Patients who are suffering from a short or long-term injury, or who have been diagnosed with a medical condition, might face difficulty when performing simple and complex tasks within the home. Thankfully, there are various technologies and assistive equipment that can support mobility and help them hold onto their independence.
There are numerous categories for assistive technology, which can enhance a person’s quality of life. Learn how patients can stay independent with the different forms of assistive technologies.
Adaptive Equipment to Support Daily Living
Adaptive equipment makes it possible for people to perform everyday tasks so that they can sustain a great quality of life. Many hospitals and facilities will also require patients to have access to these items before they will discharge them.
For example, they will need adaptive equipment to support dressing, such as dressing sticks, elastic shoelaces, sock aids, leg straps, and long-handled shoe horns. They might also need adaptive equipment for bathing, such as a supportive sliding shower chair, transfer board, mechanical lift and grab bars. Of course, there are also various technologies available for basic mobility, such as stair lifts, power wheelchairs, lift chairs and more.
Adaptive Equipment for Instrumental Activities of Daily Living (IADLS)
IADLs can transform a person’s quality of life when living with an injury or disability, as they can simplify communications and improve safety. For example, they refer to hearing aids, screen readers, amplified telephone equipment, speech generating devices, assistive listening devices and communication boards. They can also maintain their safety with medical alert systems, such as fall detection devices and wearable call buttons.
Durable Medical Equipment for Everyday Health and Safety
Durable medical equipment can effectively support a patient within their home so that they can enjoy a greater quality of life. These are items that are most likely covered by a patient’s insurance, as they will be necessary for their everyday health and safety. Examples of the assistive technologies include hospital beds, power mobility devices, patient lifts, walkers and commode chairs.
How to Acquire Assistive Technologies
While a doctor might order a piece of equipment, it is generally up to the patient to purchase the item. In some cases, a hospital or medical facility might be happy to loan an item to a patient, yet they might need to browse the market for the best option for their needs and budget.
Most likely, in one of the few lucid moments you have in your hectic, even chaotic schedule you contemplate healthcare’s greatest problems, its most pressing questions that must be solved, obstacles and the most important hurdles that must be overcome, and how doing so would alleviate many of your woes. That’s likely an overstatement. The problems are many, some of the obstacles overwhelming.
There are opportunities, of course. But opportunities often come from problems that must be solved. And, as the saying goes, for everyone you ask, you’re likely to receive a different answer to what needs to be first addressed. So, in this series (see part 1 and part 2), we examine some of healthcare’s most pressing challenges, according to some of the sector’s most knowledgeable voices.
Without further delay, the following are some of the problems in need of solutions. Or, in other words, some of healthcare’s greatest opportunities. What is healthcare’s most pressing question, problem, hurdle, obstacle, thing to overcome? And how that can be solved/addressed?
The biggest hurdle in healthcare is the adoption and ethical use of AI, and the ability to share data gathered from it in a safe and secure way to gain actionable insights. More specifically, the world is moving towards consumer genomics. This type of technology will help patients and their caregivers better understand their health and allow for more personalized care plans—this is our role in the future of precision medicine.
Randy Tomlin, CEO and chairman of the board, MobileSmith
A pressing question for many healthcare execs is “how can I gain loyalty from the next generation of patients? With the estimated lifetime value of a new patient at $600,000, and Millennials and Generation Z making up one-half of the U.S. population, the stakes are high. Healthcare lags behind other industries in adopting a mobile-first strategy, but some health systems are branding their own mobile apps because they know that it speaks to the engaged-consumer mindset of these populations. In many cases, mobile app technology has proven to increase patient engagement, education and loyalty, while improving a hospital’s bottom line.
