Electronic health record (EHR) technology has become truly transformative for the healthcare industry; prepared or not, healthcare teams are increasingly relying on new information technologies to improve the delivery and management of care. EHRs have enabled faster and easier access to patient information, and hold the promises of improved workflows, efficient sharing of information across communities and reduced costs for many physicians and hospitals.
But now that nearly 80 percent of physician practices in the U.S. today have EHR systems in place and the Centers for Medicare & Medicaid Services’ (CMS) meaningful use program is well underway, it is time to look to the next stage of health care technology and innovation. Health care teams must now move beyond the first step of digitizing patient records to transforming this valuable data into meaningful and actionable knowledge that will help care teams make more informed decisions at the point of care and ultimately, improve outcomes.
For this impact to take place at both the individual level and at the population level, care teams need to leverage clinical analytics that will provide visibility into important clinical trends across the entire population. For example, being able to review trends in diabetes care or readmission rates across a population represents an opportunity for specific, meaningful change to improve care delivery and outcomes.
For a practicing clinician, “population health management” means being able to see where an individual patient is within the clinician’s or clinic’s population (e.g., whether the individual’s chronic condition is above or below population benchmarks) and to take action at the point of care, as well as being able to refer to relevant population health metrics.
For a patient, clinical analytics presumes trust, not only in the competency and care of the physician, but also in the security of his or her information. Population health management and analytics tools must ensure that patient information can be gathered, stored, and used in a way that is demonstrably secure.
Care teams should consider four key elements when exploring clinical analytics tools for population health management:
Guest post by Dane D. Hallberg, strategic advisor, M3 Information.
Hospital readmissions continue to be a major contributor to soaring healthcare costs and a drain on the U.S. economy. According to the Robert Wood Johnson Foundation, 4.4 million hospital readmissions account for $30 billion every year, while 20 percent of Medicare patients are expected to return to the hospital within 30 days of discharge. The Affordable Care Act of 2010 requires the U.S. Department of Health & Human Services to establish a readmission reduction program.
This program provides incentives for hospitals to implement strategies to reduce the number of costly and unnecessary hospital readmissions. Centers for Medicare and Medicaid Services (CMS) has created quality programs that reward healthcare providers and hospitals with incentive payments for using electronic health records (EHR) to promote improved care quality and better care coordination. The reasons for hospital readmissions include adverse drug effects (ADE), lack of a proper follow-up care, inability of patients to understand the importance of their medications and diagnoses, unidentified root causes, and misdiagnosis. Technology could play a vital role here by properly documenting, tracking, diagnosing, monitoring, and enabling better communication between patient and provider.
Adverse drug events constitute the majority of hospital readmissions. A cohort study, including a survey of patients and a chart review, at four adult primary care practices in Boston (two hospital-based and two community-based), involving a total of 1202 outpatients indicated that 27.6 percent of these ADEs were preventable, of which 38 percent were serious or fatal. Human error was the leading contributor to these ADEs, followed by patient adherence. Additionally, patients who screened positive for depression were three times as likely to be readmitted compared to others.
Our analysis indicates that 28 percent of adult hospital stays involved a mental health condition. A study of Medicaid beneficiaries in New York State determined that, among patients at high risk of rehospitalization, 69 percent had a history of mental illness and 54 percent had a history of both mental illness and alcohol and substance use. We know that a properly implemented mental health screening protocol can lead to effective diagnosis, and that proper management of these issues can positively impact the reduction of hospital readmissions.
Further studies show that most cases of readmissions for certain chronic conditions have an underlying mental health issue, which appears in patients who have not been previously diagnosed for a mental health condition (i.e., anxiety, bipolar disorder or depression). For example, anxiety and/or depression increases the risk of stroke and decreases post-stroke survival, and plays a key role in diabetes treatment as 33 percent of this patient population is found to be depressed and patients with bipolar disorder have reduced life spans. Other cases where depression affects the patient’s survival and treatment cost include hypertension, stable coronary disorder, ischemia, unstable angina, post myocardial infarction and congestive heart failure.
