By Mark Gross, senior principal product manager, Kofax
When it comes to data security, healthcare organizations are stuck between a rock and a hard place. To provide proper patient care, their staff needs access to the right information, and quickly. At the same time, the law requires them to protect the sensitive data included in electronic medical records (EMR).
A wide array of devices are used to collect and transmit patient data – including computers, mobile devices, IV pumps and X-ray machines. Today, all of these are connected to the internet, the hospital network and other medical technologies, even though many of them have few, or no, security protocols in place.
The situation’s made even more complex by the public nature of hospital environments. Many connected devices containing sensitive data are left unattended, leaving the entire network exposed. The result’s an increase in cyber and data security threats.
Right now, nearly all healthcare organizations are facing an added challenge brought on by the COVID-19 global pandemic. Many healthcare workers aren’t working in their normal environments, they’re helping in other departments, hospitals and even pop-up field hospitals. With all the displaced healthcare workers, their normal print and capture workflows are left behind with their devices—and the security of the patient data contained in documents printed or scanned elsewhere may be at risk.
Healthcare organizations need a comprehensive security strategy to protect against a breach. The best of these is a systematic approach that tests all connected devices for vulnerabilities. Once identified, security threats should be prioritized so the most severe can be addressed quickly. Regular software updates and patches are just as important, as is replacing outdated equipment with new devices that have security built in.
Because they don’t stand out as threats, multifunction devices, printers and imaging devices are often overlooked during security reviews. In reality, however, both of these handle a lot more data than people realize.
Like the adaption and implementation of every new and innovative technology, it takes time to get used to it. Therefore, with electronic health records, being ready for change is key.
Previously, physicians were comfortable with a paper-based system because its usage had been a norm since and before they started studying medicine. The way they had to learn and adopt to a working environment when they started practicing, they will have to do the same with innovative technologies such as EHRs, built to make their lives easier.
In the initial stages, EHR documentation is likely to be cumbersome as physicians familiarize themselves with the new system.
Cloud computing services are increasingly moving into the future in healthcare. However, the protection and security of private data are two of the main reasons why the healthcare sector is generally slow to adopt new technologies. According to market researchers at MarketsandMarkets, healthcare will invest $5.4 billion in the cloud by 2017.
The “Healthcare Cloud Computing (Clinical, EMR, SaaS, Private, Public, Hybrid) Market – Global Trends, Challenges, Opportunities & Forecasts (2012 – 2017)” analyzes and studies the major market drivers, restraints and opportunities in North America, Europe, Asia. According to the report, Market researchers estimate that last year at least 4 percent of healthcare is in the cloud. This year, this share is expected to grow to 20.5 percent.
According to Cloud Times, “Cloud computing offers significant benefits to the healthcare sector; doctor’s clinics, hospitals and clinics require quick access to computing and large storage facilities which are not provided in the traditional settings, moreover healthcare data needs to be shared across various settings and geographies which further burdens the healthcare provider and the patient causing significant delay in treatment and loss of time. Cloud caters to all these requirements thus providing the healthcare organizations an incredible opportunity to improve services to their customers, the patients, to share information more easily than ever before, and improve operational efficiency at the same time.”
Meaningful use stage 2 is moving in the direction of patient engagement. The next phase in the federal incentive program sets the bar for it, but certainly doesn’t leave it here. Certainly, patients were part of stage 1, but now, they must take greater ownership of their care; probably one of the only ways we’ll actually see the needle move in regard to long-term health outcomes changes for the population.
Engagement of the patients, it is believed, will move all patients toward better choices and possibly healthier lifestyles, which obviously makes for a healthier population.
But given all of the rhetoric on the subject, and the fact that each of us is subjective, aren’t we really talking about something rather subjective?
Let me try to put it in terms that even I can understand: everyone talks about how patients must be more engaged – at the practice level, at the provider level and even at the vendor level (which is my belief) – but when it’s actually time to involve patients in their care, how is this done?
Well, one of the most popular answers is through social media sites like Facebook and Twitter. Bringing, or participating in, conversations about healthcare and interacting with patients online is considered to be a highly effective ways of reaching a broad audience, building a healthcare community, and educating and engaging patients.
