Some people jokingly say they’re “addicted” to their smartphones or to browsing online. They use their devices to visit social media platforms and websites and send texts throughout the day. But the vulnerability created by these activities for employers is no joke, and the risks extend to every industry, including healthcare, since most data breaches are caused by human error.
In doctor’s offices and other clinical operations, the risk is especially acute for providers who use cloud-based systems that require constant connection to the internet. The always-connected nature of these solutions exposes offices to ransomware and malware designed specifically for Windows, which can exploit the internet connection to steal sensitive patient information.
While many high-profile hacking and ransomware incidents have occurred over the past several years, security experts project that 2017 will be even worse as cybercriminals exploit new vulnerabilities introduced by the Internet of Things (IoT) and hackers increasingly turn to Distributed Delay of Services (DDoS) attacks. These are techniques for data theft that are only used to compromise remote data centers with shared servers, commonly called ‘the cloud’.
Practice leaders can respond with training, instructing staff on how to avoid “phishing” scams, fake web sites, fake links, and other temptations and traps, but stopping hackers will take a concerted and comprehensive effort. Encryption, platform and common sense security measures can all play a key role in protecting patient data.
Encryption’s Role in Data Protection
Encryption — the use of an algorithm to make data indecipherable to criminals without an encryption ‘key’ — is an essential component of data security. To comply with HIPAA standards, practices should use software and/or hardware that utilizes Advanced Encryption Standard (AES), the only standard that can be called encryption according to the National Institute of Standards and Technology (NIST).
HIPAA requires that providers use secure, encrypted email. HIPAA also states that providers have a duty to encrypt electronic patient health information (ePHI) that is ‘at rest’ (i.e., on a server, terminal, backup device, etc.) and ‘in motion’(i.e., traveling through an office network or to and from remote connections, etc.) and that their database be further protected with a unique, encrypted password.
Unfortunately, most practice software does not have built-in AES encryption and some do not even have a unique password. Practices with software that does not have built-in encryption who use Windows will have to purchase outside expertise to implements and monitor security and make to help them be HIPAA compliant with regard to encryption.
Platform and Security’s Role in Keeping Data Safe
Practices that use Windows software without built-in encryption must pay for IT security services to deploy encryption on every device that houses ePHI. Mac users can handle the safety of data at rest by turning on FileVault in preferences. This is a glaring example of the difference platforms make in keeping data safe and the cost to the doctor.
Virtual private networks (VPNs) are an option for practices to compensate for practice management and EHR software that does not encrypt data in motion, but VPNs increase costs and complexity and can degrade network responsiveness. But even with a VPN, practices must make sure their software provides a unique, encrypted database password; otherwise, they’re well advised to get software that does.
Hacking is on the rise, and ransomware is a huge problem for practices that operate on Windows. In March 2016 alone, 56,000 Windows users reported attacks. Practices that use native Mac software have not been affected by ransomware. Macs are also less expensive to operate in the long run: IBM gave employees the option to use PCs or Macs and found that each PC required twice as much support and cost IBM $535 more than a Mac during a four-year period.
Cloud software and hosting server farms aren’t the solution: Malware, including ransomware, can infect every device that connects to an infected computer, including offsite cloud servers and backup devices. The FBI says the only sure way to recover is to restore data from an uninfected backup that is not connected, followed by reformatting devices.
Note about “the cloud”: You have heard from cloud vendors that “everyone is going to the cloud.” What you may not have heard is that 40 percent of organizations that migrated their data and applications to the cloud are now bringing all or some of them back because of security and cost concerns. Also a recent survey of dentists indicated that of the top dental software perhaps no more than 3 percent of dentists are using cloud software, although it has been available to them for eight years.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
Time is money, an adage the world follows. When providers realized paper medical records were time-consuming, Electronic Health Records were developed to make things streamlined. Early EHRs were only meant to capture basic clinical information, and over the time EHRs have taken the form of a digital version of paper medical records. In an industry as dynamic and as focused on value as healthcare, it’s not feasible to have physicians spend almost half their time on EHRs.
