By Richard A. Royer, chief executive officer, Primaris.
Richard Royer
Back in the day – the late 1960s, when social norms and the face of America was rapidly changing – a familiar public service announcement began preceding the nightly news cast. “It’s 10 p.m. Do you know where your children are?”
Today, as the healthcare landscape changes rapidly with a seismic shift from the fee-for-service payment model to value-based care models, there’s a similar but new clarion call for quality healthcare: “It’s 2018. Do you know where your data is?”
Compliance with the increasingly complex alphabet soup of quality reporting and reimbursement rules – indeed, the fuel for the engine driving value-based car – is strongly dependent on data. The promising benefits of the age of digital health, from electronic health records (EHRs) to wearable technology and other bells and whistles, will occur only as the result of accurate, reliable, actionable data. Providers and healthcare systems that master the data and then use it to improve quality of care for better population health and at less cost will benefit from financial incentives. Those who do not connect their data to quality improvement will suffer the consequences.
As for the alphabet soup? For starters, we’re as familiar now with these acronyms as we are with our own birth dates: MACRA (the Medicare Access and CHIP Reauthorization Act of 2015), which created the QPP (Quality Payment Program), which birthed MIPS (Merit-based Incentive Payment System).
The colorful acronyms are deeply rooted in data. As a result, understanding the data life cycle of quality reporting for MACRA and MIPS, along with myriad registries, core measures, and others, is crucial for both compliance and optimal reimbursement. There is a lot at stake. For example, the Hospital Readmissions Reduction Program (HRRP) is an example of a program that has changed how hospitals manage their patients. For the 2017 fiscal year, around half of the hospitals in the United States were dinged with readmission penalties. Those penalties resulted in hospitals losing an estimated $528 million for fiscal year 2017.
The key to achieving new financial incentives (with red-ink consequences increasingly in play) is data that is reliable, accurate and actionable. Now, more than ever, it is crucial to understand the data life cycle and how it affects healthcare organizations. The list below varies slightly in order and emphasis compared with other data life cycle charts.
Find the data
Capture the data
Normalize the data
Aggregate the data
Report the data
Understand the data
Act upon the data
One additional stage, which is a combination of several, is secure, manage and maintain the data.
Find the data. Where is it located? Paper charts? Electronic health records (EHRs)? Claims systems? Revenue cycle systems? And how many different EHRs are used by providers — from radiology to labs to primary care or specialists’ offices to others providing care? This step is even more crucial now as providers locate the sources of data required for quality and other reporting.
Capture the data. Some data will be available electronically, some can be acquired electronically, but some will require manual abstraction. If a provider, health system or accountable care organization (ACO) outsources that important work, it is imperative that the abstraction partner understand how to get into each EHR or paper-recording system.
And there is structured and unstructured data. A structured item in the EHR like a check box or treatment/diagnosis code can be captured electronically, but a qualitative clinician note must be abstracted manually. A patient presenting with frequent headaches will have details noted on a chart that might be digitally extracted, but the clinician’s note, “Patient was tense because of job situation,” requires manual retrieval.
Normalize the data. Normalization ensures the data can be more than a number or a note but meaningful data that can form the basis for action. One simple example of normalizing data is reconciling formats of the data. For example, a reconciling a form that lists patients’ last names first with a chart that lists the patients’ first name first. Are we abstracting data for “Doe, John O.” or “John O. Doe?” Different EHR and other systems will have different ways of recording that information.
Normalization ensures that information is used in the same way. The accuracy and reliability that results from normalization is of paramount importance. Normalization makes the information unambiguous.
Aggregate the data. This step is crucial for value-based care because it consolidates the data from individual patients to groups or pools of patients. For example, if there is a pool of 100,000 lives, we can list ages, diagnosis, tests, clinical protocols and outcomes for each patient. Aggregating the data is necessary before healthcare providers can analyze the overall impact and performance of the whole pool.
If a healthcare organization has quality and cost responsibilities for a pool of patients, they must be able to closely identify the patients that will affect the patient pool’s risks. Aggregation and analyzing provides that opportunity.
