By John Schneider, chief technology officer, Apixio.
John Schneider
Signed into law nearly a quarter century ago, the Health Insurance Portability and Accountability Act (HIPAA) has not aged well in the information technology world. HIPAA itself is largely misunderstood. I don’t know how many times I’ve heard someone tell me about the “Health Information Privacy Act.” However, it’s easy to understand where the confusion comes from. Who hasn’t heard a story about a ransomware attack, data breach, or privacy violation in the news? And it’s not just happening in the healthcare domain—it’s happening everywhere.
The truth of the matter is that security and privacy breaches in healthcare and other industries are a common occurrence. This has resulted in an unhealthy preoccupation by the healthcare community with the security and privacy provisions in the HIPAA legislation that fall under Title II Administrative Simplification. This too is easy to understand—unlike other industries that seemingly get off Scot free after a breach, the healthcare industry is held to an actual standard, and there are penalties for not meeting this standard that can be reputationally and financially ruinous.
To fully understand the healthcare community’s preoccupation with the HIPAA Title II provisions, we need a little background on what HIPAA is. HIPAA has five provisions called Titles. The two key provisions are Title I, HIPAA Health Insurance Reform, and Title II, HIPAA Administrative Simplification. All of the security and privacy regulations stem from Title II, but “Administrative Simplification” doesn’t exactly shout out “security and privacy” (although the Privacy Rule and Security Rule are 2 of the 5 sections in Title II). Title II doesn’t even provide regulations—it simply hands that responsibility off to the Department of Health and Human Services (HHS) to create such regulations as it sees fit, so ultimately, these are the regulations that we’re contending with and are driving behavior that’s limiting the value of data we’re collecting in healthcare.
Let’s first look at the two types of regulations that cause the most adverse behavior.
Sharing Constraints: There are a number of requirements in privacy regulations that constrain sharing, and many are common-sense business-use rules that protect patients effectively. There are also some regulations that state that covered entities (regulation-speak for providers) should only share data they have with other business associates that are directly participating in the care and management of the patient. These effectively prevent the use of healthcare data to create new and innovative products because product development isn’t related to patient care or management.
Punishments for Breaches: Breaches can be financially painful or even ruinous for a business. The penalties associated with breaches make executives think twice about the use of the data they have, even with business associates helping them manage care, because the risk to them is very real. What this means in the real world is that it can take a long time for a new business with a good idea to improve healthcare delivery to gain traction because the holders of data are reluctant to give these businesses the data they need.
These issues are real and are having negative effects in the healthcare industry. However, these same issues are not impeding innovation in other industries that have just as much (or more) private information. What gives here? Healthcare isn’t getting a fair shake.
There are a number of inequities in healthcare that we should take issue with:
There’s an uneven playing field. Think about where the data is in healthcare. It’s largely in the hands of the providers. They effectively own this data, even though technically it belongs to patients. Small startups have no access to this data. They have to hunt for providers willing to share. Often, the cost of sharing are onerous business terms. The larger the cache of data, the more advantaged you become, and in an industry like healthcare that is ostensibly rallied around social good, this should not be okay.
If you do get data, you might become a target. There are many examples where companies (for example, Google this past year) are harassed for doing innovative research for no other reason than they’re visible and have deep pockets. The problem is that we have obsolete regulations that are being used to make a point that isn’t valid in our modern context.
Most of the data we’ve accumulated isn’t used for innovation. The data outlook in healthcare has come a long way in the last ten years since the HITECH act was passed. Electronic medical records have gone from being sparsely used to nearly universal, but most of this data goes unused beyond the walled gardens of the medical record systems they live in. Artificial intelligence and machine learning applications depend on large, real-world datasets and could be put to use to build technology and resources to identify distinct risk profiles, analyze the effectiveness of treatment protocols across specific patient populations, or surface insights that can dramatically improve the speed and quality of care. But only the few commercial entities that have access to data can play in this space.
As primary care providers (PCPs), we’re increasingly trying to manage total patient care for more patients and facing worsening challenges in ensuring our patients can access the care they need.
In 2009, a short ten years ago, there were an estimated 209,000 PCPs providing services for a patient population that has now already exceeded 325 million individuals. The number of specialist referrals has doubled since 1999, increasing wait times and potentially diminishing overall healthcare quality for patients. Even more worrisome and adding to the challenge of access to specialty care is the projected shortage of up to 104,900 physicians in the United States by 2030—61,800 of whom will be specialists.