But not everyone feels social media is the silver bullet. For example, I recently spoke with IDC Health Insights’ research director, Judy Hanover, who during our conversation said she thinks the healthcare community has become too infatuated with social media. She doesn’t see it as a truly effective means for engaging patients long term.
Certainly, social media has its place in building the physician/patient relationship, but its is limiting. Except for a very few people who like and want to share their personal health records online, most of us just don’t care to go into the specifics of our conditions in such a public forum.
So, the debate returns to healthcare information technology and the patient portal.
Online portals are designed to give patients anytime access to their health information. From a provider and vendor perspective, these tools have a great deal to do with meeting stage 2. For the patients, too, I suppose.
With the requirement that provider given patients access to online health information for viewing, downloading and transferring, and a second threshold requiring providers to push patient usage of this technology, it’s obvious the portal is a powerful player in this game.
Some do worry about their ability to meet the patient engagement requirement. I can imagine practices in rural areas or those that serve an older population may have some concerns.
Relying on a patient action to secure your incentive, especially after all of the work taken to meet the remainder of the MU requirements may seem like a blow to some. It would to me since my personality is one in which I like to have control of a project and not have to worry about outliers potentially derailing my progress (this sort of thing happens all of the time in school on group projects, right?)
So, how we do avoid this and encourage patients to use the portal?
What’s probably the best summation I’ve come across on the subject is in an interview Physicians Practice’s Aubrey Westgate conducted with Peter M. Kilbridge, a senior research director with The Advisory Board Company’s Information Technology. You can listen to it here.
Kilbridge’s perspective is valuable, and the tips he provides are easily accomplishable.
For example, to encourage use of the patient portal, practices should tell patients about it, and simply encourage them to use it and to talk about its capabilities. Highlight the portal’s capabilities, he says, and what it can do for patients and how it can make their live easier.
He says to highlight functions patients care about: viewing labs, sending questions, scheduling appointments. Follow it up by sending an email and paper mail reminder during about the upcoming visits or reminder
“Early success breeds confidence,” said Peter Kilbridge.
Still, the patients are truly empowered in stage 2, and all of the work invested on the part of the healthcare community might seem like it’s trivialized by the requirement needed to secure incentives.
As we move toward an environment in which technology is more widely accepted, there’s little doubt tools that organizations like hospitals and health systems (individuals, too, for that matter) use to build their brands, educate their communities and engage patients are paying dividends.
At least for the organizations taking steps to utilize the tools.
According to a new survey by CSC (Computer Sciences Corporation) conducted in July and August, of 36 hospitals, the use of social media in the space is growing, and having some positive effects on the communities each serves.
In the survey, hospitals reported using social media to enhance their brands, create awareness and manage their reputations, as well as “to promote wellness and healthy behaviors through the dissemination of generic information for a general audience.”
CSC found that for organizations, direct engagement with individual patients remains uncommon and only one hospital reported that it uses social media in care coordination or care management, unlike some individual caregivers who actually use the tools to engage patient populations with generic care instruction or knowledge transfer.
Healthcare organizations, like all of us using social media, want to attract a large audience to our message and products. However, using social media for improved patient outcomes were not a popular objective according to the survey as less than 25 percent of organizations listing it as a primary objective.
Only a couple hospitals survey said they did not use social media at all, citing fear of liability or malpractice concerns, and concerns that users would post negative comments about the organization while some organizations do not get involved in social media because they do not feel they have the internal expertise needed to drive the program.
Now the real heavy lifting begins.
According to CSC, “The next step for hospitals and health systems will be to use social media more strategically. The risk and cost of doing so is relatively small, yet the upside includes potentially substantial performance improvements and the realization of sizable competitive advantages.”
Beyond building brands and managing messages, healthcare organizations may wish to think about more their products, long-term goals like driving patient engagement and improving healthcare outcomes.
To take action and begin moving a social media and engagement program forward, CSC recommends the following, and I quote:
Develop an overarching strategy of how to make social media work for you. Begin with easy areas, such as marketing and communications, proceed to patient education and announcements, and then look for ways to leverage social media to improve care and generate other benefits. Look for ways to connect patients to providers, or providers to each other.
