Guest post by Dan Hickman, chief technology officer, ProModel.
Dan Hickman
With six in 10 U.S. hospitals functioning at operational capacity, patient flow optimization provides one of the most cost-effective ways to increase a hospital’s bottom line.
Around 6 a.m. every day, hospital-wide “huddles” occur to discuss and determine a collective understanding of the state of operations. Most of these huddles take less than an hour and provide hospital and departmental leaders a snapshot of census status and expected discharges.
But hospitals are complex, dynamic systems. By 7 a.m. a flood of patients could hit the ED, affecting everything from staffing to the census, and carefully crafted plans disintegrate.
Consider the current state of patient flow at most hospitals.
Most health systems today have a reactionary approach to admit, transfer and discharge (ADT), patient flow, census, and staffing. Moreover, there is no way of accurately predicting future patient flows to right-size staffing and optimize workflows.
Discharge processes are open loop, resulting in costly delays. Most hospital staff use spreadsheets stating the number of discharges planned for the next 48 hours. However, there is no way to look at patient census with diagnosis codes tied to the typical length of stay.
The current state of patient flow results in multiple problems:
For many hospitals, the length of stay and cost per case metrics exceed CMS value-based care efficiency measures affecting reimbursements and the bottom line.
The daily reality of hospital staff revolves around logistics — the timely and accurate flow of patients coupled with staff, equipment, and facilities needed to accommodate and provide care within the hospital. Yet most hospitals lack the tools to define, visualize, predict and optimize the logistical flow of real-time needs into the near-term future.
Compounding the problem, many patients cite time spent ‘waiting’ as an issue affecting their experience, and ultimately patient satisfaction and the hospital’s HCAHPS scores.
Hospitals are really good at examining what’s happened to a patient in the past. The staff knows where they’ve been, but they haven’t taken the next leap, which other industries have, at projecting out where they think patients will “flow” during their stay and how the next 24 to 48 hours could affect the status and the census. There are parallels with other highly complex industries where accuracy and logistical management are critical to safety and success. One example — air traffic control.
Guest post by Tim Cannon, vice president of product management and marketing, HealthITJobs.com
Tim Cannon
All jobs can be stressful at times, but anyone who works in health IT will tell you that their job is considerably stressful. In fact, 55 percent of health IT professionals surveyed in The 2016 Health IT Stress Report, by my employer HealthITJobs.com, said they are at least frequently or constantly stressed.
Among those surveyed, 38 percent rated their stress intensity as high or extremely high, while 45 percent said their stress occurs on a frequent or chronic basis.
What’s so stressful about health IT and what impact does it have on employees? Here’s a closer look at the findings and what they mean for professionals in the field:
Work management causes stress
What stresses health IT professionals out the most? Constantly changing priorities. Among respondents, 39 percent rated changing priorities as the top stressor. What’s more, 45 percent said they have little or no control over deadlines and timelines for accomplishing project milestones.
Although project management and their lack of control in the process stresses employees out, they don’t blame their manager for the problems. Only 15 percent listed managers as a top source of stress. In fact, respondents actually have great relationships with their managers, describing them as supportive, smart, and trustful.
With such supportive managers, health IT professionals should turn to them when work gets hectic. Instead of struggling with stress on your own, talk it out with your manager. Let them know when changing priorities are a problem, and talk to them about working together to set project timelines. If a deadline seems unreasonable, give your input and suggestion for a more practical timeframe for completion.
Workloads are unreasonable
After changing priorities, the workload itself gives health IT professionals the most stress — 35 percent of respondents rated it as a top stressor. An additional 35 percent of professionals said they have an unrealistic amount of work to do in the time given. And those who said they are frequently stressed were more likely to say their workload was too much to handle.
What’s bogging down workloads? Meetings could be the culprit. According to the survey, 27 percent of professionals spend 11 or more hours in meetings each week, and those who are frequently stressed are more likely to do so.
As part of an ongoing effort to ensure compliance with the HIPAA Privacy, Security, and Breach Notification Rules, the HHS Office for Civil Rights (OCR) has begun the second phase of audits for HIPAA covered entities. The first phase of the audits was conducted in 2011 and 2012 and evaluated the controls and processes implemented by 115 covered entities in order to comply with HIPAA’s requirements. This second phase of audits builds upon the findings of that first audit, and will address compliance efforts by both covered entities and their business associates.
