We tend to have a negative view of risk, regarding it as a danger to the business. But, it also presents opportunities to push boundaries. If we reframe risk as a change-maker, then what degree of risk is acceptable? The healthcare industry faces this conundrum at every turn. Whether testing a toxic chemotherapy drug that could be lifesaving, or adopting IoT devices that provide detailed analytics, these advances can all expand the threat landscape.
Unlike testing pharmaceuticals in a controlled lab setting, the world of cyber and its risks are in constant flux. Healthcare data is at the top of cybercriminals’ lists, contributing to a record amount of breached health records in the past year. Full patient medical records are a valuable commodity on the dark web and?sell for up to $1,000?each.
Now, healthcare organizations can’t stay stagnant in implementing protections.
The reality of highly-regulated industries is that compliance mandates tend to govern security operations. But where regulations are cut and dry, risks do not fit neatly into boxes of “high risk” and “low risk.” Instead, risk is on a spectrum that requires a holistic cybersecurity strategy to appropriately prioritize and mitigate risk according to what is deemed as acceptable.
To help healthcare organizations mature security policies and become more comfortable with risk, here are three recommendations for 2020 cybersecurity planning:
DirectTrust announces its Second Annual DirectTrust Summit, scheduled at the Washington Marriott Georgetown in Washington, DC, June 9-10, 2020. DirectTrust also announced its call for speaker proposals is now open to health information industry experts interested in speaking at the Summit.
DirectTrust is a nonprofit healthcare industry alliance created to advance the electronic sharing of protected health information (PHI) between provider organizations, and between providers and patients, for the purpose of improved transitions of care, care efficiency and coordination, patient satisfaction and reducing healthcare cost.
The DirectTrust Summit brings healthcare industry leaders together to share ideas and best practices around improving health information exchange and interoperability. In response to feedback from the inaugural summit this past June, the format for the Second Annual DirectTrust Summit has been expanded to include a full-day event on June 9 and a half-day of breakout sessions on June 10. Additionally, a virtual participation option via webcast is available for the full-day event and plenary sessions.
“We’re thrilled to announce the Second Annual DirectTrust Summit—and excited to be convening in Washington, DC,” said Scott Stuewe, DirectTrust president and CEO. “Our inaugural event in June was a terrific success, which is amply validated by the calls for more time and more sessions.
“As introduced, our intention with this Summit continues to be to look to the future; to build awareness and understanding of the many elements involved in and influencing the electronic sharing of health information, and to foster collaboration between DirectTrust members and DirectTrust members with non-members. Our goal is to help advance the industry’s progress toward achieving secure exchange among provider organizations, and between providers and patients nationwide,” Stuewe continued.
“With this in mind, we’re eager to learn about and share new and original applications of Direct Secure Messaging and interoperability, and invite industry experts to share their submissions on our Call for Proposals link,” concluded Stuewe.
This year’s Summit also adds a host committee responsible for evaluating speaker proposals and driving awareness of the event.
Members of the Host Committee were selected for their distinguished positions in healthcare interoperability. They include:
Jodi G. Daniel, JD, Partner, Crowell & Moring;
Leslie Kelly Hall, Founder, Engaging Patient Strategies and Consulting Executive, LifeWIRE Group;
David Kibbe, MD, MBA, Principal, The Kibbe Group;
Steven Lane, MD, MPH, FAAFP, Clinical Informatics Director, Privacy, Information Security, and Interoperability as well as a family medicine physician with Sutter Health;
Micky Tripathi, President and CEO, Massachusetts eHealth Collaborative
The Summit is open to both DirectTrust members and non-members. Additional information about the Summit—including Registration, Early Bird pricing, and Call for Speaker Proposals—may be found at bit.ly/DTSummit2020.
HITRUST CSF Certified status demonstrates that the organization’s Population Health Platform has met key regulations and industry-defined requirements and is appropriately managing risk. This achievement places Relias in an elite group of organizations worldwide that have earned this certification. By including federal and state regulations, standards and frameworks, and incorporating a risk-based approach, the HITRUST CSF helps organizations address these challenges through a comprehensive and flexible framework of prescriptive and scalable security controls.
“Organizations like ours are under great pressure to meet complex compliance requirements that include technical and process elements such as HIPAA, NIST, ISO and COBIT,” said Ben Johnson, general manager for the Relias Population Health Solution. “The HITRUST CSF is the gold-standard that needs to be met, and Relias is pleased to be able to demonstrate its commitment by achieving HITRUST CSF Certification.”
