Technology is significantly altering the healthcare sector, influencing how and when medical decisions and treatments are made. The healthcare sector demands easily accessible and precise medical data, as well as an automated process to reduce repetitive administrative tasks. The emphasis is on improving health outcomes and patient-physician communication.
Healthcare software can help to bridge the communication gap between departments, healthcare specialists, and patients. It minimizes the complexity and time of the medical care procedure.
What is healthcare software?
Healthcare software is any software designed for the healthcare industry to help medical facilities and equipment management for patients and medical personnel to monitor health issues remotely.
Don’t confuse healthcare software with medical software. Medical software is represented by a set of tools used to improve the operational efficiency, profitability, and the quality of medical care. It includes medical devices, monitoring, and evaluating patients’ medical conditions to figure out the best treatment option. Healthcare software in hospitals focuses on electronic records, appointment scheduling automation, enhancing the patient experience while engaging with a specific hospital or pharmacy, as well as drug delivery, logistics, billing, and accounting operations.
Why is using software essential in the healthcare industry?
In most instances, the digitalization of the healthcare system allows for faster diagnosis and personalized treatments for patients. First, healthcare software systems help the community by addressing the majority of a hospital’s demands and operations. Let’s look at how custom healthcare software development can benefit your business:
A new report by Emsisoft documents an increase in ransomware attacks in the US, with 2,207 US hospitals, schools and governments directly impacted in 2023.
According to the report, last year a total of 46 hospital systems and 141 hospitals were hit by ransomware attacks and at least 32 of the 46 systems had protected health information stolen.
Citing data from a University of Minnesota School of Public Health study, between 2016 to 2021, errors and delays from attacks on the US healthcare systems killed an estimated 42 to 67 Medicare patients, or about one per month.
“The longer the ransomware problem remains unfixed, the more people will be killed by it. The only viable mechanism by which governments can quickly reduce ransomware volumes is to ban ransom payments. Ransomware is a profit-driven enterprise. If it is made unprofitable, most attacks will quickly stop,” the report says.
Experts with Cigent, EchoMark and Horizon3.ai offer perspective:
By Shyam Manoj Karunakaran, executive vice president of health plans, CitiusTech.
While VBC (Value based care) is the current focus point for the healthcare industry, it is important for organizations in this sector to ensure successful and efficient management in VBC. In this article, I would like to draw your attention toward the challenges in effective contract management and how best to overcome these.
Path to value for Value-based Care
The growing markets in healthcare are now centered around government-sponsored programs like Medicare Advantage (MA), the Affordable Care Act (ACA) marketplaces, and Medicaid. This trend is steering healthcare organizations towards more direct patient engagement and the management of high-risk, high-acuity patients. As healthcare organizations increasingly focus on Medicare Advantage, ACA, and Medicaid, they encounter a unique set of challenges, encompassing system integration, data interoperability, and effective data handling, among other critical aspects.
Addressing the SaaS Sprawl
Over the years, healthcare organizations have made significant investments in a variety of SaaS solutions to facilitate their day-to-day operations. These solutions, each housing data in different data centers or cloud environments, have become integral to their business processes. However, as the focus intensifies on managing high-risk and high-acuity patients, along with an increased emphasis on direct consumer engagement, there arises a critical need to integrate data and processes across this sprawling landscape of disparate SaaS systems. This integration is essential for a holistic view of patient care and efficient service delivery.
If you find credentialing uninspiring, consider this cautionary tale. In a frequently cited negligent credentialing case, an Illinois jury awarded the plaintiff nearly $8 million dollars when the patient’s foot had to be amputated due to damage caused by the operating physician who had not completed his 12-month podiatric surgical residency and was not board certified.
Although physician credentialing may seem like a tedious administrative task, poor execution can result in serious consequences. Credentialing mistakes lead to financial losses on provider services, delays in claim reimbursements, fines or penalties, exclusion from federally funded programs, and harm to patients. Credentialing lapses can expose a healthcare organization to malpractice suits and accreditation problems. Deviating from best practice credentialing procedures puts organizations at risk for claims of negligence that could allow a lawsuit to move forward.
Best practice physician credentialing is the process in which a practitioner’s credentials are obtained, assessed, and fully verified. The proper credentialing steps can be complex and time-consuming but are a fundamental responsibility of hospitals and healthcare facilities.
To mitigate risk to your organization, avoid these eight common physician credentialing mistakes made by practitioners and the facilities that credential them.
Mistake No. 1: Relying on limited staff and administration.
Physician credentialing, also known as medical or provider credentialing, is a laborious process that requires precision, attention to detail, and patience. All certifications and licenses must be verified for every provider who administers services to patients. Depending on its size, a healthcare organization could be required to verify the employment histories and qualifications of hundreds or even thousands of physicians. This includes each practitioner’s education, medical training, residency, licenses, as well as any certifications issued by a board in the physician’s area of specialty.
