By Karen Way, global practice lead for data and intelligence, NTT DATA Services.
Karen Way
A recent study conducted by NTT DATA Services and Oxford Economics highlighted the top three challenges identified by healthcare executives and consumers: standardizing and sharing of data across the healthcare spectrum, preparing for and adapting to regulatory changes and recruiting or retaining the right resources. It’s understandable that these challenges rise to the top of the list, as trying to meet rising consumer demands for access to their healthcare data while maintaining regulatory compliance with limited resources is a bit like juggling raw eggs. If your timing or skills are just a bit off, you end up with egg on your face.
How can a healthcare organization address these challenges? First, it’s important to understand exactly which challenges are present within your own organization, and how they are impacting the patient experience.
Data Sharing
Study results showed that only 24 percent of healthcare organizations share data across the business. Why? There are several reasons:
Interoperability – Even though this concern has been expressed since the inception of the EHR/EMRs, there are still barriers to being able to communicate data between different systems in a consumable, usable format. For example, several years ago, I had a CT scan due to the sudden onset of a continuous migraine headache. After the scan, I was referred to a neurologist that practiced out of another hospital system. I took a copy of the scan (on a DVD) to my specialist appointment, but the doctor was unable to view it on her system. As a result, I had to have another CT scan for the neurologist to see what may have been happening. Data already collected could not be used due to lack of standardization across systems. As noted in Dr. Eric Topol’s book Deep Medicine, “Your ATM card works in Outer Mongolia, but your electronic health record can’t be used in a different hospital across the street.”[1]
Data Volume – The volume of data being generated daily in the healthcare industry has been estimated to be approximately 30 percent of the world-wide total. With the estimates of data generation rates of at approximately 2.5 quintillion (that’s 1, followed by 30 zeros) bytes/day, that’s a lot of healthcare related data. Healthcare organizations aren’t even beginning to tap the depths of this data, simply due to the data volume.
Disparate Data – Like patients, healthcare data comes in many different shapes, sizes and languages. Even if interoperability issues didn’t exist, sharing of data across the healthcare business is hard because of these differences. Data can be an image, a PDF, a written note, a prescription label, etc. Historically, each type of data requires different mechanisms for managing it, often using different tools or systems.
These three factors combined can be overwhelming for healthcare organizations whose main goal is to provide the best healthcare possible.
Resource Management
Another leading challenge identified in the study is that of recruiting and retaining skilled resources. Of the healthcare executives surveyed, only 51 percent stated that they were able to recruit and retain resources with the required skills and knowledge. There are two components to this issue:
Upskilling resources – With the continual advancements in technology, it is important to ensure that resources can take advantage of training opportunities and professional growth. This is often a delicate balance for organizations; time spent in training is often seen as time away from projects with deadlines.
Healthcare experience – While there may be a pool of qualified resources with the required technical skills, it can be hard to find resources with knowledge and/or experience in the healthcare sector. For example, several years ago, a client brought in resources to support their enterprise data warehouse that had extensive experience in data warehousing. There were high expectations of new and improved functionality due to the technical depth of these resources. Unfortunately, the project did not deliver as expected. Why? None of the resources had knowledge of healthcare data or business processes. One resource posed the question to the client: “what is a healthcare claim?”
Just as important as reviewing the patient experience for ways technology can solve the problem, it helps to treat your workforce like your customer and improve the experience of transforming the organization into a digital-first enterprise. A recent article in the Wall Street Journal highlights the difficulty in recruiting resources and approaches to solving this challenge. The article also reinforces that in today’s data economy, it is no longer enough that a resource be technically skilled, they must also have knowledge of the business environment in which they are applying the technology.
When you see a breakdown of your costs on a medical bill, you might be shocked at how the expensive costs add up. Even small things, like getting an ibuprofen, help rack up a huge total. If you don’t have insurance, or your insurance doesn’t fully cover the bill, it can be difficult to pay off. Medical bills are something many people struggle to pay for, and some even refuse treatments due to the costs. This is an unfortunate reality for many Americans, where we often see people having to ration insulin and other medications they can’t afford.
