News roundup: NHS announces EDITH breast cancer screening trial, Sword Health reveals mental health move in AI-first push, Evolent Health changes up board, Highmark’s enGen tech drops 208

Over 700,000 women to be screened using AI-assisted radiology. The NHS announced on World Cancer Day (4 February) a massive trial of EDITHEarly Detection using Information Technology in Health. The intent is to reduce to one the number of radiologists needed to review a patient’s mammogram, freeing up short radiology resources, cutting waiting lists, and speeding early detection of breast cancer. The Department of Health and Social Care initiative that builds on smaller AI-enabled screening trials is part of the 10 Year Health Plan/Plan for Change. EDITH is backed by £11 million of UK Government support via the National Institute for Health and Care Research (NIHR). 30 testing sites across the UK will be used to screen women 50 to 71 already scheduled for their every-three-year exam. It’s not clear from the information if different AI assists will be used. Breast cancer in the UK affects 55,000 women and 400 men annually, second only to prostate cancer. The UK.Gov release and the Daily Mail article do not state the start nor the end of the EDITH trial, nor locations.

Virtual MSK provider to employers Sword Health leaked at JP Morgan on mental health, AI-first ambitions. CEO Virgílio Bento confirmed to STAT that they are going “AI-first” for their care models. Their ambition is to be known as an “AI care company that is going to reinvent all care delivery models that are 100% labor intensive.” The first area to get the Sword treatment is mental health, using their proprietary tablet model utilized for physical therapy. Talk therapy was derided by Mr. Bento for low-acuity conditions like anxiety, and he promised a model that would be “very disruptive.” Others ‘ripe for reinvention with AI’ are speech care, GI care, and cardiac care. His POV is that AI will enable us to move away from human-first health care. Sword Health raised in June 2024 a jumbo round of $130 million and now is valued at around $3 billion, then ‘put the sword’ to 17% of its clinicians. It has plump coffers and is rumored to be prepping for an IPO [TTA 13 November 2024].

Provider management services organization (MSO) Evolent Health adds to board, announces new chair. Rick Jelinek, who joined the board as an independent director in 2023, will be moving to the chairman position, succeeding Cheryl Scott. This will be effective at the 2025 Annual Meeting, date TBD. Mr. Jelinek is currently managing partner of Czech One Capital Partners and previously was a CVS Health executive VP. Added to the board is a new independent director, Brendan Springstubb. He is currently principal of Bedell Canyon LLC an advisor to public equity investment firms primarily in healthcare. Previously, he was a principal at one of Evolent’s major shareholders, Engaged Capital, LLC. The release also announced the planned addition of another independent director before the annual meeting.

Also upcoming: Evolent’s Q4 and year 2024 earnings call on 20 February, which should be interesting.

Starting in August last year, Evolent and Engaged Capital were moving towards a sale of part or all of the company. The number booted about was $4 billion for the package; interested parties were rumored to be Elevance, TPG, KKR, and Clayton, Dubilier & Rice (CD&R). At that time (late August), their stock on Nasdaq had hit a high of above $32. As late as early November, it traded at $25 then cracked after 7 November. At today’s close, it traded at $10.37. What happened on 7 November was the announcement of a poor Q3 due to a huge increase in medical costs that greatly affected their managed care organizations and required them to lower their guidance for the remainder of the year. The release emphasizes the skills now existing on the board in creating value for shareholders. 

And on a down note, Highmark Health’s enGen health tech subsidiary lost 208 people at the end of January. enGen provides technologies for health plans and providers in a ‘payvider’ model for operations, utilization management, provider data and reimbursement, and payment integrity. Last year in March and May, 277 were laid off from their 12,000 person workforce. enGen serves about 50 Blue and non-Blue plans with 20 million members. Highmark Health, based in Pittsburgh, is a Blue Cross Blue Shield and serves central/western Pennsylvania, including Philadelphia in the east, and parts of western New York State. Pittsburgh Business Times

AI and machine learning ‘will transform clinical imaging practice over the next decade’

The great challenges in radiology are accuracy of diagnosis and speed. Yet for radiology, machine learning and AI systems are still in early stages. Last August, a National Institutes of Health (NIH)-organized workshop with the Radiological Society of North America (RSNA), the American College of Radiology (ACR) and The Academy for Radiology and Biomedical Imaging Research (The Academy) kickstarted work towards AI. Their goal was to collaborate in machine learning/AI applications for diagnostic medical imaging, identify knowledge gaps, and to roadmap research needs for academic research laboratories, funding agencies, professional societies, and industry.

The report of this roadmap was published in the past few days in Radiology, the RSNA journal. Research priorities in the report included:

  • new image reconstruction methods that efficiently produce images suitable for human interpretation from source data
  • automated image labeling and annotation methods, including information extraction from the imaging report, electronic phenotyping, and prospective structured image reporting
  • new machine learning methods for clinical imaging data, such as tailored, pre-trained model architectures, and distributed machine learning methods
  • machine learning methods that can explain the advice they provide to human users (so-called explainable artificial intelligence)
  • validated methods for image de-identification and data sharing to facilitate wide availability of clinical imaging data sets.

Another aim is to reduce clinically important errors, estimated at 3 to 6 percent of image interpretations by radiologists. Diagnostic errors play a role in up to 10 percent of patient deaths, according to this report.

It is interesting that machine learning, more than AI, is mentioned in the RSNA materials, for instance in stating that “Machine learning algorithms will transform clinical imaging practice over the next decade. Yet, machine learning research is still in its early stages.” Radiology actually pioneered store-and-forward technology, to where radiology interpretation has been farmed out nationally and globally for many years. This countered a decline in US radiologists as a percentage of the physician workforce that started in the late 1990s and continues to today with some positive trends (Radiology 2015). Perhaps this distribution model postponed development of machine learning technologies. Also Healthcare Dive, RSNA press release  

Radiology converging imaging and real-time video

Radiology was one of the first specialties to freely locate the evaluation and reporting on patient imaging almost anywhere in the world. The objective of teleradiology was to increase volume, increase RVUs (relative value units used for Medicare reimbursement) and decrease turnaround times. What has been lost is the face-to-face contact between clinicians and radiologists with live interaction for the patient’s benefit and the clinician’s knowledge base. The addition of real-time video consults synchronized with an image viewer may be a solution. Imaging 3.0 shifts the emphasis to increased quality, increased patient safety and improved outcomes. Remote radiologists can be consulted earlier in diagnosis and during rounds ‘face-to-face’, which is far easier than by telephone. This recent article by reader Howard Reis of HealthePractices explains how even patients can participate in these consults. Real-time Video: Imaging 3.0 Toolkit? Originally published in Radiology Business and with the author’s permission.