Note published by Microsoft
Healthcare needs more resources across the board, in almost every country. The number of new doctors and nurses is not aligned with the increased demand for healthcare This comes from an aging population with more chronic illnesses. Budgets are tight, and health professionals are overworked.
“In Spain, we have the same problems as everywhere else.”, points Manuel Bosch Arcos, CTO of Ribera, a private healthcare group with 16 hospitals and 74 medical centers in Spain, Portugal, and Central Europe, serving more than two million patients annually. To address the increased demand and associated costs, Ribera relies on data and technology to help improve the healthcare systems offered to its patients.
"A key part of the company is technology”, says Bosch. “We're not a traditional healthcare company. We have government contracts based on quality of care, so we can be more innovative. We need solid data to ensure what we do is good for patients, the company, and the healthcare system.”.
The Ribera Group sees technology and data as a way to transform the healthcare system. "What we're doing is rethinking both data and how healthcare can be adapted, and doing it in real time," he notes.
Manuel Bosch Arcos, CTO of Ribera.
A small percentage of patients account for a large portion of healthcare spending because they have chronic conditions, often several at the same time. Improving the health of these patients is a boon for the system, and, of course, for themselves.
Futures, the technology subsidiary of the Ribera group, created the Cynara Citizen portal not only to perform the usual tasks of hospital portals - allowing patients to make appointments, upload lab results, ask questions or conduct teleconsultations with their providers through Microsoft Teams - but also to coordinate a center management hub, with a focus on patient care, where the agents involved can meet to develop a personalized digital health plan for each patient and be able to correctly monitor it.
The many layers of Cynara technology
Cynara is the name for a genus of artichokes, highly prized in the southern Alicante area, where the initial development team is based. The name also serves as a metaphor for how the portal's many, sometimes layered, features resemble the leaves of an artichoke, Bosch shares. Ribera's use of Microsoft tools is layered like the leaves of an artichoke. He employs Dynamics 365 Contact Center, OpenAI models for generative AI projects, Azure Machine Learning tools for non-generative AI applications, Microsoft Fabric, Dynamics Business Central, and Microsoft 365 Copilot.
Through Cynara Citizen, Ribera Group healthcare professionals can track patients' health indicators, with a focus on those with chronic conditions, in order to quickly address issues without having to wait until their next appointment. Some patients with chronic conditions may tend to hold off on taking action until their condition worsens, to the point of needing to go to the Emergency Room. Through Cynara Citizen, healthcare professionals can remotely check key medical indicators and proactively communicate with patients what they should do to avoid a health emergency.
“We have linked the application with clinical outcomes.”, explains Bosch. “Patients are achieving better blood glucose control and are not visiting the emergency room as often.”According to Ribera, Tier 3 patients—those with the most complex chronic conditions—who enrolled in Cynara Citizen's Population Health Management Program showed a 23% drop in ER visits and an 18% decrease in 30-day readmissions, compared to the previous year, before Cynara Citizen launched. These patients were in the technology-enhanced clinical program for at least 12 months. Ribera compared patients' service utilization before and after being included in the program.
More broadly, Cynara Citizen—a tool Ribera developed with Microsoft technology—can reduce gaps in medical care by helping patients adhere to their health plans so they're less likely to have to go to the emergency room. By seeing in real time if, for example, a diabetic patient's blood sugar level drops, Ribera Group healthcare professionals can call the patient and get them to respond before glucose levels drop to the point that an ambulance needs to be called, or the patient enters a coma. Patients know the healthcare professionals managing their case, so they can message them in addition to scheduling appointments. Ribera believes patients feel they're receiving good care and access to services, says Bosch. The application runs on Microsoft Azure, so patients and healthcare professionals can access it easily and securely from almost anywhere.
Ribera's active investment in AI
"The advantage is that using models allows you to gather much more information. Not just five items, but up to 30, using variables that aren't easy to find, because they may be in the lab results and impossible for a person to collect them manually."
Mireia Ladios Martín, Head of Quality at Ribera and Product Manager at Futurs.
Cynara Citizen is just one of the ways Ribera is using technology. For more than four years, the Ribera group has been actively investing in Artificial Intelligence with three goals in mind: classifying data, refining it for better results, and being able to make predictions. Machine learning is expected to classify information and give both doctors and patients a better understanding of clinical cases, such as detecting patterns that indicate a patient has a high likelihood of being readmitted to the hospital, so that care can be adjusted accordingly. For example, Ribera developed a model using Azure Machine Learning to identify patients at risk of developing pressure ulcers, a major concern in hospitals. Another model can predict patients' risk of falls.
"The advantage is that using models allows you to gather much more information. Not just five items, but up to 30, using variables that aren't easy to find, because they may be in the lab results and impossible for a person to collect them manually.", poses Mireia Ladios Martín, Head of Quality at RiberaAI tools complement traditional risk identification scales.
For example, the Ribera group wanted to identify patients who might have developed an infection after surgery. To do so, a team of physicians reviewed each patient undergoing surgery and recorded whether they had an infection after 30 or 60 days. Data mining was then used to identify everything related to the infection. The resulting model provides a score for each patient, so those with high scores are identified for closer follow-up and to confirm or rule out the infection.
Manuel Bosch Arcos, CTO of Ribera, and Mireia Ladios Martín, head of quality at Ribera and product manager at Futurs. Photo by Miguel Vizcaíno for Microsoft.
Generative AI can also create content. In this area, the Ribera Group is exploring several projects to lighten the administrative burden on physicians. One uses AI to generate discharge documents for some routine procedures, such as cataract surgery, with the goal of freeing physicians from certain administrative tasks so they can dedicate more time to actual patient care.
Ribera completely anonymizes data and works with Microsoft to ensure both data security protection and the ethical and legal foundations of AI in healthcare. "We must be very careful with patient privacy, regarding what type of information we send, where, and how.", Bosch says, adding that the Ribera Group also carefully examines the justification for using AI in corporate and healthcare applications to ensure it is ethical and legal.
Bosch compares Ribera's use of AI to a taxi driver using GPS: the driver, or in Ribera's case the doctor, is still in charge and makes decisions, but the technology can help speed up the process and reduce stress.
“There is more demand than the current healthcare system can meet,” Bosch concludes, “so we must do more and better with the same resources. We need to be more efficient and provide more value.”
Cover image: Marina Sánchez Grau, diagnostic radiology technician, on the left, and María Isabel Pérez Zaragoza, nuclear medicine technician, perform an examination at the University Hospital of Madrid.o from the Vinalopó de Ribera, in Alicante. Photo by Miguel Vizcaíno for Microsoft.