If you have a medical bill you’re worried about being able to pay, here are a few ways to get it taken care of.
Ask about a payment plan
Medical bills today can easily get into five figures. If you’re like most people, that’s pretty impossible to pay off all in one go. A good option might be to ask your healthcare provider about a payment plan. Interest-free payment plans are often available for large medical bills, even though they aren’t regularly brought to the attention of the patient. An interest-free payment plan might be easier for you to tackle your medical debt.
If the initial monthly payment still doesn’t seem doable for you, you might be able to negotiate for a lower payment. Having your bill broken down into smaller payments can help you get it paid off. Paying off your medical bills monthly and on time can also help keep your credit score from falling.
Negotiate costs
Depending on your healthcare provider, you might have the chance to negotiate your bill even lower. Instead of doing a monthly payment plan, you might ask to pay a certain percentage up front and having the remaining amount dropped. Paying a percentage up front still might be a large amount of money, but you’ll at least be saving on the rest of the bill.
Check for errors
Have you really taken a good look at your medical bill? In some cases, patients can get charged for treatment they never had. It’s not uncommon for there to be billing mistakes made. Many end up paying for this simply because they didn’t realize they had these additional charges. Everyone is already aware that medical bills can be extremely expensive, so any unnecessary charges can be a huge burden. Not only can treatments you never received show up on your medical bill, you might also see duplicate charges appear. If you have insurance, you could end up finding a treatment you were charged for that should have been covered by your insurance.
No one expects you to be an expert at understanding medical billing. Even if there’s a charge you’re not sure if insurance should have covered or not, you can always call your insurance provider just to be sure. You can also call your healthcare provider’s billing manager and have them verify the charges if you’re unsure.
Request hardship assistance
If you have a low income that makes it difficult for you to pay your medical bills, you might be eligible for hardship assistance. With hardship assistance, you can get help similar to a payment plan. Your bill will most likely be broken down into payments that you’ll actually be able to pay. Some with headship assistance can also get the overall cost of their bill broken down.
By Jessica Kojima, vice president of professional services, AdvancedMD.
Jessica Kojima
Medical providers often battle inefficient and piecemeal software configurations that constitute the technological lifelines of their practices. Even if current solutions aren’t integrated to meet their needs, they sometimes feel it is easier to stick with what they’ve got instead of considering the possibility of upheaval.
Staying current—or better yet, striving for innovation—often comes at a price of temporary disruption for providers and staff. But if a new electronic health record (EHR) and practice management (PM) system are implemented with proper planning and stakeholder buy-in, the practice can realize true efficiency without substantial disruption.
Here are three best practices for implementing a new EHR or PM system for medical practices to minimize disruption.
Consider the big picture
Before the EHR/PM implementation process kicks off, the practice should assess the effectiveness of its clinical and administrative workflows. A practice that wants to cram a new EHR or PM into an existing workflow that isn’t working is thinking short-term. It’s important to consider “big picture” goals and aim to improve bad processes and optimize productivity. An effective approach will realize efficiencies across an entire practice versus one function or role. By considering the importance of productivity optimization across the whole operation, a holistic and integrated approach will enable growth and improvement for both patients and staff.
Preparing for payer migration
While considering the practice’s overall goals, the practice must also perform a payer analysis. A new PM system will require new Electronic Data Interchange (EDI) agreement enrollments to electronically submit and receive claims, remittance, eligibility, and claims status, which differ from payer to payer. This is often a forgotten aspect of moving to a new practice management system, and is arguably the most critical change. The practice should have the following items ready well before implementation:
List of payer IDs as they are credentialed. This information can be found by reviewing how the practice submits and receives electronic transactions currently, or by contacting the payer directly.
The official name as credentialed.
Understand if the providers are credentialed as a group or provider.
Tax ID.
National provider identification (NPI) number.
Many payers also require online registrations, voided checks, letters on specific letterhead—to name a few—to process an agreement. This demands timely attention by a designated individual in the practice for a seamless enrollment process. The practice should also set a “go-live” date to start submitting transactions through the new system. Preparing adequately in the weeks ahead of implementation will enable a timely kickoff of the new system.
