In virtually every context that question might be asked, we struggle to give an honest, accurate answer.
It Works If You Believe It Works
Is the medication working? Difficult to say–it may be the placebo effect, it may be counteracted by other medications, or we may be monitoring the wrong indicators to recognize any effect. Is “working” the same as “having an effect,” or must it be the desired effect?
Alternative medicine confounds the balance of expectations and outcomes even further. Right at the intersection of evidenced-based medicine and naturopathy, for instance, we have hyperbaric oxygen therapy, or HBOT. These devices are as much in vogue among emergency departments (to treat embolisms, diabetic foot ulcers, and burns) as holistic dream salesmen (to prevent aging and cure autism, if you believe the hype). When the metric being tracked is as fluid as the visible effects of aging, answering whether the treatment is working is about as subjective as you can get.
As though the science of pharmaceuticals and clinical medicine weren’t confounding enough, you can hardly go anywhere in healthcare today without politics getting added to the mix. In the wake of Trump’s victory in the 2016 presidential election, you have observers and stakeholders asking of the Affordable Care Act (ACA): is it working?
There’s Something Happening Here
It is definitely doing something. It is measurably active in our tax policy, for instance: 2016 returns are heavily influenced by the incremental growth of the ACA’s financial provisions. Of course, the point of this tax policy (depending on who you ask) is to influence behavior. As to this point, there are some signs that, again, something is happening: among young people, ER visits in general are down, while emergency stays due to mental health illness are up. We changed how healthcare is insured, and that changed, in turn, how we access our care. But is it working?
Guest post by Gaby Loria, analyst for mental health software, Software Advice.
There are certain factors clinicians are constantly working to improve at their practices, such as:
While these three P’s apply to every health care provider, regardless of practice size or specialty, they are especially important for independent physicians.
Solo and small practice doctors face more challenges than their counterparts in group-owned or hospital-affiliated organizations. They shoulder all the responsibility for:
Ensuring care quality
Retaining and attracting patients
Paying the office’s overhead costs
Keeping up with shifting regulatory requirements, which some say favor larger providers
For all of these reasons, it’s wise for small practices to invest in health IT tools that can give them an edge in a competitive and increasingly data-driven industry. The three tech trends we describe below can help improve performance, increase profitability and impact productivity without breaking tight budgets.
Improve Performance with Population Health Tools
The goal of managing population health is to achieve measurable improvements in the health outcomes of a group of people. In other words, taking steps to help groups of patients get healthier instead of solely focusing on one individual’s treatment plan at a time.
That may sound like a lot of work, but it’s not—if you have the right IT. Nowadays, there are a number of population health-enabled capabilities that are built into electronic health records (EHR) software systems commonly used by small practices. The breadth and depth of these capabilities vary depending on the system, but here are some examples:
Leveraging an EHR’s reporting module to pinpoint the percentage of prediabetic patients at a practice, then specifically sending those patients information about diet and exercise changes to lower their risk of developing Type 2 diabetes.
Setting targeted, automated appointment reminders to women who have not had a breast cancer screening in more than a year, making them more likely to come in for preventive care.
Using software to generate risk assessments grouping patients by the severity of their chronic conditions. These assessments are based on patients’ digitized clinical records, so it’s easier to identify at-risk patients.
This technology makes it feasible for busy physicians to provide extra attention and care to patient populations that need it most, so they can prevent a worsening condition from developing. Such clinical interventions on a group scale can therefore make it possible to improve the overall health of a practice’s patient base.
Increase Profitability via Telemedicine
Telemedicine is the use of technology to support remote medical services. One of the most lucrative ways small practices can adopt telemedicine is by offering video consultations, which are virtual patient-physician interactions enabled by videoconferencing software. This allows doctors to see more patients per day without adding overhead costs (e.g., office space or staffing).
Interested physicians have two main options to capitalize on this trend:
The first is to get an EHR with integrated videoconferencing capabilities. This is ideal for practices that want to offer telemedicine services to existing patients. Depending on their state laws, they may be able to get reimbursed for these virtual consultations.
