Category: Editorial

Business Intelligence’s Role in Improving Chronic Disease Management

Nora Lissy
Nora Lissy

Guest post by Nora Lissy, RN, BSN, MBA, director of healthcare information, Dimensional Insight.

It’s no surprise that chronic diseases are killing the United States both physically and financially. According to the Centers for Disease Control and Prevention (CDC), seven of the top 10 causes of death in 2010 were from chronic diseases, where two of the conditions—heart disease and cancer—together accounted for nearly 48 percent of all deaths. To add to the problem – effectively treating these conditions comes with an exceedingly high price tag. According to U.S. News & World Report, 86 percent of all healthcare spending is currently going towards the treatment of these chronic diseases, equating to more than $3 trillion annually.

So how can the healthcare industry combat the rise of chronic conditions while keeping escalating treatment costs down?

One of the most effective tools for monitoring chronic disease management while still keeping an eye on care costs is business intelligence. Business intelligence has continued to increase in prevalence within the healthcare industry in recent years. According to a HIMSS Analytics study, 41 percent of hospital respondents reported they currently use clinical and business intelligence tools for their analytics, with that number expected to continue to increase over the next two years. With business intelligence continuing to prove its value within healthcare, physicians are starting to see the true potential of this data-driven tool to positively impact the industry as whole, including with the management and overall cost of chronic diseases.

Below are three ways that business intelligence can help to improve chronic disease management and lower the rising costs of care.

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The Health Threat of Tech

Guest post by Edgar Wilson.

Edgar Wilson

We put a lot of faith in health technology: to make us better, to save our systems, to revolutionize healthcare. We may be looking at it from the wrong side entirely.

The social determinants of health matter more than our ability to deploy doctors or provide insurance; physical and mental, health is always more social than clinical.

But most of our health tech that is supposed to be revolutionary is aimed at clinical factors, rather than the social determinants of health. Yes, telehealth can increase reach, but it is still just a matter of touchpoints, not a fundamental change to the lifestyles and cultures that determine health.

Same with all our EHR systems creating more ways to record information, more ways to quantify patients, to put more emphasis on engagement and quality-based reimbursement. Even genomics and personalized medicine are taking a backseat to soliciting reviews and trying to turn the patient experience into  a number. It all puts greater focus on the clinical encounters, on how patients “feel” broadly about each minute aspect of their time in the medical facility.

A Digital Disease

As politicians trade blows on minimum wages and the ACA, the likelihood grows that insurance benefits and livable incomes (and lifestyles) will get pushed further out of reach for more people.

Modern work is tech-centric, which means lots of sitting, and manages to facilitate increased snacking without being particularly physical, a double-whammy that prevents employment or higher incomes from leading to healthier choices. For the less-skilled, normally accessible jobs are in the sights of automation and disruption. While tech is taking over medicine and opening up new possibilities, it is also transforming the labor market and closing countless doors to workers.

By extension, technology is changing the social framework that determines public health. Income inequality is growing, wage growth is stagnant, and no amount of awareness can change these front-of-mind concerns for people who may well want to eat better and exercise more, or even commit to seeing the doctor more often and following his or her advice to the letter.

Poor people can’t necessarily eat better as a simple matter of choice or doctor’s orders. Planning meals and purchasing healthful foods is a tax on limited resources–time as well as money. Working three jobs to pay the bills, many lower income individuals also don’t necessarily have time to exercise. And more likely than not, those working even high-paying jobs are sitting all day, sapping their bodies of energy and resilience, undoing the good of their intentions and smart devices  alike through attrition.

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Infographic: Key Questions to Ask Your Prospective EHR Vendor

Guest post by Christine Kilbride, digital marketing associate, Core Solutions.

In the year 2017, technology is all around us. The healthcare industry is no exception. The dawn of modern technology like computers and mobile phones has introduced an entirely new subcategory to the healthcare industry – healthcare IT (or HIT).

