People perform better if they have a vested interest in the outcome of a given situation. Employees who are given an ownership stake in their company historically perform better and enjoy a higher degree of satisfaction from their respective jobs than do their non-stake-holding counterparts.
Recent research has shown that a similar premise holds true in healthcare. Patients who are engaged in their own care generally have better outcomes and enjoy higher satisfaction in the care they received. According to the American Journal of Managed Care, “A growing body of research has established the benefits of patient activation, which is defined as the knowledge, skills, confidence and motivation to make effective decisions and take action to maintain or improve one’s health.”
According to a 2016 New England Journal of Medicine survey of 340 U.S. healthcare executives, clinician leaders and clinicians at organizations directly involved in healthcare delivery, 42 percent of respondents indicated that less than a quarter of their patients were highly engaged, and more than 70 percent reported having less than half of their patients highly engaged. And to underscore the importance of this result, 47 percent of those surveyed revealed that low patient engagement was the biggest challenge they faced in improving patient health outcomes.
This is not only true for hospitals, but also for specialty care practices. In these environments, it is imperative that practices understand the very specific needs and behavior of their patients, so they can determine how best to conduct effective outreach that will increase patient engagement and patient portal utilization.
Importance of User Interface
A results-driven (or high performance) patient engagement platform helps turn patients into partners in their own healthcare. In addition, a proper next-generation solution supports compliance with MIPS (Merit-based Incentive Payment System), a component of MACRA (Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act), and with meaningful use (MU), by providing patients the ability to view, download or share their medical record. Payback is many-fold: In addition to helping providers meet regulations through a user-friendly interface, patients are freeing up time for caregivers to spend with them by self-populating data fields that would previously have been handled by caregivers. This streamlining of the patient intake process delivers significant time and cost savings to the practice.
Equally important is a patient portal that helps patients remain engaged while enabling practices to comply with government requirements under meaningful use and the MACRA regulations, thereby increasing Medicare payments and minimizing takebacks. It is imperative that the patient portal seamlessly integrates with the organization’s electronic health record (EHR), health information exchange (HIE) and accountable care organization (ACO), if the practice is participating in one. Ideally, the solution should be able to adapt to any healthcare facility’s IT system—not the other way around. Patient engagement initiatives should permeate the practice’s entire healthcare ecosystem.
Guest post by Ken Perez, vice president of healthcare policy, Omnicell, Inc.
Ken Perez
Though largely overshadowed by the continued pursuit of repeal and replacement of the Affordable Care Act by the Trump administration and congressional Republicans, the concept of a single-payer healthcare system is gaining popularity, and a referendum on it is already starting to take place.
According to a June 2017 national survey by the Pew Research Center, 60 percent of the American public feels it’s the federal government’s job to provide healthcare coverage for all Americans, and a third of the public favors a single-payer health insurance system run by the federal government.
On September 13, Sen. Bernie Sanders (I-Vt.) introduced the Medicare for All Act of 2017. In striking contrast with his previous solitary introductions of this approach, this time 16 Democratic senators—one-third of the party’s Senate caucus—identified themselves as co-sponsors, including Senators Cory Booker, Kirsten Gillibrand, Kamala Harris, and Elizabeth Warren, all possible presidential candidates.
Medicare for All Defined
Per Sanders, Medicare for All would create a federally administered single-payer healthcare program that provides comprehensive coverage for all Americans, spanning the entire healthcare continuum, “from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments.” Every doctor would be in network, and saliently, there would be no deductibles, copays or cost-sharing requirements of any kind.
Estimating the Cost of a Single-Payer System
One admittedly simplistic way to estimate the cost of a single-payer system would be to assume that the federal government would pay for the nation’s entire national health expenditures (NHE), which the Centers for Medicare and Medicaid Services projects will reach about $3.5 trillion in 2017, which would be equivalent to a more than tripling of the roughly $1.1 trillion the federal government will spend this year on Medicare, Medicaid, the Children’s Health Insurance Program, health insurance subsidies and related spending, and Veterans’ medical care.
