Resiniferatoxin is a non-addictive pain therapy derived from a cactus-like plant.

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National Institute of Health (NIH) scientists report that a first-in-human clinical trial of a new therapy based on the plant-derived molecule resiniferatoxin (RTX) shows that it is a safe and effective agent for pain control in patients with intractable cancer pain. [The study was published in NEJM Evidence on May 27, 2025.]

Researchers tested a single injection of small quantities of RTX into the lumbar cerebral spinal fluid (by lumbar puncture) of advanced-stage cancer patients and found that it reduced their reported worst pain intensity by 38% and their use of pain-relieving opioids by 57%.

“The effects are immediate,” said Andrew Mannes, MD, lead study author and chief of the NIH Clinical Center Department of Perioperative Medicine. “This is a potential new therapy from a new family of drugs that gives people with severe cancer pain an opportunity to return some normality to their lives.”

The trial enrolled research participants with terminal end-stage cancer who were among the 15% of cancer patients unable to find pain relief from standard of care pain interventions, including vast quantity of opiates without relief.

A single injection of RTX provided patients durable relief. Patients’ need for pain-relieving opioids declined sharply, and their quality of life improved. They no longer needed to spend significant periods being sedated with opioids and after treatment were able to reengage with their family, friends and communities.

The NIH scientists believe RTX has potential to treat many other pain conditions, including other types of cancer pain, chronic pain from nerve injuries called neuromas, post-surgical pain, a facial pain condition called trigeminal neuralgia, and chronic oral inflammatory problems following head and neck radiation therapy.

“Targeting specific nerves brings many pain disorders into range of RTX and allows physicians to tailor the treatment to the patient’s pain problem. This interventional approach is a simple path to personalized pain medicine,” said senior study author Michael Iadarola, PhD, a senior research scientist in the NIH Clinical Center Department of Perioperative Medicine.

RTX is not addictive and doesn’t cause a high. Instead, it prevents pain signals from reaching the brain by inactivating a specific sub-group of nerve fibers which transmit heat and pain signals from damaged tissue. RTX is an activator of the transient receptor potential vanilloid 1, or  TRPV1 ion channel and a super-potent equivalent of capsaicin, the active molecule in hot peppers. The ability of RTX to open the channel pore in TRPV1 allows an overload of calcium to flood into the nerve fiber and block its ability to transmit pain signals.

“Basically, RTX cuts the pain-specific wires connecting the body to the spinal cord, but leaves many other sensations are intact,” Iadarola said. “These TRPV1 neurons are really the most important population of neurons that you want to target for effective pain relief.”

Iadarola’s contributions have led decades of basic science research into the neurobiology of pain and pain control. That body of research has informed them that to effectively block pain, you must block it from getting into the spinal cord and from there having it leave the spinal cord to transit to the brain, where we perceive pain.

Unlike other current approaches that use heat, cold, chemicals, or surgery to non-selectively interrupt nerves to stop pain, RTX targets the specific sensory pathways of tissue damage pain and heat. Other sensory pathways, such as touch, pin prick, pressure, muscle position sense (known as proprioception), and motor function, remain intact. It is not a generalized numbing as occurs with local anesthetics.

“What makes this unique from all the other things that are out there is this is so highly selective,” Mannes said. “The only thing it seems to take out is heat sensation and pain.”

RTX is derived from theEuphorbia resinifera plant, a cactus-like plant native to North Africa. Euphorbia extract has been known for 2,000 years to contain an “irritant” substance, which NIH scientists identified how to use for patients through basic research on living cells observed through a microscope. Adding RTX to TRPV1-containing cells caused a visible calcium overload, which Iadarola and Mannes eventually translated into an early-stage human clinical trial.

The next steps include additional, larger clinical trials to move RTX toward eventual approval by the U.S. Food and Drug Administration and clinical availability.

This research was supported by the Intramural Research Program of the NIH Clinical Center and NIH’s National Institute of Neurological Disorders and Stroke.

This news release was published by the National Institutes of Health on May 29, 2025.

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• #Opioids
• #pain

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Novel vaccine approaches are making progress, but it will likely be years before large trials show whether they can prevent HIV.

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HIV vaccine approaches that aim to train the immune system to produce specialized antibodies against the virus have taken the next steps forward, two research teams reported in Science to coincide withHIV Vaccine Awareness Dayon May 18.

Both studies showed that different engineered immunogens could trigger production of precursor immune cells with the potential to produce broadly neutralizing antibodies (bnAbs) that work against diverse strains of HIV. One study enrolled participants in Africa, which bears the brunt of the epidemic.

“We’ve now shown in humans that we can initiate the desired immune response with one shot and then drive the response further forward with a different second shot,” William Schief, PhD, of Scripps Research, said in anews release. “These trials provide proof of concept for a stepwise approach to elicit custom-tailored responses—not just for our vaccine, but for the vaccine field at large, including non-HIV vaccines.”

Scientists have spent more than three decades trying to develop vaccines to prevent HIV,with little success. Now that several traditional vaccine candidates have failed in large clinical trials, most researchers agree thatmore sophisticated approaches are needed.

People with HIV normally produce antibodies, but these usually target parts of the virus that are highly variable, so they don’t recognize new viral mutations. Only a small proportion of individuals naturally produce bnAbs that target conserved parts of the virus, but most people do possess rare immature B cells that have the potential to do so. An approach known as germline targeting uses a series of vaccines in a stepwise manner to encourage the development of these specialized B cells and train them to produce bnAbs.

Schief’s team createdan immunogen dubbed eOD-GT8 60mer, made up of 60 engineered copies of HIV’s gp120 envelope protein fused to a nanoparticle. In 2022, the IAVI G001 trial showed that a protein-based version of the vaccinespurred production of precursor B cellsthat had the potential to produce bnAbs similar to VRC01, which targets HIV’s CD4 binding site. Last year,they reportedthat a messenger RNA (mRNA) version of a primer vaccine encoding instructions for eOD-GT8 60mer, followed by a booster dubbed core-g28v2 60mer, encouraged B-cell maturation and production of VRC01-like antibodies in mice.