“HITRUST has been working with the industry to ensure the appropriate information protection requirements are met when sensitive information is accessed or stored in a cloud environment,” said Ken Vander Wal, chief compliance officer, HITRUST. “We are pleased that Relias has taken the steps necessary to achieve HITRUST CSF Certified status, and we expect their customers to have confidence in this designation.”
The shortage of specialist physicians in the United States continues to receive a great deal of attention as an area of concern. However, a lesser-known compounding factor is the increase in referral rates. In a 2012 study, the National Ambulatory Medical Care Surveys found that between 1999 and 2009, the probability of receiving a specialist referral during an ambulatory patient visit increased from 4.8% to 9.3%, a 92% increase, nearly double. While this study is now several years old, we can surmise that this trend has continued due to the persistence of several factors contributing to the overall disparity between specialist referrals and the number of available specialist physicians.
The clear impact of these compounded problems is substantially increased wait times among patients with a physician referral for specialist appointment. In 15 major metro areas, a recent Merritt Hawkins study covering the medical specialties of cardiology, dermatology, orthopedic surgery, and obstetrics and gynecology, found appointment wait times increased 25% from 2014 to 2017. Wait times averaged 24.1 days across the study, with some extreme cases waiting 165 days for an appointment.
Long wait times impact patient outcomes and healthcare operations
On top of the anguish and emotional impact of waiting for care, diseases and illnesses can progress as patients sit in appointment queues for weeks or even months on end. As NEJM describes, “long waits before appointments, particularly specialist appointments, often contribute to the development of avoidable complications,” which cause more difficult health cases both for the patient and for the physicians caring for them.
There are notable effects on healthcare operations that add to the case for reducing patient wait times as a crucial avenue for improving healthcare overall. For example, long wait times for appointments increase the prevalence of no-shows, indicating that patients are either frustrated enough to not follow through on scheduled appointments or forget appointments altogether because of the long interim period. Sometimes appointments can even be moved around by specialist physicians at the last minute, leaving patients in limbo for even longer.
Additionally, long wait times frequently lead to patients receiving inefficient care. Firstly, extended waits often deter patients from seeking initial care. This shifts the healthcare industry away from proactive to reactive care, which is less effective and more costly for all parties involved. Secondly, the inability to access the care they need and when they need it, leads to patients seeking care within inappropriate settings. These patients are more likely to be admitted to EDs, as the 30-day rate of ED and inpatient usage was 8.7 times higher for patients awaiting a specialist appointment. A study by Truven Health Analytics noted that 71% emergency room visits are unnecessary and avoidable. Each of these issues alone make strong cases for reducing patient wait times; these issues combined suggest reducing patient wait times is a crucial goal that must be prioritized when it comes to streamlining healthcare delivery and improving quality of care.
In light of these concerning figures and effects, healthcare organization operations are turning their focus toward reducing wait times and improving patient outcomes. This fits well as part of an overall strategy to increase quality and efficiency of healthcare delivery. Below, we will focus on how telehealth platforms, specifically eConsults, combat multiple factors driving specialist appointment wait times, streamlining the physician referral process and thereby reducing patient wait times for happier and healthier patients.
Positive impacts of reducing patient wait times by accessing specialty care from within primary care
Increasingly, healthcare providers are entering into value-based payment arrangements. Telehealth solutions, and specifically eConsults, can support the drive toward more efficient care by increasing access to specialists while better optimizing time and place of care.
eConsults are is an electronic form of peer-to-peer collaboration, providing PCPs with a platform to consult with specialists on specific patient cases. eConsult interaction occurs using a secure, HIPAA-compliant messaging platform, where specialist guidance is received within 24 hours, drastically reducing the interim time between referral and treatment. eConsults can replace more than 70% of routine referrals with immediate, specialist-guided treatment from the PCP, without the wait and additional cost. Keeping lower acuity patients out of the specialist referral queue means faster access to face-to-face visits for the higher acuity patients, expediting care and improving outcomes for all.
One provider (and frequent user of AristaMD eConsults) at a Federally Qualified Healthcare Center describes the challenges of securing specialty care for the patients at her clinic: “Especially with MediCal patients, it usually takes at least four or five months for a patient to complete a referral. Very often, patients end up waiting three to five months, then receive notification their appointment has changed, the specialist has moved, or even that the specialist is no longer taking that patient’s insurance. Some of these patients are then in limbo for more than six to nine months. This is where the benefit of AristaMD’s eConsult platform comes in. AristaMD specialists provide guidance on patient care plans, for example diagnostic or medication recommendations, within 24 hours.”
