post-acute care models are just fiscally unsustainable. So we can't just tinker around the edges to solve for these things, and what inspired our work is to say, what can we learn from other industries that have applied technology to reimagine how they do work? And so we look at this concept of ambient intelligence, which is essentially a network of sensors that are using computer vision and ambient listening to be able to capture data, that frankly we don't capture today in real time, massive amounts of data. And then combining that with artificial intelligence to be able to interpret that data and apply it in real time.

I'll give you a good example, if you think about how a self-driving car works, and not just a self-driving car, but an AI-assisted car with ambient intelligence. We as drivers sometimes get distracted, we're humans, but you see today capabilities where you can automatically brake before I rear-end somebody because my car will protect me, or if I'm drifting out of my lane, it'll remind me, or it'll help me to dynamically reroute away from traffic because... And so the network of sensors in AI that power that is the same technology that we're bringing to healthcare. So that as there are companies that aspiring in transportation to create the uncrashable car, we look and see, what in healthcare could we do to create the harmless hospital?

Carol Vassar, podcast host/producer:

In what way has technology made the clinical role more difficult? Jane?

Jane Mericle, Nemours Children's Health:

Oh, there are many. Probably the EHR is a good example where it was supposed to streamline our care and what you find from talking to nurses and physicians and others is that they spend what they feel like is a lot of time in front of a computer and having to input data. And so that in fact it has become a bit of a burden as opposed to being efficient in a way that I think our care teams feel like it could be.

Now, is that improving? Yes, but that would be an example of how we had to change our practice in order to meet the needs of the technology. What you want to see is that technology supports the care team's practice.

Bruce Brandes, President, care.ai:

And the other thing I would add to that, in addition to the EMR, with the best of intentions, many health systems have deployed individual point solutions, which by themselves have utility for a specific function. But unfortunately, collectively they're further fragmenting an already very fragmented patient and caregiver experience. So what we're finding is as a platform at care.ai, one of the greatest opportunities we have, and this is a key part of the financial cost justification that people have, is you can start to eliminate a lot of disparate point solutions that you have for virtual sitting, stand alone with carts for virtual sitting, or a system to detect falls, or a system for hand hygiene compliance, or a system for high acuity care versus bedside care, versus... So as you start to think about all of those point solutions and being able to unify them into one platform, it really simplifies the environment. So you're really looking at two platforms, the electronic medical record and the smart care facility platform, which works hand in glove with the electronic medical record.

Carol Vassar, podcast host/producer:

When we were talking before we were on mic together, you were saying that your vision in many ways is a virtual hospital, which we'll talk about momentarily, but it really begins with virtual nursing. So Jane, I would love for you to give us an explanation of virtual nursing, and then Bruce, talk about how that leads us to virtual hospitals.

Jane Mericle, Nemours Children's Health:

All right, thank you, Carol. And Bruce, what an excellent description of the complexity and the stress that we are currently under in healthcare. We knew as we were coming out of COVID and saw all the stresses on our workforce and knowing that we were not going to get back to normal, that we really needed to innovate and look at different models of care, that speed up to meeting with Bruce and his team at care.ai really felt like they were going to be an excellent partner, both by the advanced technology that is there, but also culturally and really willing to innovate with us. And so we so appreciate that.

What virtual nursing is, and you'll hear me starting to call it virtual care because it's going to involve our interprofessional team as well, is where there is a nurse that is at a hub at a computer, but with two-way camera so that we can actually go into the room virtually and talk to family, and talk to the patient, and they can respond back. They can see that virtual nurse on the TV. Why would we do that? Because there are a lot of administrative duties that our licensed nurses need to do, whether it's admissions, or discharges, or discharge teaching, or medication reconciliation, that you really don't need to be to provide on hands-on care. And it's more efficient for a nurse to be taking care of those administrative duties and relieve the bedside nurse of those duties, so that the bedside nurse is not sitting at a computer all day.

Now, what's beautiful about this is that was just the beginning hypothesis. The adult world has tried this, we're fresh on the pediatric front. What we have found Carol, is that not only are we relieving that administrative duty, therefore making it more likable to be a nurse on the floor and doing the hands-on, typically the work that nurses enjoy, interacting with patients and families, but we have found a lot of other benefits already. We are seeing that there are quality and safety benefits from either catching some of the things that might've not been clear to a family, or clarifying the discharge orders, or making sure that the medications are as we anticipated that they would be. So, those kind of things have really benefited. We have found that our workforce, especially our new graduates and our newer nurses benefit from having a more experienced virtual nurse there that they can actually use as a coach and a mentor.