Challenges physicians face with EHRs
EHRs, in their current state, not only consume a lot of physicians’ time, but they also draw their attention away from their direct interactions with patients. Some of the several significant challenges physicians face are:
Data entry and administrative tasks take up a lot of physicians’ time, according to a study, during the office day, physicians spend as much as 49.2 percent of their time on EHRs.
The demands of desk work and administrative work are not being reconciled with patient priorities and clinical workflows; creating huge gaps between patients and providers. For example, during patient examinations, physicians spend 37 percent of their time on data entry and desk work, compromising on their direct interaction with patients.
Physicians are only reimbursed for face-to-face visits, lab work, and medical procedures and not for EHR tasks. This increases the misalignment in fee-for-service payments and compounds the risk of physician burnout.
Why can’t we do away with EHRs?
While EHRs are not without their own set of challenges, their implementation was necessary, and that still holds true. Only recently, under the Merit-Based Incentive Payment System (MIPS), providers have started to make an effort to enhance value in the care they deliver and the meaningful use of EHRs has been included in MIPS with other substantial quality reporting initiatives. Besides that, there are many offerings of EHRs:
A quick and real-time access to patient records.
Reliable drugs and test prescriptions.
Complete clinical documentation, inclusive of patient medical history.
Accurate and streamlined coding and billing operations.
Reduced cost of operation.
EHR Optimization: Boosting your EHRs
EHR optimization is the process of enhancing and refining the operations of an already installed EHR, to enhance clinical productivity and efficiency. As more and more practices have begun the push for value-based reimbursement, they are demanding more integrated and efficient EHRs.
Opportunities for EHR optimization vary for every practice and range from simple to complex. However, the primary objective of every optimization is reducing the time consumed. Here are some ways healthcare IT platforms can optimize time spent on EHRs for improved patient outcomes:
Establish key performance indicators: Once a healthcare organization has examined its baseline performance, it can decide on goals and target a benchmark for future. Organizations can leverage advanced analytics to determine their progress across each key performance indicator which in turn, helps with quality reporting.
Comprehensive and complete clinical records: It’s important that a patient record is complete- right from their past medical history to their last lab test results. Along with that, if providers are able to look at all vital signs at once, the entire process of designing and implementing a care plan would become efficient.
Implementing clinical decision support: By combining clinical decision support with EHR data, providers can ensure safer and efficient care delivery by documenting every interaction and eliminating redundancies. With every information documented, providers can address the gaps in care well in time.
Sharing vital information across the network: More often than not, the delay in accessing information is the major reason behind improper or delayed care. It’s important that clinical data, lab test results, referrals, etc. are shared across all providers to ensure seamless treatment and population health management.
Monitor, evaluate and maintain results: To ensure the success of optimization isn’t short-lived, providers should continuously monitor their process improvement. Organizations should evaluate their growth and shortfalls and make their efforts to sustain and improve the results they achieve.
Guest post by Matthew Douglass, co-founder, SVP Customer Experience, Practice Fusion
Matthew Douglass
In part 1 of this series, we reviewed the history of digital health tools and discussed why they are not yet fully satisfying the needs of many physicians.
If you think of the U.S. healthcare system as a vast nationwide transportation network, current electronic health record (EHR) functionality is the basic highway infrastructure. The American Recovery and Reinvestment Act of 2009 provided the incentives for those highways to be built and put in place the structure for ONC-certified EHRs to define the rules of the road via regulatory standards. The roads are now mostly in place: certified EHRs all offer roughly the same base functionality for use by physicians, store clinical information in standardized ways, and have the capabilities to securely communicate with each other.
Sixty-seven percent of medical practices in the U.S. are now using EHRs to run all or part of their daily operations. Patients’ vital signs are stored as discrete values for each visit. Encrypted messages between physicians and their staff are transmitted reliably. Chart notes are being digitally documented and can be shared confidentially with patients. Physicians that have chosen cloud-based EHRs can securely prescribe and refill medications from the convenience of their mobile phones.