Several studies have already noted demonstrable decreases in wait times once eConsults were introduced in large health systems. The San Francisco Department of Public Health saw dramatic improvements following the introduction of their eConsult program. The median wait time for a non-urgent appointment with a rheumatology specialist was drastically reduced from 126 days to 29 days. Additionally, patients visiting specialists needed fewer follow-up appointments as a result of a more extensive pre-visit workup made possible by this telehealth platform. Other similar successes have been observed in Los Angeles and the NYC Health + Hospitals System, with the latter finding that median wait times for high-urgency specialist visits decreased from 30 days to 16 days as a result of eConsult implementation.
Conclusion
eConsults are ideal for addressing the growing problem of lengthy patient wait times. They empower PCPs to deliver specialist-guided care to lower acuity patients in a timely manner while freeing up the capacity for in-person specialist visits for the more complex, higher acuity patients who need them most.
The term “social determinants of health” is far more than a trendy new buzzword in health care. Serving the physical, mental and social needs of the community is not just the right thing to do but can mean substantial improvement in care and reduction in unnecessary healthcare costs.
Several studies have shown that addressing social needs, such as food or housing insecurity, can have a significant impact on a person’s healthcare outcomes and costs. Individuals experiencing housing insecurity or homelessness have higher rates of chronic diseases such as high blood pressure, heart disease, diabetes, asthma, chronic bronchitis, and HIV. This in turn leads to higher utilization of healthcare services such as emergency room visits, inpatient hospitalization and longer lengths of stay compared to those individuals with secure housing. Similar results are seen in those experiencing food insecurity.
Hospitals often state that part of their mission is to provide high quality care and improve the community’s health, or community benefit. A recent study of hospital mission statements in three states (Ohio, Florida and Texas) found that while quality was cited most often (65%), the second most frequently used term was community benefit (24%).[1] If community benefit or community health is part of your health system’s mission statement, how much are you really doing to address the whole health of a community vs. just addressing their “sickness” needs?
At PCCI, our combination of data scientists and expert clinicians believe that health systems have an obligation to address social determinants of health to ultimately remove the disparities and inequality that we see in our community’s health. Yet this is tricky because success requires outreach skills, community relationships and data insights that extend beyond the traditional promise of health-related services. That said, there are three key elements that can assist health systems in making an investment in social determinants of health a reality. To move from theory to action, my suggestion is that health systems do the following:
Leverage the board’s community presence to align on areas of greatest need
As part of health system leadership, board members ensure alignment between mission and a defined SDoH strategy at all levels of the organization. As community representatives themselves, board members can also create the momentum and connections that health systems need to bring community and business partners together to create a governance structure for launching a connected community of care. Such governance structure will guide the strategy, legal and policy needs, and the investment and execution of a connected and aligned SDoH strategy.
Invest in long-term partnerships to ensure sustainability
Recognize that as health systems, you alone cannot solve for social determinants. To truly meet the social, behavioral and emotional needs of some of the most vulnerable individuals in your community, you need to identify community partners with expertise in these areas. With the assistance of board members, assemble a partnership collaborative, with a formal governance structure, to build community-based strategies around SDoH needs. Support the sustainability of this collaborative with technology and data science techniques to identify specific root causes of social need in target populations, share data, and measure impact of interventions. Identify an independent partner to evaluate the effectively of the SDoH initiatives and measure the cost, savings and impact across the community and for the health system.
One of the many aspects that insurers focus on to create more value through their health plans is to improve communication with the members. In the era of growing digitization, most payers have started to offer online services. However, many beneficiaries still use traditional channels to interact with insurers.
Does it imply that members are averse to using digital channels for communication?
Absolutely not!
On the contrary, members are, in fact, more inclined to using digital channels than ever before. A survey revealed that 77 percent of consumers would like to pay their health insurance bills through an online portal. If members have the option to use digitized modes and they still continue to use the traditional modes, it clearly indicates there is a problem.
What prevents beneficiaries from using digital channels?
At this point in time, multinational giants such as Amazon and Google have made customers accustomed to unbeatable customized digital content. If members are still using old forms of communication, that is bad news for health plans. The probable reason behind this is unsynchronized information on offline and online channels.
Take an example of a member who has been communicating with their insurer through a call center and wants to shift to online communication. For that, they would have to share all their details on the new channel all over again, despite the fact that their information was already available to the insurer. This may lead to frustration because this interaction is neither convenient nor fast. As a result, they wouldn’t want to switch to a channel that makes the process more cumbersome than before.