Alternatively, doctors can sign up to be a provider for a stand-alone platform (e.g., Teladoc, eVisit and American Well). This is better suited for practices looking to attract new patients. Some platforms charge doctors a monthly subscription fee, while others treat practitioners as independent contractors who get a percentage of whatever the patient pays per visit.
Healthcare jobs are plentiful, and at least through 2024, the demand for healthcare professionals such as nurses, anesthesiologists and physicians will only continue to rise.
The Bureau of Labor Statistics has said that healthcare jobs are “expected to have the fastest employment growth and to add the most jobs between 2014 and 2024.” Given the healthcare industry’s propensity for increased growth, hospitals need to embrace scalable IT—for their own sake and for the sake of their patients.
Fortunately, there are options.
Healthcare organizations increasingly rely on cloud-based IT solutions, and SADA Systems has reported that the number of organizations living in the cloud could be as high as 89 percent. There’s a reason for the high percentage—cloud solutions are safe, scalable, and efficient.
Hospital data safety is no small concern.
In 2008, 9.4 percent of hospitals used EHRs. By 2014, the percentage had skyrocketed to 96.9 percent. The switch to digital records was necessary, but in the rush to modernize, hospitals were left more vulnerable to data theft than other industries that had migrated more slowly.
According to Niam Yaraghi, healthcare systems are left with an additional concern. “Hospitals cannot tolerate the consequences of computer lockdowns,” writes Yaraghi. “If Wal-Mart gets attacked, it will likely shut down for a short period of time and fix the issue…Hospitals on the other hand, are dealing with patients’ lives.”
Further arguments for cloud IT include the sheer number of patients hospitals see every year. Hospitals treat 136.3 million patients in the emergency room alone, according to cdc.gov, and believe it or not, that number is growing. Cloud IT accommodates growing demand seamlessly.
Guest post Ken Perez, vice president of healthcare policy, Omnicell.
On October 14, the Centers for Medicare & Medicaid Services (CMS) released a 2,171-page final rule for the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS had issued a proposed rule on April 27 and in the intervening period, more than 100,000 physicians and other stakeholders attended outreach sessions and CMS received more than 4,000 public comments on the proposed rule, with many of the expressed concerns pertaining to the start date for MACRA’s first performance period.
MACRA’s Quality Payment Program replaces the unpopular sustainable growth rate formula and defines how physicians in physician practices—not hospitals—will be reimbursed by Medicare. It features two alternative, interrelated pathways: the Merit-based Incentive Payment System (MIPS) and advanced alternative payment models (APMs). MIPS is designed for providers in traditional fee-for-service Medicare, while the advanced APMs are for providers who are participating in specific value-based care models, such as accountable care organizations (ACOs).
Small physician practices with less than $30,000 in Medicare charges or that see fewer than 100 Medicare patients per year are exempt from MIPS. According to an analysis by the American Medical Association, 30 percent of physicians are below one or both of these thresholds. In addition, providers new to Medicare in 2017 are also exempt (though just for the first year).
The proposed rule specified Jan. 1, 2017, as the start date for the first performance period under MIPS, which would drive calendar year 2019 payment based on performance in 2017 across the four MIPS categories: Quality, Advancing Care Information, Clinical Practice Improvement Activities, and Cost/Resource Use. The final rule allows providers to start collecting performance data anytime between Jan. 1 and Oct. 2, 2017, with data due to CMS by Mar. 31, 2018.
Under MIPS, physicians can earn in 2019 a payment adjustment that is neutral, up to 4 percent positive, or up to 4 percent negative, depending on their level of participation, the amount of data submitted, and the length of the performance period reported. The adjustment increases to plus or minus 5 percent in 2020, plus or minus 7 percent in 2021, and plus or minus 9 percent in 2022. CMS projects that 592,000 to 642,000 clinicians will submit data for MIPS during the first performance year.
