By Shane Peng, MD, chief clinical services and innovations Officer, IKS Health.
Shane Peng, MD
“Not enough time with my provider” or “my doctor isn’t listening to me” are among the top five complaints of today’s patients—and those frustrations haven’t changed much over time. Providers feel these pressures more than ever as they are pushed to provide quality care and patient engagement for less cost, while adding to their clinical documentation requirements with less time to do it.
These and other demands have driven providers to find more streamlined, digital solutions to help them save time, while government regulations (MIPS) and health plan providers have made mandates further increasing clinical documentation and reporting requirements.
These factors have led to the challenges of the last decade as stakeholders attempt to find ways to ease charting and administrative tasks during the patient appointment and unlock physician time. The federal government and commercial payers even offered mandates to encourage providers to onboard new technology aimed at optimizing performance.
Unfortunately, these technologies have not had the effect everyone had hoped for, and in fact, have sometimes amplified physician burdens rather than reducing them. Charting in an EHR can sometimes be time-consuming, difficult, and distracting, particularly when tackled during the constraints of the visit. This has led to physician frustration and stress, and worse, errors, as time pressures mount and they are asked to speed documentation while maintaining accuracy and making the appointment more patient-centered.
To lessen the strain, many providers opt to complete documentation after the appointment, often after normal business hours. However, this can quickly burnout physicians as they work a full day seeing patients and then spend their free time finishing up charts. Most physicians report an additional two hours of documentation time per work day. This can unfortunately also lead to more mistakes because the physician is documenting based on the memory of the encounter, which is inherently flawed in terms of accuracy and comprehensiveness.
It’s clear: “The way we’ve always done it” isn’t working
Although organizations appreciate the need to free physician time and smooth the documentation process, they frequently struggle to determine the best ways to realize change. It can be tempting to fall back on traditional methods like ramping up provider training or tweaking the EHR adding customized templates to hopefully streamline workflow.
However, organizations are beginning to see that these conventional tactics aren’t overly effective, and they need to approach the problem from a different angle. Entities must find means to remove the burden from physicians while still ensuring precise and thorough documentation that supports better patient care, stronger quality reporting and tighter reimbursement.
It is encouraging to see many healthcare systems and payors focusing on the impact of social determinants of health (SDoH) and looking for ways to partner with community-based organizations to address and improve these issues locally. Although this is a necessary step, I believe that providing access or referrals to community organizations is not the full answer.
While healthcare systems can provide referrals and connect patients to resources such as food banks or employment resources, it may not be enough to create individual engagement and empowerment to use those resources. We more fully need to appreciate the role played by the environment in which we grow up and the choices available to us in shaping how we respond toSDoH factors as individuals.
As part of an innovation center where we align data science withSDoH to help systematically disadvantaged individuals, I’ve been witness to projects and research that point to the theory of individual resiliency as part of the equation. The American Psychological Association defines individual-level resilience as the process of adapting well in the face of adversity, trauma, tragedy or threats.[1]
A review of the research on resilience by the WHO found that an individual’s ability to successfully cope in the face of significant adversity develops and changes over time, and that interventions to strengthen resilience are more effective when supported by environments that promote and protect population health and well-being. Further, supportive environments are essential for people to increase control over the determinants of their health.[2]
Also, in addition to traditional resilience methods, the emergence of methods to assess an individual’s capacity for self-care are adding significant insights into personal determinants of health. In particular, the needs of the growing population of complex patients with multiple chronic conditions calls for a different approach to care.
Clinical teams need to acknowledge, respect and support the work that patients do and the capacity they mobilize to enact this work, and to adapt and self-manage. Further, clinical teams need to ensure that social and community workers and public health policy advocates are part of the proposed solution. Researchers at the Mayo Knowledge and Evaluation Research (KER) Unit and the Minimally Disruptive Medicine (MDM) program led by Dr. Kasey Boehmer are developing qualitative methods and measures of capacity and individual’s ability for self-care.
Take post-traumatic stress disorder (PTSD), as an example. It has been estimated that around 50-60 percent of people in the US will experience severe trauma at some time in their lives. Around one in 10 goes on to develop PTSD, which is permanent in a third of cases.
But some people who have lived through major traumatic events display an astonishing capacity to recover.[3] A complex set of factors can be attributed increasing an individual’s resiliency to trauma including their personality, their individual biology, childhood experiences and parental responses, their economic and social environment as shaped by public policy, and support from family and friends.
Despite gains in medical technology and the use of electronic health records (EHRs), medical errors related to patient identification continue to pose significant, and in some cases, fatal risks for patients across the U.S.
Medical errors are the third-highest cause of death in the U.S., with 250,000 deaths per year, according to a Johns Hopkins University report.
Mismatched patient records and duplicate patient records are the two biggest forms of error that can lead to misidentification, according to a study by the Pew Charitable Trusts and Massachusetts eHealth Collaborative. Misidentification may result in the wrong surgery or medication, duplicate or unnecessary testing, unintended surgery, inaccurate prescriptions, and higher medical costs. The study also found medical errors occur more frequently within urban health systems where patients are more likely to be seen at more than one medical facility.