The solution? Building omnichannel capabilities
For digital channels of communications to thrive and boost member experience, payers must work on developing omnichannel capabilities. Omnichannel communication can allow members to switch seamlessly between online and offline channels at their own convenience, without any additional steps. Even though most health plans offer digital communication, can only creating omnichannel communication maximize its value?
While working in the tech industry can be rewarding due to the creation & implementation of process improvement, it also can be a demanding and high-stress environment. Companies are beginning to take notice and are looking to avoid employee burnout and improve overall morale in order to increase not only productivity, but to decrease turnover and meet employee satisfaction. Whether you’re looking to change jobs, or finding ways to enhance management style, focusing on a few ways to reduce workplace stress can go a long way in the long-term care of your employees.
Focus on Mental Health
Whether it’s providing online or in-person counseling resources, therapy can provide an ongoing judgement-free discussion outside of work where you can open up and receive a care plan that meets your overall goals. Covered by your healthcare plan with a small co-pay due at visitation, employers that provide the needed tools for mental health improvement can find employees that are not only handling stress more efficiently, productivity will improve. Employees can find comfort that as these ongoing discussions occur, the work-life balance begins to take even more shape.
Promote Flexible Schedules
With burnout occurring with long, demanding hours in the office, not to mention the commute, many companies are choosing to promote flexible work schedules in order to reduce stress. Choosing your own start and stop hours as long as you meet the minimum required amount, whether it’s 8 or 10 hours, may make the difference if some days it helps to sleep in a little to rest for staying late the following day. In addition, allowing work from home can be refreshing, as you avoid the commute, attire, and break from other staff members, in the comfort of your own home office.
By Kali Durgampudi, chief technology, innovation officer, Greenway Health.
Kali Durgampudi
Like so many industries in today’s Third Industrial Revolution, the pace of innovation in healthcare today is fast and ever-changing. New technologies – like artificial intelligence (AI), machine learning, big data, the Internet of Things (IoT) and voice recognition – are at the heart of applications and tools that are becoming demanded by patients and more ingrained in clinicians’ daily workflows.
For vendors developing new solutions based on these technologies, it appears they find themselves in a ‘race,’ striving to be first-to-market in order to establish their competitive edge. But being on the bleeding edge of innovation isn’t always easy. The healthcare industry has not been immune to this rapid quest for first-mover advantage. Often when this occurs, these new solutions sacrifice the quality and functionality required to deliver on promised improvements.
Think about the initial introduction of the electronic health record (EHR). Billed as a way to make practices and physicians more efficient, many early EHR solutions had the opposite effect – creating a significant learning curve and adding to physicians’ workloads overall. While EHRs may have made great strides toward digitizing medical records, taking paper and manual processes out of the equation, they often created new problems that placed different burdens on practices, providers and patients. In fact, in the early days, physicians reported spending more than half of their workday – an average of six hours – using the EHR, plus another 86 minutes after hours.
But EHRs are not the only healthcare technology solution attributing to this challenge – it transcends innovation across the entire health IT sector. As an industry, we must take a step back and slowdown to ensure all new technology can deliver meaningful change to practices, providers and patients.
How to Design New Healthcare Technology with the End-User in Mind
A key to ensuring healthcare technology delivers true benefits is considering how it will fit into day-to-day operations of the end-user – whether that be a patient, a nurse, a surgeon or a billing manager. Before introducing any new technology to the market, make sure your first intention is to get it right.
To do that, engineering teams must employ “user-centered design,” a concept that emerged in the mid-1980s. This approach, defined by the International Standards Organization, “aims to make systems usable and useful by focusing on the users, their needs and requirements, and by applying human factors/ergonomics, usability knowledge and techniques.” The goal ultimately is to enhance effectiveness and efficiency, improve human well-being, user satisfaction, accessibility and sustainability, and to counteract possible adverse effects of use on human health, safety and performance.
User-centered design in healthcare could entail shadowing a nurse to observe his workflow when triaging patients, following a surgeon to see how she develops post-op papers, or interviewing patients to understand how they obtain healthcare information in their daily lives.
With that experience, you can then ascertain what capabilities would make users’ lives easier or more effective. From there, determine if there’s a way to improve an existing product on the market to fulfill needs, or whether a completely new platform is required.
Key Questions to Answer When Implementing a User-Centered Design Approach
There are several questions you must consider when following this method:
DirectTrust announces its Second Annual DirectTrust Summit, scheduled at the Washington Marriott Georgetown in Washington, DC, June 9-10, 2020. DirectTrust also announced its call for speaker proposals is now open to health information industry experts interested in speaking at the Summit.
Relias announces 
While working in the tech industry can be rewarding due to the creation & implementation of process improvement, it also can be a 