Organizations are facing greater scrutiny in this increasingly regulated world. And in 2021, the focus on compliance is expected to increase. The Health Insurance Portability and Accountability Act (HIPAA) affects thousands of organizations across the U.S, including many who support healthcare providers instead of directly delivering care themselves. On top of it, the challenges of maintaining round the clock compliance with HIPAA regulations keep adding up.
While technology has brought upon new challenges in healthcare data security, technologies have also changed the way companies collaborate. For example, the advent of modern HIPAA compliance software has brought about a high level of flexibility in logging in reports and communication that allows employees, co-workers, and managers to connect easily. This helps managers to have overall transparency and a clear picture of their entire HIPAA compliance program.
In today’s article, we will take a closer look at the main challenges faced by healthcare organizations in maintaining or implementing HIPAA compliance and how our HIPAA compliance software can help you address these problems.
Simplifying the Challenges of HIPAA – 9 Pain Points for Administrators
You don’t have to acquire several solutions to ensure each critical element of HIPAA is being addressed separately. HIPAA Ready integrates all compliance modules and allows you to ensure compliance with just one solution. The federal law HIPAA was, in fact, designed to reduce administrative burden. And if your compliance efforts are proving to be more difficult rather than reducing your burden, then your entire program is meaningless.
Areas of Vulnerabilities
In addition to technology, numerous factors can affect the security of your health information data. For example, growth in your business will result in an increased number of processes, devices, and even employees. Hence, an increased number of risks are associated with the growth of your business. Risk analysis and risk management are an integral part of HIPAA compliance. Performing risk analysis can understandably be time-consuming and costly if you hire third parties to do it for you. But with HIPAA Ready, you can easily identify areas of vulnerabilities and mitigate them to the extent possible with easy to use a risk analysis and management feature.
Training and Educating Staff
If you are in the healthcare industry, you already know how crucial HIPAA training is. But this is one area most organizations struggle with. How to deliver training to employees? How to schedule these training sessions? Where should I maintain documentation for these training sessions? Have all the employees undergone training?
The challenge is even greater for larger organizations. But you do not have to worry about managing HIPAA training if you are using HIPAA Ready. HIPAA Ready will enable you to effortlessly manage and provide HIPAA training to members of your workforce and ensure that everyone is on the same page.
(Connected Communities of Care Definition: An innovative method for effective population health management using social determinants of health. A way to streamline effective coordination between medical, government and community-based organizations.)
We ask this type of question every day. For example, we may ask? “Is this product that I purchased making a difference?” or “Is this advanced training that I completed making a difference?” Implicit in this common question is the expectation that because we have made an investment in something to achieve a result, the result should be better or more improved than the pre-investment state. So too with a Connected Community of Care (CCC).
As I have discussed in previous blogs, establishing a CCC requires a substantial investment in both time and money. Therefore, it is only natural to ask? “Is this CCC making a difference, and how would I know?” Unfortunately, most CCCs are established with very little forethought given to this exact question. While we expect the CCC will help community residents improve their health and well-being, how will we know conclusively that this has happened?
How will we demonstrate its impact to a potential partner or? more importantly? a funder? This is where data, measurement, and evaluation come into play. For most people, these three words cause anxiety levels to immediately rise. But this doesn’t need to be the case; a little planning and forethought can go a long way to assuaging one’ anxiety when asked the question, “Is your CCC making a difference?”
Before we think about what data we will need to answer this question or how we will collect it, we first need to establish what we mean by “making a difference”. Understand, there is no one correct answer to this question. What may constitute a positive difference or impact for one organization may be much different for another, even similar organization. Many factors contribute to the final answer and each are usually organization-, ecosystem- and situation-specific.
In practice, there are many ways to define making a difference. First, we can look at quantitative or numeric information to make this determination. Are we providing more nutritious meals to indigent residents? Is the number of inappropriate Emergency Department visits declining or, conversely, is the number of residents having visits with a primary care provider increasing? All of these effects can be counted and judged against some predefined goal (more on this later).
Second, we can assess making a difference by asking the people that are being touched by the CCC. Through surveys or brief interviews, community residents can tell you in their own words what impact, if any, the CCC has on their lives. While this qualitative (non-numeric) information can often be more informative than simple quantitative information because it represents the voice of the individual, to answer the question of whether your CCC is making a difference, you will also still likely need to establish numeric goals.
A third way to assess whether your CCC is making a difference is indirectly via the financial and non-financial opportunities that arise as a result of having a CCC versus not having one. For example, having a CCC may make it much easier to perform contact tracing among vulnerable populations during a pandemic like COVID-19. Having a CCC may also enable a healthcare system or a community-based organization (CBO) to apply for a grant that it otherwise might not be competitively positioned to do if it did not have an integrated system of healthcare and social service providers such as a CCC.