The second phase of the OCR audits is focused primarily on compliance with HIPAA directives related to privacy, security, and breach notifications. Currently, details about the specific documentation that will be required is unavailable, but the OCR has noted that the audit will only deal with compliance with federal guidelines. Compliance with state regulations will not be addressed at all. Still, even though the specifics of the audit are still under wraps, now is a great time to review your own compliance with HIPAA rules and begin gathering documentation.
The HIPAA Audit Process: An Overview
Earlier this summer, the OCR sent notification to all HIPAA-covered entities requiring them to confirm the contact details for their organization and all business associates that handle protected data by the end of July. Once contact details are confirmed, the OCR will send out preliminary surveys to gather more information about specific organizations and their data protection protocols. From those survey responses, several hundred organizations will be chosen for desk audits, which means that they will be required to submit specific, requested documentation as instructed.
While the Phase 2 audits have many health care executives concerned, the OCR has noted that only several hundred entities will be selected for an audit, and of those, a very small percentage (only about 25 to 50 organizations total) are expected to move on to a full, on-site audit. Still, because there is no way of knowing whether your organization will be selected for audit, you need to prepare and be ready to go should that be the case.
The OCR is quick to point out that the Phase 2 auditing process is not intended to be punitive, and that the purpose is rather to identify best practices and potential weaknesses as a means to provide better guidance to covered entities on how to more effectively comply with HIPAA regulations. That being said, regulators do note that should there be serious deficiencies discovered during the process, then there could be sanctions or other corrective actions taken.
Is there an unspoken fear among caregivers that the subtext of all this digital disruption is a devaluation of the human element?
In countless industries, workers and analysts alike watch the slow march of technology and innovation and see as inevitable the takeover of human tasks by robots, AI, or other smart systems. We watched as the threat of outsourcing transformed into a reality of automation in industrial sectors, saw drones take on countless new roles in the military and in commerce, and now we hear about how driverless cars, self-checkout kiosks, and even robotic cashiers in restaurants are all waiting in the wings to dive in and displace even more formerly human occupations.
And looking at how EHRs — by virtue of their cumbersome workflows alone, not to mention all the documentation and growing emphasis on analytics and records-sharing–are taking flack for burnout and frustration in hospitals across the country, it hardly seems a reach to suggest that maybe America’s caregivers are feeling not just burdened by technology, but threatened.
Digital records are already changing what doctors and nurses do, how they work, and what is expected of them — it must surely be only a matter of time before their roles start getting handed over to the robots and supercomputers … right?
Wrong.
Change, Not Replacement
While some jobs or roles may face elimination through automation, the more common effect is transformation. In healthcare, that may mean that for many their title is the same — perhaps even the education and certification standards that go along with it–but their actual functions and roles in context will be different.
We see this already with respect to EHRs. The early, primitive documentation workflows and reporting obligations have drawn ire from clinicians who see their autonomy under attack by digital bureaucracy. But this is naturally destined for correction; medicine has advanced through trial and error for centuries, and the 21st century is no different.
The transition and disruption doesn’t manifest exclusively as growing pains. Consider the role of medical laboratory scientists and technologists: the Obama administration is pushing for a cure for cancer based on the advancement of personalized medicine; patient-centered care is becoming a priority among all caregivers as well as a quality metric in health centers across the country; genomic testing is seeing growing demand on the consumer side, as well as applications in a growing array of clinical settings.
All of these trends point to the medical lab as a newly central component of the modern care center, treatment plan, and information hub. The demands all these new technologies and applications put on laboratory professionals requires them to do more learning, adapting, and leading than ever before, especially to integrate the latest and greatest devices and tests available.
Simply put, machines are still fallible, and require assistance in providing critical context, to supplement their ability to accurately read, diagnose, and self-regulate to ensure accuracy and consistency, not to mention proper application in the clinical setting.
Guest post by Bryce Cannon, Vice President – Client Services, Modea.
Healthcare and Wearable Tech: How the Fitbit Can Improve the Patient Experience
As of 2015, 1 in 6 U.S. adults owns a smartwatch or fitness tracker. This means that there are 40MM people in this country counting steps, checking their heart rate, and tracking other data. The wearables market already represents a multi-billion dollar industry.
If this doesn’t seem like a big enough wakeup call to take wearable tech seriously, then what if I told you that soon we’re likely to be wearing smart clothing that measures breathing rate and muscle effort? Or that having small microchips embedded in your nail polish will allow you to track your movement and virtually type?
Fitness bands are just the beginning of human beings living a more measured life. And with the strong connection between wearable tech and healthcare, providers would be foolish to ignore this trend.