This set the stage for a pair of Phase I trials: IAVI G002 (NCT05001373), which enrolled 60 participants in North America, and IAVI G003, which enrolled 18 people in Rwanda and South Africa.

As described in the first Science report, participants received the eOD-GT8 60mer mRNA primer vaccine (which Moderna calls mRNA-1644) either alone or followed by the core-g28v2 60mer booster. This so-called heterologous boosting strategy is designed to guide the immune response along the path toward bnAb production. All 17 people who received both the primer and booster developed VRC01-class antibody responses, most of whom showed “elite” responses with multiple mutations linked to bnAb development. People who received only the primer generally had less mature VRC01-class antibody responses.

“What really surprised us was the quality of the immune response we saw after just two shots—one prime and one heterologous boost,” Schief said. “We didn’t anticipate it would be that favorable.”

IAVI G003 participants received two doses of the eOD-GT8 60mer mRNA primer without the booster. All but one (94%) developed VRC01-class responses with activation of immature B cells. Interesting, they showed high levels of antibody mutation and diversity similar to what was seen in IAVI G002, despite the lack of a booster.

Inanother Phase I study, Tom Caniels, PhD, of Amsterdam University Medical Center, tested a germline-targeting approach using a trimer immunogen dubbed BG505 SOSIP.v4.1-GT1.1. Here, too, the vaccine induced production of VRC01-class bnAb precursors in a majority of recipients. What’s more, a subset of these monoclonal antibodies were structurally very similar to VRC01 and neutralized wild-type “pseudoviruses” in the laboratory.

“Across the participants we saw antibody production that tells us we’re on the right track,” senior study author Rogier Sanders, PhD, of Amsterdam University Medical Center, said in anews release. “We now know we can target the right cells with atomic precision. The next step is to further stimulate these cells to secrete broadly neutralizing antibodies.”

Yet unexpected side effects could be a concern. In the IAVI trials, the vaccines were generally well tolerated, but some participants developed mostly mild to moderate skin reactions that could be managed with antihistamines. However, about 10% of IAVI G002 participants developed chronic hives lasting six weeks or longer.

Other researchersrecently reportedthat 7% of 108 study participants who received experimental BG505 MD39.3 trimer mRNA HIV vaccines developed hives, including four with persistent symptoms lasting a year. All of those with hives had previously gotten a Moderna COVID-19 vaccine. The mechanism underlying these reactions is unclear, and further analysis is underway.

Taken together, these findings are promising, but they are still early steps in a long process. Researchers have not yet tested whether the novel vaccine approaches protect animals exposed to HIV (or its simian cousin SIV), much less whether they can prevent HIV acquisition in people.

What’s more, vaccine trials have gotten harder now that highly effective pre-exposure prophylaxis (PrEP) is widely available—withtwice-yearly lenacapaviron the way—and complex vaccine regimens that require multiple doses may not be feasible in the real world.

While an effective and globally accessible HIV prevention vaccine is a high bar, germline targeting might also play a role in therapeutic vaccines that generate bnAbs in people living with HIV, which potentially could be part of a combination strategy for long-term remission, or a functional cure.

Click here for more news aboutHIV vaccines.

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• #HIV vaccine
• #mRNA
• #vaccine research

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HIV prevalence went down and viral suppression went up as more people used gender-affirming hormone therapy.

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Transgender people who receive gender-affirming hormone therapy appear to have better HIV outcomes, according to a new study published in The Lancet HIV. As the proportion of trans and gender-diverse people receiving hormone therapy rose at two primary care clinics, HIV prevalence and the likelihood of not having viral suppression declined.

“Gender-affirming care is important for optimizing HIV outcomes among trans people,” the study authors concluded. “Our results underscore the vital role of gender-affirming models of care and access to gender-affirming hormone therapy for trans people.”

Transgender, gender-nonconforming and nonbinary people have higher rates of HIV compared with the population at large, as they may be less likely to access prevention services, medical care and antiretroviral treatment. Tailored services have helped close this gap—trans people were a prioritized population in the National HIV/AIDS Strategy for 2022-2025—but political shifts put this progress in jeopardy.

Accurate information about how many trans and gender-diverse people are living with HIV and their prevention and treatment outcomes have been hard to come by. In recent years, the Centers for Disease Control and Prevention’s HIV surveillance data and care metrics have included data according to gender identity (after previously counting trans women as “men who have sex with men”), but the Trump administration has changed how trans people are classified, removed relevant data and resources, and reduced funding for targeted research and services. In fact, the researchers noted that some of the referenced sources became inaccessible after this manuscript was accepted.

Prior research suggests that trans people who receive gender-affirming therapy are more likely to be engaged in medical care and may be more inclined to start and stay on antiretroviral treatment. On the other hand, some trans people are concerned that medications used for pre-exposure prophylaxis (PrEP) or HIV treatment could interfere with the effectiveness of hormones—or vice versa—though this has not been observed in numerous studies.

To learn more, Sari Reisner, ScD, of the University of Michigan School of Public Health, Asa Radix, MD, of the Callen-Lorde Community Health Center and Columbia University Mailman School of Public Health, and colleagues assessed gender-affirming hormone therapy delivered in primary care settings as an intervention to improve HIV outcomes for trans people.

LEGACY is a longitudinal cohort of trans adults receiving primary care at two federally qualified health centers primarily serving LGBTQ+ communities: Callen-Lorde in New York City and Fenway Health in Boston. Participants are at least 18 years old and have a gender identity different from their assigned sex at birth.

