This transcript is auto generated
00;00;00;00 - 00;00;25;01
Meg Pekarske
Hello and welcome to Hospice Insights: The Law and Beyond where we connect you to what matters in the ever changing world of hospice and palliative care. But Wait: Things to Consider Before Adopting AI Tools in Your Hospice. So, Kathleen, I'm so excited for you to be joining me today.
00;00;25;04 - 00;00;27;08
Kathleen Snyder
Hey, Meg, I'm excited to be here.
00;00;27;10 - 00;00;53;09
Meg Pekarske
Yeah, well, it was it was so exciting when you came to the firm with your tremendous knowledge base, because obviously I know nothing about AI, which is why you're on the podcast. And so, so grateful to have you as a colleague. But tell tell our listeners a little bit about who you are and your background, because you have oodles of knowledge in this, in this cutting edge space.
00;00;53;12 - 00;01;20;09
Kathleen Snyder
Sure. So hi, hospice podcast world. I'm really excited to be here. So my name is Kathleen Snyder, and I am a senior counsel colleague of Meg's. I'm based in our Boston office, and my background is as a long term health care attorney. And then with a pivot to technology. So my practice really is at that intersection of healthcare and technology.
00;01;20;11 - 00;01;45;18
Kathleen Snyder
And I have been working with AIML startups for the last six or so years. So I have been really in, an a great place to kind of see what's happening, see where the industry is going. I've also had the opportunity to do a lot of volunteer work with some nonprofit accelerators. So I mentor a lot of, really small companies who are doing exciting native things in the space as well.
00;01;45;25 - 00;01;56;16
Meg Pekarske
So lots of my well, in Boston it is seems like it would be a hub for well, it's a hub for very smart minds. And so smart minds are doing
00;01;56;21 - 00;02;02;25
Kathleen Snyder
It's amazing. There's, you know, an I meet up every other day of the week. I feel like, you know.
00;02;02;28 - 00;02;04;01
Meg Pekarske
Yeah.
00;02;04;03 - 00;02;06;10
Kathleen Snyder
My my schedule is full. Yeah.
00;02;06;12 - 00;02;37;25
Meg Pekarske
Yeah, exactly. So. And I know you have a lot of experience in post-acute care, sort of generally. So I know some of the things you are going to be talking about, you know, might not just be hospice, which is largely provided in the home, but I think just to give our listeners a sense of what are the possibilities, because I think hospice right now, there could be some related tools they're using.
00;02;37;25 - 00;03;05;07
Meg Pekarske
I mean, like ChatGPT or like there's some other products, but but I still think that, you know, hospice is starting to dip their toe in it. So it would be exciting to hear sort of just what is going on larger in the space. And I think we'll give our, our listeners a sense of what might be coming, to the in the pipeline for, for them.
00;03;05;09 - 00;03;26;23
Kathleen Snyder
Sure, sure. And, you know, I like to, I, I did not coin it, but it's a, a group I belong to has called it the age tech space. So, you know, which is really, all encompassing of, you know, folks aging at home, folks, you know, in long term, you know, kind of post-acute settings all the way through, to, to the hospice community.
00;03;26;26 - 00;03;57;15
Kathleen Snyder
But, yeah. So, you know, certain, you know, recently I was at the HLA long term, care conference and I did a talk on, you know, implementing and utilizing AI in, in your practice. And we had a range of folks who were there and probably the, you know, from a poll of, of the audience, the most significant, types of AI products that they were being implemented were in the productivity.
00;03;57;15 - 00;04;32;28
Kathleen Snyder
So tools like Copilot that, you know, I think folks who are used to Microsoft or are very, you know, starting to incorporate into their their day to day, but also, you know, ambient listening tools, medical scribes, things that are helping triage, you know, appointments or phone calls. And then also, you know, on the more clinical side, you know, some of the software as a medical device, folks come in, whether it's, you know, they're, continuous glucose monitors or for looking for fall prevention.
