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HOUSTON Patients admitted to Houston Methodist Hospital get a monitoring device about the size of a half-dollar affixed to their chest and an unwitting role in the expanding use of artificial intelligence in health care.

This story also ran on Fortune. It can be republished for free.

The slender, battery-powered gadget, called a BioButton, records vital signs including heart and breathing rates, then wirelessly sends the readings to nurses sitting in a 24-hour control room elsewhere in the hospital or in their homes. The devices software uses AI to analyze the voluminous data and detect signs a patients condition is deteriorating.

Hospital officials say the BioButton has improved care and reduced the workload of bedside nurses since its rollout last year.

Because we catch things earlier, patients are doing better, as we dont have to wait for the bedside team to notice if something is going wrong, said Sarah Pletcher, system vice president at Houston Methodist.

But some nurses fear the technology could wind up replacing them rather than supporting them and harming patients. Houston Methodist, one of dozens of U.S. hospitals to employ the device, is the first to use the BioButton to monitor all patients except those in intensive care, Pletcher said.

The hype around a lot of these devices is they provide care at scale for less labor costs, said Michelle Mahon, a registered nurse and an assistant director of National Nurses United, the professions largest U.S. union. This is a trend that we find disturbing, she said.

The rollout of BioButton is among the latest examples of hospitals deploying technology to improve efficiency and address a decades-old nursing shortage. But that transition has raised its own concerns, including about the devices use of AI; polls show the public is wary of health providers relying on it for patient care. The BioButton, a monitoring device, is being used in dozens of hospitals employing artificial intelligence to analyze patients vital signs. (Phil Galewitz/KFF Health News) Houston Methodist Hospital, just a few miles south of downtown Houston, is located amid a giant medical complex that includes several hospitals. (Phil Galewitz/KFF Health News)

In December 2022 the FDA cleared the BioButton for use in adult patients who are not in critical care. It is one of many AI tools now used by hospitals for tasks like reading diagnostic imaging results.

In 2023, President Joe Biden directed the Department of Health and Human Services to develop a plan to regulate AI in hospitals, including by collecting reports of patients harmed by its use.

The leader of BioIntelliSense, which developed the BioButton, said its device is a huge advance compared with nurses walking into a room every few hours to measure vital signs. With AI, you now move from I wonder why this patient crashed to I can see this crash coming before it happens and intervene appropriately, said James Mault, CEO of the Golden, Colorado-based company.

The BioButton stays on the skin with an adhesive, is waterproof, and has up to a 30-day battery life. The company says the device which allows providers to quickly notice deteriorating health by recording more than 1,000 measurements a day per patient has been used on more than 80,000 hospital patients nationwide in the past year.

Hospitals pay BioIntelliSense an annual subscription fee for the devices and software.

Houston Methodist officials would not reveal how much the hospital pays for the technology, though Pletcher said it equates to less than a cup of coffee a day per patient.

For a hospital system that treats thousands of patients at a time Houston Methodist has 2,653 non-ICU beds at its eight Houston-area hospitals such an investment could still translate to millions of dollars a year. Email Sign-Up

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Hospital officials say they have not made any changes in nurse staffing and have no plans to because of implementing the BioButton.

Inside the hospitals control center for virtual monitoring on a recent morning, about 15 nurses and technicians dressed in scrubs sat in front of large monitors showing the health status of hundreds of patients they were assigned to monitor.

A red checkmark next to a patients name signaled the AI software had found readings trending outside normal. Staff members could click into a patients medical record, showing patients vital signs over time and other medical history. These virtual nurses, if you will, could contact nurses on the floor by phone or email, or even dial directly into the patients room via video call.

Nutanben Gandhi, a technician who was watching 446 patients on her monitor that morning, said that when she gets an alert, she looks at the patients health record to see if the anomaly can be easily explained by something in the patients condition or if she needs to contact nurses on the patients floor.

Oftentimes an alert can be easily dismissed. But identifying signs of deteriorating health can be tough, said Steve Klahn, Houston Methodists clinical director of virtual medicine.

We are looking for a needle in a haystack, he said.

Donald Eustes, 65, was admitted to Houston Methodist in March for prostate cancer treatment and has since been treated for a stroke. He is happy to wear the BioButton.

You never know what can happen here, and having an extra set of eyes looking at you is a good thing, he said from his hospital bed. After being told the device uses AI, the Montgomery, Texas, man said he has no problem with its helping his clinical team. This sounds like a good use of artificial intelligence.

