By Abhinav Shashank, CEO and co-founder, Innovaccer.
Children have entirely distinctive needs as compared to adults. Care is delivered to them in a manner entirely different than adults by care teams that hardly ever double-up as providers for the elderly.
fact, we hear numerous stories of organizations that transformed their care
delivery by fabricating children-specific strategies and have been really
successful in doing so. However, very few experts ever discuss how little
thought we put when it comes to developing healthcare technologies tailored to the
specific needs of pediatric organizations.
Do pediatric organizations have the
technology to succeed?
2017, more than 95 percent of hospitals had certified EHR technology. However,
these EHRs are heavily adult care centric and may not include measures that are
specific to pediatric populations. In fact, in a recent research piece
conducted on 9,000 pediatric patient safety reports, it was found that about 36 percent of reports were related to EHR
usability has been one of the underrated issues that we need to address if we
are to build an efficient pediatric landscape. This can be attributed to the
fact that even a slight misjudgment in comprehending the information stored in
EHRs can substantially increase the chances of errors and adverse events. The
issue is all lot serious for pediatric organizations where patients are
extremely sensitive to the care provided to them at any given point of time.
Complicated EHRs can do no good to neither children nor pediatricians.
Why is the EHR usability valid ask for
born prematurely have different needs as compared to completely healthy
infants. A 5-year old kid faces problems that a 13-year old teenager does not.
Vaccination once missed can prove costly in the future. A child with Type 1
diabetes may require care plans entirely dissimilar to other children.
Theoretically and practically, each child is unique: from a prematurely-born
child weighing less than a kilogram to an obese 105 kg 14-year-old. The EHR
should be able to ingest all such details with perfection and should provide as
many measures that pediatricians may require.
twin siblings born on the same day, having an identical vaccination cycle, and
same last name. However, they may react differently to various treatments and
have different weight or gender. If they need some medication, they might be
given different mg/dose prescription. Amidst all this, the care teams have the
onus of ensuring that each exercise is taken care of with utmost precision. For
that, they need powerful EHR systems and alert systems, among other things. In
other words, organizations need advanced decision support systems, an ask that
is only valid to deliver value-focused care.
Doctors need reliable EHRs to understand
the complete picture
often than not, there are only two sources of information during any given care
episode — data stored in the EHR and patient’s own words. However,
pediatricians cannot expect much support from their young and very young
patients. For infants, it gets all lot difficult since it gets even harder to
comprehend their symptoms.
such patients, EHRs need to tell the complete picture each time lest errors are
bound to happen. Goes without saying, children are more vulnerable to such
errors as compared to any other patient population. Ideally, pediatric
organizations need to have extremely robust, agile, and accurate EHR systems.
However, the situation is far from ideal even at this age and time.
Pediatric organizations need custom-made
EHRs and IT infrastructure
begin with, EHRs should have an extremely user-friendly interface, support for
adding or converting charts locally for specific syndromes, extremely precise
dosage range, and capabilities to identify missed or pending vaccination. They
should strictly have a pediatric-specific threshold for each symptom,
treatment, or trait, while also having a feature for identifying copied and
newly-added records. Alerts, as discussed earlier, for potentially wrong data
entry should also be a default feature.
with a layer of advanced analytics system on top of their EHRs, pediatricians
can successfully navigate the challenges as they come their way. If pediatric
organizations have a system in place to send regular immunization and wellness
visit reminders, they can both increase adherence rates and reduce potential
access to sensitive patient information and automatic triggers for varying
health trends can further play a substantial role in making care more efficient
for the young. All such steps combined can help us in realizing the dream of
creating the “Internet of Healthcare,” where every stakeholder is connected
with each other and there is a seamless exchange of information at all places
The road ahead
we embark upon the journey of creating an “Internet of Healthcare” where
everyone would be connected with everyone, we first need to have quality IT
infrastructure that can make this possible. EHRs are the building block for
such a system. It’s time we add the human touch to such technological
solutions, and take the first step in the direction of reinventing EHRS.
By Susan DeCathelineau, vice president of global healthcare sales and services, Hyland Healthcare.
Healthcare interoperability continues to be a critical topic facing healthcare technology leaders. There’s no question that achieving true healthcare interoperability is key to moving the industry forward by enabling the type of information exchange that can streamline workflows, inform clinical decision making and enable precision medicine.
However, much of the current interoperability discussion is focused on ensuring core systems, i.e. Electronic Medical Records (EMRs) are compatible with one another. Yet there is one issue that is largely overlooked: the crucial role of integrating structured data with unstructured patient information.
