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Hiring More Nurses Generates Revenue for Hospitals

Underfunding is driving an acute shortage of trained nurses in hospitals and care facilities in the United States. It is the worst such shortage in more than four decades. One estimate from the American Hospital Association puts the deficit north of one million. Meanwhile, a recent survey by recruitment specialist AMN Healthcare suggests that 900,000 more nurses will drop out of the workforce by 2027. American nurses are quitting in droves, thanks to low pay and burnout as understaffing increases individual workload. This is bad news for patient outcomes. Nurses are estimated to have eight times more routine contact with patients than physicians. They shoulder the bulk of all responsibility in terms of diagnostic data collection, treatment plans, and clinical reporting. As a result, understaffing is linked to a slew of serious problems, among them increased wait times for patients in care, post-operative infections, readmission rates, and patient mortality—all of which are on the rise across the U.S. Tackling this crisis is challenging because of how nursing services are reimbursed. Most hospitals operate a payment system where services are paid for separately. Physician services are billed as separate line items, making them a revenue generator for the hospitals that employ them. But under Medicare, nursing services are charged as part of a fixed room and board fee, meaning that hospitals charge the same fee regardless of how many nurses are employed in the patient’s care. In this model, nurses end up on the other side of hospitals’ balance sheets: a labor expense rather than a source of income. For beleaguered administrators looking to sustain quality of care while minimizing costs (and maximizing profits), hiring and retaining nursing staff has arguably become something of a zero-sum game in the U.S. The Hidden Costs of Nurse Understaffing But might the balance sheet in fact be skewed in some way? Could there be potential financial losses attached to nurse understaffing that administrators should factor into their hiring and remuneration decisions? Research by Goizueta Professors Diwas KC and Donald Lee, as well as recent Goizueta PhD graduates Hao Ding 24PhD (Auburn University) and Sokol Tushe 23PhD (Muma College of Business), would suggest there are. Their new peer-reviewed publication* finds that increasing a single nurse’s workload by just one patient creates a 17% service slowdown for all other patients under that nurse’s care. Looking at the data another way, having one additional nurse on duty during the busiest shift (typically between 7am and 7pm) speeds up emergency department work and frees up capacity to treat more patients such that hospitals could be looking at a major increase in revenue. The researchers calculate that this productivity gain could equate to a net increase of $470,000 per 10,000 patient visits—and savings to the tune of $160,000 in lost earnings for the same number of patients as wait times are reduced. “A lot of the debate around nursing in the U.S. has focused on the loss of quality in care, which is hugely important,” says Diwas KC. But looking at the crisis through a productivity lens means we’re also able to understand the very real economic value that nurses bring too: the revenue increases that come with capacity gains. Diwas KC, Goizueta Foundation Term Professor of Information Systems & Operations Management “Our findings challenge the predominant thinking around nursing as a cost,” adds Lee. “What we see is that investing in nursing staff more than pays for itself in downstream financial benefits for hospitals. It is effectively a win-win-win for patients, nurses, and healthcare providers.” Nurse Load: the Biggest Impact on Productivity To get to these findings, the researchers analyzed a high-resolution dataset on patient flow through a large U.S. teaching hospital. They looked at the real-time workloads of physicians and nurses working in the emergency department between April 2018 and March 2019, factoring in variables such as patient demographics and severity of complaint or illness. Tracking patients from admission to triage and on to treatment, the researchers were able to tease out the impact that the number of nurses and physicians on duty had on patient throughput. Using a novel machine learning technique developed at Goizueta by Lee, they were able to identify the effect of increasing or reducing the workforce. The contrast between physicians and nursing staff is stark, says Tushe. “When you have fewer nurses on duty, capacity and patient throughput drops by an order of magnitude—far, far more than when reducing the number of doctors. Our results show that for every additional patient the nurse is responsible for, service speed falls by 17%. That compares to just 1.4% if you add one patient to the workload of an attending physician. In other words, nurses’ impact on productivity in the emergency department is more than eight times greater.” Boosting Revenue Through Reduced Wait Times Adding an additional nurse to the workforce, on the other hand, increases capacity appreciably. And as more patients are treated faster, hospitals can expect a concomitant uptick in revenue, says KC. “It’s well documented that cutting down wait time equates to more patients treated and more income. Previous research shows that reducing service time by 15 minutes per 30,000 patient visits translates to $1.4 million in extra revenue for a hospital.” In our study, we calculate that staffing one additional nurse in the 7am to 7pm emergency department shift reduces wait time by 23 minutes, so hospitals could be looking at an increase of $2.33 million per year. Diwas KC This far eclipses the costs associated with hiring one additional nurse, says Lee. “According to 2022 U.S. Bureau of Labor Statistics, the average nursing salary in the U.S. is $83,000. Fringe benefits account for an additional 50% of the base salary. The total cost of adding one nurse during the 7am to 7pm shift is $310,000 (for 2.5 full-time employees). When you do the math, it is clear. The net hospital gain is $2 million for the hospital in our study. Or $470,000 per 10,000 patient visits.” Incontrovertible Benefits to Hiring More Nurses These findings should provide compelling food for thought both to healthcare administrators and U.S. policymakers. For too long, the latter have fixated on the upstream costs, without exploring the downstream benefits of nursing services, say the researchers. Their study, the first to quantify the economic value of nurses in the U.S., asks “better questions,” argues Tushe; exploiting newly available data and analytics to reveal incontrovertible financial benefits that attach to hiring—and compensating—more nurses in American hospitals. We know that a lot of nurses are leaving the profession not just because of cuts and burnout, but also because of lower pay. We would say to administrators struggling to hire talented nurses to review current wage offers, because our analysis suggests that the economic surplus from hiring more nurses could be readily applied to retention pay rises also. Sokol Tushe 23PhD, Muma College of Business The Case for Mandated Ratios For state-level decision makers, Lee has additional words of advice. “In 2004, California mandated minimum nurse-to-patient ratios in hospitals. Since then, six more states have added some form of minimum ratio requirement. The evidence is that this has been beneficial to patient outcomes and nurse job satisfaction. Our research now adds an economic dimension to the list of benefits as well. Ipso facto, policymakers ought to consider wider adoption of minimum nurse-to-patient ratios.” However, decision makers go about tackling the shortage of nurses in the U.S., they should go about it fast and soon, says KC. “This is a healthcare crisis that is only set to become more acute in the near future. As our demographics shift and our population starts again out, demand for quality will increase. So too must the supply of care capacity. But what we are seeing is the nursing staffing situation in the U.S. moving in the opposite direction. All of this is manifesting in the emergency department. That’s where wait times are getting longer, mistakes are being made, and overworked nurses are quitting. It is creating a vicious cycle that needs to be broken.” Diwas Diwas KC is a professor of information systems & operations management and Donald Lee is an associate professor of information systems & operations management. 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Rural health documentary earns Peabody Award for Georgia Southern professor

