In the handful of years since the Affordable Care Act expanded coverage to millions of previously uninsured and underinsured Americans, hospitals and health systems have seen an increase in patients. The influx has meant that the number of incoming phone calls has skyrocketed for healthcare organizations. As systems struggle to handle increased patient volume, upgrading contact center services is proving to be an important venture.
Regardless of the current state of a contact center’s operations, virtually every healthcare organization can make improvements to better serve patients and staff and strengthen their bottom line. Organizations can do this by accurately identifying where they are on the contact center maturity curve, asking smart questions about readiness to move forward and strategically deploying technology.
Hospitals and health systems are at widely different junctures on the journey toward modernizing their contact centers. Therefore, as part of planning for upgrades, organizations should perform a self-examination and determine what level of operation they are at currently. Some of the questions teams can ask as they work to identify where they are on the maturity curve include:
Are our contact center systems and processes on par with our competitors?
How many sources of patient data do we currently use?
Are we tracking and leveraging patient communication preferences in our EHR? Are we using those preferences?
Are we routing callers through a “single front door” regardless of the phone number they dial?
Do our agents have the ability to schedule for all physicians within a respective specialty (including primary care) or clinic, both hospital and ambulatory?
By considering these and other questions, hospitals and health systems can start to understand their contact center’s maturity level and how much room there is for growth and improvement. The next step is to think about what it will take to actually implement change, and evaluate readiness. To do this, organizations may want to ask questions like:
How comfortable are we when it comes to adopting new technologies?
Is our organization committed to embracing technology so we can maximize operational efficiencies and effectiveness while still maintaining the human touch?
How much do we prioritize providing a “world class” access experience for our patients and providers?
Cultural challenges sometimes make focusing on contact center optimization difficult for hospitals and health systems, because the culture within many organizations does not support contact center investments. Unfortunately, when hospitals and health systems neglect contact center updates, patient experiences and satisfaction suffer. For hospitals, maintaining high patient satisfaction is more important than ever because the financial impact of patient experiences has increased due to consumerization and value-based payment programs.
One solution that may help generate support for contact center updates is to conduct an evaluation of the competitive risk of not modernizing. The results of a competitive analysis may help spur internal support for technology upgrades and other contact center improvements.
Technology is obviously an essential part of every successful contact center, which is why so many have adopted physician answering services to help manage call volumes. With the right technology and a strategic plan for how to use it, hospitals and health systems can offer features like a single entryway into their organization, predictive interactive voice response and automatic data pass with transfers. For the following outlined reasons, these contact center features are must-haves for modern contact centers.
A Single Entryway – Having a single point of entry for all patients ensures that every patient is greeted with a consistently branded user experience. It also means less confusion and frustration for callers and staff. When calls are routed through an automated centralized phone system, efficiency increases. Overall, hospitals have more control over each caller’s experience when calls are routed through one main gateway.
Intelligent Predictive Interactive Voice Response – Interactive voice response (IVR) systems allow hospitals to automate call routing and handle higher volumes of calls. Also, an intelligent IVR makes navigation easier for patients because it can detect what they need. Ideally, when a patient calls a hospital, the IVR system will authenticate the patient, identify possible reasons for their call and connect them to the appropriate destination. The right IVR technology will not only make communications more efficient, but also more patient centered.
Automatic Data Pass with Transfers – Staff can better and more quickly assist callers if background information is transferred with each incoming call. Without automatic data pass there is typically a lot of duplication when team members end up asking patients for information they have already provided. Rather than having staff repeat work by asking questions and gathering info that has already been collected, teams can rely on technology to automatically provide necessary data.
Utilizing technology to drive automation, increase efficiency and improve patient experiences should be the aim for hospitals and health systems. Finding ways to do these things requires an understanding of current contact center operations, executive buy-in and, in most cases, technology updates. While there are challenges that come along with modernization, contact center improvements allow healthcare organizations to better service a larger number of patients.