During my surgical training, I experienced firsthand the greatest challenge facing our healthcare system today: how we train and assess our providers. Data shows that our century-old apprenticeship based system of surgical training is struggling under a growing number of procedures and decreased hands-on time with patients. At the end of at least 14 years of education and accumulating six figures of debt, 30 percent of residency graduates still cannot operate independently. Even surgeons in practice are finding immense challenges learning new procedures and bringing them to patients. This is limiting the adoption of higher value modern technologies and limiting patient access to these lifesaving procedures. Virtual reality is opening the door for increased access and skill development in a highly precise and like-life environment. Residency programs and medical device companies are adopting virtual reality to have a much more natural learning experience with a much higher retention rate than conventional observational methods such as a book or video. We have harnessed immersive technologies to improve patient outcomes, increase the adoption of higher value medical technologies and democratize access to surgical education around the world.
Most likely, in one of the few lucid moments you have in your hectic, even chaotic schedule you contemplate healthcare’s greatest problems, its most pressing questions that must be solved, obstacles and the most important hurdles that must be overcome, and how doing so would alleviate many of your woes. That’s likely an overstatement. The problems are many, some of the obstacles overwhelming.
There are opportunities, of course. But opportunities often come from problems that must be solved. And, as the saying goes, for everyone you ask, you’re likely to receive a different answer to what needs to be first addressed. So, in this series (see part 1 and part 3), we examine some of healthcare’s most pressing challenges, according to some of the sector’s most knowledgeable voices.
Without further delay, the following are some of the problems in need of solutions. Or, in other words, some of healthcare’s greatest opportunities. What is healthcare’s most pressing question, problem, hurdle, obstacle, thing to overcome? And how that can be solved/addressed?
Lynn Carroll, chief of strategy & operations, HSBlox
Lynn Carroll
Preventable medical errors are the third leading cause of death in the U.S., and frequently can be linked to inaccurate patient data, according to a study by Johns Hopkins University. Machine learning should be used to solve patient-matching challenges by analyzing and consolidating patient data from multiple systems, such as EHRs, medical charts, e-prescribing technologies, clinical documentation solutions and revenue cycle management platforms, and by creating longitudinal patient records that can be transparently shared among the patient’s care team, optimizing care coordination. The patient-matching solution is then combined with blockchain to disseminate the relevant patient data to all parties who have permission to view it.
Extending care coordination beyond the hospital walls heavily burdens providers and healthcare administrators. As the industry continues to shift from fee-for-service to value-based care, optimizing care teams to address social determinants of health and drive patient engagement is paramount. Today’s health systems must leverage an agile workforce and intuitive technology to deliver 360-degree patient-centered care.
Dr. Samant Virk, physician, founder and CEO, MediSprout
Samant Virk, MD
As a practicing physician for the last 15 years, I had a growing frustration with the fact that more than 70 percent of my time was consumed by administrative tasks that took away from my ability to help patients. The biggest challenge of healthcare right now is that we’ve lost touch with that physician and patient connection. Question: How can we reconnect physicians with patients — tech has driven a wedge between us and it’s time to fix this. Doctors would love to spend more time with the patients that need them the most while getting paid for follow-up care and communications that eats up their day. We believe that technology is the solution here.
Healthcare must shift its focus from viewing patients as “customers” and instead consider patients as “partners” within the broader healthcare ecosystem. All of the exciting innovation underway (including the increased adoption of virtual care and telehealth) should reflect what is required for the patient/partner to better manage his/her healthcare throughout the care continuum. To solve for healthcare that is truly consumer-centric, the broader healthcare ecosystem needs to identify the best investments to make which will drive quicker and better outcomes for the individual consumer (e.g., the patient/partner), overall population health, healthcare professionals, and healthcare organizations.
Price transparency for the Employers and the patient. The explanation of benefits (EOB) does not contain real financial payments between the payer and the provider. The real numbers are considered proprietary. A patient nor employer benefit plan cannot control their healthcare costs if they do not know how much was paid and for what service. At a grocery store, each item is tagged with the name of the product and the price. In healthcare the service and or product is not presented to the patient prior to the receipt of service and the services are not itemized on the bill. What to do? Make is illegal for payers and providers to have proprietary payments on healthcare goods and services.
