| 4 Min Read

Unpacking the AI Boom for Healthcare: The Journey from Hype to Practical Solutions

6/26/2024

Since 2022, large language models (LLMs) have dominated the conversation across various industries, including healthcare, where their transformative potential is particularly impactful. Well known and advanced artificial intelligence systems such as ChatGPT, Gemini, Claude, Meta AI and Apple Intelligence have proven to have extraordinary possibilities in terms of comprehending and generating human language text by analyzing massive amounts of data. Their rapid adoption and innovation are reshaping the way we live and work, offering unprecedented progress and promising future advancements driven by ongoing research and development. 

In healthcare, the application of these tools can significantly impact the complex revenue cycle space. However, to ensure your organization leverages AI effectively and achieves a meaningful ROI, hospital leaders must consider several factors. Most importantly, it is crucial to partner with experts who not only provide advanced technology, but also possess deep domain specialization, clinical expertise and a commitment to corporate responsibility. Understanding these factors is essential for maximizing the benefits of AI in the US Healthcare Market

Mastery Takes Time

Everyone is familiar with the phrase “garbage in, garbage out,” highlighting the importance of feeding AI with large, diverse sets of quality data. However, having vast amounts of data is only the beginning. The complexity of AI requires more than just data; it demands deep expertise and continuous refinement. Even with extensive datasets, AI systems can still produce erroneous and biased responses if not properly managed. This underscores that merely possessing the tool doesn’t equate to mastery. To truly harness the power of AI, it’s essential to involve the experts who have been deeply embedded in its development from inception to current state.  

The Transparency Imperative

AI is a probabilistic science,which opens up remarkable possibilities, especially in healthcare. While it’s essential to acknowledge that AI doesn’t provide definitive answers, its ability to analyze vast amounts of data can reveal insights that might elude human clinicians, coders, operators and financial leaders. 

AI should serve as a powerful tool that enhances the clinician’s ability to deliver better patient outcomes and operational efficiency. For instance, AI can help reduce the risk of claim denials by identifying missed documentation. AI can predict trends and acuity levels, enabling better staff scheduling and resource allocation. However, it’s not definitive. 

When applying AI in healthcare, the role has to always be one of augmentation, not replacement. The goal should not be to replace the clinician in the room, but rather to merely serve as another tool for a clinician in doing their work. It also means that explainability and transparency is always key. It’s not enough for the AI to say “this patient has sepsis,” it needs to explain why so a human clinician can evaluate the reasoning and decide for themselves if the idea has merit and they agree. 

Specialized-Hybrid Model vs Generic Solutions

LLMs, a type of generative AI (GenAI), goes beyond traditional natural language processing (NLP) tools by not only analyzing but also generating human-like text based on extensive training across diverse datasets. LLMs excel at generating, synthesizing, and explaining information, while NLP specializes in combing through text-based data to identify key phrases, terms, and lingo that can lead to actionable recommendations. Additionally, machine learning analyzes patterns and makes data-driven predictions about outcomes. 

Understanding these different layers of AI and how they can be fused into a hybrid model is crucial. Each type of AI – LLMs, NLP, machine learning – brings unique strengths to the table. When combined, they create a powerful AI engine capable of solving large and complex problems within healthcare. By breaking down these layers and training them with deep domain expertise, we can maximize the strength of each AI type, ensuring that the hybrid model is both robust and highly effective. 

In healthcare, where every workflow and role has custom needs that vary significantly between organizations, an adaptable and bespoke AI model is essential. For instance, in utilization management, the use of  LLM can dramatically improve efficiency. A utilization management nurse might spend 20 minutes searching through multiple systems to gather the relevant information they need to prove medical necessity. However, a GenAI-powered feature in Iodine Software’s AwareUM solution can accomplish that same task almost instantaneously, presenting that same nurse with a curated summary of information, all in one convenient location. This ready-to-go clinical summary expedites their ability to share information with other stakeholders, eliminating the need to write a summary from scratch. 

Our hybrid AI model, CognitiveML™, harnesses the full potential of all of the above AI methods, not just NLP. While many technology companies claim to be true AI-enabled by solely utilizing NLP, this approach only scratches the surface of what AI can achieve. Our model combines the strength of LLMs, NLP, and machine learning to create a comprehensive solution. 

There is no magic bullet when it comes to AI. It should be noted that because one model has success in one use case does not guarantee that it will be equally successful in another area. It’s essential in this market to instead lean on AI-enabled point solutions with deep expertise tailored to specific clinical and financial workflows, rather than rely on a one-size-fits-all approach. We strongly believe generic AI solutions lack the nuanced understanding necessary for optimizing processes like clinical documentation and revenue cycle management. Our hybrid model ensures that our AI is not only more versatile and powerful, but also precisely tailored to meet the complex needs of healthcare workflows. This depth and breadth of capability sets CognitiveML™ apart, providing a level of sophistication and efficiency that single-method AI solutions cannot match. 

Comprehensive Approaches to Deploying AI

At Iodine Software, our heritage in clinical AI technology runs deep, with a track record of pioneering solutions that enhance financial performance in the mid-revenue cycle. We have broad domain expertise in AI, and understand that having a diverse range of artificial intelligence tools at play remains key.

The mere utilization of GenAI models by a vendor does not inherently translate to groundbreaking innovations or product enhancements. As an organization, our deep grasp of the clinical mid-revenue cycle, combined with our extensive expertise in AI and our unwavering commitment to corporate responsibility, ensures that our products are effective. Iodine Software is proud to support the business imperatives of our customers and help improve the overall care paradigm within hospitals and health systems.

For those AI vendors or assessing the potential of AI models, it’s crucial to seek comprehensive approaches that address specialized pain points and use cases, backed by robust experience with a diverse set of AI tools and a steadfast dedication to transparency in AI predictions. This multi-pronged strategy is essential for driving true innovation and achieving impactful results.

Ready to revolutionize your healthcare operations with cutting-edge AI technology? Schedule a meeting with our experts today to learn how our hybrid AI model, CognitiveML™, can transform your revenue cycle management. Don’t settle for generic solutions—partner with us for specialized, impactful results.