Patients and nurses alike benefit from remote monitoring like the BioButton, said Pletcher of Houston Methodist. A nurse inside Houston Methodist Hospitals virtual intensive care unit monitors patients from afar. Nurses can track dozens of patients using technology that helps them supplement bedside care. (Phil Galewitz/KFF Health News) Sarah Pletcher, system vice president at Houston Methodist, stands inside the hospitals 24-hour virtual intensive care unit where patients are monitored by nurses and technicians. (Phil Galewitz/KFF Health News)

The hospital has placed small cameras and microphones inside all patient rooms enabling nurses outside to communicate with patients and perform tasks such as helping with patient admissions and discharge instructions. Patients can include family members on the remote calls with nurses or a doctor, she said.

Virtual technology frees up on-duty nurses to provide more hands-on help, such as starting an intravenous line, Pletcher said. With the BioButton, nurses can wait to take routine vital signs every eight hours instead of every four, she said.

Pletcher said the device reduces nurses stress in monitoring patients and allows some to work more flexible hours because virtual care can be done from home rather than coming to the hospital. Ultimately it helps retain nurses, not drive them away, she said.

Sheeba Roy, a nurse manager at Houston Methodist, said some members of the nursing staff were nervous about relying on the device and not checking patients vital signs as often themselves. But testing has shown the device provides accurate information.

After we implemented it, the staff loves it, Roy said. Houston Methodist this year plans to send the BioButton home with patients so the hospital can better track their progress in the weeks after discharge, measuring the quality of their sleep and checking their gait.(Phil Galewitz/KFF Health News)

Serena Bumpus, chief executive officer of the Texas Nurses Association, said her concern with any technology is that it can be more burdensome on nurses and take away time with patients.

We have to be hypervigilant in ensuring that we are nt leaning on this to replace the ability of nurses to critically think and assess patients and validate what this device is telling us is true, Bumpus said.

Houston Methodist this year plans to send the BioButton home with patients so the hospital can better track their progress in the weeks after discharge, measuring the quality of their sleep and checking their gait.

We are not going to need less nurses in health care, but we have limited resources and we have to use those as thoughtfully as we can, Pletcher said. Looking at projected demand and seeing the supply we have coming, we will not have enough to meet demand, so anything we can do to give time back to nurses is a good thing.

Phil Galewitz: pgalewitz@kff.org, @philgalewitz Related Topics States Health IT Hospitals Nurses Texas Contact Us Submit a Story Tip

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Harper Lee mystery:  Is there a To Kill A Mockingbird prequel and true crime novel ‘waiting to be published’?

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Harper Lee mystery:  Is there a To Kill A Mockingbird prequel and true crime novel 'waiting to be published'?

One of Harper Lee’s surviving relatives says it’s possible there could be major unpublished works by the author still to be discovered, following the release of eight of her previously unseen short stories.

Describing the mystery around a manuscript titled The Long Goodbye, which Lee wrote before To Kill A Mockingbird, Lee’s nephew, Dr Edwin Conner, told Sky News: “Even the family doesn’t know everything that remains in her papers. So, it could be there waiting to be published.”

Dr Conner says Lee submitted a 111-page manuscript, titled The Long Goodbye, after writing Go Set A Watchman in 1957.

The retired English professor explains: “It’s not clear to me or to others in the family, to what extent [The Long Goodbye] might have been integrated into To Kill a Mockingbird, which she wrote immediately after, or to what extent it was a freestanding manuscript that is altogether different and that might stand to be published in the future.”

Lee researched Reverend Maxwell's death, but no book was ever published. Pic: AP
Image:
Lee researched Reverend Maxwell’s death, but no book was ever published. Pic: AP

A second mystery exists in the form of a true crime novel, The Reverend, which Lee was known to have begun researching in the late 1970s, about Alabama preacher Reverend Willie Maxwell who was accused of five murders before being murdered himself.

Dr Conner said: “The manuscript of a nonfiction piece, that according to some people doesn’t exist, according to others who claim to have seen it, does [is also a mystery]. We don’t know where it is, or whether it is, really.

“That could be a surprise that has yet to be revealed if we discover it and it’s published, which is a real possibility.”

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He believes much of the manuscript was written in his family home and says his mother, Louise, who was Lee’s older sister, saw a “finished version of it” on the dining room table.

Dr Conner says there are “others who just as fiercely say no, it was never completed”.

A C Lee (L) - the inspiration for Atticus Finch with his grandchildren, including Edwin Conner (C), in 1953
Image:
A C Lee (L) – the inspiration for Atticus Finch with his grandchildren, including Edwin Conner (C), in 1953

‘She did want to publish these stories’

There has long been debate over why Lee published just two books in her lifetime.

To Kill a Mockingbird came out in 1960. Selling more than 46 million copies worldwide, translated into more than 40 languages and winning a Pulitzer Prize, it’s arguably the most influential American book of the 20th century.

