It seems increasingly disingenuous to frame health IT as being “revolutionary.”
For one, digitization has already swept nearly every other industry. The iPhone was a revolution in communication, but after generations of iterations and imitations, smartphones are normal, and consumers have adjusted their expectations accordingly.
To bring electronic health records (EHRs) into American hospitals and clinics is less a revolution, and more a remediation. That arguments continue over whether this upgrade will prove practical, valuable, or beneficial to patient care and clinical outcomes at all reflects that this evolution has been a top-down endeavor, rather than a true bottom-up transformation.
Despite rhetoric–and plenty of earnest optimism–the EHR rollout has been incremental, administratively-guided, federally-mandated push toward adoption. It has been a crawl toward process improvement more in the mode of Six Sigma than a grassroots “reset” button on the fundamentals of healthcare.
The true revolution–the one that patients and caregivers alike desperately need–is not merely technological, although technology may be our next best hope for realizing it.
A Mental Problem
Healthcare needs to unify behavioral and physical health, treatment, and discourse.
While physical medicine is climbing the next hill with respect to primary care provider (PCP) shortages, interoperability quagmires, and meaningful use (MU), behavioral health is facing the same primary challenges it has since well before health IT became such a hot topic.
Namely, recognition as a legitimate and necessary component of whole-person wellness and medical treatment.
But on both the side of care providers, and patients, physical health has been rigidly siloed away from behavioral health. Even EHRs have been shoehorned through America’s hospitals while behavioral health clinics have been barred from accessing incentive money. Their exclusion from the development table means fewer solutions and platforms exist at all for those facilities and caregivers who want to embrace digitization, because developers have been preoccupied with MU compliance.
The problem is sociological as much as it is a practical matter of care delivery. Stigmas persist–even as the conversation about CTE in the NFL escalates, the knee-jerk reaction is to provide players with better helmets, rather than emphasize how physical injury manifests in behavioral ways.
Have you ever sought medical care from multiple providers for the same condition? Then you probably already know how difficult it can be to coordinate care from one practice or facility to the next. One provider may not necessarily have access to the test results ordered by another provider, and even getting a prescription filled can be a hassle — you have to wait while the pharmacist fills your prescription and hope that he or she doesn’t misread the prescribing doctor’s terrible handwriting.
But all of that is changing; for many patients across the country, it has already changed, thanks to the Health Information Technology for Clinical Health (HITECH) Act of 2009. This law was enacted to encourage the transition to electronic health records (EHRs) in medical practices, hospitals, and other health facilities. Researchers agree that the use of EHRs can have many benefits for providers and patients alike, including improved patient outcomes, reduced costs, streamlined administration, and even improved ability to perform medical research.
What Are EHRs?
An EHR is an electronic record of a patient’s medical history that combines test results, diagnoses, and other data accumulated as the patient moves from one provider to another. Your EHR is meant to be longitudinal in nature, meaning that the record represents a lifetime picture of your health history.
Unlike a medical record, which is maintained by a single provider, an EHR is comprehensive; since it includes information compiled from every provider who works with you, it will offer each provider all of the information necessary to make your next treatment decision. That means no more re-ordering an expensive test you’ve already taken somewhere else, and no more waiting for test results to be faxed over from another doctor’s office.
Advantages of EHRs
Ideally, EHRs will someday travel with you. When all providers have made the transition to using EHR systems such as RevenueXL, you’ll be able to get the same quality of care from providers anywhere in the country. They’ll simply be able to check your EHR for pertinent medical information, and even update it so that your providers back home will be able to adjust your care accordingly. Even if you’re incapacitated, your EHR will ensure that providers around the country will be alerted to your medication list and existing medical conditions.
EHRs should make life easier for everyone involved in your care. You’ll be able to:
Schedule doctor’s appointments online
Ask medical questions via email
Request prescription refills electronically
Access test results whenever you want
Keep track of scheduled appointments
The use of EHRs should streamline the many administrative tasks associated with patient care. EHR system software will prompt your doctor to file necessary Medicare and insurance paperwork, will help them keep track of which best practice guidelines apply to your specific case, and will reduce numerous costs.
These are some of the most out of the ordinary medical codes you might come across if you worked as a medical coder. If you’re a patient and see these on your bill, you might raise an eyebrow once you find out the meanings. Check out the following graphic for all 15 unusual codes.
V94.810 – Civilian Watercraft and Military Watercraft Involved in Water Transport Accident
W56.11 – Bitten by Sea Lion
Y93.D1 – Accident While Knitting or Crocheting
Y92.253 – Hurt at the Opera
If you are interested in being a medical coder, the average salary is $47,870. The job outlook has a 21 percent increase by 2020. Eighty percent of medical coders have some postsecondary education. Medical coders work in both clinical and non-clinical settings, some of which are hospitals, physician offices, long-term care facilities, dental offices, mental health facilities, government agencies, and insurance companies. Graphi provided by Topmedicalcodingschools.com.
