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junipersgarden · 5 years ago

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metanoia 1. | Recover

PAIRING: Peter Parker x Superhero!Reader

SUMMARY: 8 months later from Tony’s funeral and the promise Peter and you made, where do you two stand now?

WORD COUNT: 4119 words

WARNINGS: N/A?

a/n: i did not expect this to blow up so quickly so thank you all sm!! ill be updating every Friday/ re uploading from Wattpad and converting it to here!! hope you enjoy this chapter and ill see you next Friday ; )

[NOT MY GIF]

...

8 Months Later...

...

"I have a plan. Okay. First, I sit next to Y/N on the flight."

"Mhm."

"Second, I'm gonna buy a dual head phone adapter and watch movies with her the whole time."

"Okay."

"Three, when we go to Venice; Venice is super famous for making stuff out of glass right?"

"True."

"So I'm going to buy her a white gardenia necklace because it's a really pretty flower and... because... well-"

"Is it because of the-?"

"Because of its meaning yeah. Step 4 is when we're in Paris, I'm going to take her to the top of the Eiffel Tower, give her the necklace and 5, I'm gonna tell her how I feel. And 6, hopefully she tells me she feels the same way."

"And don't forget Step 7."

"Step 7?" Peter questions and clicks the top of his pen to write down Step 7, ears perked to listen to Ned.

"Don't do any of that."

Peter lets out an annoyed and frustrated sigh as Ned gave him a look that expressed 'what? what did i do?'

"Why?"

"Because we're gonna be bachelors in Europe Peter!"

"Ned."

"Look, I may not know much, but I do know Europeans love Americans."

Peter had little belief in Ned's statement that he scrunched up his face and looked at Ned.

"Really?"

"-And more than half of them are women!" Ned exclaims to make his point.

"...Sure but, I really like Y/N man. She's awesome, she's super funny like in a kind of dork way, and whenever she looks at me I feel like- she's coming over don't say anything!" Peter quickly shuts himself up.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

"Don't say anything!" Is the only thing you hear as you walked up to Peter and Ned's table.

"Sup guys? You excited for the science trip?" You greet them, rocking your body with a smile planted on your face, your assignment folder occupying your hands. Technically you got up from your, F/N's and MJ's table so you could photo copy your guy's group project but you heard Peter and Ned rambling about Europe and thought you could start up a conversation.

"Hey! Uh, yeah! We're just talking about the trip."

"Yeah and Peter's Plan." Ned confidently slides in the conversation.

Peter's Plan?

You stop moving and shift yourself to Peter, averting your eyes so yours meet his.

"...You have a plan? For what?" You nervously smile and laugh at him, playing with your bracelet on your wrist. The bracelet was silver but held a black cross (similar to a crucifix) in the middle of it.

"I- I don't have a plan." Peter mumbles, fiddling with his pen and looking at you with anxious eyes.

"No he's just gonna collect tiny statues while we're travelling to other countries." Ned blurts out and you can see he exchanged a look to Peter.

"I didn't know you liked-" You stopped speaking immediately, your response lost in your mind, something else distracting you.

You looked past Peter's head and your eyes meet with the dozens of drawings and tributes to Iron Man, to Tony and his sacrifice.

It seemed like yesterday you were on the battlefield, when you found out Peter was Spider-Man and all of those emotions and memories swept and flooded your mind in a tidal wave.

You can feel the whole room spinning even though your feet were planted on the ground, the voices of Peter and Ned fading as the sobs of Peter replaced them and Tony's dying breath.

It's been 8 months and you thought you had finally moved on from all the grief and suffering, the sleepless nights full of insidious nightmares and the suffocating feeling that came from all those panic attacks.

"You can rest now..."

"Did you photo copy it?" Someone asks and you whirl yourself around suddenly and possibly too fast, loosing balance and landing into someone's arms. F/N.

"Oh shoot sorry F/N I was talking to Ned and Peter about Europe and got side tracked?"

"It's okay! I was just checking since MJ was sorta getting antsy since she wanted it to all be done before you guys leave tomorrow." F/N beams at you, still holding you up.

"I-I'll go do it now-"

"Y/L/N, did you firstly ask me and secondly get a hall pass?" Ms. Warren spoke up and alarmed you. She was sitting at her desk and was staring at the 4 of you.

"N-No Ms. Warren..."

"I'll go!" Peter shot straight up from his seat. Ned shook his head and F/N laughed at his eagerness.

"No Parker you've got work to do. Y/L/N, Davis can take you."

Davis... Brad Davis?

Just on cue, Brad lifted his head up from being preoccupied at his desk and sent you a friendly smile and wave. He stood up immediately and from his demeanor, seemed over the top that the teacher asked him to escort you to the printers. He looked so familiar but no matter how heard you tried, you couldn't conjure where you'd seen him from.

Brad walked over to you and was still smiling from before so you nicely smiled back. Brad offered you to go first so you walked to Ms. Warren's desk and grabbed the huge hall pass with Brad trailing after you.

"We won't be long Ms. Warren!" Brad yelled out as he closed the classroom door.