Despite having this digital highway system in place, we haven’t yet reached a destination where use of EHRs achieves better patient outcomes or improved clinical experiences. Physicians want more from digital tools than simply receiving, storing, and displaying data values about each patient visit. Rather than devoting too much of their already limited time to data entry and retrieval, physicians want to provide the best patient care possible, and they expect technology to help them achieve this goal.
There is such a thing as too much data, which physicians are reminded of each time they open a digital chart. Clinicians very often are left swimming in more data than they can adequately process, which can erode the crucial patient-provider human relationship.
To address data overload and dehumanization challenges, software partners must go back to the drawing board and visualize dramatic innovations that can be built on top of the nationwide EHR foundation. Significant cognitive overhead is required to distill hundreds of disparate pieces of clinical data into a salient picture of an individual’s overall health. The vast amount of data now available in a patient’s chart is quite often far more than any medical professional, no matter how clinically experienced, can consistently and reliably assimilate.
Physicians and their staff need intuitive technology to be their always-available, intelligent assistant, from start to finish during a patient’s visit.
When a patient’s record is displayed on the computer screen, physicians shouldn’t have to dig for relevant information about that visit. Instead, the EHR should be able to display the pertinent clinical data and health insights for the physician to review and assess a patient’s health condition more quickly and effectively. For example, lab values and vital signs relevant to that patient’s chief complaint are likely already stored as discrete values in the patient’s chart. An EHR that learns along with the physician’s workflow preferences should display only the most relevant data through easily digestible visualizations.
Guest post by Matthew Douglass, co-founder and SVP of Customer Experience, Practice Fusion.
Matthew Douglass
Despite enjoying broad technological advances in their medical practices over the past decade, many physicians still find little pleasure in having to use electronic health records (EHRs). Reasons for low satisfaction run the gamut, from a litany of potentially distracting alerts to overwhelming features that are difficult to learn. This flagging usability, combined with the growing burden of data entry and documentation, impedes physician satisfaction.
Physicians do not begin their careers in medicine so they can spend a majority of their time wrestling with technology. A recent study found that physicians spend three times as many hours working on computers as they do providing direct patient care. It is no wonder that physicians are reporting record levels of burnout and deep job dissatisfaction.
There are practical workarounds to the challenges of using EHRs, such as programs pairing physicians with scribes that are pre-med students who assist those physicians or plugging in additional technologies that reduce direct documentation overhead. However, these practical workarounds mask the root problem rather than address it; EHRs have yet to provide consistently actionable insights that will help to dramatically improve clinical outcomes.
When a physician opens a patient record in her EHR today, she is probably no better equipped than if she were to open that patient’s paper record 10 years ago. All the data points she might ever need are available for her to sift through, but where is the insight? How is she supposed to interpret clinical meaning in individual pieces of data scattered throughout her patient’s history? How is the EHR assisting her in making better, more informed care and treatment decisions for her patients’ lives that she has been entrusted with improving?
EHRs were originally created as a digital recreation of the physical paper chart that accompanied a physician into the exam room during every patient visit. Vital sign collection sheets were recreated as vital sign fields on the screen. SOAP notes that physicians judiciously completed with pen and paper after every patient visit became digital SOAP note fields in the EHR that still have to be typed by the physician or a physician’s representative at the end of every patient visit. Billing one-pagers with pre-printed ICD and procedure codes have been replaced with nearly identical digital superbills containing point-and-click picklists of diagnoses and procedures.
Although we have created a digital system, the healthcare industry lingers in an analog world: Everything still operates like paper.
In the early 20th century, Henry Ford envisioned a future where transportation was dramatically better than what the main transportation technology of the time (i.e., horses) could provide. Confronted with this problem, he didn’t try to re-engineer horses to run 10 times faster. Thankfully, he set his sights on an entirely different and improved solution, experimented with a few ideas, and succeeded in completely altering the future of human transportation by introducing the first mass-produced automobile.
