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Daniel O’Hair reflects on the clinical and medical impact of AI solutions implemented at Boulder Community Health.
What initially sparked your interest in medicine?
Two people were very influential in sparking my interest. First, my mother was an X-ray technologist and would take me to her office some Saturdays where I was fascinated by the big machines and the ability to see inside the body. Later, in high school, my girlfriend’s father was a radiologist and he said: “If you think it’s so cool, why don’t you become a doctor?” From that day forward I made becoming a doctor my goal and never looked back.
When did you become involved in medical AI?
I became involved in clinical trials of transcathter valve replacement in 2010 and quickly realized how many patients with severe heart valve disease were untreated, despite echocardiographic evidence for serious conditions. Our hospital team piloted a few ideas but lacked resources and expertise in more sophisticated methodologies. After meeting with several potential partners in the US and abroad, I ultimately encountered the Mpirik group which already had experience processing EHR data in their orthopedic applications. A partnership was formed and things quickly accelerated to the development of Cardiac Intelligence®, which augments physician care by identifying patients in need of care and links them to specialists in a timely fashion thereby enabling high value care.
What has been your experience of implementing AI solutions at Boulder Community Health (BCH)?
Delivering high value heart care to patients in need has been the focus of my career. I recognized that, regardless of the healthcare system or excellence in local care, patients still were presenting late in the course of their heart disease. In 2019, when I joined the team in Boulder, I understood that the community was highly educated and innovation was deeply rooted in the culture. Many hospitals in the country encounter the same issue – massive amounts of data hinder their ability to provide any sort of in-depth manual chart review at scale. Mpirik’s Cardiac Intelligence® platform allows us to close any gaps in the diagnosis and treatment of heart disease. We are able to analyze clusters of data at massive scale and detect both those with obvious disease and those at high risk for progressive debilitating heart conditions. From there the platform helps facilitate getting them to treatment before complications occur.
Cardiac Intelligence is a cloud-based artificial intelligence (AI) Software-as-a-Service that analyzes a real-time data stream from the electronic health record (EHR) to 1) identify patients with characteristics of cardiac disease, 2) identify those patients’ state of care, and 3) automate notifications to the appropriate clinician when the patient lacks follow-up or compliance to care pathway.
Through Mpirik’s Cardiac Intelligence® platform, clinicians can view their patient population, track disease progression, and manage identified patients without a specialist referral. Cardiac Intelligence is differentiated from other EHR-based solutions through the combination of 3 characteristics: (1) application of natural language processing (NLP) in addition to discrete queries, (2) cloud-based programmatic efficiencies, and (3) customizable clinical protocols and its ability to interface with the EHR on multiple levels linking diagnosis to care pathways.
Operationalizing and scaling of innovation is a universal challenge in healthcare. How do you approach this in your respective roles with Boulder Community Health and Mpirik?
Mpirik has provided us an amazing opportunity to scale by identifying patients who are undertreated, under diagnosed, and/or underserved who do not have an appropriate follow-up or next step in care.
At BCH, we took advantage of focusing on a small scope of disease screenings when Cardiac Intelligence® was first rolled out. We started identifying patients with a severe heart valve condition known as aortic stenosis. During our first four months of use, out of approximately 90 patients were identified with this dangerous condition. Based on scheduling data from the EMR, Cardiac Intelligence® detected that 44% would benefit from an accelerated care pathway. The program gave us the ability to directly communicate an immediate alert to the ordering physician to consider the patient for a referral for specialist evaluation. During the four month period, 26 of those patients received potentially life saving intervention. Apart from this tremendous clinical impact, the financial impact to the organization manifested as an additional average revenue of $191,000/month based on the screening for this single condition. We now screen for many more heart conditions and our next focus is to start screening patients at risk for Sudden Cardiac Arrest (SCA), heart failure, and compliance to Guideline Directed Medical Therapy.
In what areas do you see the next big advances in medical AI?
Certainly the ability to predict disease progression will be an important advance and we are making significant progress on that complex problem every day. Identifying patients at risk for rapid progression will allow more timely treatment and higher value care. Medical AI is still considered innovative at this time but more broad application and transition to Standard of Care status will undoubtedly save many lives.
What advice would you give someone starting their career in medicine or medical AI?
Dedicate yourself to a lifetime of constant learning and find a mentor who has successfully navigated the road you wish to follow.
Who’s been the biggest influence on your career?
The physicians and scientists at Columbia University College of Physicians and Surgeons in New York and their unrelenting passion for innovation have inspired me since I trained there more than 20 years ago.
What’s the best piece of advice you’ve ever received?
“It’s amazing what you can accomplish if you do not care who gets the credit.” – Harry Truman
Dr Daniel O’Hair joined Boulder Heart as Cardiovascular Surgery Program Chair in 2019. At Boulder Heart, Dr O’Hair performs a range of cardiovascular surgeries, including complex open-heart surgery and robotic-assisted mitral valve repair. In addition to surgery, Dr O’Hair takes on a significant role in adopting AI at the institution. Dr O’Hair received his medical degree from Medical College of Wisconsin, where he also completed his residency and a research fellowship in general surgery. He went on to complete an additional fellowship in transplantation as well as a residency in cardiothoracic surgery at Columbia University College of Physicians and Surgeons.