Guest post by Marti Arvin, vice president of audit strategy, CynergisTek.
The myriad of regulations associated with clinical research can be daunting. In addition to complex regulations, most research entities have the added challenge of coordinating the process across multiple stakeholders that may be spread across different organizations. One way to begin to get a handle on this is to look at integration between the EHR and other systems used in the process. The research enterprise can leverage the availability of electronic systems to the reduce duplicate effort, increase researcher satisfaction and improve compliance.
By integrating the EHR and the clinical trials management system (CTMS), an organization can create a single source of truth, consolidate efforts in teams that have the appropriate expertise and decrease the overall timeline to get a study up and running. A typical research project has multiple processes that must occur for it to get approval from the Institutional Review Board (IRB), gain appropriate funding from the sponsor, and receive any necessary approvals from committees such as biosafety or radiation safety. Traditionally, the researcher has been responsible for assuring all of the necessary approvals have been obtained, the study is appropriately budgeted and all other steps are completed to help ensure compliance, despite the fact that the researcher is the scientific expert on the project, and is often the least experienced in ensuring the study meets all the regulatory requirements.
Creating a process where the CTMS and the EHR are integrated to capture necessary information at both the study initiation phase and throughout the study can help improve the process and ensure all necessary actions are completed.
System integration can offer improved efficiency and effectiveness in a number of areas. This discussion will focus on just two examples: Clinical trial billing and HIPAA compliance.
How can system integration help with these two issues?
Clinical Trial Billing
It is necessary to evaluate the proposed budget for the clinical trial to ensure services which can be legitimately billed to the patient/subject’s third-party insurance are identified as such and services that must be covered by another source are identified– also known as the coverage analysis. The rules around what can be billed to insurance, particularly to Medicare, are complex.
The process requires someone with expertise in not only general billing and coding, but the specifics of the rules in this area and the ability to read a study protocol. The language of the study’s informed consent document is also critical. The wrong wording in the informed consent can render a service otherwise billable to third-party insurance non-billable, meaning the cost of the service must be covered by another source and makes the initial coverage analysis extremely important. Equally important is a process to ensure the services are in fact billed in the manner anticipated by the original budget and coverage analysis. This helps ensure the organization does not submit a potential false claim by billing insurance when the study should be covering the cost.
By integrating the systems (CTMS, EHR), a process can be developed to trigger certain steps to happen contemporaneously. The researcher’s initial submission to the IRB system can trigger an alert that the study needs to be established in the CTMS. The establishment of the study in the CTMS then triggers the initiation of the process to develop a coverage analysis. The development of the coverage analysis can be built in to the CTMS so that all services provide to the participant are identified on a structured calendar with the corresponding payer source identified.
Have you ever thought how giant enterprises like Facebook, Google and Microsoft have harnessed big data technology so spectacularly well? These consumer-centric industries are continuing to succeed at a global level. Do you know what they all have in common? APIs.
Short for “application programming interfaces,” APIs are like connectors that allow you to access information on your application or software. It’s basically how two softwares talk. APIs are the not-so new big thing in the tech sphere and to make a headway into delivering top-notch quality care, it’s high time we embraced them for a better tomorrow.
Constraints in healthcare today
Given the complex nature of modern day healthcare data exchange, providers are themselves held back from tapping the full potential of the available data and utilizing it to drive the best possible outcomes.
Problems arise in the very initial steps of care delivery. Accessing or exchanging the medical information of any patient who reaches a facility is a most basic requirement that should be fulfilled at the very outset of care. But, the slow and long-drawn fragmented process of data exchange, siloed nature of data sets and lack of interoperability hinders a smooth transfer of information from one provider to another.
How then is it possible to carry out comprehensive care for a patient with only partial information about the patient? How about if, the traditional and complex process of data exchange were to be replaced with a simpler, easier and faster technology.
In a world where API is a reality, sluggish data integration and exchange ought to be passé.
Simple, modular and interactive
These efficient little elves (techie companies prefer to call them APIs) make things way simpler on the surface — quite literally! While using a low-maintenance infrastructure and only a few lines of code, these elves will open that door for you to be able to engage and interact with your patients at large.
Why should healthcare take to APIs?
Sweeping changes and new data sources are continually making their way into healthcare and with that there is an ever-growing need among healthcare organizations to share information. Patients, as they become aware of their health status, too are demanding greater access to their health information. Below are some pointers laying out why APIs are a better alternative than existing means like static databases for exchanging health data:
It saves time and resources.
