Trends in Healthcare & Governance

Have you heard of ChatGPT, the new artificial intelligence tool that is taking the digital world by storm? OpenAI launched this tool in November and quickly reached more than a million active users in five days and over 100 million in 60 days.

AI is changing the face of business and healthcare, so trustees and executives must understand the capabilities of this emerging technology and how it might bring opportunities and threats to their organizations.

What is ChatGPT?

It is a simulated “chatbot” primarily designed to interact with customers on a website, provide information on products, answer frequently asked questions and process orders. Using data from sources including textbooks, websites and articles, ChatGPT generates responses to a wide range of queries. Mimicking human speech, ChatGPT interacts in a conversational way and answers follow-up questions, admits its mistakes, challenges incorrect premises and rejects inappropriate requests.

What is ChatGPT currently used for?

Surveys report that almost half of U.S. companies are already using it and 93% of them are looking to expand its use further in upcoming months.

It is a handy tool for content generation, so businesses are using it for purposes including:

• writing emails and articles;
• creating presentations;
• managing meetings;
• drafting business plans;
• generating code;
• making calculations;
• summarizing books;
• creating flyers and brochures; and
• crafting website or social media posts.

How is it transforming healthcare?

ChatGPT is already transforming the way healthcare providers deliver care to their patients — and we haven’t yet scratched the surface of its capabilities. Expect to see ChatGPT-like tools aiding clinicians with its ability to emulate how doctors make clinical decisions, provide around-the-clock medical assistance, prevent medical errors and improve physician performance.

Like other automation tools, it’s great for non-clinical, back-office tasks. Uses can include:

• virtual assistant for telemedicine;
• clinical decision support;
• medical recordkeeping;
• medical translation;
• medication management;
• disease surveillance;
• medical writing and documentation;
• clinical trial recruitment;
• creating symptom checkers;
• patient triage;
• drug information;
• medical education;
• mental health support; and
• remote patient monitoring.

Epic announced that it will use GPT-4 in its electronic health records to help physicians and nurses spend less time at the keyboard, and to help them investigate data in more conversational, easy-to-use ways.

Considerations

While there are many benefits of ChatGPT, there are also significant challenges and concerns. First, it isn’t using reasoning to create the output, so sometimes the tool is just plain wrong. The information it provides may contain biases and may present opinions as facts and it does not offer sources or citations for the information it uses, raising the issue of credibility.

It’s apparent that AI won’t replace healthcare professionals any time soon. But AI tools will increasingly be used to help them do their jobs better and more efficiently. For an in-depth look at ChatGPT, read HANYS’ recent HIT Update.

To prepare, leaders should assess potential risks and opportunities, and discuss ethical, accountability, transparency and liability implications. Policies should be developed before allowing use, including a commitment to ongoing education and training for healthcare providers, regular evaluations of the tool’s performance and outcomes, and continuous efforts to mitigate any potential biases and challenges.

By addressing all of these issues, leaders can ensure that this tool is used to enhance the quality of care for all patients, while protecting their privacy, security and rights, and the organization’s compliance with relevant regulations.

Information for this article was obtained from:

• Introducing ChatGPT – OpenAI
• Epic to use Microsoft's GPT-4 in EHRs – Becker’s Hospital Review
• 5 Ways ChatGPT Will Change Healthcare Forever, For Better – Forbes
• What does ChatGPT mean for Healthcare? – News-Medical.Net
• Revolutionizing Healthcare: The Top 14 Uses Of ChatGPT In Medicine And Wellness – Forbes
• Could ChatGPT technology join the board? – Board Agenda
• 10 Ways Businesses Are Using ChatGPT Right Now – tech.co
• Envisioning the Healthcare Landscape with ChatGPT – NYMC (note this article was written entirely by ChatGPT!)

Hospitals across New York and the nation have reported an alarming rise in patients who become caught in limbo in emergency departments and inpatient units for weeks, months and even years after they are medically ready for discharge.

These delays most often occur due to a lack of care options, administrative gridlock and/or the inability to pay for post-discharge care. Complex case discharge delays, also known as bed blocking or boarding, are devastating for patients, exacerbate bed shortages and result in enormous, unnecessary costs.

Trustees should have a good understanding of the problem to be able to discuss it in the boardroom and advocate for their organizations.

HANYS conducted a three-month data collection pilot in 2022 with hospitals statewide to learn more about the scope of the problem and recently released the results. This builds off of HANYS’ 2021 white paper, The complex case discharge delay problem, which provided an overview of this longstanding challenge and offered suggested actions.

The data collection pilot sought to estimate the number of patients who, for circumstances largely outside hospitals’ control, were unable to be safely discharged and spent more than four avoidable days in the emergency department and/or more than 14 avoidable days in an inpatient unit between April 1 and June 30, 2022.