Leading CEOs will never say “wellness” is a top priority. Instead, they care about increasing revenue, providing great customer service or disrupting their market. Most see “an engaged workforce” as a path to these results. Even today’s successful “well-being” programs, which look nothing like their early predecessors (annual biometrics and flu shots, anyone?) are largely ignored by CEOs, and rarely connect to the purpose of the company.
Yes, many employers have embraced a more comprehensive whole-person approach to well-being, one that addresses emotional, physical, work and even financial well-being. But these alone can’t solve burnout.
These evolved “well-being” programs look beyond simple health outcomes and have a direct connection to improved employee well-being and critical business outcomes like employee engagement and reduced turnover.
For example, 88 percent of employees with higher well-being feel engaged at work, compared to 50 percent of employees with lower well-being. And 98 percent of employees with both higher well-being and a higher perception that their company supports their well-being say they want to be working at the same company in one year.
But even with this data at their fingertips, most C-suite leaders still find well-being too fluffy, hard-to-measure and irrelevant to their businesses. So, they have to look even more broadly. And the well-being industry needs to evolve and become relevant, or die.
When companies take a broader look at the results associated with an engaged and energized workforce, they’ll find real ROI within programs that were once seen as traditional wellness or well-being focused. ‘Engaged’ here doesn’t mean having well-being — it means a deep connection and sense of purpose at work that provides extra energy and commitment. And that’s what drives business results. Until employers combine well-being with employee engagement in their strategies, measurement approaches and programs, they will never solve employee burnout.
From on fire to burned out Because it sits at the intersection of something CEOs largely ignore — well-being — and something they pay attention to with increasing frequency — employee engagement — it’s not typically measured in one place. (Until now.) And you can only manage what you can measure.
Employee burnout is created by ongoing and intense job-related stress. This shows up in employees as exhaustion, cynicism and inefficacy, especially among the most talented and engaged employees.
Burnout is also associated with absenteeism, intention to leave the job and actual turnover. But for people who stay on the job, burnout leads to lower productivity, and decreased job satisfaction. Plus, it has negative impacts on team members. Burnout is often “contagious,” spreading toxicity across a team or spilling over into life outside of work. Cynical people just do worse work. It’s proven.
To burn out, an employee must be highly engaged and care deeply enough to get to the point of feeling burned out. Those at most risk for burnout are the top performing employees that employers can’t afford to lose.
In a new report, the Limeade Institute determined that burnout emerges when a highly engaged employee begins to have low well-being. Sadly, this is often a result of work pressure and lack of support from the employer.
“You have to be on fire in order to burn out,” said Dr. Hamill, lead researcher and Chief Science Officer of the Limeade Institute. “While both disengaged and burned out employees are at high risk for turnover, burnout is not the same as disengagement. If an employee isn’t feeling the energy or commitment from being engaged at work, then they’re most likely disengaged — not suffering from burnout.”
The Limeade Institute found employers are actively driving out top talent by causing the burnout and leaving it up to employees to deal with alone. The most common causes of burnout are not individual, but rather organizational; think work overload, role ambiguity, lack of feedback, lack of support and a perceived lack of fairness.
Burnout is acutely rampant in healthcare, particularly among caregivers. According to research from the Mayo Clinic, more than half of physicians report one or more symptoms of burnout. Similar research found the prevalence of burnout among nurses is as high as 70 percent and as high as 50 percent for physicians, nurse practitioners and physician assistants. And Stanford Medicine research highlights that it costs them between $250,000 and almost $1 million every time they need to replace a physician. They estimate physician burnout costs at least $7.75 million a year. Keeping just a dozen physicians from burning out is worth millions to just one hospital.
The world is a big place. However, since the introduction of the internet, the world just seems to get progressively smaller because of our ability to communicate with people who are leagues away. We are able to share information to a vast audience without any delay. And with the budding concept of “the internet of things”, it’s not a far-fetched idea that we should soon find that we’re able to control devices over an internet connection.
While the ability to share information has always been our strongest trait as a species, a lot of specialists, especially in the medical field, are severely limited by one thing — distance. Despite our ability to share information, we cannot completely transfer skill and experience from one person to another. Skilled doctors are sought all over the world because they carry something that they cannot simply transfer over the internet — their skill. There are many things that simply cannot be taught, such as how to maintain a steady hand during complex procedures or how to remain composed during a high-risk medical operation.