You shot F/N a look that said 'okay guess i go and also what just happened?' and F/N shrugged back with no explanation and return back to MJ. You saw Peter looking at you as you left and saw him sigh heavily and immediately get back to his work. I hope Peter's okay.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

The cold, crisp breeze whirled through the dim lit streets of Queens as you walked back home; the streets were always alive at night with people hurrying from one place to another, lights shine brightly, beaming against tall, towering buildings and billboards, apartments until rooftops could reach the sky. New York was always cold in the night and what lurked in the darkness was even colder. Robberies, assaults and muggings were a regular sighting in alleyways but with yourself as Saviour and Peter as Spider-Man, the number has been decreasing over time thanks to the both of you. School was weird today with the whole Peter and Ned thing and especially with Brad. He was nice taking you to the printers but he kept asking way to many questions about you and you caught him staring a couple of times... weird.

You gripped your coat tightly around you, wrapping it as much as you could around your body to fight the wind, shivers being sent down your spine. Your mind had been blurry lately; balancing the lifestyle of school, social life and duties into one while trying to properly rest and to be there whenever anyone needed you was a struggle; the biggest fear you had was if you just took one, innocent day off that'd you regret it for the rest of your life. You also found it hard to escape your thoughts, insecurities and nightmares whenever you'd zoned out or even closed your eyes for a second. Despite it all you had your anchors though; the people who were holding you down from losing yourself from all the madness happening. You slip out a smile at the thought of those special individuals; friends that you put above anything or anyone else. Peter, Ned and even Michelle were all you had and all you were relying on to help you back up.

"Help! Someone!" A stranger cries into the night, pleading for a saviour, followed by the sound of gunshots and glass shattering.

Show time.

Reacting instantly, you check for your surroundings before fleeing into the shadows of a lonesome alley and with a single flick of your bracelet, it lets of a white glow, letting you know its activated.

"Hello Ms. L/N, how may I assist you tonight?"

"You know the drill ARIS: suit up."

"Right away Y/N."

On command, the familiar cool and sensational feeling of the nano tech being released from your bracelet began spreading all across your body; you loved the feeling of your suit coming alive just by wishing it, AI on the ready and that the suit was also with you, being a part of you.

As you relished in the moment your suit was fully on your body, you rushed out of the alleyway, concealing your true identity under your mask, prepared to fight, you begin to follow the cries of the citizen in need.

You felt your heart beat and pace fasten, senses heightened and the adrenaline coursing through your veins.

A shift in your vision changes as you feel your pupils fill fully black and steady themselves with your mask lenses, you exert all your energy into a singular jump and successfully land on the rooftop.

"ARIS, scan for location of activity."

"The distress signal appeared from 21st Street."

Ahhh, classic bank robbery.

"Okay ARIS, are all systems ready to go?"

"Affirmative. Initiating heads up display and initializing flight power."

You roll your head back and crack your knuckles, jumping up and down on the spot, ready for take off.

Nodding your head, you extend your arms out and feel the palms opening up and see the infinite blue glow from your thrustsers and feel the energy spreading and going to the soles of your suit.

Staring down the run way of the roof, you start walking before speeding up into a full sprint, running across the abandoned roof top. Steps quickening, you can see the end of the roof nearing with each step you take; you're going to jump. Before you know it you've leapt off the roof and it feels like time has stopped and you're floating on nothing; it's only you, the sky and the city's blurred noises and lights.

"Flight power fully restored." ARIS states, crashing and hauling you back into reality.

The euphoria of you floating has started to turn into the immense awareness that you are plummeting straight down with such speed to the lively streets and roads of New York below.

Extending your arms and legs, you point them into the direction of 21st Street and hear the whirring of your suit taking control and then, you're off. You're flying, just like Tony did, in the late night sky of New York City to stop a robbery.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Positioning yourself, your eyes meet with the victim in front of you; the typical situation.

"Hey."

The criminals all stop with their actions and immediately turn their heads to you. The hostages look up at you with hope and desperate, tears of fear and joy being to stream from their eyes.

"Looks like you forgot your credit cards huh fellas?"

2 out of the 4 robbers stand up and you took the chance to fire an energy blast, distracting them you slide on your knees towards the captives.

"Go! Go!" You beckon as you freed them from their constraints, they hurried out of the door shouting 'thank you's' and praises for your service and gratitude.

Getting up from the ground quickly, you turn around and see the 2 robbers running toward you.

You spring off the floor, back onto your feet and observe your surroundings; the 2 robbers are still sprinting towards you. You ball your fists and stance yourself ready to fight.

"Guys, guys, guys! You can either return back the money and nothing happens or we can do this the annoying and hard way."

One of the robbers racing towards you pulls back their gun and you hear a gunshot and feel a little ting and flick on your suit; the robber was really dumb enough to shoot you and your bulletproof suit.

"Well, guess you chose the hard way."

The 2 robbers still at full speed rush towards you but before they can even touch you, you step to the side and they loose control and crash into the wall.

"Ooooh! That's at least gotta leave a bruise.' You mock them.

You dart towards the fallen robbers, dizzy and dazed from the impact. You hit your right wrist twice on your suit and it opens up and greets you with what you were looking for; your trusty tool and invention of electric rope. The rope appeared as a blue wire with white sparks that shot out of it and you used it to tie up criminals and lets say if they were to hesitate or make a runner, they'd get a bit of a shock.