Fifty-five years later, Lee published a sequel, Go Set A Watchman, written ahead of Mockingbird, but set at a later date.

Then aged 88, and with failing health, there were questions over how much influence Lee had over the decision to publish.

Asked how happy she’d be to see some of her earliest work, containing early outlines for Mockingbird’s narrator Jean Louise Finch and the story’s hero Atticus Finch, now hitting the shelves, Dr Conner says: “I think she’d be delighted.”

A previously unseen image of one of Lee's short story transcripts. Pic: Harper Lee Estate
Image:
A previously unseen image of one of Lee’s short story transcripts. Pic: Harper Lee Estate

He says Lee had presented them to her first agent, Maurice Crane, at their first meeting in 1956, “precisely because she did want to publish these stories”.

And while dubbing them “apprentice stories,” which he admits “don’t represent her at her best as a writer,” he says they show “literary genius of a kind”.

Notoriously private, he says the stories – which were discovered neatly typed out in one of Lee’s New York apartments after her death – offer “deeply enthralling new glimpses into her as a person”.

Never marrying or having children, he says Lee maintained a degree of privacy even with her family: “You never saw her complete personality… We thought we knew her, we thought we’d seen everything, but no, we hadn’t.”

George W Bush awards Lee with the Presidential Medal of Freedom in 2007. Pic: Reuters
Image:
George W Bush awards Lee with the Presidential Medal of Freedom in 2007. Pic: Reuters

‘That’s it, I’m not giving any more interviews’

While describing her as a “complicated woman,” he insists Lee was far from the recluse she’s frequently painted as.

He says: “In company, she was most of the time delightful. She was a lively personality, she was funny, witty, and you would think she was very outgoing.”

But Lee was known to have struggled with her success.

Dr Conner explains: “She never ever wanted fame or celebrity because she suspected, or knew, that would involve the kind of uncomfortable situations in public situations that she found just no satisfaction or pleasure in”.

He says while in the early years of Mockingbird Lee gave interviews, the wild success of the book soon rendered such promotion unnecessary, leading her to decide: “That’s it, I’m not giving any more interviews”.

While he admits she was subsequently much happier, he goes on: “Not that she was a recluse, as some people thought. She wasn’t at all a recluse, but she didn’t enjoy public appearances and interviews particularly. She wanted the work to speak for itself.”

Truman Capote and Harper Lee in April 1963. Pic: AP/The Broadmoor Historic Collection
Image:
Truman Capote and Harper Lee in April 1963. Pic: AP/The Broadmoor Historic Collection

‘Deeply hurt’ by Truman Capote

Famously close to Truman Capote, one of the pieces in Lee’s newly released collection is a profile of her fellow author.

Dr Conner says that piece – a love-letter of sorts, describing Capote’s literary achievements – is all the more remarkable because at the point Lee wrote it in 1966, when she and Capote “were not even on speaking terms”.

He says Lee “probably knew [Capote] better than any other person alive when that was written”, adding, “she did love him as a friend very much, even when he was not speaking to her”.

Friends since childhood – and the prototype for the character of Dill in Mockingbird – Capote later hired Lee to help him research his 1965 true crime novel In Cold Blood.

Despite his book’s relative success, Dr Conner believes Capote was “bitter” over the fact Mockingbird far eclipsed it in accolades and recognition.

“He had been writing for much longer. He felt that he was at least as good as she was, and he was very envious of her success”.

Dr Conner says Lee was “deeply hurt” at Capote’s rejection of her, never speaking about him in later life.

Recalling his own meeting with Capote many years later, Dr Conner says he “got a personal sense of how [Capote] could charm the socks off of anybody, male or female”.

He says it was noteworthy that while Capote asked about his mother, who he had been fond of, he “never once mentioned” Harper.

Sky News has contacted Lee’s lawyer and the executor of her estate, Tonya Carter, for comment.

The Land of Sweet Forever: Stories and Essays, by Harper Lee is on sale from Tuesday

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MIT Detects Traces of a Lost ‘Proto Earth’ Deep Beneath Our Planet’s Surface

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MIT researchers have discovered rare isotopic traces of a “proto Earth” that existed before the giant impact that shaped our modern planet. Found deep in ancient rocks, these potassium isotope signatures reveal remnants of Earth’s earliest material, offering fresh insight into the planet’s formation and the solar system’s earliest history.

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Astronomers Detect Heavy Water in Planet-Forming Disk Around Young Star

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Scientists have detected heavy water in the planet-forming disk around young star V883 Orionis, confirming the water existed long before the star formed. The discovery, made using ALMA, shows that water’s origins trace back to ancient interstellar clouds, linking molecular gas, comets, and planetary systems across billions of years.

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