We are also seeing that using virtual nursing, we're seeing that our discharge rate is more efficient. We're seeing that our length of stay is going down. We're seeing that the ability to complete the different educational teachings are really improving.

So, I would recall the first meeting that I had with Bruce and we were talking about virtual care and he goes, "Jane, just the tip of the iceberg." So what you've heard me talk about is not the AI portion of it yet, but what we are doing is getting comfortable with all the technology and bringing it into the patient room and doing this interface, so that where I would say it's the foundational of what is yet to come. Very exciting.

Carol Vassar, podcast host/producer:

So virtual care is the foundation here, which marries nicely with the platform, care.ai, from what I'm hearing. So Bruce, pick up the story from what Jane just eloquently described, and what is a virtual hospital?

Bruce Brandes, President, care.ai:

Great. So let me start just by saying, I don't know one nurse that was inspired to go to nursing school to do paperwork and type into an electronic medical record.

Carol Vassar, podcast host/producer:

True.

Bruce Brandes, President, care.ai:

So to Jane's point, we want to start with quick wins where there's an immediate problem to be solved. And I'll also go back to the analogy of the car. Think about the incremental improvements that were made by having a backup camera in a car. I get in fewer fender benders in a parking lot. It's absolutely incrementally better and it's now standard. And so I think of virtual nursing and virtual inpatient care is kind of that first step, that backup camera. But the true transformational change in transportation is through autonomous driving cars, where we can look at legacy costs and inefficiencies that we've just grown to accept.

And so for us, the way we've architected virtual nursing and virtual inpatient care is not just putting a camera in the room that you could buy at Best Buy. We actually purpose build our medical device to have that bidirectional camera so that we can do that and take control of the TV, but it's actually a much, much more sophisticated system in there that does computing on the edge so that it's digesting a lot of information using advanced sensors that I mentioned. Use computer vision, LiDAR, radar, the same type of technology that are watching as you're driving a car.

Apply that to healthcare so that all the data that needs to be understood of what's happening in a patient care space in any given moment is captured first of all, because today we're limited by what a human being sees or hears and takes the time to type into a computer or if you happen to be hooked up to a patient monitor. So there's a subset of the data that we have. And then the second is as we capture that data, to then apply it to specific use cases where we create AI algorithms that take that data and then apply it toward action.

And so examples in the adult setting that we've started with are things like falls prevention, not falls detection, but falls prevention, pressure injury prevention, hand hygiene compliance, rounding compliance. So we can capture a lot of data, what's happening. And what's exciting about our partnership with Nemours is, we know that in the pediatric setting, there are very specific use cases that this technology can have real value in right out of the gate. So we don't want to get distracted with the foundation being put in place first. But the nice thing about this model is, and the partnership we have is, we listen well, we iterate quickly. We have a great partner who understands the issues very well, and together we will continue to layer in all of the other use cases that are possible. And at the end of the day, what we really want to do is take all of the administrative and clerical burden off of our caregivers and arm them with the best possible information so that they can do the things that only human beings can do, which is care for our patients.

Carol Vassar, podcast host/producer:

Can you share with us one of those use cases, maybe off the top of your head?

Bruce Brandes, President, care.ai:

In the pediatric setting where we've talked about ambient monitoring for children tugging at their lines, so that if something comes dislodged. We've also talked about patient self-harm. We have a lot of live sitters that have to monitor a patient that might be at risk for harming themselves. Well, why not be able to care for every patient in that way, using ambient capabilities to detect motions and listen to agitation of voice and other things?

The other thing that I'll say is, going back to the foundational pieces. There's a lot we can do today with the foundational piece of the bidirectional camera to be able to involve the family members in care. And so there are a lot of quick wins before we get ahead of painting this picture of the smart hospital with what sounds like futuristic technology, there's a lot that we can do immediately today just by applying the capabilities we have. And that's really where we're focused as phase one with Nemours and our other pediatric hospitals and our other clients in general, is to build that foundation because then layering in those other use cases becomes very easy because because the sensors are already in the room.

Carol Vassar, podcast host/producer:

Jane?

Jane Mericle, Nemours Children's Health:

And I think one of the things that we can do very soon is these cameras are so capable that you can literally go in and look at a patient's pupil through the camera. And so there are tasks that nurses do that need a second nurse, like our changing our central line dressings, or double checking a medication, or things like that, that now we'll be able to just push a button and ask the virtual nurse to be the second nurse. Right? Today, I'm looking down the hall to see who's available and often, everybody's busy. So those are the kind of practical things that we can do.