So how can you ensure that you don’t miss the wearable boat? In this article I’ll share two examples of hospitals that have already found a way to tap into the growing trend of wearables, as well as three benefits that you can realize for your own practice if you do the same.
Cedars-Sinai – Using Fitbit to Help Cancer Patients
Dr. Arvind Shinde, a faculty physician in the departments of Supportive Care Medicine and Hematology and Oncology at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, knows that activity level has a strong correlation to whether or not an oncology patient can physically make it through chemotherapy. To quote Dr. Shinde, “People who are spending more time in bed usually get harmed by the treatment we give, even if the cancer is responsive to the treatment.”
The problem is that the typical method for assessing patient activity level is simply to ask them and accept their word. But thanks to wearable tech, Dr. Shinde saw an opportunity to use empirical data.
So he rolled out a test in January of this year to enroll 30 adult cancer patients who have access to an internet-connected smartphone. Dr. Shinde provided each one with a Fitbit Charge HR device so that he can monitor stats like heart rate and miles walked. The goal is to assess patient activity levels over a fixed period of time, and then correlate that data with patients’ outcomes from cancer treatment.
According to Dr. Shinde: “The next step will be to do a larger study across multiple tumor types and follow people longitudinally for a much longer period of time. We can see how they do as they progress through their treatments, follow their ups and downs. We’ll be able to get changes over baseline and create a better algorithm for this assessment.” (To read more about Dr. Shinde’s trial, read this article.)
Through Dr Shinde’s work, Cedars-Sinai has found a way to leverage wearable tech to improve quality of life and provide better patient outcomes.
Dartmouth-Hitchcock Rolls Out ImagineCare to Improve Sustainable Health
Built on 2 years of research surveying best practices across areas from hospitality to high tech, Dartmouth-Hithcock has rolled out a new platform (ImagineCare) allowing patients the ability to tap into a full network of health alerts and personalized support, as well as to voluntarily supply connected health data to their care providers. It’s particularly focused on those managing chronic diseases. The platform incorporates use of the Microsoft Band activity tracker to measure and collect personal health data. In their own words:
“Patient health data is captured, monitored and analyzed in a sophisticated command center using powerful applications developed in partnership with Microsoft. ImagineCare combines patient health data with other relevant data sets, for example from national health organizations like the Centers for Disease Control and Prevention (CDC), and applies care pathways, which have been developed using the latest clinical evidence and best practices…”
This video helps bring it to life:
By bringing together wearable tech, personalized support, and a new ImagineCare app, Dartmouth-Hitchcock is providing a holistic care platform that helps patients to manage chronic health issues and better provide self care.
Integrating with Connected Health Data
As a healthcare provider there are many ways to get started integrating with wearable data. As a first step, I’d recommend exploring Apple HealthKit. In 2014 Apple released the “Health” app for iOS. Now over 75MM iPhone users in the U.S. can track statistics like activity and heart rate, just by carrying their phone around in their pocket.
Later that year, Apple released “HealthKit”, an accompanying developer platform that allows software developers to hook their own apps into collected data on Health via API.
HealthKit allows other applications to access data collected by Health (with the user's permission of course). For example, a nutrition application can inform a fitness application how many calories a user consumes in a given day.
Building into HealthKit would allow your practice to integrate personally connected data from ~100MM adults in the U.S. market.
In addition, you can also consider tapping into data from other devices with developer platforms, such as the Fitbit or the Microsoft Band.
If terms like “integrate” or “API” freak you out, then consider working with a digital partner to help you navigate the wearable device trend and build out a strategy.
Regardless of how you decide to get started, here are three benefits that you can realize as a provider by tapping into data from wearables.
1 – Achieve Better Patient Outcomes
Can healthcare practices that encourage the use of wearables or (better yet) integrate with wearable tech to provide more holistic care actually provide a better patient experience? The answer lies within how using wearable tech can change patient engagement. Here’s a quote from a recent HiMSS study:
“Even without universal agreement on ‘one’ definition of patient engagement, two truths are emerging: a patient’s greater engagement in healthcare contributes to improved health outcomes, and information technologies can support engagement.”
Healthcare is being consumerized, with people taking an increasingly active role in their own care experience. By providing patients with the option to easily share personal health data, providers are not only helping doctors to be more informed, they’re increasing the value of connected data for the patient. And doing so increases patient engagement and empowerment.
Getting doctors more informed and patients more engaged will lead to better patient outcomes.