00;04;32;28 - 00;05;12;10
Kathleen Snyder
And, yeah, there there were quite a few folks who were really interested in the, you know, in the fall prevention aspect of leveraging AI to implement that. So it's, you know, it's really a variety of, of tools. Although I, I think some of the things you think about as, you know, as you're going ahead and, and trying to understand well what would work in your setting, you know, you really have to have to think about the, you know, the context of how you're deploying the AI and the tool and the vendor and the data that the tools, you know, trained.
00;05;12;13 - 00;05;33;17
Kathleen Snyder
I mean, there's really just, you know, kind of a peeling of an onion effect of, you know, a lot of things that you need to think about. So, you know, who's the user, what's the use case? And, you know, it really gets at and may stop me any time, but it really look at the, the need for really good governance in your organization.
00;05;33;17 - 00;05;56;07
Kathleen Snyder
You know, whether you're adopting, you know, productivity tools, just for the staff to help them write emails and respond and, you know, are they are they using those productivity for case notes and summaries? Well, then they need to pay more attention, right? Because then it becomes clinical as opposed to admin a purely administrative, it becomes partially clinical.
00;05;56;07 - 00;06;18;11
Kathleen Snyder
And then, you know, on on the other side of the spectrum, you have truly clinical. So you know, just looking for met interactions and you know, other, other areas where it becomes really, really clear that it's, it's clinical and you want to make sure that it's, you know, FDA cleared and has gone through that whole process.
00;06;18;14 - 00;06;50;04
Kathleen Snyder
But I tend to focus, you know, in that sweet spot between the productivity, productivity tools and the, you know, the administrative, clinical light. Yeah. I think that's where there is really just a, a ton of excitement in the space. Everyone is looking to try to help with burnout. And, you know, it's hard, really hard, to, you know, for some of our nurses and, and physicians in the space.
00;06;50;07 - 00;07;03;03
Kathleen Snyder
And so I think that this is a great opportunity for folks to implement, with their eyes open, they really need to to be aware, and I don't wanna say cautious, but.
00;07;03;05 - 00;07;24;03
Meg Pekarske
Well, no, I think that, it's the new shiny thing. And so I think there's some people with new and shiny like, oh, I just want to keep doing things. The way I've always been doing. And then you have people who are excited about these things, but then sort of the thinking risk management side comes later.
00;07;24;03 - 00;07;43;26
Meg Pekarske
And I think the point of this podcast is really to talk about how do some of the infrastructure staff, because this is coming in if you're not already using it. I mean, like ChatGPT, you know, we can talk about that in particular because like, that's something you might not control. Right. And so yeah.
00;07;43;26 - 00;07;44;16
Kathleen Snyder
Well that.
00;07;44;17 - 00;08;08;10
Meg Pekarske
Term is I've been a real early adopter of a lot of I, I will preface that I have to use date events. So I may be the very my head in the sand kind of, person, but like I, I know we just got an email sent out, like you shouldn't be using ChatGPT like, but general version because.
00;08;08;13 - 00;08;33;24
Meg Pekarske
Yeah, problems with that. And so I just think that like you should do the thinking now because of course you might be using AI and you're not even thinking about that. You're using AI or just through the work that I do. I know that there's a lot of tools and, vendors that are developing tools specifically for hospice.
00;08;33;26 - 00;08;46;21
Meg Pekarske
And we we're probably going to have some of those folks on the podcast at some point, you know, if that's scheduling visits in the most efficient way. So, you know, our nurses and, you know.
00;08;46;24 - 00;08;46;26
Kathleen Snyder
You.
00;08;46;26 - 00;08;48;03
Meg Pekarske
Know, yeah.
00;08;48;05 - 00;09;18;27
Kathleen Snyder
100%, 100%. So just to just address the ChatGPT, you know, right here, we'll talk about a little bit later. But the most important takeaway, I think, for folks who are listening to this podcast who have not implemented policies regarding the use of ChatGPT, this is number one for your compliance risk management group. You need to have a policy that very clearly articulates the generative AI tools that your staff can use.
00;09;19;00 - 00;09;49;12
Kathleen Snyder
It's really easy to pull up the website and just kind of say, hey, can you summarize this chart or it can you summarize this information? And if you're not using an enterprise version of, you know, a generative AI tool and your data is just going out there, that becomes a real privacy problem and real, you know, even with without clinical information, if folks are using confidential business information, then they're, you know, asking ChatGPT to create, a chart or something else.