Among the 8,109 participants in 2019, just over a third (36.5%) were transgender women, nearly a third (31.3%) were transgender men, 12.4% were nonbinary assigned female at birth, 6.2% were nonbinary assigned male and the remaining 13.6% reported another trans or gender-diverse identity. The median age was 29 years, with a majority (57.2%) being age 30 or younger. More than half (54.8%) were white, 20.5% were Latino, 16.3% were Black and 6.1% were multiracial. About half had private insurance, and a third were covered by public insurance (such as Medicaid or the Ryan White HIV/AIDS Program), but 5.6% were uninsured. About 40% had an income below the federal poverty level. Only about 3% had been prescribed PrEP, and about 4% tested positive for other sexually transmitted infections.

Using electronic health records from 2013 through 2019, the researchers analyzed associations between gender-affirming hormone therapy and the likelihood of testing positive for HIV and, among those with an HIV diagnosis, maintaining viral suppression on antiretroviral therapy over the past 12 months (defined here as a viral load below 200). Gender-affirming hormone therapy included puberty blockers, anti-androgen medications, estrogens, progesterone and testosterone.

During the first year of the study period, most of the smaller population of 2,983 participants (85.5%) were prescribed gender-affirming hormone therapy. At that point, 272 people (9.1%) were HIV positive; of these, 61 (22.4%) did not have viral suppression. By 2019, the cohort population had reached 8,109 participants, and the proportion on hormone therapy had risen to 89.4%. A smaller proportion was HIV positive (560 people, or 6.9%); of these, 88 (15.7%) did not have viral suppression.

The overall HIV prevalence in this study is lower than rates previously reported for trans people. The researchers suggested that this might be due to the high proportion of trans men and nonbinary people assigned female, whereas most prior studies mainly looked at transgender women.

However, Black, Latina and multiracial transgender women in this analysis were much more likely to be HIV positive compared with the full cohort, at 29.4%, 18.0% and 17.8%, respectively. HIV prevalence was lower among transgender men; Black trans men had the highest rate, at 5.9%. While HIV seropositivity appeared to be stable for most groups during follow-up, it increased for Black transgender women. Looking at treatment outcomes, younger trans people were less likely to have viral suppression.

Based on these findings the researchers calculated that gender-affirming hormone therapy was associated with a 37% lower rate of HIV seropositivity and a 44% lower likelihood of having uncontrolled HIV compared with trans people not on hormones.

The reasons for the beneficial effects of gender-affirming hormone therapy are unclear, but the researchers noted that hormone therapy has been linked to reduced mental distress and improved quality of life, which could facilitate behaviors such as condom use or adherence to antiretrovirals. Gender-affirming care might also increase trust with providers, reducing barriers to discussing sexual health concerns or adherence difficulties. Unfortunately, federal funding cuts are likely to hamper further research along these lines. Indeed, as STAT reported, Reisner has lost all of his existing grants from the National Institutes of Health.

“Years retained in care predicted increased risk for HIV seropositivity and decreased risk for viral non-suppression, highlighting engagement in care as key to identifying new HIV infections and enhancing viral suppression,” the study authors wrote. “Combination interventions that pair gender-affirming hormone therapy with other services, such as PrEP for HIV prevention and HIV care, might hold promise.”

Click here for more news about HIV and transgender people.

• #antiretrovirals
• #gender-affirming care
• #HIV
• #hormone therapy
• #nonbinary
• #PrEP
• #transgender

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The Department of Health and Aged Care has released the Aged Care Data and Digital Strategy and accompanying action plan.

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Writing to the health secretary and the deputy national security advisor, the lawmaker cited recent cyber hygiene failures by healthcare organizations and asked the agency to propose mandatory minimum cyber standards already under consideration.

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U.S. Senator Mark R. Warner, D-Va., wrote to the U.S. Health and Human Services Secretary Xavier Becerra and Deputy National Security Advisor Anne Neuberger this past week and asked them to quickly develop and release mandatory minimum cyber standards for the healthcare sector. 

“Both the size and increasingly interconnected nature of the sector create a vulnerable attack surface,” Warner said.

WHY IT MATTERS

Warner, a cofounder of the Senate Cybersecurity Caucus, said that he is concerned not only about the economic risk to one of the largest sectors in the U.S. economy, with health expenditures “expected to grow to nearly 20% by 2032,” but also the risks to providers and patients.

“Simply put, inadequate cybersecurity practices put people’s lives at risk,” he said in the letter. 

Financially motivated threat actors know that PHI is highly valuable – “health records are more valuable than credit card records on the dark market,” he said, and it’s all too easy to disrupt healthcare-provider operations leaving patients without access to care and their PHI potentially sold to the highest bidder on the dark web.

In the letter, he did not mince words over known security lapses by organizations, including Change Healthcare. 

The for-profit healthcare payment processing organization was crippled after a February ransomware attack, inflicting widespread provider operational and patient care disruptions as a result. The Change provider-payments outage also threatened the closure of small practices and prevented pharmacists from confirming patient drug coverage.

“Due to some entities failing to implement basic cybersecurity best practices, such as the lack of multi-factor authentication resulting in the successful attack on Change Healthcare, the capability required of a threat actor to carry out an operation in the sector can be quite low,” Warner charged.

He also highlighted the recent cyberattack on Ascension, one of the largest nonprofit healthcare systems in the U.S., and the significant delays in care it caused.

Noting that policymakers, cybersecurity professionals and patients are calling voluntary healthcare cybersecurity “insufficient and dangerous,” Warner urged Becerra and Neuberger to ensure that the healthcare sector is required to be fully engaged in “developing, implementing and maintaining a coherent and effective cybersecurity regime” through mandatory cybersecurity requirements.

THE LARGER TREND

The scope of cyber threats has only escalated in severity and cost since healthcare experienced the top three largest data breaches of 2015.

In 2022, Warner called for a federal healthcare cybersecurity leader and presented several regulatory options in the policy paper Cybersecurity is Patient Safety to stimulate government action.

