By Donald Voltz,MD, Aultman Hospital, department of anesthesiology, medical director of the main operating room, assistant professor of anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Dr. Donald Voltz
In his HIMSS keynote address, Alphabet’s former executive chairman and now current technical advisor Eric Schmidt warned attendees that the “future of healthcare lies in the need for killer apps.” But he also cautioned that the transition to a better digitally connected health future isn’t just one killer app, but a system of apps working together in the cloud. He also advocated transforming the massive amount of data held in EHRs into information and knowledge.
Schmidt is correct in his assessments. There is a need for interoperable “killer apps” for new health IT priorities and procedures. The apps need to deliver better patient outcomes by integrating and optimizing patient data while driving healthcare facility financial incentives such identifying cost savings and streamlining insurer payments. These types of needs are accelerating convergence in the health care sector for interoperability across clinical, financial, and operational systems, not simply EHR connectivity.
One of the cloud “killer apps” that is a strategic component of convergence and hospital growth are Annual Wellness Visits (AWVs). First introduced by private insurers and then by CMS in 2011 as part of its preventative care initiative under the Affordable Care Act (ACA), AWV’s are designed specifically to address health risks and encourage evidence-based preventive care in aging adults.
The typical visit requires a doctor or other clinician to run through a list of tasks like screening for dementia and depression, discussing care preferences at the end of life, asking patients if they can cook and clean independently and are otherwise safe at home. Little is required in the way of a physical exam beyond checking vision, weight, and blood pressure.
On its own merit, some could argue that while this app can greatly contribute to better patient care, it does not significantly impact hospital and clinic growth, but when integrated with other apps, it becomes a key healthcare growth catalyst with its treasure trove of patient data. That data, when streamlined, can enable expedited payments to government and private insurers, help lay the foundation for AI and other knowledge initiatives as cited by Schmidt.
Chronic Care Continuum App
Another “killer app” is the care continuum integration of treatment for chronic diseases ranging from diabetes to dementia and behavioral and mental health issues such as the U.S. opioid epidemic, heroin addiction, alcoholism and suicide. The ECRI Institute released its “Top 10 Patient Safety Concerns for Healthcare Organizations” in March 2018 and cited the management of behavioral health needs in acute care settings as the 6th highest ranked safety concern.
“Organizations should consider working with other partners, such as psychiatrists, behavioral health treatment programs, clinics, medical schools and teaching programs, and law enforcement,” says Nancy Napolitano, patient safety analyst and consultant, ECRI Institute. “Being able to communicate remotely and seamlessly, assessing risk and complexity, as well as delivering high-quality connected care are critical. Relationships and partnerships are what get you what you need.”
By Donald Voltz,MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Donald Voltz, MD
Healthcare is evolving quickly and HIMSS 18 offers a broad range of healthcare issues to explore. New requirements for implementing HIT systems have changed dramatically in the last few years as new health IT priorities and procedures have emerged. Convergence in the health care sector has accelerated the need for interoperability, not just for EHRs, but also across clinical, financial, and operational systems. This need is also challenging and changing one of the biggest traditions in healthcare—the doctor patient medical visit.
In the past, patients would simply make appointments to visit their physicians. Now, we have the popularity of Annual Wellness Visits (AWVs) and the growing need for chronic care treatments caused by the opioid epidemic and other behavioral health issues. This trend is causing physicians to be the ones actively pursuing patients, but with both sides reaping the benefits of this new arrangement. The new approach to the traditional doctor-patient relationship enables patients to receive better care while clinics and hospitals build up a roster of new and potentially long care patients.
Disrupting this office visit tradition are also larger, long-term HIT trends, such as the widespread implementation of electronic health records (EHR) and other healthcare practices. However, these trends spurred many challenges, but also a great deal of opportunities, many of which have yet to be fully capitalized upon. To understand these changes, we need to be cognizant of the increasing opportunities patients and physicians have in accessing and interfacing with the healthcare system.
Patients have a great deal more choices and entry points to the complex and dynamic healthcare system than they had even 10 years ago. When Medicare, Medicaid, organ transplantation and synthetic insulin were coming in vogue 50 years ago, patients had relatively limited access to healthcare. Those that did often choose to enter the system through a single physician who they had built a long-term relationship with and who served as the conductor of any labs, studies or further consultation from specialists. With the implementation of governmental and private healthcare insurance options, patients had improved access to care. Commensurate with this increased access to care, an increased national health expenditure followed.
With increased costs, healthcare responded by changing the way patients interacted with the system. Beginning in the ‘70s and continuing into the ‘80s, the rise of HMOs and capitation attempted to improve national healthcare, but this led to limitations in patients’ choice and began the concept of bundling services, cost sharing, and expansion of preventative care. Other managed care plans and a focus on utilization of care continued to decrease the cost of care.
Although many aspects of these managed care structures benefited patients, such as preventive services and prescription coverage, access to services and specific physicians were constrained as “in” and “out” of network coverage, limiting patient choices. The implementation of EHRs has established the foundation upon which opportunities are and will be found to improve healthcare quality by improving the decisions being made.
Enhanced access of patient data by authorized patients, professionals and algorithms focusing on analytics or artificial intelligence is now a requirement for enhanced patient engagement, improving professionals’ delivery of care, enhancing clinical decision making and optimizing patient outcomes while maintaining choices that are consistent with best practices, patient values and prior empirical experiences.
Evolving Relationship Drives Healthcare Revenue
While the doctor-patient relationship has evolved, hospital systems and physicians must still derive revenue which is still at the core of that relationship. The healthcare industry is now looking at revenue which can be generated through the interoperability of annual wellness visits (AWVs), chronic care and service care transitions between physical and behavioral health services. Hospitals and healthcare clinics that can connect these services with technologies such as bi-directional information flow will benefit by creating new profit centers of revenue through reimbursements by CMS and private insurers.
