By Derek Jones, vice president of enterprise strategy, Deputy.
Derek Jones
The recent COVID-19 pandemic has highlighted one aspect of our healthcare system: the global healthcare industry was not prepared to face a crisis. The lack of preparedness has significantly disrupted the healthcare supply chain: sharp surge of demand, lack of protective equipment, shortage of medical supplies and employees protesting against unsafe work conditions have all contributed to a slowdown of the healthcare industry.
Meanwhile, the coronavirus outbreak has been rapidly progressing — more than 175 countries have reported cases of COVID-19, with more than 735,000 cases and 35,000 deaths, as of March 30.
Discussed below are the steps that healthcare facility managers should take to keep things running as smoothly as possible.
Getting ready to face a crisis
It is also essential you find the time to meet up with your staff to educate them on all the aspects of the crisis. The common end-goals for everyone should be the same: reduce fatality rate, minimize disease transmission and ensure the healthcare system is operational.
Preparing your healthcare facility
Plan ahead for your facility’s supply of personal protective equipment to be ready to deal with any shortages.
Get in touch with all your suppliers and work out a flexible mechanism to re-supply in case of shortages.
Use visual cues and alerts at entrances and strategic locations within your facility to provide instructions on hand hygiene, respiratory hygiene, and cough etiquette.
Prepare a properly sanitized containment area to welcome any infected patient or personel.
Handling patients queries
Brainstorm different alternatives to the traditional face to face visits to limit the transmission of diseases in your facility.
Encourage patients to use alternate advice lines, such as online portals and self-assessment tools.
Assign the appropriate staff to handle queries you’ll be receiving via your alternate advice lines.
Set up protocols to determine which patients can be managed remotely and which ones will need to come to your facility.
Keep a schedule of the number of patients in your facility and advise your patients when to come in at a less crowded time.
By David Gregg, M.D., chief medical officer, StayWell.
David Gregg
Technology can be harmful to our health, especially our emotional health. Those are the latest findings from Cigna’s recent study highlighting the epidemic of social isolation. The report details the impact technology has on younger adults, communities, and even workplaces. While health care continues to focus on the latest tech advances, including artificial intelligence and machine learning, providers are seeing a steady increase in social isolation linked to technology.
With an ever-expanding inventory of digital health tools at our fingertips, we need to balance the benefits that these advances offer, with a human-centered, personal touch to improve the health and well-being of individuals.
Digital health has made significant strides in improving the health of patients, expanding a network of apps, digital platforms, wearables, and plug-ins – creating greater connectivity among patients, providers, payers, and employers, while capturing meaningful health data.
As technology advances we’re seeing innovative ways to use this data to reveal trends, detect health issues much earlier, trigger alerts, and personalize health care. But the digital health universe still cannot capture a full picture of a patient’s entire health. For that we still need a human approach.
Social media is a double-edged sword, bringing us all together as never before, but causing greater isolation and diminishing the richness of person-to-person interaction. Digital health technology poses a similar dilemma — we can link patients to care systems as never before and generate new avenues to share timely data, but can we maintain the valuable patient-care team relationship and avoid overwhelming care teams with too many data sources and administrative tasks?
More data is good, but is it the right data and are we applying it to deliver optimal care and improve health? Advanced technology is good, but is it producing efficiency and enabling care teams to do what they do best – take care of patients?
Digital health is a balancing act – we want to leverage high-tech while we preserve high-touch. For example, to maintain focus on the patient, health coaches are playing a more prominent role in the delivery of care. Health systems and employers are turning to health coaches to serve as a high-touch health champion to drive engagement and support treatment adherence. Health coaches serve as the human bridge between patients, care teams, and health plans. Coaches help make sense out of the wealth of digital health data.
There are several regulatory compliance requirements that healthcare organizations must follow. Even so, it’s the Health Insurance Portability and Accountability Act (HIPAA) that gets the most recognition. If your organization is involved in the healthcare industry, you should ensure that it complies with the Health Information Technology for Economic and Clinical Health Act (HITECH) as well.
These two compliance requirements are somehow interrelated. However, HITECH is meant to enhance information technology in the healthcare industry while protecting the security and privacy concerns regarding ePHI. HITECH significantly modified HIPAA and the Social Security Act. Therefore, it can be difficult to understand how these regulatory compliance frameworks complement each other.