Properly credentialing every single individual is an enormous amount of work for a team to handle. Hospitals or health systems may not allocate adequate resources or staff to complete the medical credentialing process, resulting in lost revenue and stressed, overworked staff who are more likely to make mistakes.
By Matt Bridge, senior vice president – Strategy and Solutions, AGS Health.
Optimizing financial clearance and other patient access operations is an important aspect of any strategy to offset revenue cycle issues that are behind more than half of all claim denials. Healthcare organizations struggle to do so, however, thanks to staffing and technology limitations that impede efficient operational processes and increase front-end authorization errors.
Those barriers are starting to crumble as artificial intelligence (AI) and automation become more deeply embedded in healthcare revenue cycle management (RCM). Of particular note is the emerging subset of tools designed to streamline and expedite aspects of financial clearance operations, including eligibility and benefits determination and prior authorization processes. Early adopters of these intelligent authorization tools are reporting rapid return on investment (ROI), including 70% to 85% faster eligibility and benefit determination and 85%-90% improvement in authorization determination time.
Also being reported are 65% to 80% less time on authorization initiation and authorization follow-up times that are up to 85% shorter, as well as 80% faster price estimating. The result of these improvements is not only higher revenue growth and employee retention, but an improved overall patient financial experience.
Challenges to Financial Clearance
Operational inefficiencies, outdated technology, and staffing limitations are among the main contributors to rising denial rates, which were up to nearly 12% in the first half of 2022. More than 41% of those denials are the result of front-end RCM issues, including eligibility, authorization, and other financial clearance activities, which also contribute to higher net revenue leakage via avoidable write-offs.
Breakdowns in the financial clearance process can also drive down patient experience scores, with one survey reporting that 93% of patient respondents indicated provider loyalties hinge on their financial experience and more than half said it also impacts their decision to refer a friend or family member. Forty-one percent said they’re unhappy with their overall medical billing experience, with many pointing to a lack of pricing transparency or certainty despite the No Surprises Act mandate to provide them with both.
One cause is the critical shortage of RCM professionals. More than 60% of providers face RCM staff shortages, and nearly half of CFOs and revenue cycle vice presidents from large health systems and physician groups say their labor shortages are severe, with four in 10 reporting vacancy rates between 51%-75%.
The opportunity to resolve these challenges while also eliminating error-prone manual processes from financial clearance is why nearly 80% of healthcare organizations surveyed are turning to AI and automation. Financial clearance and its redundant and time-consuming tasks is a prime candidate for AI and automation, with 42% of respondents to one survey saying their organization would benefit most if eligibility checks and prior authorizations were automated.
Artificial intelligence (AI) applications are making waves across industries. But in healthcare, we frequently find ourselves fighting against being left behind when it comes to new technology adoption. While the field inherently necessitates more caution when implementing emerging technologies into workflows that impact patient outcomes and human lives, AI is proving to be beneficial in offloading administrative, repetitive, and easily manageable tasks from an overburdened healthcare workforce.
When it comes to medical imaging, AI applications are accelerating time to diagnoses and improving accuracy by going much further than any human can. AI-driven insights and machine learning capabilities are able to mine hundreds of body scans in a matter of minutes for differences that the human eye can miss. With these new applications of AI in medical imaging, there is the potential for hospitals and health systems to detect problems earlier, track patients through their care journey more accurately, and offer more lifesaving treatment to patients at the time they need it.
The storage and retrieval of digital images is an integral component of any digital imaging system. A picture archiving and communication system (PACS) turns data into actionable insights by displaying, storing, and retrieving important imaging data used for the diagnosis and treatment of complex conditions. A PACS can also ensure long-term data retention and reduce physical storage needs, offering substantial cost savings, when they are running on the right system and platform that optimizes performance.
This means that seamless digital imaging processing systems are paramount to patient and provider success. When running on a platform or service that might slow down a PACS, providers are losing valuable time and patient outcomes may be impacted. Health systems are then left scrambling for something better, which in this case can mean the difference between life and death for patients with complex conditions.
The Golden Hour of Critical Care Is Impacted by Slow Operating Systems
Founded in 1907, Adventist Healthcare is one of the longest-serving healthcare systems in Maryland and delivers comprehensive care at over 50 locations across the Washington D.C. area. Adventist Healthcare delivers high-quality care across specialties but is primarily known for its expertise in cardiology, maternity, orthopedics, and mental health.