Grabbing the 1st and 2nd robber's hands, you wrap the wire around them both so they are both stuck together and unable to escape.

2 down, 2 to go.

The other 2 robbers that were still looting money had stopped since they'd heard the crash and the groaning of pain from the one's you'd taken on.

One robber stands up and places his fingers in his mouth and whistles.

You tilt your head in confusion but see that 3 more step out from the remaining safes.

"Aww brought more of your friends for me? How sweet..."

They all attack you at once, bullets ricochet off you and bounce back, flying back at them.

In unison they all duck down behind a counter from the bullets and curse out profanities and you take the opportunity to dash forward and leap onto the counter and land in front of them.

They all jump to their feet and a robber steps in front of you and tries to land a hit. You grab their arm and twist it and they let off a howl of anguish, you tasered him with your bracelet and flipping and throwing him to the floor.

Another takes his place and goes to hit you but one from behind tackles you and pins your arms, locking them in a firm and harsh grip.

Even through the suit, you can feel sharp fingernails attempting to latch and pierce you.

The guy in front of you clutches a solid grasp on both of your shoulders, forcefully yanks you down into his knee and hits your stomach. Already you can feel a bruise forming on your lower abdomen.

Jesus this one will be hard to cover...

You groan at the extensive, burning sensation building, your skin becoming tender and aching from the hit. The guy holding your arms down is tightening his grip and

"Given up huh Saviour?" The robber in front of you spits.

"T-that's the thing...." You let out a breathless chuckle, "I'm only getting started."

The robbers stare at each other and back before laughing furiously at you, the rest approaching you with guns.

What the robbers were thinking is that they'd won; they had successfully robbed Queens County Saving Bank and had taken down one of Queen's own superheroes. You on the other hand, had plans and knew perfectly well how criminal's minds worked; allow them to think they've won, they'll loose all focus and control on the situation, so you'd gotten them in the spot you wanted them: busy getting ready to celebrate a fake victory and not realizing the black smoke manifesting around them.

"As I said, I'm just getting started." A smirk lies on your covered face as you look deeply into the taunting robber's eyes full of bewilderment and fear.

The black smoke begins flurrying around your body finds it way around the robber's hands, instantly making him let go you. You lunge forward and punch the one in front of you with full power, he stumbles back and falls to the ground defeated. You then sharply turn and kick the other in the face.

The two out of the three still left go to attack you but you raise your arm in defense and send a gust of smoke flying to them. They stagger back and remain frozen as the smoke curls around and drags them to the ground. You rush over and deploy more of your rope onto the two and wrap it tightly around them, restraining them to the one place.

The last robber you spot is kneeling on the ground, trembling slightly with fear and piling as much money possible into one bag, trying to make a clean getaway.

Slowly and antagonistically, you make your way over to him and stand there, staring at him and waiting for him to notice. So busy and frantically he continues filling the bag he doesn't take care of his surroundings or even the cries of his comrades.

"I'll take that thank you." You cleanly snatch the bag and kick him to the ground with your heel.

He lands flat on his chest, hands out to the side you grab them and wrap them around once more.

People emerge from hiding and cry out cheers of joy and appreciation, a few giving you a pat on the shoulder, hugging you and the occasional asking for photos. The sound of police sirens ring in the distance, signaling its time to go. Waving your goodbyes, you turn to flee the scene but you hear and notice the vibration of a tap being played on your suit. You pivot back around and see one of the bank accountant's smiling frailly at you, evidently anxious and nervous in your presence.

"T-thank you so much Saviour, how ever can we repay you?" The accountant's eyes full of tears and lost distress begged.

"You don't need too; this is my job. Saving people's lives is what I do." You reply to the accountant, taking off into the night.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

"You did quite an excellent job tonight might I say so myself Y/N."

"Why thank you my Another, Rather, Intelligent System."

"Was that perhaps what you call, a flex?"

"...Yes ARIS, that was a flex." You mumble with a hint of embarrassment.

Currently soaring in the air with another criminal taken down, the fresh and cool wind rattles against you. Patrols were always 'relaxing' in a sense to you; gliding around the city and if your AI or you come to the attention of any law breaking activity, you swoop in (literally) and handle it. At times, you would bump into now and then into Spider-Man and the two of you mixed with your skills, would work together as a dynamic duo to take down the enemy. Queens loved and adored the both of you as individuals but as partners as well. Before knowing Peter was Spider-Man, there was a bit of tension and jealously and bickering from both of you: 'Dibs I had him first!' 'No, you know I patrol this area!' arguments occurred so many times that even the Avengers were pulled into it.

"I apologize for interrupting your thinking but it seems to be you have approximately 3 missed calls from your mother and from Pepper Potts accordingly."

Missed calls from Mum is bad but wait- Pepper called?

"W-when did they call ARIS? Any voicemails?"

"Your mother called to say to be home earlier from 'study group' to prepare for Europe tomorrow and that not to miss dinner again... which you did and Ms. Potts left nothing for you."

"C-can you auto text Mum that study group when longer than expected and that Y/F/N's offered dinner so I stayed and that I'll be home soon?"

"Already on it and for Pepper?"

"Don't text her anything."

"Text sent."

Pepper? The Pepper Potts? It's been 8 months; what does she want and is that Peter?

