Guest post by Will Hayles, technical writer and blogger, Outscale.
We tend to conceive of the Internet as a place of human communication. In reality, a significant proportion of the traffic carried over the networks that comprise the Internet is generated by machines talking to other machines. For the most part, there is no human in the loop of these so called machine-to-machine (M2M) interactions. Data is gathered from sensors attached to devices which are connected to the Internet. That data it is stored and analyzed in the cloud. Only at the end of the process is a human involved, once the deluge of data generated by machines has been squeezed down to extract useful information.
To take a simple example of how machine-to-machine processes can deliver useful information to human decision makers and system designers, consider a pet store that specializes in selling tropical fish. The store has several dozen aquariums filled with sensors that report the nutrient content and chemical composition of the water — data that is stored on a cloud platform. Another system records the store’s purchases, stock levels and waste. An analytics solution designed by the store’s developers takes both sets of data and tries to develop feeding and water treatment regimens that reduce waste (dead fish) and increase yield (fish growth). Every day, workers at the store get a list of tasks generated by the system — perhaps one of the aquariums is slightly too acidic and action needs to be taken or waste will increase.
The bulk of the communication is machines talking to machines, the culmination of which could be a text message that instructs the fish store owner to add three drops of a particular chemical to a specific tank.
Now that you have a basic grasp of the fundamental idea of M2M communication, let’s focus on how it is being used in the healthcare sector to improve patient outcomes and increase spending efficiency.
Healthcare treatments often involve many different professionals, from general practitioners to specialists, and from radiologists to physiotherapists. Complex cases can require input and decisions from a dozen or more individuals across several institutions. To be effective, it’s essential that healthcare professionals have access to up-to-date and comprehensive information about the case. With paper record keeping, it’s all too easy for information to fail to reach the right person at the right time. M2M systems, in which relevant data, including test results and real-time monitoring, are made available to all stakeholders simultaneously and automatically can make a real difference to healthcare outcomes, radically increasing the efficiency and efficacy of treatment regimes.
Remote Patient Monitoring
Remote patient monitoring is the classic case for M2M communication. With the advent of sensor-equipped medical devices with internet connectivity, patient status can be monitored in realtime, with physicians and other healthcare professionals receiving alerts when a decision or action needs to be taken.
It isn’t that doctors aren’t skilled, intelligent or capable enough—it is that the demands being placed on them are too great.
Time and documentation demands mean that something has to give. As many physicians have pointed out over the years of the HITECH Act’s implementation, the thing that normally “gives” is facetime with patients: actual, hands-on delivery of care and attention. Instead, they are driven to input data for documentation, follow prompts on EHR interfaces, ensure their record-keeping practices will facilitate correct coding for billing, as well as tip-toeing around HIPAA and the explosion of security and privacy vulnerabilities opened up by the shift to digital.
The reality of modern medicine—and especially the rate at which it evolves, grows, and becomes outdated—means that doctors need what most every other industry has already integrated: more brains. Not simply in the form of EHRs for record-sharing, or voice-to-text applications as a substitute for transcriptionists, but as memory-supplements, or second brains.
As a species, humans are also evolving away from memory as a critical element of intelligence, because we now have devices—“smart” devices—always on, always on us, and always connected to the ultimate resources of facts and data.
Our smart devices—phones, tablets, etc.—are gateways to the whole of human knowledge: indexes of information, directories of images, libraries question and answer exchanges. In effect, we are increasingly able and willing to offload “thinking” onto these devices.
Supplement or Supplant?
Depending on the context and application, this trend is both helpful and potentially harmful. For those prone to critical thinking and equipped with analytical skills, offloading some elements of memory to these devices is a question of efficiency. Even better, the more they practice using it, the more effective they become at integrating devices into their cognitive tasks. In others (those less prone to think critically), it is a shortcut that reduces cognitive function altogether: rather than a cognitive extension, the devices act as substitutes for thinking. Similarly, increasing over-reliance on the internet and search engines further diminishes already deficient analytical skills.