Get involved in social media now at whatever level you feel comfortable with and/or have the resources to manage (do not take a wait-and-see attitude or it will be too late and your patients will find someone else to interact with). It is often possible to recruit savvy users internally who are excited about the technology
Pre-empt possible negative experiences by communicating openly about social media with employees and with patients. Develop a social media policy that outlines appropriate use for staff, and post a disclaimer on your site informing patients that information provided is not meant to serve as medical advice. Social media is a force for good; concerns about the use of social media are often overstated. Individuals are more likely to share positive health-related experiences via social media than negative experiences.
We’re here now, we’re ready and the tools are available to serve the greater good. It’s time to engage, damn the consequences.
I’ve known Dr. Anne Brooks for nearly three years and I consider her a friend. She’s always receptive, available and willing to lend an ear, and offers insight I can only hope to have one day.
Plus, her stories are chronicle-like and filled with wit, humor and poignancy. And she’s got a tomb’s worth of them she could tell, and probably should. But, perhaps she doesn’t have the time. She’s too busy caring for the folks of her adopted hometown of Tutwiler, Mississippi.
Dr. Brooks is a nun. She’s taken a vow of poverty. In Tutwiler, she’s needed it. The people here are part of the one of the poorest in the United States. Patients pay for their care, if they can, with vegetables or other goods. Some times they drop a few bucks on the counter, but it’s a guarantee that by the end of the year, the clinic – Tutwiler Clinic – is going to be significantly short of operating funds.
More than 75 percent of its operating funds come from donations by individuals and grants. Those who wish can contribute through a PayPal donate button on the clinic’s site.
The Tutwiler Clinic is a nonprofit founded in 1983 by Dr. Brooks, D.O. and three other Sisters of the Holy Names. Its purpose is to provide wholistic healthcare in Tallahatchie County, located in the middle of the Mississippi Delta. According to its site, the median household income in the county is $18,800, while the US poverty level for a family of four is set at $20,650.
Two-thirds of the clinic’s new patients have no Medicare or Medicaid or other health coverage assistance. To say Brooks has operated the clinic as a personal mission for the last 20 years is no understatement.
The clinic is her calling; Tutwiler is her home.
She became a physician at age 40, following a career in education. However, for 17 years prior, from the time she became a nun, she was confined to a wheelchair because of what had been diagnosed as severe rheumatoid arthritis. She eventually met a physician in Clearwater, Florida, who asked to treat her and through osteopathic methods and acupuncture, eventually she was out of the chair and walking again.
The same doctor to help treat her was the same physician who encouraged her to join him in the medical ranks. She acquiesced and eventually began to study.
When she graduated, she wandered around the south through Mississippi, Louisiana and Florida seeking a clinic to serve. Next, she wrote several letters to towns that were in medically deprived areas offering her services. Tutwiler was only community to respond.
The town gave her a few funds to refurbish the clinic that had been shuttered since the early 1960s and she opened it in August 1983. By January she was seeing more than 700 patients a month. The clinic had a segregated waiting area when she arrived, but she immediately changed tat.
She serves as medical director and chief administrator at the Tutwiler Clinic, serving about 8,500 patients a year. She also is Chief of the Department of Medicine at the Northwest Mississippi Regional Medical Center in Clarksdale, where she has also is on the board of trustees and has served as Chief of Staff.
She is one of three doctors in the county, and currently mentors two medical students. She admits that she is desperate for another doctor at the clinic, which has a staff of 30.
She prays every day for anew doctor to join their staff, but to date (she’s been searching nonstop for months) she’s received little interest.
Brooks is a country doctor in so many ways, like you’d imagine from the 19th century: she makes house calls, and has seen the greatest level of poverty and unhealthful living. Her heart seems to explode with passion for those she cares for and the folks she cares for often suffer from sever chronic conditions, such obesity and diabetes, because of lack of quality nutrition because of their poverty.
She prays a lot for them. When she’s not praying, the 74-year-old who works 12 hour days, most days a week. She believes in wholistic care — taking care of the whole person and enabling a person to care for themselves.
When not providing care, she and her staff run a Habitat for Humanity program that has built 37 homes, and she also started a second-hand clothing store and a community center, with a gym and library and helps residents learn everything from life skills like cooking, to earning a GED, to staying fit with Zumba. To fund the community center, they sell locally made quilts.