While the U.S. Health & Human Services proposed new cybersecurity requirements for hospitals and outlined voluntary healthcare-specific cybersecurity performance goals in December, the American Hospital Association pushed back on the proposal to penalize breached organizations, telling lawmakers that penalties on hospitals like Ascension and other healthcare organizations diminish funding for their cyber defenses and threaten the closure of cash-strapped HCOs.

“The cybersecurity proposal put forward in the President’s FY 2025 budget that would penalize hospitals is misguided and will not improve the overall cybersecurity posture of the healthcare sector,” AHA said in April at an HHS budget hearing.

We reached out to AHA for a comment and will update this story if one is made available. 

ON THE RECORD

“The stakes are too high, and the voluntary nature of the status quo is not working, especially regarding healthcare stakeholders that are systemically important nationally or regionally,” Warner said in the letter.

The HIMSS Healthcare Cybersecurity Forum is scheduled to take place October 31-November 1 in Washington, D.C. Learn more and register.

Andrea Fox is senior editor of Healthcare IT News.Email: [email protected]Healthcare IT News is a HIMSS Media publication.

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Erie County Medical Center Corporation’s RPM initiative has been successful in “improving health outcomes and reducing the risks associated with hypertension,” says its VP of population health.

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Hypertension, the most prevalent risk factor for cardiovascular disease, affects 1.39 billion adults worldwide and has a 46% uncontrolled rate. That poses a substantial burden for hospitals and health systems – and necessitates a paradigm shift in management strategies, clinicians say. 

THE PROBLEM

Uncontrolled hypertension can lead to recurrent heart attacks, strokes, heart failure, chronic kidney disease and death. Social determinants of health and disparities magnify the likelihood of such deadly complications.

Erie County Medical Center Corporation serves Western New York. It encompasses Erie County Medical Center, one of only five public hospitals in New York State and the region’s only Level 1 Adult Trauma Center. It also is the largest safety net hospital, serving a large proportion of at-risk and vulnerable patients.

Located in the heart of Buffalo, ECMC is an anchor institution in Buffalo’s historic East Side community with more than 100 years of providing quality healthcare that specializes in treating patients disproportionately impacted by SDOH and chronic disease complications. Currently, ECMC serves a total of more than 6,500 hypertensive patients.

“The prevalence of cardiovascular disease in Erie County is alarming, with higher rates of stroke-related fatalities than both the national average and the aggregate of New York State,” said Lucia Rossi, vice president of ambulatory services and population health at ECMC. “Heart disease fatalities in this region are 33% higher than the national average, pointing to increased vulnerability among residents.

“Moreover, risk factors like high blood pressure and overweight/obesity are more prevalent, exacerbating the situation,” she continued. “Routine preventive health checks, including blood pressure and cholesterol screenings, are significantly lower at 58% among Buffalo and neighboring residents, compared with the 75% national average.”

This discrepancy raises concerns about undiagnosed conditions, highlighting the urgent need for proactive and targeted healthcare measures in this area, she added.

“Internal needs assessment data and the Erie County Community Health Needs Assessment revealed that ECMC’s patients suffer from disproportionately high rates of cardiovascular disease, hypertension, diabetes and obesity,” Rossi said. “Cardiovascular disease is the leading cause of death in the U.S. Hypertension, the most prevalent risk factor for cardiovascular disease, has become one of the most commonplace chronic conditions in the U.S.

“The combination of SDOH and disparities that contribute to the worsening of a condition have kept hypertension management in a steady state of evolution,” she continued. “Transportation barriers, a common SDOH in economically challenged groups, can have a tremendous impact on treatment adherence and achieving positive health outcomes in hypertension patients.”

In Buffalo, disparities in healthcare related to socioeconomic status and race/ethnicity continue to drive poor health outcomes for hypertensive patients.

“50% of U.S. adults are diagnosed with hypertension, and 50% of those adults are uncontrolled,” Rossi explained. “A staggering 80% of hypertensive Black adults are uncontrolled – a clear disparity in comparison to the population as a whole.

“At ECMC, 56% of patients diagnosed with hypertension were categorized as uncontrolled,” she reported. “58.2% of ECMC’s patients are Black, and 28.6% of residents live below the poverty line. Healthcare professionals are challenged with the need to consider disparities and barriers to care and to seek non-traditional care delivery and patient engagement methods like remote patient monitoring to effect substantial change.”

There is a critical need to explore and integrate innovative technologies, patient engagement strategies and care management frameworks to optimize patient outcomes and curb the escalating impact of hypertension on patient health and quality of life, she added.

PROPOSAL

Vendor Brook Health’s remote patient monitoring technology is designed to address the unique challenges faced by patients with hypertension who encounter transportation barriers. This system seamlessly integrates wearable devices and a mobile app into a HIPAA-compliant platform.

“This integration empowers patients to conduct continuous monitoring of critical health metrics such as blood pressure and heart rate from the convenience and privacy of their homes,” Rossi said. “By eliminating the necessity for frequent clinic visits, the RPM solution ensures that patients maintain consistent oversight of their health status, fostering proactive management and early intervention.

“Key features of the RPM system include robust capabilities for real-time data tracking, which provides healthcare providers with immediate access to vital health information,” she continued. “Automated alerts are triggered for critical readings or missed medication doses, enabling timely interventions that can potentially prevent acute health incidents.”

The system’s advanced analytics enable comprehensive trend analysis over time, facilitating personalized treatment adjustments tailored to each patient’s unique health profile and response to therapy, she added.

“In addition to its monitoring and alert functionalities, the RPM system incorporates integrated patient education resources,” Rossi explained. “These resources empower patients with comprehensive information on hypertension management, medication adherence strategies, lifestyle modifications and early symptom recognition. By equipping patients with knowledge and resources, the aim is to enhance their confidence and ability to actively participate in their healthcare journey.

“Healthcare providers leveraging RPM technologies stand to benefit significantly from improved patient outcomes,” she continued. “The proactive monitoring capabilities enable healthcare teams to detect and address deviations from optimal health parameters promptly, potentially reducing the incidence of severe hypertension-related complications such as strokes or heart attacks.”