Lee Horner serves as Stratus Video’s president of telemedicine, bringing more than 25 years of experience in enterprise software and healthcare IT industry. Most recently, Horner served as the president of CareCloud, a health care technology company specializing in practice management and EHR software. During that time, his core focus was setting the direction and strategy of the company while managing the top- and bottom-line revenues. He also drove both technology excellence and platform growth to meet CareCloud’s clients’ goals. Prior to CareCloud, Lee also held executive roles at Vitera Healthcare (formerly Sage Healthcare, where I worked with him; now Greenway Health) and Eliza Corporation.
You recently joined Stratus as president of telehealth – what motivated your decision and why is this such an important field nowadays?
In today’s mobile and fast-paced world, telehealth is a necessity. Telehealth is healthcare 2.0 – it can cut wait times, costs for both the provider and the patient, inefficiencies. At the same time it can elevate the kind of expertise and quality of the care patients receive, as well as give new opportunities to connect doctors to the patients who need them most. Telehealth is the future of health. It’s not only preserving that face-to-face connection between patients and providers – which is essential to great healthcare – it’s making that connection available to so many more people in so many different contexts. By enabling these essential connections, telehealth expands the probability of people getting the care they need, and is inevitably helping to save lives.
What is your background in health IT?
I have been involved in healthcare IT for the past 10 years. I have experience operating businesses in the payer, ambulatory and health system markets. It is a great field to be in. It’s very progressive and always changing.
Why is health IT where it’s at today? What do you feel has made this industry successful?
This market is expanding rapidly and technological advancement is at the forefront of that expansion. Smart people with extreme passion for improving patient quality care are really what is making this industry successful.
What are some of the things that most inspire you about the space and it’s work?
I am inspired every time I see the changes we are making improve a patient’s quality of care. It is incredible to see our work start to make a difference.
What are the most important areas in telehealth nowadays?
One important area is how telehealth is opening opportunities for more health industry professionals – and this is in turn, leading to a more robust patient experience. Predictable disruption is a huge theme in telehealth. You saw unpredictable disruption with industries like car ride service – when Uber and other apps came out, people who weren’t taxi drivers were suddenly entering that industry. In healthcare, it’s different – apps are creating opportunities for people already within the industry, allowing more providers to help the patients who need them most and more patients to connect with the providers best suited to their needs.
A couple of other important areas are readmissions and urgent care:
The Affordable Care Act penalizes hospital readmissions, because it’s important to incentivize successful treatment. Unfortunately, the nature of healthcare and the nature of life is that you sometimes need to go back in for continued treatment or to inquire about something. But maybe you moved or you’re too sick to keep going back to your treating physician. Discharge solutions are allowing people to reconnect and get the follow-up care they need without the hassle.
Urgent and emergency care solutions are also becoming really important. Imagine a burn victim walks into an ER at 4 a.m. and needs to see a specialist – but the staff is all tied up or there isn’t a specialist working in that particular facility. Without an urgent care app, the patient would be waiting and suffering, while the provider would be struggling to give them the care they need. With an app, they’d be able to pull up a tablet and connect that patient face-to-face with the doctor they need almost immediately.
About two decades ago who would’ve thought of the invention of Nano robots that are able to carry drugs all the way to the human bloodstream?
It’s happening. Technology is revolutionizing the conventional ‘human country doctor’ health care and there’s not much to be surprised of. With modern machines and software taking over the healthcare industry, one often wonders, “What good is technology doing to it?”
Health information technology (HIT is information technology applied to health and health care. It supports health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors) is the burgeoning specialized combination of information technology, communications, and health care and it is altering the course of patient care for the better. Here’s how:
Practicing medicine is a lifelong learning. Doctors need to be on their toes all the time to acquire the knowledge of the latest developments in their field. Not updating themselves can make their practice stagnant – nobody would want to consult a doctor like that. Health IT brings the knowledge about everything, be it patients, therapies, diseases or medicines at their easy disposal. This knowledge can be easily shared between consultants, patients, and can even be updated when needed. That’s a whole new world of medical science for the doctors and patients to explore.