An important point to note: congestive heart failure is the major driver of hospital readmissions in the U.S., accounting for 24.7 percent of all readmissions. Another study concluded that patients with severe anxiety had a threefold risk of cardiac-related readmission, compared to those without anxiety.
Guest post by Paul McRae, director of business development, healthcare, AirWatch by VMware.
The evolution of mHealth has caused a dramatic increase in the use of mobile devices across the healthcare landscape. Mobile innovations are now positioned to vastly improve both the quality and quantity of the lives of human beings. New technologies and applications are helping organizations lower costs and provide higher quality service to patients. Mobile deployments in the healthcare industry enable clinicians and healthcare IT professionals to access medical records, diagnose illness, integrate with existing providers, enhance patient engagement and improve EHR interoperability.
As EHRs and the growth of deployed mobile devices and apps become increasingly popular, the need for mobility management and security is paramount. To embrace mobility, healthcare organizations must provide secure, easily accessible apps for staff and IT departments must manage devices while remaining HIPAA compliant and protecting patient records.
Enter containerization, an emerging class of management tools that carve out a separate, encrypted zone on the user’s smartphone within which corporate apps and data can reside. Policy controls apply only to what’s in the container, rather than to the entire device. Mobile containerization offers a way for hospitals to securely deliver apps and data to clinicians without interfering with the users’ ability to access their personal content.
Currently, the end user is divided into two separate personas – the personal and the corporate. Duality provides two different levels of security for very different forms of information present on a device. For example, the corporate security measures might require compliance with federal or HIPAA regulations, a form of monitoring that would be seen as invasive to employee privacy.
Mobile platforms are beginning to integrate containerization into their frameworks, which allows for more secure and tighter amalgamations of data with their corresponding operating systems. OEM’s are placing containers for work use with the underlying OS for greater efficiency, better feature support and improved user transparency. This embedded form of containerization allows IT to maintain consistent security policies to mitigate threats on every mobile device, from smartphones and tablets to laptops, peripheral devices and emerging machine to machine (M2M) technologies.
Containerization allows healthcare organizations to remain compliant with the stringent security requirements they must meet, while providing employees a consistent user experience across multiple platforms. However, each mobile operating system presents its own security challenges, such as Web-based malware or the ability to download apps outside of designated app stores. Securing corporate information that has been accessed on personal devices from applications and content repositories remains a major challenge, especially to ensure data loss prevention (DLP) if the device is stolen or the employee leaves the organization.
Guest post by Ken Perez, vice president of healthcare policy,Omnicell.
Accountable care organizations (ACOs) are primarily associated with Medicare or commercial payer-led arrangements. However, the Affordable Care Act (ACA) also authorized limited demonstrations that allow states to test Pediatric ACOs from 2012-2016. In addition, the Centers for Medicare and Medicaid Services (CMS) has provided guidance letters to several state Medicaid directors on how to implement integrated care models, which may include ACOs, in their Medicaid programs.
With this encouragement from CMS and the need to rein in Medicaid spending—which is generally increasing due to the ACA and is shared by the federal government and states—it is estimated that about half of the states are at some stage of planning Medicaid ACOs.
This emerging trend runs counter to a couple of the conventional caveats about ACOs—they won’t scale to handle large populations, and they won’t work with patients who are economically disadvantaged.
However, these caveats are being challenged by the experiences of Colorado, Utah and Oregon, respectively, as well as the plans for North Carolina’s Medicaid ACO program.
Colorado’s Accountable Care Collaborative (ACC) has been in existence since 2011 and today has more than 350,000 members, almost half of the state’s Medicaid population. The ACC has focused on connecting members with their primary care physicians, using care coordinators, and leveraging analytics extensively.
According to the report on the ACC’s most recent fiscal year, which ended in June 2013, the program generated gross savings of $44 million, returning $6 million to the state after expenses. It accomplished this in part by reducing hospital re-admissions by between 15 percent and 20 percent and decreasing the use of high-cost imaging services by 25 percent versus a comparison population prior to implementation of the program. In addition, relative to clients not enrolled in the ACC program, it slowed the growth of emergency department utilization, lowered rates of exacerbated chronic health conditions (e.g., hypertension by 5 percent and diabetes by 9 percent), and reduced hospital admissions for chronic obstructive pulmonary disease patients by 22 percent. Most importantly, Colorado has seen improved health for the ACC member population.