00;09;49;15 - 00;10;14;01
Kathleen Snyder
You know, that information is out there. So everyone listening, you know, make sure that you have a no ChatGPT from home policy that, you know, your employees are only allowed to use their, you know, the, the approved tools that that the company has vetted and, you know, either has a subscription or understands where the data is going and how it's being used.
00;10;14;04 - 00;10;15;20
Kathleen Snyder
That number one takeaway.
00;10;15;22 - 00;10;16;16
Meg Pekarske
That.
00;10;16;19 - 00;10;23;09
Kathleen Snyder
To everyone likely number one takeaway. Yeah. Because now we can we can jump at chance.
00;10;23;12 - 00;10;49;06
Meg Pekarske
Yeah. Because I think that that's really important because it is just available to to anyone. And I think you point out a really important intersection and with HIPAA, privacy and all this stuff, which sort of bleeds into the question of what is the law in this space, because it's like, I mean, it's probably federal and state and it's like, you know, that.
00;10;49;06 - 00;10;49;27
Kathleen Snyder
I mean.
00;10;49;29 - 00;11;00;13
Meg Pekarske
It's owned by my venture. Very Michael would always say we're building the plane while we're flying it. And so this seems like a good analogy for this.
00;11;00;15 - 00;11;37;05
Kathleen Snyder
Yeah, 100, 100%. So, I think the best way to describe the law is that it's fluid. When with regard to AI specific regulation, the new administration has rolled back some of the previous administrations executive orders regarding AI and the use of AI. So on the federal level, it's, it's a little bit in flux. I think that folks in the healthcare space are very cognizant of privacy, which is great.
00;11;37;07 - 00;12;02;17
Kathleen Snyder
I'm a we we really spend, half have spent decades thinking about HIPAA and how hypo applies. And I'm making sure that we're, we're, you know, our our staff is trained and and folks really understand the, the parameters of, of HIPAA. So so on on that front, you know, HIPAA still applies. It's really important to understand where your data is going.
00;12;02;19 - 00;12;50;04
Kathleen Snyder
But, you know, some of the really interesting, work I think is happening now at the state level, which again, is fluid. You know, California, of course, California has, you know, a newly effective law in place that, you know, requires a, you know, kind of disclosure if someone if a patient communication is, you know, generated by AI or, without without any kind of human intervention, if a doctor has read it, then, you know, maybe you don't have the same disclosure requirements, but, you know, it does appear that a lot of the the work that's out there in the AI space, people want to know, am I talking to a bot
00;12;50;07 - 00;13;19;07
Kathleen Snyder
or am I talking to a human? And sometimes you can't tell, right? Especially perhaps if you're elderly and, and I think that that's kind of an impetus behind a lot of the legislation that you want to that transparency. And so I think, many of the vendors that I have interacted with in this space, either as clients or, you know, mentees or just, you know, companies in the space, they tend to disclose, you know, hi, this is I bought from, you know, x, y, Z.
00;13;19;09 - 00;13;40;17
Kathleen Snyder
And let me help you with your scheduling. Right. So, people tend to be in that space where they are, you know, disclosing. But not everyone, not everyone is in that. I, recently was working on, some, diligence for a deal. The company was an AI company, and it didn't disclose that you're talking to a bot.
00;13;40;19 - 00;14;09;23
Kathleen Snyder
They also didn't have anyone who was tracking the state and federal laws regarding AI. So that was. Whoa, yellow. Sticky. Yeah. Yeah. That, that diligence email. But, you know, I do think it's really important that folks have a trusted, you know, source for this. And, shout out to our colleagues in Denver who have a really robust, process for tracking all of the AI state laws and, you know, federal laws that are that are out there.
00;14;09;23 - 00;14;20;08
Kathleen Snyder
I think it's it's, you know, it's it's a task that they I think they update it once a week. It's just continuously evolving. So, so.
00;14;20;11 - 00;14;49;24
Meg Pekarske
Is the and it's probably hard to generalize. But I'm assuming states are trying to squash this and say, like we shouldn't evolve into AI. Is it more the focus of the regulation is about transparency and the security of the data. Like what what generally his government trying to regulate around in in this space.