This worsening shortage in specialty care physicians adds to other factors challenging access, including Medicaid and Medicare acceptance rates, geographic barriers, and financial burden. eConsults can provide a solution for this growing problem. eConsults help mitigate access challenges by providing rapid specialist insights to PCPs who allow us to provide more comprehensive care, improving patient outcomes and satisfaction, all while reducing healthcare costs for patients and paying entities.
From my experience, there are three main benefits that eConsults contribute to delivering timely access to high-quality care:
At community health center practices, a routine referral can take 1 to 2 months before patients are able to be seen face-to-face by a specialist. For our patients, barriers to specialty care access are multi-faceted including limited regional specialist availability, patient transportation to and from visits, as well as a multitude of cost factors such as missed work, childcare, and out-of-pocket expenses. The use of eConsults provides a method of collaborating with specialists via an online portal to quickly provide access to specialty care for many patients—some of whom may otherwise go without.
Leveraging eConsults allows us to identify whether a face-to-face specialist referral is necessary for a patient, or if they can be treated within primary care with specialist guidance. eConsults are capable of replacing a large percentage of face-to-face referrals, but even in cases where the eConsult specialist does recommend a face-to-face visit, PCPs gain insight prior to the appointment on any workup that can be done in advance of the patient’s specialist visit. This saves time for both patients and overworked specialists. AristaMD’s eConsult platform is a guide to help PCPs provide patients with comprehensive, efficient, and effective care. It gives us the ability to provide “double the care for the patient” as they are being cared for by their primary physician and the consulting specialist.
In my experience, eConsults have been particularly successful with endocrinology cases. Typically, these cases don’t require a face-to-face visit, but instead require diagnostics that can be ordered by a PCP and reviewed by a specialist who provides a quick recommendation on the patient’s treatment plan. I’ve had cases in the past where a specialist’s treatment plan included diagnostic lab testing every 4 to 6 months for the patient. In this case, the patient was able to avoid numerous specialist visits and was able to do the routine lab regimen within primary care.
As PCPs, it’s our responsibility to do what we can to positively impact the health of our communities. As part of this duty, it’s imperative we shepherd innovative solutions, such as different types of telehealth. I’ve used eConsults as an effective tool to reduce specialist referrals, which results in low-acuity patients being treated quickly within primary care. This ensures many patients are able to access care within days, opposed to months. For many patients, this is the difference between a worsening condition and sending them to the ER, versus managing their conditions within the comfort of their PCP’s office.
Imagine your favorite football team is in a real neck-to-neck with another team, and the game could tip in anyone’s favor. It is the last minute, and in an insane turn of events, the quarterback throws the ball in the air, hoping the player in the end zone could make a touchdown. Instead, the reckless throw results in confusion, the guy in the end zone gets tackled, and the game ends in disappointment.
Now, let’s step out of football and look at these statistics that show a little picture of referrals in healthcare:
Only about 50% of referrals result in a completed appointment
Less than 25% of referrals are completed as intended by the referring provider
In case one, the player didn’t score a touchdown, and in the second case, the patient didn’t end up with the right provider and the treatment. The reason being the process— a reckless throw and an inefficient referral procedure.
Most healthcare organizations lose about 30% to 60% of patients on account of inefficient referrals. Value-based care is expected to become the leading payment model by the year 2020, and healthcare organizations cannot afford losing more than half of their revenues due to reduced referral leakages.
How do you know that your referral management needs healing?
Imagine a situation where a patient, in his early 60s, suddenly suffers from severe abdominal pain. He goes to his doctor, and the doctor directs him to a specialist she knew out of her professional knowledge.
Now the situation can unfold in many ways, where the patient might end up getting treated or the exact opposite of it. In all the scenarios, the part where things might go wrong is the process of referring the patient. The problems that these stakeholders might face include:
The inability to identify in-network providers
Lack of proper patient information
Limited access to information flow among providers
Reliance on age-old techniques of fax-based referrals
… and many more.
Now the question is: ‘What is the solution?’
It all boils down to just one thing— having the right data. Imagine you visit your doctor. The moment you tell him your problem, he looks into his screen to look for the right specialist. In just one click, he gets all the correct specialists in a listicle format. And all he has to do for the rest of the story is just click on the ‘Refer’ button.
Seems undoable? Actually, all we need is a data-driven strategy.
Don’t just plan your data but also your approach
It is never about just knowing the patients but understanding them, their health, their socio-economic condition, and their care journeys. All of this is not possible if we do not have access to the right data. Whether it be a lab test or spiking blood pressure— nothing should be left undetected.