EHR vendors have a similar opportunity today, as they imagine the future of digital health technology that will be highly usable and incredibly helpful for physicians. Fortunately, EHRs are now broadly distributed enough that there is a solid foundation in place on which to build . Now that the vast majority of patient clinical information lives in a digitized form, we can look to the future and ask a novel, crucial question: How can this rich repository of clinical data evolve into upgraded tools that can be used to broadly improve patient health and physician satisfaction?
To best answer these questions, EHR vendors need to reevaluate the specific assistance that physicians can garner from digital health tools. First, clinicians and their staff must be intimately involved in the functionality discovery process in partnership with EHR vendors. This research can then be converted into success metrics and key questions that clinicians and vendors’ product teams utilize as benchmarks for measuring overall successful implementation.
Am I happier as a clinician because of this functionality?
Am I able to devote more or less time to focusing on my patient because of this functionality?
Overall, did this functionality save or cost my practice time and money?
Are my patients healthier and more satisfied with the service my practice provides them?
Further, as physicians are evaluating which digital health technology vendors to partner with in their practice, there are a few advantageous traits they should consider. EHR vendors that operate in a secure cloud offer distinct advantages because they can roll out frequent updates that do not interfere with a practice’s day-to-day operations. If a bug or usability issue does arise, the problem most often can be addressed quickly and without interruption.
Owning and running a practice doesn’t come without its barriers and certain difficulties. That’s why the selection, evaluation, purchase, and integration of a medical software system that is right for you and your practice is of innate importance. Having the correct software system will let your practice run more efficiently and effectively, all while adding to your bottom-line.
Choosing Medical Software that is Perfect for Your Practice
There are several variables to keep in mind when deciding on a software system for your practice; not the least of which are the initial financial investment, overall upkeep and maintenance costs, and the quality of technical support.
A good characteristic to look at when deciding on a software system is comprehensive integration, with data seamlessly connected and shared between scheduling, billing, and electronic medical records. In order to see a rise in efficiency in your day-to-day procedures and routines, your data should be instantly accessible, both onsite and remotely, and formatted to be easily read.
Now let’s talk budgeting: It’s important to properly calculate your practice’s current financial standings so you can have an idea of the system that is right for you. Software options can either be purchased directly or leased to purchase.
Practices will be able to identify outstanding transactions, which will result in more efficient strategies for both collecting income and preventing loss of income.
Track Patients More Efficiently and Increase Productivity within Your Practice
Another element to running a more successful practice relates to maximizing patient workflow and staff productivity. The importance in tracking your patients cannot be understated, and utilizing the right software system is the essential step towards tracking patients most effectively and increasing overall staff productivity within a practice.
As owners of a practice, two things that can be intrinsically frustrating are patient “no-shows” and lost revenue from canceled or missed appointments. Well, utilizing scheduling software can help track and manage your patient’s appointments to avoid these situations from ever happening again. Managing this data under the right system can promote management strategies that can foresee patient trends so practices can plan accordingly. For example, a practice can provide reminders or alerts to those patients with a history of canceling or missing appointments to maintain patient volume.
These medical software systems also have the ability to verify patient eligibility the day they come in, or even before whenever their appointment is scheduled for. Obviously this drastically reduces wasted time within your staff and increases time for patient care, resulting in a far more efficient practice.
Organize Clinical Data with Ease through EHR Integration
Now to talk about clinical reporting within your practice. Organization cannot be easier and more efficient when utilizing a software system to help manage your practice. Below are some practical techniques that can help you see large benefits within your practice:
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
The world of healthcare analytics is vast and can encompass a wide range of data that has the incredible potential to tell stories about health and healthcare delivery: right from individual patients to entire populations. Having numbers and an easy-to-use visualization at hand gives providers and caregivers the power to not only look into the lives of individual patients but also track the ongoing activities in their organizations. Simply showing visualizations are not enough and to fully understand their value, healthcare organizations have to take a few steps beyond basic graphs.
The Case for Data Visualization
In the words of Edward O. Wilson, the father or social biology:
“You teach me, I forget.