The Pew study cited patient misidentification as a nationwide crisis, with matching rates as low as 50 percent in some healthcare facilities.
We must do better.
The collective outcry of our patient population demands we do more. Our patients deserve more. As CEO of the American Health Information Management Association (AHIMA), and with the full support from our Board of Directors, I will continue to advocate for the adoption of a nationwide patient identification solution that addresses the need to accurately identify patients as they move through our healthcare systems.
We are not there yet, but help is on the way.
In June of last year, the U.S. House of Representatives passed an amendment to the Labor-HSS Appropriations bill that removed a ban prohibiting federal dollars from being used to adopt a national patient identifier. In December 2019, when Congress passed the 2020 spending package, language was included to address patient safety, and efforts in furtherance of a nationwide patient identification strategy:
Patient matching: The general provision limiting funds for actions related to promulgation or adoption of a standard providing for the assignment of a unique health identifier does not prohibit efforts to address the growing problems faced by health systems with patient matching. The agreement encourages HHS to continue to provide technical assistance to private-sector-led initiatives to develop a coordinated national strategy that will promote patient safety by accurately identifying patients to their health information.
The news that Ascension and Google are working together on a system using machine learning, called Project Nightingale, at first seems like a step forward toward better patient care. Because it’s challenging for any healthcare provider to exchange information about patients and patient care, it only makes sense that the healthcare industry would look for technology solutions that could solve some of these obstacles.
The design of a new software system that could suggest changes in care and make medical records easily accessible to any doctor treating a single patient would help alleviate many of the challenges our healthcare system faces today.
However, it’s important that these two entities move through the process with great care and consideration. Google is no stranger to controversy regarding data privacy, machine learning and ethics. In April, the tech leader vanquished its AI ethics board after a public outcry over board members and the potential misuse of Google’s AI systems. Further, Google has been accused of inappropriately using data to personalize online marketing and advertising. While it is true that Project Nightingale doesn’t break any laws under the Health Insurance Portability and Accountability Act (HIPAA), what is most concerning is the potential misuse, release or breach of the data without patient permission.
As a senior consultant for an IT security and risk management firm, I have spent years guiding government health agencies toward common-sense approaches to data management using technology. In order to ensure the greatest transparency for Project Nightingale, it is crucial to give patients an option to opt-in or -out of the program namely because of the risk for data to be breached or misused.
First, Google and Ascension should be tasked with clearly outlining how this project will progress in the future, or who the intended users are. Is it only for healthcare providers? If Google has access to patient data, will it be marketed in the future? While Google may say it will not share or sell user data, we don’t know how Ascension plans to use this data set in the future.
Using the information as part of a medical study that could help improve patient care is much different than using patient data to better market or advertise healthcare solutions or pharmaceutical products. Without this information being publicly available, how are patients and the public supposed to know safeguards were set up at all? This is one reason that so many in the technology industry, including myself, are hesitant to support this project.
Second, any technology is at risk for a data breach, no matter what kind of security is in place. Any device can be hacked, whether by a nefarious organization or a person living in their mother’s basement. Therefore, it is vital to stay a step ahead while anticipating vulnerabilities and risks.
As industry economics change, health care organizations are increasingly being pressured to provide financial transparency while improving the patient experience. Patient financial clearance (PFC) departments are increasingly under pressure to reduce costs and improve their own performancemetrics.
Yet it is difficult to improve baseline PFC key metrics such as days outs, denials, patient escalations, and write-offs without adding staff, an additional expense.
How can PFC departments reasonably achieve performance and productivity goals while still fulfillingtheir core functions? The first step toward PFC improvement is to understand how most PFC departments work, then sequentially adding measures to enhance PFC performance.
Understanding PFC
PFC departments, usually operating within a provider’s revenue cycle division, are typically resource challenged to curtail internal costs. A PFC department’s greatest cost is staffing, since most authorizations require staff-conducted phone calls to payers. Furthermore, authorizations are often complex for PFC to obtain, since they are based on specific payer rules and valid for only a set period of time.
PFC staff are also responsible for communicating the status of the authorization to not only the patient but also clinic staff. Given that a PFC department’s most important metrics directly pertain to patient health, it is imperative that PFC’s work is done in a timely manner and that financial status and payment are explained clearly to both the patient and provider, so that both parties can be educated in their decision-making process.
The organizational structure of a PFC department can assist or impede its overall productivity, based on the PFC team’s technology, workflow, and communication. For example, keeping teams in siloes may make team members specialized in their work but it can also create difficulty in achieving a streamlined overall process, due to the number of handoffs required to complete simple takes. Factors such as these illustrate the need for PFC departments to emphasize continuous improvement and workflow “optimization” which aligns technology, people and processes.
Improving PFC Performance
PFC performance improvement starts with understanding the department’s technology limitations an exploring potential options to automate PFC functions. For example, technology to verify insurance and benefits should be considered to reduce manual intervention as well as optimizing work queues to improve performance. Most EHRs have integrated insurance verification tools which can be configured to maximize the organization’s payers.
