Spine's AI nonnegotiables

Spine

Artificial intelligence has made its way into healthcare, and spine surgeons are exploring the best ways to use it in their daily work.

Here ar​​e the inevitable ways AI will integrate into the specialty.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.

Next question: What spine cases will stand out as the most cost-effective to perform within the next decade?

Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Tuesday, Feb. 4.

Editor's note: Responses were lightly edited for clarity and length.

Question: What will become a nonnegotiable utilization for AI in the next five years for spine surgeons?

Michael Briseño, MD. North Texas Orthopedics & Spine Center (Grapevine): In my mind, the next most important utilization for AI in the next five years is in the office visit. Specifically, with encounter documentation as well as order entry and coding. There are several platforms already in existence with ambient listening technology that assist significantly with documentation. The next natural progression of this is to have the AI platform then use that technology to not only generate a clinic note, but also to help place orders electronically in the EMR and generate the proper ICD-10 and E&M coding. This is a game changer in terms of maximizing a clinician’s efficiency in the clinic and allow them to primarily focus on taking care of the patient, not just documenting and EMR charting. In addition, I see the technology of AI being more utilized in the operative setting when combined with navigation technology already in existence. This likely is a little further away from wide-spread implementation. 

Brian Fiani, DO. Spine Surgeon. (Birmingham, Mich.): Predictive analytics. This will involve leveraging AI algorithms to assess risks, predict surgical outcomes, and guide pre-operative planning by analyzing large datasets from past surgeries. Additionally, AI-driven imaging tools will become essential for precise diagnostics and surgical planning, enhancing visualization and accuracy during procedures. 

Furthermore, real-time monitoring systems powered by AI will be critical for post-operative care, enabling early detection of complications or anomalies. As the field continues to evolve, incorporating AI into clinical workflows will not only improve efficiency but also enhance patient safety and overall surgical success rates. Adopting these technologies will be essential for spine surgeons to remain competitive and provide the highest standard of care.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: AI is permeating pretty much all aspects of life, and now, unsurprisingly, medicine. As spine surgeons, it is important to keep AI in a place that is comfortable for you as the doctor. In the coming years, AI algorithms will tell you what to do. There is no doubt that we will be spoon-fed all the guidelines and "data-driven" big data stuff (that may or may not be reliable) and utilized to dictate care. This tech will be utilized probably not only by insurers in terms of determining payment but also potentially by program directors, heads of departments and hospitals. Expect more interference in the humanity of care, both for better and for worse.

Philip Louie, MD. Virginia Mason Franciscan Health (Tacoma, Wash.): Reduction of the administrative burdens of care.

These growing demands don't just eat away at our time — they reduce the number of patients we can treat, reduce the quality of our interactions, drive up unnecessary costs, and, perhaps most concerning, fuel burnout in our profession.

AI tools need to streamline these burdens while still maintaining the quality and accuracy of our intake and decision-making across multiple providers in different systems.

We are getting closer. Yet, with each step forward, we seem to encounter new barriers. Each advancement promises to simplify our workload, but the reality often feels like more complexity disguised as "innovation". These AI tools will hopefully move from being a "nice-to-have" to a nonnegotiable necessity!

Alex Vaccaro, MD, PhD. Rothman Orthopaedics (Philadelphia): The potential for AI to substantially impact spine surgery, and frankly the entire field of medicine, is essentially limitless. We are already seeing some of it in action, including electronic medical record alerts, surgical navigation, and robotics. However, I think an area where it can truly transform the way surgeons practice is revenue cycle management. Billing in healthcare is complex and requires navigating contracts and government payer regulations. Manually doing so is inefficient, but I envision AI-driven systems will be able to cross reference between patient records, surgeon billing, and payer contracts to ensure accurate reimbursement.

AI will and is streamlining the payer denial and appeals process. By analyzing and identifying trends in denial patterns, it will provide solutions for how visits and procedures should be billed appropriately. In addition, AI systems will be able to seamlessly follow-up on payer denials to confirm whether payment was accurate and initiate appeals processes when necessary. Overall, automating these processes through AI would significantly reduce the administrative burden on a surgeon's staff and ultimately result in greater revenue for the practice.

Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Artificial intelligence is now already an essential part of spine care. Within the realm of spine surgery, navigation has proven to be an immense tool with growing utilization. The utilization of robotics has also grown, although not at the same pace as navigation. I would argue that particularly navigation, which increases accuracy of screw placement, will become nonnegotiable in the next five years for spine surgeons. We also increasingly see the utilization of AI for surgical planning. Surgimap was probably one of the earliest iterations of this, but there are now an array of surgical planning tools that help surgeons achieve the correct alignment and meet the surgical goals for a case more precisely than we were able to do even 10 years ago. I do see surgical planning as another arena for nonnegotiable use of AI in the next five years. Outside of the operating room, we also see tools being used for decision support and triage. Importantly, in the nonsurgical arena, we are also seeing AI being used for the delivery of care, including digital physical therapy. These tools have vastly improved access to care for millions of Americans and people around the world. This is truly improving access to care, and therefore will also become nonnegotiable in the next five years. 

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): An immediate utilization for AI in healthcare will be data driven, evidence based, information availability for (spinal) disease application afforded to patient and provider alike. AI-driven diagnostics and personalized medicine potentiates a revolutionized healthcare market, making it more accessible, accurate, and efficient. For complex spinal surgeons, nationally accepted standards of care are delineated by parent organizations such as the AANS, AAOS and NASS and not academia, region nor locality, the guidelines and recommendations of specialized healthcare will be better suppositious and not inferred. Possessing a tool that affords personalized care based on symptom application in a comparative collective shapes strategic foresight to the present.

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