Since the beginning of what is known as the “Information Age,” paper has been viewed as a canvas to document ideas, record relevant material and deliver messages to prospective readers. Continued innovations in technology have given billions of workers the ability to connect seamlessly — oftentimes with little effort. Convenience and efficiency are deemed topline must-haves, as we have handy cloud services that digitize essential materials like images and documents. Thus, common tasks like writing letters or printing receipts are now seen as passé as they can be streamlined or, in some cases, avoided altogether by utilizing email, apps and/or direct electronic messages.
Paper serves as a conduit for information to be shared easily among several parties. Because of this, until there is one other common denominator that everyone can recognize, paper and the need to utilize it will remain evergreen for people of all ages. As the original device of modern communication, paper has long held its position as a lifeline for several industries, most notably in healthcare. As an industry that adopted mobile working styles to great effect, healthcare has still seen the use of paper as a mission-critical component to their quest of providing quality patient care. For instance, in the health sector, paper is required for appointment and insurance documentation, differentiating prescriptions for patients and communicating clinical decision-making and objectives.
As one of the standard ways of utilizing paper, printing is also seen as a surefire way to quickly and succinctly relay a set of messages into a clear, readable format. But with several tech vendors proudly touting their robust “paperless” capabilities in an effort to curb waste and conserve ink, it begs the question – in the long run, where will paper end up for our communication needs? Outside of the workplace, does it still make sense to consider printing and paper “dead” when it was one of the first sources of communication? Will it serve us or become obsolete in our electronically-dependent world? No. In truth, paper, in tandem with printing, will always be around in some capacity.
Today, one of the growing general notions of technology is that electronic sources of communication have eclipsed functions that were previously considered the norm. However, in the workforce, printing is a central, vital function. But what advances will industries have to do to maintain innovation and relevancy in an increasingly digital world? Continued flexibility to support mobile and BYOD work styles, compatibility with cloud documents and the bandwidth to securely support multiple print devices within a single environment are a few features that can the healthcare sector evolve with the technological curve while still maintaining some of its classic characteristics.
Guest post by Richard A. Royer, MBA, chief executive officer, Primaris.
Richard Royer
It has been several years since Medicare began introducing payment changes aimed at driving the healthcare industry away from volume-based payments and toward value-based reimbursements. One of the main purposes of the payment system’s overhaul is to improve the quality of care that healthcare providers deliver to patients. Of course, the other main goal is to keep costs in check. In simple terms, the shift to value-based incentives rewards providers that deliver on cost, quality and patient outcome measures. What many providers have learned along the way is that technology plays an important role in the transition to value-based care, and meaningful use of electronic health records is necessary for success under value-based incentive programs.
Value-Based Payment Basics
For healthcare providers that are working to adapt to new payment models and are just beginning to make adjustments, understanding the basics of value-based care is the first step to success. Some of the key points healthcare providers need to recognize about value-based reimbursements are:
The value model rewards performance. That can mean a number of different things, for example, achieving high quality and patient satisfaction scores or making improvements to care over time. The point is, providers must focus on meeting certain standards for care and cost in order to be eligible to earn financial incentives and to avoid penalties.
Value-based care models are extremely data driven. Providers need to measure and report performance outcomes in order to assess their efforts internally, and also so they can earn reimbursements from external payers. As a result, healthcare providers need to continuously measure and analyze patient data, not just collect it.
Collaboration is an important success factor under value. Patients – particularly those with chronic health conditions – receive care from multiple providers as they move across the care continuum. To ensure that treatments, medications, and care plans are safe and effective, and that patient outcomes (which impact reimbursements) are the best they can be, providers need to communicate with each other and work to coordinate care. Value-based programs demand coordinated care.
Guest post by Gillian Christie, health innovation analyst, Vitality.
Gillian Christie
An era of self-quantification of health behaviors using technology is emerging outside of the doctor’s office. Consumer-facing health technologies empower individuals to monitor their health in real-time, employers to understand the health of their workforce, and researchers to uncover health trends across geographies. Eventually, the data from these technologies will re-enter the hospital setting by linking to our electronic medical records.
Deluges of data are rapidly being generated by these technologies. An estimated 90 percent of the world’s data has been created in the past two years. IBM’s CEO, Ginni Rometty, indicates that data is the “next natural resource.” But how are these data protected and secured?