John D’Amore, president and chief strategy officer, Diameter Health
The most pressing problem for US healthcare is improving quality of care while reducing cost. Intelligently leveraging clinical information — for predictive analytics, precision medicine, population health analytics and other analytic purposes — is critical to solving this problem. The largest impediment to actionable analytics is dirty clinical data entered by more than four million clinicians into more than one hundred certified EHRs resulting in a clear and present need for scalable technology to normalize, de-duplicate and enrich clinical data so that data scientists can spend more time identifying actionable insights from data, and less time fixing clinical data.
I see our shortage of primary care physicians as the biggest challenge the American healthcare system faces over the next 20 years. PCPs are crucial to the patient experience, and preventative care that can help drive value. Tied to this is my concern is the lack of investment/acceleration in technology designed to improve physician experience and utilization. PCPs spend way too much time entering data when there are opportunities like voice assisted scribe or authentication that reduce data entry and allows them to spend more time completely focused on patients providing quality care.
Most likely, in one of the few lucid moments you have in your hectic, even chaotic schedule you contemplate healthcare’s greatest problems, its most pressing questions in need of solving, obstacles and the most important hurdles that must be overcome. And how solving these problems might alleviate many of your woes. That’s likely an overstatement. The problems are many, some of the obstacles overwhelming.
There are opportunities, of course. But opportunities often come from problems that must be solved. And, as the saying goes: For everyone you ask, you’re likely to receive a different answer. What must first be addressed? In this series (see part 2 and part 3), we ask. We also examine some of healthcare’s most pressing challenges, according to some of the sector’s most knowledgeable voices.
So, without further delay, the following are some of the problems in need of solutions. Or, in other words, some of healthcare’s greatest opportunities — healthcare’s most pressing questions, problems, hurdles, obstacles, things to overcome? How can they be best addressed?
Nick Knowlton, VP of strategic initiatives, Brightree
Throughout the healthcare ecosystem, patient-centric interoperability has historically been a huge challenge, specifically throughout post-acute care. This problem results in poor outcomes, unnecessary hospital re-admits, patients not getting the treatment they deserve, excessive cost burden and poor clinician satisfaction. This challenge can be solved through creating better standards, adapting existing interoperability approaches to meet the needs of post-acute care, implementing more scalable interoperable technologies, and involvement with national organizations, such as CommonWell Health Alliance and DirectTrust, amongst others.
Cybersecurity is one of the most pressing hurdles in the healthcare industry. The life and death nature of healthcare and the shift to electronic health records (EHR) creates an environment where hackers that successfully deploy ransomware and other cyberattacks can extort large sums of money from healthcare entities and steal highly sensitive data. To address this challenge, healthcare entities need to continue to increase their investment in cybersecurity and focus on improving their overall security posture by implementing tools and processes that will monitor all devices and assess their compliance with security policies; stop phishing attacks; keep all servers patched and current; ensure third party vendors comply with policies; and train employees on proper security hygiene.
Cyberattacks continue to expose the security vulnerabilities of healthcare institutions, keeping many industry stakeholders awake at night. This is why every organization handling protected health information (PHI) needs to build security frameworks and risk sharing into their infrastructure by implementing risk-mitigation strategies, preparedness planning, as well as meet industry standards for adhering to HIPAA requirements. Hospitals and healthcare systems must keep their focus on strategies and tactics that ensure business continuity in the event of an attack as it’s clearly not a matter of if a breach can happen but when.
The core problem for healthcare isn’t science, technology or caregiving intervention. It’s making sure that the systems of delivery and communications are thought through and actually respond to the way patients need and expect healthcare to be delivered. This means it doesn’t matter how advanced and perfected your health system may be — unless it conforms to culture — the way people think and behave — it will do nothing but confuse and frustrate patient needs, which are psychological and social, as well as physical and mental.
If you ask doctors, you’ll hear that electronic health records (EHR) have been both the best thing and worst thing to happen to medicine in the past 40 years. Having real-time information at your fingertips is an incredible advancement, but it’s only helpful if you can see what you need to diagnose and treat your patient. Healthcare providers consistently state their frustration with the lack of consistent, accurate data within the EHR system.