The standard roadmap for a medical education entails a lot of memorization—of anatomy, of diseases, of incredible volumes of data to facilitate better clinical performance. It isn’t memorization simply for the sake of recitation, though; it is the foundation for critical thinking in a clinical context. As such, medical professionals ought to be leading candidates for integrating smart devices not as crutches, but as amplifiers of cognition.
So far, that has been far from the dominant trend.
Enter the Machine
Integrating computers as tools is one thing, and even that has proven an uphill battle for physicians: the time and learning curve involved in integrating EHRs alone has proven to be a recurring complaint across the stages of Meaningful Use and implementation.
Patient engagement—another of the myriad buzzwords proliferating the healthcare industry lately—is another challenge. Some patients are bigger critics of the new, digitally-driven workflows than the most Luddite physicians. On the other hand, some patients are at the bleeding edge of digital integration, and find both care providers and the technology itself moving too slowly.
As president and COO of a leading electronic health record (EHR) and practice management (PM) provider, part of my job is to be in constant communication with providers about health IT. They tell me and my team what works for them and what doesn’t work; what brings joy to their practice and what keeps them up at night. All this insight helps polish my crystal ball, making it clear what we can expect to see in 2016:
EHR system will pivot from regulatory compliance to physician productivity. EHRs are generally blamed for fueling the professional dissatisfaction of physician. A few software vendors are looking at the problem-oriented medical record (POMR), a more intuitive approach that works similarly to the way a doctor thinks. It organizes clinical records and practice workflows around specific patient problems, making it faster and more satisfying for physicians to use.
The problem list not only delivers a “table of contents” to clinically relevant issues, but also gives a provider a longitudinal view of a patient’s healthcare over time. This intuitive method of information organization makes it easier for provider and patient to set the agenda at the start of the exam. During the exam, the POMR supports the nonlinear nature of a patient encounter.
The POMR also helps reduce cognitive overload, which can lead to medical mistakes such as misdiagnosis and other potentially life-threatening errors. Providers can see “bits” of data like lab results associated with a specific problem, thus easing the number of mental connections required to make sound medical decisions.
Chronic care management (CCM) will grow quickly because it makes sense for both patients and providers. Our healthcare system is changing to address the needs of an aging population with chronic illnesses like hypertension, diabetes, heart disease, and more. To promote the effective care coordination and management of patients with multiple chronic illnesses, the Centers for Medicare and Medicaid Services (CMS) introduced CPT code 99490. This code reimburses providers for remote, inter-visit outreach, such as telephone conversations, medication reconciliation, and coordination among caregivers.
The reimbursement for CCM services is an average of $42 per month for Medicare beneficiaries. New levels of technology integration will enable clinicians to complete CCM reporting of remote care from inside their EHR system.
Guest post by Amy Sullivan, vice president of revenue cycle sales, PatientKeeper.
The multi-year run-up to the ICD-10 cut-over last October had a “Chicken Little” quality to it. There was prolonged hand-wringing and hoopla about the prospect of providers losing revenue and payers not processing and paying claims – the healthcare industry equivalent of “the sky is falling.”
Then CMS helped calm things down by announcing last July (as the AMA reported at the time), “For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.”
Since ICD-10 is all about specificity – the number of diagnosis codes increased approximately four-fold over ICD-9 – this was a big relief to all involved. And, if you believe new research data, the sky indeed has not fallen: Sixty percent of survey respondents “did not see any impact on their monthly revenue following Oct. 1, 2015… Denial rates have remained the same for 45 percent of respondents. An additional 44 percent have seen an increase of less than 10 percent.”
Still one has to wonder what will happen after Oct. 1, 2016, when the current leniency expires and ICD-10 code specificity is required. Will physicians be in a position to enter their charges completely and accurately once “in the general neighborhood” coding no longer suffices?
They will if their organization has invested in technology that adheres to best practices in electronic charge capture system design. The three watch-words are: specialize, simplify and streamline.