2 – Become More Efficient
Hospitals are under constant pressure to scale back and do more with less. Coupling mobile technology with wearable tech, physicians can connect live with a patient via video conference and scan data from activity trackers like the Apple Watch or Fitbit. They can even source data from “smart” household items like a scale or thermometer. All of this can be done without the patient or doctor having to leave their homes.
Sound like the future? It is, but it’s also the present. Companies like AmWell already provide in-home, fully digital care via web and mobile apps. The service also integrates with wearable data to ensure that doctors are making the best possible diagnosis. With a typical price point of $49 per “visit”, AmWell has created a more efficient model for delivering urgent and therapeutic care.
3 – Brand Perception
We may not always think of brand when it comes to providing healthcare. But as patients become increasingly empowered to make their own care choices, their perception of your brand could become a deciding factor in whether they choose you as a provider (or not). Paul H. Keckley, PhD, Executive Director of the Deloitte Center for Health Solutions said the following:
“Consumers have more skin in the game now than ever before. They’re able to compare prices and outcomes for simple medical treatments. And they can access their own medical records to compare their signs, symptoms, risk factors, and comorbidities to clinical algorithms and better understand where to get the appropriate care, and how much that care will cost.”
As consumers continue to be more empowered and many healthcare services continue to commoditize, being seen as a progressive brand and an early adopter of using connected health data from sources like Apple HealthKit can position your practice as the go-to place for the best, most progressive care.
Conclusion
More and more U.S. adults are measuring personal health statistics. This trend is not going away. Rather, it’s accelerating the consumerization of healthcare. Tapping into wearable data to improve the patient experience will help position your practice for the future.
Got thoughts or questions about how to take your practice into the future? Send me an email I’d love to hear from you.
Since 2011, more than $870 million have been invested in more than 65 healthcare artificial intelligence (AI) startups. These startups concentrate on various areas, from nursing to drug discoveries, where AI’s potential can be put to best use. This is where the world’s heading towards and the future of healthcare lies.
The roots of AI may have been from some science fiction storytellers, but now, the reality is that AI plays a major role in our everyday life. Beginning with the IBM Watson supercomputer defeating the longtime Jeopardy champion, Ken Jennings, the world started taking notice about what artificial intelligence can do.
With Google and IBM making tremendous progress with their AI initiatives and the other tech giants (Like Apple, Dell, Facebook) trying to catch up, it makes us wonder what will happen when one day we have robots running around doing our everyday chores.
But, the main question should be what will happen when AI does fully breach our day to day lives: Will we embrace this reality and let robots take us over? And do we really need or is it desirable to have self-driving cars and artificial intelligence? Should computers acquire enough data and knowledge to replace our existing doctors?
Maybe we do or maybe we don’t, but let’s stop before we get ahead of ourselves.
AI should not be perceived as “artificial intelligence” but rather as “augmented intelligence.” It has the potential to process data and make cognitive decisions, which an average human can take many months to process. AI has truly opened numerous opportunities in the field of healthcare, which was humanly impossible just a few years ago.
Getting into the facts, the main advantage AI has over a normal human being is the ability to process a gazillion data points within seconds.
So let’s imagine a patient walks in with a flu – even to diagnose and treat this common illness with the right medication can take a while. There are some cases where the patients don’t even react to the medication. These are common scenarios, as each body reacts differently to different medicines leading to an increased treatment time. Whereas, if the diagnosis is powered with an AI backed system to help, doctor’s will be armed with all the right data and can diagnose and prescribe the right medication within minutes.
How’s that for a game changer?
Yes, AI is the perfect medical assistant to healthcare professionals.Through an iPad based electronic medical record, even the patient genome studies could be integrated into their electronic medical reports. Armed with this data, AI has enough information to make a better analysis and provide accurate treatment plans based on the patient’s medical history, genetic conditions and other medications they are taking for other illnesses.
Guest post by Ben Oster, product manager, AvePoint.
Ben Oster
Balancing the strategic needs of a business with the user-friendliness of its systems is a daily struggle for IT pros in every industry. But for healthcare organizations, safeguarding the data living in these systems can be especially daunting. According to a study by the Ponemon Institute, healthcare is a minefield for various security hazards. Within the last two years, 89 percent of healthcare organizations experienced at least one data breach that resulted in the loss of patient data. As healthcare businesses and the patients they serve adopt a mobile-first approach, providers must strike a balance between innovation and risk to prevent patient data (and internal information) from falling into the wrong hands.