Drifting down from the air, you land quietly behind a wall and crouch down behind it, peering out carefully and you see Peter in his Iron Spider suit, eyes red and wet with tears as he stares at a piece of graffiti.

What's so bad about- oh.

The piece of artwork was of Tony; no wonder he was so distraught.

"You okay Spider-Man?"

"Y-yeah, I j-just c-crashed into a w-wall?" His voice high pitched, obviously lying.

"Uh huh... mind if I sit?"

"O-oh uh... no! No, you can sit!"

Giggling at Peter's awkwardness, you slide next to him and take a seat. You knew something was wrong by the way he was breathing and that his eyes were wet and red but how do you bring it up?

"So..."

"So...?"

"H-how is everything Spidey?" God that was awful.

"T-things could be s-so much better... just, the whole Blip thing is, it's getting to me."

"Blip?"

"The Blip? W-where the alien guy on Titan s-snapped his fingers and e-everyone d-disappeared?"

"Wait that's called the Blip?"

"Well that's what everyone is calling it."

"It sounds better than something to do with a maniac murdering half of the Earth's population... plus it's easy to say and remember."

And for the first time in a long time, you actually heard Spider-Man and Peter laugh. It was more of a sad and dry chuckle but, at least it was something.

"I'm assuming you didn't hear about 21st Street then?"

"21st Street what now?"

"Just now there was a robbery; apparently some of uhhh, what's his name? The macho, pacho penguin looking guy? Sends out his henchmen to do all the dirty work?"

"K-Kingpin?"

"Yeah! Pretty sure that's the one! But, really? Kingpin? Sounds really dumb; reminds me of bowling or something instead of an evil business man."

"His head does look like a bowling ball..." Peter murmured quietly.

You smiled brightly and threw your head back as you laughed; that's the Peter and Spider-Man I know.

From his mask, you could tell he was smiling since the corner of his mouth was showing the little peaks from out of it.

Your and his laughter began to die down you two just stayed silence and looked up into the cloudless sky.

"It's beautiful isn't it?"

"It really is... makes my night."

"And mine as well, I mean besides your company." Spider-Man, well more like Peter coughed, trying to cover up what he said.

"T-thank you though.. this was a nice chat Saviour. Not to alarm you or anything, but I'm not gonna be here much longer-"

"W-woah, what the hell do you mean-"

"N-no! Sorry, I worded that wrong don't panic! What I meant to say is I'm not going to be here because, I'm going on vacation."

Parker I swear...

You lightly hit his shoulder and let out a breath of relief. "Don't scare me like that! I did not need that!"

"S-sorry! B-but yeah... I'm going on vacation.. can you handle Queens without me?"

"I already do. Besides, there's always the other Avengers who can."

"Y-yeah... the Avengers... a-anyways Saviour, I-I'm gonna go now. I'll s-see you soon?"

"See ya Spidey and don't go crashing into any walls!"

"When did I- oh."

"Ratted yourself out. Bye Spideyyyyy!" You call out and wave as you watch him swing away and make tracks home yourself.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

"I dunno how I did it, but I snuck back in ARIS."

"Well, your mother is asleep-"

"Shhh lemme have this!"

"... Congratulations Y/N."

"Thank you ARIS-"

"Even though I do not condone this behaviour."

Rolling your eyes, you shrug your body and switch your bracelet and your suit slowly peels away from your body, the nano- tech shrinking so it all fits inside the bracelet. You stretch your body but wince from your stomach. Cautiously, you lift your shirt and see the enormous bruise left on you from the robber and his knee.

Bye, bye crop tops...

Plopping yourself on your bed, you lie down and sigh in exhaustion. Closing your eyes slowly, you feel yourself falling to asleep. Until the chime of your best friend's ringtone plays from your phone which causes you to lurch up and open your phone to look at the text.

from: F/N ✌️

yeah.... i'm really sorry that I can't go to Europe...

from: you

i get it, it's totally fine! your family needs you.

don't feel bad trust me it's all g.

from: F/N ✌️

...if you say so dude. just, have a great time,

take photos and promise to text me when you can?

from: you

you know I will 😤

from: F/N ✌️

kk. well, I better go. it's late and unlike you, people have school tomorrow.

from: you

haha, very funny... well, goodnight nub > : (

from: F/N ✌️

see ya geek : P

Reaching over you place your phone back on the charger and look at the ceiling and sigh.

New York has been chaotic since the Snap- Blip. The Blip. And the amount of crimes has only doubled since before then and everything with school and my friends, Ned, MJ, F/N and Peter and oh god...

Hopefully Europe gives me a break.

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TAG LIST !! < 3

@eridanuswave

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csrgood · 5 years ago

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Podcast: How Intelligence at the Healthcare Edge Saves Lives

When a patient contracts sepsis during a hospital stay, speed to diagnosis and treatment is critical: If the infection goes undetected, the patient could die within hours. Now, using an algorithm, along with edge sensors, Wi-Fi data networks, and artificial intelligence, hospital caregivers can more rapidly diagnose sepsis and other serious illnesses―not only saving lives but helping to detect health issues before they become life-threatening.

"The caregivers are now able to use the connected technology to take readings from all of the devices and analyze them at the speed of computers," says Rich Bird, industry marketing manager for healthcare and life sciences at Hewlett Packard Enterprise, which has partnered with Cerner on connecting bedside technology "to actionize data."