A charge capture system is specialized when it exposes only relevant codes to physicians in a particular specialty or department, and when it provides fine-tuned code edits. With different types and processes of workflows (and let’s face it, personal preferences), physicians need an intuitive and personalized application that easily fits into their individual work styles. A tailored user experience allows providers to build and display their patient lists in whatever way is most convenient and meaningful to them – down to lists organized by diagnosis and “favorites.”
Guest post by Steve Tolle, chief strategy officer, Merge Healthcare, an IBM Company.
The volume of health-related data available to physicians and other healthcare providers from disparate sources is staggering and continues to grow. In fact, a 2014 University of Iowa, Carver College of Medicine report projects that the availability of medical data will double every 73 days by 2020. Such data overload can make it difficult for clinicians to keep up with best practices and innovations.
Perhaps because imaging is so pervasive in healthcare, the medical imaging field has turned to data analytics and cognitive computing to help clinicians use large volumes of data in a meaningful way. These decision-support tools help them manage data to improve patient care and deliver value to referring physicians and payers.
At RSNA15, the crowds packed presentations on data analytics and cognitive computing and flocked to vendor exhibits featuring these decision-support tools — indicators of their expanding role in healthcare. In years past, exhibit space was primarily devoted to showcasing new imaging modalities.
Interest in analytics is growing rapidly as the U.S. health system transitions from volume- to value-based payment models — models that challenge physicians involved in medical imaging to demonstrate value. Physicians are under pressure to deliver educated, accurate, useful and efficient interpretations even as imaging studies become increasingly large in size and complex in scope. And these physicians are expected to communicate this information quickly and in a user-friendly manner. As a result, clinicians are turning to analytics-based solutions to boost efficiency and enhance the quality of their service to help them deliver the value demanded by payers, referring physicians and patients.
Guest post by Cathy Reisenwitz, content specialist, Capterra.
Every year at Capterra we predict the top trends in business technology. Last year we predicted gamification, wearables, telemedicine, mobile medicine, and 3D printing would be the top 5 medical technology trends for 2015.
This year, we expect wearables, telemedicine, and mobile medicine to continue to advance. They’ll be joined by cloud computing, patient portals, and big data.
Telemedicine has come a long way, from remote villagers using bicycle pedal-powered, two-way radios to communicate with the Royal Flying Doctor Service of Australia to helping recovering stroke patients in rural Minnesota avoid hours-long (and often snowy) drives for follow-up care.
As the technology has improved, the investment has increased. Transparency Market Research valued the global video telemedicine market at $559 million in 2013. Today, they predict it will grow to $1.6 billion by the end of 2020. Walgreens, the largest U.S. drugstore chain, and telehealth provider MDLive recently expanded their virtual care collaboration to 20 more states in November, bringing the total to 25.
Telemedicine offers tons of value to a large, growing segment of the population: seniors. Telemedicine improves care by getting it to remote patients who live far from hospitals. It also enables homebound patients to get high-quality care. It makes care cheaper, and allows seniors to stay at home longer. It benefits providers by making their jobs more flexible. And it also eliminates picking up new illnesses in a clinical care setting.
In rural Minnesota, nurses check motor skills by asking patients to push, pull and squeeze with their hands and feet. A doctor, located further away from patients, can advise on care onscreen.
Going back to wearables, their mass adoption has made store-and-forward telemedicine much easier. Devices like Fitbits automatically collect valuable health data. Store-and-forward telemedicine just means that data goes to a doctor or medical specialist so they can assess it when they have time. Watch for more EHRs learning to connect with wearables in 2016.
More EHRs will provide patient portals
Patient portals grew in popularity in 2014 and 2015. Twenty-six percent more patients received lab tests via an EHR patient portal between 2013 and 2014. Patients also received 50% more health and disease education through their portals in that time. “Patient engagement through health technology such as patient portals is rapidly increasing,” Craig Kemp, leader of innovative partnerships for Merck Vaccines, told mmm-online.com.