The joint venture just announced between Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. is anticipated to bring profound transformation to the healthcare industry. By joining forces, these three giants hope to leverage their technological, sales, and investment expertise to address and resolve the many inefficiencies in the current U.S. healthcare system. The objective of this partnership is to harness their considerable scale and operational efficiency to manage healthcare’s rapidly growing costs, placing greater emphasis on providing high-value healthcare services.
Regardless of whether the partners are successful in disrupting the healthcare industry, one positive outcome is the strength these new players bring the comparative weakness of the fragmented American healthcare system into sharp relief. In the press release, Berkshire Hathaway Chairman and CEO Warren Buffett explains the primary motivator of the joint venture with the now-infamous phrase, “The ballooning costs of healthcare act as a hungry tapeworm on the American economy.” With healthcare accounting for 17.9 percent of the gross domestic product in 2016, the “hungry tapeworm” of exploding healthcare costs is fueled by the widespread inefficiencies of the U.S. healthcare system.
The industry is still riding out significant aftershocks from recent M&A activity. In the last month alone, CVS purchased Aetna for $69 billion to remake the consumer healthcare experience, Catholic Health Initiatives (CHI) and Dignity Health joined forces to expand their reach across 28 states with 700 care sites and 139 hospitals, and Providence St. Joseph Health and Ascension are expected to merge to create the largest hospital operator in America. In the statement, Amazon Founder and Chief Executive Jeff Bezos acknowledges, “The healthcare system is complex, and we enter into this challenge open-eyed about the degree of difficulty.” With the healthcare industry in the midst of significant upheaval, any new players will face an uphill battle in addressing rising healthcare costs and creating transparency within a notoriously-opaque system.
Addressing the “Tapeworm Effect,” as Buffet mentions, presents a blue ocean for disruptive innovation. The paradigm shift from fee-for-service to value-based care models requires healthcare systems to become increasingly patient-centric. To lower their costs, healthcare systems must eliminate variations and inefficiencies in their care processes that lead to poor patient outcomes, such as hospital-acquired infections and 30-day readmissions. By investing in data-driven technology, healthcare organizations can create systemic improvements in care delivery at every touchpoint across the patient journey.
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.
Donald Voltz, MD
Healthcare is evolving quickly and HIMSS 18 offers a broad range of healthcare issues to explore. New requirements for implementing HIT systems have changed dramatically in the last few years as new health IT priorities and procedures have emerged. Convergence in the health care sector has accelerated the need for interoperability, not just for EHRs, but also across clinical, financial, and operational systems. This need is also challenging and changing one of the biggest traditions in healthcare—the doctor patient medical visit.
In the past, patients would simply make appointments to visit their physicians. Now, we have the popularity of Annual Wellness Visits (AWVs) and the growing need for chronic care treatments caused by the opioid epidemic and other behavioral health issues. This trend is causing physicians to be the ones actively pursuing patients, but with both sides reaping the benefits of this new arrangement. The new approach to the traditional doctor-patient relationship enables patients to receive better care while clinics and hospitals build up a roster of new and potentially long care patients.
Disrupting this office visit tradition are also larger, long-term HIT trends, such as the widespread implementation of electronic health records (EHR) and other healthcare practices. However, these trends spurred many challenges, but also a great deal of opportunities, many of which have yet to be fully capitalized upon. To understand these changes, we need to be cognizant of the increasing opportunities patients and physicians have in accessing and interfacing with the healthcare system.
Patients have a great deal more choices and entry points to the complex and dynamic healthcare system than they had even 10 years ago. When Medicare, Medicaid, organ transplantation and synthetic insulin were coming in vogue 50 years ago, patients had relatively limited access to healthcare. Those that did often choose to enter the system through a single physician who they had built a long-term relationship with and who served as the conductor of any labs, studies or further consultation from specialists. With the implementation of governmental and private healthcare insurance options, patients had improved access to care. Commensurate with this increased access to care, an increased national health expenditure followed.
With increased costs, healthcare responded by changing the way patients interacted with the system. Beginning in the ‘70s and continuing into the ‘80s, the rise of HMOs and capitation attempted to improve national healthcare, but this led to limitations in patients’ choice and began the concept of bundling services, cost sharing, and expansion of preventative care. Other managed care plans and a focus on utilization of care continued to decrease the cost of care.