Single-payer advocates argue that administrative savings and decreased waste would reduce spending, generally by 20 percent to 30 percent, but such savings would likely be offset by the cost of covering the approximately 25 to 30 million Americans without health insurance, as well as higher demand (from those currently with coverage), resulting from the elimination of all cost-sharing requirements, which tend to curb overutilization of medical services. Per a landmark 1982 Rand Corporation study that examined the spending patterns of patients with insurance that covered 100 percent of expenses versus those with copays and deductibles, patients without out-of-pocket fees spent 30 percent more for medical services. A 30 percent increase in demand for medical services would add more than $1 trillion to the nation’s annual healthcare bill.
Citing the lower per capita costs of healthcare in other industrialized countries with single-payer systems, Sanders argues that NHE would actually decrease under his single-payer plan, by $6 trillion over 10 years. Sanders’ white paper, “Options to Finance Medicare for All”— which outlines a dozen tax revenue-generating ideas —presents $16.2 trillion as the implied expected increase in federal expenditures over a 10-year period under Medicare for All.
As technology evolves and there’s more emphasis on streamlining business practices, there’s an increasing reliance on electronic health records. In 2014, private healthcare providers were required to adopt electronic medical records to maintain their existing Medicare and Medicaid reimbursement levels. The move was a part of the American Recovery and Reinvestment Act, which aimed to improve quality, safety, efficiency and reduce health disparities.
The Act also offered financial incentives to those providers who could prove meaningful use in the adoption of electronic health reporting. Non-compliant healthcare providers faced penalties, including a 1 percent reduction in Medicare reimbursements. When it was officially mandated, the U.S. Bureau of Labor Statistics (BLS) predicted a 12 percent growth in employment opportunities from 2014 to 2024. Positions they expected to open up included medical records and health information technicians, computer systems managers, health managers and computer support specialists.
If you’re unsure about the role electronic health reporting can play in your practice, using the following information as a valuable resource. Every practice can benefit from EHR, and it’s important to understand the how and why.
Electronic Medical Records vs. Electronic Health Records
Electronic medical records and electronic health records are often used interchangeably, but there are some key differences. Medical records offer a more narrow view of an individual’s medical history, and it’s used mainly for diagnosis and treatment. They are unique to a specific practice and are not designed to be shared outside of that practice.
Electronic health records, on the other hand, show a patient’s overall history. It is a comprehensive medical chart that’s intended to be shared with other practices. It includes everything from images to allergies to lab results. If the patient were to move across state lines, their electronic medical record would follow them, while an electronic health record stays with the practices they leave behind.
Improved Efficiency and Cost Savings
Electronic health records can provide immense benefits in terms of increased efficiency. This can be demonstrated by current statistics on EHR. One survey found that 79 percent of users stated that EHR allowed their practices to run more efficiently. Of the doctors surveyed, 82 percent reported that sending prescriptions electronically saved time, 75 percent received lab results even quicker, and 70 percent reported increased data confidentiality.
As technology evolves and there’s more emphasis on streamlining business practices, there’s an increasing reliance on electronic health records. In 2014, private healthcare providers were required to adopt electronic medical records to maintain their existing Medicare and Medicaid reimbursement levels. The move was a part of the American Recovery and Reinvestment Act, which aimed to improve quality, safety, efficiency and reduce health disparities.
The Act also offered financial incentives to those providers who could prove meaningful use in the adoption of electronic health reporting. Non-compliant healthcare providers faced penalties, including a 1 percent reduction in Medicare reimbursements. When it was officially mandated, the U.S. Bureau of Labor Statistics (BLS) predicted a 12 percent growth in employment opportunities from 2014 to 2024. Positions they expected to open up included medical records and health information technicians, computer systems managers, health managers and computer support specialists.
If you’re unsure about the role electronic health reporting can play in your practice, using the following information as a valuable resource. Every practice can benefit from EHR, and it’s important to understand the how and why.
Electronic Medical Records vs. Electronic Health Records
Electronic medical records and electronic health records are often used interchangeably, but there are some key differences. Medical records offer a more narrow view of an individual’s medical history, and it’s used mainly for diagnosis and treatment. They are unique to a specific practice and are not designed to be shared outside of that practice.
Electronic health records, on the other hand, show a patient’s overall history. It is a comprehensive medical chart that’s intended to be shared with other practices. It includes everything from images to allergies to lab results. If the patient were to move across state lines, their electronic medical record would follow them, while an electronic health record stays with the practices they leave behind.