Georgia Southern University Professor Matthew Hashiguchi has won a Peabody Award for his documentary, “The Only Doctor,” which focuses on rural health and the services provided by a single doctor in southwest Georgia. The Peabody Awards are prestigious accolades in storytelling across television, radio, streaming and other digital mediums. Categories for winning a Peabody include journalism, social video, interactive documentary, gaming and more. The nearly hour-long feature received the award in the Public Service category, which recognizes projects that address or respond to public health concerns, enhance public engagement or educate the public. For Hashiguchi, the award represents a personal and career accolade. “This award isn’t just a professional achievement, but also represents a moment in my life where I became a father,” said Hashiguchi. “I started filming right before my first daughter was born, and finished right after the second. While this award is an incredible acknowledgment of my work, it means even more to me as a priceless moment from their childhood.” The documentary focuses on Karen Kinsell, M.D., the sole physician serving 3,000 citizens in Clay County, Georgia, near the Georgia-Alabama border. The film spotlights the plight of a community in need of medical assistance and the dedicated doctor fighting to keep her clinic’s doors open. Hashiguchi delves into Kinsell’s sacrifices for her clinic’s operations, revealing her commitment to her patients. “Dr. Kinsell gets calls at home at all hours of the day and night,” Hashiguchi said. “She, at times, has had to pay the bills from her own bank account. But I’d say the biggest sacrifice is that she’s a doctor who does not have breaks.” The final cut of “The Only Doctor” is a bit different from the angle Hashiguchi took when he began work on it several years ago. He initially started the project to better understand the risks associated with maternal health care and childbirth when he and his wife were expecting their first child. Through his work, he learned of a more complex issue of health care access in rural communities. The documentary first premiered on the PBS program Reel South and is now available internationally on Al Jazeera’s documentary series “Witness.” Hashigchi’s work earned him a 2019 Gucci Tribeca Documentary Fund award and a 2021 American Stories Documentary Fund award from Points North Institute. The film’s world premiere took place at the 2023 Hot Docs International Documentary Film Festival in Toronto, Canada, and was awarded Best Documentary Feature at the 2024 South Georgia Film Festival, Best Feature at the 2023 Newburyport Documentary Film Festival and Award of Merit at the 2023 University Film and Video Association Conference. His rise to media prominence wasn’t on his radar early in his academic career. He described himself as a “C student,” and still sees himself as that young boy struggling with math and science courses. With one of the nation’s highest media honors, he can show his students new paths to success as well as the skills it takes to win a Peabody. “I want my students to know how I failed and know that I struggled,” he said. “I tell them that if they want to excel, they really have to put in hard work. That’s very much who I am now as I devote myself to these films.” If you're interested in learning more and want to book time to talk or interview with Matthew Hashiguchi then let us help - simply contact Georgia Southern's Director of Communications Jennifer Wise at jwise@georgiasouthern.edu to arrange an interview today.

ChristianaCare Brings Primary Care and Neurointerventional Care to Sussex County at New Milford Location

ChristianaCare is enhancing care options in Milford, Delaware, with the addition of two highly skilled physicians to better serve the community's growing health needs. Chinwe Ike-Chinwo, M.D., is a board-certified primary care physician with a special interest in preventive medicine. Thinesh Sivapatham, M.D., is a fellowship-trained neurointerventional surgeon and member of ChristianaCare's Neurointerventional Surgery team, specializing in minimally invasive techniques to treat conditions affecting the blood vessels of the head, neck and spine, including strokes and aneurysms. The practice is located at Halpern Plaza, 701 N. DuPont Blvd. To schedule an appointment, patients can call 302-725-3420. Convenient and Accessible Primary Care At the new ChristianaCare Primary Care at Milford practice, Ike-Chinwo is passionate about building long-term relationships with her patients, helping them achieve optimal health through personalized care. “I am excited to serve the Milford community and help individuals achieve their best health,” she said. “Through prevention, chronic disease management and wellness care, we aim to support our patients in leading healthier, more fulfilling lives.” Ike-Chinwo introduces herself in this video. The primary care practice offers a comprehensive range of services to adult patients, including sick visits, immunizations, physical exams, preventive screenings and treatment for both acute and chronic conditions and women’s health. The practice is open Monday through Friday, from 8 a.m. to 4:30 p.m. In March 2025, the practice will welcome a second provider. In April 2025, the Milford site will also offer ChristianaCare’s My65+ program, which focuses on preventive care and chronic disease management for patients 65 and older. The providers at ChristianaCare’s new Milford location will play a crucial role in addressing the growing health care needs of Sussex County, which is experiencing rapid population growth, particularly among older adults. Sussex County has been designated as a Medically Underserved Area by the federal government, with projections showing that the population will increase from 237,378 in 2022 to over 361,000 by 2050, further intensifying the demand for primary care services. As the demand for primary and specialty care in Sussex County grows, especially among older adults, ChristianaCare is committed to meeting the health care needs of the community with personalized, patient-centered care. “Our mission is to make high-quality, compassionate care accessible to every resident of the communities we serve,” said Priya Dixit-Patel, M.D., physician executive for Core and Advanced Primary Care at ChristianaCare. “As primary care providers remain in short supply in many areas like Milford, we are focused on delivering care that can prevent disease, manage chronic conditions, and improve overall well-being, particularly for older adults.” Specialized Neurointerventional Consults Close to Home Sivapatham is excited to bring neurointerventional care to the Milford community and surrounding areas. “Neurointerventional Surgery is a highly specialized field that is often only found in larger metropolitan areas,” said Sivapatham, who speaks about treatment for stroke in this video. “I look forward to working closely with patients to ensure they receive the same high-quality care right here in Sussex County.” Kim Gannon, M.D., Ph.D., medical director of the Comprehensive Stroke Program and physician executive of the Neuroscience Service Line at ChristianaCare, highlighted the importance of improving access to physician consults for patients in Sussex County. “Providing neurointerventional care closer to home significantly improves access to specialized services for stroke patients who might otherwise need to travel to Newark,” said Gannon. “We want to ensure that patients receive the ongoing care and support essential for their recovery and long-term health at a location close to where they live.”