In the United States, laws have historically protected consumers from the misuse or abuse of their medical information. The Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH) have protected medical data from inappropriate uses. Data generated by consumer-facing health technologies, however, are not covered by these Acts. Companies can use the data for their own purposes. This means that companies must be ever more vigilant in ensuring the trust of their consumers through their data practices.
How can we collaborate across sectors to maintain and enhance trust? As a start, Vitality, Microsoft and the Qualcomm Institute at the University of California, San Diego, published an open-access, peer-reviewed commentary that outlined ethical, legal and social concerns associated with emerging health technologies. The call to action was for guidelines to be developed through a consultative process on the responsible innovation of these technologies and the appropriate stewardship of data from the devices. Between July and October 2015, we hosted a global public consultation to identify best practices. On Mar. 2, 2016, at HIMSS, we released the finalized guidelines for personalized health technology. They include five recommendations:
Guest post by Eduard Goodman, chief privacy officer, IDT911.
Eduard Goodman
Earlier this year, Centene Corporation lost six hard drives containing personal and health information of almost one million of its clients, including names, addresses, dates of birth, Social Security numbers, member identification numbers and health information. Unfortunately, Centene is only one of many healthcare organizations that recently had their sensitive patient information exposed. More than 113 million health records were breached in 2015 – which translates to one out of every three Americans being affected by a healthcare record breach last year. Medical identity theft is a disastrous trend that needs to be addressed. The good news is there are many steps healthcare organizations can take to reduce the risk of data breaches.
Electronic Health Records
As more and more healthcare organizations transition away from paper medical records and move to electronic health records, it is critical that security features are put in place to protect the vast amount of data being collected. Just as the digitally stored health information is more easily accessible for employees, it is also easier for cyber criminals to access. According to the Ponemon Institute’s The State of Cybersecurity in Healthcare Organizations in 2016 report, nearly half of those surveyed said their organizations have experienced an incident involving the loss or exposure of patient information during the last year. Strong encryption, routine vulnerability patches and multi-factor authentication are key to protect health data.
Mobile and BYOD
Greater connectivity means more convenience, but this also opens more doors for hackers to access healthcare networks. Healthcare organizations should set clear BYOD policies so employees understand what can and cannot be accessed from mobile devices, what operating systems are approved for use on the network, what security features and settings are required and what type of data can be stored on devices. While using mobile devices can significantly improve productivity, it is important to minimize security risks in order to protect sensitive data.
Internet of Things
The Internet of Things is a growing trend in the tech world that has also become popular in the healthcare industry. Now, medical devices can collect, track and share enormous amounts of data instantly through internet connectivity. As these medical devices were most likely added to pre-existing networks, they may not have the necessary security protections. Security vulnerabilities are not just limited to EHR and health networks anymore – medical devices must be thoroughly inspected as well. Just as computers and servers are patched for vulnerabilities, medical devices that connect to healthcare networks must also be regularly patched. If these IoT enabled devices do not have the necessary layers of security, they will become an easy target for hackers to access the healthcare network.
Guest post Ken Perez, vice president of healthcare policy, Omnicell.
Ken Perez
Soon after passage of the Affordable Care Act (ACA), the Congressional Budget Office, the Obama Administration and private research firms, such as Health Policy Alternatives, concluded that the health reform law would generate budget surpluses over the 10-year period of 2010-2019 of $124 billion to as much as $150 billion.
However, according to the CBO’s report, “The Budget and Economic Outlook: 2016 to 2026,” released in January of this year, the divergence between past rhetoric and current reality has widened, at least in terms of the coverage expansion initiative of health insurance exchange subsidies.
According to an April 22, 2010, memorandum from Richard S. Foster, chief actuary for the Centers for Medicare and Medicaid Services (CMS), the ACA’s health insurance exchange subsidies were projected to total $153 billion from 2014-2019. However, arguably because of the higher-risk pool of individuals participating in the exchanges, the recent CBO report projects $347 billion in federal outlays for health insurance exchange subsidies for 2014-2019, leading to a deficit just for the subsidies of $194 billion for that period, outweighing the previously projected budget surplus.
Even worse, the higher health insurance exchange subsidies aid a significantly smaller exchange enrollment population, down about 40 percent from 21 million to 13 million individuals for 2016, per the CBO. Moreover, the CBO projects exchange enrollment to peak at 16 million in the next decade, a third less than the 24 million it predicted in March 2015.
Have you ever sought medical care from multiple providers for the same condition? Then you probably already know how difficult it can be to coordinate care from one practice or facility to the next. One provider may not necessarily have access to the test results ordered by another provider, and even getting a prescription filled can be a hassle — you have to wait while the pharmacist fills your prescription and hope that he or she doesn’t misread the prescribing doctor’s terrible handwriting.