The U.S. government has even seen the value in healthcare technology, validating that sentiment in 2014 with a mandate requiring a conversion from paper files to electronic health records (EHR) for healthcare providers, public and private. Since then, the healthcare IT industry has boomed. Many new and established companies have honed their own version of an EHR or EMR (electronic medical records) platform.

Although adopting EHR is mandatory, the type of EHR system you select is entirely up to you. But deciding on one particular provider can be a challenge in itself. Currently there are more than 600 providers, according to HealthIT.gov.

So where should you start? Core Solutions produced the following infographic to help you identify the needs of your organization, in terms of an electronic health record system.

First, you should consider the needs of your organization. Are you public or private? Does your short list of EHR providers currently service clients like yourself? These considerations are important, because healthcare is a very diverse landscape, and familiarity with your organization-type can only aid the process.

Another concern is the product itself. Brainstorm what features are most important to your organization prior to nailing down a short list of EHR companies. Do you need a new billing system? Would you like an integrated system with appointment scheduling and referral management?

EHR software can be highly customizable, so take advantage of the exploratory process to truly define what your needs are.

Lastly, pay close attention to the outlined implementation process in each proposal. What time frame would you prefer? Will you be offered continued technical support after the product is implemented? What kind of training is offered? These concerns are important for the longevity of your EHR system, and for ease of use within your administration.

Consider the infographic below for additional questions to address with your prospective EHR provider.

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Why is Population Health Management Important?

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

The way we see healthcare today is very different from what it was a couple of decades ago. Back then, we did not have the technology to capture the best practices. But, today we have the capability to use medical data as a source of innovation and create impact at scale. But the question is are we capitalizing on it? Have we made the lives easier for both patients and care teams? Are we close to the goals we started chasing ten years ago?

When we talk about innovation in healthcare, we stumble across intuition. The intuition of care teams enhanced by data-driven approaches. It is not just limited providing connectivity to healthcare organizations; it is also about providing advanced analytics and reducing the cumbersome, tedious work! Like deep diving for hours on Excel or making quality tracking and reporting easier.

The concept of population health management is a new one. It has evolved from an idea to become a clinical discipline that works on developing and continually refining measures to improve the health status of populations. A successful population health management program thrives on the vision to deliver robust and coordinated care through a well-managed partnership network. This said, there is no one definition of Population Health Management, fifty different CIOs in an interview gave different definitions to this term. It is a broad concept and covers a lot under its umbrella.

What does an ordinary health IT setup lack?

True, the healthcare systems are working on building the skills to interact and develop well-planned health intervention strategies to move away from the traditional fee-for-service model to value-based reimbursements and incorporating value, but they are falling short in many areas:

Limited EHR capability: EHRs played a pivotal role in digitizing health care, but with EHR technology many restrictions came along. Today, only a few are equipped to support the necessary interoperable standards. To deliver better clinical outcomes, it is of paramount importance that we have the data and right analytics to ensure improvements; something healthcare organizations lack even today.

Integrating data sources: A patient who is being relocated to a new state and will have a new PCP and Care Coordinator. Can we say with confidence that the patient’s information will be available to the new PCP? In a large healthcare network, there is labs, pharmacy, clinical, claims, and operational data, but the capability to integrate it into a single source of truth is still a challenge for many! This has limited the potential of care teams and made them communicate in a disconnected ecosystem.

Risk Stratification: 50 percent of expenditure in healthcare is on 5 percent patient population. Wouldn’t it be great if we could find these patients and cure them before any acute episode? Back in 2012, about 117 million Americans had one or more chronic conditions, and account for 86 percent of the entire healthcare spending. The road to population health management will require care teams to recognize at-risk population timely to reduce cost and improve outcomes!

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Biggest Challenges Facing Healthcare Providers

Guest post by Saqib Ayaz, co-founder, Workflow Optimization.