Data is exchanged in real-time at faster pace.
Its processing is autonomous and easy to manage.
It makes information readily available on all devices, mobile or immobile.
It allows for very little delay in receiving or extracting information.
It facilitates seamless and secure data sharing.
Keeping technicalities aside, let me tell you that standardization is simpler with APIs and that is a huge plus point because it’s easier to process information when everyone speaks the same language. True, EMRs also work through APIs, however, open APIs can enable you to use whatever type of data on whichever device. Wouldn’t it be great if you could have your lab results and prescriptions appear on your phone, your vitals clear on the screen and your appointments listed on your calendar? APIs enable this and a lot more.
All that’s great. But what’s in it for the providers?
By bringing APIs into the fold, providers can make use of interfaces that are uniquely designed for their systems, helping them attain better clinical decision making.
They can use APIs to build their own custom apps and can have vital information about health conditions, medications, surgeries, and other details for use in their own applications or platforms.
Guest post by Joanna Gorovoy, senior director product and solutions marketing, Axway.
Healthcare organizations need to unlock the value of their data In 2018, the healthcare industry will accelerate its shift toward value-based healthcare as the industry struggles to address challenges associated with rising cost burdens, an explosion of data and increased mobility. Along with evolving government policy, organizations across the healthcare ecosystem will face a rise in healthcare consumerism as patients bear more risk, face higher out of pocket costs, and demand more value.
Unlocking the value of a wealth of patient data will be key to improving patient engagement, delivering more personalized healthcare products and services, and improving collaboration and care coordination across the patient journey – all critical to enabling value-based care delivery and improving outcomes.
In 2018 AI goes from science fiction to reality in healthcare Population health and precision medicine are among the initiatives where AI is expected to have the greatest impact. Based on a recent HIMSS study: About 35 percent of healthcare organizations plan to leverage artificial intelligence within two years — and more than half intend to do so within five. Focusing AI investments on population health, clinical decision support, patient diagnosis and precision medicine supports the industry shift toward value-based, personalized care models and reinforces the use of AI to augment intelligence and skills of physicians and drive efficiency in diagnosis and treatment.
Some current use cases include: Enhancing speed and accuracy of diagnosis medical imaging, supporting surgeon workflow and decision-making during (e.g. spine implants), virtual assistants to enhance interactions between patients and caregivers to improve the customer experience and reduce physician burnout, and digital verification of insurance and claims information.
One ageless trend emerging for 2018 is the quest of hospitals, larger carriers and clinics to identify new revenue streams; not just managing revenue cycles, but creating them. The healthcare industry is now looking at revenue which can be generated through the interoperability of annual wellness visits (AWV), chronic care and service care transitions between physical and behavioral health services. Hospital systems and other healthcare facilities that can connect these services with technologies such as bi-directional information flow will benefit by offering these services and creating a new profit centers of revenue through reimbursements by CMS and private insurers.
These types of market drivers are noted in The Global Healthcare Revenue Cycle Management (RCM) Software Market report for 2017-2021, issued a few months ago. The report predicts that the global healthcare revenue cycle management (RCM) software market will grow at a CAGR of 4.50 percent during the period through 2021.
Healthcare service providers deploy automated systems to address RCM processes and to fill the payment gap that arises from the processes of medical billing and collections. However, the report points out IT applications such as hospital information system and EHR have outdated technology platforms that lack advanced functionalities needed to address RCM issues, causing hospitals and health systems to prefer to outsource these services due to the lack of interoperability between revenue cycle processes and workflows. This type of outsourcing drains hospital revenue.
Meanwhile, global business researcher Radiant Insights issued a study in November reporting that the healthcare information technology market will have growth through 2022 of close to $50 billion. Factors such as increasing focus on improving quality of care and clinical outcomes, rising need to reduce healthcare costs and minimize errors in medical facilities, along with government support for healthcare IT solutions will drive the market. Increasing adoption of technologically advanced software solutions including EHR and EHR connectivity systems, e-prescribing and clinical trial management software and clinical decision support systems is helping to improve healthcare productivity.
The study also cited the growth of cloud computing in the healthcare industry is improving real-time communication and data exchange. Interoperable systems and cloud computing are integrating healthcare systems at a rapid pace and are identifying infectious diseases and tracking the incidence as well as occurrence rates of chronic diseases.