For the three-month data collection period, 52 participating New York hospitals reported:

• 1,115 patients impacted;
• approximately 60,000 delay days;
• an average ED discharge delay of close to two weeks;
• an average hospital inpatient unit discharge delay of two months; and
• $169 million in estimated associated costs (for much of which hospitals receive no reimbursement).

Who experienced the most frequent and longest delays?

Children and older adults living with medically complex and/or behavioral health conditions.

What caused the delays?

An absence of post-discharge care options, followed by a lack of insurance coverage or means to pay for post-discharge care, and extended administrative processes, such as state and local agency referrals and determining eligibility for services and benefits.

To learn more details and a framework to focus solutions, review the full report: The scope of complex case discharge delays in New York state.

HANYS shared the pilot findings and recommendations with policymakers. We continue our work to develop policy solutions and strategies to address this longstanding challenge.

Trustees can help support their organizations by sharing their facility’s complex case discharge experiences and the impacts on patients and care delivery with legislators and media.

Information for this article was obtained from HANYS’ Complex Case Discharge Delay webpage.

The healthcare industry is undergoing substantial transformation; board governance is too. The American Hospital Association recently released its latest triennial report on governance structures and practices at U.S. hospitals and health systems, based on data from 933 hospital and health system CEOs surveyed between November 2021 and March 2022.

The survey report describes board structures, composition, culture, diversity and other practices that are transitioning in today’s changing environment. Board members and executives are encouraged to compare their own structures and practices with the report’s findings.

To help, the report provides commentary from an array of governance experts and discussion questions to help boards evaluate where they are rising to meet challenges and opportunities for improvement.

The AHA survey report highlights positive governance trends including:

• Progress has been made in racial/ethnic diversity and gender diversity on boards.
• Ninety-one percent of respondents said they are interested in identifying and engaging board candidates who represent diverse characteristics.
• Nearly 70% of all responding boards have engaged in restructuring to improve their governance.
• The use of knowledge, skills and behavioral competencies to select board members has steadily increased in the past decade. This is considered a governance best practice.
• The use of a board portal, considered a governance best practice, has become more prevalent.

However, there are opportunities for improvement:

• A third of respondents’ boards did not use term limits.
• Survey results indicated a growing number of older board members and a declining number of younger members.
• More than 75% of respondents’ boards either did not replace board members during their terms or continued to reappoint them when eligible during the past three years, resulting in low levels of board turnover.
• Sixty-one percent said they do not have a continuing education requirement for board members.
• More than a quarter of boards did not do any type of assessment in the past three years.
• About half of all boards do not hold the CEO accountable for diversity, equity and inclusion goals as part of their performance review.

AHA’s 2022 National Health Care Governance Survey Report is complimentary to AHA members.

Information for this article was obtained from AHA Trustee Services. © Used with permission of the American Hospital Association.

For a board to be effective, it must first be engaged. Today’s complex and volatile healthcare environment requires that boards be highly engaged in the mission and business of your hospital or health system.

While not all-inclusive, here are seven activities that can support board member engagement:

1. Provide board members with clear job descriptions and share your vision of what board engagement looks like.
2. Have a thorough on-boarding and orientation process for new members, and assign a mentor.
3. Involve board members in activities beyond the board room, such as programs, events, meetings and other opportunities to interact with stakeholders — leading them to fresh insight into your organization’s mission and business.
4. Make sure your board meetings have plenty of opportunities for meaningful discussion.
5. Make it clear board members should question assumptions; probing questions are welcome at meetings.
6. Make sure board members receive materials with ample time to review before board meetings.
7. Make information easy to find for board members — allow them to satisfy their own curiosity.

People join boards because they want to contribute — and the way their time is spent at board and committee meetings can make a big difference. In his article, The right stuff, the right way. Barry Bader identifies 10 steps for optimizing the way a board uses its meeting time and 10 ideas for creating more engaging board meetings.

How do you know if your board is engaged? Board member engagement can be measured by tracking attendance, evaluating preparation for meetings, having candid board discussions and assessing whether there’s a positive, constructive relationship with the CEO and mutual trust and respect among board members. But this only provides a partial view. Ultimately, trustees need to provide direct input through a board assessment. Results of the assessment should be used to make improvements and work to achieve the level of governing excellence required for success in today’s challenging healthcare environment.

Information for this article was obtained from “7 Ways to Destroy Board Engagement,” Board Effect; “The right stuff, the right way: 10 ways to improve board meetings”, AHA Trustee Services; and “Assessing the Engagement and Effectiveness of Boards”, AHA Trustee Services.