By minimizing the need for unnecessary clinic visits, an RPM system can optimize healthcare efficiency and resource allocation, allowing providers to allocate more time and attention to patients requiring immediate medical interventions, she added.

MEETING THE CHALLENGE

Adherence to hypertension treatment, including pharmacological therapies, self-management techniques, behavioral modification or a relative combination, is critical for effective blood pressure control.

However, barriers to taking prescribed medications, lifestyle changes, and compliance with treatment plans and medical care, significantly hinder successful hypertension management.

“As such, non-traditional, comprehensive approaches to improve access and adherence to crucial healthcare services are essential for patients suffering from uncontrolled hypertension, barriers to care and health disparities,” Rossi said. “Remote patient monitoring, telehealth, care management with nurse interventions and behavioral intention screening have been individually recommended as techniques for effectively managing hypertension.

“Therefore, Erie County Medical Center implemented a comprehensive hypertension program interconnecting remote patient monitoring, telehealth, care management with nurse interventions and behavioral intention screening,” she continued.

“The comprehensive hypertension program was intended to engage active primary care patients at Erie County Medical Center in the city of Buffalo diagnosed with uncontrolled hypertension to measure and improve blood pressure control and behavioral intention.”

Erie County Medical Center included three outpatient primary practices – The Internal Medicine Center, The ECMC Family Health Center and the YOU Center for Wellness – to identify and enroll uncontrolled hypertensive patients in the comprehensive hypertension program. The program began on June 1, 2022, and is ongoing.

“The program was designed to eliminate all cost to the patient and promote participation for those patients coming from socioeconomically challenged circumstances,” Rossi explained. “A BodyTrace blood pressure cuff is provided to the patient at no cost, and telehealth video visits are used to address transportation barriers and ease patients’ compliance in the program.

“The blood pressure cuff directly connects the patient’s cell phone through Bluetooth, eliminating the need for wireless internet,” she continued. “Patients who do not have a cell phone are linked with a social worker who is able to help them obtain a cellphone through local government aid.”

Patients are screened at the beginning of the program for SDOH, and a care manager is assigned to work with the patient to address needs outside of hypertension management such as housing and food insecurity. The program addresses the clinical and social needs of the patient through comprehensive care coordination embedded in the remote patient monitoring program.

“Throughout the program, patients receive comprehensive remote patient monitoring care including extensive health teaching, weekly blood pressure assessments and medication compliance counseling from a specialized pharmacist,” she noted. “Research proves that Black patients with high blood pressure can benefit greatly from therapeutic lifestyle changes such as diet modification, physical activity and weight management.

“Therapeutic lifestyle interventions in this program emphasize patient self-management and are tailored to the individual’s cultural heritage, beliefs and behavioral norms,” she continued. “The use of remote patient monitoring and telehealth capabilities affords providers at ECMC the time and opportunity required to address disparities and tailor treatment to each unique patient without pressuring the patient to attend in-person visits.”

ECMC and its partners plan to use the impactful results of this program to ignite policy analysis, research, community engagement and payer reform to support the changes in the way healthcare is delivered that are necessary to reduce health disparities. The work focuses primarily on the Zip codes in Buffalo where Black residents are dying at three times the rate as their white counterparts.

“The health inequities plaguing these Zip codes are a result of the downstream effects of unemployment, failing education, low property values, poor access to public transportation, absence of grocery stores and poor access to healthcare,” Rossi noted.

RESULTS

The program with Brook Health launched in June 2022 and has demonstrated positive results. To date, the program has successfully enrolled 830 patients with a retention rate of 92%.

“This is especially impressive considering the challenges posed by our patient population’s social determinants of health and the historically high rates of non-compliance,” Rossi said. “This retention rate underscores the program’s effectiveness in engaging and retaining participants. One of the most notable achievements is the substantial improvement in hypertension control compliance.

“The baseline data indicated a primary care clinic blood pressure control rate of 44.2%, but since the program’s inception in June 2022, an impressive 74% of the patients enrolled in the program for more than three months have achieved an average blood pressure less than 140/90,” she reported. “32% of the patients have a blood pressure less than 130/80 and 80% of the controlled patients have been maintaining a controlled blood pressure for more than two months.”

This significant increase in blood pressure control and maintained control reflects the program’s ability to empower patients with the tools and resources needed to manage their hypertension effectively, she added.

“Through a qualitative prospective repeated-measures pre-post validated approach, progress is monitored weekly to study the effectiveness of remote patient monitoring on improving behavioral intentions, healthcare access, utilization and clinical outcomes for hypertensive patients,” she explained.

“A Likert-style pre-post questionnaire is being used to measure behavioral intention and perceived behavioral control toward self-measuring blood pressure, ease of accessing care and treatment compliance to show if patients feel they have more or less control over their health at the end of the program versus the beginning,” she said.

The behavioral intention outcome data to date has reflected that patients expressed a high level of confidence in their ability to attend visits (77%) and check blood pressure daily (77%) after participating in the program.

“The outcomes are a clear testament to the program’s success in achieving its objectives of improving health outcomes and reducing the risks associated with hypertension,” Rossi stated.

ADVICE FOR OTHERS

“Begin by conducting a thorough assessment of your patient population to identify specific demographics that would benefit most from RPM, such as elderly patients or those with chronic conditions requiring frequent monitoring,” Rossi advised.

“Selecting the right RPM technology involves choosing platforms that seamlessly integrate with your existing electronic health records system, ensuring compatibility with your practice’s workflow while prioritizing data security and HIPAA compliance,” she continued. “Comprehensive training programs are essential for both healthcare staff and patients to ensure proficiency in using RPM devices and software.”

Staff should be equipped to interpret RPM data effectively and integrate it into clinical decision-making processes, she added.