Without accurate data in the patient’s chart, doctors struggle to provide accurate and appropriate care. That’s why clinics and hospitals need to go the extra mile and customize their records in the following ways:
Invest in consulting to configure software
It’s too much to ask of our healthcare providers for them to become IT and software experts. Accessing records of earlier care and making accurate diagnoses is dependent on doctors and providers’ ability to input and extract relevant information quickly.
Even a lively family physician practice needs assistance to set up and configure an electronic healthcare record system. Even with technical staff, it’s unrealistic to expect them to configure and customize a highly complex software system to suit a unique workflow. As organizations upgrade or adopt new technology, they are relying on artificial intelligence or a technical sales support representative to migrate data.
Data is only as good as the input
Without expert configuration and data migration, the accuracy of the data is in question. Patient records need to be correct, and it needs to appear in the right place in the record. Relying on a software program to migrate data accurately may preserve your data, but if it doesn’t populate the proper fields, it’s not useful.
Efficiency is key
With only 20 minutes to see each patient, the data needs to be more than accessible. Many small offices find it cost prohibitive to fully take advantage of the software system’s features and discover it’s even more challenging to configure and customize the software to meet its full potential. Although the cost is a prominent factor, the value of a properly configured and deployed EHR is priceless.
Hire a consultant
Setting up an electronic health record is a complex endeavor. Innovative software design makes it possible to customize fields, provide reporting, and give alerts. Used efficiently, an EHR can help doctors reach conclusions more quickly and show information in a way that leads to faster diagnoses.
If the EHR isn’t configured efficiently, or if the data isn’t captured in a way that providers can access and leverage it to make smart clinical decisions, it becomes more of a roadblock than a powerful tool. Apathetic software users create inaccurate or missing data.
By Drs. Will Brandon, PhD., president and CEO of Learning ARTS, and Michael Harrington, PhD.
Dr. Will Brandon
About one in 59 children has been identified with autism spectrum disorder (ASD), according to recent estimates from the Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring Network.
Though it is still unclear whether the difference is primarily due to increased incidence of such disorders or more accurate screening procedures, ASD has become a national priority. The demand placed on treatment service is outstripping availability. One organization, Learning A.R.T.S., is turning to information technology to meet this soaring demand.
Founded in 1994 and based in California, Learning A.R.T.S. has embraced applied behavior analysis (ABA) and its focus on in-home, one-on-one instruction to improve patients’ social and life skills. It has enjoyed rapid success expanding to 11 regional locations spread across the state.
Learning A.R.T.S. programs help teach patients skills—from tying shoes to writing résumés—and foster an information- and communication-rich environment. Initially, as the organization expanded its services, the challenges were to communicate and coordinate operations across geographically dispersed facilities and client locations using traditional paper and telephone-based communication.
Applied behavioral analysis and treatment programs involve Board Certified Behavior Analysts (BCBA), specialists, and technicians. Coordination between team members is central to success of ABA, placing a premium on the flow of information among them.
Increased demand has doubled the organization’s caseload, however. To meet this demand, Learning A.R.T.S. developed a new case management strategy driven largely by the adoption of an information management technology system by Laserfiche.
Previously, Learning A.R.T.S. dealt with volumes of paper forms and data records that needed to be authenticated, reviewed, duplicated, stored and retrieved. The organization now works with the same records in digital form stored in a central computer repository. This transition required the digitization of hundreds of thousands of existing paper records, and then training staff to work with the information in a new, digital format.
The effort resulted in seemingly endless opportunity to apply new technologies for information management that could not be applied to paper records. More importantly, those opportunities mean many more ASD children and families are getting the timely assistance they need.
For example, Learning A.R.T.S. field workers can now use mobile devices, such as tablets and smartphones, to gather and file patient information in real time, on location. The data is managed through digital workflow processes that eliminate reams of redundant paperwork, and can be stored in archives and accessed immediately through a central server. This translates into significant efficiencies in HR management of staff, accounting and billing, as well as in faster delivery of client services.
The organization has seen cost savings in terms of staff accounting, new employee onboarding, payroll and billing. But one benefit outweighs any monetary return: better patient care and more positive results.