The world is swiftly moving towards specialization. Healthcare is no different. A single hospital stay could mean being under the observation of several different specialists at the same time. These specialists are required to coordinate with each other on every case they deal with. The way forward is paved by health IT. Health IT helps bring everything related to your condition from nutrition to neural complications in tandem with each other. The specialists know which condition can make regular course of treatment difficult for you or which medicine would trigger your skin allergies. The result? There are fewer chances of problems arising in your healthcare.
The most significant way IT is transforming the healthcare industry is in the form of better outcomes. Automation streamlines the operations of a medical facility, making them more effective and efficient. It is easier for different doctors and nurses to coordinate and diagnose a particular case. There are less chances of human error which ultimately leads to higher quality and safer care. With less time wasted in going through physical files and other manual work, doctors and nurses have more time on their hands to spend with patients.
The Patient’s Involvement
If anything, health IT has made patients increasingly vigilant about their health. It enables them to gain electronic access to their medical history, health records, and doctor’s recommendations. They get a chance to take control of their health. Patients’ portals and online knowledge hubs help patients educate themselves about their conditions, its symptoms and treatment procedures. Health IT makes it easier for patients to get in touch with doctors and nurses for better health outcomes and medical care.
Guest post by Dean Wiech, managing director, Tools4ever.
Identity and access management (IAM) in healthcare continues to be a growing part of the industry. The management of identities, user accounts and access to both data and applications is a large task for hospitals and healthcare organizations. In the healthcare industry especially, the need to follow strict access and security rules and regulations exists, which makes IAM even more challenging. This need has led to newer solutions to meet the needs of healthcare organizations.
Here are the top four account management issues in healthcare that can be significantly improved:
Onboarding of Employees
The first issue that many healthcare organizations face is efficiently onboarding new clinicians and employees. For example, when a new doctor or nurse begins employment, they need their account created, and the correct access to the systems and applications they require in order to assist patients. The issue is, too often, new employees are waiting idle while all of their access and accounts are created.
By streamlining and automating the account management processes, this issue can be improved. Automating the process allows administrators to easily enter new employee’s information into a source system, such as the HRM system and check off which systems the employee needs access to and accounts in; and the new accounts are automatically created.
Changes to Accounts
Next, there is the issue of movement or changes to an employee account throughout their employment. Often, clinicians need to contact their manager to ask for permission for a change to or additional access, who then in turn needs to contact IT or HR to have the change carried out.
IAM software with workflow management capabilities has evolved to assist with this situation. A web portal with workflow can be set up so that employees can easily request changes to their account and then have it securely carried out.
As an example, a nurse moves to a different unit, or floor, and needs access to a different set of data or applications. A nurse can easily request the access through a portal and the request is automatically sent to the correct people for approval. Once the approval is given, the change automatically is made. If the request needs multiple levels of approval, it will move to the next person in line. In addition, all of these changes are logged so that the healthcare organization knows exactly what changes are made, when they were made and who approved them.
Hardly a day goes by without some new revelation of a US IT mess that seems like an endless round of the old radio show joke contest, “Can You Top This”, except increasingly the joke is on us. From nuclear weapons updated with floppy disks to needless medical deaths, many of which are still caused by preventable interoperability communication errors as has been the case for decades.
According to a report released to Congress, the Government Accountability Office (GAO) has found that the US government last year spent 75 percent of its technology budget to maintain aging computers where floppy disks are still used, including one system for US nuclear forces that is more than 50 years old. In a previous GAO report, the news is equally alarming as it impacts the healthcare of millions of American’s and could be the smoking gun in a study from the British Medical Journal citing medical errors as the third leading cause of death in the United States, after heart disease and cancer.