For example, EMRs are designed to capture and manage structured patient data, and they do that job well. That is to say, they capture content using controlled vocabulary rather than narrative text. But the lack of structured data and standardization in the healthcare industry today creates major issues when sharing EMR content within and across healthcare organizations.
EMRs are not built to natively ingest the plethora of unstructured information that exists on a patient. This unstructured content includes things like diagnostic medical images, clinical documents and notes, visible light images and more. According to many industry estimates, as much as 75 percent of the information that exists on a patient lives outside of core applications like EHRs. Instead, this unstructured content is scattered in a multitude of legacy data silos.
Manage your unstructured clinical content
A recent whitepaper by Signify Research illustrates just how pervasive ineffective management of unstructured content is in today’s health systems, and just how vital this effort is to interoperability initiatives. In the paper, author Steve Holloway explains how the growth of healthcare networks resulting from merger and consolidation activity is driving the need for true interoperability. These ever-larger healthcare enterprises are increasing demand for incoming and outgoing information exchange between a diverse ecosystem of providers, patients and payers.
He continues to say that EMRs and health information exchanges have had “limited success in addressing the myriad of nuanced applications and unstructured content outside of core administrative patient records and financial billing processes.”
Holloway proposes that support for multi-disciplinary care and robust, multi-node interoperability will never be achieved without a more holistic approach to integrating structured and unstructured data.
Make the connection, see your whole patient
Providing a “holistic approach” to integrating structured and unstructured healthcare content is a core focus at Hyland Healthcare. Experience has shown that providing a suite of connected healthcare solutions allows healthcare providers to harness the unstructured content in every corner of their enterprise — whether it be a diagnostic medical image, clinical document, video file or audio recording — and link it to the core clinical or business applications they use every day. Addressing unstructured content needs is made possible by combining both a full suite of content services and enterprise imaging tools.
In short, healthcare providers – and by extension the entire healthcare enterprise – work best when it is possible to see your whole patient. By enhancing the EHR or other core clinical application with unstructured content that currently resides in disparate data silos, provider organizations can complete the patient picture. This delivers a truly comprehensive medical information repository at the fingertips of key healthcare stakeholders.
As the addiction epidemic continues to plague even the smallest of communities throughout the country, substance abuse treatment specialists from coast to coast have embarked on a unified effort to raise the tide to improve the continuum of care for individuals struggling to break the cycle.
The national interoperability committee has been making strides over the last year to ensure that regardless of a patient’s unique individual treatment history, care providers are able to efficiently receive seamless access to the complete detailed medical records necessary to begin helping create lasting and effective care.
The committee effort is spearheaded by ZenCharts co-founder Dan Callahan, a 36-year veteran of the behavioral health care industry.
“It’s not uncommon for a patient to go through rehab five or more times — I’ve seen some with over 20 — and communicating information from each of those episodes can be where things start to fall apart,” Callahan said. “Clinicians need the tools to help make the right decisions. If they have all the data, they can see what the patient went through — what was the length of detox? What things were tried, how were they tried and were they were successful?”
With the fragmentation of EHR systems across the country, and privacy laws, sharing medical records can be a significant hangup. When that happens, it puts the burden on the patient to bring a new provider up to speed.
“We’re making changes in the industry as a whole, and helping push the boundaries for how we can help these people,” Callahan said. “We need to help clinicians meet and work with patients where they currently are, and know more accurately where they’ve been.”
By Gevik Nalbandian, vice president of software development, NextGate
If you wanted a clear snapshot of the progress we’ve made—or rather, haven’t made—in patient data sharing and exchange, look no further than a new report from the American Hospital Association (AHA) and six other national hospital associations—America’s Essential Hospitals, Association of American Medical Colleges, Catholic Health Association of the United States, Children’s Hospital Association, Federation of American Hospitals and the National Association for Behavioral Healthcare.
Urging all stakeholders to “unite in accelerating interoperability,” the report, released January 22, is a grass roots effort to get hospitals, EHR vendors, consumers, health information exchanges (HIEs), government and medical device companies to come to the table, play their respective roles, and make full interoperability a reality.
The benefits of interoperability are obvious: better care coordination, improved patient safety and care quality, reduced costs, increased efficiencies and the conduit to population health. Interoperability is also increasingly a legal requirement and prerequisite for reimbursement.
So why has healthcare’s goal of industry-wide interoperability remained so elusive?