Improved Efficiency and Cost Savings
Electronic health records can provide immense benefits in terms of increased efficiency. This can be demonstrated by current statistics on EHR. One survey found that 79 percent of users stated that EHR allowed their practices to run more efficiently. Of the doctors surveyed, 82 percent reported that sending prescriptions electronically saved time, 75 percent received lab results even quicker, and 70 percent reported increased data confidentiality.
EHR Cost Savings
There are immense cost savings associated with EHR. For example, large hospitals can save anywhere between $37 million to $59 million over a five-year period, not including incentive benefits. The majority of those savings come from the ability to eliminate various labor-intensive tasks and other paper-driven responsibilities. With better access to patient data and smart error prevention alerts, the chances of medical errors are greatly reduced. You’ll also experience easier communication across the entire medical channel. You can track electronic messages from staff to labs to other hospitals and clinicians.
Many administrative tasks are streamlined, resulting in time reduction. Filling out forms and taking care of billing requests often take up a significant portion of healthcare costs. Electronic health records also provide more information on next best steps, and can automatically siphon information that needs to be shared with various public health agencies.
Augusta University Medical Center reported that it had become a victim of phishing for the second time within a 12-month period although fewer than 1 percent of patients were impacted by the second effort. A trio of cybercrime rings took over 26,000 open MongoDB servers and demanded ransom for the owner to retain the data. A successful intrusion of Medical Oncology Hematology Consultants was detected, with 19,203 compromised patient records; however, by that point, the hackers had been inside the system for 20 days.
Kaleida Health announced that it had been victimized by phishing, with 744 patients affected; actually, though, that was adding to a previous tally – with 3,544 total records accessed. Ransomware brought down Pacific Alliance Medical Center; two months later, the firm said that 266,123 patients were impacted.
What do all of these situations and figures have in common? They are all Health Insurance Portability and Accountability Act (HIPAA) violations that took place in 2017. Also, you don’t want to be that organization. Forget the threat to your credibility (perhaps especially the much-dreaded Wall of Shame; the sheer expense is overwhelming. For any data breach, the average drop in revenue experienced by a healthcare firm is $3.7 million
So, with all that said (i.e., since it is more common than anyone would like, and since these cyberattacks are so incredibly costly), it is only reasonable to look over some HIPAA fundamentals and review security best practices for protecting HIPAA compliant data. With the information you collect, you can strategize implementation of the most strongly protected possible system.
Here are a few tips so that your environment can integrate best practices for securing the protected health information (PHI) that is under your watch:
Encrypt everything
Encryption is critical. Just look at a study published in Perspectives in Health Information Management in 2014. While this research is slightly dated, it is compelling because it is a true big data study that looked at all the breaches of HIPAA-protected files that were currently within the HHS Department’s system. At the time of the report, which used all events through September 22, 2013, 27 million people’s records had been compromised, via successful attacks of 674 covered entities and 153 business associates. Forms of intrusion included hacking, improper disposal, loss, theft, unauthorized access, etc. Breaches occurred in various digital environments both through devices and backends, as well as through hard-copy paper documents.
When you look at the data on types of breaches as pieces of the whole, you see how prominent theft is. Here are the top five types of breach in descending order of volume, with the number of individuals, covered entities, and business associates affected in each case (numbers that have now grown substantially): 1. theft – 12,785,150 people (via 344 CEs and 52 BAs); 2. loss – 7,359,407 people (via 74 CEs and 23 BAs); 3. hacking or IT event – 1,901,111 people (via 59 CEs and 20 BAs); 4. unauthorized access – 1,334,118 people (via 136 CEs and 44 BAs); and, 5. improper disposal – 649,294 people (via 32 CEs and 5 BAs).
The key concern here is that these issues are not just about theft. If it were just about laptops being stolen, that would not be as much of a problem because the criminals would not be able to get anything of them necessarily. All of these cases are ones in which the information on the devices that was stolen was unencrypted. In other words, all you need to do is encrypt that data – and even if it does get stolen, you don’t need to worry about it as a violation.
Assess your risk
Conduct a complete risk assessment of all the elements of your ecosystem that store, process, or transfer ePHI, along with other ways in which your information may be exposed physically. Related to the data center environment (whether it’s internal, third-party or hybrid), you want to ask these questions: Are natural disasters common in the location of the data center? Is there a responsible party associated with all hardware components? Have you assessed the security mechanisms that are now in place and any risks that are present? Have you taken into account all ways in which ePHI is accessed or manipulated within your system? Consider the creation, receipt, maintenance and transfer of this information.