“Programs such as revenue cycle management are important for any healthcare institution’s bottom line, but when carriers can actually drive revenue using cloud based, bi-directional interoperability technologies that enable doctors to spend more time with patients and therefore provide superior care, then flipping the traditional patient-doctor relationship is a winning trend for the healthcare industry,” said Doug Brown, managing partner, Black Book Research.
Driving this trend are new apps and innovations that address the payment gap caused by medical billing and collections processes with outdated EHR platforms and inoperable systems. New technologies from organizations, such as Core Care Medical and others, fueled by the growth of cloud computing in the healthcare industry are improving real-time communication and data exchange. Here are some examples of how this is working which you might not hear about at HIMSS.
Hospital CEO Drives Revenue with Doctor Patient Visit Apps
A healthcare colleague, David Conejo, CEO, Rehobath McKinley Christian Healthcare Services (RMCHS) is boosting revenue right now using this doctor/patient flipping model as a strategy to help in his effort to improve behavioral healthcare for Gallup, New Mexico’s large Indian Reservation community who suffer from addiction to alcoholism and opioids.
He integrates data from the hospitals’ three clinics using a cloud application that streamlines data from AWVs and integrates it with any EHR system without data duplication. The Zoeticx ProVizion app also allows for the management of support tracking for wellness visits, provides a physical assessments guide through preventative exams, and maps out the risk factors for potential diseases for patient follow-up visits. He can then enter the relevant data about the patient.
In addition, it includes everything else that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurers billing requirements. RMCHS’ business is growing with full or near-full compliance. And with its ACO in startup mode, RMCHS is also receiving a bonus check for $80,000 from Medicare for containing costs, in addition to the new revenues being generated.
The fact that more patients can be seen is a bonus. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, but if a physician saves 10 minutes per patient, at 18 patients a day that’s an extra 180 minutes. More minutes, more patients.
Guest post by Donald Voltz,MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Donald Voltz, MD
As Halloween approaches, the usual spate of horror movies will intrigue audiences across the US, replete with slashers named Jason or Freddie running amuck in the corridors of all too easily accessible hospitals. They grab a hospital gown and the zombies fit right in. While this is just a movie you can turn off, the real horror of patient data theft can follow you.
(I know how terrible this type of crime can be. I myself have been the victim of a data theft by hackers who stole my deceased father’s medical files, running up more than $300,000 in false charges. I am still disputing on-going bills that have been accruing for the last 15 years).
Unfortunately, this horror movie scenario is similar to how data thefts often occur at medical facilities. In 2015, the healthcare industry was one of the top three hardest hit industries with serious data breaches and major attacks, along with government and manufacturers. Packed with a wealth of exploitable information such as credit card data, email addresses, Social Security numbers, employment information and medical history records, much of which will remain valid for years, if not decades and fetch a high price on the black market.
Who Are The Hackers?
It is commonly believed attacks are from outside intruders looking to steal valuable patient data and 45 percent of the hacks are external. However, “phantom” hackers are also often your colleagues, employees and business associates who are unwittingly careless in the use of passwords or lured by phishing schemes that open the door for data thieves. Not only is data stolen, but privacy violations are insidious.
The problem is not only high-tech, but also low-tech, requiring that providers across the continuum simply become smarter about data protection and privacy issues. Medical facilities are finding they must teach doctors and nurses not to click on suspicious links.
To thwart accidental and purposeful hackers, organizations should implement physical security procedures to secure network hardware and storage media through measures like maintaining a visitor log and installing security cameras. Also limiting physical access to server rooms and restricting the ability to remove devices from secure areas. Yes, humans are the weakest link.
Growing Nightmare
Medical data theft is a growing national nightmare. IDC’s Health Insights group predicts that one in three healthcare recipients will be the victim of a medical data breach in 2016. Other surveys found that in the last two years, 89 percent of healthcare organizations reported at least one data breach, with 79 percent reporting two or more breaches. The most commonly compromised data are medical records, followed by billing and insurance records. The average cost of a healthcare data breach is about $2.2 million.
At health insurer Anthem, Inc., foreign hackers stole up to 80 million records using social engineering to dig their way into the company’s network using the credentials of five tech workers. The hackers stole names, Social Security numbers and other sensitive information, but were thwarted when an Anthem computer system administrator discovered outsiders were using his own security credentials to log into the company system and to hack databases.
Investigators believe the hackers somehow compromised the tech worker’s security through a phishing scheme that tricked the employee into unknowingly revealing a password or downloading malicious software. Using this login information, they were able to access the company’s database and steal files.
Healthcare Hacks Spread Hospital Mayhem in Diabolical Ways
Not only is current patient data security an issue, but thieves can also drain the electronic economic blood from hospitals’ jugular vein—its IT systems. Hospitals increasingly rely on cloud delivery of big enterprise data from start-ups like iCare that can predict epidemics, cure disease, and avoid preventable deaths. They also add Personal Health Record apps to the system from fitness apps like FitBit and Jawbone.
Banner Health, operating 29 hospitals in Arizona, had to notify millions of individuals that their data was exposed. The breach began when hackers gained access to payment card processing systems at some of its food and beverage outlets. That apparently also opened the door to the attackers accessing a variety of healthcare-related information.
Because Banner Health says its breach began with an attack on payment systems, it differentiates from other recent hacker breaches. While payment system attacks have plagued the retail sector, they are almost unheard of by healthcare entities.