Errors in prescription can happen for various reasons, like pharmacists’ incompetence, miscommunication between clinicians or doctor’s bad handwriting. Among medication errors, prescription inaccuracy is one of the major causes of concern for healthcare professionals. Today’s most effective technological solution is to implement an electronic prescribing system. With the help of e-prescribing software, prescription errors can be prevented in 80 percent of cases. It is also an actual solution for the opioid epidemic that puts Americans’ lives at risk.
The results, indeed, are impressive. But at the same time, eRx systems are considered inconvenient and costly for small practices. We’ve tried to explore e-prescribing market and identify the main problems of widespread system adoption.
Hitchhiker’s guide to eRx
Electronic prescribing (eRx) is a system that enables healthcare providers to generate digital prescriptions and send them to pharmacies directly from the point of care. e-Prescribing, in fact, improves accuracy, enhances patient safety and quality of care since there is no handwriting.
Systems integrated with EHRs, which include comprehensive patient data.
Stand-alone systems, which means that they can be used only for e-prescribing.
Some eRx systems offer advanced features that allow healthcare providers to access generic medication alternatives, insurance benefit info, and patient medication lists and histories. These extra features have the potential to improve physicians’ decision-making capabilities and increase the use of e-prescribing systems.
E-prescribing market analysis
A prospective EHR vendor has to comply with the regulatory requirements of their customers and know how to develop e-prescribing software. But is investing in eRx worth it?
According to the recent Transparency Market Research, the global market for e-prescribing is expected to reach a CAGR (Compound Annual Growth Rate) of 23.5 percent from 2013 to 2019. Persistent Market Research estimated that the market will reach $887.8 million in 2019.
While Europe holds the largest share in e-prescribing market, the US turned out to be the fastest-growing region. Indeed, increasing adoption of healthcare management software and extensive use of health IT for patient engagement are the key factors in industry growth. Furthermore, electronic prescribing is a requirement for healthcare providers aiming at achieving meaningful use under the Medicare and Medicaid EHR Incentive Programs.
What do prospective vendors need to begin with electronic prescribing?
Major players on e-prescribing market: Cerner Corporation, DrFirst, HealthFusion, Surescripts, Allscripts Healthcare Solutions Inc., Aprima Medical Software, eClinicalWorks, athenahealth Inc. and Relayhealth Corporation.
To show what usability results you can expect, we have chosen the case of Surescript as an “open-source” company. Surescript is a VA-based operator of a nationwide electronic network for prescription-related data and information. Its platform connects EHRs, pharmacy benefit managers (PBMs), pharmacies and clinicians, plus health plans, long-term and post-acute care organizations.
Their 2017 National Progress report shows that 13.7 billion secure health transactions took place via the Surescripts network including 1.74 billio e-prescriptions. This is a 26 percent increase from 2016. This improvement was owing to five key elements: Drug Description, Representative National Drug Code (NDC), RxNorm, Structured and Codified Sig and Potency Unit Code.
Moreover, the network connected 1.47 million healthcare professionals — 13 percent more than in 2016 — with secure patient data for 233 million Americans, or 71 percent of the population.
Various government initiatives which focus on reducing medical errors, and the need to cut escalating healthcare costs foster the growth of the eRx market. The increasing cooperation between software vendors and network providers and the vast untapped regions are expected to provide significant development opportunities for industry players.
Included amongst the segments of healthcare such as post-acute care that until recently had been mostly overlooked, specialty pharmacy now is in the spotlight as a key area of healthcare utilization and spend in the U.S. Critical, expensive and often life-sustaining medications for high complexity disease states, as well as care management programs that help patients through their healthcare journey, are at the core, driving nearly $175 billion in drug spend for the 2 percent to 3 percent of the U.S. population considered medically complex. Specialty pharmacy operations typically involve a cross-functional staff of insurance experts, patient care coordinators, nurses and pharmacists that interact with patients and stakeholders to ensure therapeutic success in a historically fragmented, manual process-driven model.
Challenges in specialty pharmacy operations
As with many aspects of the healthcare system, specialty pharmacy operations are fraught with many pragmatic, economic, and clinical care challenges.
