By Tom Bizzaro, vice president, health policy and industry relations, First Databank
Tom Bizzaro
Healthcare delivery is changing drastically. Demographics, technology, economics, societal forces and many other factors are prompting the industry’s transformation as we head into 2016 and beyond. And, while change is always a bit jarring, sometimes it actually makes sense.
Here are eight emerging trends that are changing healthcare for the better:
The move toward telemedicine
Is there anyone out there who can honestly admit they are thrilled about traveling to a provider’s facility for their care? In today’s world, time has value and patients are much less willing to spend their time waiting for care. Now, in some cases, it is critical to be face-to-face with your caregiver. However, in many cases, it is just an inconvenience. I am pretty sure that surgery and treating a broken bone won’t lend themselves to a virtual visit, but think about all those things that do. Using Skype for virtual doctor visits; reading medical images taken in Indianapolis by a physician in Australia; and using a kiosk to get access to a nurse consultation have become commonplace — and much more is expected as telemedicine continues to expand.
The adoption of evolving electronic communication tools
I read recently that people under the age of 25 prefer texting as a means of communication with their doctors. It seems that phone calls and even emails are too intrusive and time consuming. In a world where email is too slow, where people are cutting the cord to cable TV, and newspapers are the last place young people get their news, healthcare organizations must stay on top of their constituents’ constantly changing communication preferences. Even those that aren’t young enjoy electronic communication tools like a medical guardian, these devices provide peace of mind for their owners and they in turn can save lives when necessary.
The return of home care
While patients are pushing healthcare providers to adopt the latest technologies, at the same time “what is old is new again.” Home healthcare services are growing as aging Americans want to stay in their homes as long as possible. Pharmacists are making home visits to the most at-risk patients to manage medication therapy. Doctors are making house calls to help improve care and decrease hospital readmissions. Nurses are performing all types of infusion therapy in patients’ homes.
Telemedicine technologies are evolving rapidly, enabling better care, greater patient access and the promise of bending the healthcare cost curve. Telemedicine has evolved dramatically over the past few years, and providers have come to realize the profound ways in which it can improve patient care. With this evolution has also come the increasing sophistication of telemedicine practitioners. Doctors, nurses and administrators now desire easier integration, clinical adaptability and configurability, support for multiple specialties on a single comprehensive platform, and robust data collection and analytics.
REACH Health, a leading provider of enterprise telemedicine solutions, has identified five key technology trends for the coming year, each promising benefits for providers and patients. These trends for 2016 include:
Obsolescence of Proprietary Hardware and Networks: Although proprietary hardware and networks were standard in the early generations of telemedicine technology, healthcare providers now desire affordable, flexible solutions. Effective telemedicine programs are increasingly powered by off-the-shelf PC components, standard, low-cost cameras and emerging networking standards such as WebRTC. These open, standardized products allow providers to choose the most appropriate end-point for the clinical need; whether it be a high performance cart, a PC or a mobile device such as an iPad, Android or Surface tablet. Providers also now increasingly seek specialty-specific telemedicine software applications that are deployable across these commodity hardware devices using open networks.
The Rise of the Software Platform: Healthcare systems now seek enterprise-wide telemedicine solutions that can be scaled to support multiple service lines and a variety of delivery models, all on one common platform. Just as single-function “dumb phones” have been rendered obsolete by multi-purpose “smart phones,” providers want a single platform to accommodate all their telemedicine needs. They expect a simple, effective solution that supports varied telemedicine requirements across the continuum of care and works wherever it is needed, on a variety of devices. These platforms must also be designed with an open architecture, providing the ease of plug-and-play connectivity with specialized, interoperable components such as high quality peripherals.
The long awaited road to true healthcare IT system interoperability is being implemented at Good Samaritan in Indiana, enabling the 232-bed community healthcare facility to better deliver on its commitment to delivering exceptional patient care. The system will also enable the hospital to substantially increase their practice’s revenue while containing healthcare system integration costs.
“We strive to be the first choice for healthcare in the communities that we serve and to be the regional center of excellence for health and wellness,” said Rob McLin, president and CEO of Good Samaritan. “We are proud to be the first hospital in the country to implement this great integrated health record system that will allow us to provide a much higher level of continuity of care for our patients, as they are our top priority.”
The integration is being made possible with Zoeticx’s Patient-Clarity interoperability platform that will integrate WellTrackONE’s Annual Wellness Visit (AWV) patient reports with Indiana’s Health Information Exchange (IHIE) and the hospital’s Allscripts EHR. IHIE is the largest HIE in the US, serving 30,000 physicians in 90 hospitals serving six million patients in 17 states.
Revenue Generator for the Hospital
WellTrackONE and Zoeticx will enable patient’s AWV data to flow from the application to Allscripts EHR and the IHIE system. With Zoeticx’s Patient-Clarity platform and WellTrackONE’s software, the healthcare IT integration passes on increased revenue from the Centers of Medicare & Medicaid Services (CMS) and decreased IT costs for medical facilities.
