Key RIMS Observations and Their Industry-Wide Implications

Guest post by Mitch Freeman, chief clinical officer, Mitchell International, Pharmacy Solutions.

Mitch Freeman
Mitch Freeman

Another gorgeous San Diego spring, no surprise there. Another enormous RIMs convention hall packed with Insurers, TPAs, and service providers, no surprise there either. San Diego is probably the most prime location for this venue of all. Convention hall on the waterfront, luxury accommodations, views of the harbor and Coronado, a teeming Gaslamp district keeping the attendees in tight proximity for after-conference networking with great food and libations, what could be better?

I’m a believer that the terms like “changing,” “different,” or even “same” should not imply the assumptive application of the terms “better” or “worse.” Plainly said, I observed a few notable differences or trends with this conference that I have not seen in the past and that has no bearing on the conference being better or worse than previous conferences.

WC service providers are less prominent in the overall convention

RIMS has always been a conference heavily attended by workers’ compensation insurers and TPAs “WC payers.” This is the conference where WC payers get the chance to meet with prospects or existing customers and win new business, or solidify existing relationships. WC service providers offering pharmacy benefits management (PBM), medical bill review, and ancillary services have historically exhibited in hope to network with the multitude of attending WC payers. This year, there were noticeably less prominent booths from WC service providers and some chose not to exhibit at all.

Why?

A recent shift has occurred from the “good ole days” of relationship-based selling to selling on value. Payers are more focused on what a service provider actually delivers than how much they wine and dine, all be to an extent. Furthermore, many contract decisions are now being driven by procurement departments within payers. That’s not to say that relationships within the industry are not still important, it just means that exhibiting is a less critical component of the recipe to winning or retaining business.

Property loss prevention is filling the void

I observed far more property loss prevention service providers than I have ever seen exhibiting at RIMS. There were several flood recovery providers present, ServPro and their competitors. I experienced first-hand virtual reality by donning “Oculus Rift” type goggles and toured a research facility where the company can essentially recreate your building and burn it in front of your face in 3-D. This type of marketing push outside of WC has not been seen before at RIMs.

Continue Reading

Collaboration of Data Key for Healthcare Interoperability

By Darin M. Vercillo, MD, chief medical officer and co-founder, Central Logic.

 Darin M. Vercillo, MD
Darin M. Vercillo, MD

Healthcare has been changing rapidly for the last 60 years and advances have now reached record speed, including in the realm of data intelligence. In trying to keep pace as well as to protect and advance their own businesses, many processes and systems have understandably been organized into silos.  That era must come to a close.

Care coordination teams need rich collaboration of data and must now be connected.  Hospitals, clinics, home health care workers, primary care physicians, vendors, and others must speak with each other, in the same language, and completely share patient data with an open, collaborative attitude. The industry is all abuzz with this uncharted territory called interoperability. It is clear that data warehouses, now bursting with valuable information, must be streamlined for three very simple reasons: patient safety, cost-effective healthcare delivery and overall population health management. A happy byproduct when data intelligence becomes actionable and systems work collaboratively is a financial benefit, but as a physician, I believe excellent patient care always wins the day, and should be the driving factor.

Reducing Re-admissions

Consider that about one-fifth of Medicare beneficiaries are re-admitted within 30 days of discharge and upwards of one-third are re-admitted within 90 days. One study by the American College of Physicians showed that 20 percent of patients have a complication within three weeks of leaving the hospital, more than half of which could have been prevented. In all, Medicare spends $26 billion annually on re-admissions, $17 billion of which could be “preventable.”

At the risk of this being looked at as “just a financial issue,” consider also that hospitalization is generally a marker for severe illness. Our goal is a healthier population. As we (patients and providers) succeed collectively with hospital treatment and post-acute care, then re-admissions will naturally decrease, and patients will live healthier, more satisfied, lives. Ultimately, this is our goal.

Appropriate, timely sharing of vital patient information will not only address re-admission rates that have clearly become egregious, but improved collaboration of data needs to happen to better inform decision making at the point of care. Without a keen eye to patient safety and success, it is too easy for details to slip through the cracks. All too often, history has demonstrated that hand-off points are the riskiest for failures in patient care.

Nearly everyone has a story where the current system has failed patients — just ask Jennifer Holmes, our CEO. Her father’s healthcare team made an error in medication that ultimately cost him his life. Similar medication errors and decreased duplicate testing can be avoided when a patient’s entire care coordination team has visibility into the data – all the data – to improve care efficiencies and diagnoses.