Even though she lives in a world seemingly lost, if not a little forgotten, she’s dedicated the Tutwiler Clinic to employing the most current tools to ensure her patients receive the best care possible.
As such, she utilizes an electronic health record.
In her 20 years as a physician, “Care has changed in many, many ways,” she said recently.
There are new forms of care, new understandings of how various body systems that medicine can affect, and, most notable to her, are genome studies and the potential for tailoring medicine to a specific patient.
“You know, every direction you turn, especially in your area of expertise, there are new and exciting ideas about integrating medical records seamlessly into patient care,” she said, “or should it be the other way around?”
Perhaps it makes no matter. Machine at her side or not, she still knows how to provide the best care she knows how to provide, and the people she cares for are blessed to have her at home in her community. In many cases, they owe her their lives; at the very least she should be given some thanks.
Perhaps that’s why the American Osteopathic Foundation recently named her the 2012 physician of the year.
Any mention of money and people’s ears seem to perk. Work, for the money, on the other hand, seems to stifle a person’s desire to embark on the profitable journey.
“What’s that, you say? Money? Where?”
“Well, I’m glad you asked. By taking the following simple steps, by performing the following tasks, you might be able to save your practice time and money.”
The above over dramatization is courtesy of yours truly. Stellar dialogue, wouldn’t you say? Among my many talents. I’m actually a playwright. No, really. Published and everything.
Anyway, getting to the point, it seems that not matter where we turn, in this new healthcare environment where there seem to be opportunities for ‘49ers where ever you turn, someone is trying to tell you how to produce more profitability or efficiency for your practice.
Despite the zingers, there really are a few good pieces of advice out there that do seem to make sense, but, yes, you’ll need to put in a little time and work.
Here’s one example, courtesy of Carol Stryker and Physicians Practice magazine. According to Stryker, 30 percent of any activity is wasted. Thus, as she so eloquently writes, “The more useless labor you can eliminate, the bigger the increase in productivity and the fewer mistakes. A careful review of some or all of the processes in a medical office can generally be expected to yield productivity gains of at least 30 percent in the areas addressed.”
So, to eliminate wasted work and improve efficiency, which improves profitability, establish a process and iron out the wrinkles. The following six steps will help, she says.
1. Choose a process to streamline. One that is causing problems will most likely be easy to identify and will probably already will be taking your attention.
2. Answer this question, Stryker says: “What should the process accomplish and why is that important?” She encourages practice leaders to clearly identity the purpose and value of the process and write it down. “This is the yardstick for future evaluations. This is the only aspect of the project that the physician(s) cannot delegate or outsource,” she said.
3. Write down the steps to follow, in order. Once all the steps are documented, walk them through them to be certain you have not left anything out. Add what you left out and walk through again. Repeat until all steps have been captured.
4. For each step, ask the group: “What does this have to do with the goal?” If nothing, eliminate it. If not much, eliminate it or combine it with another step.
“Is another step performing the same function?” If so, which one produces the best outcome? Eliminate the less effective step.
“Is there a better way?” Do you have a tool, not available when the process was first developed, that gets the job done more effectively and/or efficiently?
“Could a step be added that would have a positive impact on a subsequent step?”
5. For the amended process, ask: “Are any additional steps necessary? If something will be printed now that was not printed before, what will be done with the paper?
“Are the steps in the most logical order?” Examine alternative sequencing as a possible improvement to the process.
“Is the process intuitive?” Will it be easy for the person doing the work to remember or to engage?
“Are any steps error-prone?” What can be done to eliminate error? If it can’t be done away with, what can be done to validate the step was done properly?
Repeat from Step 5 until satisfied with the proposed process.
6. Once the improved process is implemented, choose another process and repeat the analysis. Continue until satisfied with the way the office works.
According to Stryker, “The only difficulty is finding the time and discipline to perform an analysis of a process and implement improvements. Each successful project frees up resources and makes it easier to address another process. Morale improves because office operations are improving. Stress decreases because there is actually time to do what needs to be done. Staff turnover goes down and profits go up.”