Focus on people
Instinctively, an EHR and PM implementation might seem to be all about the software technology. Not so: it’s about the people. It’s vital that a medical practice identifies an implementation champion who will be responsible for both supporting and managing the transition. Depending on how aggressive the go-live goal is, the practice may need a practice management and a clinical champion to ensure all of the configuration and training occurs simultaneously. The champion’s role is to listen to every staff member affected by the transition and communicate openly with the team about why the switch is being made and how the leadership will support them. Ideally, everyone agrees on the approach, objectives, and expected outcomes.
When you think of an industry that’s mastered the creation of a seamless, digitally integrated experience for the customer journey, the airline and travel sector is unlikely the first that comes to mind. The experience has become so seamless as to be practically invisible, and any breakdown in that seamlessness is highly painful and disruptive for the customer.
The airline industry is the perfect example of one that has succeeded in orchestrating the customer journey and improved customer experience. Rather than calling a travel agent to book or manage one’s travel itineraries, passengers now research, book and manage flights on their own – and do so digitally. Not only do these digital tools allow passengers to check-in, upgrade and receive loyalty benefits, but they also keep passengers current with real-time flight status – from check-in times and cancellations or delays, to re-booking and satisfaction surveys.
What used to be a highly fragmented journey for travellers is now seamlessly connected thanks to online services that deliver the sort of automatic, digital experience that today’s consumers have come to expect in every aspect of their lives, from online retail shopping to booking travel accommodations.
Healthcare is not exempt from that expectation. In fact, consumers – Millennials and Generation Z, in particular – who are accustomed to this new world of always-on, instant service are causing the healthcare industry to undergo its own consumerization. Patients want the ability to manage their healthcare digitally the same way airline passengers automatically manage their travel.
Evidence of this industry wide shift has been steady. For example, mail-order prescriptions have been around since the 1990s, slowly increasing in popularity over the years and are more prevalent now than ever before. Just within the past year, we’ve seen new startups like NowRx and Capsule emerge while tech giants (the originators of today’s consumer experience) snatch up others as they foray into healthcare, such as Amazon’s acquisition of PillPack.
In fact, Amazon’s entry into the healthcare market alone is proof of the industry’s broader consumerization. Amazon’s business model has completely disrupted the retail industry and been a primary driver in creating today’s consumer expectations for seamless, digital experiences. Most recently, Amazon announced that its Alexa device is now HIPAA-compliant, allowing health organizations to use the voice-enabled speaker to help patients book appointments, access hospital post-discharge instructions, check the status of a prescription delivery, and much more.
This recent development is further proof of patients’ desire for convenience through using digital tools in their healthcare – something the industry has been slow to adopt.
Prepare for takeoff
Healthcare today consists of a broken, fragmented patient experience. The industry, however, stands at a turning point, where vast amounts of digital patient data are already available. By leveraging this data, healthcare organizations have an opportunity to differentiate their brands and create a seamless care journey – just like airlines keep passengers continually engaged, and ultimately deliver better service at a lower cost.
How can healthcare use available data to take off and further consumerize the patient experience? Real-time health systems, which Gartner considers “a management and operating paradigm…for the next-generation healthcare provider,” will play a pivotal role in transforming the way providers deliver care. Not only can real-time health systems orchestrate the care journey, but they also deliver real-time situational awareness about the patient’s history, as well as current and future care needs. Embracing real-time health systems will be key to unlocking a truly digital consumer experience, ensuring that computer systems execute best-practice behind every care journey.
Each year, Hyland Healthcare conducts focus groups with HIMSS members representing top healthcare provider organizations. The interactive, in-depth discussions always reveal powerful insights we can use to improve our solutions.
This year’s topic was enterprise imaging. We wanted to gain a better understanding of the drivers, strategies, challenges and desires healthcare leaders have in this area.
Consensus from the group seemed to indicate that the evolution of healthcare in general is driving the demand for enterprise imaging. For example, increased consolidation, partner collaboration and merger and acquisition activity are creating imaging environments that are complex and extremely difficult to manage. It becomes problematic, expensive and risky to attempt to manage and maintain multiple silos of imaging data throughout all of these locations.