This was exactly the problem that the Da Vinci Medical robot was meant to address, and since its introduction in 2000, it has done exactly that. Because of this technological development, distance was no longer an issue when it came to providing skilled medical assistance. Because of the Da Vinci Medical Robot, skilled physicians were able to conduct complex and risky procedures despite being miles away from the actual patient.
Other times, instead of being able to emulate the movements of a doctor who’s miles away, robots can also serve to assist the doctor. This is the case with the first dental surgical robot, Yomi. This robot, unlike the Da Vinci Medical robot, is designed to help dentists perform procedures more accurately.
Yomi is a robot that was built by Neocis, a company that hails from Miami, Florida. It was recently approved for production by the FDA. The robot is programmed to plan out dental procedures based on the results of a patient’s CT scan results. Apart from this, the robot is also able to guide the drill as the dentist performs the procedure.
As the healthcare industry is strongly focused on efficient workflow, mobile apps are what can help doctors and patients interact on the go. According to a survey, 90 percent of medical institutions already use or plan to use mobile apps for patient treatment and/or internal management. With the growing number of hospitals that start to launch mobile apps, there has increased a need to shift away from the one-app-fits-all model to systems that serve to accomplish specific tasks. Urgent care clinics are the first in line to try enhance the efficiency of their work by turning to mobile applications.
To provide preventive care to more patients, most healthcare systems have created retail and urgent care clinics for people to visit and arrange an appointment on the same day. While retail centers provide mostly basic services, for instance, chronic conditions treatment, urgent care clinics deal with more serious cases. Also, such clinics typically have labs and offer X-Ray services. That’s why it is very important to provide these medical centers with appropriate software that will serve the overarching goal – effective patient treatment. So why not use a mobile app to improve the entire workflow? Let’s weigh up all the pros and cons.
Benefits and drawbacks of custom mobile apps for urgent care
If you plan to get a custom mobile app for an urgent care center, thoroughly consider finances, time and energy that you are going to invest in the project. If an app is developed to serve doctors, then all the risks are worth taking. Apps for smartphones and tablets speed up urgent care delivery and help doctors find the fastest solution in code blue situations.
Another matter is getting a mobile app to serve patients. The urgent care market focuses quite narrowly on doctor-on-demand apps for patients. Moreover, most patients turn to urgent care less than 2 times a year. So is the effort justified? Apps may be installed when needed and removed if not needed any more. That’s why it seems reasonable to download an app from the App Store or use a website to get the updated patient information.
What is the best solution for urgent care providers
Though custom mobile apps for urgent care centers may be optional, there is always a strong need in other software. Clinics demand healthcare management information systems (HMIS), custom imaging and visualization apps, patient administration systems, electronic health record (EHR) systems and other medical software to improve patient outcomes and meet the needs of a certain clinic and its staff. Healthcare policy management software can aid the facility in its short- and long-term management goals while considering the stringent regulations and healthcare standards.
McKinley County, New Mexico, is the namesake of the assassinated 25 U.S. President William McKinley. Many locals, particularly those Native Americans of Navajo decent living on reservations, have also been the victim of assassination, but in character in addition to physical attacks. Three decades ago Gallup, New Mexico, which borders on the Navajo Reservation, was known as “Drunk Town, USA.”
For many years Northwest New Mexico’s Gallup ranked number one nationally in the number of alcohol-related deaths. This reputation also killed many resident’s spirits, contributing to addiction, joblessness and homelessness, further highlighting the need for behavioral health care in this region. Native American youth have the highest rates of alcoholism of any racial group in the country, according to the National Institutes of Health.
McKinley County Is One of Poorest in U.S.
There are many stories like this. Addiction’s partner is the adjunct poverty of McKinley County, one of the poorest counties in the U.S. In Gallup there is a large population of Navajo and Na’nizhoozhi Indians. It is the most populous city in the county with 22,670 residents and is situated between Albuquerque and Flagstaff with 61 percent living below the federal poverty line and unemployment at 8.4 percent.