Learning A.R.T.S. has found that response times are critical to successful treatment. ASD patients frequently act out in frustration, often becoming violent, which also can be emotionally draining for field staff. Treatment response involves not only accurate and timely communications, but also a considerable amount of orientation and training relevant to the technician’s functions.
Health Level Seven(HL7) International, the global authority on interoperability of health information technology with members in 55 countries, announced election results for its board of directors at the 32nd Annual Plenary and Working Group Meeting in Baltimore, Maryland. The 2018 class of HL7 Fellows and the 2018 recipients of the W. Edward Hammond, Ph.D. volunteer of the year awards were also recognized at the event.
Incoming Board Chair
Walter Suarez, M.D., M.P.H., executive director, health IT strategy and policy, Kaiser Permanente, was selected by the membership to serve as the chair-elect in 2019 and as the board chair, 2020-2021.
HL7 Board Member Elections
Four members were elected to the HL7 board of directors for the 2019-2020 term:
Director — Kensaku Kawamoto, M.D., Ph.D., associate chief medical information officer, University of Utah Health Care
Director — Janet Marchibroda, fellow, Bipartisan Policy Center
AffiliateDirector — Diego Kaminker, owner, Kern-IT SRL and member, HL7 Argentina
2018 HL7 Fellows
The HL7 Fellow Award was presented to five individuals during HL7’s 32nd Annual Plenary and Working Group Meeting in Baltimore. The award was established to recognize HL7 members with at least 15 years of active membership as well as outstanding service, commitment and contributions to HL7. The 2018 recipients of the HL7 Fellowship Award include:
David Hay, M.D.
Beat Heggli
Patrick Lloyd
Rob McClure, M.D.
Corey Spears
HL7 Volunteers of the Year
HL7 honored three members with the 22nd annual W. Edward Hammond, Ph.D. Volunteer of the Year Award. Established in 1997, the award is named after Dr. Ed Hammond, one of HL7’s most active volunteers and a founding member as well as past board chair. The award recognizes individuals who have made significant contributions to HL7’s success. The 2018 recipients include:
Brett Marquard, principal, WaveOne Associates, Inc.
Ulrike Merrick, lead specialist, informatics terminology, APHL – Association of Public Health Laboratories and public health information specialist, Vernetzt, LLC
Bryn Rhodes, owner, Database Consulting Group and chief technology officer, HarmonIQ Health Systems Corporation
About the Volunteers:
Brett Marquard, has been a member of HL7 since 2008. Brett has held several positions throughout his 10-year tenure at the organization. For seven years, he co-chaired the HL7 Structured Documents Work Group. In addition, Marquard has served as the vice chair of the HL7 US Realm Steering Committee since 2016 and has chaired the newly established CDA Management Group since 2017. He is active in the effort to advance HL7 Fast Healthcare Interoperability Resources (FHIR®) and works with the ONC within the context of addressing their HL7 requests. Finally, Marquard been instrumental in the standards development process as the primary editor of the Consolidated CDA (C-CDA) and US FHIR Core implementation guides.
Ulrike Merrick, has been an active member of HL7 since 2008. She has served as a co-chair of the Orders and Observations Work Group since 2014 and was recently appointed to HL7’s newly established Version 2 Management Group. In addition, Merrick was elected to serve on the HL7 Technical Steering Committee beginning in January 2019 as the co-chair of the Administrative Steering Division. Much of her involvement in HL7 is focused on lab testing and reporting, and she has used her background in this area to engage the CDC in HL7 initiatives. Merrick has leveraged her broad network in the laboratory community to provide input from subject matter experts in relevant HL7 specifications, such as the HL7 Specimen Domain Analysis Model.
Bryn Rhodes, has participated in HL7 for several years and joined as a member in 2018. He serves as an interim co-chair of the Clinical Decision Support Work Group. Rhodes has also been involved in the efforts to extend HL7 FHIR into the clinical decision support and clinical quality measurement domains. He is the co-author of several HL7 specifications including the following: Clinical Quality Language (CQL), FHIRPath, FHIR Clinical Reasoning Module, QI Core/Quick and the CQL-based HQMF. In addition, Rhodes oversaw the transfer of the CMS electronic quality measure (eCQM) work using the CQL across multiple measure developers. Finally, he was instrumental in the Centers for Disease Control and Prevention (CDC) Adapting Clinical Guidelines for the Digital Age project’s incorporation of FHIR clinical reasoning and FHIR resources into the CDS L3 output and operationalizing the process by use in a CDC opioid management clinical guide.