“The acquisition of outpatient imaging centers combined with the disparate imaging silos we already have internally creates a lot of waste,” said Peter Overeem, CTO of Adventist Healthcare. “Several efficiencies can be gained by bringing all our images — both inpatient and outpatient — together into one consolidated system.”
Furthermore, it was agreed upon that PACS is a dated technology that is centered on radiology and cardiology, and likely not the best equipped to handle the centralized management of images throughout an enterprise.
“With the advancement of AI, we need to start adopting enterprise tools,” said Michael Knopp, MD, professor and director at Ohio State University. “We can’t maintain an environment where everyone has their own departmental solution. PACS vendors are focused on specific niches and are fairly slow to add new innovations that benefit the enterprise. The solutions you implement today need to be capable of adapting and innovating at a much faster pace.”
One-size does not always fit all
The demand for enterprise imaging tools was clear from the group. However, participants also communicated several challenges and roadblocks when it comes to implementing solutions that satisfy the needs of all the stakeholders involved.
“We can’t get the different imaging-centric departments to agree on one technology platform that meets everyone’s needs,” said Overeem. “What one person likes, another hates. We’re concerned about implementing an enterprise solution that causes some departments to settle for a less optimal solution for their specialty.”
Blockchain offers countless opportunities for growth and development of many industries. Sectors like finance, banking, government and public services, education and commerce have already taken the first steps at embracing this revolutionary technology.
One of the industries blockchain can change beyond recognition is healthcare. In this post, we will cover the opportunities blockchain offers for the healthcare sector, and the present use cases of blockchain in healthcare.
Why does healthcare need blockchain?
Healthcare industry has a lot of issues on a local, national and global levels. It has been struggling with data collection, storage, and transfer problems for a long time now. Federal regulations and rules make all the healthcare procedures lengthy and tedious. The current healthcare system does not manage patient data well. Pretty often it happens so that one patient cannot gather all of their medical records in one place and in one format quickly, or cannot gather the needed information at all.
Unfortunately, critical patient information is in most cases scattered across different healthcare institutions in different formats. What makes it even harder for healthcare providers and patients is that data management systems and security regulations often vary across different institutions and states. What’s even worse, many medical records have mistakes in them, and the outdated data management systems cannot trace and fix these mistakes. It all boils down to this: in extreme situations and in time of urgent need, it is practically impossible to access all the needed patient information easily, quickly and securely.
What can blockchain do here? With the help of this innovative technology, healthcare providers will be able to facilitate their data management processes beyond recognition. Blockchain can help healthcare providers collect, exchange, analyze and secure medical records seamlessly. It will give doctors and patients an opportunity to access any needed patient data from anywhere without tolerating the privacy or security of any party.
Can blockchain be a panacea for the healthcare industry? One thing is for sure — this technology can help the healthcare system improve healthcare services greatly without rising the costs of the corresponding processes significantly.
Blockchain and patient data handling
Blockchain can help the healthcare sector solve the issue with patient data storage. Potentially, it can cancel all the cultural, geographical, political and religious limitations that interfere with patient data handling nowadays. When the patient data is stored in the blockchain, it can be processed, managed and transferred seamlessly and securely. It means that in times of greatest need and urgency all the required data will be there to save a life.
MedRec, an Ethereum-based system, is one of the first blockchain-powered solutions that aim at facilitating patient data management. MedRec makes it easy for patients and doctors to view and manage patient data securely.
Your health is the most personal part of your life. Going into a doctor’s office or hospital makes a person feel vulnerable, even if they’re only there for a routine checkup. There’s an unspoken trust between patient and doctor that whatever is discussed or recorded will remain private. When your protected health information (PHI) gets out, either accidentally or purposefully, it can be embarrassing and seriously affect your life.
The Health Insurance Portability and Accountability Act (HIPAA) has been around since 1996. It was created to formalize data and privacy security requirements so that PHI remains safe. Healthcare administrators and staff such as nurses who work with patient records must be trained in these regulations, and they also must know how to handle HIPAA violations.
