Carrot Health has developed the COVID-19 Risk Index, which predicts those populations and communities that are most susceptible to the negative impacts from a coronavirus outbreak. The risk index does not predict where and when an outbreak will occur, rather it helps inform public health and intervention decisions at the national, regional and community levels by identifying who is most vulnerable.
Because risk variations across a single metro area can be significant, Carrot Health is also preparing to publish an interactive dashboard that shows the COVID-19 Risk Index and allows users to drill into the data down to the zip code level to identify granular pockets of risk and model different outbreak scenarios. This information can help inform coordination of resources to protect those who are most vulnerable.
“With the right data, public health personnel can turn panic and passivity into preparation and progress, directing intervention efforts and resources more effectively and appropriately,” said Carrot Health CEO Kurt Waltenbaugh. “It allows for better informed decisions about the types of advance preparations that are necessary and where to divert scarce resources like ventilators and test kits in the event of an outbreak, and identifies populations that require closer monitoring so rapid interventions can be staged with when circumstances warrant.”
Carrot Health Insights | Predicting Coronavirus Risk, which includes multiple charts and graphs breaking down population-based risk, can be accessed online here. It will be updated as more data and scientific studies become available.
Research also suggests that approximately 2% to 4% of people with the virus die, depending on where they live. So far, deaths are higher in males and much higher for those over age 65.
By coupling this information with its extensive database of social determinants of health information and consumer insights, Carrot Health was able to predict COVID-19 vulnerabilities. The following map shows forecasted COVID-19 population risk at the county level (red = high, green = low):
Source: Carrot Health
New data and additional studies might change the assumptions upon which this initial analysis was based. In addition, the actual infection rate may be higher than reported, which would mean that mortality rates could be lower than currently estimated. To that end, the COVID-19 Risk Index will evolve over time.
“These insights are not meant to inspire panic, but to promote thoughtful preparation. Data-driven insights will be critical in saving lives, deploying resources, and minimizing disruption, both for this public health crisis and for future ones. While the U.S. currently remains less affected than some parts of the world, it is nonetheless more vulnerable due to a healthcare system that does not promote prevention or early intervention,” said Waltenbaugh. “Fortunately, we have powerful data tools at our disposal to better prepare and deploy resources, and a culture of helping those who are vulnerable.”
By Dr. Jason Hallock, MD, chief medical officer, SOC Telemed.
On March 13, President Trump declared the novel coronavirus (COVID-19) pandemic a national emergency. The declaration opens more than $42 billion in federal funding to combat the virus by expanding resources in key areas, including telehealth across the nation. While COVID-19 is novel there’s nothing new about telehealth solutions that are now moving to the forefront care in light of this virus.
Funding will support an increase in COVID-19 testing and expand telehealth services to virtually care for patients. HHS can waive licensing regulations to allow out-of-state physicians to treat patients via telehealth wherever outbreaks occur. And, critically, the declaration of emergency allows for $500 million in Medicare waivers for telehealth restrictions.
The action comes at a critical moment, as the U.S. health care system is confronted for the first time in its modern history with the possibility of a hospital capacity crisis. If too many COVID-19 positive cases descend on our hospitals at once, we could be in the unenviable position of lacking the onsite equipment, the beds, tests, staff and other resources to provide life-saving care for all. Such dark medical realities are already true elsewhere in the world.
As the contents of the national emergency declaration show, telemedicine is poised to play a key role in the fight against COVID-19. It’s not by accident.
While the virus spread rapidly to pandemic status, the reality is that the healthcare industry long anticipated the possibility of a fast-spreading global contagion. As we in the industry planned for the possibility of such an event, telemedicine was always among the solutions.
The role of telemedicine in the time of a pandemic is not an experiment or for use in a limited trial—it’s actively being used to treat COVID-19 today. In fact, the Centers for Disease Control and Prevention (CDC) continues to urge doctors and hospitals first to assess potentially infected patients remotely whenever possible, and to care for patients with mild COVID-19 symptoms from home using virtual check-ins.
As COVID-19 continues to spread in the United States, health care providers are turning to technology to help treat patients who may be infected and also prevent the spread of the illness.
While there are no known cases of COVID-19 in Alabama, plans to use telehealth technology to fight the spread of the virus are already in place at the University of Alabama at Birmingham.
According to Eric Wallace, M.D., the medical director of UAB eMedicine, UAB is considering using telehealth through three approaches to help care for patients both in Birmingham and around the state.
Keep patients at home
The first approach is to keep as many patients who do not have upper respiratory symptoms at home, especially those who have weakened immune systems. The most common COVID-19 symptoms are fever, runny nose, dry cough, shortness of breath, fatigue and body aches.