Easier it is for providers to understand, efficient will be the referral
You cannot expect the rest of the process to be perfect if the beginning is imperfect. If the provider is stuck finding the information, not only will this delay the referral but also increase the chances of errors. What they need is a single screen view of specialists in a list that includes every detail such as geography, specialist ranking, availability, and fees, among others.
Connecting communities and care teams to deliver the best care
It is crucial that care teams and communities remain aware of the events happening in the patients’ care journeys. They need a streamlined tracking of patient referrals at the clinical or patient level. It will reduce the turnaround time for escalations.
The patient lost in the process is the revenue lost
The right referral strategy includes two significant aspects:
Increasing the visibility into the process to the patient
Using advanced analytics tools to develop a lens into the referral process
What they need is a simple reminder that enlists all the details regarding the visit and gives timely updates to them regarding the specialist and the appointment date. Organizations can increase patients’ access to telehealth services by allowing plans to propose the use of telehealth services instead of promoting in-person visits.
By Adarsh Jain, editor, Transparency Market Research.
A rosy picture is always a tricky perception. Artificial Intelligence or AI as it is known, is also very similar. Research publications are inundated with the findings that integrate AI with industry for better outcomes. And in most cases, these findings prove to be worthy in one way or other. But, the picture for healthcare is not as rosy as it seems to be. While tech companies across the world have invested in developing products that will assist the practitioner in making better decisions, doctors have their own doubts in implementing them. Despite these doubts, there is enough hope for players in an upcoming market like AI in healthcare, finds a Transparency Market Research study.
Will AI take away jobs?
In most industries, this has been the million dollar question. And, as serious as it may sound, experts have, time and again, clarified that AI is not going to take away jobs. It, of course, will augment decision-making and, thus, help produce better outcomes. Healthcare should be no different.
Before medical practitioners make a hasty call, it is important for them to realize that AI is a machine, and it clearly works based on algorithms. A machine does not have a human brain to be able to take conscious decisions. It, however, is only a critical aid in taking better decisions. There is no doubt that a large pool of data on admissions, medical history, procedures, conditions, etc. remains untouched across the world, states the TMR study. Processing and inferring from this large a pool of data is humanly impossible. This is where AI can aid physicians. What has happened is that the use of AI has affected radiologists and pathologists the most. For long, these two healthcare professionals have been the backbone of discerning abnormalities in human body functions or detecting conditions.
While healthcare organizations and experts, including government representatives, have proposed the use of AI in diagnosis, the risk of misjudgment bothers medical professionals. A wrong diagnosis or treatment could result in loss of life, and invite severe action against the healthcare professional. This argument from the healthcare professionals hold weight and, perhaps is a strong emotional reason for doctors from being reluctant towards introducing AI in their practice.
Lack of regulations is the caveat
A process bound by regulations is always more effective. In most countries, there is no law that defines the use of AI in medical practice. There is hardly any information that speaks about the limit to which the use of AI should be restricted. Also, the lack of information on the right usage, and ensuring all inferences or decisions based on AI are error-free is a huge caveat.
At a time when tech giants, especially in the United States, are vigorously working towards rolling out AI in healthcare, it is prudent to have regulations that define usage. It is just the matter of one country making the move, and when that happens, the rest are likely to follow suit, states the TMR report.
The Health Insurance Portability and Accountability Act (HIPAA), a bill passed initially in 1996, consists of a set of rules and regulations that protect the privacy and security of health information and provide individuals with certain rights to their health information.
Health and health-related entities play a pivotal role in protecting the privacy and security of sensitive data, so it is important that those entities are perfectly aware of what constitutes a breach under HIPAA terms, in addition to knowing what the actual regulations say and are all about. Check below some examples of HIPAA breaches.
Foreword: not all data breaches are HIPAA breaches
It is common for someone to think that, under HIPAA, any data breach constitutes an immediate breach of HIPAA regulations. However, this is not always the case, and the reason for that is quite simple.
Breaches are something relatively common and that happens in virtually all industries. Even tech giants fall victim to breaches caused by attacks so, even if a company holds strongly to each and every HIPAA regulation, it is impossible to guarantee 100% security, which is especially true considering how fast technology and hackers evolve.
As one might expect, one of the most recorded types of data breaches has to do with one of HIPAA’s core goals, which is the protection of healthcare records. Usually committed by employees, this breach can often result in termination and even in criminal charges for the offender. While relatively uncommon, the entity can also be fined.
Lack of PHI access controls
Protected Health Information (PHI) is the name for any information about health status, provision of health care, or payment for health care that is created or collected by a health or health-related entity and is also a central point of HIPAA.