You show me, I remember.
You involve me, I understand.”
There are many disparate data sources healthcare providers have to deal with: EHRs, departmental data, claims data, resource utilization, administrative data, etc. Consolidating the data and spreading it out in a visually adaptive manner offers a more agile approach to managing complex population health data.
Data visualization was developed with the aim to make it easier to gain actionable insights from volumes of information and work on improving health programs, clinical healthcare delivery, and post-episode care management. Visualization provides real value in learning from disparate data sources, finding outliers, bringing out hidden trends out on the front, and delivering better health outcomes.
Streamlining Different Data Sources into a Single Source of Truth
Since the data pertaining to a patient’s health comes in from various sources, it is vital to pool all the data sets and obtain an aggregated, standard format of data every authorized person can view and manipulate.
Data in the healthcare industry can broadly be categorized into two sources:
Claims data: that comes from payers and contains extremely uniform and updated data about the care patients receive and how they are billed for it. This data is usually structured and has all the meaningful data required for provider reimbursement.
Clinical data: this data comes in from the providers’ end and contains valuable information about their diagnoses, claims, and medical history. While this data isn’t often structured, incorporates data elements critical to analyze a patient’s health in every time frame.
Fine-tuning Real-Time Visualization
The amount of data healthcare institutions aggregate is enormous: by 2012, it was estimated to be a whopping 150 exabytes (150 million * million * million) and is growing at a rate of 48 percent per year. As the volume grows, healthcare organizations need state-of-the-art, real-time analytical capabilities to improve the care quality and its effectiveness. Real-time analytics can turn the tables in ways more than one:
Monitoring end-to-end care delivery across a wide range of facilities.
Observing the progress of clinical decision support systems.
Identifying overhead cost drivers and detect care or documentation gaps.
Since data visualization holds great advantage to understand the going-ons in the organization in real-time, here are some key elements that count as best practices for data visualization:
Customized reports: Each set of users in healthcare requires different metrics and different orders. Offering customized reports with specific visualization provides actionable insights and can answer specific questions about risks, rewards, and success of the organization.
Visually adaptive: Data presented on the dashboards has to be complete with functional and visual features that aim to improve cognition and quick interpretation. Data listed in a color coded-manner will provide physicians with functional features and real-time alerts.
Create actionable insights: A dashboard or any other visualization tool will provide clinicians with the data, but unless someone looks at it, it will go unnoticed and may have potentially critical outcomes. Users should be made aware of how to review the dashboard, drill down to every immediate level, and initiate corrective actions.
The end user’s ultimate need: It’s paramount that end users can communicate their needs and demands and what is even more important is that their demands and performance indicators are incorporated well in advance of structuring the report.
Wrap-up with Healthcare IT
By leveraging healthcare IT, organizations can have their hands on simple but effective visualization and take a look at additional, important information that might have been difficult to notice in tabular format. Here are some ways healthcare IT can drive real-time data visualization to success:
Immediate access and sharing: Putting bidirectional interoperability to use, providers can access and share relevant data across the network, despite technological barriers.
Clear data visualization: Graphic, color-coded cues help physicians swiftly learn about the areas that need performance improvement or track the growth their organization is making.
Drilling down: To learn more about the reason behind certain shortfall, physicians can always drill down and narrow their area of focus to pinpoint the anomaly, and take quick remedial actions.
Driving Value with Visualization
With healthcare IT now an integral part of the value-based care system, there is little doubt that convenient, real-time data visualization will be heavily used to achieve positive health outcomes. Combining real-time data with advanced analytics will completely reshape how healthcare IT can improve clinical and operational outcomes. Once physicians move away from long, incomprehensible data flows, and find an alternative that helps them instinctively read, isolate, and act upon the insights, only then can we be one step closer to a data-driven value-based care.
Guest post by Ken Perez, vice president of healthcare policy, Omnicell, Inc.
Ken Perez
The recently concluded debate about the American Health Care Act (AHCA), the Republicans’ first attempt at a Patient Protection and Affordable Care Act (ACA) replacement plan, centered largely around issues of insurance coverage and access to care.
