Guest post by Mark Ott, vice president of product, RoundingWell.
As 2016 unfolds, the move from fee-for-service to value-based care is entering a more advanced stage. As the process evolves, priorities for healthcare providers of resources, teams and tools becomes more convoluted. To keep on track, both for healthcare organizations and CMS changes, providers should keep in mind the following:
The care management/coordination record rises in importance, especially as team-based care models expand
Some call it a care management medical record and others call it a care coordination record. Regardless of the term, the concept is essentially the same. EHRs are basically encounter management systems, but as care expands beyond the in-person encounter, capturing and tracking what happens between patient visits will be of utmost importance. In addition, enabling care teams to stay on the same page about a patient’s care plan, track action steps, and reduce the friction of working together will be crucial to succeeding in a value-based world. Expect to see the Care Management Record concept start catching fire in 2016.
Demand will increase for consumer-grade user experiences in healthcare enterprise software
For so long, clinicians on the frontlines of care delivery have had to struggle with software that’s hard to use, difficult and downright frustrating. The biggest culprit for poor user experiences in healthcare software has to do with the enterprise purchasing process. Vendors build for buyers, like the C-suite, who aren’t also the end users. If the end user and the buyer were the same, you’d see healthcare software vendors value user experience like what we see in other B2B industries, not to mention B2C industries. Regardless, in 2016 we will see more buyers value products with consumer-grade user experiences. Much of this has to do with end users’ reluctance and sometimes outright resistance to adopting technology in their worklife. Clinicians often get a bad wrap for being technology averse. But in reality, it’s not that they’re averse to technology; it’s that they’re averse to bad technology.
Integrating wearables and their data into care delivery processes will remain a niche activity
The enthusiasm around wearables, trackers and remote monitoring is exciting and there is enormous potential for device data to impact the delivery of care in ways that benefit both patient and provider. But the technology hasn’t caught up with the promise of what they can be, and that won’t change in 2016. Not only is the technology not yet able to deliver, but the incentives and processes to support wide-scale deployment are not in place yet. Though all signs point to wearables becoming an integral part of delivery of care, this won’t happen next year.
Telemedicine technologies are evolving rapidly, enabling better care, greater patient access and the promise of bending the healthcare cost curve. Telemedicine has evolved dramatically over the past few years, and providers have come to realize the profound ways in which it can improve patient care. With this evolution has also come the increasing sophistication of telemedicine practitioners. Doctors, nurses and administrators now desire easier integration, clinical adaptability and configurability, support for multiple specialties on a single comprehensive platform, and robust data collection and analytics.
REACH Health, a leading provider of enterprise telemedicine solutions, has identified five key technology trends for the coming year, each promising benefits for providers and patients. These trends for 2016 include:
Obsolescence of Proprietary Hardware and Networks: Although proprietary hardware and networks were standard in the early generations of telemedicine technology, healthcare providers now desire affordable, flexible solutions. Effective telemedicine programs are increasingly powered by off-the-shelf PC components, standard, low-cost cameras and emerging networking standards such as WebRTC. These open, standardized products allow providers to choose the most appropriate end-point for the clinical need; whether it be a high performance cart, a PC or a mobile device such as an iPad, Android or Surface tablet. Providers also now increasingly seek specialty-specific telemedicine software applications that are deployable across these commodity hardware devices using open networks.
The Rise of the Software Platform: Healthcare systems now seek enterprise-wide telemedicine solutions that can be scaled to support multiple service lines and a variety of delivery models, all on one common platform. Just as single-function “dumb phones” have been rendered obsolete by multi-purpose “smart phones,” providers want a single platform to accommodate all their telemedicine needs. They expect a simple, effective solution that supports varied telemedicine requirements across the continuum of care and works wherever it is needed, on a variety of devices. These platforms must also be designed with an open architecture, providing the ease of plug-and-play connectivity with specialized, interoperable components such as high quality peripherals.
As the excitement of the festivities continued to roil on in Chicago for the annual Healthcare Information and Management Systems Society (HIMSS) conference, and as health systems leaders merged with colleagues and partners for what is health IT’s biggest event of the year, I was not among those in attendance. As the conference opened and buzz at the show began to swell, excitement for news and new developments flowed from nearly every available channel, I was back home, far from the excitement of the show or its announcements, developments and news makers.
As health system leaders and their technology partners discussed how their solutions could make care better, engage patients more effectively and lead to better outcomes, greater efficiencies and higher quality care, my wife and I were in the center of the care universe in the heart of our local hospital where I was helping her through the delivery of our second child. Though the process was relatively straight forward and was done very quickly, the experience made me realize several things about healthcare technology from the patient’s perspective.