While about half of physicians offer patient portals right now, almost another fifth of them plan to offer one in the next 12 months. In a 2015 survey of more than 11,000 patients, 237 physicians, and nine payer organizations representing 47 million lives, almost a third of patients said they were interested in using a patient portal to engage with their physician, track their medical history, and receive educational materials and patient support. However, almost 40 percent said they’d never heard of a patient portal.
Educating patients on how and why to use portals will be key to getting them to use them in 2016.
Despite all the advances in technology over the last three decades, many large health payers are still conducting aspects of their business the way they did in the pre-Internet days of the 1980s, relying on manual processes and interactions with members and providers.
That mindset can no longer continue. Between the huge influx of individual members that resulted from the Affordable Care Act (ACA) and the expectations of the customer experience members have based on their interactions with retail, telco and other industries, payers must make significant changes to prepare themselves for success in the 21st century – and beyond.
The days of sprawling campuses housing thousands of employees, acres of call centers and a labyrinth of file rooms archiving mountains of incoming paper documents are going away. Following are some of the key adjustments health plans will start making in 2016.
Deploy robust web portals. The use of self-service web portals has become common in many industries. Consumers can go online to obtain information or complete transactions whenever they want from wherever they are using whatever device they prefer. Health plans will start making this same level of self-service available to their members and providers rather than relying solely on phone, email or snail mail. By providing more answers through online self-service portals, payers can focus call center personnel on answering more difficult, complex questions that provider higher value to members and payers while reducing their costs to deliver that level of service.
Implement 24/7 online claims administration. Most health plans cannot afford the high level of overhead required to staff claims processing or authorization department around the clock. By implementing online claims administration technology, payers will be able to offer continuous, 24/7 processing of incoming claims and authorizations, removing delays and delivering resolution faster. They can also use these technologies to identify exceptions and pass them to the appropriate personnel for immediate review, ensuring they receive the proper attention rather than getting “lost in the shuffle” of paperwork.
Anyone who grew up playing video games ought to have a greater appreciation for the future of healthcare.
When they moved out of the arcade halls and into living rooms, video games became more accessible to more people. And when a wave of fitness-related console titles were released in the late 1990s and early 2000s — Dance Dance Revolution, EyeToy: Kinetic, and Yourself!Fitness/My Fitness Coach — women joined in the fun. By 2014, a study by the Entertainment Software Association revealed that women represented 48 percent of the gaming population in the United States, and the addition of this untapped market allowed the gaming industry to make the pivot that would eventually merge gaming with healthcare.
The title character of My Fitness Coach was Maya, a virtual personal trainer. Maya was the agent who coached couch potatoes and weekend warriors alike to reach whatever fitness goals they might have. A doctor, similarly, knows what’s best for patients and has a reason behind every instruction — and the difference between the virtual video game trainer and the Ph.D. isn’t the vast ocean it once was.
With innovations from FitBit and Jawbone for wearables, Biosensing to Augmedix and Entrada for electronic health records (EHRs) and clinical workflow apps, as well as direct competitors such as Doctors on Demand and TeleDocs, traditional healthcare institutions are facing consumer-direct competitors whose products and services are almost exclusively based on the use of self-care technology. A new wave of innovation is coming soon. Venture funding of digital health companies surpassed $4 billion in 2014, nearly equivalent to the previous three years combined.
So, what’s next?
Self-care apps like FitBit, RespondWell, Caremerge and others that feed a patient’s data into a cloud have the potential to enrich clinical observations in ways that the occasional hospital visit cannot. If you have a device producing conclusive data that says “your heart rate is higher than it should be,” “you’re taking too many pills,” or “you’re walking with a gait,” a physician can say with confidence “something bad is going to happen to you.” Predicting a person’s proclivity for injury and illness is more of a science than ever.
There is an industry-wide surge in providers, payers and post-acute care providers whose needs for transitions-in-care are unmet by their current healthcare IT capabilities. As such, 2016 will likely be the year that referral management comes to the forefront for all stakeholders in the healthcare system.