But all this sharing and playing nice in the sandbox is easier said than done.

Continue Reading

Despite HIMSS Conference “Pledge” Middleware Integration Solutions Gaining Popularity As Interoperability Sling Shot

Guest post by Thanh Tran, CEO, Zoeticx.

Thanh Tran
Thanh Tran

The lack of EHR interoperability continues to pose a serious threat to healthcare initiatives, according to a recent report published by the American Hospital Association (AHA). The report discusses the various aspects of the healthcare industry and care delivery that are negatively impacted by a lack of interoperability.

The report notes that the exchange of health information is critical for the coordination of care. When patients receive care from multiple different providers, physicians should be able to securely send relevant patient information to the practicing physician. However, that tends not to be the case because EHR systems are not interoperable and cannot exchange information.

Last year, the ECRI Institute released a survey outlining the Top Ten Safety Concerns for Healthcare Organizations in 2015. The second highest concern was incorrect or missing data in EHRs and other health IT systems caused by interoperability. For the second year in a row, EHR data is identified as a concern.

The Partnership for Health IT Patient Safety, a branch of the ECRI Institute, has released safe practice recommendations for using the copy and paste function in EHRs that can adversely affect patient safety, such as the use of copy and paste that can overpopulate data and make relevant information difficult to locate, according to the partnership’s announcement.

Meanwhile, a survey of 68 accountable care organizations conducted by Premier, Inc. and the eHealth Initiative found that despite steep investments in health information technology, they still face interoperability challenges that make it difficult to integrate data across the healthcare continuum.

The survey found that integrating data from out-of-network providers was the top HIT challenge for ACOs, cited by almost 80 percent of respondents. Nearly 70 percent reported high levels of difficulty integrating data from specialists, particularly those that are out-of-network.

User Frustration Over Lack of HIE and Interoperability Standards

The Office of the National Coordinator for Health Information Technology (ONC) is once again asking the healthcare community for its thoughts on establishing metrics to determine if or to the extent to which electronic health records are interoperable. The push to achieve interoperability is in response to last year’s mandate by Congress, contained in the Medicare Access and CHIP Reauthorization Act (MACRA). Among provisions of that law is a requirement to achieve “widespread” interoperability of health information by the end of 2018.

When it comes to how Health Information Exchanges (HIEs) handle the challenges associated with interoperability, a recent Government Accountability Office (GAO) report cites the following barriers–insufficient health data standards, variations in state privacy rules and difficulty in accurately matching the right records to the right patient. In addition, the costs and resources necessary to achieve interoperability goals, and the need for governance and trust among entities to facilitate sharing health information.

In its annual interoperability survey of hospital and health system executives, physician administrators and payer organization IT leaders released in April 2016, Black Book Research found  growing HIE user frustration over the lack of standardization and readiness of unprepared providers and payers.

Of hospitals and hospital systems, 63 percent report they are in the active stages of replacing their current HIE system while nearly 94 percent of payers surveyed intend to totally abandon their involvement with public HIEs. Focused, private HIEs also mitigate the absence of a reliable Master Patient Index (MPI) and the continued lack of trust in the accuracy of current records exchange.

Public HIEs and EHR-dependent HIEs were viewed by 79 percent of providers as disenfranchising payers from data exchange efforts and did not see payers as partners because of their own distinct data needs and revenue models. Progressive payers are moving rapidly into the pay-for-value new world order and require extensive data analytics capabilities and interoperability to launch accountable care initiatives.

Those looking at touted standards such as Fast Healthcare Interoperability Resources (FIHR) point out that it is only capable of connecting one medical facility to another and requiring specific end point interfaces to even do that.  For every additional facility, a customized interface must be built.  At the end of the day, FIHR is really a point-to-point customized interface requiring extra steps and ties developers to specific hospitals or EHRs and without universal access.

“Progressive FHIR standards can allow EHRs to talk to other EHRs should standard definitions develop on enough actionable data points as we enter a hectic period of HIE replacements, centering on the capabilities of open network  alliances, mobile EHR, middleware and population health analytics as possible answers to standard HIE,” said Doug Brown, managing partner of Black Book.

Continue Reading

How Wearable Tech is Revolutionizing Healthcare Services

Matthew Zajechowski
Matthew Zajechowski

Guest post by Matt Zajechowski.