In fact, HIPAA clearly establishes, in its HIPAA Security Rules, that entities and their partners (i.e., other entities they communicate PHI and other sensitive data with) need to ensure that PHI can only be accessed by authorized individuals. This is a common breach and is often met with high financial fines.
Failure to encrypt (or similar protection) PHI
One of the most effective ways to ensure PHI privacy and safety is to use encryption on all stages of PHI usage, including offline storage, online storage, and data transmission over a network. Encryption is very safe – in fact, so safe that breaches of encrypted PHI do not have to be reported (unless the decryption key is also stolen or if the data is re-encrypted, a situation in which the responsible entity would also lose access to that data).
While HIPAA does not enforce the use of encryption, it is by far the best option to store and transmit PHI. If it is not used, an alternative kind of protection needs to be used – otherwise, PHI data breaches will surely happen.
Over the last few years, hospitals and healthcare practices throughout the country have started adopting new technology that helps them provide better care to their patients and make life easier for their employees.
For example, 64 percent of physicians now send electronic messages to their patients via text or email. Meanwhile, 63 percent allow their patients to view their medical records online.
Are you looking for new ways to bring your practice into the 21st Century? Listed below are seven of the top healthcare technology trends you ought to know about and consider implementing in your practice.
Electronic Medical Records
Electronic medical records (or EMR for short) are one of the most popular tech trends in the healthcare world.
Lots of practices have started using EMR to simplify the process of searching for patient records. EMR has also made it easier for patients to access their medical records online.
Even though plenty of practices are making use of EMR, there are still a lot of them that haven’t made the switch yet. The sooner you start making your files available in a digital format, the sooner you’ll start reaping all the benefits of EMR.
For example, EMR provides immediate access to patient records. It also helps physicians make better decisions about their patient’s care.
They can spot patterns more easily when everything is in front of them. This, in turn, allows them to choose the best treatment approach and avoid missing something important.
Blockchain Technology
Blockchain has started to make its way into the healthcare world, and it’s not showing any signs of leaving.
Blockchain technology allows healthcare practices (and other businesses, for that matter) to store digital information without taking up a ton of space. It also allows them to store their information in a more secure way since it cannot be copied.
In the digital age, patient security and privacy protection are of the utmost importance to many healthcare professionals.
Blockchain systems allow practice owners and managers to ensure they’re keeping patient records and information safe. It also helps them to avoid expensive and harmful (on many levels) data breaches.
Telemedicine
In 2019, many people are looking for new ways to get things done without leaving their homes. They have groceries delivered to their door, for example, and they communicate with friends and family via video chat.
Lots of healthcare practices are jumping in on this trend and are making it easier for patients to have their medical needs met from the comfort of their own homes as well.
Telemedicine allows patients to talk to doctors, receive medical advice, and even have prescriptions filled, without having to make a special trip to the doctor’s office.
Physicians are also using these same technologies to communicate with each other in more effective ways and come up with better, more comprehensive solutions for their patients.
Artificial Intelligence
Artificial intelligence is for way more than gaming. It’s also one of the biggest healthcare trends of 2019.
Physicians and researchers have started or have plans to start using artificial intelligence in a variety of ways.
As artificial intelligence technology becomes more refined, it will be easier for healthcare professionals to monitor their patients and provide better diagnosis and treatment.
It will also likely enhance the telemedicine world as well, as it will make it easier for physicians to see their patients without having to be in the same physical location as them.
Wearables
Wearable health monitoring devices are not new. However, they’ve become more popular than ever, and they’re also becoming more advanced.
As these devices become more accurate and able to provide more details about the wearer’s health, it’s likely that many physicians will start relying on them to gather information about their patient’s health and daily habits.
For any expectant new mum, it’s important that you take care of yourself during pregnancy and understand how to lower your risks of harming the baby. While there are occasions when health risks to your baby are unpreventable, there are also many things you can do to avoid problems occurring, so you can give birth to a healthy baby.
It’s vital you take the below points into consideration, but try not to become so obsessed that you start to lose the enjoyment of being an expectant mum. Here are just some of the best things you can do to stay healthy during pregnancy: 1. Eat right A healthy diet is even more important for pregnant women, as your baby needs the right foods in order to grow fully and reduce the chances of developing health issues. While you should still be eating the foods you enjoy, you should try implementing more fruits, vegetables, and calcium-rich foods into your diet, so your baby has been given the very best nutrition before they enter the world.