But one of the things that, and I get ahead of myself, Bruce and I have talked about is, what about that voice activation? Can I imagine a day where a team rounds and the roles are recognized and go right into that computer and you don't have people documenting? There's all kinds of... Making it almost the what we know as the Alexa or the Hey Google, right? And being able to pick up distress maybe, and the family and respond to that because of that. There are so many applications. So I think that some of the things are still ideas, some of the other things are we can do tomorrow. We are finding that we're needing to prioritize.

The one other point I'd like to make is that Bruce talked about, sometimes technology happening to our teams, and so our teams have to adjust around that technology. The beauty of this is, from the very beginning with this virtual care, we have involved our frontline nurses and other team members who actually are doing the work to help design the processes, the flow, what things we can do first, and we're using them to help set the pace. So that as we started with two innovative units, one in Florida, one in Delaware, where both of our hospitals are, and now are spreading that. So the intention is to be able to use that wherever we're delivering inpatient care. And so we're putting that technology in.

Bruce Brandes, President, care.ai:

And what's particularly exciting is once these caregivers at the bedside understand what's possible with the technology, they know what issues are most pressing for them and the families that they're caring for. And what we're finding is they come up with other use cases, many of which requires no additional development on our part, it's just additional workflow as they're starting to think.

And I'll give you a couple of good examples. We had one client who in the spare time that the nurse had in between admissions and discharges, was just intentionally doing purposeful rounding. And this was in an adult hospital where she rounded and went into a patient's room virtually, found that the patient was non-responsive, and called a code. Apparently the patient had just had a seizure and they resuscitated the patient and patient turned out to be fine. But if not for her doing that and having the ability to virtually go into the room, it would've been another four hours before somebody on the floor would've checked on that patient and it might've been a very different outcome. So-

Carol Vassar, podcast host/producer:

So this is life-saving technology, when it really boils down to it.

Bruce Brandes, President, care.ai:

It's empowering caregivers to do what they're great at, which is to care for patients and get the other stuff out of the way.

Jane Mericle, Nemours Children's Health:

And the other thing, the case uses that we're going to use is also bringing our interpreters into the room virtually so that they can help. Sometimes you're waiting or you may sometimes not communicate as effectively with a family because English is not their first language. And so we can bring that resource right into the room. There are so many applications. I love the one that Bruce brought to us from another client where their hospital was engaged in patient and family-centered rounds. And sometimes, once again, the care nurse can't come right to that bedside because they're busy with something else. Well, the virtual nurse can then come in and be a part of those family-centered rounds with the team.

We're finding that our patient satisfaction scores are going up, because I think that our families are also finding the benefit of having this layer and this interaction. At first we were worried, how are our families going to feel about this? Is this going to feel funny? Interestingly, I think that's one of the things that the world of COVID helped us with. People were kind of used to this virtual interaction, and so we just capitalized on it and we're finding that we can do a lot more with the virtual care.

Bruce Brandes, President, care.ai:

And to build off of that, one of the quickest wins is especially in a pediatric setting where you have potentially multiple parents and grandparents who are working or might be in different cities. The physician or the virtual nurse, as they're meeting with the patient and explaining what's happening, they can pull in just like you can into a Zoom meeting. We send what essentially shows up as a text. You click on the link, give permission for your camera and microphone, and now you are in that meeting to hear exactly what the physician is explaining or what, if the nurse has questions about, "Hey, tell me again what meds this child is on." And the parent at the bedside doesn't know. This is a way to pull in all the right stakeholders to get all the right information. And one of the outcomes that come from that, because we're capturing better information upfront on things like meds administration. We have one of our clients just reported that they've reduced in the first six months, reduced adverse drug events by 50%.

Carol Vassar, podcast host/producer:

Wow.

Bruce Brandes, President, care.ai:

Because they're capturing better meds history upfront. And then on the back end, because all of the family understands the discharge instructions and make sure that their pharmacy is, that they're getting their meds, they're going home with their meds, that the readmission rate-

Carol Vassar, podcast host/producer:

Decrease.

Bruce Brandes, President, care.ai:

... is decreasing because everybody understands. And if they don't speak English, the interpreter is on part of it within 10 seconds.