“Patients need thorough education on how to monitor their vital signs, interpret readings, and respond to alerts or notifications promptly,” she said. “Establish clear protocols for RPM data management, including who receives alerts, how responses are triaged and documentation procedures for interventions.

“To enhance patient engagement, emphasize ongoing communication and support,” she concluded. “Regular check-ins with patients to review their progress, discuss any concerns and reinforce the benefits of remote monitoring can significantly improve adherence and outcomes.”

Follow Bill’s HIT coverage on LinkedIn: Bill SiwickiEmail him: [email protected]Healthcare IT News is a HIMSS Media publication.

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The companies will further develop speech-to-text technology that takes healthcare provider’s notes and can upload key excerpts to EHR-agnostic files, while the agency accepts feedback on the sole-source solicitations.

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The U.S. Department of Veterans Affairs plans to award new contracts to two winners of this year’s AI Tech Sprint program, designed to help reduce the burden of clinical documentation.

WHY IT MATTERS

The VA says it intends to award firm fixed-price contracts to Abridge AI and Nuance Communications to test and evaluate commercial, cloud-based, ambient scribe software in live VA environments.

The administration said it needs software-as-a-service tools to transcribe clinical encounters and generate notes in order to integrate with its electronic health record, and so that doctors can insert visit information “without copy and paste manual effort,” according to the July 11 notice.

Moving beyond storing and retrieving data more efficiently to impact people’s lives and solve important problems was the spirit behind the tech sprint – Documenting VA Clinical Encounters and Integrating Community Care Data – according to Charles Worthington, VA chief technology officer and chief artificial intelligence officer. 

While the VA has made great strides in cloud and mobile computing that have enabled more veterans to access their benefits and patient information, the agency is on the cusp of a major transition to a new way to deliver software that is about creating inferences or predictions, based on large models and complicated mathematics, Worthington said at an award ceremony on May 21, when the finalists were announced.

“This paradigm is quite different. I think all of the techniques we’ve used to get to this point we’re going to have to rethink because all of those techniques are necessarily applicable to a world where we’re generating inferences and using those inferences to deliver outcomes,” he said.

Other winners of the Ambient Dictation for Clinical Encounters track were Althea Health, ARETUM, Cognosante Military and Veterans Health, Commure, Contrast AI, Credence Management Solutions, DeepScribe, TranscribeMD AI, Knowtex, QuantumTechIT, Sourceree, Tali AI and Veterans EZ Info.

Any interested party that believes it could satisfy the requirements can respond to the VA notice, the agency said. 

THE LARGER TREND

The $1 million AI Tech Sprint initiative was first launched this past year with the goal of developing ambient dictation for clinical encounters, as well as an advanced document-processing system for its Community Care program. 

To address provider burdens, the agency is seeking “high fidelity, traceable records of provider encounters” from a platform that can also interoperate with VA health system information. 

Part of the challenge was incorporating advanced software features, like source vetting and an ability to extract structured CPT codes, SNOMED CT codes and/or LOINC codes into medical records and its Summit Data Platform Health Information Exchange.

“AI solutions can help us reduce the time that clinicians spend on non-clinical work, which will get our teams doing more of what they love most: caring for Veterans,” Dr. Shereef Elnahal, the VA undersecretary for health, said in a statement when the challenge was announced in November. “This effort will reduce burnout among our clinicians and improve veteran healthcare at the same time.”

Both tracks offered a first-place prize of $300,000, $150,000 for second place and $50,000 for third. More than 150 teams competed across the two tracks, and there were 25 finalists, according to the VA’s Office of Research and Development AI Tech Sprint website.

“We could all but eliminate the administrative load that has eroded the quality of doctor-patient conversations and has famously broken the spirit of many clinicians,” said Dr. Shiv Rao, a practicing cardiologist and CEO of Abridge, one of the AI contract awardees.

Generative AI can attract the next generation of healthcare workers by simplifying difficult and labor-intensive processes, he told Healthcare IT News last year.

Microsoft subsidiary Nuance, through its long-term partnership with Epic, advanced ambient documentation products with genAI last year. 

“For the first time, we can see how conversational understanding, generative AI, and clinical context can together generate high-quality documentation,” Sean Bina, Epic’s VP of patient experience, said in the announcement.

ON THE RECORD

“The challenge was a rigorous and competitive evaluation process authorized under the America COMPETES Act and aligned with the directives of Executive Order 14110,” said VA officials in its contract notice.

Andrea Fox is senior editor of Healthcare IT News.Email: [email protected]Healthcare IT News is a HIMSS Media publication.

The HIMSS AI in Healthcare Forum is scheduled to take place September 5-6 in Boston. Learn more and register.

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Humberto Farias of Concepta Technologies discusses his new Machine Advancement and General Intelligence Center and offers AI advice for healthcare C-suite executives and other health IT decision makers.

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Humberto Farias has been watching the explosion of generative AI very closely.

Farias is cofounder and chairman of Concepta Technologies, a technology company specializing in software development and programming in the areas of mobile, web, digital transformation and artificial intelligence.

For example, he noticed that Apple is putting generative AI at the very center of the lives of hundreds of millions of iPhone-toting people. But with recent data leaks, patient privacy problems and other IT issues, he says he’s worried health IT teams will become prone to seeing AI as a threat rather than a tool.

The question becomes: How can health systems protect valuable patient data while still reaping the benefits of generative AI?

Farias has debuted the Concepta Machine Advancement and General Intelligence Center, or MAGIC, a collaborative research program, virtual incubator and service center for artificial intelligence and advanced technologies.

Healthcare IT News spoke recently with Farias to learn more about MAGIC and understand concerns he has heard from healthcare CTOs about implementing artificial intelligence. He offered tips and real-world examples to securely deploy AI and learning and described what he believes should be the primary focus for CIOs, CISOs and other security leaders at hospitals and health systems as AI and machine learning continue to transform healthcare.