The first thing is that no matter how important we claim the technology used in the care setting to be, it matters little to those receiving care. For those receiving care, they want and need a seamless process where they have immediate access, without a wall of technology between them, to their care providers whether that’s a nurse, physician or some other support personnel. Patients, at the point of care, don’t want to face the burdens of interacting with the technology their caregivers are concerned with, but we as patients want their full attention. If patients must break through a fourth wall of technology, as I’ve seen to be the case on more than one occasion, the care staff, and more importantly, the health system, has failed the patient.
Secondly, patient engagement is more than a portal or access to one. And while patient engagement means different things to different provider types – like ambulatory vs. in-patient –the patient is still at the heart of the care, not the technology. Those who believe that technology can solve the patient engagement ills are wrong, and likely are failing to truly engage patients because they believe the myth that it can. Perhaps meaningful use has bastardized the term “patient engagement,” but it’s a sad thing when the entirety of that conversation centers around some form of technology or device. The irony of an event like HIMSS, where most of health’s relevant vendors clamor to meet with health system leaders, is that the buzz is built to surround the movement of the patient. The patient is at the heart of care, not technology or some bolt-on software solution.
We, patients, have been at the heart of care since the existence of healthcare; technology is an infant at play here. Let’s not forget that.
Two big communicable disease scares—Ebola and measles—gripped the attention of the general public recently. They did so with enough strength that the average person on the street spoke out and demanded that actions be taken to protect themselves and families. It was virulent on social media. The total count of Ebola deaths at the end of last year was 5,021 worldwide. The CDC reported 10 Ebola cases treated in the U.S. and two patients died as of January 2015. There were 121 total measles cases in the U.S. this year in 17 states. All but 18 of the measles cases were because of an outbreak that spread from Disneyland in California.
What is remarkable is that these two infectious diseases affected a total of less than 200 people across the nation. Yet it triggered a vigorous response from masses of people who were afraid that they could contract Ebola when the actual chances were significantly lower than dying from a lightening strike. The spread of measles among children erupted into online wars between the vaccinated and unvaccinated.
Contrast this with the lack of concern over the flu vaccine’s low effectiveness against this year’s virus, which the CDC estimates kill 3,300 to 49,000 people in the U.S. every year. Warnings from the CDC that the flu strain this year is worse and getting the flu shot will at least temper the illness seems to have had little effect on increasing vaccinations.
Ebola attracted the public’s attention with such obsessive coverage that the public expected exposed individuals to be quarantined even though an individual had no symptoms to indicate a contagious state. More importantly, contact with fluids of an infected person is necessary to become infected. Contrast this with measles where the air and surfaces an infected person has coughed or sneezed remain contaminated for up to two hours. Measles is contagious up to four days before the telltale rash appears. According to the CDC, about one in every 1,000 children who contract measles will die and 90 percent of the non-immune people close to an infected person will get it.
Fear was the driver for Ebola’s patient engagement. The measles outbreak engaged parents because it raised the issue of the high rate of non-immunized children of a highly contagious and serious disease, but there were no calls to quarantine measles victims and guard them as with Ebola victims.
According to Patient-Centered Primary Care Collaborative, the patient-centered medical home (PCMH) is a “model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety.” PCMHs power business and clinical processes by using clinical decision support tools to connect patients with members of their healthcare team to improve both the patients’ and the providers’ experience of care. This coordination encourages a stronger physician-patient relationship, leading to better care delivery, more involved and engaged patients and reduced avoidable costs. According to the National Committee for Quality Assurance (NCQA), these models are “transforming primary care practices into what patients want, focusing on patients themselves and all of their healthcare needs. They also are foundations for a healthcare system that gives more value by achieving the ‘triple aim’ of better quality, experience and cost.”
The NCQA recognizes over 10 percent of U.S. primary care practices as patient-centered medical homes. In order to be recognized by the NCQA, these primary care practices must offer access both afterhours and online, allowing patients to receive care when and where they need it. They work with patients to make treatment decisions based on individual preferences and help patients engage in their own health. The practice as a whole works as a team to coordinate care from other providers and community resources to maximize efficiency. Additionally, PCMHs focus on preventive care and the management of chronic conditions to prevent complications and emergencies.
The Louis W. Sullivan Institute for Healthcare Innovation, which is dedicated to distribute health information technology innovation to transform quality and efficiency of healthcare delivery worldwide, announced the release of “A Year in Review: An Update on the 2013 WEDI Report & Roadmap for the Future of Healthcare Exchange.” The industry report evaluated public and private stakeholder progress in critical areas of focus.