How HITECH And HIPAA Are Similar
HITECH and HIPAA compliance is overseen by the Health and Human Services Department (HHS). Typically, healthcare organizations tend to focus on HIPAA compliance since it is the backbone of the Privacy Rule that sets national standards regarding PHI and medical record protection. The Privacy Rule was adopted in 2000. Since then, HHS has only made one modification. That was in 2002 when the Privacy Rule was modified to become one of the initial information privacy and security regulations.
The Office of the National Coordinator for Health Information Technology (ONC) is mandated to promote the quality of healthcare by advancing health IT. ONC is also tasked with the role of securing ePHI and establishing procedures for electronic health records (EHRs) to promote privacy.
Therefore, while HITECH and HIPAA complement each other, they are dissimilar. HITECH focuses on information technology as well as the preservation of electronic information, whereas HIPAA dwells on protecting privacy as well as expanding beyond information systems.
How HITECH And HIPAA Differ
Although HITECH and HIPAA have many similarities, the two regulations also differ on various vital details. HITECH was meant to expand HIPAA. Even so, the latter remains focused on addressing privacy and breach notification issues to protect against identity theft and fraud. On the other hand, HITECH differs from HIPAA because it established restructured criminal and civil compliance penalties. Furthermore, HITECH extended HIPAA’s breach notification requirement beyond covered organizations also to include business associates.
From an IT perspective, compliance managers ought to focus on the significance of robust encryption. In case malicious actors breach the ePHI, effective encryption will mitigate rule violations. Therefore, if the encryption makes the information unreadable, the organization won’t be fined. Nonetheless, proving effective encryption means complying with the NIST Federal Information Process Standard. Therefore, healthcare regulatory compliance can only be realized if you fully understand your organization’s IT infrastructure.
The Centers for Medicare & Medicaid Services (CMS) has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic.
“Healthcare providers are making massive financial sacrifices to care for the influx of coronavirus patients,” said CMS Administrator Seema Verma. “Many are rightly complying with federal recommendations to delay non-essential elective surgeries to preserve capacity and personal protective equipment. They shouldn’t be penalized for doing the right thing. Amid a public health storm of unprecedented fury, these payments are helping providers and suppliers – so critical to defeating this terrible virus – stay afloat.”
The streamlined process implemented by CMS for COVID-19 has reduced processing times for a request of an accelerated or advance payment to between four to six days, down from the previous timeframe of three to four weeks. In a little over a week, CMS has received over 25,000 requests from health care providers and suppliers for accelerated and advance payments and have already approved over 17,000 of those requests in the last week. Prior to COVID-19, CMS had approved just over 100 total requests in the past five years, with most being tied to natural disasters such as hurricanes.
The payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners and durable medical equipment (DME) suppliers. While most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months.
The CMS Accelerated and Advance Payment Program is funded from the Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) trust funds, which are the same fund used to pay out Medicare claims each day. The advance and accelerated payments are a loan that providers must pay back. CMS will begin to apply claims payments to offset the accelerated/advance payments 120 days after disbursement.
The majority of hospitals including inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals will have up to one year from the date the accelerated payment was made to repay the balance. All other Part A providers and Part B suppliers will have up to 210 days to complete repayment of accelerated and advance payments, respectively.
The coronavirus (COVID-19) has had a significant impact on healthcare at home providers’ ability to see or care for patients, and the much-publicized lack of personal protective equipment (PPE) is a very real issue, according to findings of a survey conducted by healthcare technology leader Axxess.
More than 80 percent of respondents said the virus has had an impact on their organization’s ability to see or care for patients, and three-fourths of respondents said they do not have adequate PPE for staff.
The survey of thousands of home-based care providers from organizations of all sizes from March 25-30 confirmed that agencies have a critical need for PPE, including N95 masks, gloves, face masks, gowns and hand sanitizer.”
In addition, billing or cash flow has been interrupted for nearly 60 percent of respondents’ organizations, and more than half of respondents indicated their organization has experienced staffing challenges as an impact of the virus.