Guest post by Michele Hibbert-Iacobacci, CMCO, CCS-P, vice president, information management and client services, Mitchell International.
The International Classification of Diseases – 10th Revision, Clinical Modification and Procedural Coding System’s (ICD-10-CM/PCS) implementation in the United States is being delayed yet again. According to the latest polls and surveys, there are many organizations (most who need to use it) that were ready to roll with the new classification on October 1st 2014. The change came about because the Senate approved a bill (H.R. 4302) on March 31, 2014, that delays the implementation of ICD-10-CM/PCS by at least one year and then a subsequent official announcement by CMS announced a forthcoming interim final rule that would set the new compliance date for October 1, 2015.
How will this new implementation date affect Property and Casualty payers and providers? For an industry that was not required to change, P&C was ready to go – mainly because of the dependency on payments and bill processing. The question was, “Will we see ICD-9 and/or ICD-10?”
Fortunately, from a processing perspective the P&C industry was prepared for most anything. Payers were creating processing systems and/or contracting with vendors who considered all possibilities including bills submitted with both codes and the submission of ICD-9 codes well after effective dates. These payers also considered the compliance environment as most are guided at the state level.
As difficult as it may be to be ready for the effective date of ICD-10 just to have it changed, most aspects are positive for property and casualty. Additional time for testing, communication to providers and overall education (external/internal) enhances the readiness for the new date. The negative is the cost – staff has been added and enhanced with testers, educators and coders for the initial date. Maintaining staffing levels for a longer period of time was not accounted for in most budgets. The cost will be higher to implement now and many companies did not plan on the additional timeline.
So how will this shake out moving forward? Providers will likely react by submitting ICD-10 codes to P&C payers before the implementation date of October 1, 2015. Payers will need to make decisions on how they will handle these claims since P&C is not guided by the same rules under HIPAA as the health side. Some payers may decide to turn these claims back to providers and others will translate to ICD-9 for payment. Compliance standards, whereby a state has implemented mandates on the use of code sets that need to be addressed and/or revisited, may also impact the way payers process ICD-10 codes prior to October 1, 2015.
Guest post Kathleen Myers, MD, FACEP, is an emergency physician and founder/chief medical officer of Essia Health.
A few years ago, JAMA published a drawing by a 7-year-old girl after a recent visit to the doctor. It showed the girl on the examination table. Her older sister was seated nearby in a chair, as was her mother, who was cradling her baby sister. The doctor sat staring at the computer, his back to everyone – including the patient. The picture was carefully drawn with beautiful colors and details, and you couldn’t miss the message: Technology is making us physicians less human.
This powerful picture paints the role of the medical scribe in re-humanizing healthcare: If a medical scribe had been there, the doctor would have been able to focus 100 percent on the little girl while the scribe entered the necessary documentation into the computer.
Medical scribes specialize in charting physician-patient encounters in real-time in the electronic health record (EHR) during medical exams, freeing physicians from the data entry burden. They are typically bright, tech-savvy college students or recent graduates interested in pursuing a career in medicine and other healthcare disciplines. Many of them go onto medical school and become physicians themselves, having gained invaluable experience and insights into real-world medicine through scribing.
When I first started using an EHR, I realized that I didn’t want to be the doctor depicted in that drawing. And I was sure other doctors felt likewise. So I started a medical scribe program in my emergency department physician group as a way to integrate EHRs while re-humanizing healthcare – helping physicians maintain a more personal relationship with their patients, helping hospital customers ensure high-quality care for their patients and helping create a meaningful place for people to work. It wasn’t long before I realized that the model I started to solve our needs internally had significant potential in the marketplace, so I turned our program into a company that could serve the medical scribe needs of other healthcare providers.
In the nearly 10 years I’ve personally been using a scribe, I have observed how they are improving the practice, as well as the business, of healthcare. And our customers have confirmed these benefits time and time again.