Villanova Nursing Professor Addresses Overlooked Roles in Mental Health Care

Mental health crises, such as suicidal ideations or attempts, present profound challenges, not only for the individuals experiencing them, but also for the families and professionals who provide care. Parents, in particular, often find themselves stepping into the role of a primary healthcare provider when a child returns home from mental health inpatient treatment. Guy Weissinger, PhD, MPhil, RN, the Diane Foley Parrett Endowed Assistant Professor of Nursing at Villanova University’s M. Louise Fitzpatrick College of Nursing, explores the complex challenges parents face during these delicate situations and how the healthcare system can better prepare them for these responsibilities. Dr. Weissinger’s research also emphasizes the need to rethink how educators train and support healthcare providers involved in mental health care and suicide prevention. In a recent conversation, Dr. Weissinger shared insights into his research, the unique roles that parents and nurses have in managing mental health crises and the steps needed to create a more holistic and inclusive approach to care. Q: A large part of your research examines the parents of youth who are experiencing mental health crises. What challenges do parents face when tasked with providing ongoing healthcare for their children who might be facing these issues? Dr. Weissinger: There’s been a lot of recent work looking at how parents can be better supported in any kind of health crisis as their child is experiencing it. At the end of the day, a physician, therapist or nurse practitioner (NP) can support a patient with their clinical expertise in the hospital, but when those patients return home, the responsibility most often falls on the parent to continue that care. If we're then requiring parents to act as case managers and healthcare providers for their children, how can we best equip them to fill those roles? Q: How does a parent’s role in managing a child’s mental health crisis differ from the roles of a physician or therapist? Dr. Weissinger: I studied family intervention science, which looks at both the individual and family processes that may be related to adolescent suicide risk or any other mental health concern, so I like to ask the question: what is this person's role in their family system? Parents oftentimes have a particular role in the family system, and when there's any kind of mental health crisis, that role may have to change: how they act, what tasks they perform, etc. I’m studying the role transition of a parent during a suicide crisis—what are their struggles and what are parents identifying as their big needs? I’m finding that a lot of parents are feeling really alone or shameful in some way, and then they’re using their own money, time or social resources to try to provide care for their child. This often happens because they feel like the mental health system is not providing the support they need to take on that role, so they’re trying to figure out what to do on their own. Q: An additional part of your research surrounds the role of a nurse practitioner in suicide crises. What are some of the findings from your recent research with nurse practitioners (NPs) about their suicide prevention education? Dr. Weissinger: The findings, which will soon be published, are really interesting because they’re very mixed. I went out and asked NPs what they were taught about suicide prevention and when they were taught it as part of their education and training. Some said that their primary care education integrated suicide prevention as a focus of the curriculum. Others mentioned that they didn’t learn about it in their undergraduate or master’s programs, but they’re still expected to know about suicide prevention as part of their job responsibilities. It’s important to highlight these discrepancies and how we need to think about adapting nursing education to include these important topics. Q: What are some of the overlooked responsibilities and challenges of nurses in managing adolescent mental health? Dr. Weissinger: A large percentage of primary care visits are currently conducted by nurse practitioners, and now suicide screenings are expected to be a standard of practice in primary care visits, even though some NPs don't have that specific training. NPs are often left out of consideration and conversation around best practices related to suicide prevention, so we need to make sure that anyone who's conducting these screenings surrounding suicide has the training and the preparation to do so. It's a difficult conversation for NPs to have, especially when they’re working with kids and families. Q: Why is suicide prevention important to study from a nursing lens? Dr. Weissinger: So much mental health research lumps together groups or only studies psychologists and physicians, so a lot of people who provide mental health services or do suicide prevention screenings are left out of these studies. For example, nurses provide a majority of the discharge education on what parents are expected to do at home when a child leaves the hospital—whether that’s administering injections for a child with diabetes or making a house safer for preventing self-harm. Most of the time, a nurse is walking parents through next steps, answering questions and checking in on patient progress. It’s not the psychologists who evaluated the child, or the physicians who decided that the individual needed to be inpatient, it’s the nurses who are providing those points of contact. Q: What do you hope is the main takeaway from your work surrounding mental health and suicide crises? Dr. Weissinger: Suicide is a really complex thing to address, and it needs to be a conversation that isn’t looking for a silver bullet. It’s a conversation that asks the questions: how do we improve the mental health care system? How do we get primary care providers trained and involved in these discussions? How do we best prepare family members to support individuals who are struggling? Not all researchers need to work on every part of this, but it needs to be a total, all-encompassing effort.