“Understanding how challenged providers are at this uncertain time, we appreciate everyone who took the time to help provide visibility into the needs of the industry,” said John Olajide, founder and CEO of Axxess. “Our brief survey was designed to give a voice to our heroes on the frontlines of caring for those most vulnerable to coronavirus.”
The survey, which included respondents from all levels of organizations, including management and caregivers directly working with patients and clients, showed nearly half of respondents have a negative view of coronavirus’ (COVID-19) eventual impact on their business.
The long-term impact of coronavirus (COVID-19) on the industry is less certain, with about a third of respondents feeling it would ultimately be positive, a third feeling it would be negative and about a third having neutral feelings.
“I am incredibly proud to be part of such a caring community,” Olajide said. “We can’t know how long this crisis will last, but it should be reassuring to all of us that we are all working together and demonstrating leadership, providing expertise, displaying innovation and sharing resources.”
The full survey report is available in the Axxess COVID-19 Resource Center.
By Julie Pursley Dooling, MSHI, RHIA, CHDA, FAHIMA, director of HIM practice excellence; AHIMA.
Release of patient information during COVID-19
What insiders have long known has become clear during the COVID-19 pandemic: health data is a vital element of health care, including efforts to curb the pandemic. Of course, that data is important to patients, providers, and healthcare staff. And even during COVID-19, if a patient wants to access their data, release of information services (ROI) teams must comply with a strict set of processes set forth by the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). These regulations ensure that patients retain safe and secure control of their personal health information and record requests are timely, accurate, and complete.
So, what should providers and patients expect during this time? For years, patients have been able to walk into a provider’s office or a health records office and request a copy of their records. During a stay at home order, however, that’s not such a good idea.
The American Health Information Management Association (AHIMA) recommends that organizations temporarily suspend walk-in access for medical records inquiries during COVID-19. Organizations should work closely with their ROI vendor (if they have one) to ensure continuity, while also displaying signage on doors and windows to redirect patients and families to alternative resources. In addition, it would be prudent to post process changes to the organization’s website and through automated messaging systems, while alerting the patient access staff.
It’s important for organizations to provide patients and their families with alternate record request options during COVID-19. All requests via phone should be authorized by health information staff who witness and document it in the patient’s record. And voicemails should be directed to a patient portal so they can be returned.
And just how can a health professional be assured they’re talking to a patient or one of their relatives? They should ask the caller to verify their patient demographic data such as a date of birth, home address or the last four digits of a social security number (if applicable). Other examples of data may include cell phone numbers, nicknames or another reliable data source that is consistently collected.
As the public is ordered to stay home to flatten the curve, healthcare systems are tasked to ‘raise the line’ by increasing staffing, adding beds, and moving to a telehealth model to keep patients out of hospitals. Clinicians who are not on the frontlines of the COVID-19 response are being asked to help assist the rest of medicine. During these virtual care visits, it’s critical for these clinicians to utilize clinician decision support software to aid in diagnosis and keep as many patients out of the acute care setting. These software systems can not only help triage cases of COVID-19 but also help quickly and accurately treat patients presenting with other conditions that still require care. Clinical decision support also supplements telehealth services to improve the patient experience, ease patient anxieties, and reduce some administrative burden for providers.
Response from Chris Caulfield, RN, NP-C, co-founder and chief nursing officer, IntelyCare
As a result of COVID-19, demand for healthcare professionals is at an all-time high, with nurses on the front lines providing care to patients in need. In this unprecedented time, nursing and other healthcare professionals need their provider organizations more than ever to support and protect them. One significant aspect of keeping nurses and their patients safe is COVID-19 education. The virus is rapidly evolving and nurses don’t always have time to find and walk through new COVID-19 protocols before each shift. Organizations can offer and promote online learning so that nurses can complete training on their devices and on their own time, and so facilities can ensure the entire workforce is well-equipped to treat and prevent the spread of COVID-19.
Another way to protect facilities, staff, and patients from unnecessary exposure to COVID-19 is the implementation of an online symptom screening that enables workers to remotely verify whether or not they are experiencing COVID-19 symptoms. Nurses that are experiencing COVID-19 symptoms can be removed from the shift without penalty, which can prevent the further spread of the virus to other nurses and the vulnerable populations they’re treating.