00;14;49;26 - 00;15;19;27
Kathleen Snyder
Sure. So, I'll, I'll, I'll say I don't think the states are trying to squash it. I don't think the regulation is trying to, you know, kind of tamp down. But I, I think that they some is depending on how some of the laws, you know, actually are implemented because, you know, the, the, for example, the California, health AI, a law is just effective at the beginning of this year.
00;15;19;29 - 00;15;44;25
Kathleen Snyder
It'll we'll see how it plays out in real life. But it's looking for transparency. Right. You know, you see a lot of proposed bills that physicians need to make or, you know, a healthcare professional needs to make the decision about health care. There's there's a lot of concern about the use of algorithms in, prior authorization and other areas, which is not exactly on on point for, you know, this, this population.
00;15;44;25 - 00;16;12;07
Kathleen Snyder
But but there is a, you know, a lawsuit going on right now with the use of algorithms targeting rehab stays, you know, and, you know, so an a Medicare advantage, based so, you know, it's it's very much but want to make sure that their doctors are, are making the decisions about their health care. And, you know, there there's a lot of administration around that.
00;16;12;07 - 00;16;41;02
Kathleen Snyder
And like, we could we could go way into the details. Massachusetts has a proposed bill that that I'm like under Massachusetts insurance laws already kind of require this. So, you know, there's some you duplicative requirements that may not align. Exactly. So you really need someone who's who's focused on it and thinking about it and saying how, you know, how does this insurance law in Massachusetts overlay with this proposed, you know, I regulation and is it cook it of doing need it.
00;16;41;07 - 00;17;22;12
Kathleen Snyder
Couldn't you infer from the insurance. Yeah. But and and so it's it's been pretty interesting. I I was recently, doing some work for a client and looking at Medicaid requirements, some state laws, just by virtue of their procurement requirements for state vendors, which in this particular state included, medical, Medicaid, excuse me, providers that they were pushing down their state I policies to to the, you know, the groups that that treated Medicaid patients as a quote.
00;17;22;14 - 00;17;47;20
Kathleen Snyder
But I guess there are people paying attention to this. That part was, I'm glad it's on my radar now. It's it's now on my checklist. But that was, a surprise. So I, I think, just again, take a step back. The federal law is, is definitely, in flux. I, you know, I think that there will be there is some, you know, there are guidance out there from the FDA, certainly.
00;17;47;20 - 00;18;05;07
Kathleen Snyder
And there's guidance from, ONC that, regulates, health care, technology. And so I think those are likely to, to stay where they are. But, you know, we we really have to stay tuned. But I think the real action is going to be at the state level.
00;18;05;09 - 00;18;31;17
Meg Pekarske
Yeah. Well and I think heard the last thing I wanted to get into is sort of the do's and don'ts, like what's how to operationalize AI and thinking about legal and compliance issues. And I, I think one thing as you're talking that and it's that diligence story is this is just an observation. So you tell me if it's right.
00;18;31;17 - 00;18;59;28
Meg Pekarske
But like don't expect that your vendor has knows the laws in your particular state. So they may be selling you a product that like actually you as the provider who's going to buy this and use this probably needs to know what your state law is around using these tools, because we know, I mean, I'm sure this isn't any different than other contracts.
00;18;59;28 - 00;19;25;25
Meg Pekarske
Like there may be very few, you know, representations that this complies with law or anything like that. So so I think it is that the onus of the provider to, as you say, understand what laws are in their state related to. I don't just think, well, this vendor said sending, you know, selling this in New Hampshire or so must be like okay.
00;19;25;25 - 00;19;47;16
Meg Pekarske
And however it functions as fine. Right. Because yeah, it's it's and there's, you know, great of the sales job that someone might do. Right. You, you I think need to, you know, make sure that you have an understanding of that and not just rely on, you know, what's maybe a sales pitch.
00;19;47;18 - 00;20;13;27
Kathleen Snyder
Yeah, that's that's, 100%. Right. The second most important thing out of that, I'd, I'd love for people to take away from this podcast is that you have to diligence your vendors. You really you really need to understand, you know what what they're selling, you offer and using your data, you know, are they compliant? And, you know, you just need to be thoughtful about it because many of these vendors are new and innovative.
