Many hospitals and healthcare organizations say they’re committed to moving to a paperless or paper-light environment. Greater document digitization is key to a more seamless flow of information within the healthcare enterprise, increasing worker productivity and reducing costs while also enhancing patient data security and ultimately improving quality of care.
Electronic health records (EHRs) are viewed as a foundational component of this strategy. In 2016, more than 95 percent of all eligible and critical access hospitals demonstrated meaningful use of certified health IT including EHRs, according to Health IT Dashboard. The conventional wisdom would lead some to expect subsequent decline in paper usage, but quite the opposite is happening.
Studies have shown that despite the growing adoption of EHRs and other digital technologies, paper in the healthcare enterprise remains prevalent – and is even growing. Experts say hospitals are seeing as much as an 11 percent increase in their annual print volumes driven by the Meaningful Use program, the Affordable Care Act, ICD-10, and the adoption of electronic record-keeping.
Why is this happening? Sometimes we find that physicians to not yet fully trust EHRs. Approximately 27 percent of a doctor’s time is spent with patients, the rest being spent on office work, documentation and EHRs – a common source of physician frustration. Also, disjointed processes of gathering paper-based information from a variety of points within a facility lead to delays in uploading this information to the EHR – leading to physicians keeping copies of patient files on hand.
EHRs alone are not enough to decrease the mountains of paper in hospitals and healthcare facilities. Organizations should consider augmenting EHRs with the following capabilities:
Integrated Document Workflows
Even healthcare organizations that have achieved late-stage meaningful use continue to print and process high volumes of paper for assorted reasons – from patient admissions and discharge, to belongings and consent forms, to prescriptions and pharmacy records. The benefits of EHRs can only be achieved insofar as they are integrated with digitally-based document workflows – the series of electronic steps by which a process is executed.
Consider physicians submitting prescriptions to pharmacies. When the EHR is directly integrated into this process, it can be automatically flagged if the patient is on another medication or has an existing condition which could cause an adverse reaction. If the EHR is not integrated, the entire process is disjointed and not as seamless and safe as possible. Or, consider the discharge process – when the EHR is integrated, discharging physicians have immediate access to patient files and charts – negating the need to print this information. Furthermore, studies show that “hybrid” paper-electronic workflows are ripe for error.
By Ken Perez, vice president of healthcare policy, Omnicell, Inc.
Ken Perez
“If at first you don’t succeed, try, try again.”
During the first half of 2017, two mergers, each pairing national health plans—Aetna with Humana and Anthem with Cigna, respectively—were blocked by two federal judges, both of whom concluded that the mergers would reduce competition in the health insurance market and, therefore, raise prices.
Departing from the horizontal merger approach, three national health insurers are now involved in proposed or possible vertical mergers. CVS Health announced its intent to acquire Aetna in December 2017; Cigna announced its plan to acquire pharmacy benefits manager Express Scripts in March 2018; and Walmart is reportedly in acquisition talks with Humana. Because of their size, the interesting value delivery chains they would create, and potential synergies, these corporate combinations have been described as disruptive and industry game-changers.
From a health policy standpoint, what has contributed to these mega-mergers?
First, the specter of a single-payer healthcare system—as most ardently promoted by Sen. Bernie Sanders (I-Vt.)—has been greatly diminished by the election of Republican Donald Trump as president in 2016, continued Republican majorities in both the House of Representatives and the Senate, and perhaps most saliently, the passage of the Tax Cuts and Jobs Act of 2017 (TCJA) in December 2017.
It is a truism in Washington, D.C. that taking back something that has been given to the public is hard, if not impossible. Since a single-payer healthcare system would clearly entail a major expansion of the federal government that would require not only the repeal of the TCJA’s tax breaks for individuals and corporations, but also the imposition of additional tax increases, it would appear to be a political impossibility for at least until 2021.
Second, Medicare Advantage (MA), Medicare’s managed care program, increasingly is where the action is for health plans. Congressional Republicans strongly support MA, and the program is gaining in popularity with Medicare beneficiaries. The Centers for Medicare and Medicaid Services projects that 20.4 million people will enroll in MA for 2018, an increase of 9 percent over 2017, about three times faster than the growth of the total Medicare enrollee population. More than a third (34 percent) of Medicare beneficiaries are enrolled in MA.
The proposed mega-mergers involving Aetna, Cigna and Humana secure control of significant shares of the Medicare population, including sizable shares of the MA enrollee pie.