The use of mobile devices and apps certainly enhance patient-provider relationships, but these complex information systems present new concerns surrounding compliance, security, and privacy. As employees and patients increasingly adopt smartphones, tablets, and cloud-based software into their daily lives, healthcare leaders must prioritize users’ needs while mitigating security risks. Mastering this dynamic requires healthcare companies to balance mobility trends like BYOD and cloud computing with regulatory requirements like HIPAA.
To lower the risk of data breaches, healthcare organizations need to defend their systems by identifying, reporting on, and safeguarding sensitive data. Here are a few steps the healthcare industry can take to join the mobile revolution without compromising security:
Start with discovery – Traditionally, healthcare organizations have taken a “security through obscurity” approach to protecting data. In other words, relying on the ambiguity of the data in their systems to ward off malicious attacks and breaches. But as technology emerges that personalizes patients’ end-user experience – such as online patient portals and electronic medical records – the less obscure healthcare organizations’ data becomes. With patients and medical staff accessing this data through a range of devices and workflows, knowing precisely what content exists in a healthcare organization’s infrastructure is essential to security. That’s why discovery is the first step to safeguarding content. Healthcare IT teams should also roll out internal classification schemas to determine which user groups need access to this data. By categorizing content based on these factors, healthcare companies can lay the framework for a truly secure system.
Obviously, the health care providers in your facility do great work every day. You might even argue that miracles are a common occurrence. But when we talk about halos in health care, we aren’t talking about health care in a spiritual sense. When we refer to a halo, we’re talking about the overall impression that patients and their families have of your hospital, and how it can influence your patient satisfaction scores. Because as it turns out, your HCAHPS scores aren’t always based entirely on the actual patient experience.
Understanding the Halo Effect
In 1920, psychologist Edward Thorndike coined the term halo effect to refer to the cognitive bias that influences our impressions of others. According to Thorndike, the overall impression that we have of someone influences the assessment of their character. When someone rates another person highly in one trait, for example, leadership, they are more likely to carry those positive impressions over to other traits, and consider that person more intelligent and dependable as well. We see the halo effect often in our ratings of celebrities: Because celebrities are often attractive and successful, we are more likely to evaluate them with other positive associations as well, such as being kind or intelligent, despite not having any evidence to support that impression.
The halo effect does not only apply to individuals, though. When asked to rate businesses or services — including healthcare — people who have a positive experience in one or more areas are more likely to rate the entire experience as being a good one. What constitutes a positive experience depends on the individual; for example, someone who values tidiness might be upset that their room is not cleaned and straightened up often enough, and thus rate the entire experience more negatively because their experience in one area clouded the entire stay.
The Halo Effect and Satisfaction Surveys
Often, hospital administrators approach patient satisfaction surveys and scores literally. That is, they look at the areas where they are perhaps not up to snuff and focus on improving those specific aspects of the patient experience. While that’s undoubtedly important, by improving the overall experience that patients have with your hospital you can also see an uptick in your overall satisfaction scores. In other words, patients who have a generally extraordinary experience with you are going to rate you higher on the HCAHPS even if every aspect of the experience wasn’t perfect, then a patient who had a less than ideal experience. If the room wasn’t cleaned enough and the food was subpar then those experiences will influence their responses on questions relating to other areas, which may have been excellent.
So how do you “polish your halo,” so to speak? By focusing on the entire patient experience, and identifying the factors that most strongly influence how patients respond to patient satisfaction survey questions, and developing plans to improve in those specific areas. Healthcare administrators are well served to follow the lead of facilities like the Cleveland Clinic, which went so far as to develop an entire department devoted to patient experience and operates under the notion that patients view service as synonymous with quality in healthcare.
As part of an ongoing effort to ensure compliance with the HIPAA Privacy, Security, and Breach Notification Rules, the HHS Office for Civil Rights (OCR) has begun the second phase of audits for HIPAA covered entities. The first phase of the audits was conducted in 2011 and 2012 and evaluated the controls and processes implemented by 115 covered entities in order to comply with HIPAA’s requirements. This second phase of audits builds upon the findings of that first audit, and will address compliance efforts by both covered entities and their business associates.
Obviously, the health care providers in your facility do great work every day. You might even argue that miracles are a common occurrence. But when we talk about halos in health care, we aren’t talking about health care in a spiritual sense. When we refer to a halo, we’re talking about the overall impression that patients and their families have of your hospital, and how it can influence your patient satisfaction scores. Because as it turns out, your HCAHPS scores aren’t always based entirely on the actual patient experience.