By: John LoGioco, CCO.
The common rhetoric around AI and medical imaging is that AI technology will eliminate jobs. However, as AI technology starts to be implemented within clinical workflows the introduction of new technology will likely create more opportunities for employment in the near term. This is evident in the bone health sector, specifically within how Fracture Liaison Services (FLS) programs are being executed.
The core mission of a successful FLS program is to identify patients who are in need of treatment to help prevent or delay life changing events such as a primary or secondary hip fracture. The leading biomarker for predicting hip fracture events is the presence of the vertebral compression fracture. Unfortunately, as cited at the recent annual meeting of the World Congress on Osteoporosis, 70% of compression fractures are missed. The reasons are attributed to either pure misses on the part of the radiologist, high variability in reporting which causes errors and failures in follow up and indifference on behalf of the physicians as vertebral compression fractures are often incidental findings and not the acute focus of admission. At the time of this writing algorithms that are already approved for regulatory use have tested out above 85% accurate in finding vertebral compression fractures. One can easily imagine a day when bone algorithms are running on all CT and x-ray scans and in doing so will help practitioners pick up mostly all compression fractures that exist. This will be a transformative advancement in bone health management as it will flag a great number of patients who are at risk long before a life changing event such as an index or secondary hip fracture occurs.
The creation of a Fracture Prevention Program is growing in popularity across many regions. In fact it’s estimated that 1 new FLS program is started every week on a global basis. A major reason for the proliferation is the positive ROI these programs can operate within. The common denominator to all successful FLS programs is the role of the Nurse Coordinator whose role is to ensure patients who are identified with bone risk are re-engaged to start a path for treatment. In many of the longest running and successful FLS programs, this single position is operating either at full or over capacity.
Introducing the new AI powered tools, it’s feasible to estimate that a health system could identify between 70% and 85% of all vertebral compression fractures instead of the current 30% – 50%. Specifically the use of AI in the bone health sector focuses on leveraging the power of algorithms to further interpret data within ubiquitous CT contrast/non-contrast chest and abdomen scans to identify the presence of vertebral compression fractures and calculate bone density without the need for a DEXA scan. As such, the algorithms will produce a great many more patients who are eligible for bone health treatment before the first index fall. The increased patient flow will increase the volume of patients in an FLS program to a degree that will likely warrant the hiring of an additional Nurse Coordinator.
There has been considerable research and documentation on the positive ROI for properly run FLS programs. The cost savings for preventing a single hip fracture index and secondary fall health systems is staggering, $33,000 USD in the USA, 16K pounds in the UK and on a country level the totals for fracture care reaches into the billions. Calculating the fully loaded cost of 1 full time Nurse coordinator, related expenses and an annual cost of an AI software product, the break even point would be achieved after the algorithms and Nurse coordinator prevent only a handful of incremental index fractures from a vast pool of newly eligible patients. When you consider that an average FLS program with 1 Nurse Coordinator is handling 400 patients per year, it’s not hard to envision the exponential ROI added into the FLS program structure and overall cost savings to the health system from the use of AI.
2018 will be a transformative year for how technology can help the bone health sector. Osteoporosis is a space to watch. There is a giant opportunity for all stakeholders, patients, providers and payors to better the sector for all to benefit, no matter if your KPI is increased revenue, cost savings, practicing better medicine or staying alive longer and being happier in your years age 50 plus. We can no longer accept the status quo of allowing 70% of compression fractures to go unaddressed, or waiting until patients have an index fall to start identifying and treating for bone density issues in a meaningful way. 2018 will see the rollout of new AI technologies in leading bone institutions who run some of the best FLS programs in the world and in short order we will have further evidence that technology can help us solve some of our biggest challenges around bone health and fighting the devastating effects of osteoporsis. The solving of these challenges, in part accelerated by AI powered algorithms won’t necessarily translate into the elimination of jobs, in fact it’s likely to do the opposite, starting with the Nurse Coordinator role at your local health institution.