By Courtney Tesvich, vice president of regulatory, Nextech.
Data interoperability is once again poised to take a giant leap forward and there are many factors propelling this evolution. For example, the Office of the National Coordinator’s (ONC) March 2020 introduction of the interoperability rule as part of the 21st Century Cures Act is set to advance interoperability regulations. COVID-19’s spotlight on the need for data transparency and seamless information exchange to enable efficient care delivery across diverse settings is revealing a critical use case.
The rapid onboarding and use of telehealth to virtually deliver safe and secure healthcare underscores the importance of modernizing interoperable solutions. Given all these factors, the time is right for healthcare organizations to evolve their thinking around data sharing.
While larger, multi-setting health systems may have teams of people dedicated to advancing their organization’s interoperability strategy, smaller entities (including specialty physician practices) are often left to figure out the right path forward on their own. This can be overwhelming, and it may be tempting for smaller organizations to delay work on this issue. However, it will only postpone the inevitable.
Over the next two years, the capabilities and requirements to exchange electronic health information will change drastically. The ONC is allowing two years to implement the new interoperability requirements and technology will likely change in that time. So, starting the effort now can make it easier to adapt as solutions evolve. The bottom line? To meet this deadline, practices need to develop their strategies, update compliance efforts, understand upcoming changes and begin to update processes to ensure they are fully prepared for the near future.
But how can an organization get started? Here are a few steps to consider.
Educate yourself on the intent and nuances of the ONC rule. The primary goal of the interoperability rule is to give patients greater access to their health information and allow them to share the data more easily with all providers. As electronic health record (EHR) vendors continue to develop their products to meet the updated requirements, more information than ever before will be available electronically both for patient use and for exchange. Factors that providers should be aware of include:
Future availability of free text notes in the patient portal as well as nearly all lab, radiology and pathology results. As EHR vendors develop and certify to the US Core Data for Interoperability requirements, patients will see additional data beyond the previously available CCDA information in their portal, including visit notes.
Patients will be able to seamlessly select independent apps to aggregate their own health records.
Ensure your practice understands how to handle requests for information in a timely manner. This includes requests by patients for their data as well as data requests by insurance companies, employers and consumer-facing apps. Develop a policy and train staff before the new Information Blocking deadline of April 5, 2021. Ensure you continue to follow HIPAA guidelines as well.
Practices will also need to regularly update clinician information in federal databases.
These suggestions merely scratch the surface of what the new rule requires. Providers should delve deeper and make sure they are moving towards compliance and not inadvertently standing in the way of information exchange.
Healthcare consumerism was already on the rise before the pandemic hit. The provider-patient power differential was already beginning to shift, with more high-deductible health plans being offered and employers shifting the burden of managing healthcare expenses to individual employees. Before COVID-19 entered our shared lexicon, patients were beginning to take a more active role as purchasers and managers of their own care.
This year’s explosion in telehealth, brought about by the COVID-19 pandemic, has dramatically upped the ante in terms of competition, enabling budget- and value-minded patients to shop for their care unfettered by geographical restraints. The turn to digital care isn’t one that will be undone after the pandemic, either. Eighty percent of patients say they’re likely to continue utilizing virtual visits with their doctors, even after the pandemic ends.
Providing an ever-more-discerning patient population with a new, vast array of providers has disrupted the longstanding monopoly hospitals held over their local patient populations. The fallout has come in the form of widespread network leakage and lost revenue. By October, in fact, revenue for hospitals in the U.S. was down 9.2% year-over-year. Able to select providers from the comfort of home and with an ever-increasing amount of personal health data at their fingertips, patients have far more freedom in 2021 to choose the provider that works for them.
That means that to compete, traditional providers have had to adapt quickly, training staff on remote care and making telehealth an option for every patient. According to McKinsey, health systems, independent practices, behavioral health providers, and others have reported 50-175x jumps in the number of telehealth visits since the pandemic began.
Having the technology to compete in the telehealth arena won’t be enough, however, for mainstream providers to compete, not to mention recover any lost revenue. Patients often don’t feel the same kind of brand connection or loyalty to hospitals that they might to other products or organizations. To keep patients in the network, we’ll see a new push in 2021 toward marketing, patient experience, and most importantly, loyalty.
2020 was a year none of us could have predicted or prepared for. For the healthcare industry, 2020 may well be remembered as an “annus horribilis” as Queen Elizabeth II once coined. Sadly, we are closing out the year with record number of hospitalizations and deaths from COVID-19, even as a vaccine begins to make its way across the country.