Saqib Ayaz
Saqib Ayaz

Healthcare providers or physicians in the US have lately been facing an increasing number of challenges on multiple fronts; from unresolved insurance issues to juggling the administrative and medical aspects of their work. Some of these issues are more pressing than the others, and directly impact the health care provider’s productivity, cutting down on the quality time that needs to be given to their patients. Thus, physicians find it hard to cope with the recent changes introduced on the national level in the medical health sector.

Some of the major challenges that have put healthcare providers in hot water have been discussed below:

Seeking Reimbursement for Provided Services

Getting paid for services from insurance companies has emerged as one of the major challenges in the recent past. The problem is all the more vexing when it comes to filing claims to seek their due payment. Claims often get denied on the pretext of not being supported with enough documentation, rendering the claims weak to be accepted. This issue has forced some providers to opt out of accepting health insurance altogether, moving to the simple ‘pay as you get treated’ method.

Moreover, the passing of Affordable Care Act or Obamacare on a national level implies a shift to value based compensation to the health care providers, instead of the straight method of payment. The problem escalates for physicians working with patients on Medicaid right now.

Losing Time in Administrative Concerns

Many of the health care providers, because of privacy breach concerns, control the patients’ record keeping and sensitive information in their own hands; handling which requires a huge amount of time. This involvement and handling of all the administrative work becomes challenging as it impacts their ability to tend to the actual work that they’re qualified for; being a doctor and treating the patients. Moreover, a major chunk of what’s left after sorting out the administrative concerns is spent in preparing prior authorizations which are instrumental to having important procedures; getting hold of crucial drugs and medicines while improving the overall value of the treatment of the patients.

Getting Deductibles

The patients that have registered themselves under the Obamacare/ACA are entitled to an extra time frame of three months to pay the cost of their treatments, as part of the act. Healthcare providers find it increasingly challenging to keep up with these patients and recover premiums from them. One of the major problems that many complain about is the ultimate inability of ACA covered patients to pay the premiums, which the doctors then have to forego completely. This is a major blow to their earnings. On one hand, they cannot deny patients the extra time; while on the other hand, the inability of patients to pay premiums is completely out of their control.

Other than the major ones briefly discussed here; operational expenses, tough decision making between independent practice and being employed by another, keeping consistency between staff members and rising costs, and the reins of control being handed over to the patients gradually are some of the other challenges that healthcare providers perpetually face.

Improving Patient Access in Urgent Care to Remain Competitive

By Tom Gordon, senior vice president and chief information officer, Virtua.

Tom Gordon
Tom Gordon

Virtua’s first and foremost priority is providing quality patient care, and providing easy and fast patient access is one of the first steps in ensuring that quality. Automating patient access would give them the easy and fast solution they wanted, and would give us the solution we were looking for. We decided to move forward with an online appointment scheduling system, which took roughly ten weeks to implement and was an easy and seamless transition.

First, we rolled online patient scheduling out for our primary care physicians. After its immediate success with patients booking appointments online, we expanded this to other areas of our health system, starting with our urgent care centers.

When you think about how you, as a consumer, want to schedule a service or appointment, you want to book it quickly and easily. Today, the preferred way to book an appointment is online. You do not want to be restricted by the time of day you book, and you want the ability to book it in as few steps as possible.

We worked with DocASAP, the online appointment scheduling solution provider, to develop urgent care workflows that patients would need to schedule an immediate appointment.

We want to make sure that patient’s experience is as easy, quick and comfortable as possible. In our urgent care centers, patients have the ability to check in online which allows them to jump into the queue to see an urgent care provider. Moving forward, patients will have the ability to check wait times after they book an appointment from their phone so that they can come at the appropriate time to receive immediate care. While this functionality exists in many industries, it’s a rarity in healthcare. The more we evolve with technology, the better we can provide timely and quality care to our patients.