The growth of HIPAA violations
HIPAA compliance has always been important, but it’s become even more of a hot topic in recent years as the number of data breaches has climbed. Between 2009 and 2015, HIPAA violations occurred mainly because of loss or theft of healthcare records and PHI. Encryption and improved policies reduced those types of breaches. From 2015 to 2018, top causes of HIPAA violations included hacking incidents and unauthorized access and disclosures. There’s more than one healthcare data breach reported per day, and nearly 190,000,000 healthcare records have been stolen or exposed since 2009.
Common HIPAA security violations
A HIPPA violation involves the loss or unauthorized access of PHI. This includes identifying information that gets out, such as the patient’s name, date of birth, contact information, photos, or healthcare records. A data breach may occur when:
A tech device, like a laptop, smartphone or USB, is lost or stolen
PHI is accidentally sent to the wrong patient
A break-in at the medical office results in theft of patient records
A cybersecurity breach occurs, like hacking, malware or ransomware
Employees talk about PHI outside the medical office
There’s a security breach by a business associate or another unauthorized individual
PHI is shared online (such as via social media) or via text
When developing a mobile health app, the software does not follow software-specific HIPAA requirements
Privacy rights are violated while discussing a case in court. Note that there are times when privacy laws may be temporarily waived, like during a medical malpractice case
Brightree has announced plans for its home health and hospice customers to access more than 50,000 provider locations and health systems nationwide via the CommonWell Health Alliance, a nonprofit national trade association of health IT companies, and through CommonWell to Carequality, a national, consensus-built common interoperability framework.
Traditionally, home health and hospice agencies obtained critical patient health data manually from each of a patient’s other care providers. This required significant resources and often resulted in large gaps in patients’ records, hindering the speed and quality of care patients received. Through CommonWell, Brightree home health and hospice customers will be able to quickly and easily retrieve documents and data from a patient’s previous hospital and physician visits within their EHR solution. They can also share patient updates with physicians and other providers in the CommonWell network who serve that patient. This seamless information exchange will help home health and hospice agencies improve their efficiency, as well as patients’ care coordination and quality of care.
“What this amounts to is a smoother journey for patients moving from care setting to care setting, which is traditionally difficult to navigate,” said Nick Knowlton, Brightree vice president of business development and CommonWell board vice chair. “Our customers can now help provide a better experience more efficiently, which can lead to improved outcomes. By including this service in Brightree’s EHR offering, we are helping create a better future for our providers and patients.”
“Our mission at CommonWell is to break down longtime technological and process barriers so individuals and caregivers can access important health data efficiently, affordably and securely,” said Jitin Asnaani, executive director of CommonWell Health Alliance. “We’re thrilled to be welcoming a new wave of home health and hospice providers into the network, and commend Brightree for its leadership in this space.”
In a forthcoming Brightree survey, 60 percent of referring providers say they would select a post-acute care delivery partner based on their ability to interoperate with the referral source.
“Fluid data exchange is so critical to successful patient management across a system of care, and Brightree is leading in this space,” said Denise Schrader, MSN, RN, NEA-BC, vice president of integrated services at Mosaic Life Care in Saint Joseph, Mo., a Brightree customer.
Getting a diagnosis for a rare disease is a long and often painful journey that can take an average of five years1 and hundreds of doctor visits. Sometimes, the answer never comes; conventional diagnostics does not always provide a diagnosis for diseases that are only found in one in a million or one in 10 million people. Because most rare diseases are genetic in nature, genomic DNA sequencing can be used to provide answers that conventional approaches cannot.
Most families affected with rare diseases are under financial strain, making access to genetic sequencing technologies difficult. Rare Genomics Institute (RG), a non-profit patient advocacy group, meets these patients at the end of their diagnostic odyssey – when all other means of diagnosis have failed and when financial resources are no longer available to continue the diagnostic process.
The Patient Research Services of RG has created an ecosystem of leading technology partners and genetic experts from top research institutions around the world to give patients pro-bono access to world-class genomic sequencing, data analysis and interpretation services. Often, RG works with their partners and volunteer experts to re-analyze cases that have hit a dead end.