AI Everywhere: Where Artificial Intelligence and Health Care Intersect

Imagine a world where AI doesn’t just support health care providers, but anticipates their next move — detecting diseases faster than human eyes, analyzing patterns and patient data that humans might overlook and revolutionizing health care decision making at every level. Driven by data, AI can identify which patients are most likely to have repeated emergency department visits or thrive from personalized medicine. With the power of robotics enhanced by AI, people with medical needs can gain more independence, managing daily tasks such as taking medication, monitoring their health and receiving personalized care, all from the comfort of their own homes. And this is just the beginning. “AI is transforming – and is going to continue transforming – every industry, especially health care,” said Bharat Rao, a notable figure in the fields of health care, technology and AI. Rao himself has made significant contributions to artificial intelligence, machine learning and data analytics, particularly in health care innovation. His current start-up, CareNostics, uses AI technology to identify patients at increased risk for chronic disease. “We take this for granted,” he said, “but it’s like what I used to see on Star Trek as a kid. The opportunities are limitless.” Rao was a keynote speaker at ChristianaCare’s inaugural Innovation Summit, a two-day conference at ChristianaCare’s Newark campus in Delaware, in fall 2024. During panel discussions and keynotes, more than 200 attendees heard about current and future health tech from national innovators and thought leaders, as well as technical advice for inventors who want to patent ideas and protect intellectual property in a world where “AI Is Everywhere,” the conference’s theme. Speakers emphasized that it’s not just technologists, but also researchers, clinicians and other health care professionals who play an essential role in implementing AI-based health care solutions. “There’s no AI without HI, which is human intelligence,” said Catherine Burch, MS, CXA, CUA, vice president of innovation at ChristianaCare. “You want to help shape the future, not wait for it to shape you.” How AI helps improve patient care “AI is incredibly good at reducing noise in images,” said speaker David Lloyd, a technical leader at Amazon, who discussed the use of AI in radiology. “It can detect anomalies, and it can automate radiologist reports, which saves time for radiologists.” Data informatics is another example of the power of AI to help health professionals determine which patients are at an increased risk for falls, malnutrition or recurrent asthma attacks, enabling them to optimize patient health and prevent hospitalizations. “Some patients with asthma go to the ER repeatedly because their treatment plan isn’t working,” said speaker Vikram Anand, head of data at CareNostics. When patients have uncontrolled asthma, data-rich platforms like CareNostics can provide treating physicians with guidelines and other support to improve patient care, which may lead to evidence-based medication changes or other therapies, he said. Using robots as part of the health care team in patient homes may sound like science fiction, but speakers discussed the current evolution of consumer robotics, like Amazon’s Astro. Astro follows patients around their home, interacts with them and supports their care. When ChristianaCare tested Astro’s impact on HomeHealth patients, they found that it reduced feelings of isolation by 60%. “Astro is like Alexa on wheels,” said speaker Pam Szczerba, PT, MPT, CPHQ, director of ChristianaCare’s HomeHealth quality, education and risk management, who studied patients’ experiences with Astro. “People like interacting with Alexa, but they can only interact in the room they’re in. Astro’s mobility lets it go to the patient.” Based on early successes, health professionals are assessing robots as an extension of clinicians in the home. Early results show that patients with robots show improved activation with their care plans. This may lead to more widespread distribution of household robots to newly diagnosed patients to help prevent disease complications, avoidable emergency department visits and re-hospitalizations. How AI helps ease provider burden Speakers also discussed the potential of AI to improve health care delivery and patient outcomes by handling more administrative work for health professionals. “We can reduce some of the redundancy of work to free up time for people to be creative,” said speaker Terrance Bowman, managing director at Code Differently, a company that educates and prepares people to work in technology-driven workplaces. “AI should be taking the ‘administrivia’ – administrative trivial tasks – out of your life,” said speaker Nate Gach, director of innovation at Independence Blue Cross. “When you want folks to do the creative part of the job that takes brain power, have ChatGPT respond to easy emails.” Other examples shared included the power of AI to record meetings, create summaries and send participants automated meeting minutes. Benefits can be seen across industries. Specific to health care, eliminating the need for note-taking during visits enables more personalized and attentive provider-patient interaction. With the evolution of ambient speech apps, clinicians are no longer just dictating notes into the electronic health record. Now AI is listening to the conversation and creating the notes and associated recommendations. “The physician is no longer spending ‘pajama time’ doing catch-up work, at home late into the evening,” said speaker Tyler Flatt, a director and leading expert in AI and digital transformation at Microsoft. “Especially as we’re dealing with burnout, it’s better for patient and physician satisfaction.” AI may also help caregivers uncover details that they hadn’t noticed, helping them diagnosis patients with subtle symptoms. “We feed a large quantity of data and have it suggest commonalities about patients,” said speaker Matthew Mauriello, assistant professor of computer and information sciences at the University of Delaware. “Some things are very insightful, but humans miss them.” AI has also been used for patient engagement, including chatbots that can assist with tasks like scheduling clinical appointments or acknowledging patient questions. “One of the things AI is great at is natural language understanding,” said David Lloyd. “You can alleviate a lot of the burden if you have something that can talk to your patients, especially if it’s an administrative task.” Creating new health innovations “The key is to think of something you’ve done that’s original and non-obvious,” said Rao, who holds more than 60 patents in AI. “The process of writing about it will help you flesh it out.” Turning breakthrough ideas into game changers is just the start — protecting these innovations is what ensures they shape the future, rather than fade into the past. “Keeping it secret and internal to your organization until you know what you want to do with it is important,” Greg Bernabeo, partner at FisherBroyles, LLP, said. “Otherwise, the opportunity is lost, and you can’t get the genie back in the bottle.” Benefits of non-obvious thinking People who pursue “non-obvious” ideas are often on the cutting edge of technology in and out of health care, said keynote speaker, Ben DuPont, while discussing innovative ideas with Randy Gaboriault, MS, MBA, senior vice president and chief digital and information officer at ChristianaCare. “Amazon was not founded by a book retailer; Airbnb was not founded by somebody who was in hospitality,” said DuPont, author, entrepreneur, and co-founder and partner at Chartline Capital Partners venture capital fund. “Before Uber, the founders were running around Paris and they couldn’t get a taxi.” Innovative ideas often arise when people consider non-obvious points of view while thinking about solutions, DuPont said. Non-experts have the ability to cut through the clutter and find the frustration, which can lead to innovative solutions, which DuPont explores in his book “Non-Obvious Thinking: How to See What Others Miss.” Health providers, for example, may discover ideas when they move out of their comfort zones. “If you want to be a better doctor, go do something that has nothing to do with medicine,” he said. “Innovation happens at the collision of seemingly unrelated disciplines.” Diversity in the workplace is necessary, “but it’s not just diversity in the way people look: It’s diversity in how people think,” DuPont said. “There are people that think in dramatic and different ways. We need those people around the table. They might say: ‘If we just move this little thing over here’ … and it starts an avalanche that changes the world.” Involving the future generation During the Innovation Summit, students with an interest in STEM (science, technology, engineering, and mathematics) from St. Mark’s High School in Wilmington, Delaware, competed against one another at ChristianaCare’s inaugural HealthSpark ChallengeTM. Twenty-six high school juniors and seniors were divided into five teams, then challenged to brainstorm ideas for solutions to address the negative mental health effects of social media on teenagers. Each team created a concept poster and pitched their ideas to Summit attendees. The attendees then voted for their favorite solution. The winning solution, Editing Identifiers, is designed to help minimize negative feelings about body image among teens. The solution would use AI technology to identify altered photos on social media. The goal would be to show teens that photos of “perfect” people aren’t real and alleviate the feelings of body dysmorphia. Looking forward Summit speakers highlighted many ways that AI is already incorporated into health care, as well as ways that health tech, AI, and robotics may improve care for patients in the coming years. “We are just scratching the surface,” Rao said. “It’s like laparoscopic surgery – years ago, it was considered experimental or dangerous. Today, surgery is commonly done laparoscopically, with better outcomes and less infection. AI can help identify care gaps and get the right treatment to the right patient. It’s going to be good for the patient.” In a rapidly evolving landscape, the integration of AI into health care not only enhances patient care but also creates opportunities for innovation and collaboration, said ChristianaCare’s Gaboriault. “As AI continues to advance, the health care industry stands on the brink of a revolution, one where the possibilities are as vast as the data that fuels them.”