“We plan to use telehealth technology to see as many patients in their homes as possible, especially those who are most at risk, such as the elderly and immunosuppressed patients,” Wallace said. “For example, if you have a urinary tract infection, the last thing you should do is go to the doctor’s office and wait in a waiting room when you could have had your UTI treated from home.”
If you have any of the COVID-19 symptoms, you should call your health care provider first before going to the doctor’s office. If you do not have any of the symptoms, but need medical care, Wallace recommends calling your doctor or using UAB’s eMedicine online service. The service allows doctors to diagnose and treat patients for a variety of common conditions online. Furthermore, UAB’s eMedicine online service is now serving as a location to help screen patients with COVID-19 symptoms to determine whether referral for in-person testing is necessary.
On Mar. 9, 2020, the U.S. Department of Health and Human Services (HHS) finalized “two transformative rules that will give patients unprecedented safe, secure access to their health data.” Issued by the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS), the Final Rules implement interoperability and patient access provisions of the 21st Century Cures Act and support President Trump’s MyHealthEData initiative.
In its release announcing the Final Rules, HHS noted that together “these final rules mark the most extensive healthcare data sharing policies the federal government has implemented, requiring both public and private entities to share health information between patients and other parties while keeping that information private and secure, a top priority for the Administration.”
Cures Act Final Rule implements the interoperability provisions of the 21st Century Cures Act, passed by Congress in 2016 to promote patient control over their own health information while still allowing providers to choose the IT tools that let them provide the best care for patients without excessive costs or technical barriers.
Specific to patient matching, the Cures Act Final Rule adopts as standard the first version of the United States Core Data for Interoperability (USCDI v1), making its use a requirement as part of the new application programming interface (API) certification criterion.
According to ONC, adoption of the USCDI standard “supports improved patient matching through the exchange of USCDI and its patient demographic data elements.” The Final Rule integrates additional data elements to the patient demographics data class to improve patient matching:
Phone Number Type
“Any improvement strategy must include data standardization and promote a more consistent, comprehensive collection of patient data at all entry points,” said Karen Proffitt, MHIIM, RHIA, CHP, vice president of industry relations and chief privacy officer, Just Associates. “The Final Rule requirement for adoption of USCDI standards, including historical data and more relevant data elements such as phone number and email address, represents a significant step toward improving interoperability and minimizing MPI errors overall.”
Interoperability and Patient Access Final Rule gives patients access to their health information when they most need it, in a way they can best use it. It is focused on driving interoperability and patient access to health information by leveraging CMS’s regulatory authority over Medicare Advantage, Medicaid, CHIP, QHP issuers and FFEs to free patient data.
Specific to patient matching, which was one of two requests for information included within the proposed rule, CMS noted that while “accurate patient identity management is critical to successfully delivering the right care to the correct patients,” patient matching challenges are beyond the scope of the current rule. However, the comments provided will be taken into consideration for potential future rulemaking.
“As a healthcare community, we must recognize the critical role improved data capture and MPI data quality play in enabling patients to have more comprehensive access to their health information by ensuring complete and accurate data is available for viewing or transmitting,” said Proffitt.
She adds, “any process to incorporate patient verification of data along the way could be very beneficial.”
The U.S. Department of Health and Human Services (HHS) recently finalized a new rule to support seamless and secure access, exchange and use of electronic health information (EHI). The legislation aims to drive sharing of patient EHI, allowing for greater coordination of care. It also takes a strong stance against information blocking and would hold health IT developers accountable as a condition of certification.
The regulations take a crucial step forward for nationwide interoperability and health care by requiring open, standardized application programming interfaces (APIs) for patient and population services. The rule is designed to promote data transparency between health organizations through a central and secure exchange of EHI. For hospital systems, this includes clinical notes and admits, discharges and transfer (ADT) files. For payers, this includes anything from claims to clinical data, including labs, pharmacy, immunizations and vitals.
For stakeholders, having access to real time and actionable information at the point of care is a significant improvement over information from claims filed 60-90 days after the care was provided. This also demands that patients be fully informed about how apps will use their personal data and information.
As many health IT developers know, the challenge is that EHRs are only as good as the information fed into them. The moment a patient goes outside of that circle of care, the user loses all sight into the services being provided.
Improving on the Current EHR
The current absence of interoperability creates a burden for hospital systems and undermines payer efforts to achieve high quality care and more appropriate utilization. It also impacts reimbursement and profits. When more information is shared historically, it allows payers to manage the whole patient experience.
This is where an innovative EHR browser extension comes in.
The ideal browser extension serves as a population health solution built upon an EHR foundation and completes the circle of care by aggregating information through continuity of care documents, claims, labs, health information exchanges, vendors, ancillary providers and hospitalists groups to not only answer the question of “who is in my office now?” but also “who should be in my office?”