As a result, Virtua has experienced these results in the seven months since going live:

4 Care Coordination Strategies to Drive Change

Guest post by Andy Ridinger, director of client experience, MyHealthDirect.

Andrew Ridinger
Andrew Ridinger

Despite much of the uncertainty facing the future of the health care industry, the shift to value-based care is not going to go away. Regardless of what new laws may decide, organizations need care coordination tools now more than ever to be successful. Doctors and hospital officials continue to cite care coordination as a key advantage in accountable care models, which seek to more tightly integrate providers and maintain joint financial incentives that deliver better-quality and lower-cost services.

In the United States, more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Referrals are the crucial link between primary and specialty care. Yet despite this frequency, the referral process itself has been a great frustration for many years. The transformation to value-based healthcare is well underway with a shift away from the quantity of patients to the achievement of better health outcomes.

The current state of the specialty-referral process in the U.S. provides substantial opportunities for improvement, as there are breakdowns and inefficiencies throughout. These are inevitable when the process hinges on a patient following through on a slip of paper. It is no wonder that of the one third of patients that receive referrals, 20 percent never follow through to schedule a visit. Of the referrals that are completed, a host of other challenges often result. Sometimes it is just a disconnect of information between the two providers but can be an incorrect provider altogether. The final outcome is poor for everyone involved; patient, referrer, and target provider alike.

To improve the referral process and care coordination, here are four strategies to facilitate greater convenience in care coordination initiatives:

Make it digital 
Just by enabling online booking, referral lead times (time between a PCP and specialist office visit) decrease by up to 36 percent, and show rates improve by 20 percent. Additionally, on the spot booking to a specialist reduces patient leakage for health systems. It can guarantee that care is rendered by the best-suited physicians within your preferred network.

Make it best-fit 
The most effective appointment maximizes show rates and minimizes lead times. A provider must select the preferred physician with the earliest availability at a time the patient is likely to show up. Optimized scheduling can yield up to a five times increase in referral completion rates.

Make it measurable 
The best way to improve referral completion rates and reduce lead times is to capture the relevant data points in a timely manner so that you can track changes over time. Presenting the data in an easily consumable and actionable format is equally critical.

Connect the docs 
To know if patients complete visits, it is critical that all parties share the right information and facilitate two-way communication in real time. A primary care physician making a referral is far better equipped to manage a patient’s health if she receives show status and notes back from the specialist visit as soon as that information is entered into the specialist’s electronic health record.

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Eight Tips to Successful Data Migration During an EHR Change

Guest post by Calvin Chock, vice president, product management and engineering, McKesson Specialty Health.

Calvin ChockSwitching from one electronic health record (EHR) system to another is no small task. One of the biggest hurdles is the transition of legacy data to the new system, but good understanding of the process and a strong technology vendor relationship can help overcome this challenge and lead to a successful EHR migration.

Many practices are currently confronted with the need to change EHR systems. In some cases, their current system is simply outdated or may not be certified to meet Meaningful Use requirements. Others need an option that will satisfy their needs to support value-based care models. Whatever the reason, all practices want to find a solution that not only meets their operational and patient care needs, but also minimizes disruption to the practice during the transition.

Conceptually, most EHRs capture the same types of information, however, when EHRs were first introduced, there was no standard industry terminology for diagnoses, regimens or allergies. Each system created its own logical categories or terms, which makes it difficult to automatically map data from one system to another.

As an example, many older EHRs have a category for patients with seafood allergies. In EHRs today, that allergy is more accurately broken down as either a shellfish or non-shellfish allergy. During a data migration, this difference means the allergy information cannot be automatically synced to the new system. It requires someone to review the information and make a decision about how to categorize it.

Oncology EHRs are quite extensive because of the complexity of the diseases and treatments. There may be as many as 50 different categories into which varying types of data is stored, which means when categories cannot be automatically mapped by the IT team, extensive manual labor is required by the practice’s staff to make sure data has transferred correctly and to re-categorize data that doesn’t neatly fit into a category in the new system.