The Indian Health Service (IHS), an operating division within the U.S. Department of Health and Human Services (HHS) is the principal federal health care provider for Indians. Its mission is to raise their health status to the highest possible level. However, there are still issues such as the life expectancy for Indians being approximately 4.5 years less than the general population of the United States, 73.7 years versus 78.1 years.
Data from a 2014 National Emergency Department Inventory survey also showed that only 85% of the 34 IHS respondents had continuous physician coverage. Of these 34 sites surveyed, only four sites utilized telemedicine while a median of just 13 percent of physicians were board certified in emergency medicine. Another behavioral health related disease afflicting the territory is diabetes. In 2016, diabetes was the sixth leading cause of death for New Mexicans and the seventh leading cause in the U.S.
RMCHCS Hospital Fights Addiction with Behavioral Health Apps
Despite the drumbeat of bad news and discouraging statistics, organizations such as Gallup’s Na’ Nihzhoozhi Center Inc.’s (NCI) has 26,000 admissions every year and is the nation’s busiest treatment center with many repeat customers. The detox center was the result of an effort 30 years ago which began when more than 5,000 people marched from Gallup to Santa Fe to demand assistance from state lawmakers and received a $400,000 for a study to build a detoxification center. The hospital then received two-million-dollar ongoing yearly federal grant out of which NCI was born.
The leader of that effort in the ’80s and ’90s was David Conejo who returned in 2014 as the CEO of Rehoboth McKinley Christian Health Care Services (RMCHCS) where he leads the fight against addiction with traditional tactics, but also behavioral healthcare innovations that have captured the attention of the healthcare industry.
Turing the Tables on Addiction
When he became CEO of RMCHS a few years ago, he took a financially failing hospital and turned it around with the help of William Kiefer, Ph. D who is the hospital’s chief operating officer. Recognizing the root cause of the region’s health problem was addiction, Conejo revitalized a former rehab building on the hospital’s grounds and with some fundraising he launched the Behavioral Health Treatment Center.
The center is operated by Ophelia Reeder, a long-time healthcare advocate for the Navajo Nation and a board member of the Gallup Indian Medical Center. Bill Camorata, a former addict, is the behavioral special projects director. He opened “Bill’s Place,” an outdoor facility where he and hospital volunteers treated the homeless with meals, clothing and medical triage as part of Gallup’s Immediate Action Group that he founded and serves as president. The center has treated more than 200 addicted residents since the center opened in 2015 and has a staff of 30 who manage resident’s case work, provide behavioral health services and are certified in peer support.
By Brooke Faulkner, a writer in the Pacific Northwest; @faulknercreek.
Healthcare is in a constant state of updating. From new technologies to the latest scientific research, nothing stays the same for long. If it does, there’s almost certainly someone, somewhere, attempting to find a better way.
Right now, though, more than just the medicine is changing. The way we interact with our doctors and the way our doctors interact with each other is redefining what patient care looks like. Slowly but surely, the communication and management of healthcare data is joining the rest of us in the 21st century and going digital. Doctors are available on demand, medical records can be accessed without waiting for a courier, and the amount of information available to the public is growing by the second.
It’s not all so optimistic, though. Concerns about privacy exist in tandem with the benefits of increased access, and medical facilities can be vulnerable to a variety of cyber attacks. Whether you’re considering public health on a global scale or just going to the doctor for a yearly wellness check, digital health data is changing the way we see medical care.
Public Health Opportunities
Increased connectivity in the medical world makes more data available to more people. It’s easier than ever to track disease outbreaks, compare national statistics, and identify trends in global health. In the United States, the field of public health research is expected to spend more than $3.7 trillion in 2018 alone.
We have fewer communicable disease epidemics now than at any time in recorded history. Diagnosis and treatment protocols are more sophisticated, but more often than not, we don’t have to worry about smallpox, measles, or rubella thanks to vaccinations. Instead, many of the health concerns facing Americans are preventable, non-communicable diseases borne of unhealthy lifestyles. In 2017, more than 36 percent of the adult population was obese and 9.4 percent had type II diabetes.