Although many aspects of these managed care structures benefited patients, such as preventive services and prescription coverage, access to services and specific physicians were constrained as “in” and “out” of network coverage, limiting patient choices. The implementation of EHRs has established the foundation upon which opportunities are and will be found to improve healthcare quality by improving the decisions being made.
Enhanced access of patient data by authorized patients, professionals and algorithms focusing on analytics or artificial intelligence is now a requirement for enhanced patient engagement, improving professionals’ delivery of care, enhancing clinical decision making and optimizing patient outcomes while maintaining choices that are consistent with best practices, patient values and prior empirical experiences.
Evolving Relationship Drives Healthcare Revenue
While the doctor-patient relationship has evolved, hospital systems and physicians must still derive revenue which is still at the core of that relationship. The healthcare industry is now looking at revenue which can be generated through the interoperability of annual wellness visits (AWVs), chronic care and service care transitions between physical and behavioral health services. Hospitals and healthcare clinics that can connect these services with technologies such as bi-directional information flow will benefit by creating new profit centers of revenue through reimbursements by CMS and private insurers.
“Programs such as revenue cycle management are important for any healthcare institution’s bottom line, but when carriers can actually drive revenue using cloud based, bi-directional interoperability technologies that enable doctors to spend more time with patients and therefore provide superior care, then flipping the traditional patient-doctor relationship is a winning trend for the healthcare industry,” said Doug Brown, managing partner, Black Book Research.
Driving this trend are new apps and innovations that address the payment gap caused by medical billing and collections processes with outdated EHR platforms and inoperable systems. New technologies from organizations, such as Core Care Medical and others, fueled by the growth of cloud computing in the healthcare industry are improving real-time communication and data exchange. Here are some examples of how this is working which you might not hear about at HIMSS.
Hospital CEO Drives Revenue with Doctor Patient Visit Apps
A healthcare colleague, David Conejo, CEO, Rehobath McKinley Christian Healthcare Services (RMCHS) is boosting revenue right now using this doctor/patient flipping model as a strategy to help in his effort to improve behavioral healthcare for Gallup, New Mexico’s large Indian Reservation community who suffer from addiction to alcoholism and opioids.
He integrates data from the hospitals’ three clinics using a cloud application that streamlines data from AWVs and integrates it with any EHR system without data duplication. The Zoeticx ProVizion app also allows for the management of support tracking for wellness visits, provides a physical assessments guide through preventative exams, and maps out the risk factors for potential diseases for patient follow-up visits. He can then enter the relevant data about the patient.
In addition, it includes everything else that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurers billing requirements. RMCHS’ business is growing with full or near-full compliance. And with its ACO in startup mode, RMCHS is also receiving a bonus check for $80,000 from Medicare for containing costs, in addition to the new revenues being generated.
The fact that more patients can be seen is a bonus. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, but if a physician saves 10 minutes per patient, at 18 patients a day that’s an extra 180 minutes. More minutes, more patients.
Hospitals should be places of healing and safety for providers, patients and guests. Yet hospital employees are four times more likely to experience a violent encounter in a hospital than in any other location.1 According to studies cited in a 2016 review paper in the New England Journal of Medicine, 80 percent of emergency medical workers experience violence during their careers. Seventy-eight percent of ED physicians in the U.S. reported having been the target of workplace violence in the previous year, and 40 percent of psychiatrists reported they had been physically assaulted.2
To mitigate violence and protect staff, experts advise hospitals to form an addiction conflict and substance use disorder team, initiate healthcare-specific training on the management of aggressive behavior, and establish a strategic management assessment response team. In many hospitals, security personnel lead these initiatives and team up with local police, as well as department leaders throughout the hospital.
All of these programs are good recommendations, but in the moment when an armed individual invades the hospital or someone already in the hospital threatens care team members, how can hospital staff respond to minimize violence, protect themselves and others and get help fast from security personnel or police? The answer lies in the right communication system.