And hopefully, once all of the steps in the process have been completed, you’ll find yourself with more time, a more efficient practice and you’ll identify ways to free up a little extra cash.
For some, it’s frightening time to be in healthcare.
Given the continual changes related to reform and reimbursements, compounded by the fact that independent practices are being gobbled up by hospital systems and independent practitioners are becoming employees, but a new study commissioned by The Physicians Foundation say that roughly 60 percent of physicians would quit the profession or retire today if given the opportunity.
This is no new trend. And as noted in HealthLeaders Media report, that’s what makes this latest piece of data so much more shocking.
What’s also somewhat shocking about the Physicians Foundation study, which featured more than 13,000 physicians, is that the results clearly reflect this sentiment – that physicians are frustrated with the overwhelming pressure facing them – and that they would rather get out than picture themselves as professional caregivers for the long haul.
Certainly, this is not insignificant. These are not your typical professionals working a job, taking an hour lunch and then heading home to the family. It’s not like they’re working in one field one week and they decide to try a new job at a different company the next week. These are highly educated professionals who have dedicated their lives to a cause and a belief that they could make a difference by helping people “get better.” Simply put, they’ve made a lifelong decision to practice medicine that the majority could sooner walk away from.
Apparently, physicians just don’t feel they are being heard. They feel their opinions don’t matter so the only way they may have to make themselves heard is to pack up and hit the road.
Because of the pressure they face from regulation, reduced reimbursements and providing greater quality at a lesser cost, many feel alienated, and some are beginning to do something about it.
For starters, they’re reducing or eliminating the number of Medicare and Medicaid patients they’re seeing. Some are leaving private practice (some by choice, others not) and becoming employees where they’ll have fewer managerial worries than if they were to stay put in their practices. After all, employees are hired to do a job; managers are required to solve most of a business’ problems. Employed physicians are employed because, for the most part, they got tired of trying to solve the world’s problems.
But, according to the study, becoming an employee is not viewed as a positive move. Especially for what has traditionally been a fiercely independent population.
What’s most troubling about this study is that most physicians just want out. They want to turn in their white coats and head for the sunset. They want to come to Florida, where the sun always shines, hit the beach and play with sand between their toes. (I made that last part up.)
Here’s the heart of it, and I quote the HealthLeaders story: “We found that 60 percent said they would retire today if given the opportunity. What was worrisome is that this is up from 45 percent in 2008,” Walker Ray, MD, vice president of the nonprofit foundation. “We also know from the survey that we disaggregated it into certain categories, 47 percent of physicians under 40 said they would retire today if given the opportunity.”
Almost half of physicians under age 40 would board the windows and find another way to pay their student loans.
In some cases, there are certainly doctors among this population that just got into practice. These are the physicians who are supposed to be changing the way, setting the new normal for the industry; unabashedly accepting that this is the new world order of things and the hells bells, we’re in it to win it.
If this is indeed the truth, that so many young physicians are wondering why they spent so much time in school and spending so much money on their educations just so they could become employees of the “state,” the future doesn’t see that much different than the present and we have bigger problems that we’re anticipating.
Dr. Eugene Heslin has always loved technology. In his 20 years in practice, he’s embraced it. From the start, in 1992, he brought in a practice management system when he opened his practice’s doors.
Since then, the practice has grown to a five-physician group of family practitioners serving more than 14,000 patients is Saugerties, New York — about 100 miles north of New York City — and has added an electronic health record system to the mix.
The “home-grown” practice serves patients ranging from younger than one month to older than 107; from near life to near death, and everything in between. Physicians at the practice, Bridge Street Family Practice, see the whole gambit and provide care to a lot of people using technology to do so, Dr. Heslin said recently.
Heslin is a self-proclaimed technology advocate. As far as he’s concerned, it provides clear benefits at the practice level, and, ultimately, improves patient care.
“Technology is exponentially changing the practice of care, and I consider it a tool much the same as my stethoscope or my reflex hammer,” he said. “I’ve pretty much given up my desk for my laptop.”
He spoke to me as he sat on a train headed to the City where was able to access his EHR remotely and send a few messages to the practice and patients. He also reviewed a few records and handled some administrative work all from his laptop.