Training is fundamental
It is easy, especially related to electronic protected health information, to become obsessed with the systems and to forget about the huge potential for human error. Your staff must be properly trained, especially since the threat landscape is evolving, with an increasingly sophisticated toolset for accessing the data. A very simple yet devastating mistake that is often made is phishing, when a staff member either clicks on a link or submits data, such as usernames or a Social Security number that, thereby, connects them in to a fraudulent system. It is horrifying but true that something as simple as a fake email could create a point of entry for malware or viruses.
Guest post by Ann Richardson, communications and change management consultant, Pivot Point Consulting.
Ann Richardson
Healthcare has seen its fair share of transformation over the past two decades. The waves of change reshaping the industry include new coding sets, evolving value-based payment models and countless technology implementations, just to name a few. As healthcare pivots from tech laggard to technical innovator, those working in the field sometimes struggle to adapt.
Healthcare organizations have made big investments in electronic health records (EHRs) and other healthcare IT systems, but not without some pushback from the people tasked with using them. Clinician frustration with EHR adoption has been well documented. In our push to implement new—and badly needed—resources to bring greater efficiency to healthcare, it’s important not to overlook managing the human side of change.
Effective Communication: The Crux of Change Management
In my work managing projects as a communications and change management consultant, I’ve learned that each company has its own unique culture and way of doing things. Some organizations are adaptive while others are more change resistant. Regardless of the nature of the project—be it an EHR upgrade, revenue cycle management (RCM) software training or other initiative—an assessment of an organization’s capacity for change during the early stages of project development is crucial. By identifying changes and related impacts early on, change managers can help project teams develop an effective strategy to support employees as they move through the change process and adapt to the new way of working at their organization.
To identify potential points of friction and build a game plan for plugging any readiness gaps, remember to include the people tasked with managing the human side of change (communication, change management and training managers) along with technical and operational resources at every stage of the planning and execution process. These folks can work closely with project teams to develop effective communication, change management and training plans designed to build awareness, reduce resistance, increase adoption and pave the way for a smooth transition at go-live.
10 communication tips for a smooth go-live:
Include communications/change management managersin process designdiscussions. Communications and change management resources must be able to clearly articulate changes and their impacts to end-users.
Identify, analyze and document workflow and system changes, including impacts, risk level and who is impacted, so a plan for addressing potential resistance and risks can be developed.
Offer a broad array of ways employees can get information about the project. Try to appeal to different learning styles (i.e., visual, aural, verbal, physical, logical, social and solitary) and information consumption preferences (intranet, email, e-newsletter, bulletin board, print, video clip, events or activities).
Leverage existing communication channels already in use by the client to offer users a point of familiarity.
Create a project website so employees have a dedicated place to turn to for project details.
Consider using weekly email blasts to avoid overwhelming employees with multiple emails, i.e., “email fatigue.” Link to the project website to keep messages brief, yet provide additional detail for those that may need or want additional information.
Write messaging that is clear, concise and jargon-free. Think bullet points. Avoid large blocks of text but do provide sufficient context for users not actively involved in the project. Use a screenshot, image or diagram if it can clarify a complex message.
Spell out acronyms. Don’t assume everyone can decipher healthcare and health IT acronyms.
Get feedback from clinical and operational team members before distributing messaging aimed at other clinicians.
Meet the informational needs of your target audience(s) by asking these three questions when creating messaging:
Who is the target audience?
What do they need to know?
What do I want them to do?
Change resistance can thwart even the best-laid implementation plans. By getting communications and change management resources involved early on in a project, healthcare organizations can better support their employees who are impacted by the transition to a new system. Dedicating time and resources to helping employees adopt new workflows and applications can go a long way in ensuring the success of your next project.
It’s not exactly a sweater or tie that gets worn once and then relegated to the top of the closet, but it turns out that patient data may have something in common with unloved holiday gifts. Both, it appears, are shared and then seldom used.
At least that’s one takeaway from a recent Health Affairs study on interoperability and how far forward we’ve actually moved the ball. The authors used the most recent available data (2015) and the four interoperability standards established by the Office of the National Coordinator (ONC)—finding, sending, receiving, integrating—to conclude that progress on this measure is lagging, at best.