Kert Anzilotti, M.D., Appointed President of the Medical Group of ChristianaCare

Kert Anzilotti, M.D., MBA, FACR has been appointed president of the Medical Group of ChristianaCare. Anzilotti has served as interim president since June 2024. He will also continue in his role as system chief medical officer of ChristianaCare. As president of the ChristianaCare Medical Group, Anzilotti will seek to improve every aspect of care for every person the Medical Group touches. He will focus on the optimization of care delivery, strategic visioning, network development, clinical technology implementation and leveraging medical informatics. Anzilotti will continue to develop new care models that transcend settings, promote value-based care and improve the patient experience across the clinical enterprise. Among his priorities are the adoption of population health measures, the embedding of health equity into care delivery and workforce development, further expansion of access points for patients and the continuous enhancement of patient and caregiver experience. “Dr. Anzilotti is exceptionally qualified to lead the Medical Group of ChristianaCare,” said Janice E. Nevin, M.D., MPH, president and CEO of ChristianaCare. “His passion for our mission and vision for the future strength of our Medical Group is unwavering. Since joining ChristianaCare in 2011, Dr. Anzilotti has earned a well-deserved reputation as a thoughtful and collaborative leader.” Anzilotti has served in numerous leadership roles at ChristianaCare, including as chief medical officer, acute care; chair of the Department of Radiology; medical director of Imaging Services; and physician leader of the Neurosciences Service Line. He also previously served as Interim President and CEO for the eBrightHealth ACO with responsibility for physician leadership and network operations. He is board certified in Neuroradiology. “Over the many years I have been at ChristianaCare, I have had the privilege of witnessing the dedication and compassion of my Medical Group colleagues as we served together with love and excellence,” Anzilotti said. “I am honored to lead this incredible, dynamic group that is reshaping the future of care, ensuring everyone we serve can achieve their best health.” Anzilotti earned his medical degree from Jefferson Medical College of Thomas Jefferson University in Philadelphia. He earned his MBA at the University of Delaware, completed the Managing Health Care Delivery Course at Harvard Business School and graduated as Physician Executive Fellow in the Health Management Academy, GE Fellows Program. The Medical Group of ChristianaCare consists of over 2,200 dedicated doctors, nurse practitioners, physician assistants and other caregivers. This highly skilled team delivers exceptional care through ChristianaCare’s community-based primary care and specialty care practices serving Delaware and surrounding states. Additionally, the Medical Group collaborates with ChristianaCare hospitalists to ensure seamless continuity of care for our patients, from primary care to hospital care and back again.

Ask the Expert: Understand the latest on COVID-19 and mpox

As the university physician at Michigan State, Michael Brown advises the president and other leaders on major health policy or programs that impact life on campus or education abroad programs. He is also chair of the Department of Emergency Medicine in the MSU College of Human Medicine. Here, Brown shares the latest guidance about two viruses that are making news — COVID-19 and mpox, which was formerly called monkeypox. Is COVID-19 changing? COVID-19 will be with us for years to come. It seems to come and go in waves and now, it’s surging again across the United States. We’re seeing more cases, but the number of severe cases is much lower than the peaks we saw during the height of the pandemic. This is good news. Just a small fraction of the people who get COVID-19 actually become sick enough to go to the emergency department. We have to keep that in perspective. How can people stay healthy? The virus does mutate — that’s what viruses do — and a couple recent variants have become predominant. Ideally, the next vaccine will target the latest prevalent variants. I expect the Food and Drug Administration to release a new vaccine very soon, and I definitely will be in line to get one when it’s available. In fact, I highly encourage everyone to get a vaccine this fall. The effectiveness peaks about four weeks after you receive it and lasts at least four to six months — maybe longer. The people who are most protected are those who have had a bout of COVID-19, built up their immunity and received a vaccine. This combination is the best protection from getting an illness that’s severe enough to send you to the hospital. What symptoms are associated with this strain of COVID-19? The symptoms are much like what we’ve seen from COVID-19 in the past. It is an upper respiratory illness, so you may have a sore throat, congestion and a cough, but there can be other symptoms like headache. Some people experience nausea, vomiting or diarrhea. Fever and muscle aches are also common. What if someone tests positive for COVID-19? False positives are very rare with COVID-19 tests so if you get a positive result, you should take care of yourself and protect those around you. The Centers for Disease Control and Prevention recommend that you stay home and wear a mask around others. You should also treat your symptoms, stay hydrated and take acetaminophen for fever and muscle aches. After 24 hours of feeling better and being fever-free (with no acetaminophen), you can go out in public. It’s advised that you wear a mask for an additional five days to protect people who are vulnerable. And what about mpox? Mpox is a viral disease largely found in the Democratic Republic of the Congo in Central Africa. The people there are accustomed to living with it. But it mutates, and we have seen a change in the disease patterns in the past few years. One of the new variants is more severe and is now spreading in the Congo region. It has become a critical situation there, but we have not seen the more severe variant here in the United States. Mpox is not as transmissible as COVID-19 because it requires close contact — usually intimate contact or other close physical proximity like sharing a towel. Symptoms include a rash that may start on the face or genital area along with fever and body aches. A vaccine is available, and an experimental drug can be prescribed as treatment. The World Health Organization has asked developed countries like the United States to assist with research to better understand the new variant. Looking to know more - we can help. Michael Brown is available to speak with media - simply connect with Dalin Clark now to arrange an interview today.