As Cerner's Missy Ostendorf explains, when a patient's vitals "fall outside of safe parameters, [the Cerner sepsis algorithm] automatically sends alerts to the care team so they can take immediate action. There is 80 percent to 90 percent improvement in lives saved when you can take that early intervention."

Listen to this HPE Voice of the Customer podcast with host Dana Gardner to learn how this intelligent edge technology is transforming patient care―throughout hospitals, across communities, and around the globe.

Dana Gardner: Hello, and welcome to the next edition of the BriefingsDirect Voice of the Customer podcast series. I'm Dana Gardner, principal analyst at Interarbor Solutions, your host and moderator for this ongoing discussion on the latest insights into the confluence of edge computing and artificial intelligence (AI).

Our next intelligent edge adoption benefits discussion focuses on how hospitals are gaining proactive alerts on patients at risk for contracting serious sepsis infections. An all-too-common affliction for patients around the world, sepsis can often be controlled when confronted early.

Now, using edge sensors, Wi-Fi data networks, and AI solutions that identify at-risk situations, caregivers at hospitals are rapidly alerted to susceptible patients so they can head-off sepsis episodes and reduce serious illness and deaths.

Stay with us now as we hear about a cutting-edge use case that puts near real-time AI to good use by outsmarting a deadly infectious scourge.

To learn how, please join me now in welcoming our guests, Missy Ostendorf, global sales and business development practice manager at Cerner Corp. Welcome to the show, Missy.

Missy Ostendorf: Thank you very much.

Gardner: We're also here with Deirdre Stewart, senior director and nursing executive at Cerner Europe. Welcome, Deirdre.

Deirdre Stewart: Thank you very much.

Gardner: And we're also here with Rich Bird, worldwide industry marketing manager for healthcare and life sciences at Hewlett Packard Enterprise (HPE). Welcome, Rich.

Rich Bird: Thank you, Dana, and hello everyone.

A new era of intelligent healthcare tech

Gardner: Missy, what are the major trends driving the need to leverage more technology and process improvements in healthcare? When we look at healthcare, what's driving the need to leverage better technology now?

Ostendorf: That's an easy question to answer. Across all industries resources always drive the need for technology to make things more efficient and cost-conservative―and healthcare is no different.

If we tend to lead more slowly with technology in healthcare, it's because we don't have mission-critical risk―we have life-critical risk. And the sepsis algorithm is a great example of that. If a patient turns septic, they have four hours and they can die. So, as you can imagine, that clock ticking is a really big deal in healthcare.

Gardner: And what has changed, Rich, in the nature of the technology that makes it so applicable now to things like this algorithm to intercept sepsis quickly?

Bird: The pace of the change in technology is quite shocking to hospitals. That's why they can really benefit when two globally recognized organizations such as HPE and Cerner can help them address problems.

When we look at the demand spike across the healthcare system, we see that people are living longer with complex long-term conditions. When they come into a hospital, there are points in time when they need the most help.

What [HPE and Cerner] are doing together is understanding how to use this connected technology at the bedside. We can integrate the Internet of Things (IoT) devices that the patients have on them at the bedside, medical devices traditionally not connected automatically but through the humans. The caregivers are now able to use the connected technology to take readings from all of the devices and analyze them at the speed of computers.

So we're certainly relying on the professionalism, expertise, and the care of the team on the ground, but we're also helping them with this new level of intelligence. It offers them and the patients more confidence in the fact that their care is being looked at from the people on the ground as well as the technology that's reading all of their life science indicators flowing into the Cerner applications.

Win against sepsis worldwide

Gardner: Deirdre, what is new and different about the technology and processes that make it easier to consume intelligence at the healthcare edge? How are nurses and other caregivers reacting to these new opportunities, such as the algorithm for sepsis?

Stewart: I have seen this growing around the world, having spent a number of years in the Middle East and looking at the sepsis algorithm gain traction in countries like Qatar, UAE, and Saudi Arabia. Now we're seeing it deployed across Europe, in Ireland, and the U.K.

Once nurses and clinicians get over the initial feeling of, "Hang on a second. Why is the computer telling me my business? I should know better." Once they understand how that all happens, they have benefited enormously.

But it's not just the clinicians who benefit, Dana, it's the patients. We have documented evidence now. We want to stop patients ever getting to the point of having sepsis. This algorithm and other similar algorithms alert the front-line staff earlier, and that allows us to prevent patients developing sepsis in the first place.

Some of the most impressive figures show the reduction in incidents of sepsis and the increase in the identification of the early sepsis stages, the severe inflammatory response part. When that data is fed back to the doctors and nurses, they understand the importance of such real-time documentation.

I remember in the early days of the electronic medical records; the nurses might be inclined to not do such real-time documentation. But when they understand how the algorithms work within the system to identify anything that is out of place or kilter, it really increases the adoption, and definitely the liking of the system and what it can provide for.

Gardner: Let's dig into what this system does before we look at some of the implications. Missy, what does the Cerner's CareAware platform approach do?

Ostendorf: The St. John Sepsis Surveillance Agent looks for early warning signs so that we can save lives. There are three pieces: monitoring, alerting, and then the prescribed intervention.