The Hospital Re-admissions Reduction Program took effect in 2012 with the goal of sustainably lowering hospital re-admission rates. Since then, the program has levied nearly $2 billion in penalties (in the form of reduced Medicare payouts) for hospitals with high re-admission rates.The intentions behind the program were good, but it hasn’t played out quite as expected — a 2019 study determined there was no significant change in re-admission rates of heart-failure patients since the implementation of HRRP.
The program also impacts safety-net hospitals more acutely because they serve all patients regardless of insurance status; their patient populations are generally older, sicker, and bring in less income.
A better solution to the re-admission problem might be for healthcare providers to focus more on educating patients — both on preventive care and aftercare — and shoring up these efforts through technological innovations that make education and awareness accessible to all.
How Tech-Enabled Communication Can Lower Re-admission Rates
Truly improving patient outcomes and decreasing re-admission rates is about more than just treatment. In fact, discharge is a critical point in a patient’s recovery as well. Without proper education on aftercare, patients are likely to end up back in the hospital without a better understanding of their current health or how they can improve it.
If healthcare providers can find more effective methods of patient education and communication, they can actively change the course of a patient’s future. Healthcare providers must do more than send out a pamphlet or quickly run through home care at the end of a doctor’s visit.
In an ideal world, all patients understand their conditions, know how to treat their symptoms, and can help prevent re-admission. In reality, however, only 12% of American patients are proficient in health literacy. This means the majority of people are either misinformed or completely uninformed about their health conditions and treatment plans.
Search engines haven’t helped matters, either. Another study determined that Googling symptoms not only stresses people out, but also causes them to misdiagnose themselves. When it comes to patient education, healthcare providers need to take the reins if they’re serious about long-term wellness. Otherwise, misinformation and anxiety will rule the day.
There has been a more in-depth exploration of technology in the healthcare industry. Every pioneering discovery is attributed to advancements in technology. What was not possible decades ago is now being implemented through various techniques, thanks to technology. Without a doubt, the core business of health today is anchored on digitally-enabled models. Technology has proliferated in the different industries that serve the healthcare segment. There are very many tech-enabled methods of research, drug production, treatment, and many more. Transformative digital technologies are aligning to come up with a powerful force for change, and market participant’s adoption is phenomenal.
It isn’t straightforward to predict the future, but at least, if technological trends continue in the current direction, many impactful technologically motivated innovations are to come. Digitization has been massively adopted in medicine, and it is well integrated into the detection and diagnosis of medical problems. It is even turning out to be a need rather than a necessity. Market participants are also wondering if artificial intelligence is going to replace doctors in the future – an ideology that is hard to rule out.
Today, disease diagnosis is being conducted remotely. Doctors are connected through centralized systems that allow them to monitor their patients remotely. Innovation has allowed telemedicine, where you engage with a doctor in the comfort of your home. Therefore, it is evident that artificial intelligence and the internet of things (all powered by technology) are going to alter how the healthcare system works. Most healthcare facilities have started adopting these changes, and they are becoming commercialized. Soon, receiving remote diagnosis and monitoring from your doctor will be a regular occurrence.
Better and Easier Treatment Using Advanced Medicine and Techniques
Imagine having a pocket-sized ultrasound device. Connect the device to your smartphone, and you can watch your baby move in your belly. You can also speed up your rehabilitation process using virtual reality. These are just a few of the significant innovative trends hitting the healthcare industry. They are making treatment faster, more relaxed, and more comfortable for many.
When a person is injured in an accident, because of the negligent actions of another it may take the injured party weeks or months to recover. After going to the emergency room for initial treatment, the injured person or persons could be faced with a number of additional visits to physicians including:
Orthopedic surgeons to treat any broken bones or fractures sustained in the accident
Plastic surgeons for skin grafting if the injuries are from a dog bite
Therapists to assist with general rehabilitation
Obtaining Medical Records is Crucial to Any Personal Injury Case
If the injured party retains an attorney, the attorney will be responsible for ordering and receiving detailed medical and billing records for their clients. This can be an arduous task depending on the hospital, facility or medical provider where the client treated.
Medical and billing records are crucial because they form the basis of the case an attorney builds for their clients. When an attorney, with the approval of their client presents a settlement demand to the insurance company, that demand must be supported with records that demonstrate the extent of the injury and the costs of treatment. A full recovery for the person who was injured is the primary goal.
Most medical providers, through their Release of Information (ROI) department, have similar processes in place. Generally speaking, it follows these steps in order:
A records request is made by the attorney, which includes a HIPAA form (Health Insurance Portability and Accountability Act) signed by the client
The request is received by the ROI department and entered into an electronic system or a hardcopy is placed in a manual filing system
The request is validated making sure that the patient information is correct and that the patient in fact treated at the facility
An invoice for records retrieval is created and sent to the attorney’s office
The attorney pays for the request with either a credit card or by mailing a check
Once payment is received by the provider, the records are released and sent to the attorney
The process sounds pretty straight forward but in big cities like Houston, with large hospitals and a medical center, there are literally thousands of requests made every day.
