Back [[3 Oct 2024 - HIMSS Asia Day 2]] Speaker: Dr Nirvana Luckraj, Chief Medical Officer, Healthdirect, Australia Summary: - Something that Singapore could be doing as well, borrow some idea like “Digital Front Door”, - CDSS reliability, validity need to be tested. - Need to have feedback loop, continuous training and improvement to the system. - Something HOPES ClinDash can implement. - CDSS also need to be created. ----- ![[Implementing AI Powered Triage for a National Virtual and Digital….jpeg]] - Free virtual hospital for Australia - Healthdirect - helpline and digital, - Virtual GP - Video Call - Ambulance secondary triage (NSW and WA) Special Line: - Pregnancy - My aged care - National Health services directory - Head to health (connection to mental health care) ![[Implementing AI Powered Triage for a National Virtual and Digital… 1.jpeg]] - Countries have some version of helpline. Australia got integration to health pathways, medicines informations. ![[Implementing AI Powered Triage for a National Virtual and Digital… 2.jpeg]] - Looking at AI, and consumers style system. Virtual Frontdoor - Nurse helpline - Manned by 600 registered nurses, - Uses a clinical decisions tools tools, to help calls find services. Why did we choose an AI powered system? ![[Implementing AI Powered Triage for a National Virtual and Digital… 3.jpeg]] - They consider their use cases, thus decided to go with AI-powered system. - Tree-based system can only tolerate ONE symptoms. Shortlisted many and decided to go with Poland’s Informedica. ![[Clinical decision support system (CDSS).jpeg]] - Recommendations is generated by the AI: ![[How did we confirm the CDSS' safety and accuracy.jpeg]] - how to validate, or test the CDSS? - Vignette (sample patient stories) - ran through CDSS, and found consistent to recent publish study. - They tested it to be accurate. (Idea for HOPES, to create different vignette to test out signals?) ![[What challenges have we overcome.jpeg]] Change management to encourage healthcare to use new technology for old tasks ^4cf22f - Nurses was frustrated because now they got to ask more questions, ask more unrelated questions. Nurses used to be able to predict questions in the past. ![[How did we successfully train the workforce.jpeg]]Help clinicians understand black box. (Reflection: how HOPES works?) (Does HOPES promote workflow efficiency?) Training. Feedback loop to continuous improvement — Helpline staff doesn’t have to agree the recommendations, they can upgrade or downgrade (disagree) CDSS output. (Reflection) ![[Implementing AI Powered Triage for a National Virtual and Digital… 4.jpeg]]- Consumer satisfaction score is highest in 3 months, - Nurses changes the recommendation Less. - Accuracy of CDSS continuously improved by clinical feedback (Make it easy for the feedback to be log, time asked, and tag to recommendation) ![[How do we harness this tool to broaden Healthdirect's capabilities.jpeg]] Symptom Checker: - No healthcare professional in between. “Digital front door” - remove the nurses. They can book services directly. ![[Implementing AI Powered Triage for a National Virtual and Digital… 5.jpeg]] - divert half of the calls to emergency, because of secondary triage - Virtual ED - maned by nurse to a virtual ED, video call - Urgent Care Services - Not ED but clinics that can manage emergency, first aids - General Practise - 372,000 appointments booked with a nearby GP via Service Finder. - Virtual GP - phone or video appointment, then connect to non ED - Pharmacy - can book nearest pharmacy ![[Implementing AI Powered Triage for a National Virtual and Digital… 6.jpeg]] Symptom Checker Digital Front door ![[Implementing AI Powered Triage for a National Virtual and Digital… 7.jpeg]] a website. - answer questions to your symptoms. - Then recommend whether to go ED, and possible diagnosis. - A 24 hour help line. In future: Tailored information specific to their symptoms input. **Questions?** 1. CDSS procure third party, they continue to expand on their products. API feed to their products. Localised it for Australia, that contain to Australia specific situations. 2. Integrate to local healthcare system. Symptom Checker 1. Medical and Legal - what if we give the wrong information. what if the thresholds. False positive, negative? 1. Disclaimers this information is advise only. Always safety net in advise we provide. 2. The nurses use the same system, collect feedbacks from patients and users. 1. Nurses use the same engine (different UI). 3. This is not medical device yet (no regulatory) 4. How effective is the feedback loop? - 1. Regular meet up with nurses and CDSS providers. Accuracy improved 10%. How long does the Nurse take to take a call? 1. No time difference new and old CDSS? 1. 3-5 mins / call. Rule out any life threatening. 10-12mins