It goes to what Deirdre was speaking to about the documentation is being done in real time instead of the previous practice, where a nurse in the intensive care unit (ICU) might have had a piece of paper in her pocket and she would write down, for instance, the patients' vital signs.

And maybe four hours later, she would sit at a computer and put in four hours of vitals from every 15 minutes for that patient. Well, as you can imagine, a lot can happen in four hours in the ICU. By having all of the information flow into the electronic medical record, we can now have the sepsis agent algorithm continually monitoring that data.

It surveys the patient's temperature, heart rate, and glucose level, and if those change and fall outside of safe parameters, it automatically sends alerts to the care team so they can take immediate action. And with that immediate action, they can now change how they are treating that patient. They can give them intravenous antibiotics and fluids, and there is 80 percent to 90 percent improvement in lives saved when you can take that early intervention.

So, we're changing the game by leveraging the data that was already there, we are just taking advantage of it, and putting it into the hands of the clinicians so that action can be taken early. That's the most important part. We have been able to actionize the data.

Gardner: Rich, this sounds straightforward, but there is a lot going on to make this happen, to make the edge of where the patient exists able to deliver data, capture data, protect it, and make it secure and in compliance. What has had to come together in order to support what was just described by Missy in terms of the Cerner solution?

Healthcare tech progresses to next level

Bird: Focusing on the outcomes is very important. It delivers confidence to the clinical team, always at the front of mind. But it provides that in a way that is secured, real-time, and available, no matter where the care teams are. That's very, very important. And the fact that all of the devices are connected poses great potential opportunities in terms of the next evolution of healthcare technology.

Until now, we have been digitizing the workflows that have always existed. Now, for me, this represents the next evolution of that. It's taking paper and turning it into digital information. But then how do we get more value from that? Having Wi-Fi connectivity across the whole of a site is not something that's easy. It's something that we pride ourselves on making simple for our clients, but a key thing that you mentioned was security around that.

When you have everything speaking to everything else, that also introduces the potential of a bad actor. How do we protect against that, how do we ensure that all of the data is collected, transported, and recorded in a safe way? If a bad actor were to become a part of external network and internal network, how do we identify them and close it down?

Working together with our partners, that's something that we take great pride in doing. We spoke about mobility, and outside of healthcare, in other industries, mobility usually means people have wide access to things.

But within hospitals, of course, that mobility is about how clinicians can collect and access the data wherever they are. It's not just one workstation in a corner that the care team uses every now and again. The technology now for the care team gives them the confidence to know the data they are taking action on is collected correctly, protected correctly, and provided to them in a timely manner.

Gardner: Missy, another part of the foundational technology here is that algorithm. How are machine learning and AI coming to bear? What is it that allowed you to create that algorithm, and why is that a step further than simple reports or alerts?

Ostendorf: This is the most exciting part of what we're doing today at Cerner and in healthcare. While the St. John's Sepsis Algorithm is saving lives in a large-scale way―and it's getting most of the attention―there are many things we have been able to do around the world.

Deirdre brought up Ireland, and even way back in 2009, one of our clients there, St. James's Hospital in Dublin, was in the news because they made the decision to take the data and build decision-making questions into the front-end application that the clinicians use to order a CT scan. Unlike other X-rays, CT scans actually provide radiation in a way that's really not great. So we don't want to have a patient unnecessarily go through a CT scan. The more they have, the higher their risks go up.

By implementing three questions, the computer looks at the trends and why the clinicians thought they needed it based on previous patients' experiences. Did that CT scan make a difference and how they were diagnosed? And now with ML, it can tell the clinician on the front end that this really isn't necessary for what you are looking for to treat this patient.

Clinicians can always override that. They can always call the X-ray department and say, "Look, here's why I think this one is different." But in Ireland, they were able to lower the number of CT scans that they had always automatically ordered. So with ML, they are changing behaviors and making their community healthier. That's one example.

Another example of where we are using the data and ML is with the Cerner Opioid Toolkit in the U.S. We announced that in 2018, to help our healthcare system partners combat the opioid crisis that we're seeing across America.

Deirdre, you could probably speak to the study as a clinician.

Algorithm assisted opioid-addiction help

Stewart: Yes, indeed. It's interesting work being done in the U.S. on what they call opioid-induced respiratory depression (OIRD). It looks like approximately one in 200 hospitalized surgical patients can end up with an opioid-induced ventilatory impairment. This results in a large cost in healthcare. In the U.S. alone, it's estimated in 2011 that it cost $2 billion. And the joint commission has made some recommendations on how the assessment of patients should be personalized.

It's not just one single standardized form with a score that is generated based on questions that are answered. Instead, it looks at the patient's age, demographics, previous conditions, and any other history with opioid intake in the previous 24 hours. And according to the risks of the patient, it then recommends limiting the number of opioids they are given. They also looked at the patients who ended up in respiratory distress and they found that a drug agent to reverse that distress was being administered too many times and at too high a cost in relation to patient safety.