While this year tested every aspect of normalcy, in the midst of such massive challenges, we also discovered glimmers of hope within the healthcare industry. From new tech advancements, to rapid medication production, to recognition of medical staff, there were some positive moments amidst the challenges of 2020:
Healthcare takes main stage – As COVID-19 began to take its toll across the globe, physicians, nurses, clinicians, and medical staff everywhere stepped up to the challenge and delivered care for the thousands who became sick with the virus. In cities across the country, nightly cheers showed our appreciation for healthcare workers, who are fighting to keep us alive and fighting against the virus. While the pandemic continues, we have discovered a renewed gratitude for healthcare workers and the lengths they go to protect our health.
Digital Health Goes Mainstream – COVID-19 disrupted traditional healthcare services as we once knew it. Providers suspended non-emergent visits and care, leading people to explore and discover new ways of living and working amid a lockdown, and digital health tools saw an increase in usage. With daily life upended, we took to using our Fitbits, Apple Watches, and digital drug companions to manage health on our own. During 2020, digital health tools saw an increase in use of nearly 50%. And with increased connectivity, more advancement in health monitoring and outputs, and the improved use alongside smartphones, digital health looks to support patient engagement into 2021.
As a physician entrepreneur with a background in critical care, I view the COVID-19 pandemic from a unique perspective. COVID-19 has compelled the healthcare industry to evaluate areas that are successful and those that must be altered to improve care delivery for both clinicians and consumers. This time of contemplation is an opportunity to move healthcare forward for the benefit of everyone.
In addition to providing many lessons for the healthcare industry, the COVID-19 pandemic has exposed some particularly vulnerable areas, revealing five valuable teachings.
Five Insights from the Pandemic
The need for more palliative care providers: The pandemic brought to light the shortage of palliative care providers in America. Some hospitals reacted to the abrupt wave of patients by staffing palliative care physicians in the ED. These hospitals leveraged the experience of palliative care physicians to engage patients in goals-of-care discussions, enabling their patients to have increased access to goal-concordant care. Others offered further palliative care support through telehealth to bridge the gap between onsite clinician resources and demand. Palliative care will continue to be in high demand throughout the pandemic and moving forward, and there must be a considerable effort to encourage more providers to join the specialty.
A stronger emphasis on end-of-life care planning: COVID-19 has illustrated the importance of proactively initiating end-of-life conversations with patients and their loved ones to achieve patient-centric value-based care. It is also critical for these wishes to be documented in a clear and easily accessible manner, as the traditional way of completing advance care planning documents with pen and paper is no longer sufficient. Hospitals and health systems need to integrate digital advance care planning documentation into their EHR systems to ensure that these documents are available to all clinicians, patients and their selected caregivers when they are needed.
The fragile state of fee-for-service revenue: Many health systems still depend on procedures, imaging and infusions to account for a significant amount of their top-line revenue. While this pandemic is a particularly acute case, it has revealed the fragility of these revenue streams. Risks to an organization’s fee-for-service revenue, such as competition in the market, losing a physician specialty group and more, always exist. There is hope that the exposure of this fragility will drive further engagement in value-based initiatives – at the very least to help prevent disruptions of fee-for-service revenue in the future, but in the end, because these reimbursement models can provide higher quality care at lower costs.
The importance of prioritizing public health: Much more could have been done to prepare for COVID-19, in terms of preemptive and continuing investments in public health. Moving forward, the connected global community must prioritize preparation, so we can successfully respond to future public health emergencies.
Greater investment in supply chain infrastructure: COVID-19 has uncovered deficiencies in the U.S. healthcare supply chain. Though some health system executives tried to say the concept of just-in-time supply chain is not effective in healthcare, the truth is just-in-time supply chains can be effective during unexpected incidents. To be successful, they need significant planning and investment in supply chain infrastructure, and COVID-19 exposed some of these preparation shortcomings.
By John Danaher, MD, president, global clinical solutions, Elsevier.
At the beginning of last year, we all had our own thoughts on how the year would unfold. However, a few months into 2020, we realized that the year would be quite different than we previously imagined because of the COVID-19 pandemic. With 2021 underway, we will continue to witness the digital transformation of the healthcare industry that was accelerated by the COVID-19 pandemic.
Clinicians were quick to embrace different types of innovative technology, such as telemedicine platforms and non-contact solutions to track patient vitals, that allowed them to provide patient care remotely. I believe that in 2021, we will continue to see an evolution of technology to assist clinicians and widespread adoption of digital health services. I also expect the industry will take key learnings with them as we move towards the future, such as the importance of building more trust in science and data.
Investments in AI are paying off
We have seen the impact of AI in the fight against COVID-19, specifically in the diagnosis and tracking of cases, predicting future outbreaks and assisting in selecting treatment plans.