Q. Please describe your new organization, MAGIC. What are your goals?

A. Our mission is to push the boundaries of AI research and development while providing practical applications and services that address real-world problems. At MAGIC, we aim to foster cutting-edge research for both fundamental technologies and applied solutions, support and nurture early-stage AI ventures, educate and train professionals in AI skills, provide consulting services, and build a network of collaboration.

Some of our initial partnerships include healthcare companies dedicated to improving healthcare for patients, hospitals and clinical teams. They combine assessments, analytics and education, and then measure it all to improve healthcare for everyone. Through our partnership, we are implementing AI to make programs run even more efficiently and cost-effectively for their teams.

We’re open to working with large health systems on some of the key issues they’re facing when it comes to AI implementation. We’ve worked with health systems like Advent Health on other software technology and are well-equipped to handle the unique regulatory and patient security issues healthcare faces.

Q. What are some of the concerns you have heard firsthand from healthcare CTOs about implementing AI into their business structures?

A. I’ve heard from healthcare CTOs that their main concerns regarding the implementation of AI into their business structures is still data privacy and security. Health executives want to ensure the privacy and security of sensitive patient data are a top priority, given the stringent regulations from HIPAA and other mandates.

There also is hesitation around how AI solutions can integrate with legacy systems and if they are compatible, as well as navigating the complex regulatory landscape to ensure AI solutions comply with all relevant laws and guidelines.

There also is a cost to implement AI, and many healthcare CTOs are uncertain about the return on investment this technology can provide. I’m always looking for ways to cut these costs by collaborating with peers and ensuring we don’t operate in a silo – learning from mistakes and building upon successes from other leaders in the industry.

In pairing with that, there is also a lack of skilled personnel to develop, implement and manage AI systems. Health systems already are on tight budgets and experiencing cutbacks, so working with an AI research program can fill this need and help advance the use of AI throughout their institutions.

We’re working to educate health systems on how AI can be used for simple things like minimizing repetitive admin tasks and large-scale projects that can improve workflows for providers and care with real patients.

Finally, there always are ethical concerns when it comes to AI, healthcare CTOs want to ensure AI is used ethically, particularly in decisions that directly affect patient care. The top concerns in this area are informed consent and data bias.

Patients must be aware AI is included in their care, as well as making sure data used to train AI algorithms does not result in biased healthcare decisions that exacerbate disparities in healthcare outcomes among different demographic groups.

Q. What are some tips and real-world examples you can offer to safely and securely deploy AI, especially considering sensitive medical data?

A. There are several ways healthcare executives can deploy AI safely and securely. One of those is through data encryption. It’s important always to encrypt sensitive medical data both in between networks and when filed in records systems to protect against unauthorized access.

Another tip is to implement robust access control mechanisms to ensure only authorized personnel can access sensitive data. Large healthcare centers should employ multi-factor authentication, role-based access controls and a 24/7 monitoring system. Conducting regular security audits is another way to ensure security and safety by continuous monitoring to detect and respond to potential threats promptly.

Regulating compliance is another tip to ensure trust; you would do this by aligning AI deployments with regulatory frameworks such as HIPAA and GDPR. Making a priority to develop and adhere to ethical guidelines for AI usage is another tip, making sure to focus on fairness, transparency and accountability.

For instance, Stanford Health Care has an ethics board that reviews AI projects for potential ethical issues.

Q. What would you say is the primary focus CIOs, CISOs, and other security leaders at hospitals and health systems should have as AI continues to explode in healthcare?

A. The use of AI is inevitable in healthcare, so the primary focus for CIOs, CISOs and other security leaders should be to continue to ensure data privacy and security and to protect patient data from breaches. The top priority should be making sure programs comply with regulations.

Healthcare leaders also should focus on the development of a scalable and secure IT infrastructure that can support AI applications without compromising performance or security. Then to support this system, provide ongoing training for staff at every level – from staff to providers to C-suite – on the latest AI technologies and security practices to mitigate risks associated with human error.

To ensure there’s a fail-safe plan, healthcare leaders should develop and maintain a comprehensive risk management strategy that includes regular assessments, incident response plans and continuous improvement.

Collaboration is key to creating the best team ready to handle the challenges of the world we live in, encouraging collaboration between IT, security and clinical teams to ensure AI solutions meet the needs of all stakeholders while maintaining security and compliance standards.

The HIMSS AI in Healthcare Forum is scheduled to take place September 5-6 in Boston. Learn more and register.

Follow Bill’s HIT coverage on LinkedIn: Bill SiwickiEmail him: [email protected]Healthcare IT News is a HIMSS Media publication.

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It recently digitised its registration and patient management systems.

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Bangkok Hospital, one of Thailand’s largest private healthcare providers, has moved away from the paper and manual process of registering and managing patient flow in its headquarters.

AI technologies provided by its partner, local startup Agnos Health, now underpin its patient registration and management systems. 

HOW IT WORKS

As part of its enhanced patient flow system, the tertiary hospital implemented self-service kiosks that run on multiple AI, integrating various registration steps. 

It features AI face recognition to identify and confirm patient identities; an AI symptom checker that initially screens a patient’s history to refer them to an appropriate department or clinic; and robotic process automation for automatic insurance verification. The system can also acquire a patient’s electronic consent for collecting personal data and issue e-visit slips to track service status.

Meanwhile, Bangkok Hospital’s check-up department, the Health Design Center (HDC), also transitioned from manual patient queue distribution to a digital system. 

Its nurses can now monitor and manage patient queues, the status of which are delivered to patients via mobile channels and the department’s television screen. The system has an AI that tracks service status and recommends repurposing rooms to relieve foot traffic in certain areas. 

The HDC can now send electronic forms that patients can fill out, even before going to the hospital. An AI assesses these for health risks and then recommends appropriate check-up packages. 

The department’s AI co-pilot processes patients’ check-up lists, wait times, appointments, and clinical priorities to recommend an optimal examination order. 