Included amongst the segments of healthcare such as post-acute care that until recently had been mostly overlooked, specialty pharmacy now is in the spotlight as a key area of healthcare utilization and spend in the U.S. Critical, expensive and often life-sustaining medications for high complexity disease states, as well as care management programs that help patients through their healthcare journey, are at the core, driving nearly $175 billion in drug spend for the 2 percent to 3 percent of the U.S. population considered medically complex. Specialty pharmacy operations typically involve a cross-functional staff of insurance experts, patient care coordinators, nurses and pharmacists that interact with patients and stakeholders to ensure therapeutic success in a historically fragmented, manual process-driven model.
Challenges in specialty pharmacy operations
As with many aspects of the healthcare system, specialty pharmacy operations are fraught with many pragmatic, economic, and clinical care challenges.
Operational, pragmatic challenges include:
Multiple fax and phone communications between prescriber and specialty pharmacy supporting referrals, prescriptions, authorizations and patient care coordination
Challenging and fragmented patient engagement combining traditional phone-based communication with other methods such as texting with mixed results
Overlapping prescriber and patient communications among health plan, pharmaceutical manufacturer patient service hubs, prescribers and specialty pharmacy
These process challenges are creating an economic strain for the pharmaceutical industry, the payer, the provider, and most importantly the patient – where insurance benefit and funding source determinations often create confusion between overall coverage and patient out-of-pocket costs. This is compounded by complex coordination of benefits, billing and payment processing of medical and pharmacy claims, as well as other sponsored funding sources. Increasing patient cost share can make specialty drugs unaffordable for many patients which impacts medication adherence and ultimately patient outcomes.
The resulting clinical challenges make it difficult for critical patient care information to be easily shared (e.g. labs, patient assessments, medication profiles, side-effects, etc.). Additionally, treatment objectives often overlap among specialty pharmacy channel providers, resulting in crossed communications and patient confusion. In the end, key success metrics (both economic and clinical) are not easily measured, and often not operationally and clinically aligned.
The power of data accessibility and real-time analytics
Compressed specialty pharmacy margins require significant technology investment to offset operating costs and increasing service expectations. Technological advances help to address several of these challenges and as a result drive improvement in patient care and satisfaction, lower operating costs and more informed clinical decision-making.
Several of these technological advances that are showing early evidence of changing the historical paradigm include:
Interoperability with EHRs and other critical patient history data sources providing access to holistic views of patient medical records which can improve patient engagement, therapeutic interventions and reduce unnecessary procedures
Sophisticated workflow software driven by data-informed electronic protocols to support overall multi-party process efficiencies
Robust and timely analytics that provide comparative and predictive insights that influence optimal patient care at the lowest cost as well as provide more timely, accurate patient insights that drive patient success, including medication adherence
Integrated patient engagement technologies that improve patient interactions when and how the patient wishes to engage
Impact across the continuum
The application of advanced capabilities in connectivity and analytics in the specialty pharmacy space creates a more efficient system and a better result for all involved. Successful implementation of these technologies accelerates patients onto the most appropriate therapy, optimizes patient treatment plans and improves the overall patient experience which support medication adherence goals. It can also help establish innovative and more productive relationships between health plans, employers, providers, specialty pharmacies, pharmaceutical manufacturers and patients.
If you ask doctors, you’ll hear that electronic health records (EHR) have been both the best thing and worst thing to happen to medicine in the past 40 years. Having real-time information at your fingertips is an incredible advancement, but it’s only helpful if you can see what you need to diagnose and treat your patient. Healthcare providers consistently state their frustration with the lack of consistent, accurate data within the EHR system.
Health Level Seven