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A nurse’s take on AI

The ideas and innovators shaping health care
Nov 14, 2023 View in browser
 
Future Pulse

By Daniel Payne, Evan Peng, Ruth Reader and Erin Schumaker

WORKFORCE

Nursing assistant 29-year Daria from Ukraine measures the blood pressure of a patient at the St. Johannes hospital in Dortmund, western Germany, on May 10, 2023. Within the framework of the promotion of the recruitment of skilled workers from non-European countries, against the background of the acute shortage of skilled workers in the health and care sector, approximately 80 people,   including 20 nurses from Ukraine, have been trained as nursing staff at the Johannes hospital to date. In order to be able to start a new working life in an unfamiliar country, the linguistic, professional and cultural integration of international nurses into the world of the German hospital system is of extraordinary importance. (Photo by Ina FASSBENDER / AFP) (Photo by INA FASSBENDER/AFP via Getty Images)

Nurses don't see how AI can replace all they do. | AFP via Getty Images

A major nurses’ union is making its position on artificial intelligence in health care plain: The tech comes with big risks.

How so? National Nurses United brought the message to Senate Majority Leader Chuck Schumer’s recent AI forum in which he heard from stakeholders likely to feel the impact of AI use.

Bonnie Castillo, the group’s executive director, told Daniel that the systems have already, in some instances, been “imposed" on them and are making their lives more difficult.

“It's a stumbling block,” she said in an interview. “There’s been a great deal of frustration.”

The nurses’ case: The systems limit human judgment in health settings and, therefore, put patients at risk, Castillo said, adding they often devalue the work and skills of nurses.

Many health care industry leaders see AI as a tool to improve outcomes, increase access and reduce costs.

But for now, Castillo sees them as more burdensome than helpful.

She said that earlier technology, such as electronic health records, promised to ease the load of health workers — but is now synonymous with tedious documentation tasks loathed by many in the profession. And even after years of use, EHR systems haven't fulfilled their promise, she said — suggesting AI could have the same fate.

“Think of all the time that was there to fix it,” she said of EHRs. “It's really hard for me to have a lot of confidence that they’re going to do what’s in the best interest of the patient or the consumer.”

What’s next? The nurses’ union is calling on lawmakers to be cautious when regulating technology and put privacy, patient safety and workers’ rights at the center of their efforts.

“Health care is unique, and nursing in particular cannot be replaced by AI,” she said.

 

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This is where we explore the ideas and innovators shaping health care.

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THE NEXT CURES

CHENGDU, CHINA - DECEMBER 1: (CHINA OUT)  A migrant worker wears a red ribbon during an event organized by the local government to promote HIV/AIDS knowledge among migrant workers on December 1, 2005 in Chengdu of Sichuan Province, southwest China. China has pledged to keep the number of people living with HIV/AIDS below 1.5 million by 2010, Health Minister Gao Qiang stated at a media conference.  (Photo by China   Photos/Getty Images)

New tech could help get HIV preventive drugs to the people who need them. | Getty Images

To stop HIV, machine learning could help.

A team including researchers from Harvard developed an automated decision support tool with interactive alerts to help primary care clinicians identify patients likely to benefit from PrEP drugs, which prevent HIV infection.

How it works: The tool used a prediction model to identify patients at increased risk for HIV. It then prompted caregivers to initiate a discussion about a patient’s options, complete with a sample script.

Patients at clinics that used the tool received PrEP prescriptions at 4.5 times the rate of those at clinics that didn’t.

Why it matters: PrEP could end the spread of HIV in the United States, if only public health officials could figure out how to get people to take it.

Overall in the U.S., more than a third of those who could benefit are taking PrEP, but coverage remains greatly stratified across demographics, with uptake lagging among Black people, Latino people and women.

And doctors rarely raise PrEP during checkups. In one Veterans Health Administration study, 94 percent of PrEP discussions were initiated by patients.

Interviews with providers who used the automated tool said it helped facilitate PrEP discussions, particularly for clinicians who otherwise would not have broached the issue themselves due to feelings of stigma.

Even so: House Republicans plan this week to pass a bill that would cut most funding for a core component of the federal government’s PrEP efforts.

 

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INNOVATORS

Doctor n a computer inside the emergency department

Companies are pitching AI as a helping hand for overworked docs. | Geoffroy Van Der Hasselt/AFP via Getty Images

One use case for AI in health care isn’t as controversial as the rest: burnout cure.

That’s the aim of Abridge, a company that develops tools meant to reduce paperwork and, as a result, burnout using generative AI, which produces, or generates, content.

How so? The company is one of many that says its systems can do the paperwork usually left to a doctor or nurse — and give those workers two to three hours of their days back — by converting their patient conversations into notes they can review instead of having to perform the lengthy process of inputting the information themselves.

Burnout is difficult to address, given the time needed to teach more professionals how to deal with growing patient loads — and that’s what makes the tech appealing.

“What’s most important is to support the front lines urgently,” Dr. Tina Shah, Abridge’s chief clinical officer and former adviser to the surgeon general, told Daniel. “We have no time to lose.”

Big bets: Late last month, Abridge announced $30 million in series B investments — including support from CVS Health Ventures, Kaiser Permanente Ventures, Lifepoint Health, the Mayo Clinic, The SCAN Group, UC Investments (from the University of California) and the American College of Cardiology.

Next steps: The company hopes to move beyond helping draft notes to also making sense of them: a concept that excites and worries innovators and regulators.

“Abridge is not technology simply to take away the burden of writing a note,” Shah said, noting the promise of AI breaking language barriers with patients and eventually taking input from diagnostic tests. “It’s really technology to aid in every single way.”

 

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