Stephen Pearlman, M.D., Honored for Excellence in Neonatology Education

Stephen Pearlman, M.D., MSHQS, will receive the 2024 Avroy Fanaroff Neonatal Education Award at the American Academy of Pediatrics’ annual meeting in September. This honor, presented by the AAP’s section on Neonatal-Perinatal Medicine, recognizes an educator who makes outstanding contributions in neonatal-perinatal medicine for health care students, professionals or the public. Pearlman, an expert in neonatology, intensive care and pediatrics, is clinical effectiveness officer for acute care at ChristianaCare. He is also professor of pediatrics at Sidney Kimmel College of Medicine at Thomas Jefferson University. “Stephen is deeply committed to excellence in neonatal education and the highest quality care,” said Kert Anzilotti, M.D.,MBA, system chief medical officer at ChristianaCare. “As a faculty member, physician and leader, he continues to make a lasting impact at ChristianaCare and beyond with his pioneering initiatives in quality improvement and safety in health care.” A faculty member for almost 40 years, Pearlman has served ChristianaCare in clinical, educational and administrative roles. Among them, he was chair of the Pediatric and Neonatal Safety Committee, director of Neonatal Quality Improvement, associate director of Neonatology and director of Pediatric Medical Education. Pearlman has led initiatives that have been spotlighted by the federal government as exemplars of how to improve safety at health systems. He developed an innovative quality-improvement curriculum for neonatal fellows, which the Organization of Neonatal-Perinatal Training Program Directors adopted. “I’m passionate about educating clinicians about ways to improve the quality of patient care, so it’s humbling to receive this recognition,” Pearlman said. “I am honored to have been selected as a recipient of this award.” Pearlman is also an associate editor of Quality Improvement for the Journal of Perinatology and an executive committee member of the American Academy of Pediatrics’ Perinatal Section.

Expert Insight: Training Innovative AI to Provide Expert Guidance on Prescription Medications