00;20;13;29 - 00;20;35;12
Kathleen Snyder
I mean, there's some more mature companies in the space, but I think that, you know, especially if you're working. Yeah. You know, and I, I come from a startup background, so, you know, I don't want to be telling tales out of school here. Yeah, but you really want to make sure that as a, a provider, you're, you're looking into where is your data.
00;20;35;12 - 00;21;07;06
Kathleen Snyder
Like what is happening with the data. How are they using your data. And then, you know, how are they interacting with your, your patients, you know, are they. Yeah. And then this is for more clinically, you know, engagement, but but also for, you know, the scheduling and, and some of those things where you're still engaging with patients and, you just want to kind of keep that in mind and ask really good questions, ask, you know, deep questions, ask about their model.
00;21;07;06 - 00;21;34;03
Kathleen Snyder
Ask about the data their model was trained on. And this becomes more important as we move into, you know, actual clinical use cases where you are, you know, something that worked in one hospital might not work in, you know, a rehab space or, hospice space. It the the data is different. The population makeup is different.
00;21;34;06 - 00;21;57;29
Kathleen Snyder
The case mix is different. So you really just want to kind of think about but that but then also, you know, how how what kind of insurance into these the companies have just, you know, the, the risk shifting provisions that, you know, contract lawyers love. You know, they're not the indemnification portion could be beautiful, but if they don't have any money, then, you know.
00;21;58;01 - 00;22;08;04
Kathleen Snyder
So exactly. Make sure you're asking, you know, that your have your lawyer ask the like the hard border questions and then it becomes a little bit of a risk management. Yeah.
00;22;08;05 - 00;22;36;10
Meg Pekarske
But and again let's pause there because I think that's a really important point. And I think these contracts that you're going to be signing for these products probably worth having a lawyer look at those because so EMR contracts, we rarely get asked to review those when we get asked to review them is when they're, you know, at the hospice is wanting to terminate those.
00;22;36;10 - 00;22;55;18
Meg Pekarske
And then, you know, the vendor is holding their data hostage. And we're having to deal with all this. And it's like, you should have spent some time and energy on the front end now, you know, negotiated an EMR contract like they're probably not going to budget a lot of that stuff. But like.
00;22;55;20 - 00;22;58;07
Kathleen Snyder
I'm going to I'm going to use all my backup.
00;22;58;10 - 00;23;24;20
Meg Pekarske
Cash, all my chips in on these two point like yeah, the rest of it. And so I think, you know, word to the wise here that, you know, as you said, like the risks are about where is your data being held, who owns it, all that stuff. You know, the insurance, I mean, that's sort of an internal thing too, is what insurance do you have if something goes wrong and whatnot?
00;23;24;20 - 00;24;00;10
Meg Pekarske
But I do think this is and obviously I don't feel qualified to review these contracts. But thankfully I have folks like you and and others that that have a lot of experience in the space to be able to issue spot and also, I think be pretty practical about what is worth pushing back on and what is that, you know, so you're not saying, you know, giving a really, you know, an email that says everything that's wrong with this contract because it's sort of like, well, no, you're not going to be able to get most of that.
00;24;00;10 - 00;24;07;26
Meg Pekarske
So that's just you know, zone and other things that we think we can actually get movement on that are critical from a risk management standpoint.
00;24;07;26 - 00;24;32;29
Kathleen Snyder
Absolutely. And you know, I think you'd be surprised sometimes, you know, especially you know, smaller companies that are really excited to work with you because they'll have access to your data and they can continue to improve and, and, their products and know the performance service and improve the service. You know, they, they want to work with you almost as much as you want to work with them.
00;24;33;01 - 00;24;55;24
Kathleen Snyder
Because of that ability to continue to, you know, improve and, and fine tune the products that they're, they're selling. So, you know, I, I definitely think that you have some leverage, but there's also and and we haven't really touched on that at all. But there's liability for, you know, your providers for your licensed professionals that, you know, they, you want to keep in mind.