The moment of referral is an opportune time to engage with patients: with the increase in high-deductible plans and out-of-pocket expenses, patients are extremely motivated to seek care from high-quality, cost-effective, in-network providers. Providing patients with the resources they need, while enabling providers to align their efforts, is a mission-critical need in healthcare today.
There are a few key factors driving improvements in referral management for providers, payers, and post-acute care providers alike:
With the move to fee-for-value reimbursement, we are seeing a rise in the number of physicians moving to independent physician associations, ACOs, and clinically integrated networks. This is happening for two reasons: first, to negotiate more effectively with payers and second, to equip themselves to take on risk in the future. In order to take on risk effectively, healthcare organizations will need to ensure that patients stay within their systems. In addition, these groups of physicians often have multiple EMRs and are looking for solutions to expand them. Therefore, we have seen an increase in all kinds of provider groups looking for intelligent decision support that guide referrals in a systematic and strategic fashion.
With the increase in high deductible, narrow network plans, there is a greater need to direct patients to high-quality, low-cost providers. Payers, in partnership with providers, are looking for the ability to navigate patients in this way. Given the cost of specialist visits, payers are also particularly interested in making sure patients get to the most appropriate specialist to receive the care they need.
For example, Carefirst BCBS has pioneered a program, through their PCMH plan, to provide information on specialist costs and quality to inform referrals. They see this as a way to improve quality while, over time, bending the cost curve. This could be the beginning of a broader trend among payers, to acknowledge the importance of referrals and encourage the use of tools designed to implement insightful decision support and a standardized process around transitions-of-care.
For post-acute care providers
As providers have consolidated, so has the post-acute care space. Readmission penalties and bundled payments have further put pressure on post-acute care to ensure a seamless transition from acute care to – and within – different post-acute services.
Patient-centricity , patient centered thinking, and the rise of the “p-suite” in pharma companies continued a trend established over a year ago when Sanofi broke new ground by hiring Dr. Anne Beal, former deputy executive director of the Patient Centered Outcomes Research Institute (PCORI), to the newly created role of chief patient officer. Her new responsibilities included elevating the perspective of the patient within Sanofi and finding better ways to incorporate the unique priorities and needs of patients and caregivers.
Yet as life sciences companies continue the pursuit of a 360-degree view of “customers” typically classified as healthcare professionals (HCPs), a view of patients has been even harder to come by. Partly because of HIPAA and privacy requirements, but also because, unlike healthcare providers and payers who have regular contact with patients, life sciences companies engage primarily at the level of clinical trials and consumer marketing.
Better understanding of the patient is top priority in life sciences for 2016, and executives will continue to push cultural change facilitation, enhanced cross-functional collaboration, and increased employee engagement. But what would a life sciences company consider to be a key patient engagement metric and a measure of ROI?
With data about patients spread across a significant number of sources, including internal, external and social, merely identifying and collating that data can be a challenge – let alone deriving insights that can support patient-centric strategies and programs. Technology exists today to turn patient data into actionable insights for better R&D and commercial efficiency, as well as to deliver better services to the patient. In order to rapidly analyze data and target audience needs with products and services, life sciences will need to close the loop by tracking and monitoring the effectiveness of their offerings. In other words, they have to be both patient-centric and data-driven.
Healthcare Providers and Payers Will Take Data-driven to the Next Level
Healthcare providers and payers have approved access to member and patient data, as compared to life sciences companies, so are able to develop a new breed of data-driven solutions built to serve individuals, employers, providers, brokers and more. These tools, products and services bring value to every stakeholder, and ultimately benefit the patients themselves in the form of better care, lower premiums and improved efficacy.
However, being able to do so requires a significant step up in data management capabilities. Today’s modern data management platforms are not just cloud-based, but include a reliable data foundation that in generations past, used to cost IT teams millions of dollars in hardware, software and implementation resources alone to produce.