Response from Erin Jospe, MD, chief medical officer, Kyruus
With health systems needing to respond nimbly to the rapidly evolving landscape of caring for patients in the midst of a public health crisis, the key, as with any crisis, is to pursue a plan of action with thought and purpose. At a time when the majority of people seek healthcare information and services online, this principle and plan must extend to the role of digital access. The promise of digital technology is to leverage it creatively as a force multiplier, and to do so with an eye toward minimizing friction in care delivery and enabling the safest care possible. In the ambulatory setting, there are three distinct populations we need to think about servicing this way.
The first is the general population needing guidance on safely assessing their health while physically staying in their homes if at all possible. This is best achieved through the interplay of screening tools and virtual assistants with appropriate triaging for 1) those who can safely obtain self-care instruction 2) those who should have additional assessment through a combination of virtual appointments and direction for screening tests if warranted and 3) those who require immediate direction to the closest hospital or care facility. Screening engagement platforms, in conjunction with telemedicine, can decompress call centers, thereby freeing up staff, and help keep more patients safely at home.
In addition, more clinical staff can work remotely to provide virtual visits, maximizing the use of dwindling PPE resources for those who continue to serve on the front lines in direct patient contact. Digital technology can thus similarly benefit this second population, your health system staff and clinicians, by respecting their need for technology that works for and with them, promotes their physical safety, and conserves increasingly limited resources.
The third key population is patients with non-COVID medical needs, who require attention and outreach to help maintain their health. Digital platforms (e.g., telemedicine, automated outreach) can play an important role in keeping these patients well-informed, monitored, and safe, with clear access to information, both static and offered dynamically through real-time interactions when needed. Furthermore, those with chronic conditions that can become increasingly complex if left unchecked and where compliance issues may be exacerbated due to economic pressures, must be supported during this time even in the absence of acute symptoms – for their own well-being and to minimize the need to compete for scarce complex care resources.
While we all struggle to act quickly under these exceptional circumstances, using your digital investments to speak creatively to the needs of these populations is not only possible, it is necessary.
A team of healthcare professionals and evidence-based medical experts at EBSCO Information Services (EBSCO) has launched a COVID-19 portal which aggregates real-time information updates from authoritative sources to provide information on all aspects of the COVID-19 pandemic.
The portal was created to meet the needs of the healthcare information community in a time when information is released at a rapid rate, from all areas of the knowledge ecosystem. The COVID-19 portal provides researchers and healthcare professionals with consolidated access to real-time, credible information. Librarians and information professionals are also called upon to suggest resources that should be added to the site.
EBSCO Information Services chief medical knowledge officer Brian S. Alper, MD, MSPH, FAAFP, FAMIA, says the portal was developed to provide useful information to many professionals seeking information about COVID-19. “This is a time of massive and rapid information demand.
By creating this portal, we are responding to the needs of many sectors of society by making COVID-19 information available for a diverse set of users. To meet this great need, we have enabled information professionals and others to contribute — to leverage their expertise developing collections and vetting sources — which we’ve made possible through this portal.”
The portal was created in collaboration with EBSCO’s Stacks division. Stacks Founder and EBSCO Information Services vice president of SaaS product and technology Kristin Delwo says the portal is an evolving platform that aims to include all trusted resources to best meet the needs of the online research community. “At its simplest level, the COVID-19 portal is a way to help people share and find information. As experts in clinical content, EBSCO is well positioned to curate a site of this magnitude and to understand the best curators of this valuable content.”
The EBSCO Clinical Decisions division provides clinical decision support resources to healthcare institutions around the world. The COVID-19 portal is one of several ways that EBSCO has made healthcare information accessible during the pandemic. DynaMed, EBSCO’s clinical decision support tool, has made its COVID-19 clinical topic open, offering easy access to evidence-based information related to treatment that is updated daily.
EBSCO has also developed a healthcare resource center to provide open access to the content it provides to medical, nursing and allied health professionals.
The Centers for Medicare & Medicaid Services (CMS) has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic.
The coronavirus (COVID-19) has had a significant impact on healthcare at home providers’ ability to see or care for patients, and the much-publicized lack of personal protective equipment (PPE) is a very real issue, according to findings of a survey conducted by healthcare technology leader Axxess.
By Julie Pursley Dooling, MSHI, RHIA, CHDA, FAHIMA, director of HIM practice excellence;