Radiant Insights points to up-and-coming organizations such as Zoeticx, Inc., a provider of medical software, that has introduced a cloud app called ProVizion Wellness. This software can be beneficial for streamlining data integration for annual wellness visits by offering interoperability through bi-directional data flow. Hospitals and other healthcare facilities are benefiting by providing this service through private and government insurers. This system provides management capabilities for supporting tracking ability on population progress for AWVs. The report also mentioned prominent players operating in the healthcare information technology (IT) market include 3M Health Information Systems, Lexmark Healthcare, Conifer Health Solutions, and CSI Healthcare.
The Chemistry of Linking Unrelated Hospital IT Landscapes to Revenue
As the hospital revenue trend for 2018 looks promising, we are still facing the same old interoperability issues despite the advances in technology pointed out in the previously mentioned research. What can hospitals and clinics do to be a revenue leader? As we move into 2018, it might be a good time to examine what is necessary to solve a complex problem like the ability of hospitals to link interoperability and the benefits that arise from adopting tools, technologies and concepts from unrelated landscapes.
When we look at the value generated in healthcare, we remain enamored with acute care administration to address patients’ concerns with a new illness or exacerbation of a chronic condition. One of the stated goals of widespread EHR adoption was to assist in this aspect of care. EHRs are being used to capture patient data, as well as to label and extract detailed metrics in an attempt to quantify the amount and quality of the care delivered, irrespective of the geographic and temporal boundaries of where the data was captured. The design of EHR’s is to allow for capture and subsequent analysis and billing for the care delivered.
However, the value of health IT lies in the robustness of applications. This might seem obvious since most of the technology we have direct experience with relies on the applications which drive value such as cloud based assets. For hospitals, investing in an application seems more prudent then investing in a protocol. However, by looking at the problems faced in healthcare, changing the perspective of the problem from an application-centric one to that of a protocol-centric view brings new revenue possibilities.
Guest post by Marie Murphy, managing director of health solutions, CTG.
Since the inception of meaningful use in 2011, healthcare organizations have been implementing technology designed to help protect and improve the quality, safety, and efficiency of patient data. Three years after the launch of meaningful use, organizations that claimed to reach Stage 2 were given patient portal requirements to help achieve the Institute for Healthcare Improvement’s Triple Aim Initiative: To improve the patient experience of care, improve population health, and reduce the per capita cost of healthcare.
The premise behind the Triple Aim was that if patients had better access to information about their health, along with the ability to schedule appointments and better communicate with their providers, their satisfaction and outcomes, and thus costs, would improve. While 90 percent of hospitals offer portals as a result of the requirements, actual usage by patients is stagnant, reaching a meager 15 percent. Understandably, healthcare providers are frustrated by this, and as a result of their frustration have become intent on showing the symbiotic benefits of these patient portals.
Ironically, higher performing organizations, like Kaiser Permanente, have reported much higher rates of patient portal use—upwards of 45 percent adoption by patients in some cases. This supports the case for the patient portal by demonstrating its direct correlation to satisfying Triple Aim initiatives, yet healthcare organizations still struggle to engage their patients. For many organizations, limited functionality and the use of multiple portals with multiple log-in requirements from the same hospital system are a big barrier to patient adoption. To encourage portal usage, healthcare organizations need to address the root of the problem – selecting the wrong patient portal for your organization.
Here are five keys to selecting a patient portal solution that will encourage adoption and help healthcare organizations achieve the Triple Aim:
Looking back at 2017, we see some of the same significant trends that have been gaining momentum, along with a few newcomers. Together, these top-five trends will impact hospital medicine in 2018 in both traditional and unexpected ways.
Growth Despite Reimbursement Parity Confusion
The telemedicine industry’s growth continues rapidly despite the widespread confusion over reimbursement for telemed services from state to state. Why? Because most hospital leaders understand they face far more significant costs from the lack of proper physician and specialist coverage than they ever would by a less-than-optimal reimbursement rate for telehealth. A teleneurologist consult in the ED might be reimbursed at a lower rate than an in-person visit with an onsite neurologist, but keeping the stroke patient in the hospital could mean a $10,000 DRG reimbursement that the hospital would lose if the patient had to be shipped to a tertiary referral center for treatment. Which is the smarter investment? And more importantly, which scenario better serves the patient?
Expansion into New Types of Inpatient Settings
As micro-hospitals and long-term acute care hospitals (LTACHs) grow, they are looking for single-source providers of solutions, with one point of contact, one operating system, and one set of tools and processes. Telemedicine fits their models very well, helping them avoid contracting with a wide array of specialists to meet their patients’ needs. Micro-hospitals are already established in 19 states, and LTACHs are growing since a federal moratorium prohibiting their expansion expired on Sept. 30, 2017. Being able to access a variety of specialists via telemedicine, depending on the needs of patients on any day, is something these facilities need in order to fulfill their commitment to the communities they serve.