The real turning point for the AHCA seemed to be the Congressional Budget Office’s March 13 release of its analysis of the bill, which concluded, among many things, that millions more Americans would be uninsured under the AHCA than under the ACA (14 million in 2018, 21 million in 2020, and 24 million in 2026).
After it became clear that the roughly three-dozen member Republican House Freedom Caucus—which sought a more aggressive piece of legislation that would gut the ACA—would not support the bill, House Speaker Paul Ryan concluded that the Republicans lacked the needed votes. Thus, on March 24, he pulled the AHCA from the floor. Ryan told reporters, “I don’t know what else to say other than Obamacare is the law of the land” and “We’re going to be living with Obamacare for the foreseeable future.”
With the focus mainly on coverage and access issues, a largely unasked question has been, “What will happen to value-based care?” The AHCA did not address this area, though, perhaps the Republicans intended to cover it in phase two or three of their grand plan to repeal and replace the ACA. As originally envisioned by congressional Republicans, phase two will consist of executive branch initiatives (e.g., actions by the Department of Health and Human Services and presidential executive orders), and phase three will include subsequent pieces of legislation addressing other aspects of the ACA.
The fate of value-based care is an important topic because U.S. healthcare costs continue to escalate and outpace general inflation—increasing 5.8 percent and reaching $3.2 trillion in 2015, equal to almost $10,000 per person per year. In addition, the ACA mandated five major healthcare delivery reforms promoting value-based care:
The Hospital Value-Based Purchasing (VBP) Program
The Hospital-Acquired Condition Reduction Program (HACRP)
The Medicare Shared Savings Program (MSSP)
The national pilot program for payment bundling
The Hospital Readmissions Reduction Program (HRRP)
Moreover, the ACA provided funding of $10 billion over 10 years for the Center for Medicare and Medicaid Innovation (CMMI), which was tasked with testing and evaluating various payment and service delivery models involving, in most cases, voluntary provider participation, with only a few models being mandatory.
Guest post by Nora Lissy, RN, BSN, MBA, director of healthcare information, Dimensional Insight.
Nora Lissy
It’s no surprise that chronic diseases are killing the United States both physically and financially. According to the Centers for Disease Control and Prevention (CDC), seven of the top 10 causes of death in 2010 were from chronic diseases, where two of the conditions—heart disease and cancer—together accounted for nearly 48 percent of all deaths. To add to the problem – effectively treating these conditions comes with an exceedingly high price tag. According to U.S. News & World Report, 86 percent of all healthcare spending is currently going towards the treatment of these chronic diseases, equating to more than $3 trillion annually.
So how can the healthcare industry combat the rise of chronic conditions while keeping escalating treatment costs down?
One of the most effective tools for monitoring chronic disease management while still keeping an eye on care costs is business intelligence. Business intelligence has continued to increase in prevalence within the healthcare industry in recent years. According to a HIMSS Analytics study, 41 percent of hospital respondents reported they currently use clinical and business intelligence tools for their analytics, with that number expected to continue to increase over the next two years. With business intelligence continuing to prove its value within healthcare, physicians are starting to see the true potential of this data-driven tool to positively impact the industry as whole, including with the management and overall cost of chronic diseases.
Below are three ways that business intelligence can help to improve chronic disease management and lower the rising costs of care.
Care plan adherence: Chronic conditions such as heart disease, diabetes and hypertension all require consistent adherence to care plans to improve a patient’s health status. A major part of this also includes frequent follow up appointments scheduled by physician offices that allow providers to check in on a patient’s progress. A business intelligence capability can significantly help with ensuring that these consistent follow ups occur. Through work queues and alerts, physicians can gain insight and visibility into each individual patient within a population cohort, allowing them to use the most accurate and timely information when scheduling follow up appointments. Business intelligence also provides insight into disease trends across a patient population. Through these insights, physicians can also allow for more personalized and cost effective treatment plans to be leveraged.
