Guest post by Nora Lissy, RN, BSN, MBA, director of healthcare information, Dimensional Insight.
It’s no surprise that chronic diseases are killing the United States both physically and financially. According to the Centers for Disease Control and Prevention (CDC), seven of the top 10 causes of death in 2010 were from chronic diseases, where two of the conditions—heart disease and cancer—together accounted for nearly 48 percent of all deaths. To add to the problem – effectively treating these conditions comes with an exceedingly high price tag. According to U.S. News & World Report, 86 percent of all healthcare spending is currently going towards the treatment of these chronic diseases, equating to more than $3 trillion annually.
So how can the healthcare industry combat the rise of chronic conditions while keeping escalating treatment costs down?
One of the most effective tools for monitoring chronic disease management while still keeping an eye on care costs is business intelligence. Business intelligence has continued to increase in prevalence within the healthcare industry in recent years. According to a HIMSS Analytics study, 41 percent of hospital respondents reported they currently use clinical and business intelligence tools for their analytics, with that number expected to continue to increase over the next two years. With business intelligence continuing to prove its value within healthcare, physicians are starting to see the true potential of this data-driven tool to positively impact the industry as whole, including with the management and overall cost of chronic diseases.
Below are three ways that business intelligence can help to improve chronic disease management and lower the rising costs of care.
With the yearly bluster and promise of HIMSS, I still find there have been few strides in solving interoperability. Many speakers will extol the next big thing in healthcare system connectivity and large EHR vendors will swear their size fits all and with the wave of video demo, interoperability is declared cured. Long live proprietary solutions, down with system integration and collaboration. Healthcare IT, reborn into the latest vendor initiative, costing billions of dollars and who knows how many thousands of lives.
Physicians’ satisfaction with electronic health record (EHR) systems has declined by nearly 30 percentage points over the last five years, according to a 2015 survey of 940 physicians conducted by the American Medical Association (AMA) and American EHR Partners. The survey found 34 percent of respondents said they were satisfied or very satisfied with their EHR systems, compared with 61 percent of respondents in a similar survey conducted five years ago.
Specifically, the survey found:
42 percent of respondents described their EHR system’s ability to improve efficiency as difficult or very difficult;
43 percent of respondents said they were still addressing productivity challenges related to their EHR system;
54 percent of respondents said their EHR system increased total operating costs; and
72 percent of respondents described their EHR system’s ability to decrease workload as difficult or very difficult.
Whether in the presidential election campaign or at HIMSS, outside of the convention center hype, our abilities are confined by real world facts. Widespread implementation of EHRs have been driven by physician and hospital incentives from the HITECH Act with the laudable goals of improving quality, reducing costs, and engaging patients in their healthcare decisions. All of these goals are dependent on readily available access to patient information.
Whether the access is required by a health professional or a computers’ algorithm generating alerts concerning data, potential adverse events, medication interactions or routine health screenings, healthcare systems have been designed to connect various health data stores. The design and connection of various databases can become the limiting factor for patient safety, efficiency and user experiences in EHR systems.
Healthcare, and the increasing amount of data being collected to manage the individual, as well as patient populations, is a complex and evolving specialty of medicine. The health information systems used to manage the flow of patient data adds additional complexity with no one system or implementation being the single best solution for any given physician or hospital. Even within the same EHR, implementation decisions impact how healthcare professional workflow and care delivery are restructured to meet the constraints and demands of these data systems.
Physicians and nurses have long uncovered the limitations and barriers EHRs have brought to the trenches of clinical care. Cumbersome interfaces, limited choices for data entry and implementation decisions have increased clinical workloads and added numerous additional warnings which can lead to alert fatigue. Concerns have also been raised for patient safety when critical patient information cannot be located in a timely fashion.
Solving these challenges and developing expansive solutions to improve healthcare delivery, quality and efficiency depends on accessing and connecting data that resides in numerous, often disconnected health data systems located within a single office or spanning across geographically distributed care locations including patients’ homes. With changes in reimbursement from a pay for procedure to a pay for performance model, an understanding of technical solutions and their implementation impacts quality, finances, engagement and patient satisfaction.
As president and COO of a leading electronic health record (EHR) and practice management (PM) provider, part of my job is to be in constant communication with providers about health IT. They tell me and my team what works for them and what doesn’t work; what brings joy to their practice and what keeps them up at night. All this insight helps polish my crystal ball, making it clear what we can expect to see in 2016:
EHR system will pivot from regulatory compliance to physician productivity. EHRs are generally blamed for fueling the professional dissatisfaction of physician. A few software vendors are looking at the problem-oriented medical record (POMR), a more intuitive approach that works similarly to the way a doctor thinks. It organizes clinical records and practice workflows around specific patient problems, making it faster and more satisfying for physicians to use.
The problem list not only delivers a “table of contents” to clinically relevant issues, but also gives a provider a longitudinal view of a patient’s healthcare over time. This intuitive method of information organization makes it easier for provider and patient to set the agenda at the start of the exam. During the exam, the POMR supports the nonlinear nature of a patient encounter.
The POMR also helps reduce cognitive overload, which can lead to medical mistakes such as misdiagnosis and other potentially life-threatening errors. Providers can see “bits” of data like lab results associated with a specific problem, thus easing the number of mental connections required to make sound medical decisions.
Chronic care management (CCM) will grow quickly because it makes sense for both patients and providers. Our healthcare system is changing to address the needs of an aging population with chronic illnesses like hypertension, diabetes, heart disease, and more. To promote the effective care coordination and management of patients with multiple chronic illnesses, the Centers for Medicare and Medicaid Services (CMS) introduced CPT code 99490. This code reimburses providers for remote, inter-visit outreach, such as telephone conversations, medication reconciliation, and coordination among caregivers.
The reimbursement for CCM services is an average of $42 per month for Medicare beneficiaries. New levels of technology integration will enable clinicians to complete CCM reporting of remote care from inside their EHR system.