Medicare pays medical facilities $164.84 for each initial patient visit under the AWV program and $116.16 for each additional yearly visit. With the AWV integration in place, the hospital is now able to meet CMS’s stringent requirements for patient reimbursements.
It is estimated that the Good Samaritan will be able to generate $500 to $1,200 per AWV patient from follow up appointments for additional testing and referrals for approximately 80 percent of the Medicare patients that are flagged by the AWV for testing, imaging and specialty referrals within the hospital.
This subscriber number is expected to trend upwards into 2050 and will create billions in new healthcare revenue through the US as the population ages. The hospital is not charged any costs for the system until it is reimbursed by CMS.
Overcoming Healthcare System Limitations
The hospital began offering Medicare’s AWV’s a few years ago, but had to develop its own tracking protocols, which impacted its budget and staff resources. The system it had created also operated poorly, allowing hospital staff to only view about 10 percent to 15 percent of patient data.
Good Samaritan medical teams were also constrained by interoperability, having to enter new illness findings and other medical info manually and fax PDFs to other facilities where they would have to again be entered into a different system. The hospital also had all of the data contained in WellTrackONE and Allscripts’ system, but no way to integrate the two, let alone achieve that integration with IHIE. Providers were also spending valuable patient face time trying to find specific patient data buried in the EHR system.
“Our systems were working fine, independently of each other,” said Traci French, director of business development and revenue integrity. “But we could not achieve true interoperability between the two systems. The best we could do was basically reshuffling PDF documents. The next challenge was to integrate that data with the exchange. We needed to get data to providers where they needed it, when they needed it.”
More and more healthcare practitioners are turning to social media to disseminate health related information and communicate with customers and others in their field. However, healthcare practitioners should pay close attention to the information that they share out there to ensure that they comply with HIPAA Security Rule. Here are a few guidelines to assist you in implementing a social media strategy that complies with HIPAA standards.
What is HIPAA?
First, let’s begin with a basic understanding of the law. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law mandating the non-disclosure of private and personal patient information by healthcare professionals and their business associates. The exception to this rule is that the patient’s information can be shared internally within the confines of the hospital between doctors and healthcare professionals, or between the hospital and the insurance company for payment purposes. Unless the patient voids the non-disclosure, their information has no place outside of the databases of both the hospital and the insurance company.
Guidelines for remaining HIPAA compliant
An accidental error in the information that has been shared on social media can mean that HIPAA compliance has been inadvertently violated. While the mistake may not be on your part, it could mean a host of problems for you, your business, and your reputation. Staying cautious about the information that is disseminated through your organization’s Facebook, Twitter, or other social media pages is significantly important to your career.
Seek patient consent before you post anything – Before you write about a case, seek your patient’s consent. Confidentiality is a fundamental aspect of the relationship you share with those who have sought your professional assistance. Acquiring prior consent should never be overruled, regardless of whether your client’s identity has been omitted from the information you shared online.
Inform before you engage – Some patients are less private about their medical conditions, and would like to communicate with you through social media. You should attempt to take the conversation into the privacy of your workplace. If your patient persists on an online dialogue, inform them of the risks associated with revealing personal information online, then acquire the patient’s consent before communicating through social media.
Guest post by Pawan Sharma, director of operations for healthcare at Chetu.
Pawan Sharma
Healthcare is quickly adapting to the digital environment by leveraging web-based technologies, electronic health records (EHR) and mobile devices to facilitate the movement of information. With innovative software technology comes great responsibility. One of the unfortunate downsides to increasing the use of technology for data sharing in the healthcare world is the risk of data falling into the wrong hands. Full measures need to be put in place to protect patient’s Protected Health Information (PHI). The Health Insurance Portability and Accountability Act (HIPAA) mandates that all PHIs be secured. Any breach, if not handled appropriately under established procedures, can lead to grave consequences including heavy penalties, jail time, or both. Needless to say that proper mechanisms need to be implemented to secure data while it is stored, transmitted and consumed.
Understanding Regulatory Standards
Knowledge is power. It is paramount that software providers look for back-end development partners that have Healthcare IT experience. This includes extensive knowledge and proficiencies with federal regulations like American Recovery and Reinvestment Act (ARRA), meaningful use stage 1 and 2, Accountable Care Act, etc. Also, regulatory health information exchange (HIE) standards such as Health Level 7 (HL7), Health Information Exchange Open Source (HIEOS), Fast Healthcare Interoperability Resources (FHIR), Consolidated-Clinical Document Architecture (C-CDA), Continuity of Care (CCD/CCR) as well as clinical and financial work flows.
Encryption
With information traveling over a network it may be subject to interference. Hence, it is important that data be encrypted in transit. Vendors must include encryption technology to prevent disclosure of patient health information while data is communicated between the application and the server. Web traffic must be transmitted through a secure connection using only strong security protocols such as Secure Sockets Layer (SSL) or Transport Layer Security (TLS). SSL/TLS certificates are light weight data files that are purchased and installed directly onto the server. Once implemented, a user will be able to connect to the web-based application server via a secure tether with an internet browser.