This is done through alerts, defaulted based on the systems history, or on the specific user based on what they care to see. The concept centers on creating a user journey that notifies the provider of an admission through real-time application programming interfaces (APIs), sending care alerts to the case manager, flagging the risk-bearing entity to a potential future cost and relevant information to patients and caretakers via a mobile app.
Anyone who watches the news should be aware of the constant threat of identity theft. Every day, hackers create new scams and tactics to steal private information that they can sell to the highest bidder or use to take out loans and credit cards and put victims in debt. Unfortunately, few industries are as exposed to these threats as the healthcare industry.
Every time someone goes to the doctor, they are sharing personal details with their medical provider and other staff, which gets logged into a computer for later — and hackers are eager to unlock this treasure trove of private info. As technology advances, so will the threats, so extra precautions will be necessary. Below are the threats coming down the pike and how to prevent them.
Emerging Healthcare Threats
Healthcare will always be a huge target for cyber thieves simply because of the pure amount of information that is created with every doctor’s appointment or surgical procedure. An emerging threat that is gaining steam is ransomware attacks, where hackers take control of patient data with the hope of illegal profit.
Just one example includes how, early in 2019, hackers gained access and encrypted the data within the computer system of provider NEO Urology. Fearing the worst, the staff paid the requested $75,000, and the data was freed. It was a painful price to pay for a threat that could have been avoided.
All it takes is one successful scheme to bring the criminals out of the woodwork. Since the NEO hack, several other ransomware attacks have occurred around the country, including instances in New York and California, where thousands of patient records have been compromised. When these attacks occur, it is not only patients that face the consequences, but also the business, as the cost to repair a corporate image and fix the damage could cost a company millions.
New technologies are on the horizon, but they too must be safeguarded from cyber threats. Lately, the idea of integrating artificial intelligence into hospitals has been gaining steam, as experts believe that this technology could limit the number of hospital errors as well as assist with earlier detection of medical issues. However, while this technology continues to evolve, it is still open to the risk of cybercrime.
As a first step to securing your hospital systems, a penetration test should be completed. Penetration testing involves inspecting your system for vulnerabilities, such as weak firewalls or poor security policies, and creates a report, so you know what to fix to protect patient information involved. Your baseline security should be intact before adding any new features.
By Kim Huynh and Esther Ketelaars, health and life sciences experts, PA Consulting.
Studies unanimously show the negative effects medication non-adherence has on clinical outcomes and healthcare costs. Adherence is critical to ensure that medications work properly and important for pharmaceutical companies because it helps keep their drugs covered under health plans. Healthcare insurers want to ensure their covered drugs are treating their members effectively and are seeking to prevent more costly health care.
So, while traditionally medical adherence solutions have been paid for and promoted by pharma and payors, a new player has a chance to enter the scene and challenge the status quo. Now is the time for providers to proactively address medication adherence as they start to bear more financial risk through value-based care models.
How can providers play a larger role?
Provider organizations who focus on medication nonadherence have a great opportunity to improve patient outcomes and support their value-based care models. According to the Center for Disease Control medication nonadherence results in 10% of hospitalizations and 125,000 preventable deaths in the U.S. each year. Likewise, low medication adherence leads to treatment failures between 30% and 50% of the time.1 These negative impacts become even more relevant to providers as patient outcomes continue to be more closely tied to reimbursement and payment incentives.
Pharmaceutical companies, payors, some providers, other consumer-focused companies in the healthcare value chain, and even governments have tried to address nonadherence. With the recent growth of digital health solutions especially, many have focused on leveraging novel technologies. However, there are a myriad of reasons for patients not compliant with their medication and adopting a single tool or technology has rarely been effective in reducing nonadherence.
A one-size-fits-all approach will often only address a single issue for a limited number of patients. With their direct access to patients, providers have a better chance of addressing the complex mix of reasons for nonadherence and design medication adherence programs customized to each patient. Personalized intervention plans invite a direct solution to each patient’s reasons for nonadherence with the appropriate tools that address the underlying cause for that individual.
Developing such a program requires factoring in root causes and reasons for nonadherence, using predictive analytics to identify high-risk patients, and gathering a diverse set of interventions to address those root causes. The position and shared decision-making power between providers and consumers indicate that providers can address medication adherence for more patients, improve patient outcomes, and reinforce value-based care.
Designing a patient-centered medication adherence program
Many of the tried and tested programs have been designed based on an assumption of the underlying reason for nonadherence. However, for these programs to be truly effective provider organizations need to understand and diagnose the patient’s reasons for nonadherence and tailor their intervention with the right tools.