Increasing Use of Telemedicine in Metropolitan Hospitals
Rural hospitals have long been a sweet spot for telemedicine. The physician shortage is certainly more acute in rural areas as community hospitals struggle to recruit physicians, keep beds filled and, in many cases, stay solvent. Recently, however, more metropolitan hospitals have seen the advantage of telemedicine in two key areas. When cross-coverage calls are handled by telemedicine teams, it takes considerable pressure off night hospitalists who may already be overwhelmed with admissions, and yet their phones are ringing constantly with requests to respond to patient issues on the floor.
By the same token, telemedicine offers “surge protection,” providing assistance with patient admissions during ED bottlenecks, and cost-effective relief from hospitalist overload.
Virtual Partners for Solo Specialists
Individual specialists in pulmonology, cardiology, nephrology, and other areas might be on call with a local hospital 24/7/365, with no backup for nights, weekends, holidays, or vacations. Telemedicine specialists share coverage with these physicians—individuals and small practices alike—to help ease the demands on them. For example, a community hospital has a local cardiologist on call 15 days a month, and a telecardiology team on call the other 15 days of the month. This is just one real-life example we’ve seen as hospitals find new ways to meet the challenges of another trend that just keeps growing: physician burnout, coupled with a greater value placed on work-life balance than in generations past.
The revenue cycle management (RCM) process is one of the most vital parts of an efficient and functional healthcare entity. The vitality of this process to the healthcare industry as a whole cannot be understated, and it continues to grow with each passing year. In fact, it is predicted that the RCM market will reach more than $43 billion by 2022, underlining the increasing importance RCM has for healthcare providers. By offering the process by which healthcare providers receive reimbursement for their services from insurance providers, proper RCM can be the difference between sinking and swimming for healthcare facilities.
In understanding the facets that go into an effective RCM process, it’s important to note the key factors that successful RCM processes tend to share. These fundamentals all contribute toward creating an RCM process that brings the best results for healthcare facilities while minimizing their pain points and streamlining the experience for patients. Healthcare providers would do well to examine their RCM processes closely and determine whether or not these key fundamentals exist within their systems. If not, they may need to take a stark look at their processes and make significant changes if they are to have any hope of functioning at optimal efficacy.
For example, high accuracy is one of the most vital features of a successful RCM process. Without high accuracy, the data healthcare providers use to optimize their processes may be lacking, leaving them open to making serious errors in judgment. In turn, creating a domino effect that can have catastrophic effects on the rest of their RCM framework. Successful RCM processes also must incorporate a physician advisory module or component that can provide physicians with the resources from which they can navigate the regulatory environment with better success and ease. This can reduce obstacles that are encountered commonly with regards to legal requirements — in effect, streamlining the entire RCM process.
The below infographic from R1 RCM outlines these and the many other aspects that go into creating a successful RCM process for healthcare providers. Understanding these key components only becomes more important all the time. Meaning, there’s no excuse for not getting started on building a better RCM process today.
One of the largest barriers of delivering mental healthcare is the critical shortage of mental health professionals across the country, despite the significant prevalence and impact of mental health conditions. The National Alliance on Mental Illness and the National Institute of Mental Health report that 1 in 5 Americans live with a mental health condition and more than half of American adults with mental illness did not receive treatment in 2016. The U.S. Health Resources and Services Administration estimates an additional 70,000 mental healthcare providers are needed by 2025 to meet the expected growth in demand. In Chicago alone, patients may wait upwards of 10 months for a psychiatrist appointment.
Timely and quality behavioral healthcare is essential for improving patient mental health outcomes and increasing provider satisfaction. Telehealth is emerging as a viable approach to traditional on-site care methods, as it can rapidly improve the delivery of care by effectively addressing patient needs while reconciling the workforce gap. Specifically, telehealth can allow for immediate consultation (especially crucial in time-sensitive situations), increased treatment capacity and collaboration across the continuum of care, and improved outcomes (especially by allowing patients to receive care in the comfort of their own home).
Increased Access to Care In a given year, approximately one in 25 adults in the U.S. experiences a serious mental illness that substantially interferes with, or limits, one or more major life activities according to the National Institute of Mental Health. The American Journal of Psychiatry reported that untreated mental illness is estimated to cost approximately $100 billion annually in lost productivity.