Now with the algorithm, they have managed to reduce the number of patients who end up in respiratory distress and limit the number of narcotics according to the specific patients. It's no longer a generalized rule. It looks at specific patients, alerts, and intervenes. I like the way our clients worldwide work in the willingness to share this information across the world. I have been on calls recently where they voiced interest in using this in Europe or the Middle East. So it's not just one hospital doing this and improving their outcomes―it's now something that could be looked at and done worldwide. That's the same whenever our clients devise a particular outcome to improve. We have seen many examples of those around the world.

Ostendorf: It's not just collecting data; it's being able to actualize the data. We see how that's creating not only great experiences for a partner but healthier communities.

Gardner: This is a great example of where we get the best of what people can do with their cognitive abilities and their ability to contextualize and the best of the machines to where they can do automation and orchestration of vast data and analytics. Rich, how do you view this balancing act between attaining the best of what people can do and machines can do? How do these medical use cases demonstrate that potential?

Machines plus, not instead of, people

Bird: When I think about AI, I grew up in the science fiction depiction where AI is a threat.

But we want to be clear. We're not replacing doctors or care teams with this technology. We're helping them make more informed and better decisions. As Missy said, they are still in control. We are providing data to them in a way that helps them improve the outcomes for their patients and reduce the cost of the care that they deliver.

It's all about using technology to reduce the amount of time and the amount of money care costs to increase patient outcomes and also to enhance the clinicians' professionalism.

Missy also talked about adding a few questions into the workflow. I used to work with a chief technology officer of a hospital who often talked about medicine as eminence-based, which is based on the individuals that deliver it. There are numerous and different healthcare systems based on the individuals delivering them. With this digital technology, we can nudge that a little bit. In essence, it says, "Don't just do what you've always done. Let's examine what you have done and see if we can do that a little bit better."

We know that personal healthcare data cannot be shared. But when we can show the value of the data when shared in a safe way, the clinical teams can see the value generated. It changes the conversation. It helps people provide better care.

The general topic we're talking about here is digitization. In this context we're talking about digitizing the analog human body's vital signs. Any successful digitization of any industry is driven by the users. So, we see that in the entertainment industry, driven by people choosing Netflix over DVDs from the store, for example.

When we talk about delivering healthcare technology in this context, we know that personal healthcare data cannot be shared. It is the most personal data in the world; we cannot share that. But when we can show the value of data when shared in a safe way―highly regulated but shared in a safe way―the clinical teams can then see the value generated from using the data. It changes the conversation to how much the technology costs. How much can we save by using this technology?

For me, the really exciting thing about this is technology that helps people provide better care and helps patients be protected while they're in hospital, and in some cases avoid having to come into the hospital in the first place.

Gardner: Getting back to the sepsis issue as a critical proof point of life-enhancing and life-saving benefits, Missy, tell us about the scale here. How is this paying huge dividends in terms of saved lives?

Life-saving game changer

Ostendorf: It really is. The World Health Organization statistics from 2018 show that 30 million people worldwide experience a sepsis event. In their classification, 6 million of those could lead to deaths. In 2018 in the U.K., there were 150,000 annual cases, with 44 of those ending in deaths.

You can see why this sepsis algorithm is a game changer, not just for a specific client, but for everyone around the world. It gives clinicians the information they need in a timely manner so that they can take immediate action―and they can save lives.

Rich talked about the resources that we save, the cost that's driven out―all those things are extremely important. When you are the patient or the patient's family, that translates into a person who actually gets to go home from the hospital. You can't put a dollar amount or an efficiency on that.

It's truly saving lives, and that's just amazing to think that. We're doing that by simply taking the data that was already being collected, running that through the St. John's sepsis algorithm, and alerting the clinicians so that they can take quick action.

Stewart: It was a profound moment for me after Hamad Medical Corp. in Qatar, where I had run the sepsis algorithm across their hospitals for about 11 months, did the data and they reckoned that they had potentially saved 64 lives.

And at the time when I was reading this, I was standing in a clinic there. I looked out at the clinic―it was a busy clinic―and I reckoned there were 60 to 70 people sitting there. And it just hit me like a bolt of lightning to think that what the sepsis algorithm had done for them could have meant the equivalent of every single person in that room being saved. Or, on the flipside, we could have lost every single person in that room.

Mothers, fathers, husbands, wives, sons, daughters, brothers, sisters―and it just hit me so forcefully and I thought, "Oh, my gosh, we have to keep doing this." We have to do more and find out all those different additional areas where we can help to make a difference and save lives.

Gardner: We have such a compelling rationale for employing these technologies and processes and getting people and AI to work together. In making that precedent, we're also setting up the opportunity to gather more data on a historical basis. As we know, the more data, the more opportunity for analysis. The more analysis, the more opportunity for people to use it and leverage it. We get into a virtuous, positive adoption cycle.

Rich, once we've established the ability to gather the data, we get a historical base of that data. Where do we go next? What are some of the opportunities to further save lives, improve patient outcomes, enhance patient experience, and reduce costs? What is the potential roadmap for the future?

Personalization improves patient care, policy

Bird: The exciting thing is, if we can take every piece of medical information about an individual and provide that in a way that the clinical team can see it from one end of the user's life right up to the present day, we can provide medicine that's more personalized―so, treating people specifically for the conditions that they have.

Missy was talking about evaluating more precisely whether to send a patient for a certain type of scan. There's also another side of that. Do we give a patient a certain type of medication?