“… Progress toward interoperability has been slow, with fewer than 30 percent of hospitals engaging in all four domains of interoperability in 2015 and with an increase of only 5 percentage points from 2014,” the authors write.
The low percentage of hospitals using all four standards is particularly significant in that simply sending or receiving data does not guarantee its use. Of those hospitals that said they sometimes, rarely or never use outside patient data in care (55.8 percent), or didn’t know (11.2 percent) how often they used it, the most oft cited explanation was that “clinicians could not view the information in the EHR as part of their workflow.”
“Issues with integrating information into existing EHR systems and clinical workflows were the most commonly cited barriers for hospitals that were not routinely using external information for patient care, which further underscores the need to shift the policy focus from transmitting information to information usability.”
Ah, yes, usability … yet another technological imperative that ends in ‘ability.’ Health Affairs suggests that data usability has a lot to do with EHR sophistication.
But is it having an advanced EHR that improves data usability? Or is it perhaps having the same EHR as the facility you share data with? As Health Affairs points out, those hospitals that most frequently share patient data via HIE are those working with an EHR and HIE from the same source.
“Without strong incentives that would have created market demand for robust interoperability from the start, we now must retrofit interoperability, rather than having it be a core attribute of our health IT ecosystem,” writes Julia Adler-Milstein, also an author of the Health Affairs study, in a recent NEJM Catalyst article. “And, if there had been stronger incentives from the start, we would not now need to address information blocking: the knowing and intentional interference with interoperability by vendors or providers.”
Adler-Milstein argues that policymakers dropped the ball more than any stakeholder group. The EHR vendors and providers, she says, are just working within the boundaries to retain or improve their respective positions.
“Of the stakeholders, only policymakers have a clear, strong interest in promoting interoperability,” she says. “Therefore, it is up to them to ensure that robust, cross-vendor interoperability is a stay-in-business issue for EHR vendors and providers.”
Then you are seriously in need of healthcare IT solutions.
With advancements in technology, the healthcare sector is becoming digitized. The focus is on personalized and patient-centric technology, which can help in accelerating the process of treatment.
Healthcare IT solutions are meant for delivering the best service to the patients as well as to enhance operational efficiency. The American Recovery and Reinvestment Act of 2009 was passed to provide $19 billion for the purpose of promoting the use of EHR technology in hospitals and medical practices. This proves the growing importance of healthcare IT solutions.
Healthcare IT includes the latest technologies like analytics, cloud computing, electronic health record systems, as well as data management systems. A growing number of institutions are successfully implementing healthcare IT solutions to improve their efficiency. It has been observed that manual entering of data and health records of patients are taking up too much time of the administrative staff as well as the medical personnel. This time can be utilized to provide better services to the patients.
Here are some of the benefits of using healthcare IT:
EHR technology –– Electronic health records are part of the digital revolution that has taken over the healthcare sector. EHRs make the whole process of keeping patient records very streamlined and efficient. Data can be accessed both by the doctors as well as the patients because it is available on an electronic platform. The personal health records portal helps in management of patient information. Medical personnel can take better care of the patients when they have all the information on one platform. Time and effort spent on manually entering the data are saved so that doctors can provide better treatment to the patients and can serve the people who are in need of doctor care.
Better coordination of patient care — Healthcare IT solutions help in better coordination between physicians, specialists, nursing staff, lab technicians and other medical personnel. Vital information regarding the patient’s health is available to all of them. When the same data can be accessed by everyone, the problems of duplicate tests, contradictory medication prescription and miscommunication can be avoided. This saves time and minimizes the chances of errors leading to improvement in the overall quality of care that is provided to the patients.
Patient empowerment– When the patient has access to all his personal health records, he can play a more active role in managing his overall well being and determine the outcome of the treatment that he receives. All the lab results, medical history records as well as drug information are available on an online platform for the patient. The EHR system allows the patient to schedule appointments, communicate with the doctor as well as to refill prescriptions. Such healthcare IT solutions increase patient satisfaction.
Cost savings — Healthcare IT not only saves time, but expenses too. Easier documentation reduces the administrative cost and increases the number of patients that a medical facility can treat. This leads to an overall increase in revenue generation.