Most people are familiar with wearable technology today and how they track information related to health and fitness of the wearer or the person engaging with it. One in five American’s now owns a wearable tech device. The focus on wearable tech is on for both the consumer as well as the health care providers and the health insurance industry.

Susan Hahn-Reizner, who is on the advisory board of Northwestern School of Professional Studies, has put together a comprehensive infographic that looks at how wearable technology is changing the healthcare services industry.

The Current State of Wearables

The use of wearable tech is still in its infancy; however, users are starting to weigh in on both the benefits of wearable technology as well as the unmet expectations that come with it.

The most popular wearable devices in the market are fitness bands and smart watches. On the consumer side of wearable tech, 56 percent of consumers believe the average life expectancy increases at least 10 years because of wearables monitoring vital signs. Forty-six percent of consumers also believe wearable technology can help them to lose weight and maintain a more active lifestyle.

On the flip side there are many unmet expectations that come with wearable technology. Abandonment is a big issue with wearable technology with more than 33 percent of wearable device consumers using the device less or not at all after a year of purchase the device. Another big issue for consumers is privacy and security breaches that come with this technology. Eight-two percent of consumers have concerns because of invasion of privacy and another 86 percent worry that wearables make them more vulnerable to security breaches.

How Health Insurance Companies Are Pushing Wearable Technology to Consumers

The health insurance company Humana began using wearables to reward fitness activities with reduced premiums, gift cards and health devices. A three-year study of employees who participated in this program showed a 44 percent decrease in the number of sick days taken.

BP distributed 16,000 FitBits to its employees as part of a larger healthcare plan for its workforce. This helped to drop corporate healthcare costs well below the national growth rate. Over the course of 25 years, it’s estimated that wearable technology and remote patient monitoring technologies could help to cut hospital costs and save more than $200 billion. As you can see wearables can help to put a huge dent in cutting healthcare costs.

Continue Reading

How HIT Employee Expectations Are Changing—And What You Need to Do to Hold Onto Your Best Employees

Guest post by Ben Weber, managing director at Greythorn.

Ben Weber
Ben Weber

The pace of life has changed over the last few decades, and it’s changed absolutely everything. Now, we expect communication to be instantaneous by email and text. We expect delivery to be two-day (and free), thanks to Amazon. And increasingly, expectations about work and careers have changed, as well. The time spent at a single organization has been condensed, going from 40 years down to three, five or sometimes even less. Most people anticipate working for multiple companies over the course of their career, not to mention some may have multiple careers in the course of their working lives. Either way, this is a costly trend for employers.

That’s one reason we here at Greythorn conduct an annual survey of healthcare IT professionals: so we can understand what’s motivating them to stay, or seek out new employment. Have a look at some of our key findings and consider what this may mean for you and your team/organization. Perhaps there’s a nugget or two within that may help you ensure you’re doing everything you can to retain your top talent.

Motivation #1: A higher salary

It should come as no surprise that a higher salary can tempt someone away, even from a job they love. What might surprise you, however, is how many of your employees expect their salary to increase right now in their current roles: a full 87 percent of survey respondents said they expect at least a 3 percent increase in the next 12 months. If this expectation isn’t managed or met, the odds are good that you may start seeing some of your best employees begin to grumble.

According to our research, job security is no longer a top motivator for healthcare IT professionals. In our last survey, it slid from the top three—where it’s remained for several years—to number six. Meanwhile, 71 percent of the full-time employees who participated in our research said they’d consider joining the uncertain world of consulting—mainly, because the money’s superior. They’ve accepted that in consulting, job security is rare, and are choosing to embrace that higher degree of risk in order to capitalize on their earning potential.

So what can you do? Besides the obvious and often less feasible option of increasing everyone’s salary, you can provide transparency to your staff. Ensure they understand what’s expected of them and are accountable for delivering on your key objectives. Provide documentation to support a salary review and/or a guaranteed raise based on meeting those objectives. Explain some of the  obscured  issues going on within your hospital or health system, which may make a raise unattainable (for now), and/or why the annual bonus was potentially smaller than what they’d hoped for. Although they may be disappointed with the news you’re sharing, you’ll further a  trusted relationship—and their loyalty—with your honesty.

Motivation #2: Advancement and interesting work

Think about your top employees for a moment: What makes them great? Likely, they all share a few characteristics such as being highly motivated and satisfied by a job well done, not to mention passionate about their work. They’re probably people who thrive on the challenges that come with achievement, correct? It’s traits like these that make them valuable to your organization, and also contribute to why they’ll consider leaving it.