In some institutions, the use of mobile communications technology has helped reduce the amount of time required for security to respond to violence or aggression. For example, staffers in some hospitals wear hands-free communication badges to connect quickly and directly to internal security officers when an incident of violence begins or appears likely.
At the emergency department of Upstate Medical Center in Syracuse, N.Y., any ED staff member can use such a badge to summon university police and public safety officers in the event of a violent encounter or other emergency. In many cases, this can be faster than making a phone call. A peer-reviewed study found that this approach reduced average security response times from 3.2 minutes in the six months before the badges were adopted to 1.02 minutes in the six months after use began.3
Michael Garron Hospital in the Toronto East Health Network used a similar system to reduce the time it takes security officers to get to the scene of an incident from an average of 2 ½ minutes to 59 seconds. Besides enabling a badge user to contact security personnel quickly, the device can also alert people outside the hospital and act as a real-time locator if a staff member can’t say where he or she is located.4
A “panic button” system can also be harnessed to help police pinpoint the exact location in a hospital where a violent incident is occurring. For example, in 2014, an armed intruder threatened nurses in Halifax Health Medical Center, a large hospital in Daytona Beach, Florida. They were able to use their clinical communication system, which has a panic feature, to broadcast a special beep that alerted other clinicians and hospital security about the rapidly evolving incident and where in the facility it was taking place. As a result, an ED security officer was able to guide arriving police directly to the site on the hospital’s second floor where the man with the gun was located.5
There is an ample amount of evidence to back-up the notion that electronic health records (EHRs) help improve medical practice management, by ultimately increasing overall price efficiencies and cost savings within a practice. In fact, a national survey done in August of 2012 rendered the following statistics as evidence to back up this claim:
– 79 percent of providers’ report that with an EHR, their practice functions more efficiently
– 82 percent report that sending prescriptions electronically (e-prescribing) saves time
– 68 percent of providers see their EHR as an asset with recruiting physicians
– 75 percent receive lab results faster
– 70 percent report enhances in data confidentiality
These results offer an abundance of proof towards the fact that there is an obvious correlation between EHRs and overall practice efficiency, as well as general cost savings.
Now that we can provide plenty of evidence towards the notion that EHR software can result in a more effective practice, let’s look into what specific items are actually being reported by individuals. More specifically, what particular results of EHR solutions are providing them with fewer headaches in managing patient records.
In a study completed for the Journal of Revenue and Pricing Management, these are the main reductions and overall time-savers that stem from these profound digital records:
– Reduced transcription costs
– Reduced chart pull, storage, and re-filing costs
– Improved and more accurate reimbursement coding with improved documentation for highly compensated codes
– Reduced medical errors through better access to patient data and error prevention alerts
– Improved patent health/quality of care through better disease management and patient education
These points can, of course, be quite apparent once you implement EHR solutions into your practice. However, there is another huge benefit that is often reported by members of practices that initialize EHR solutions. That being the resulted drop in paperwork, which is often the biggest strain on office managers and administrative office workers for practices of any size. However, EHRs can streamline these tasks and create a practice that can largely benefit from this move towards a digital platform.
Guest post by Justin Rockman, vice president of sales and business development, Surgimate.
Justin Rockman
Since the late ’80s, the inflexible and cumbersome Health Level 7 (HL7) protocol has been the standard form of sending messages between healthcare applications. However, HL7 integration is timely to implement, technically limited and costly. It is not uncommon for a medical practice to face upwards of $10,000 in expenditure for one simple message.
Application programming interfaces (APIs) have recently become a fashionable alternative. The term API sounds complicated, but it’s really just a way in which software applications (like your EHR) can talk to other systems, and exchange large amounts of data rapidly and securely. In short – they support better, faster, cheaper interoperability.
In addition to transmitting data between systems, APIs offer the ability to plug in chunks of functionality to another system, in a clean and predictable manner. Instantaneous and seamless interaction between systems is the leanest and trendiest way to design software in 2018. New applications should not “reinvent the functionality wheel” but provide unique integratable services.