Recently, RG announced a strategic partnership with Genomenon, a big data genomics company that uses artificial intelligence to connect the genetic mutations described in medical research publications with patient data obtained from genetic sequencing. Using technology that wasn’t available just a few years ago, Genomenon puts the research for over 4.1 million genomic variants at the scientist’s fingertips to make sure that no stone is left unturned in providing a comprehensive diagnosis.
In a recent case, a patient had their whole exome sequenced and analyzed by a leading genetics laboratory as part of their long diagnostic odyssey. The lab was unable to find any clinically relevant genetic mutations that could provide a diagnosis. That was where RG stepped in; Dr. Lipika Ray, a computational geneticist on the Patient Research Services team, reanalyzed the patient’s DNA, which included a search of the Mastermind Genomic Search Engine.
Dr. Ray was able to find a single research report in the scientific literature that matched the patient’s DNA data. The patient in the report shared similar symptoms with the patient being analyzed. With this finding, RG recommended that the patient be re-examined based on the diagnosis found in the scientific research.
“Sometimes there is only one research paper that can connect a patient’s DNA with a diagnosis. Searching through millions of research papers to find a patient’s genetic mutation can be like trying to find a needle in a haystack. With advanced AI techniques used by Genomenon, the needle can pop right into view.” said Dr. Ray. “I can say with certainty that without the findings obtained from Genomenon, I would not have been able to provide a diagnosis for this patient.”
Healthcare organizations know just how important it is to comply with the HIPAA Privacy Rule to protect sensitive and unstructured data such as patient records, scripts, discharge summaries, medical forms, authorizations, prescriptions, and insurance claims. However, in the event of an emergency, HIPAA compliance is usually the last thing on people’s minds. As a result, hospitals are often granted a HIPAA waiver of up to 72 hours from the time they first implement their disaster protocol. Unfortunately, without a HIPAA waiver, hospitals may face substantial liabilities and penalties for non-compliance.
Even worse, if a hospital’s network is affected by a natural disaster, cyberattack, or system outage, doctors may not be able to access medical records and patients will not receive the proper care. With any type of downtime, some disruption within a hospital is expected to occur. In some cases, these disruptions could be life-threatening. Reports have shown that more than 2,100 patient deaths are linked to hospital data breaches each year. Unfortunately, doctors are often so preoccupied with remediation activities after a breach occurs that patients no longer receive quality care.
Secure exchange network
To prevent tragedies, human errors, and system failures from occurring in the event of an emergency, healthcare organizations must utilize a HIPAA compliant, secure, and trusted network. The ideal secure exchange network will leverage hybrid cloud technology and military-grade encryption to provide 100 percent secure communications at all times. Document and fax transmissions sent via a trusted network will never traverse an external telephone network and, therefore, will remain secure between the remote client site and the secure exchange network at all times.
Disaster recovery
In addition to a secure exchange network, having a complete disaster recovery solution in place is business-critical. A disaster recovery solution works to ensure that organizations never experience downtime while inbound and outbound fax communications remain secure and protected from technical failures due to catastrophic events and natural disasters.
When you see a breakdown of your costs on a medical bill, you might be shocked at how the expensive costs add up. Even small things, like getting an ibuprofen, help rack up a huge total. If you don’t have insurance, or your insurance doesn’t fully cover the bill, it can be difficult to pay off. Medical bills are something many people struggle to pay for, and some even refuse treatments due to the costs. This is an unfortunate reality for many Americans, where we often see people having to ration insulin and other medications they can’t afford.
Your health is the most personal part of your life. Going into a doctor’s office or hospital makes a person feel vulnerable, even if they’re only there for a routine checkup. There’s an unspoken trust between patient and doctor that whatever is discussed or recorded will remain private. When your protected health information (PHI) gets out, either accidentally or purposefully, it can be embarrassing and seriously affect your life.
Brightree has announced plans for its home health and hospice customers to access more than 50,000 provider locations and health systems nationwide via the CommonWell Health Alliance, a nonprofit national trade association of health IT companies, and through CommonWell to Carequality, a national, consensus-built common interoperability framework.