2. Don’t smoke
Decades ago, it was the norm for expectant mothers to smoke while pregnant; however, there have now been findings to suggest that it can increase the likelihood of SIDS (Sudden Infant Death Syndrome), premature birth, miscarriage, and other health disorders. If you are a smoker, it should be in your interests to research more on the impacts of smoking during pregnancy and the best ways to quit.
3. Reduce stress levels
Everyone deals with some form of stress in their life, but extreme stress during pregnancy can have an impact on the baby’s health and even result in negative birth outcomes. Having said that, problems during birth aren’t always at the fault of the mother. Sometimes, injuries caused by medical professionals during birth can go on to have long-term health impacts for your new-born. If ever this were to be the case, you need to seek help and get the compensation through birth injury solicitors who will help you get the justice you deserve. 4. Get plenty of sleep
Everyone should be getting enough sleep, but this is even more important when you’re pregnant. With that being said, it can be difficult to sleep well through the night once your baby gets bigger. An average 7-9 hours would be recommended, so both yourself and your baby are well-rested. Always aim to sleep on your left side, as it’s not only the most comfortable position but also allows your heart to pump blood around the body much easier, which passes through to your baby.
5. Exercise
The U.S department of health recommends that pregnant women should be getting an average of 2 hours and 30 minutes of exercise each week to improve your baby’s health. This will be easy to achieve if you’re already fairly active or have a regular workout routine to keep up. However, it may be best to talk to your GP to check that the exercise you carry out isn’t too vigorous. Carrying out a regular exercise routine can have the following benefits:
Better sleep pattern
Reduced pregnancy-related issues, including swelling in the ankles and feet, back pain, and constipation.
Losing a friend or family member is a very stressful experience, especially if the death has come about unexpectedly. During this time, it can be difficult to know what the correct processes and procedures are to go through. Emotions can be high, and so it can be easy to lose track of what happens when and what your obligations are.
This article looks at some of the more common procedures that need to be taken into account following the death of a family member or close relative for which you have responsibility and can help make things simpler.
Seek a Formal Declaration of Death
Part of officially registering the death will involve specifying the cause of death. In some circumstances where the cause of death was unknown, or the death may have arisen from suspicious circumstances it will be referred to a coroner. A coroner’s inquest can take up to six months from the date of death. If it’s found that the death was a result of medical negligence, you will need to find out the medical negligence claims time limit and begin the process of making a claim.
After the coroner’s verdict, or if the cause of death was clear the death can be officially registered by a medical professional. They will need to formally pronounce whoever has passed away as dead. If the death has occurred outside of a place where there are medical professionals present then you will need to follow this process. If someone has died in a hospital, for example then this will usually be done by a member of the medical staff in that institution.
Arrange a Ceremony or Funeral
After someone has died their body will usually be transferred to a mortuary or a funeral home. It’s at this point that you will be able to make decisions about whether the body will be buried or cremated. Both places will be able to provide you with official certificates of death.
Before passing, whoever has died may have specified their preference as to whether they would like to be cremated or buried. This might make this decision easier as you should honor their last wishes. They may have also left money behind to pay for all or part of a ceremony – which can be found in their will.
Once you have organized the funeral, or a few days before you do, you will need to notify friends and family about their death. This can be a very difficult activity, and it may help to have someone close to you to help you with this.
Deal with Bills and Housing
One of the last things you will need to do is inform utility companies and cancel social security. This will ensure that any benefits they were receiving will stop and that things like power and water are turned off in their home. Banks, employers, and any other accounts will also need to be canceled.
After this, you will need to begin clearing out their belongings from the house and put them into storage, sell them, or give them away to goodwill.
Imagine your favorite football team is in a real neck-to-neck with another team, and the game could tip in anyone’s favor. It is the last minute, and in an insane turn of events, the quarterback throws the ball in the air, hoping the player in the end zone could make a touchdown. Instead, the reckless throw results in confusion, the guy in the end zone gets tackled, and the game ends in disappointment.
A rosy picture is always a tricky perception. Artificial Intelligence or AI as it is known, is also very similar. Research publications are inundated with the findings that integrate AI with industry for better outcomes. And in most cases, these findings prove to be worthy in one way or other. But, the picture for healthcare is not as rosy as it seems to be. While tech companies across the world have invested in developing products that will assist the practitioner in making better decisions, doctors have their own doubts in implementing them. Despite these doubts, there is enough hope for players in an upcoming market like AI in healthcare, finds a 
Over the last few years, hospitals and healthcare practices throughout the country have started adopting new technology that helps them provide better care to their patients and make life easier for their employees.