With a mission to improve the lives of people living with diabetes and chronic conditions worldwide, Fit4D delivers scalable and effective programs through an optimized mix of technology human-based interactions.
Founder’s story:
David G. Weingard
At just 36 years old, David Weingard was diagnosed with Type 1 diabetes. With no family history of diabetes, he was confused and overwhelmed about the diagnosis. He had two sessions with his doctor on how to use insulin and that was it. Having received limited support and education on his diagnosis, Weingard was left to manage his diabetes on his own and needed help.
He then found Cecilia, a certified diabetes educator (CDE), who compassionately gave him the correct steps to follow to help him become productive again, personally and professionally. Cecilia sparked an idea for Weingard – to scale the personalized coaching he received, to millions of people living with diabetes, but using a technology platform. With the daily vigilance and management of his diabetes, he left his corporate job and founded Fit4D.
Market opportunity
Fit4D has established business partnerships with clients that include major health plans and providers such as Humana, HealthFirst and several Blue Cross Blue Shield plans, along with major pharmaceutical and medical device companies. The company delivers scalable and cost-effective diabetes management programs through an optimized mix of human-based touch points and technology to deliver measurable outcomes in an affordable manner.
Fit4D is driving improvements in diabetes outcomes across the socio-economic spectrum, achieving a relatively high enrollment rate, lowering blood sugar levels, and delivering significant cost-savings and ROI for clients.
Results include:
20 percent increase in adherence leads to three times increase in ROI for pharma/device companies.
One- to two-point reduction in HbA1c levels demonstrates improved health outcomes for enrolled patients.
28 percent enrollment rate saves $380 per patient for payers and providers.
More than 95 percent patient engagement rate
Who are your competitors?
Fit4D is unique in that we scale and deliver personalized one-on-one support through the optimization of human touch and technology. There are other companies in the market that are combining patient healthcare services with a heavy focus on technology, such as Livongo and Omada; however, they don’t offer a personalized patient approach to diabetes. Fit4D emphasis on combining human touch with a dedicated CDE throughout the length of the program, allowing the patient to build a strong fruitful coaching relationship. As a result, our service is highly valued for the likes of payers, providers, pharma and medical device companies.
By Donald Voltz,MD, Aultman Hospital, department of anesthesiology, medical director of the main operating room, assistant professor of anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Dr. Donald Voltz
In his HIMSS keynote address, Alphabet’s former executive chairman and now current technical advisor Eric Schmidt warned attendees that the “future of healthcare lies in the need for killer apps.” But he also cautioned that the transition to a better digitally connected health future isn’t just one killer app, but a system of apps working together in the cloud. He also advocated transforming the massive amount of data held in EHRs into information and knowledge.
Schmidt is correct in his assessments. There is a need for interoperable “killer apps” for new health IT priorities and procedures. The apps need to deliver better patient outcomes by integrating and optimizing patient data while driving healthcare facility financial incentives such identifying cost savings and streamlining insurer payments. These types of needs are accelerating convergence in the health care sector for interoperability across clinical, financial, and operational systems, not simply EHR connectivity.
One of the cloud “killer apps” that is a strategic component of convergence and hospital growth are Annual Wellness Visits (AWVs). First introduced by private insurers and then by CMS in 2011 as part of its preventative care initiative under the Affordable Care Act (ACA), AWV’s are designed specifically to address health risks and encourage evidence-based preventive care in aging adults.
The typical visit requires a doctor or other clinician to run through a list of tasks like screening for dementia and depression, discussing care preferences at the end of life, asking patients if they can cook and clean independently and are otherwise safe at home. Little is required in the way of a physical exam beyond checking vision, weight, and blood pressure.
On its own merit, some could argue that while this app can greatly contribute to better patient care, it does not significantly impact hospital and clinic growth, but when integrated with other apps, it becomes a key healthcare growth catalyst with its treasure trove of patient data. That data, when streamlined, can enable expedited payments to government and private insurers, help lay the foundation for AI and other knowledge initiatives as cited by Schmidt.
Chronic Care Continuum App
Another “killer app” is the care continuum integration of treatment for chronic diseases ranging from diabetes to dementia and behavioral and mental health issues such as the U.S. opioid epidemic, heroin addiction, alcoholism and suicide. The ECRI Institute released its “Top 10 Patient Safety Concerns for Healthcare Organizations” in March 2018 and cited the management of behavioral health needs in acute care settings as the 6th highest ranked safety concern.