Code Hardening
Organizations have been keen on securing networks and internal infrastructure from external threats. With this in mind, malicious entities are looking to breach data at the application level. Healthcare software proprietors must protect their application from security threats by employing hardening tactics, which shields bugs and vulnerabilities in the coding. This technique primarily includes code obfuscation. Code obfuscation is the act of intentionally creating obscure source code to make it difficult for entities to decipher. Properly employing this tactic hinders a threats ability to reverse engineer and tamper with an application to facilitate a breach.
Can you remember how you operated without a cell phone at your disposal 24/7? If you’re like most people today, braving the outside world without a cell in hand probably gives you palpitations. The healthcare industry has seen a comparable shift as a result of technology innovation over the past couple decades. So much so that healthcare practitioners who are somewhat new to the industry may not be accustomed to the manual practices that were in use just a few years ago.
As for today, we know that healthcare companies are using cloud. Perhaps most prominently, electronic health records (EHR) are widely adopted. In fact, the Healthcare Information and Management Systems Society (HIMSS) reports that a majority (83 percent) of healthcare organizations are using cloud services today. With adoption spanning nearly the entire industry, cloud technology has transformed how healthcare is administered.
Given the scale of cloud adoption, a few questions remain. Namely, how is healthcare using cloud today? Now that the industry has adopted the cloud, what does the future hold?
How Is Healthcare Using Cloud?
To start, let’s explore one specific use case. Medicalodges, a post-acute healthcare organization based in Kansas, was looking to get away from managing its own infrastructure. By moving to the cloud, it was able to improve collaboration, security, and set up a business continuity/disaster recovery (BC/DR) solution. Today, the organization has virtualized its servers with dinCloud’s Hosted Virtual Server (dinServer) solution. As a result, Medicalodges reports benefits including: improved collaboration, security, disaster recovery, cost savings, and scalability. Looking ahead, Medicalodges has future plans to run a mix of browser-based thin clients and continue to expand its cloud infrastructure.
In its 2014 Analytics Cloud Survey, HIMSS found that 43.6 percent of surveyed healthcare organizations are currently hosting clinical applications and data. Meanwhile, 35.1 percent are using the cloud for BC/DR, 14.9 percent have virtualized servers, and 8.1 percent are using hosted virtual desktops (HVDs). In another case, a medical organization needed to run several versions of a specific testing application. However, they could not run it on the same computer because of compatibility conflicts of running the same application in multiple instances. They leveraged application publishing from dinCloud to virtualize the application. The application sits in the cloud and can be opened in multiple instances on the same computer now.
From financial services, to technology, to telecommunications, retail and more, big data has made a meaningful impact across industries. In healthcare specifically, big data is being used to create a more efficient, effective and personal approach to providing care.
The statistics speak for themselves: As the $2.8 trillion industry continues to evolve, big data could add as much as $300 million per year.
But big data for healthcare is about more than revenue growth.
As the healthcare industry shifts towards a world of value-based and proactive patient care, big data offers health systems the ability to improve patient quality of life, increase preventable care and enhance patient engagement. Furthermore, big data has the ability to provide actionable insights in hospital settings while saving time, and ultimately costs, by allowing healthcare systems to operate more efficiently and effectively.
Learn more in the infographic below on how big data potential creates improvements in healthcare.
Guest post by Robert S. Oscar, R.Ph. CEO and president, RxEOB.
Robert Oscar
Prior authorization exists to reduce drug costs, to manage appropriate brand medication prescribing, and to curb medication abuse. Despite its good intentions, this extra step to determine whether or not a drug is appropriate for a patient’s symptoms has gained a reputation of inconvenience for both physicians and consumers.
In a 2013 study by SUNY Upstate Medical University, it was revealed that U.S. primary care physicians and their office staff have experienced significant increases in time consumption as a result of prior authorization and its associated requirements. For consumers, hours can be wasted waiting to find out whether or not they are allowed a particular prescription under the conditions of their health plan.
Reducing this negative aspect of prior authorization is paramount for the betterment of overall health costs and medication adherence. By streamlining the time spent between medical record lookup and prescription delivery, healthcare organizations and consumers can begin to experience more efficient prior authorization. If efforts made toward better big data advancements, mobile health (mHealth) and health IT are prioritized, doctors can confirm drug eligibility faster to help their patients recover faster.
Below are five reductions that can come from implementing electronic prior authorization (e-PA):
Reduced Labor Costs: When a doctor pulls up a patient’s medical records he must sift through numerous data points to determine which drugs are approved and which drugs are going to require prior authorization. The hours spent processing this data is costly for healthcare staffing, but lost time can be reduced by moving the process online and implementing electronic methods. This can allow physician offices and PBMs the ability to review, submit and determine authorization almost immediately.
Reduced Consumer Delays: A consumer will typically experience the unattractive side of prior authorization at the pharmacy. If a doctor issues a prescription without knowing the patient’s medication history or pushes a popular name brand drug without suggesting a generic, the consumer will likely get sidelined with prior authorization processing at the point of sale. Having an e-PA process that can review and determine which drugs a patient is already approved for before they head to the pharmacy can reduce customer wait times and greatly increase consumer satisfaction.