The GAO interoperability report, requested by Congressional leaders, reported on the status of efforts to develop infrastructure that could lead to nationwide interoperability of health information. The report described a variety of efforts being undertaken to facilitate interoperability, but most of the efforts remain “works in progress.” Moreover, in its report, the GAO identified five barriers to interoperability.
Insufficiencies in health data standards
Variation in state privacy rules
Difficulty in accurately matching all the right records to the right patient
The costs involved in achieving the goals
The need for governance and trust among entities to facilitate sharing health information
CMS Pushing for “Plug and Play” Interoperability Tools that Already Exist
Meanwhile in a meeting with the Massachusetts Medical Society, Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services’ (CMS) acknowledges in the CMS interoperability effort “we are not sending a man to the moon.”
“We are actually expecting (healthcare) technology to do the things that it already does for us every day. So there must be other reasons why technology and information aren’t flowing in ways that match patient care,” Slavitt stated. “Partly, I believe some of the reasons are actually due to bad business practices. But, I think some of the technology will improve through the better use of standards and compliance. And I think we’ll make significant progress through the implementation of API’s in the next version of (Electronic Health Records) EHR’s which will spur innovation by allowing for plug and play capability. The private sector has to essentially change or evolve their business practices so that they don’t subvert this intent. If you are a customer of a piece of technology that doesn’t do what you want, it’s time to raise your voice.”
He claims that CMS has “very few higher priorities” other than interoperability. It is also interesting that two different government entities point their fingers at interoperability yet “plug and play” API solutions have been available through middleware integration for years, the same ones that are successfully used in the retail, banking and hospitality industries. As a sign of growing healthcare middleware popularity, Black Book Research, recently named the top ten middleware providers as Zoeticx, HealthMark, Arcadia Healthcare Solutions, Extension Healthcare, Solace Systems, Oracle, Catavolt, Microsoft, SAP and Kidozen.
Medical Errors Third Leading Cause of Death in US
The British Medical Journal recently reported that medical error is the third leading cause of death in the United States, after heart disease and cancer. As such, medical errors should be a top priority for research and resources, say authors Martin Makary, MD, MPH, professor of surgery, and research fellow Michael Daniel, from Johns Hopkins University School of Medicine. However, accurate, transparent information about errors is not captured on death certificates which are the documents the Center for Disease Control and Prevention (CDC) uses for ranking causes of death and setting health priorities. Death certificates depend on International Classification of Diseases (ICD) codes for cause of death, but causes such as human and EHR errors are not recorded on them.
According to the World Health Organization (WHO), 117 countries code their mortality statistics using the ICD system. The authors call for better reporting to help capture the scale of the problem and create strategies for reducing it. “Top-ranked causes of death as reported by the CDC form our country’s research funding and public health priorities,” says Makary in a press release. “Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves. It boils down to people dying from the care that they receive rather than the disease for which they are seeking care.”
The Root Cause of Many Patient Errors
Better coding and reporting is a no-brainer and should be required to get to the bottom of the errors so they can be identified and resolved. However, in addition to not reporting the causes of death, there are other roadblocks leading to this frighteningly sad statistic such as lack of EHR interoperability. Unfortunately, the vast majority of medical devices, EHRs and other healthcare IT components lack interoperability, meaning a built-in or integrated platform that can exchange information across vendors, settings, and device types.
Various systems and equipment are typically purchased from different manufacturers. Each comes with its own proprietary interface technology like the days before the client and server ever met. Moreover, hospitals often must invest in separate systems to pull together all these disparate pieces of technology to feed data from bedside devices to EHR systems, data warehouses, and other applications that aid in clinical decision making, research and analytics. Many bedside devices, especially older ones, don’t even connect and require manual reading and data entry.
Healthcare providers are sometimes forced to mentally take notes on various pieces of information to draw conclusions. This is time consuming and error-prone. This cognitive load, especially in high stress situations, increases the risk of error such as accessing information on the wrong patient, performing the wrong action or placing the wrong order. Because information can be entered into various areas of the EHR, the possibility of duplicating or omitting information arises. Through the EHR, physicians can often be presented with a list of documentation located in different folders that can be many computer screens long and information can be missed.