Operational, pragmatic challenges include:
Multiple fax and phone communications between prescriber and specialty pharmacy supporting referrals, prescriptions, authorizations and patient care coordination
Challenging and fragmented patient engagement combining traditional phone-based communication with other methods such as texting with mixed results
Overlapping prescriber and patient communications among health plan, pharmaceutical manufacturer patient service hubs, prescribers and specialty pharmacy
These process challenges are creating an economic strain for the pharmaceutical industry, the payer, the provider, and most importantly the patient – where insurance benefit and funding source determinations often create confusion between overall coverage and patient out-of-pocket costs. This is compounded by complex coordination of benefits, billing and payment processing of medical and pharmacy claims, as well as other sponsored funding sources. Increasing patient cost share can make specialty drugs unaffordable for many patients which impacts medication adherence and ultimately patient outcomes.
The resulting clinical challenges make it difficult for critical patient care information to be easily shared (e.g. labs, patient assessments, medication profiles, side-effects, etc.). Additionally, treatment objectives often overlap among specialty pharmacy channel providers, resulting in crossed communications and patient confusion. In the end, key success metrics (both economic and clinical) are not easily measured, and often not operationally and clinically aligned.
The power of data accessibility and real-time analytics
Compressed specialty pharmacy margins require significant technology investment to offset operating costs and increasing service expectations. Technological advances help to address several of these challenges and as a result drive improvement in patient care and satisfaction, lower operating costs and more informed clinical decision-making.
Several of these technological advances that are showing early evidence of changing the historical paradigm include:
Interoperability with EHRs and other critical patient history data sources providing access to holistic views of patient medical records which can improve patient engagement, therapeutic interventions and reduce unnecessary procedures
Sophisticated workflow software driven by data-informed electronic protocols to support overall multi-party process efficiencies
Robust and timely analytics that provide comparative and predictive insights that influence optimal patient care at the lowest cost as well as provide more timely, accurate patient insights that drive patient success, including medication adherence
Integrated patient engagement technologies that improve patient interactions when and how the patient wishes to engage
Impact across the continuum
The application of advanced capabilities in connectivity and analytics in the specialty pharmacy space creates a more efficient system and a better result for all involved. Successful implementation of these technologies accelerates patients onto the most appropriate therapy, optimizes patient treatment plans and improves the overall patient experience which support medication adherence goals. It can also help establish innovative and more productive relationships between health plans, employers, providers, specialty pharmacies, pharmaceutical manufacturers and patients.
By Zachary Blunt, manager of product management population health, Greenway Health
Electronic health records (EHRs) were expected to revolutionize healthcare practices, making them more efficient, reducing costs and enabling them to provide more coordinated care.
But ask healthcare providers about the EHRs they’ve deployed, and the results are far from what was expected.
In fact, more than 60 percent of healthcare professionals rank their return on investment (ROI) for EHR systems as “terrible” or “poor,” according to a recent survey from Health Catalyst. Another study, published in the Journal of the American Medical Association, estimated the costs of billing and insurance-related activities using EHRs ranged from $20 for each primary care visit to $215 for inpatient surgery, totaling 3 percent to 25 percent of professional revenue.
So, why aren’t EHRs living up to the hype and delivering the promised investment? In many cases, it has to do with these systems not being used to their highest potential.
Here’s a look at five steps healthcare practices can take to address challenges resulting from EHR implementation and maximize their ROI.
Get Buy-In Across the Board — from IT to Finance to Front Office Staff
Adopting EHRs to manage clinical activities impacts many revenue cycle-related functions, such as patient registration, insurance eligibility, scheduling and the services/treatments a patient received during each clinical encounter. To achieve ROI, EHRs must be able to improve several operations of a practice and streamline the workflows of different departments. It’s best practice for all clinicians and staff to weigh in before installing new systems or technologies.
Provide Strong Leadership, Communication and Training
Changes in common practices during EHR implementation can result in significant resistance from users or a longer learning curve that hampers efficiency and adds to the cost of the system. To achieve results, healthcare leaders should clearly articulate the EHR implementation plan, prepare themselves for a transition period and develop a training protocol so all users understand their roles in using the system. In addition, users should have a solid background and understanding on how their roles factor into the overall success of the system and the practice at large.
Improve Staffing Efficiency While Improving Operating Margins
Labor costs can account for nearly half of a healthcare provider’s operating costs. But providers often fail to take a strategic look at how adjusting staffing can improve the bottom line. Often, providers use historical averages to determine staffing levels at their practices, resulting in an outlay of overtime pay outside the planned budget when unexpected staffing demands occur. Data from EHR solutions, as well as enterprise resource planning (ERP) sources, can be analyzed to gain a better understanding of historical staffing trends. Accenture estimates that by getting insights from EHR and ERP data, U.S. healthcare providers could save more than $77 billion over the next five years by reducing overtime and overall labor costs.