Of our survey respondents, nearly a third—30 percent—said they left their last job to pursue career development and advancement. An additional 11 percent said they left their last job to find more challenging and interesting work. This is a huge jump from the 3 percent who cited a new challenge the year before—a 30 percent increase year over year.

Think again about your top employees—they’re motivated by interesting work, but the longer they stay with you, the more likely it becomes that they’re losing interest if their work isn’t evolving.

They’re also motivated by achievement—so are you helping move your top employees up through the organization? If they aren’t moving within your hospital system, they may look for other routes to the top.

What can you do? Stay attentive to ensure your top staff members are motivated by and interested in their work. Communicate the path to career advancement within your organization, bi-annually at least. Whenever possible, try to get your top performers involved in new projects; do what you can to keep them excited about coming into work each day. Verbalize your appreciation for their work when they reach a goal or finish a project—even small gestures can provide a sense of achievement.

Continue Reading

Just How Dangerous is Ransomware?

Guest post by Cody Jaster, digital marketing manager, Netsurion.

Cody Jaster
Cody Jaster

The word “ransomware” has been in the headlines quite a bit this year. The Institute for Critical Infrastructure Technology (ICIT) has even called 2016 the year of ransomware.

Ransomware is a company’s worst nightmare. This malware infects computers and restricts the users from accessing any of their data until paying the ransom. Imagine a hospital unable to access patients’ data or a financial institution unable to manage their customers’ accounts? What would you do to get that data back? Victims of ransomware have been presented with the following choices: Restore their backups (if they had any and if they do, it takes quite a few days to retrieve it all) or pay the ransom to get the data back. Assuming they get the data back, at that point these businesses have had operations grind to a halt for days, spent money on retrieving this data and most of all, their reputations have taken a hit.

Take action before being the next victim. In addition to having remote-managed network security as your first line of defense against ransomware, here are a few things you can do yourself to protect your business.

Preventative and Proactive

Staff Training and Education

Limit Access

Continue Reading

Why Do Hackers Want Medical Records?

A stolen credit card record can be sold for as low as a quarter while a medical record can be sold for $50. Why is that? When a credit card is stolen, the owner is able to cancel it as soon as he/she notices fraudulent activity and then they are also able to dispute the charges. But think about a medical record – changing your Social Security number, birth date, home address and medical history isn’t that simple, even impossible.

The problem becomes much bigger than just financial identity theft. Think about what would happen to a person whose medical record is stolen and being used to obtain free healthcare and subscriptions. Then think about the customer going in for an emergency with the wrong records on file and getting the wrong blood transfusion.

Protecting patients’ medical records should be every hospital’s and physician’s office’s concern. But with many issues in the healthcare industry vying for attention, security may fall through the cracks.

Keystroke logger malware was recently discovered on Muhlenberg Community Hospital computers in Kentucky—but it could have gone undetected for nearly four years. Potentially compromised data includes patient names, addresses, telephone numbers, dates of birth, Social Security numbers, driver’s license/state identification numbers, health plan information, financial account numbers, payment card information and employment information.

Though there’s currently no evidence the information has been used maliciously, it’s just another reminder that medical information is an intriguing target for hackers. Netsurion, a provider of remotely-managed data and network security services for multi-location business, just released this infographic on the value of a medical record. It’s insightful.

Continue Reading

Healthcare’s Next Revolution Is Social, Not Digital

Guest post by Edgar T. Wilson, writer, consultant and analyst.

Edgar T. Wilson
Edgar T. Wilson

It seems increasingly disingenuous to frame health IT as being “revolutionary.”

For one, digitization has already swept nearly every other industry. The iPhone was a revolution in communication, but after generations of iterations and imitations, smartphones are normal, and consumers have adjusted their expectations accordingly.

To bring electronic health records (EHRs) into American hospitals and clinics is less a revolution, and more a remediation. That arguments continue over whether this upgrade will prove practical, valuable, or beneficial to patient care and clinical outcomes at all reflects that this evolution has been a top-down endeavor, rather than a true bottom-up transformation.

Despite rhetoric–and plenty of earnest optimism–the EHR rollout has been incremental, administratively-guided, federally-mandated push toward adoption. It has been a crawl toward process improvement more in the mode of Six Sigma than a grassroots “reset” button on the fundamentals of healthcare.

The true revolution–the one that patients and caregivers alike desperately need–is not merely technological, although technology may be our next best hope for realizing it.