00;24;55;24 - 00;25;33;26
Kathleen Snyder
And I can tell you as a vendor attorney, I always 100% it is always the physician's responsibility to confirm xyzzy. You know, it is always the obligation of the entity that is using the tool to confirm that it is accurate and correct. And, you know, I, I was recently at a conference where, you know, there was a physician who's pushing back on that stent because that that's pretty universal, that, you know, folks are, you know, you wouldn't you wouldn't take on your interns work without kind of giving it a once over so that the physician, the licensed professional, really has to, sign off on it.
00;25;33;28 - 00;26;03;20
Kathleen Snyder
And the physician who is speaking with, like, how many people review, you know, the terms and conditions before you buy an app, before you use something. And my hand was one of very few that went up and there in the audience and they're like, that's right. You can't expect physicians who are being told to use this by their institution who are, you know, being provided this, this tool by their, their EHR, who are, you know, being pushed in this way to then have to take all of the liability from a professional licensure.
00;26;03;20 - 00;26;35;07
Kathleen Snyder
So there's a balance. You know, certainly. And I but I think it is, is very much important that that folks understand. And, you know, maybe we could talk just a little bit about governance, in this space. So if you're thinking about using, an AI tool and, you know, running the gamut from a, you know, a productivity copilot as to the, you know, the more focused, focused clinical and everything in between, you really want to think about your use cases.
00;26;35;09 - 00;27;03;26
Kathleen Snyder
And you one thing about, okay, who's going to be using it? How is it going to be used, what happens if it goes wrong and it's really important that you partner, you know, from governance at the, at your institution that you, you partner with your, it group if you have a CIO, right. If you have outside IT support you or a consultant, actually, some of our folks have, sometimes to do a little AI governance, at the firm.
00;27;03;26 - 00;27;28;05
Kathleen Snyder
So that might be something to think about. We have a group that does that, but it, and then to partner with your legal, your compliance, your risk management. And, you know, sometimes an organization's legal and it are not, you know, they don't always agree. Yeah. And so for the implementation of AI products, I think it's so important that folks come together at the front end, understand the use cases.
00;27;28;05 - 00;27;56;03
Kathleen Snyder
And you know, if you're if you're an IT or operational, person listening to this, I would definitely, you know, encourage you to bring your lawyers up to speed at an early, you know, state check, like, hey, we want to, you know, do this, please do that. Use cases so that that your lawyers can feel comfortable that, you know, ultimately your your patients and your business are going to be, you know, safe.
00;27;56;06 - 00;28;22;24
Kathleen Snyder
Yeah. So I think that that that governance piece is really important. And there are lots of great experts out there. Your your internal in-house lawyers might not be an expert in, you know, how it but there are lots of folks who you know, who are and who are able to, you know, kind of help, you know, either other consulting basis or, you know, we work with our clients, you know, as our external, counsel to help with specialized questions.
00;28;22;28 - 00;28;31;07
Kathleen Snyder
So I think that's just a really important to have that holistic governance approach. Yeah. From from day one, from day to.
00;28;31;10 - 00;28;58;16
Meg Pekarske
So now's the time to start on this infrastructure. So the do is is begin and the don't is put your head in the sand because ChatGPT is out there right now. You got a you know people using whatever the open one is not the enterprise version. So there's you know, some basic stuff even if you're not think you're not using AI right now.
00;28;58;18 - 00;29;20;22
Meg Pekarske
You know, there's things in it to do. So, what a what an interesting, exciting, you know, area. Thank you so much for sharing your expertise. Then given that it's a fluid space, my guess is you're going to be back here, momentarily. We'll have to get this podcast out quickly because who knows? There's a change. I did, but before we know it.
00;29;20;22 - 00;29;25;07
Meg Pekarske
So super, super fun topic. So thank you so much.
00;29;25;09 - 00;29;31;09
Kathleen Snyder
Yeah, it's my pleasure. Thanks for having me.
00;29;31;12 - 00;29;51;18
Meg Pekarske
Well, that's it for today's episode of Hospice Insights: The Law and Beyond. Thank you for joining the conversation. To subscribe to our podcast, visit our website at huschblackwell.com or sign up wherever you get your podcasts. Until next time, may the wind be at your back.