In broad terms there are three types of data migrations. The first, migration to a newer generation of an EHR system already in use, is the easiest to complete. If, for example, a practice is upgrading to a newer version of their current EHR system, chances are much of the legacy data could be automatically mapped to the new version. This type of migration can often occur over a weekend with minimal down time and disruption to patient care.

The second type is migration to an EHR of a cooperating vendor. Although migration from one vendor’s EHR system to another’s is more complicated, if the original EHR’s vendor is willing to share information about their data with the new vendor, much of the mapping process can be finalized before the actual migration occurs.

The third, and most difficult, type is migration to an EHR without vendor cooperation. When the vendor of the current EMR system is not willing to share information about how data is stored, the new vendor must figure out how to interpret the data before any mapping can be done – a task made even more challenging when the older EHR system is not able to export data so that it can be read.

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Password Management In Healthcare

Guest post by Dean Wiech, managing director, Tools4ever.

Dean Wiech
Dean Wiech

Passwords are everywhere. Despite the endless headlines about their death and sure destruction in countless publications across the globe, passwords are and will continue to be used in nearly every business setting for the foreseeable future. Whether you’re a physician making the rounds in a hospital, a mechanic at a service garage, a CIO for a major software firm, a bank teller logging into several applications to assist customers or an employee at a manufacturer, chances are better than average that you access these systems with a user name and password.

Organizations of all sizes use credentials for their employees to ensure security of the information in their systems, and to protect against unwanted access to the data in the systems. As with any solution used, once in play there’s bound to be some issues incurred with these passwords. Regardless of how many passwords employees need to remember and how often they need assistance to reset them, passwords remain crucial ingredient to a network’s security protocols.

Passwords: Where We Have Come

The first passwords were created in the 1960s for MIT’s Compatible Time-Sharing System. Passwords were first used because several users needed to access the system as unique entities. Each user created a password, which were then stored on the computer system. However, program leaders soon learned that this method of storage did not work after one user who wanted more time on the computer simply printed out the passwords from the machine and logged in as a different user than himself – since each user was only granted so much time per week under their identity. Thus, program leaders discovered that program needed more secure methods for password usage and storage. This also was likely the first recorded data breach anywhere in the world.

The next phase led to encrypted passwords so that no one could easily go in to steal all of the users’ credentials, as was the case at MIT. Passwords began protecting secure information rather than just taking on a gatekeeper role. As they spread into business and workplaces worldwide, passwords became encryption devices that could not easily be hacked or pilfered.

Finally, millions of organizations began to rely on computers, obviously, for all of their business needs and users needed to enter credentials for each system they needed to access. To easily remember all of these passwords, users began to either user very simple passwords or the same password for each system. Again this became an issue since hackers utilized tools to easily compromise the password and gain access to the systems.

Where We Are Today

Welcome to today. As we know, organizations are overwhelmed by the issue of password breaches. Solution? To mitigate this problem, organizations often require employees to use complex passwords, each unique to the different systems they are using. To say the least, this process has evolved into a difficult mental exercise. According to a recent Tools4ever survey, end users access up to an average of 12 different systems and applications to perform their jobs. Humans are usually only capable of remembering about six complex passwords at the most. The rest get written down or filed on some random Excel sheet on the computer’s desktop. So what are they doing to remember all of their credentials?

Of course this defeats the purpose of the use of complex passwords for security, and often leads to frustration of users who take their anger out on the help desk, which is usually overwhelmed by such problems already. Think customer service is considered quality in these organizations? Usually not when these types of processes are in place.

The problems don’t end there. Employee productivity is cut when they must deal with these types of password maintenance issues. For example, every day in a typical healthcare setting, 91 minutes are wasted because of inefficient systems and workflows. On average, healthcare providers login to workstations and applications 70 times per day and spend an average of only 46 percent of their time on direct patient care.