The nation’s largest health systems employ thousands of people dedicated to dealing with “non-interoperability.” The abundance of proprietary protocols and interfaces that restrict healthcare data exchange takes a huge toll on productivity. In addition to EHR’s physical inability, tactics such as data blocking and hospital IT contracts that prevent data sharing by EHR vendors are also used to prevent interoperability. Healthcare overall has experienced negative productivity in this area over the past decade.
Interoperability will be healthcare IT’s biggest trend in 2016 as the industry finally sees momentous forward movement.
In fact, interoperability is not a new trend. It has been an important mission (and a challenge) for healthcare administrators for decades, but the past couple of years have been game-changing:
First, the U.S. Department of Health and Human Services (HHS) wants interoperability to be a common feature in all EHRs by 2024 so that patient data can be shared across systems to provide better care at a lower cost. Since the 2009 passage of the Health Information Technology for Economic and Clinical Health Act (HITECH), a $30 billion initiative to accelerate EHR adoption, more than 433,000 professionals (95 percent of eligible hospitals and 60 percent of eligible professionals in Medicare and Medicaid programs) have received incentive payments.
Second, the HHS’s ambitious announcement that mandates moving 50 percent of Medicare payments from fee-for-service-based to value-based alternatives by 2018 puts care coordination and interoperability at center stage. This historic initiative is transformational for patient-centered care based on accountability and outcomes and is the first step toward achieving better health overall with lower cost.
Third, there’s been significant industry momentum with more than 40 organizations coming together to work on HL7 FHIR (Fast Healthcare Interoperability Resource), dubbed “Project Argonaut,” an industry-wide effort to create a modern API and data services sharing between the EHR and other healthcare IT systems based on Internet standards and architectural patterns. Project Argonaut began in December 2014 and has made impressive progress. And while still evolving, the recently released Stage 3 meaningful use rules have emphasized interoperability — more than 60 percent of the proposed measures require interoperability, up from 33 percent in Stage 2.
Guest post by Karen Holzberger, vice president and general manager, diagnostic solutions, Nuance Healthcare.
A few years ago, there was a witty car commercial advertising an alert feature that took the guesswork out of filling your tires by gently beeping to signal the appropriate pressure had been reached. It featured a series of vignettes where the car horn would beep, cautioning the owner to reconsider just as he was about to overdo something (for instance, betting all of his money on one roll of the dice). The concept of getting a reminder at the point of a decision is a compelling one, particularly if it can save you time or aggravation and guide you to do the right thing. In healthcare, any technology that can provide that level of support will have a profound impact on patient care.
Albeit humorous, that car commercial wasn’t far off the mark with healthcare challenges. Unnecessary medical imaging exposes patients to additional radiation doses and results in approximately $12 billion wasted each year, but it has also has another unintended downstream effect. It has fueled a culture of medical certainty, where tests are ordered in hopes of shedding light on some of the grey areas of diagnostic imaging, including incidental findings. The reality is that incidental findings are almost always a given, but not always a problem. So how do you know what to test further and what to monitor? And while one radiologist may choose the former option with a patient who has an incidental node finding, another might decide to go with the latter option, so who is right?
Beep! It’s important
It is important that when a radiologist sees a nodule and it has certain characteristics, he or she makes recommendation for follow-up imaging, which is why the American College of Radiology (ACR) has released clinical guidelines on incidental findings. By offering standard clinical decision support on findings covering eleven organs, the ACR is helping radiologists protect their patients through established best practices for diagnostic testing.
The results of having this information at the radiologists’ fingertips are impressive. In fact, studies show that when these clinical guidelines are built into existing workflows, 90 percent of radiologists align with them, as opposed to alternative methods, such as paper print outs, which result in 50 percent concordance.