A new wave of medications meant to treat Type II diabetes is grabbing headlines around the world for their ability to help people lose a significant amount of weight. They are called GLP-1 receptor agonists. By mimicking a glucagon-like peptide (GLP) naturally released by the body during digestion, they not only lower blood sugar but also slow digestion and increase the sense of fullness after eating. The two big names in GLP-1 agonists are Ozempic and Wegovy, and both are a form of semaglutide. Another medication, tirzepatide, is sold as Mounjaro and Zepbound. It is also a glucose-dependent insulinotropic polypeptide (GIP) agonist as well as GLP-1. Physicians have been prescribing semaglutide and tirzepatide with increasing frequency. However, both medications come with a host of side effects, including nausea and stomach pain, and are not suitable for every patient. Many clinics and physicians do not have immediate access to expert second opinions, as do the physicians at Emory Healthcare. Creating a Digital Twin That lack of an expert is one of the reasons Karl Kuhnert, professor in the practice of organization and management at Emory University’s Goizueta Business School, is using artificial intelligence to capture the expertise of physicians like Caroline Collins MD through the Tacit Object Modeler™, or TOM. By using TOM, developed by Merlynn Intelligence Technologies, Kuhnert and Collins can create her “decision-making digital twin.” This allows Collins to reveal her expertise as a primary care physician with Emory Healthcare and an Assistant Professor at Emory School of Medicine, where she has been leading the field in integrating lifestyle medicine into clinical practices and education. Traditional AI, like ChatGPT, uses massive amount of data points to predict outcomes using what’s known as explicit knowledge. But it isn’t necessarily learning as it goes. According to Kuhnert, TOM has been designed to learn how an expert, like Collins, decides whether or not to prescribe a drug like semaglutide to a patient. Wisdom or tacit knowledge is intuitive and rooted in experience and context. It is hard to communicate, and usually resides only in the expert’s mind. TOM’s ability to “peek into the expert’s mind makes it a compelling technology for accessing wisdom.” “Objective or explicit knowledge is known and can be shared with others,” says Kuhnert. "For example, ChatGPT uses explicit knowledge in its answers. It’s not creating something new. It may be new to you as you read it, but somebody, somewhere, before you, has created it. It’s understood as coming from some source." Karl Kuhnert “Tacit knowledge is subjective wisdom. Experts offer this, and we use their tacit know-how, their implicit knowledge, to make their decisions. If it were objective, everyone could do it. This is why we hire experts: They see things and know things others don’t; they see around corners.” Mimicking the Mind of a Medical Expert Teaching TOM to see around the corners requires Collins to work with the AI over the course of a few days. “Essentially what I do is I sit down with, in this case, a physician, and ask them, ‘What are thinking about when you make this decision?'” says Kuhnert. “The layperson might think that there are hundreds of variables in making a medical decision like this. With the expert’s tacit knowledge and experience, it is usually between seven and twelve variables. They decide based on these critical variables,” he says. "These experts have so much experience, they can cut away a lot of the noise around a decision and get right to the point and ask, ‘What am I looking at?’" Karl Kuhnert As TOM learns, it presents Collins with more and different scenarios for prescribing semaglutide. As she makes decisions, it remembers the variables present during her decision-making process. “Obviously, some variables are going to be more important than other variables. Certain combinations are going to be challenging,” says Collins. “Sometimes there are going to be some variables where I think, yes, this patient needs a GLP-1. Then there may be some variables where I think, no, this person really doesn’t need that. And which ones are going to win out? That’s really where TOM is valuable. It can say, okay, when in these difficult circumstances where there are conflicting variables, which one will ultimately be most important in making that decision?” The Process: Trusting AI After working with TOM for several hours, Collins will have reacted to enough scenarios for TOM to learn to make her decision. The Twin will need to demonstrate that it can replicate her decision-making with acceptable accuracy—high 90s to 100 percent. Once there, Collins’ Twin is ready to use. “I think it’s important to have concordance between what I would say in a situation and then what my digital twin would say in a situation because that’s our ultimate goal is to have an AI algorithm that can duplicate what my recommendation would be given these circumstances for a patient,” Collins says. “So, someone, whether that be an insurance company, or a patient themselves or another provider, would be able to consult TOM, and in essence, me, and say, in this scenario, would you prescribe a GLP-1 or not given this specific patient’s situation?” The patient’s current health and family history are critical when deciding whether or not to prescribe semaglutide. For example, according to Novo Nordisk, the makers of Ozempic, the drug should not be prescribed to patients with a history of problems with the pancreas or kidneys or with a family history of thyroid cancer. Those are just the start of a list of reasons why a patient may or may not be a good candidate for the medication. Kuhnert says, “What we’re learning is that there are so many primary care physicians right now that if you come in with a BMI over 25 and are prediabetic, you’re going to get (a prescription). But there’s much more data around this to suggest that there are people who are health marginalized, and they can’t do this. They should not have this (medication). It’s got to be distributed to people who can tolerate it and are safe.” Accessing the Digital Twin on TOM Collins’s digital twin could be available via something as easy to access as an iPhone app. “Part of my job is to provide the latest information to primary care physicians. Now, I can do this in a way that is very powerful for primary care physicians to go on their phones and put it in. It’s pretty remarkable, according to Colllins.” It is also transparent and importantly sourced information. Any physician using a digital twin created with TOM will know exactly whose expertise they are accessing, so anyone asking for a second opinion from Colllins will know they are using an expert physician from Emory University. In addition to patient safety, there are a number of ways TOM can be useful to the healthcare industry when prescribing medications like semaglutide. This includes interfacing with insurance companies and the prior approval process, often lengthy and handled by non-physician staff. “Why is a non-expert at an insurance company determining whether a patient needs a medication or not? Would it be better to have an expert?” says Collins. “I’m an expert in internal medicine and lifestyle medicine. So, I help people not only lose weight, but also help people change their behaviors to optimize their health. My take on GLP-1 medications is not that everyone needs them, it’s that they need to be utilized in a meaningful way, so patients will get benefit, given risks and benefits for these medications.” The Power of a Second Opinion Getting second, and sometimes third, opinions is a common practice among physicians and patients both. When a patient presents symptoms to their primary care physician, that physician may have studied the possible disease in school but isn’t necessarily an expert. In a community like Emory Healthcare, the experts are readily available, like Collins. She often serves as a second opinion for her colleagues and others around the country. “What we’re providing folks is more of a second opinion. Because we want this actually to work alongside someone, you can look at this opinion that this expert gave, and now, based on sourced information, you can choose. This person may be one of the best in the country, if not the world, in making this decision. But we’re not replacing people here. We’re not dislocating people with this technology. We need people. We need today’s and tomorrow’s experts as well,” according to Kuhnert. But also, you now have the ability to take an Emory physician’s diagnosing capabilities to physicians in rural areas and make use of this information, this knowledge, this decision, and how they make this decision. We have people here that could really help these small hospitals across the country. Caroline Collin MD Rural Americans have significant health disparities when compared to those living in urban centers. They are more likely to die from heart disease, cancer, injury, chronic respiratory disease, and stroke. Rural areas are finding primary care physicians in short supply, and patients in rural areas are 64 percent less likely to have access to medical specialists for needed referrals. Smaller communities might not have immediate access to experts like a rheumatologist, for example. In addition, patients in more rural areas might not have the means of transportation to get to a specialist, nor have the financial means to pay for specialized visits for a diagnosis. Collins posits that internal medicine generalists might suspect a diagnosis but want to confirm before prescribing a course of treatment. “If I have a patient for whom I am trying to answer a specific question, ‘Does this patient have lupus?’, for instance. I’m not going to be able to diagnose this person with lupus. I can suspect it, but I’m going to ask a rheumatologist. Let’s say I’m in a community where unfortunately, we don’t have a rheumatologist. The patient can’t see a rheumatologist. That’s a real scenario that’s happening in the United States right now. But now I can ask the digital twin acting as a rheumatologist, given these variables, ‘Does this patient have lupus?’ And the digital twin could give me a second opinion.” Sometimes, those experts are incredibly busy and might not have the physical availability for a full consult. In this case, someone could use TOM to create the digital twin of that expert. This allows them to give advice and second opinions to a wider range of fellow physicians. As Kuhnert says, TOM is not designed or intended to be a substitute for a physician. It should only work alongside one. Collins agreed, saying, “This doesn’t take the place of a provider in actual clinical decision-making. That’s where I think someone could use it inappropriately and could get patients into trouble. You still have to have a person there with clinical decision-making capacity to take on additional variables that TOM can’t yet do. And so that’s why it’s a second opinion.” “We’re not there yet in AI says Collins. We have to be really careful about having AI make actual medical decisions for people without someone there to say, ‘Wait a minute, does this make sense?’” AI Implications in the Classroom and Beyond Because organizations use TOM to create digital twins of their experts, the public cannot use the twins to shop for willing doctors. “We don’t want gaming the system,” says Collins. “We don’t want doctor shopping. What we want is a person there who can utilize AI in a meaningful way – not in a dangerous way. I think we’ll eventually get there where we can have AI making clinical decisions. But I don’t think I’d feel comfortable with that yet.” The implications of using decision-making digital twins in healthcare reach far beyond a second opinion for prescription drugs. Kuhnert sees it as an integral part of the future of medical school classrooms at Emory. In the past, teaching case studies have come from books, journals, and papers. Now, they could come alive in the classroom with AI simulation programs like TOM. "I think this would be great for teaching residents. Imagine that we could create a simulation and put this in a classroom, have (the students) do the simulation, and then have the physician come in and talk about how she makes her decisions." Karl Kuhnert “And then these residents could take this decision, and now it’s theirs. They can keep it with them. It would be awesome to have a library of critical health decisions made in Emory hospitals,” Kuhnert says. Collins agreed. “We do a lot of case teaching in the medical school. I teach both residents and medical students at Emory School of Medicine. This would be a really great tool to say, okay, given these set of circumstances, what decision would you make for this patient? Then, you could see what the expert’s decision would have been. That could be a great way to see if you are actually in lockstep with the decision-making process that you’re supposed to be learning.” Kuhnert sees decision-making twins moving beyond the healthcare system and into other arenas like the courtroom, public safety, and financial industries and has been working with other experts to digitize their knowledge in those fields. "The way to think about this is: say there is a subjective decision that gets made that has significant ramifications for that company and maybe for the community. What would it mean if I could digitize experts and make it available to other people who need an expert or an expert’s decision-making?" Karl Kuhnert “You think about how many people aren’t available. Maybe you have a physician who’s not available. You have executives who are not available. Often expertise resides in the minds of just a few people in an organization,” says Kuhnert. “Pursuing the use of technologies like TOM takes the concept of the digital human expert from simple task automation to subjective human decision-making support and will expand the idea of a digital expert into something beyond our current capabilities,” Kuhnert says. “I wanted to show that we could digitize very subjective decisions in such areas as ethical and clinical decision-making. In the near future, we will all learn from the wisdom codified in decision-making digital twins. Why not learn from the best? There is a lot of good work to do.” Karl Kuhnert is a Professor in the Practice of Organization & Management and Associate Professor of Psychiatry, School of Medicine and Senior Faculty Fellow of the Emory Ethics Center. If you're looking to connect with Karl to know more - simply click on his icon now to arrange a time to talk today.