And by the way, I should mention, we don't do interpretive services. This is to leverage the existing interpretive services that the hospital uses. Just like, this technology is designed to be invisible, just like from a workflow perspective, it's embedded into the electronic medical record, the existing nurse call system, pulling data from other patient monitors. If you have a large language model that you're using for documentation for virtual scribes, we can run that large language model on our platform so that you don't have to have a separate device in the room. So this truly is designed to be a universal technology that works within the existing infrastructure and assets, and becomes invisible to fill in gaps that we have to transform these types of outcomes.

Carol Vassar, podcast host/producer:

So much potential, so much that can happen. I'm hearing a lot about cameras and EHR access. How do you ensure privacy, Jane?

Jane Mericle, Nemours Children's Health:

We actually have our teams looking at that. We always ask for permission, like knock on the door, to come in and see the family. And then there's a light that actually shines so that a family member could see if it was on. So we do not go in without the family's permission unless there's an emergency. And we've had a cascade of alarms that have gone off and we feel like we need to be able to check on the patient.

Bruce Brandes, President, care.ai:

And the camera's always pointed at the ceiling when it's off. So it's pretty clear that it's not watching. The other thing is, and I mentioned to you, the ambient sensors uses computer vision, which is essentially a de-identified, I just see the outline of a human being, the outline of the bed. So it doesn't identify the human being, we just know that this is a patient in need.

The other thing that I'll say is, we never record anything. So this is real time. So from a HIPAA standpoint, we don't store any information, this is the EMR's information is the system of record. So we're not taking information from the EMR that could compromise from that perspective. And the system is always available.

Carol Vassar, podcast host/producer:

In terms of data collected, a lot of data is collected. Does that help care.ai to become a better platform and ultimately benefit patients? And also, can it be used in a de-identified form, of course, for research purposes?

Bruce Brandes, President, care.ai:

You're touching on a great area of future opportunity. One, today we do capture a lot of data to help train our algorithms around falls prevention, for example. So again, de-identified data helps our algorithms become more precise in terms of how they act, and that's one of the reasons why we're excited to work with Nemours. And we're also working with Akron Children's and Children's of Orange County, which gives us a building database to train algorithms for pediatric use cases as well. As well as the aggregated data, to your point, properly stored and de-identified creates a lot of additional research opportunities because it's data that today we don't have, we are very early in this journey. We've covered a lot of ground on a lot of things that can be done today and also a lot of potential for what can be done in the future. I always describe, we're in very early innings. A key reason why we came together with Stryker is because now we have the resources to really do this at scale on a global basis, to be able to benefit everyone who could have this.

I think too often in healthcare, we've been slow and the status quo has been acceptable to us. And I think for the first time now, we have a real great opportunity for transformation. And we know that our hospitals can't end up like Sears and JCPenney and Kmart. We have to figure out, how do we empower our caregivers to do the things that they were originally trained to do? To empower our hospitals to build a care delivery mechanism that eliminates a lot of the traditional geographical boundaries and temporal boundaries and monetary boundaries that have limited our ability to deliver care everywhere that it's needed. And this is really the very, very tip of the spear. In terms of where all this can go as we start to create smart hospitals and smart care teams.

Jane Mericle, Nemours Children's Health:

And I would add to that and say that our desire is not only to impact the children and the health of children in our care, but the health of children everywhere. And so what we are finding is that we will collaborate, and we've already started publishing, we want to share our experiences. And I have to brag about children's hospitals in general, we really do work together to learn together, and so this is going to be transformational. This is not the kind of care I delivered as a young nurse, and I'm just very excited about the future and how we will move forward on this.

Carol Vassar, podcast host/producer:

Jane Mericle on care.ai. Jane is Nemours Executive Vice President, Enterprise Chief Nursing Executive, and Patient Operations Officer. We also heard from Bruce Brandes, President of care.ai.

Music:

Well Beyond Medicine.

Carol Vassar, podcast host/producer:

Thanks to Jane and Bruce for taking time to talk with us while at the 2024 American Academy of Pediatrics Experience National Conference in Orlando. More of our interviews with healthcare leaders from AAP coming your way in the next few weeks, including an important discussion on firearm safety for children and youth. That's next time, on the Nemours Well Beyond Medicine podcast. Please join us.

Missed an episode? We have a solution for that. Head over to NemoursWellBeyond.org, and subscribe to the podcast to have episodes delivered to you each and every Monday, or catch up on episodes you may have missed. That's NemoursWellBeyond.org. Our production team this week includes Cheryl Munn, Susan Masucci, and Lauren Teta. I'm Carol Vassar. Until next time, remember, we can change children's health for good well beyond medicine.

Music:

Let's go, oh, oh, Well Beyond Medicine.