The United States Preventive Services Task Force (USPSTF) lowered the recommended age for colorectal screening to 45 years in 2021.
In North Dakota, where the rate of colon cancer incidence is higher than most states in the country, the change had an immediate impact.
"As the USPSTF moved the recommendation down to age 45, we gained 100,000 new people in our footprint that needed to be appropriately screened for colon cancer," said Jeremy Cauwels, MD, a hospitalist and chief medical officer at Sanford Health. "What we did not gain was a closet full of GI doctors."
Without a new influx of doctors, Sanford Health turned to augmented intelligence (AI)—also called artificial intelligence—and the results have been staggering.
Sanford Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
In a recent episode of “AMA Update,” Dr. Cauwels shared more about how Sanford Health continues to benefit from AI for colon cancer screenings.
Limiting colon cancer screening delays
In the aftermath of the USPSTF recommendation, Sanford Health leadership turned to its data and analytics team for help determining ways to risk stratify the system's patient base. The goal was to understand how to find what patients needed to be screened sooner than others.
The team identified about 85 different items available in any patient's electronic medical record that could then be tabulated into a risk score.
"While not making decisions for doctors," Dr. Cauwels said, "it can help us understand a little bit about the risk of the patient sitting in front of you."
Using the risk score, Sanford Health identified nearly six times as many patients who were at a high risk of colon cancer, Dr. Cauwels said. That increase has a dramatic effect in places such as Fargo, North Dakota, where Sanford Health had a nearly 18-month backup of patients waiting for a colonoscopy.
After using retrospective data to test the effectiveness of AI and the risk score, the system was ready to run a pilot program with its own physicians.
"We knew that we had to find a better way to appropriately screen people, not to take people in or out of the line, but to make sure that the line was appropriately risk adjusted," Dr. Cauwels said. "What we discovered was in advancing both AI and advancing stool-based testing, we were able to decrease the total number of people in that line, which gets those higher risk patients into and in front of our GI doctor sooner."
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Reducing cognitive burden
Identifying patients at greater risk of colon cancer is not the only way Sanford Health is leveraging AI. The system recently piloted an ambient AI listening tool for 100 doctors that was designed to improve patient and physician experience during a medical appointment.
The listening tool served as a scribe for the physicians, allowing them to focus more on conversations with parents and less on typing on a keyboard.
The results were overwhelmingly positive.
Every doctor in the pilot said they would be disappointed if they were not allowed to use the tool in the future. Ninety-five percent of those doctors said they experienced a reduction in their amount of cognitive burden while 88% said they would recommend the tool to their partners.
Four out five of the doctors in the pilot said they enjoyed their work more than they did prior to the ambient listening tool.
"Not only did we see a tremendous improvement in our physicians' understanding and our physicians' joy in work, but we also had a tremendous improvement in patient experience during that same time," Dr. Cauwels said. "It really did aim toward those things that we really always wanted to do as doctors and patients in health care."
One doctor told Dr. Cauwels that prior to using the tool, he spent years never making it home in time for a family activity before dinner because he had to chart and go through his notes. Once he started using the ambient listening tool, his timing changed.
"His daughter had recently turned 16, and they went car shopping before dinner," Dr. Cauwels said. "For him, it was a real game changer in work-life balance."
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Moving forward with the help of AI
Sanford Health is quickly discovering the limitless opportunities AI brings to improve efficiencies throughout its health system.
One example is using AI to create a scoring system for chronic kidney disease. Similar to the screening score for colorectal cancer, the goal is to help physicians identify patients who are at greater risk so they can be treated sooner.
"We were able to put a calculator in that uses AI to look up things that all doctors could look up," Dr. Cauwels said. "It just looks them up faster."
The system is also turning to AI to assist with triage and helping physicians better manage their in-basket. Like the other examples, the goal is helping physicians best manage their time to make them more efficient—and more effective.
"We continue to look ahead and say, 'How does the technology that we currently have do a better job of moving us forward?'" Dr. Cauwels said.
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