WHY IT MATTERS

Since augmenting its registration system with AI, Bangkok Hospital saw front-end and back-end procedures reduced, including taking patients’ medical histories. Wait times were also cut as registration steps were lessened by 45% from the previous system. 

The hospital claims patient queues in the check-up department are also now evenly distributed. The HDC manages between 200 and 300 patients daily, each with varied check-up packages, procedures, and time. With AI, staff spends less time informing patients about their wait times and next steps and answering oft-repeated questions. Wait times are down by half from the previous manual system.

THE LARGER TREND

Private hospital operators in Thailand have increasingly invested in and adopted data and digital technologies in recent years as part of their digital transformation initiatives. 

Srisawan Hospital, a private tertiary hospital in Nakhon Sawan, a city north of Bangkok, recently sought the assistance of GE HealthCare and InterSystems to digitise its asset and workforce resource management and install an integrated HIS at its Bangkok branch. 

To prove its maturity in the use of EMR technology, Princ Hospital Suvarnabhumi, part of the private Principle Healthcare Group, underwent the assessment for Stage 7 of the HIMSS Electronic Medical Record Adoption Model. It is currently the only hospital in Thailand to have achieved this highest validation, which it received early this year.

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“By relying on the AI technology to convert information into discrete data elements in our Epic EHR, we have significantly reduced the amount of manual entry required by our staff,” an inpatient pharmacy operations supervisor reports.

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Carle Health, an eight-hospital health system based in Illinois, is dedicated to giving patients the care they need at every point in their healthcare journey. Through collaboration and engagement, the health system aims to ensure the highest level of care by applying accurate data and innovative, evidence-based best practices.

THE PROBLEM

Medication reconciliation is a critical process that ensures patients’ medication lists are accurate and up to date during transitions of care, such as hospital admissions, transfers and discharges.

“To ensure accurate reconciliation, our pharmacy technicians need to know not only the medications a patient has been prescribed but what they are actually taking,” said Jason Tipton, inpatient pharmacy operations supervisor at Urbana, Illinois-based Carle Foundation Hospital. He holds a doctorate in pharmacy. “To verify that prescriptions – especially for high-risk medications – were being picked up, the pharmacy staff was spending a lot of time making phone calls to pharmacies.

“During the pandemic, that became a problem because pharmacies were overwhelmed by staffing shortages and closures,” he continued. “Our staff could be on hold for up to an hour for a conversation that lasted less than a minute, which was an inefficient way to make sure a patient’s medication history was up to date.”

The result was an increased burden on staff as well as unwelcome interruptions for the retail staff at local pharmacies. It also caused delays in medication history collection that could affect patient care.

“We were pulling medication history from a standard industry feed, but the information was often incomplete because it lacked detailed prescription instructions (sigs) and failed to capture all medication fill data, especially from local or independent pharmacies,” he noted.

PROPOSAL

Carle Health researched options for importing more medication history data directly into its Epic electronic health record system so staff could spend less time manually gathering data while improving patient safety.

“Vendor DrFirst delivers medication history from local and independent pharmacies in addition to the big box retailers,” Tipton explained. “Instead of showing only that a medication was prescribed, the DrFirst data would include a sold date so we could see when the medication was dispensed. That’s important because it helps our pharmacists see gaps in medication adherence.”

For example, a physician may prescribe an anticoagulant and provide the patient with a coupon at discharge for one month free. The prescription shows up on the patient’s medication history list but doesn’t reflect that they stopped taking it after the first month because it wasn’t affordable.

“The new technology would also give us more data in terms of specific medication information and prescription instructions such as dose and frequency,” Tipton said. “That would allow for our medication history staff to work more efficiently and give our staff pharmacists more accurate dose information for recent dispenses, thus improving recommendations during admission order reviews.”

MEETING THE CHALLENGE

At the end of 2021, Carle Health integrated the medication history system from DrFirst into the Epic EHR, making more data available to doctors, nurses and pharmacists directly within the electronic record without any changes to their standard clinical workflows.

“Since going live, we’ve seen an evolution in the AI function of the system, which translates prescription sigs such as dose and frequency into our system’s standard terminology,” Tipton explained. “Over time, the AI has improved so that it can accurately import data into the appropriate fields with less manual entry by our staff.

“Pharmacy techs now get access to the most up-to-date medication history for the patient, including dose and other prescription instructions, while eliminating a large proportion of phone calls to pharmacies,” he continued.

The new system also became key to the transitional care pharmacy program, which the health system had implemented in 2019. At admission, it’s important to get medication history to physicians quickly, especially for high-risk medications like anticoagulants.

Getting these medication details right boils down to patient safety. At discharge, pharmacy staff reviews medication lists to identify barriers that could prevent the patient from adhering to the physician’s orders. This gives pharmacy a more in-depth role in medication management and enables the organization to notify the provider in advance of possible issues.

RESULTS

“According to reporting data from DrFirst, our clinical staff is consulting the external medication history on 99% of our high-risk patients,” Tipton reported. “Considering that reviewing external medication history is a critical part of the best possible medication history (BPMH) process, specifically for high-risk patients, this puts our practices at a high level that is significantly above DrFirst’s peer average of 77%.

“By relying on the AI technology to convert information into discrete data elements in our Epic EHR, we have significantly reduced the amount of manual entry required by our staff,” he added.

ADVICE FOR OTHERS

It’s a challenging time for both retail and hospital pharmacies, industry observers say.

“New technology gives us the opportunity to take a more in-depth role in medication management while creating more efficient processes for things like gathering medication history and reconciling medication lists,” Tipton concluded. “By reducing the need for numerous phone calls and manual-based processes, we can provide better care to our patients and unburden our retail partners from frequent interruptions that take them away from their customers.”

Follow Bill’s HIT coverage on LinkedIn: Bill SiwickiEmail him: [email protected]Healthcare IT News is a HIMSS Media publication.

The HIMSS AI in Healthcare Forum is scheduled to take place Sept. 5-6 in Boston. Learn more and register.

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