“Organizations should consider working with other partners, such as psychiatrists, behavioral health treatment programs, clinics, medical schools and teaching programs, and law enforcement,” says Nancy Napolitano, patient safety analyst and consultant, ECRI Institute. “Being able to communicate remotely and seamlessly, assessing risk and complexity, as well as delivering high-quality connected care are critical. Relationships and partnerships are what get you what you need.”
Over the past 5 years, healthcare data has fallen prey to unethical attacks that compromise sensitive patient information. If you look back at 2015, it was the worst year in healthcare data security when data breaches hit an all-time high by affecting 113 million individuals approximately.
As of today, the number of breaches reported to the Office for Civil Rights (U.S. Department of Health and Human Services) has been consistently increasing. Also, the number of individuals affected does not seem to improve despite regulatory enforcement procedures and laws drafted to put a check on this.
This infographic by Kays Harbor establishes a comparative analysis and infers how data breach patterns have evolved in all these years up to 2017. It highlights the following major findings:
HIPAA data breaches reported in 2017 were more than double the number of breaches in 2016. Though, the individuals that are estimated to be affected by these breaches was much less than the past four years.
Healthcare providers again made it to the top of the list for reporting 231 data breaches – highest in all these years.
Information technology continues to be a major reason for these breaches so far, showing an upward trend in contribution of hacking and IT incidents resulting in data loss.
Kentucky based healthcare organization, Commonwealth Health Corporation reportedly filed a breach confirmation related to theft affecting 697,800 individuals.
While Texas reported maximum hacking incidents, breached entities in California filed maximum thefts two years in a row.
Furthermore, it discusses the trends and predictions by the C-suite in healthcare industry for the coming year. David Muntz, principal at StarBridge Advisors said, “There seems to be a growing gap between the demand and supply of cybersecurity professionals that needs to be addressed. On the positive side, vendors are providing strict countermeasures for vulnerable products and services which will result in HIPAA being perceived as an enabler for data sharing as well.”
As a matter of fact, 2018 has set all hopes high and CIOs are looking forward to a decline in the breached numbers with active cybersecurity measures challenging the perils of vulnerable healthcare systems.
Technological advancements have taken healthcare from a basic level to what, in comparison, seems sophisticated and state-of-the-art. For example, MRI, CT, PET and ultrasound technologies have drastically improved diagnostics and treatment in healthcare. Technology’s impact on communication has also radically changed healthcare. Images and information can be sent and received instantly, allowing medical professionals to consult and collaborate with each other regarding a patient’s diagnosis and treatment.
With digital means of recording and accessing patient medical history, continuity of care is easier than ever. With all of the changes technology has brought to the healthcare system, it would seem that patients and providers would be more than satisfied with the level of care and efficiency.
Unfortunately, reality says the contrary. According to a 2017 Gallup poll, over 70 percent of Americans think the healthcare system in the US is “’in a state of crisis”’. Patients, providers, and insurance companies face frustrations daily. Patients struggle to interpret their benefits and get approved for treatment. Denial of benefits and delayed payments plague patients and providers. The problem isn’t a lack of technology, as previously discussed. The problem is a lack of a mechanism to capitalize on existing technology. Information is already digital in the majority of medical offices, and a range of methods for electronic communication already exist. What the healthcare system needs now is a streamlined way of getting information where it needs to go in real time.
Blockchain to the Rescue
At first mention, it may seem far-fetched that blockchain technology would help the healthcare system. Most people know little about what blockchain technology, and if they are aware of it, it’s most often associated with cryptocurrency. Interestingly, the same blockchain technology that makes cryptocurrency possible is being applied in many arenas outside of cryptocurrency due to its ability to securely and efficiently verify and log transactions.
The blockchain is essentially a ledger of events that updates in real time. In cryptocurrency, for example, algorithms verify authenticity of coins, and coins are sent and received once verification is determined. The transaction is then stored in the blockchain. This is appealing to many people for many reasons. One reason is that quicker transfers of currencies are possible when the middle man is eliminated. Algorithms can do in seconds what banks take days to do. Another reason is that information is encrypted, which means privacy and security of information.
In terms of healthcare, a company called Solve.Care has undertaken the challenge of solving the existing problems in the healthcare system using the blockchain. The biggest plagues in healthcare are rooted in the administrative area. Many hours are spent tracking down information that should be easily and instantly available to relevant parties. For instance, it may take days or weeks to receive a letter denying an insurance claim.