Like most health systems, we at Adventist have been trying to keep pace with the digitization of our industry and the fast-paced adoption of emerging tech, while remaining stable and scalable to meet organizational goals and patient needs. We were facing challenges that were delaying diagnoses, adding to physician workloads, and leaving patient information not as secure as it could be. Our life-saving services, including acute-care hospitals, primary care and imaging centers, home health services and more, could not be left up to chance– so we looked at strategic tech investments and partnerships to advance our operations and ensure that we are meeting the needs of patients and providers across the Maryland and D.C. region.
In an environment where every second matters, the underlying technology supporting critical healthcare systems must keep pace with growth. Our PACS and the storage needed to keep it operational and insightful directly influence our ability to save lives. For instance, when it comes to heart attack and stroke diagnoses and recovery, the ability to pull up prior patient images to make quick comparisons within the “golden hour” of an episode greatly increases the chance of patient recovery. When the storage behind our PACS began to experience performance issues, we had to look for solutions to leverage in order to gain speed, stability, and security, while cutting costs and complexity from our current data storage infrastructure to allow for better operations and room for business growth.
By Todd Moore, vice president of data security products, Thales.
On Nov, 13, 2023, New York Governor Kathy Hochul proposed a new set of cybersecurity rules for state hospitals. This includes a mandate that hospitals must develop their own programs and response plans and appoint chief information security officers (CISOs). The regulations are part of a statewide cyber strategy that Hochul launched in August to improve cyber resilience as attacks continue to rise.
The strategy is built on three central principles: Preparedness, Resilience, and Unification. It is also New York’s first roadmap to mitigate cyberthreats and attacks and has a long road ahead to combat the growing phishing and ransomware attacks across the state.
Are the regulations up to the task? Let’s take a look.
Preparedness
Tackling multiple cybersecurity threats in recent years may have weathered healthcare’s capacity for self-defense. But the industry is still more vulnerable than most. According to the Thales 2023 Healthcare and Life Sciences (HLS) Report, 71% of healthcare organizations have cited an increase in ransomware attacks this year, far higher compared to other industries at 49%. The higher frequency is mainly due to the vast personal data they store (medical records, PII, etc.) that present a goldmine for identity theft.
Under Hochul’s proposal, preparedness will involve providing advice and guidance to ensure New Yorkers are empowered to take charge of their own cybersecurity. Healthcare facilities will have to develop their own cyber programs and incident response plans, with written policies, procedures, and regular risk and response assessment tests in place.
From a glance, these give facilities a good foundation on which to establish their cybersecurity strategies, particularly for the less tech-savvy ones. But while the regulations are a good starting point and may develop expansively, right now we’ve only gotten high-level objectives. There isn’t a clear direction for managing crucial resources in use, such as the cloud, which could undermine Hochul’s efforts to foster resilience and unification.
Resilience
We live in a multi-cloud reality. Nearly 90% of healthcare respondents deploy two or more cloud providers to better manage data. Over the past year, data security in the cloud has become increasingly complex (from 44% to 55%). Unfortunately, this makes cloud resources a leading target for attackers, particularly for healthcare (78%) over other industries (67%).
The American healthcare system is under enormous strain; plagued by looming physician and nursing shortages that grow more dire every day and bogged down by inefficient and costly administrative processes that account for billions in wasteful spending every year. All this adds up to a healthcare system that is not only ineffectual but also extremely costly.
Healthcare budgets are rising exponentially while more and more pressure is placed upon healthcare workers who are increasingly understaffed and overburdened, leaving hospitals and providers unable to provide their patients with high-quality and accessible care. What has caused this precipitous fall in American healthcare, and how can this trend be reversed?
One of the largest obstacles that healthcare has been unable to overcome is its failure to adopt advancing technologies in its administrative processes. Doctors—already stretched thin—are forced to waste valuable time and resources navigating a tangled and disjointed web of health platforms in order to perform the simplest of administrative tasks.
License renewals and credentialing, processes that should take minutes with the assistance of digital technologies such as artificial intelligence, take months or more to execute. Providers must cross multiple platforms in order to manage, track, and monitor a host of different administrative processes, which cause onboarding delays, credentialing and privileging issues, siloed data management, and slower enrollment processes. This, in turn, reduces the efficiency and efficacy of services provided and increases the cost to both the provider and the patient.
Furthermore, these frustrating and tedious processes not only are responsible for delays that account for hundreds of thousands of dollars in lost monthly revenue, but they also take away from the limited amount of time a physician has to see patients and contribute to increased instances of physician burnout, which further depletes our ranks of healthcare professionals.
Technology is significantly altering the healthcare sector, influencing how and when medical decisions and treatments are made. The healthcare sector demands easily accessible and precise medical data, as well as an automated process to reduce repetitive administrative tasks. The emphasis is on improving health outcomes and patient-physician communication.
By Shyam Manoj Karunakaran, executive vice president of health plans, 