With the data recorded by fitness trackers, electronic food diaries, and other health-focused devices, public health researchers can paint a clearer picture of the lifestyle choices that lead to illness. Public health campaigns can become more targeted and an emphasis placed on follow up and plan adherence through personal technology. By crunching the numbers generated from various populations, researchers can compare and contrast differences among nationalities, noting genetic trends and trying to tease out nature from nurture.
Dental health has always been an important aspect of your overall well-being. While most people may perceive dentistry as a means to improve one’s aesthetic, this is but an extra perk of visiting your dentist regularly. There are a wide variety of diseases and they all function the same way —through infection.
When a pathogen is able to gain ingress into your body that is called an infection. And one of the means of ingress are the teeth. A tooth cavity or an abscess are both dangerous in the sense that they are infections waiting to happen.
In the digital age, daily life is enhanced by the technology that we have. For one instance, traditional X-ray images had to be printed on a metal sheet and processed the way you would a camera film. Today, thanks to digital photography, the image is instantly projected onto monitors and saved to a database. There’s no longer the waiting phase. It goes straight to the diagnosis phase.
In previous iterations of the technology, the way that orthodontic diagnostics were performed was that dentists had to make a temporary mold of the patient’s crown (to be replaced) while the permanent mold of the crown would be made back at the lab.
Because of digital photography and 3D printing, dentists simply have to scan the crown that they intend to replace and add it to the database. The computer then simply prints out the replacement crown on the spot.
And while this technology seems impressive, there has been one piece of tech that has been on everyone’s lips for the past few months — artificial intelligence.
It first became publicly known when Google introduced it with its new line of Pixel phones. The artificial intelligence found in these phones was able to significantly improve the photo quality taken by the phone camera. A plethora of phone manufacturers, such as Asus, Huawei, and Oppo, followed suit thereafter.
What most people don’t know is that in the medical field, AI is currently being used to make the process of diagnosis more efficient and more accurate. IBM brought its Watson platform into the picture and it is currently used to help doctors make the best diagnosis and recommend treatment based on the patient’s medical history.
The software is even being further developed for it to be able to schedule medical procedures based on its estimated procedure durations. What this does is that it helps improve the efficiency at which hospitals operate by ensuring that time is used in the best way possible. So, this translates to an overall higher number of patients treated.
The same application can be brought into dentistry. A program known as VisualDX allows dentists and doctors alike to input images onto a computer. The computer is then able to produce a full list of all possible diagnoses.
In the area of health insurance, there is an increasing need for providers to streamline the process of securing coverage for their clients. With this, technology is at the center of innovation, and so providers will need to secure wider adoption of helpful tools and applications to ease up the workflow.
For sure, evaluating a client’s risk profile as well as processing accident claims are just two of the most tedious tasks insurers will have to handle. Other than that, insurers will also need to maintain their profit margins to ensure the seamless delivery of insurance services.
It is against this background that insurers will need to invest considerably in terms of acquiring the needed technologies and/or update their current equipment inventory.
The first step to this would be identifying which technologies to adopt and to make sure that such technologies can help in the long run.
Claims management software
Insurers that offer retirement plans will find it essential to use the right software and web applications to better deliver their services. Along these lines, it is best to opt for software that has the substantial features that are valuable for recording client information and relevant details in the event that a client wants access to their claims.
Also, insurers will need to implement systems capable of handling large amounts of data seamlessly. Finally, with a proper system in place, insurers can use certain features to accurately calculate total costs per claim. Indeed, an insurance claims management system can be a powerful tool that can help insurance providers cut costs, shorten waiting times, and avoid fraudulent claims through a more systemic yet faster validation process.
Risk assessment software
Before getting covered by an insurance product, it is imperative for clients to undergo a risk assessment process. Such a system provides a whole range of benefits to independent agents as well as hospitals. Accuracy, after all, is a key concept in the health insurance industry. So, making sure your patient’s records are free from errors can also lead to a more streamlined process.
What’s more, having the capability to perform risk assessment forms an important part of what this software can do to the bottom line. At least, with such a system insurers can essentially save on operating costs and avoid possible legal costs in the event of an error.
Healthcare is in a constant state of updating. From new technologies to the latest scientific research, nothing stays the same for long. If it does, there’s almost certainly someone, somewhere, attempting to find a better way.