In recent years, the public sector has become increasingly aware of the multifaceted potential of big data. These days, government agencies around the world collect vast amounts of data from people’s activities, behaviors, and interactions—a virtual treasure trove of information that the public sector can utilize and turn into actionable insights, and later, into actual solutions.
The big challenge, however, is that government agencies are falling under more and more pressure to find relevant insights from complex data while relying on limited resources and technologies with inadequate capabilities. And with the sheer size of data being generated nowadays, it’s becoming more difficult to extract meaning from what the data hides beyond their colossal façade.
Thankfully, there is one critical technology that is redefining the way public sector agencies study and utilize data, and this is artificial intelligence. Today, artificial intelligence solutions that make use of technologies like machine learning and topological data analysis can automatically process big data and discover patterns and anomalies no matter how complex and seemingly disjointed these different points of data are.
Precisely because of these advantages, artificial intelligence solutions are now being used by numerous public sector agencies and institutions around the world. In this article, we’ll fill you in on the basics of three important areas of the public sector in which AI is currently making waves.
Financials
The financial industry is one of the biggest producers and exchangers of data, and as such, it stands to benefit immensely from artificial intelligence technologies. Every day, government-owned banks and other financial institutions buy, borrow, and trade currencies and financial products, generating massive amounts of data from customers, partners, and other stakeholders.
By using artificial intelligence solutions for financial services, institutions can develop an intelligence framework that will allow them to cater to customer needs, understand and manage regulatory risks, and proactively prevent money-laundering activities. This way, public sector financial services are able to assume a position of strength over increasingly complex challenges.
Population Health
In many jurisdictions over the world, value-based care is being adopted as an alternative healthcare model that focuses more on accountability, and on the type and quality of service provided to patients instead of the volume of care provided. With this increased emphasis on value, government-aligned health providers and insurance systems have begun using artificial intelligence software in order to become more agile and proficient at managing the risks of patient pools.
This way, even with the immensity and complexity of patient data, public sector providers and health payers are able to better understand clinical variations, as well as automatically predict individual and subpopulation risk and health condition trajectories. Through insights gained from these data, clinicians and other personnel across the healthcare spectrum can then better determine the best and most affordable courses of care, in addition to being able to confidently recommend the most appropriate health programs for their governments to implement.
Artificial intelligence is a topic that should interest us all, as it changes the world with every second. And the healthcare system is one of the areas that AI has already started to revolutionize. These are the main ways in which that is happening.
Precision Medicine
Due to the introduction of personalized diagnosis and precision medicine, now doctors can treat a patient’s condition, by taking into account his/her background, as opposed to merely treating the disease. This is accomplished by using proteomics, which is a type of DNA mapping, as well as advanced AI machine learning.
Killing Occam’s Razor
Occam’s Razor is also known as the Law of Parsimony, and it refers to providing a range of solutions to a given problem. Also, according to this principle, the simplest solution is, most of the time, the correct one. Considering that both machine learning and AI doesn’t have the human assumption element, their capacity of reading and analyzing amounts of data can significantly increase the accuracy of the diagnosis.
Accordingly, this can be really helpful in diagnosing elderly patients, in particular, as they are more likely to suffer from various diseases at the same time.
Google Can Spot Eye Disease
DeepMind is a Google-owned AI company that has come up with a way of diagnosing eye disease. After assessing and attentively analyzing the medical records of a significant number of patients, it has created machine learning technology that should help doctors diagnose eye illness earlier. This merely outlines that, even though AI is innovating almost every field, it still relies on human help.
Automated Cancer Treatment
It appears that AI can also play an important role in treating cancer, which affects more and more people. Accordingly, the CareEdit tool can be utilized by oncologists for crating practice guidelines. To be more specific, the tool analyzes considerable amounts of data such as past treatment regimens, aiming at comprising a clinical decision support system that should help physicians treat each patient. This can significantly enhance the rate of survival, while cutting down the costs associated with the treatments.
Virtual Health Assistant
Interestingly enough, at the time being, there are apps that carry the roles of personal health coaches. This functions the same way as a customer service representative at a call center. What is more, the digital assistant can do as much as take notes, ask questions, even provide specific advice while streaming the information to the healthcare provider. This has the role of simplifying the process.
With a mission to improve the lives of people living with diabetes and chronic conditions worldwide, 