Understand the reasons for medication nonadherence
Exploring the factors contributing to nonadherence allows organizations to understand the inherent complexity of nonadherence. Most interventions fail to produce the desired results because they don’t consider the many contributing factors. The reasons for nonadherence go beyond simple forgetfulness. Only 30% of patients cite forgetfulness as the cause of their nonadherence.
The coronavirus is dangerous because of how easily it spreads from person to person. If you believe you have it or have been confirmed to have it through testing, then you will need to self-quarantine.
Self-quarantining is a precaution that everyone should aim to take if they have been in an infected area or are experiencing flu-like symptoms. Though the chances of you yourself dying or reaching a critical state are overall low, if you are infectious, you could pass the disease on to someone who is at risk. Those who are older or who have underlying health conditions are at risk of reaching a critical state if they catch the coronavirus. Quarantine yourself if you have a cold, take these precautions, and get better fast:
Try to Stay Away From Non-Infected Family Members
This can be difficult if you live in a small space, but if you can try to stay away from members of your family who aren’t sick as much as possible. This might mean further quarantining yourself to your room while testing is done or while you are sick. It might mean having your non-sick family member stay with a friend in the area instead. Go through your options to help reduce the risk of spreading the disease to others.
Order Food and Supplies to Your Door
When you are under self-quarantine, you won’t want to leave your home, even if it’s just to buy groceries. Thankfully there are many door-to-door options out there. Your grocery store might offer a delivery option, or you might have to go with a company like Uber Eats or Post Mates.
Do note that some companies have changed their policies in light of the coronavirus, so you might not see the delivery person, and instead have your order placed outside the door instead of handed to you.This also applies to supplies. There are many online retailers to help you bulk up, even for medical supplies like a finger bandage or medicine. Knowing how and where to shop for these items is going to be important when it comes to caring for and providing for your family under self-quarantine.
Catch the Cold
While you are sick, you will want to catch the cold, so to speak. Have tissues at the ready to cover your mouth or nose if you cough or sneeze. Immediately throw the tissue out and then wash your hands. This will help reduce the spread of the coronavirus in your own home.
HIMSS and Forrester today announced the results from a study that investigates adoption of consumer and employee experience capabilities within healthcare. Respondents were asked about their current strategies for improving both patient and provider experiences, and the perceived value of those programs.
Based on insights from more than 170 U.S. health systems respondents, the study found that strategies used to improve customer and employee experience in other industries are largely underutilized in healthcare. Additionally, the study finds that nine out of 10 health system workers do not believe that providers in their organization are equipped to deliver the best care possible.
Results further reveal that provider experience remains the forgotten leg of the Quadruple Aim – emphasizing that healthcare organizations (HCOs) must not ignore provider burnout within their organizations.
Currently, 60 percent of HCOs lack a formal strategy to accurately measure this. At the same time, more than a third of the health systems surveyed report that they have no strategy in place to measure electronic health record (EHR) satisfaction. According to the study, the most successful HCOs moving forward will be the ones that invest in a patient-centric and outcome-first digital strategy that helps build lasting doctor-patient relationships.
The American Medical Association (AMA) today announced that the CPT Editorial Panel approved a new addition to the Current Procedural Terminology (CPT) code set that will help streamline data-driven resource and allocation planning in the battle against the novel coronavirus (SARS-CoV-2) as the number of confirmed COVID-19 cases continues to rise in the United States.
“In the face of the COVID-19 pandemic, the CPT Editorial Panel has expedited approval of a unique CPT code to report laboratory testing services that diagnose the presence of the novel coronavirus,” said AMA President Patrice A. Harris, M.D., M.A. “The new CPT code assigned to the test for the novel coronavirus provides analytical advantages for tracking, allocating and optimizing resources as testing ramps up in the United States.”
For quick reference, the new Category I CPT code and long descriptor are:
87635 — Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
The code is effective immediately for use as the industry standard for reporting of tests for the novel coronavirus across the nation’s health care system. In addition to the long descriptor, CPT code 87635 has short and medium descriptors that can be accessed on the AMA website.
The CPT Editorial Panel, the independent body convened by the AMA with sole authority to manage revisions to the CPT code set, expedited the code development process for the novel coronavirus test. Development, review and approval of the new CPT code involved broad input from practicing physicians, the Centers for Disease Control and Prevention (CDC) and other experts.
The AMA continues to invest in resources that keep physicians informed of the CDC’s guidance and updates, including the recent launch of the AMA’s Physician’s Guide to COVID-19, a quick-start reference to help physicians and their practices prepare for the pandemic. This is an expanded, downloadable and shareable version of resources available on the AMA’s COVID-19 resource center for physicians. Additionally, the AMA’s JAMA Network™ has a comprehensive overview of the novel coronavirus—including epidemiology, infection control and prevention recommendations—available on its JN Learning website.