The 2013 WEDI Report, the first roadmap for healthcare information exchange produced by WEDI since 1993, provided a framework for the next generation of healthcare information exchange designed to lower healthcare costs, improve healthcare delivery, and achieve better healthcare outcomes. In the past year, the Louis W. Sullivan Institute for Healthcare Innovation has monitored those stakeholder efforts to drive improvements through technology and data exchange, and has produced a progress report on those initiatives, which can be found here.
The initial report identified four key areas of focus and 10 related recommendations that would advance healthcare information exchange. Summarized below are assessments of how industry has performed in each of the core focus areas:
Progress rating = Green
Although the industry has lagged in driving improvements in health IT literacy, there has been continued momentum in patient information capture and patient identification. Private sector efforts, combined with a new federal vision and roadmap for health IT, are deemed to be on pace in meeting WEDI recommendations.
Progress rating = Yellow
Over the past several years, new payment models have leveraged technological advances to rapidly iterate, evolve, and scale across the country. However, models such as ACOs have yet to fully mature, and their success and sustainability remain uncertain – particularly in light of the mixed performance seen in 2014. A framework of core attributes and technological functionalities has yet to be developed and the industry needs further directed efforts to achieve the recommendations outlined in the initial report.
In today’s concierge economy there is an increasing number of things available on-demand at our beck and call. TV shows and movies, car services, local dining hot spots, even directions, are all accessible at the ready. With the proliferation of voice commands, typing has even been removed from the equation in certain instances. Patient portals aren’t quite there yet but the consumerization of IT has forever changed user expectations and unfortunately, left many industries struggling to catch up.
For the healthcare industry specifically, it’s been a hard pill to swallow as organizations have gone after the various government incentives offered through the HITECH Act. As those organizations have found out, the trail from paper-based records to fully digital portals can be a long and weary journey, but if the lofty consumer expectations can’t be met, the impatient patients will rear their ugly heads and make meaningful use requirements an even more elusive prey. The good news is that there are ways for healthcare organizations to make their patient portals seamless and efficient without having to develop an extravagant user experience that is on par with an Apple operating system.
When developing a patient portal, first and foremost, ease of use is of the essence to minimize the time needed for patients to accomplish tasks. Patients have very short and finite attention spans that are easily surpassed if they have to jump through too many hoops. Stage 2 meaningful use requirements included secure messaging, the ability to access and download electronic information, reminders sent for preventative and follow-up care, and general education materials.
These are all very basic tasks, but the parallel consumer experiences are incredibly user friendly, fast and intuitive. The key point to make is that the majority of patients really only need one of those criteria met for patient portals … speed. If patients can get what they need quickly, they are often satisfied. It’s not a social network, it’s a tool, so building patient portals with speed in mind is key to driving the patient engagement percentages required to meet the meaningful use standards. Given that so many of these processes are document heavy, streamlining the document viewing process is a key piece of the pie.
That document viewing part of the puzzle centers on the fact that patients benefit if only one method is needed to view the multitude of documents used in the healthcare realm. Records, prescriptions, X-rays and charts; the list goes on and on, not to mention the different digital formats in which the documents are often stored. Add to that the complexities involved when different organizations have different approaches to creating and storing these documents and the potential for complications and problems starts piling up quickly. Unfortunately, the place where all of these complexities converge is the patient. Portals need to be able to handle all of these document types with ease and again, quickly. HTML5 technology is a huge boost to this process as it enables browser-based document viewers to be easily integrated into patient portals. This means that any patient with an Internet connection and a standard browser can easily access any of their documents. There is no need for additional software downloads, such as Microsoft Word or Adobe Acrobat or even an image viewer, which is often the last straw for patients before giving up on the system completely.
Quality of care has long been a primary factor in choosing a healthcare provider, but convenience and communication are also becoming key considerations for patients. Still, many physicians do not appear to be offering the digital engagement services that can meet those demands.
According to a new nationwide survey conducted by TechnologyAdvice Research, a majority of patients (60.8 percent) said digital services like online appointment scheduling and online bill pay are either “important” or “somewhat important” when choosing a physician. However, when asked what services their current physician provides, less than one-third of patients indicated they have access to either online bill pay, online appointment scheduling, or the ability to view test results and diagnoses online, which are the top three services that patients report wanting the most.
