His track record on other issues notwithstanding, Trump might be excused for not knowing that American medicine is a bizarro-world where the good intentions of outsiders and insiders alike transmogrify into destruction, disruption, and bureaucratic chaos.
Big Business That Depends on Regulation
In a world where insurance wasn’t a prerequisite for accessing almost any care, and the free market actually was the primary force in driving patient and provider behaviors, broad strokes deregulation might work.
But in America’s healthcare system, “access” isn’t access. Rather, having a payer on board who will cover drugs, treatment, and providers is “access.” Simply knowing that a new wonder-drug exists doesn’t help people who need it. Steamrolling the FDA so that drugmakers can offer the drug on the open market, it should come as no surprise, also helps no one in particular. Because payers–insurers–look to the FDA for evidence of a drug’s value and clinical efficacy (rather than, say, patients desperate for a cure or drugmakers looking to cash in), disrupting the approval process serves also to disrupt payer confidence.
In other words, without the FDA’s lengthy, cumbersome, and expensive approval process, payers will be shy to cover new drugs–and thereby enable patients to access them. Drugmakers, by extension, would rather not face the uncertainty of what payers, providers, and patients might decide to do with new drugs absent the structured system of insurers taking their cues from the FDA, and thereby driving the behavior of the rest of the system.
To be fair, the FDA and its system for testing and approving new medications and devices has flaws. An overreliance on drugmakers’ own data, rather than independent research, sometimes leads to a lack of rigor and poor follow-up allowing unsafe drugs and devices to slip through to market only to be proven faulty by consumers, rather than regulators. A lack of clarity in its labeling requirements creates onerous demands on manufacturers and retailers, yet provides little to no benefit to the very consumers it is supposed to help protect and inform. There is no shortage of ways in which the FDA and its operations could be improved.
But Trump’s approach to the FDA treats the organization like a Gordian knot — something more easily cut through than carefully managed — with predictably mixed and messy results. He isn’t entirely wrong that there are problems to be solved, but his approach also isn’t graceful or nuanced. More than that, though, it makes the mistake so ubiquitous in business and leadership today, of relying too much on generously vague terms like “innovation” and the amorphous power of “science” at large to provide cures not just for injury and illness, but all of society’s woes.
When Will Science Save Us
In a tech-obsessed period of American life, the instinct–apparently shared from the Trump White House on down through to developers and plenty of consumers and patients–is to rely more on automation and digital systems like EHRs to facilitate the spread of knowledge, best practices, and to capture performance and quality metrics. But overcoming both the imperfections of the FDA as well as the habits of practicing clinicians may still fall to the humans of the medical profession, rather than to their tools and tech.
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.
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.
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.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
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!
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.
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.
By Tom Gordon, senior vice president and chief information officer, Virtua.
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:
46 percent of bookings done via mobile allowing patients to book appointments with a digital medium of their choice.
44 percent of bookings are after-hours providing 24/7 access to patients at a time that is convenient for them.
48 percent of appointments are booked within same day or next day allowing for immediate appointments for urgent care.
Guest post by Andy Ridinger, director of client experience, MyHealthDirect.
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.
Shifting from one electronic health record (EHR) system to another can be a highly disruptive and anxiety-filled process for a health system. Often, among the largest obstacles encountered is the need to migrate legacy EHR data between the old and new EHR systems. But a good understanding of this data migration process — and a strong technology vendor relationship — can help overcome this challenge and lead to a successful EHR transition.
There can be many reasons for a health system to transition between EHR systems. The original EHR system could be missing key features, or it might have reached its end-of-life, or perhaps it is not certified to meet evolving meaningful use requirements. The old EHR may not have kept up with new population management requirements on health systems, such as the need for more support for value-based care models. Whatever the reason, all health systems will want to find a solution that not only meets their projected operational and patient care needs, but which also minimizes disruption to the health system during the transition.
Conceptually, most EHRs capture the same types of information. However, when early (and still market-dominant) EHRs were first introduced, there were very few mature medical content standards, even for important categories of medical content, like diagnoses, lab results, medications and allergies. As a result, many of these early systems created their own proprietary terminology. When current standards (as incorporated into Unified Medical Language System – UMLS) began to coalesce, these early EHR systems typically struggled to migrate to the new terminology standards. Often this resulted in vast corpuses of legacy/non-standard historical patient chart data remaining in the EHR. Understanding and mapping this blend of standard and proprietary legacy data, for the purpose of coalescing each patient’s history into a new EHR, can be a tremendous challenge. Trying to fully automate this mapping process with a high level of accuracy and with larger patient volumes is a still greater challenge.
To give a specific example of this mapping problem, an older EHR may have a patient listed as having a “seafood allergy.” In meaningful use certified EHRs today, that “seafood allergy” description as such might not exist; that patient’s allergy entry would need to be accurately translated & codified into a new standardized term, perhaps referencing a either a specific shellfish allergy, or perhaps for any number of non-shellfish seafood allergies. Trying to faithfully automate terminology mapping decisions like this when there isn’t enough information to make an accurate determination can be nearly impossible. Yet not properly translating and mapping this allergy means the new EHR cannot properly use this information to trigger important patient safety system alerts (e.g., a drug-allergy interaction alert). Further, without accurate translation & coding, the new EHR will not be able to properly transfer this important part of a patient’s record to another healthcare system, like a patient portal, a clinical decision support service, an HIE, or another EHR.
In my experience, it is possible to identify three types of data migrations.
The first type of migration involves shifting to a newer version of the same product, perhaps running on a new technology platform. This type of data migration will typically allow the most comprehensive transfer of data with the least amount of disruption.
Another type of migration involves switching to a new EHR from another vendor, but with the aid of a cooperating & generally supportive EHR 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 structure and ontology with the new vendor, it will typically ensure access to a larger subset of key data elements are and more reliable data mapping. Look for established migration pathways, since EHR-to-EHR migration processes often improve each time they occur. This class of migration is often suggested by an older EHR vendor when they decide to sunset or end-of-life an EHR product.
Finally, the most difficult type of migration, involves a move to an EHR with very limited inter-vendor cooperation. This also happens to be the most common type of migration, especially when a health system chooses to migrate to an EHR vendor’s competitor’s EHR. The vendor of the current EMH system is often not willing to share more than the legally-required level of information, so the new vendor must rely on either a proprietary data extract or a batch of patient CCDA files (CCDA is an export format for patient summary data, which all EHR vendors must supply.). In either case, these patient data extracts will then need to be manually loaded, reviewed, and electronically (or manually!) reconciled for every patient chart.
Health systems planning this third type of migration should allot many additional months to work with the new vendor’s IT staff as they determine how to transform and load the old EHR’s patient data. Further, the health system must be aware that the transition will require a much higher investment of staff time for the data to be cleaned up and reconciled. This type of transition can take months or even years to complete.
If upgrading to a newer version of a current is not a viable option, a health system should follow these general guidelines for a successful transition to a new system:
Find an experienced vendor partner.
In addition to finding an EHR system that meets your health system’s operational/functional needs, try to find a vendor partner with experience migrating data from your current EHR vendor.
Focus on your staff workflows.
The new EHR will not do everything the same way as the old EHR. Your goal is to ensure new EHR vendor understands and supports the various workflows in your health system: billing, scheduling, pharmacist, physicians, etc. Ensure the new system can load enough data from your old system that the impact to your staff’s workflows will be tolerable.
Create an internal implementation team with a blended skill set.
The best EHR transitions occur in health systems that assemble an internal team with members representing all disciplines & workflows within the organization. This transition team will typically:
Guest post by Dean Wiech, managing director, Tools4ever.
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?