With the increasingly “on the go” nature of technology and communication, information is accessible from the palm of a user’s hand in the form of mobile devices. Subsequently, the success of modern EHR software lies in the moment accessibility on mobile devices like smartphones and tablets.
The addition of mobile functionality for EHR systems is driving the adoption of electronic health record systems and software in the industry and contributing to meaningful use for patients and physicians alike. Patients benefit from doctors and staff who can make informed decisions by easily accessing their medical records from an easy-to-use mobile interface. Mobile EHRs allow practice staff and physicians to access valuable and crucial patient records, while increasing communication between healthcare facilities in a more efficient, secure manner.
This is incredibly useful in critical care or emergency situations; allowing physicians and other care staff to quickly, securely and accurately view patient information on the fly is a major advantage when emergency surgery or care has to be administered. With the continued scourge of the opioid epidemic requiring investments in patient and physician safety and with continued staffing shortages in the industry leading to further implementation of AI and technology based solutions, mobile EHR will be a critical tool in a healthcare staff’s arsenal, allowing the relaying and accessing of accurate information in a constantly evolving environment.
In addition, the internet, office tools and desktop computers are no longer necessary for effective documentation; mobile EHR allows offline record populating whenever and wherever it’s necessary, increasing the accuracy and timeliness of documentation. By allowing physicians and staff to accurately and conveniently exchange documentation and patient records through a secure, mobile platform, informed decisions can be made 24/7. This drives meaningful use by improving quality, safety, efficiency and care coordination for public health.
By utilizing EHR on mobile platforms, staff and physicians can increase their efficacy and accuracy when updating documentation or accessing patient files. By creating a friendly, innovative platform to access crucial information, EHR software that features mobile functionality is a necessity in modern EHR applications. It will continue to drive meaningful use and accessibility in the healthcare industry going forward as evidenced by the infographic featured below.
Federal healthcare organizations, such as CMS, have spent billions of dollars over the years trying to bridge the gap between medical data and quality patient care with interoperability requirements and data integration, the mesh used to try and bridge the gap. Many government rules have been written to address the type of mesh needed and many EHR companies have claimed to meet these government requirements and claim the throne of the ultimate mesh maker.
However, hospitals and clinics found the mesh contained many holes, such as enabling hospitals to customize EHRs, but only if the EHR customers purchased the EHR systems for the manufacturers for millions of dollars that hospitals could ill afford. Also issues such as proprietary connectivity to their own brands that left the hospitals’ other EHR systems to serve as dead-end data silos. Rules and solutions came and went, but few had any teeth until now.
Anyone for A Slice Of PI?
To end the lack of interoperability morass and data duplication, the Department of Health and Human Services (HHS) issued 1,883 pages of proposed changes to Medicare and Medicaid. The changes rename the Merit-Based Incentive Payment System (MIPS) Advancing Care Information performance category to Promoting Interoperability (PI).
CMS announced the change as part of a proposed rule that will transform the EHR Incentive Programs commonly known as meaningful use under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed policies are part of the MyHealthEData initiative, which prioritizes patient health data access and interoperability improvements.
But this time the name change wasn’t just that. For the first time a new CMS rule specifically requires providers to share data to participate in the life blood of hospital reimbursement—Medicare and Medicaid. The rule also floats the idea of revising Medicare and Medicaid co-pays to require hospitals to share patient records electronically with other hospitals, community providers and patients — a clear-cut demand for interoperability.
PI also reduces hospital interoperability requirements from 16 to six, revamping the program to a points-based scoring system and is requiring that hospitals make patients’ EHRs available to them on the day they leave the hospital beginning in 2019.
Does Your EHR Have the Right Stuff?
While this news from CMS appears to be a step in the right direction to solve a problem that has plagued the healthcare industry for many years, it must first be made a reality by those ultimately responsible for its implementation—hospital HIT organizations. The days of data obstruction and silo logic must end with a focus on new EHR markets built on interoperability.
Interoperability requires multiple layers to demonstrate an EHR system can be accessed. Meanwhile, every EHR system claims to support some form of interoperability, ranging from web interfaces to API protocols or to the lowest and highest cost HL7. However, healthcare systems will have to demonstrate their operability to CMS to abide by PI and therefore allow access of their EHR systems. Hospitals and clinics can encounter many challenges with this, such as HIPAA compliance and support for their infrastructure for open secure access, requiring an HIE and the funds to support data synchronization and IT support.
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.