In addition, 68.6 percent of respondents said it was either “somewhat important” or “very important” that a physician follow up with them, yet only 30 percent of respondents reported receiving a follow-up that wasn’t related to bill pay
“Primary care physicians are reporting some of the highest rates of EHR adoption to comply with government regulations and to receive incentives from Meaningful Use, but a significantly lower number of patients claim to have access to these patient portal services,” said TechnologyAdvice Managing Editor Cameron Graham, who authored the survey. “The issue here may not be implementation of digital services, but instead a lack of patient awareness. If physicians are offering these in-demand digital services, a more proactive approach to promoting them is needed and could create an advantage in attracting and retaining patients.”
Guest post by Scott Zimmerman, president, TeleVox.
If you caught Maria Bartiromo’sinterview with ex-Apple CEO John Sculley in late December, you would have heard him say this to the Fox Business Network’s Global Markets Editor:
“Telehealth is going to be a booming industry.”
Why? Sculley pointed to consumers’ taking on more responsibility for their own healthcare, the result of a new awakening to its high costs. He sees this as a derivative effect of Obamacare, as patients confront greater out-of-pocket payments in the face of higher deductibles.
Sculley went on to compare his expectations for the success that he expects telehealth to experience to the success that ATMs and online banking have seen in the last 20 years: “People said, ‘I wonder if it will be successful. We all know it was. The same thing is going to happen in telehealth.”
The renowned tech titan is very much onto something here. Consumers – especially those with chronic conditions who grapple with the challenges of adhering to prescribed treatment plans – will want more efficient and lower-cost ways to more regularly engage with their healthcare providers as part of a continuous-care model. But there’s so much more that is influencing the move by medical professionals to complement in-office visits with remote patient engagement strategies and communications solutions.
One important reason is that healthcare providers and institutions have financial incentives for more aggressively managing patient cases. In the age of accountable care, hospitals want physicians who have ties to their healthcare systems to boost patient communications for care coordination, to help them steer clear of penalties for avoidable readmissions. The focus on rewarding quality of care delivered, rather than quantity of services provided, also increases the importance of doctors’ keeping closer tabs on how their patients are doing in between office visits.
It’s always better that physicians know as soon as possible if their patients are having problems complying with care instructions or experiencing other complications, but especially so under these new scenarios. By the time the next office visit rolls around, things may have worsened to a considerable extent, potentially leading to more tests, additional medications, or even the need for hospitalization – all of which can take its toll on meeting accountable care standards.
Progress Is Underway
Of course, it’s simply not possible for healthcare professionals to regularly call each patient who is suffering from a serious condition to see how he or she is doing between appointments.
Guest post by Michael Simpson is the CEO of Caradigm.
It’s been five years since the HITECH Act was enacted as part of ARRA, and while there’s still a lot of debate about the technical details, rules and timelines involved with electronic health record (EHR) adoption and meaningful use, it’s clear that the focus on EHRs – and incenting hospitals and professionals to use EHRs in a meaningful way – represents a critical, foundational step in transforming health care in this country.
After all, meaningful use targets the right goals – goals that every hospital, health system and healthcare professional supports, including improved quality, safety and efficiency of care; reduced disparities; more engaged patients and families as core members of the care team; improved care coordination and population health; and more secure patient health information.
More important, the stages of meaningful use drive a set of progressively more advanced capabilities that are fundamental to achieving those goals. Digitizing data was the first critical step, and the good news is that according to a recent HHS press release, about 60 percent of all hospitals have adopted an advanced EHR, leaving the paper world behind. The next steps are sharing that data – securely – among providers and patients, reporting on quality to understand and improve it, using clinical decision support at the point of care, and many other capabilities critical to transforming care and outcomes. If providers and professionals meet meaningful use requirements, we should see more transparency, greater efficiency, reduced waste and more healthy people in our communities over time.
Stage 2 Challenges
It’s a long and challenging journey, and while hospitals and health systems are making good progress against Stage 1 requirements, very few are prepared for Stage 2. In fact, according to survey data from the American Hospital Association, fewer than 6 percent of hospitals have met the criteria for Stage 2, and only 10 percent have met the requirement for patients to be able to view, download and transmit their health information online.
Why are providers getting stuck as they try to move to Stage 2? Because as the requirements become more demanding – e.g., using clinical decision support, generating patient lists, protecting patient health information, engaging patients – these organizations need a new set of technology capabilities to meet those requirements. These capabilities leverage and extend the functionality and benefits of the EHR.
Moreover, to reach the ultimate goals targeted by Meaningful Use — improved quality, efficiency, outcomes and population health — providers will need to aim even higher than meeting the requirements of meaningful use stages, strategically using data from EHRs and myriad other systems across the care continuum to enable a new level of capabilities.