Think of the great things your teams could do if they didn’t have to worry about logging in and out of workstations as they care for patients. While the data accessed may differ from department to department and facility to facility, what remains the same is the fact that, if multiple passwords and login credentials are in-play, there is a high probability that productivity is being negatively impacted. Providing direct access to systems and tools when and where it’s needed is key.

Password issues can also have a huge effect on your employee’s productivity. Think about how long it takes to resolve an issue when an employee is locked out of their account and needs to get a password reset? They need to contact the helpdesk, start a ticket, request that the helpdesk team resets the password, log in then get back to the work they need to accomplish. All of this is time that is taken away from the project they are working on, or the patient they are supposed to be helping. On the technical side, depending on the size of the organization, password management can require a full-time position at a large organization, since one of the top calls to the helpdesk is for password resets.

Another problem with passwords: all the steps, or “clicks,” and authentication processes some employees need to take just to access their applications. When time is critical, such as in hospitals, or when customer service is a priority, every minute counts and passwords can become a deterrent. If nothing else, they can be a time waster, as the 91 lost minutes suggests.

When these issues start to effect productivity of your employees is when it becomes an issue. So as the password and authentication process has evolved and become increasingly complex, how can organizations easily resolve the issues that have come about?

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Challenges Ahead for Advancing Health IT Outside Hospital Environment

A new study from HIMSS, unveiled today at the 2017 HIMSS Conference & Exhibition, reinforces the positive impact health IT has on the U.S. economy while signaling challenges ahead for the expansion of health IT’s footprint.

Weaving together two historically seminal HIMSS research efforts (the annual HIMSS Leadership Survey and the biennial HIMSS Workforce Study), the new HIMSS Leadership and Workforce Survey report details the health IT priorities of key stakeholder groups and their linkages to various strategic initiatives (e.g. employment of select IT leaders) and economic measures (e.g. workforce projections). In an era of maturing EHR adoption, the study finds health IT leaders continue to report positive market growth metrics. Yet, health IT staffing structures and experiences in provider sites outside the hospital, coupled with their unique clinical IT priorities, point to a need to address the challenges faced by these types of providers in order to propel the sector’s growth.

“Health IT continues to be a bright spot in the U.S. economy,” said Lorren Pettit, vice president, health information systems and research for HIMSS. “Health IT workers continue to see strong demand for their skills, as employers across the provider and vendor/consultant spectrum embrace various health IT strategic initiatives. But the specific hurdles faced by some sectors suggest that the health IT field will need to creatively address its expansion outside the hospital walls.”

Key findings include:

  • Demand for health IT talent leaves employers struggling. The majority of health IT employers (61 percent of vendors/consultants and 43 percent of providers) have positions they are looking to fill. The findings suggest the demand for health IT workers is strong, as evidenced by the fact that only 32 percent of vendors / consultant organizations, and 38 percent of provider organizations, claim they are fully staffed.
  • The majority of health IT employers grew or at least maintained the size of their IT workforce over the past year. 61 percent of vendors/consultants and 42 percent of providers reported IT staffing increases, and the majority of respondents across both groups expect to further increase or hold steady over the next year.
  • IT budgets continue to rise. Although projections are not uniform between the two groups, the majority of providers (56 percent) and vendors/consultants (87 percent) project increases in their IT budgets this year.
  • A significant disconnect exists between providers and vendors/consultants on certain select clinical IT priorities – notably electronic health records (EHRs). Vendors/consultants seem to be “moving on” to other issues, whereas providers appear to be wrestling with how to best leverage their existing EHR investments.
  • However, the stakeholder groups are generally aligned on the biggest priorities facing those leveraging clinical IT, including privacy/security, care coordination, culture of care and population health.

The 2017 Leadership and Workforce Survey reflects the responses of 368 U.S. health IT leaders between late November 2016 and early January 2017. Download the complete report.