As the EHR market estimated to reach $28 billion in 2016, it is no surprise that tech titans like Amazon, and Apple are looking for ways to get a slice of the pie. With top of the line products sure to come from those companies and others, here are 4 reasons why healthcare IT vendors must offer their clients a way to integrate using APIs.
Platform Stickiness
Physicians need easy access to data supported by EHRs, but hate the time it takes to manually enter patient information. It’s no wonder – doctors typically spend 50 percent of their day working with an EHR. If a physician isn’t happy with the usability or efficiency of their system, they’ll drop it and choose another. While the annual EHR adoption rate among providers is 67 percent, the EHR vendor switch rate is about 15 percent.
APIs offer cheaper and deeper integration options. For EHR vendors to provide better value for their customers they must embrace the API and ditch the expensive, outdated and rigid HL7 protocol.
Using an EHR that is integrated with other programs will make switching systems even more inconvenient. EHR vendors who give customers the additional functionality offered by their partners will be rewarded with brand loyalty, and lower churn.
An Additional Revenue Stream
Innovative EHR vendors are partnering with upstart technology companies to generate additional revenue. Greenway and athenahealth advertise an array of solutions in their marketplace, and provide partners with utilization of their APIs. In exchange, they receive monthly or recurring payment for each license sold. Since most practices already have purchased an EHR, finding new revenue streams is crucial for a company’s growth.
The healthcare API market is predicted to exceed $200 million in the next few years. Former engineers from Epic Systems saw the industry’s need for interoperability and raised $15 million in venture capital to found Redox – a company solely focussed on building bridges between healthcare applications. Creating platforms that deliver easy integrations at reasonable costs will greatly benefit the healthcare industry.
As we launch into 2018, questions remain about the healthcare policy environment and how it can impact many healthcare initiatives. As Yogi Berra said, “It’s difficult to make predictions – especially about the future.” I feel confident, however, about some fundamental trends in the healthcare landscape. These include a steady shift toward value-based care, an increased focus on data and analytics as a core enabler for digital transformation, and the all-consuming focus on the patient experience.
Here are my four key predictions for the healthcare IT trends that will transform the industry in 2018:
Patient Satisfaction Takes Center Stage
The era of healthcare consumerism is here. Patients are bearing increasing financial responsibility for healthcare costs, and seek improved experiences as a part of the value-for-money equation. In response, providers are taking a 360-degree view of patients, employing better analytics to leverage patient data such as demographic information, lifestyles and individual preferences, to personalize interactions and treatment.
Artificial Intelligence (AI) Becomes Entrenched in Clinical Settings
Despite the overuse of the term AI to describe many types of technology-enabled solutions, the adoption of AI has been steadily gaining ground in a wide range of settings. Deep learning algorithms will increasingly be used in clinical settings to support medical diagnosis and treatment decisions, predict the likelihood of patient re-admissions and help providers better leverage the data that has been accumulating in electronic health records. According to the 2017 Internet Trends Report by venture capital firm Kleiner Perkins, medical knowledge is doubling every three years, and the average hospital is generating more than 40 petabytes of data every year.
While all this accumulated information empowers more informed physicians, the growing range of data and knowledge sources creates a challenge as well, since physicians and clinicians must manage and stay on top of this information on specific conditions, especially in fields such as oncology. AI technologies are enabling time-constrained and overworked physicians to make sense of the vast amounts of data, helping them uncover hidden insights and supporting their medical diagnoses and decisions with timely and relevant input at the point of care.
Open Source Finally Takes Hold
Healthcare organizations have been conservative when it comes to open source technologies, largely due to concerns about data security and privacy. With the growing adoption of cloud-enabled solutions and a gradual shift of enterprise IT workloads to the cloud, they no longer have to worry about risks to the IT environment and can rely on mature cloud service providers, such as Amazon Web Services (AWS) or Microsoft Azure. And, open source architecture can now incorporate robust technology components with rich functionality. Our current collaboration with Partners Healthcare to build a digital platform for clinical care is based on an open source architecture. As the industry shifts rapidly to value-based care, cost pressures will force healthcare enterprises to transform their technology strategies, turning to open source solutions to rapidly build new solutions cost-effectively.
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