The financial implications of the COVID-19 pandemic are generally considered to be secondary to the health crisis, but there’s more overlap between them than you might think. A viewpoint published in the Journal of the American Medical Association cites the challenge of running a financially solvent hospital in the face of staffing shortages, overwhelming demand, and a pause in the outpatient and elective procedures that often make up the bulk of a hospital’s revenue.
While the situation looked dire when the article was published in May 2020, the health crisis across most of the country has only intensified. For health systems themselves to survive the pandemic, they’ll need to take a hard look at revenue cycle management best practices and implement new efficiencies whenever possible.
A proven way to inject much-needed efficiency is to rely on technologies such as artificial intelligence to automate tedious manual processes and improve the speed and accuracy of humans as they perform complicated tasks. One of those complex areas is clinical documentation.
Clinical documentation has always been a bit of a black box, with every provider documenting patients’ clinical issues differently and using shorthand that only they understand. This information is critically important, but it’s all stored in the form of unstructured data, and 56% of healthcare professionals believe it’s obstructing clinical workflow optimization.
Now that almost all clinical documentation lives in an electronic health record, the goal of standardization is pushing facilities to evaluate the documentation that accompanies each encounter. Payers are adding to the pressure, denying reimbursement to providers that fail to adequately prove the necessity of services. New payment models that incorporate risk scoring have also made it critical for providers to document underlying issues during visits, creating an additional layer of complexity — and an additional opportunity for solutions that can facilitate the process.
In January 2015, the Department of Health and Human Services set a goal to tie 50 percent of the Medicare payments to value or quality by 2018. This transition has put physicians on the frontlines of healthcare, as they play a major role in the value-based roadmap of an organization.
However, on the downside, this shift is causing substantial physician burnout — PCPs are spending more than 50 percent of their workday in the EHR doing documentation, order entry, billing, and coding, instead of spending time with their patients. There is a need to reduce physician’s IT usage by giving them easy and quick access to actionable information such as care-, and coding- gaps, thereby allowing physicians to focus on things that matter most – delivery and improvement of care.
Regardless of how many patients physicians see per day, they have to put in an equal, if not more number of hours in front of the EHRs for logging in every single detail. Physicians are likely very interested in quality care and making the care processes efficient; it is important to understand the implications that would be created on their reimbursements with a solution that mitigates IT usage burnout. Physicians should automatically be updated instead of having to inquire about information they need at any given moment as it might be disengaging. It is possible to engage physicians so that they can take forward the quality improvement efforts.
Alternative Physician engagement methodologies and their adoption
Making improvements to the healthcare system are the top of the agenda but how does the current scenario of physician engagement compare to this? Addressing the problem of physician burnout, several methods for engaging physicians have surfaced over the past few years:
Print / Fax PVP
Push data back in EMR
Medium in young physicians
Low in older physicians
Another Web Portal
All of these methods are sub-optimal – either they are labor-intensive, or costly to implement, or require physicians to leave the EHR and go to another portal, thus decreasing the physician adoption rates. It is critical to engage physicians in a timely and effective manner to bring information transparency across the network and allow for prompt identification of low-quality care outcomes and unnecessarily high-cost events.
The solution: Engaging physicians with point of support for smarter and holistic care
Addressing above limitations, there is a dire need for a smart point-of-care support for physicians that is automated, easy to implement, and user-friendly. A support system that operates right besides EHR, pinpoints and surfaces only relevant insights, including care gaps and risk factors, which will help physicians right at the point of care without being overloaded with too much information.
Providing precise insights
Physicians require a solution that pops up just the precise insights like care gaps and risk factors to assist them in working with the patient within the EHR at the point of care. Moreover, creating a holistic picture of patients remains highly essential for physicians, however, it is still a challenge because of siloed data storage platforms in healthcare. This lack of a 360-degree view for every patient is a major barrier to collaborative and coordinated care efforts. These challenges can be addressed by integrating various patient-specific datasets, including clinical and claims and surfacing key insights on the physician’s screen in nearly real-time.
Personalizing patient interactions
Almost 80 percent of healthcare data is unstructured, and thus, to create impact at scale, physicians need pioneering analytic capabilities. For example, if a patient has visited the ED three times in the past two months, he needs to be tagged as a ‘frequent ED visitor.’ Giving physicians access to this information will guide them to revisit and optimize their care-programs for this patient such that the patient’s ED visits go down, which would further translate into decreased overall spend for the network.
In this series, we are featuring some of the thousands of vendors who will be participating in the HIMSS15 conference and trade show. Through it, we hope to offer readers a closer look at some of the solution providers who will either be in attendance – with a booth showcasing and displaying key products and offerings – or that will have a presence of some kind at the show – key executives in attendance or presenting, for example.
Hopefully this series will give you a bit more useful information about the companies that help make this event, and the industry as a whole, so exciting.
Wolters Kluwer’s Clinical Solutions provides integrated and comprehensive solutions in clinical decision support, drug information, patient surveillance, disease management and intuitive documentation, terminology and coding solutions at the point of care. Serving more than 150 countries worldwide, clinicians rely on Wolters Kluwer’s market leading information-enabled tools and software solutions throughout their professional careers from training to research to practice. Our offerings bridge multiple care settings, including hospitals, health systems, ambulatory surgery centers, physicians’ offices and retail pharmacies, and are integrated via common processes, systems and highly motivated and experienced people.
Market Opportunity & Problems Solved
Physicians struggle with the growing amount of data pouring into clinical systems and must often act upon more information than any one person can handle. In addition to EHRs, clinicians must make sense of information from multiple, disparate systems, including labs, pharmacies and others. The first solution to emerge from Wolters Kluwer’s Innovation Lab is POC Advisor, a comprehensive platform that aggregates, normalizes and codes patient data and runs it against clinical scenarios to deliver actionable, evidence-based advice at the point of care. The first application of POC Advisor aims to reduce the mortality and morbidity of sepsis (septicemia), a disease which claims an estimated 750,000 lives in the U.S. alone and costs hospitals $20 billion annually, making it the most expensive condition in the country.
A significant contributor to the negative outcomes involving sepsis – often the result of delayed or improper diagnosis that can rapidly lead to a cascade of events culminating in organ failure and death – is the siloing of crucial data in disparate clinical information systems. The inability of physicians to access and process the entirety of a patient’s data, forces them to make critical decision based on fragmented evidence. By utilizing a patient’s complete information, POC Advisor alerts care provides to potentially septic patients allowing clinicians to begin treatment long before the condition becomes life threatening.
In addition to the Sepsis Module, the Innovation Lab has already started work on applying POC Advisor to MEWS (Modified Early Warning Score) and future applications are expected to include heart disease, pneumonia, diabetes, CLABSI (central line associated bloodstream infection) and CAUTI (catheter associated urinary tract infection). Leveraging health IT to disseminate patient-specific, actionable, clinical knowledge across the care continuum results in a higher quality of treatment and more complete care. Ultimately, POC Advisor exemplifies Wolters Kluwer Health’s goal of providing an integrated suite of services designed to improve triple aim initiatives.