First, patient satisfaction increases when they receive a physician’s full and focused attention. In fact, studies show improvement of 40 percent to 45 percent in Press Ganey patient satisfaction scores to overall levels 90 percent and higher when scribes are used.
With more than 2,000 entrepreneurs, investors, data scientists, researchers, policy experts, government employees and more in attendance, the Department of Health and Human Services (HHS) is releasing new data and launching new initiatives at the annual Health Datapalooza conference in Washington, D.C.
Today, the Centers for Medicare & Medicaid Services (CMS) is releasing its first annual update to the Medicare hospital charge data, or information comparing the average amount a hospital bills for services that may be provided in connection with a similar inpatient stay or outpatient visit. CMS is also releasing a suite of other data products and tools aimed to increase transparency about Medicare payments. The data trove on CMS’s website now includes inpatient and outpatient hospital charge data for 2012, and new interactive dashboards for the CMS Chronic Conditions Data Warehouse and geographic variation data. Also today, the Food and Drug Administration (FDA) will launch a new open data initiative. And before the end of the conference, the Office of the National Coordinator for Health Information Technology (ONC) will announce the winners of two data challenges.
“The release of these data sets furthers the administration’s efforts to increase transparency and support data-driven decision making which is essential for health care transformation,” said HHS Secretary Kathleen Sebelius.
“These public data resources provide a better understanding of Medicare utilization, the burden of chronic conditions among beneficiaries and the implications for our health care system and how this varies by where beneficiaries are located,” said Bryan Sivak, HHS chief technology officer. “This information can be used to improve care coordination and health outcomes for Medicare beneficiaries nationwide, and we are looking forward to seeing what the community will do with these releases. Additionally, the openFDA initiative being launched today will for the first time enable a new generation of consumer facing and research applications to embed relevant and timely data in machine-readable, API-based formats.”
Guest post by Kim Lennan serves as director of healthcare markets for Hexis Cyber Solutions.
The cost of IT security data breaches in the highly regulated healthcare industry is staggering, as it tops even the likes of financial services market. No one is immune. Nearly 94 percent of medical institutions report that their organizations have been victims of a cyber attack, according to findings by the Ponemon Institute. With the update last year to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and HITECH Act of 2009, signs of increasing expenses are again a reality. The annual cap on fines for security breaches has also skyrocketed from a maximum of $25,000 per year to $1.5 million.
With breaches in healthcare spanning from insider, nosey-neighbor snooping, to external, cyber-threats, such as malware, there is an obvious urgency for detection and remediation solutions that engage not only the hardened perimeter, but also the soft center, spanning all the way out to the ancillary systems which at once stood alone, but are now networked and part of the entire electronic healthcare ecosystem.
Establishing a single, integrated, active defense approach to bolster your security posture and mitigate insider breach, as well as cybercrime in healthcare, begins with a motion to break down internal barriers. Organizations need technology and organization leaders who champion a bridging the gap between the two influential and liable, yet often un-collaborating services providers responsible for protecting these domains: Privacy and compliance and enterprise IT security.
Coordinating the effort to monitor networks and applications to achieve a greater understanding of risky behavior is a giant step toward detecting early indicators of compromise and strengthening the weak links in your security practice. We recommend an assessment of the often overlooked, non-standard variety of electronic data carriers, which can fall into the category of the “Internet of Things,” those medical device end-points, video surveillance systems, x-ray machines and call contact systems. These must be treated as part of the entire electronic ecosystem to achieve a greater degree of data protection. They carry patient health information (PHI) and even intellectual business property, and are largely unprotected by traditional intrusion detection solutions. While often perceived as immune to breaches, they represent readily available ports of entry for an attacker.
A unified approach to end-user education and monitoring for early breach detection that fosters risk mitigation requires tight coordination between privacy and IT security. The challenge is in how. Functional groups are often siloed and share very little information with each other. This becomes a major issue in the event of a breach, as neither side is able to understand the full spectrum of the threat without the others’ data. Let’s take a look at a couple of examples.