I hope to see more infections decline as populations receive access to the COVID-19 vaccines and I see a renewed focus in how AI can help healthcare systems recover from the pandemic. Artificial Intelligence will be paramount in aiding many healthcare systems’ return to their regular operations as they were pre-pandemic. Artificial intelligence helps systems work faster to address the backlog of patient cases across other diseases and conditions that were postponed due to the pandemic, and deal with the financial strains caused by the virus. These tools can be used in revenue cycle management to assist with staffing, bed and device management, and provide a better understanding of patient utilization.
Artificial intelligence will continue to play a larger role as telemedicine tools and solutions rise in popularity.
Widespread use of telemedicine
One of the longest lasting effects of this pandemic is how clinicians have adjusted their delivery of care. The use of telemedicine applications is now a widely used practice, with the U.S. seeing an increase of 154% in telehealth visits in March 2020, compared to the same time period in 2019. There’s no doubt that the rise in the usage of telehealth services have benefited both healthcare providers and patients.
Mainly, the adoption of services has decreased the number of patients in medical offices seeking non-emergency care and ultimately minimizing the risk of exposure to COVID-19. While telemedicine will not replace in-person care, it will remain a necessity in 2021 and beyond. As patients are now more accustomed to the convenient delivery of care services, they will be more inclined to expect these remote services, along with other services, such as drive through testing sites and at-home delivery of prescription medications that do not require in-person visits.
By Abhishek Danturti Sharma, assistant general manager and lead data scientist for business transformation, HGS.
Health plans are all too familiar with the challenges of member experience—that perfect storm of call/processing volume surge, staffing challenges, and critical moment-of-truth engagement pressures. According to JD Power research, the stakes are even higher for 2021.
The organization’s fourth annual study found that member satisfaction averages dropped from 712 on a 1,000-point scale in 2009 to 701 in 2020. J.D. Power and Associates measures health plan satisfaction of 133 health plans in 17 U.S. regions in seven areas: coverage and benefits, provider choice, information and communication, claims processing, statements, customer service, and approval process.
To be successful, today’s digital-led member engagement must meet the needs of Generation “C” – the “connected” customer demographic that spans generations. These consumers make purchasing decisions based on brand reputation and a more personalized experience. A strong digital toolkit, containing interaction analytics; AI-powered data capture; and automation, will elevate and customize engagement to earn and retain these buyers. It may be counterintuitive, but digital enablers such as analytics, AI-powered intake, and bots can deliver a more empathetic, customized member enrollment experience—one that earns and retains customers for life.
Utilize Interaction Analytics
Interaction Analytics solutions offer key advantages along all consumer journey touchpoints, delivering essential ROI with voice of consumer insights related to preferences and experience enhancements to drive higher CSAT and NPS. Contact centers have a goldmine of customer feedback. Insights can be built from speech data that is a valuable information source of customer sentiment and intent. The data tells the unbiased story here – to avoid missed opportunities or misalignment of feedback. The proactive insights built at the crucial open enrollment phase are actionable by helping health plans to tailor their product development to consumer choice across key member demographics.
Apply AI-powered data capture
Today’s cutting-edge machine learning, optical character recognition (OCR), and intelligent character recognition (ICR) for cognitive intake have elevated the document management process once considered highly burdensome for payers. The open enrollment process is a touchpoint ideally suited to intelligent data capture. Open enrollment is a highly paper-intensive process that presents an excellent opportunity for improvement. With the inherent paperwork and processing, AI-powered innovation provides tremendous opportunity for workflow enhancements to minimize subjectivity of structured/unstructured data—for faster turnaround and cost savings.
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The internet has been the greatest force on the planet to get vast amounts of information out to the public. However, its decentralized, leaderless structure means there is no gatekeeper to determine whether information is factual or credible before it is published. This is especially problematic for medical information, given the potential repercussions of following incorrect or misleading medical advice.
Many articles related to health on the internet are produced by content mills and individuals with no medical training. Even so, this does not mean that the internet is devoid of reliable health information. It’s all about knowing how to find it. Here are some practical tips.
1. Prioritize Health Search Engines Over Google
Google is the undisputed king of internet queries. No one can match the sheer scale of online information the search giant has indexed. But Google is akin to a fishing trawler. Whileit has gone to great lengths to improve the quality of its search results, it is extremely difficult for Google to exhaustively review the trillions of indexed pages for content reliability.
You can use Google and other mainstream search engines to search for health information online. However, it is best to do so only after you have exhausted other sources, such as a reliable health search engine or portal like MedlinePlus. Health search engines are devoted to medical-related information only and have taken time to provide accurate, proven and reviewed content.