A Mental Problem

Healthcare needs to unify behavioral and physical health, treatment, and discourse.

While physical medicine is climbing the next hill with respect to primary care provider (PCP) shortages, interoperability quagmires, and meaningful use (MU), behavioral health is facing the same primary challenges it has since well before health IT became such a hot topic.

Namely, recognition as a legitimate and necessary component of whole-person wellness and medical treatment.

But on both the side of care providers, and patients, physical health has been rigidly siloed away from behavioral health. Even EHRs have been shoehorned through America’s hospitals while behavioral health clinics have been barred from accessing incentive money. Their exclusion from the development table means fewer solutions and platforms exist at all for those facilities and caregivers who want to embrace digitization, because developers have been preoccupied with MU compliance.

The problem is sociological as much as it is a practical matter of care delivery. Stigmas persist–even as the conversation about CTE in the NFL escalates, the knee-jerk reaction is to provide players with better helmets, rather than emphasize how physical injury manifests in behavioral ways.

Continue Reading

How EHRs Are Poised to Revolutionize Medicine

what are EHRsHave you ever sought medical care from multiple providers for the same condition? Then you probably already know how difficult it can be to coordinate care from one practice or facility to the next. One provider may not necessarily have access to the test results ordered by another provider, and even getting a prescription filled can be a hassle — you have to wait while the pharmacist fills your prescription and hope that he or she doesn’t misread the prescribing doctor’s terrible handwriting.

But all of that is changing; for many patients across the country, it has already changed, thanks to the Health Information Technology for Clinical Health (HITECH) Act of 2009. This law was enacted to encourage the transition to electronic health records (EHRs) in medical practices, hospitals, and other health facilities. Researchers agree that the use of EHRs can have many benefits for providers and patients alike, including improved patient outcomes, reduced costs, streamlined administration, and even improved ability to perform medical research.

What Are EHRs?

An EHR is an electronic record of a patient’s medical history that combines test results, diagnoses, and other data accumulated as the patient moves from one provider to another. Your EHR is meant to be longitudinal in nature, meaning that the record represents a lifetime picture of your health history.

Unlike a medical record, which is maintained by a single provider, an EHR is comprehensive; since it includes information compiled from every provider who works with you, it will offer each provider all of the information necessary to make your next treatment decision. That means no more re-ordering an expensive test you’ve already taken somewhere else, and no more waiting for test results to be faxed over from another doctor’s office.

Advantages of EHRs

Ideally, EHRs will someday travel with you. When all providers have made the transition to using EHR systems such as RevenueXL, you’ll be able to get the same quality of care from providers anywhere in the country. They’ll simply be able to check your EHR for pertinent medical information, and even update it so that your providers back home will be able to adjust your care accordingly. Even if you’re incapacitated, your EHR will ensure that providers around the country will be alerted to your medication list and existing medical conditions.

EHRs should make life easier for everyone involved in your care. You’ll be able to:

The use of EHRs should streamline the many administrative tasks associated with patient care. EHR system software will prompt your doctor to file necessary Medicare and insurance paperwork, will help them keep track of which best practice guidelines apply to your specific case, and will reduce numerous costs.

Continue Reading

Infographic: Bizarre Medical Codes, Industry Outlook

These are some of the most out of the ordinary medical codes you might come across if you worked as a medical coder. If you’re a patient and see these on your bill, you might raise an eyebrow once you find out the meanings. Check out the following graphic for all 15 unusual codes.

V97.33XD – Sucked Into Jet Engine

Y93.D: V91.07XD – Burn Due to Water-Skis on Fire

V95.40 – Injured by Spacecraft Collision

R46.1 – Bizarre Personal Appearance

V96.00 – Unspecified Balloon Accident Injuring Occupant

W61.12XA – Struck by Macaw

V94.810 – Civilian Watercraft and Military Watercraft Involved in Water Transport Accident

W56.11 – Bitten by Sea Lion

Y93.D1 – Accident While Knitting or Crocheting

Y92.253 – Hurt at the Opera

If you are interested in being a medical coder, the average salary is $47,870. The job outlook has a 21 percent increase by 2020. Eighty percent of medical coders have some postsecondary education. Medical coders work in both clinical and non-clinical settings, some of which are hospitals, physician offices, long-term care facilities, dental offices, mental health facilities, government agencies, and insurance companies. Graphi provided by Topmedicalcodingschools.com.

Continue Reading