First in Delaware to Offer MR-Guided Ultrasound for Treatment of Essential and Parkinson’s Tremor

Revolutionary technology gives patients immediate relief from debilitating tremors without the need for invasive surgery. ChristianaCare is the first health care provider in Delaware to offer FDA-approved focused ultrasound treatment for people suffering from essential tremor and Parkinson’s disease. The new option – called MR-guided focused ultrasound – uses sound wave energy to destroy precise areas of brain tissue that is the source of the tremor. No surgical incision or anesthesia is necessary, and many patients experience immediate and significant reduction in tremors, which can make daily activities challenging. Dr. Martello explains that the procedure involves the use of high-frequency sound waves directed with pinpoint precision by magnetic resonance imaging to ablate, or burn, the focal point deep within the brain that is causing tremors. “This minimally invasive technology dramatically improves the lives of patients with essential tremor and tremor-dominant Parkinson’s who haven’t fully responded to traditional treatments,’’ said Justin Martello, M.D., director of the Parkinson’s and Movement Disorders Programs, and Focused Ultrasound Program at ChristianaCare. What is tremor? Tremor is a neurological condition that includes involuntary shaking or trembling movements in one or more parts of the body. It most commonly affects the hands and can make daily tasks such as writing, eating and using a computer or phone extremely difficult. Tremor affects approximately 1% of the population overall and 5% of adults age 60+. It is expected to increasingly impact Delawareans as the state’s population ages. Essential tremor is the most common type of tremor. It can occur at any age but is most common in older adults. Tremor is also the most well-known symptom of Parkinson’s disease. An estimated 1.5 million Americans suffer from Parkinson’s disease, a progressive neurodegenerative disease that affects movement and can also affect speech, balance and cognitive function. A newer, better option for patients who don’t respond to medications The procedure of MR-guided focused ultrasound involves the use of high-frequency sound waves directed with pinpoint precision by magnetic resonance imaging to ablate, or burn, the focal point deep within the brain that is causing tremors. Patients are fitted with a frame affixed to a specialized helmet that combines the focused energy of more than 1,000 high-frequency sonic beams directed through the skull. The treatment does not require cutting through the skull, or radiation, as in gamma knife technology. “Today, there are basically three options for managing tremor,” said Pulak Ray, M.D., of Delaware Neurosurgical Group and associate director of the Focused Ultrasound program. “The first is medication, which is effective and affordable for many patients, but its effectiveness tends to diminish over time. The second is deep-brain stimulation, which is the most invasive and costly treatment option. The newest is MR-guided ultrasound, which tends to be the preferable option for most patients who do not respond well to medication, because it is a simple, non-invasive outpatient procedure that is highly effective, safe and produces instant results.” Benefits of MR-guided Focused Ultrasound MR-guided focused ultrasound reduces tremor immediately, with shorter recovery time, lower risk of side effects and lower associated health care expenses compared to surgical alternatives. This treatment dramatically improves patient experience and quality of life for people with Parkinson’s disease or essential tremor. For many patients, MR-guided ultrasound reduces their dependence on caregivers to assist with activities of daily living. Candidates must first undergo a CT scan to ensure a skull density sufficiently thick to accommodate the procedure. The patient is awake during the procedure and situated within an MRI machine for real-time imaging of the brain. The physician tests the precise location by heating the area, then ensuring the patient is able to control tremors by tracing lines on a spirograph. At that point, the physician then permanently ablates the focal point, usually a sphere a few millimeters in length. “Our team is very excited to bring this technology to Delaware and to open up access to potentially life-changing treatment that until now has required long wait times and significant travel for patients,” said Kim Gannon, M.D., Ph.D., medical director of the comprehensive stroke program and physician executive of Neuroscience Service Line at ChristianaCare. “Many tremor patients have suffered for years or even decades with this debilitating and progressive condition and helping them live a more active and independent lifestyle is extremely rewarding.” MR-guided focused ultrasound is covered by Medicare and most insurance plans.