Patients can benefit from providers who use video-based technology to conduct “virtual consults” when providing an initial diagnosis, as well as making recommendations for admission, treatment, transfer, or discharge. Additionally, for ongoing treatment, video offers patients a way to participate in ongoing care and support via “virtual visits” with mental healthcare providers. Convenient access to care can help patients who may avoid seeking initial mental healthcare and/or ongoing treatment as some patients may unfortunately avoid visiting a nearby mental health clinic or provider for a needed diagnosis if they are wary of public recognition and social disapproval. Patients might also not adhere to scheduled follow-up appointments if visits to these “known” mental health clinics in one’s community are required. With telehealth, patients can remain comfortably at home and confidentially receive the care they need.
Patient monitoring systems have long sounded off at the first sign of trouble, giving doctors and nurses the opportunity to divert their attention to the most serious medical situations. Generally, a series of alarms and chimes would sound off and give medical professionals an indication that a patient was having a medical emergency.
Today’s clinical alerting systems monitor much more than heart rate. In addition, they don’t just make sounds that can be heard by everyone within earshot. Clinical alerting systems are now more precise, with patient status indications being sent directly to the handheld communication devices carried by nurses and doctors. Here is a look into how patient monitoring systems have improved and the ways in which hospital workers are communicating more precisely.
Medical Alerts Issued Faster
In many emergency room settings, the steady sound of beeps, chimes, alarms and whistles goes off every other second. Some sounds indicate that everything is all right with a patient while others can give doctors and nurses legitimate cause for concern. Sometimes a critical care alarm can go unnoticed, especially if there is another emergency going on nearby. Newer clinical alerting systems have a smaller margin of error as they operate totally differently.
Direct Patient Emergency Warnings
The main nurse station at hospitals can be empty if there are multiple patients that need specialized care simultaneously. In other words, patient calls and even clinical alerts can go unnoticed if a healthcare center is operating on an outdated system. Beepers and pagers might help doctors on call to know when to go to the hospital, but more precise forms of communication are necessary for healthcare professionals who are working on the front lines. All it takes is the right setup for a healthcare provider to get information faster and in a more direct manner.
Reduced Emergency Care Response Times
When a patient in a hospital suddenly flatlines, medical professionals only have a few moments to turn the situation around to preserve life. While there may be several emergency care nurses in close proximity, they have to alert the doctor on call while working to save the patient who needs critical care. Modern patient monitoring and alert systems cut down on the amount of work that first responders must do to communicate. This has led to reduced response times as well as overall loss of life.
The reason why many hospitals or medical practices fail to integrate the EHR system effectively is that they have not gone for in-depth healthcare workflow analysis before implementing the EHR tool. Healthcare workflow analysis helps hospitals and medical centers to find out areas where health IT solutions can help in increasing the efficiency of performance.
It is important to design an EHR which smoothly fits into the workflow pattern of the medical establishment. The same EHR model does not work for every medical center. This is where healthcare workflow analysis techniques come in useful in designing the best EHR system for the medical facility.
Here are some steps that need to be followed during the healthcare workflow analysis in order to implement the EHR system perfectly:
Mapping of processes
This is the first thing that needs to be done while carrying out healthcare workflow analysis. The core processes that usually take place with regard to individual patients and which need to be analyzed in detail are as follows:
Scheduling: When a person first approaches a medical center, an appointment is fixed. The medical center receives multiple appointment requests every day and all these appointments need to be properly recorded in schedule calendars. Fact sheets are prepared to record the number of patients that the medical center receives during a particular time period. The scheduling process also includes alerts. Both the patient and the doctor should receive alerts about the upcoming appointment in order to be ready for it.
Patient visit: When the patient comes to the appointment, the doctor conducts a medical evaluation. The general checkup is followed by a psych evaluation. After the evaluation process is over, the doctor carries out the diagnosis process. Every step needs to be recorded so that progress notes can be made and the doctor can charge the patient accordingly.
Patient admission: After the diagnosis process is over; the patient gets admitted into the medical facility on the recommendation of the doctor. The enrollment process requires the signing of various forms so that the medical facility gets all the details about the patient.
Treatment process: Once the patient is admitted into the facility, the doctor makes a treatment plan. Either individual therapy or group therapy is provided along with medication management so that the patient can recover as soon as possible.
Discharge from the hospital: When the treatment process comes to an end, the patient is discharged on the date suggested by the doctor. A discharge plan is made and lots of reports are generated in order to record the treatment process of the patient in detail.