When we're in a situation where we have the patient's whole data profile in front of us, clinical teams can make better decisions. Are they on a certain medication already? Are they allergic to a medication that you might prescribe to them? Will their DNA, the combination of their physiology, the condition that they have, the multiple conditions that they have―then we start to see that better clinical decisions can be made. We can treat people uniquely for the specific conditions.

At Hewlett Packard Labs, I was recently talking with an individual about how big data will revolutionize healthcare. You have certain types of patients with certain conditions in a cohort of patients, but how can we make better decisions on that cohort of patients with those co-conditions? You know, at a specific time in their life, but then also how do we do that from an individual level of individuals?

Rather than just thinking about patients as cohorts, how could policymakers and governments around the world make decisions based on impacts of preventative care, such as more health maintenance? We can give visibility into that data to make better decisions for populations over long periods of time.

It all sounds very complicated, but my hope is, as we get closer, as the power of computing improves, these insights are going to reveal themselves to the clinical team more so than ever.

There's also the population health side. Rather than just thinking about patients as individuals, or cohorts of patients, how could policymakers and governments around the world make decisions based on impacts of preventative care, such as incentivizing populations to do more health maintenance? How can we give visibility into that data, into the future, to make better decisions for populations over the longer period of time?

We want to bring all of this data together in a safe way that protects the security and the anonymity of the patients. It could provide those making clinical decisions about the people that are in front of them, as well as policymakers to look over the whole population, the means to make more informed decisions. We see massive potential around prevention. It could have an impact on how much healthcare costs before the patient actually needs treatment.

It's all very exciting. I don't think it's too far away. All of these data points we are collecting are in their own silos right now. There is still work to do in terms of interoperability, but soon everybody's data could interact with everybody else's data. Cerner, for example, is making some great strides around the population health element.

Gardner: Missy, where do you see accelerating benefits happening when we combine edge computing, healthcare requirements, and AI?

At the leading edge of disease prevention

Ostendorf: I honestly believe there are no limits. As we continue to take the data in in places like in northern England, where the healthcare system is on a peninsula, they're treating the entire population.

Rich spoke to population health management. Well, they're now able to look across the data and see how something that affects the population, like diabetes, specifically affects that community. Clinicians can work with their patients and treat them, and then work with the actual communities to reduce the amount of type 2 diabetes. It reduces the cost of healthcare and reduces the morbidity rate.

That's the next place where AI is going to make a massive impact. It will no longer be just saving a life with the sepsis algorithm running against those patients who are in the hospital. It will change entire communities and how they approach health as a community, as well as how they fund healthcare initiatives. We'll be able to see more proactive management of health community by community.

Gardner: Deirdre, what advice do you give to other practitioners to get them to understand the potential and what it takes to act on that now? What should people in the front lines of caregiving be thinking about on how to best utilize and exploit what can be done now with edge computing and AI services?

Stewart: Everybody should have the most basic analytical questions in their heads at all times. How can I make what I am doing better? How can I make what I am doing easier? How can I leverage the wealth of information that is available from people who have walked in my shoes and looked after patients in the same way as I'm looking after them, whether that's in the hospital or at home in the community? How do I access that in an easier fashion, and how do I make sure that I can help to make improvements in it?

Access to information at your fingertips means not having to remember everything. It's having it there and having suggestions made to me. I'm always going back and reviewing what those results and analytics are to help improve the next time, the next time around.

From bedside to boardroom, everybody should be asking themselves those questions. Have I got access to the information I need? And how can I make things better? What more do I need?

Gardner: I'm afraid we'll have to leave it there. We've been exploring how hospitals are gaining proactive alerts on patients at risk for contracting life-threatening sepsis infections. But we've also learned about a larger perspective of how edge computing and AI are enabling caregivers around the world to respond to more types of issues and become more intelligent about providing better care for people.

Please join me in thanking our guests, Missy Ostendorf, global sales and business development practice manager at Cerner Corp. Thank you so much, Missy.

Ostendorf: Thank you. It was fun to be here.

Gardner: We've also been joined by Deirdre Stewart, senior director and nursing executive at Cerner Europe. Thank you so much, Deirdre.

Stewart: It was an absolute pleasure. Thank you.

Gardner: And lastly, we've been here with Rich Bird, worldwide industry marketing manager for healthcare and life sciences at HPE. Thank you, Rich.

Bird: Thank you.

Gardner: And lastly, a thank you to our audience for joining this BriefingsDirect Voice of the Customer Internet of Things and AI strategies interview. I'm Dana Gardner, principal analyst at Interarbor Solutions, your host for this ongoing series of HPE-sponsored discussions.

Thanks again for listening. Please pass this on to your community, and do come back next time.

Saving lives with edge intelligence: Lessons for leaders

Healthcare providers are using a combination of edge computing, AI, and Wi-Fi data networks to rapidly detect, monitor, and treat deadly sepsis infections in hospitals.

Cerner and HPE have partnered to better connect bedside technology, making data more actionable.

In addition to helping treat sepsis more quickly, intelligent edge devices are improving treatments for other serious health conditions, including opioid addiction.

source: https://www.csrwire.com/press_releases/43855-Podcast-How-Intelligence-at-the-Healthcare-Edge-Saves-Lives?tracking_source=rss

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