“The access to information is much improved. I’m practicing smarter because I am able to access information in my time instead of sitting with a pile of paper charts,” he said.
His is a story similar to others. When he implemented the EHR he got rid of the paper, found time for other more important things than paperwork and now provides care from anywhere. Because he’s connected, he can interact directly with his patients through his EHR’s patient portal, which patients seem to like.
But the real power of his EHR is in its ability to help track and manage the patient population’s health and outcomes. Though there is much that can be done in an electronic system that can also be done using a paper record, this is just not one of those things, he said.
He’s now in control of all the patient data in his practice and it’s truly helping improve patient’s lives, especially those with chronic conditions.
“The true power of EHRs for the majority of physicians is that we’re going to need this data, and the only way to gather the data is to do so electronically,” he said.
A lover of technology, Heslin is not brand loyal and he’s not married to any system. He’s on his second EHR and he’s seen or tested several of the market’s top names. Each does some things very well, but not everything.
But as the market continues to change and with adoption recently reaching 70 percent of all physicians, Heslin said that the systems are going to be standard equipment for any practice in the near future.
Certainly that comes as no surprise, he admits. What’s next, he said, is interoperability of the each of the different vendor’s systems so that information can easily flow from one to another. Ultimately, the data contained in each must be controlled by the physician rather than by the vendor.
Care givers need to be able to move data within the health sphere, with each system offering point-to-point communication abilities that are far more advanced than today’s version of glorified email.
As the landscape continues to embrace electronic records, the data extracted will become more robust and provide for better modeling of care. Perhaps one day, the technology will begin to allow for a bit of predictive analysis, he said, at which point care can become about prevention of disease rather than about fighting existing conditions.
Essentially, if people can be kept out of the hospital or from exhaustive care programs, resources can be reallocated and eventually saved.
Heslin’s are not predictions of a country doctor hoping for the best through the use of technology. In the health IT community he has some clout. A board member (he’s actually treasurer) of the New York eHealth Collaborative (NYeC), he’s part of one of the most proactive groups in the United States working to improve care.
NYeC works to educate the healthcare industry and those in need of treatment, with a goal of elevating the level of general understanding as to how health IT can improve care. He’s part of the public/private partnership that’s working to move healthcare forward with health IT. Everyone, like himself, has an opportunity to participate, he said, which strengthens the movement.
New York is a complex place, though. There’s a great deal of diversity in the care and cultural spectrum. However, if a successful program to move health policy forward can be built here, it can be built anywhere, he said.
And if the policies lead to better care outcomes, more engagement from the community and its professionals, then real change can be accomplished, and all of the efforts made over the course of the last several years will be worth it, he said.
What might be considered somewhat of a sizeable victory for the world of Health IT can be found in the recent announcement made by writer Ken Terry on the pages of InformationWeek in his article, “EHR Adoption Passes The Tipping Point.”
According to Terry’s article in which he features a report from CapSite, electronic health records are now being used by about 70 percent of physicians.
Really, this is no small achievement and should be celebrated by all of us in health IT. The promise of the technology is being realized, and federal incentives aside, I believe physicians are clearly standing behind the fact that EHRs do in fact create more efficient, streamlined care that will help produce better care outcomes and improve lives.
Clearly, as a community, we have decided that as an industry, it’s time to move forward like many of the other giants of our age, like banking and web commerce. Technology is paramount, mobility is a requirement and access is no longer optional.
Patients realize the importance of access to data and they (we), are skeptical by nature. We want to be coddled and to be assured that everything is going to be okay. Like children, we are growing more comfortable with the fact that with an electronic, connected system we are able to make better decisions, can more easily engage and, frankly, can better educate ourselves when needed.
And I believe we are educating ourselves, especially when it comes to the value of these electronic systems.
This education is helping us, as patients, encourage our care providers to adopt electronic health records. Personally, I don’t believe, meaningful use is sole reason behind the increased adoption. A large portion, yes, but, obviously, not the only thing driving adoption. As consumer patients, we’re helping drive change in healthcare, and through this partnership, there are many great things coming.
The first of which is the news that as far as adoption of electronic health records, we’ve finally reached a passing grade.
As we continue moving forward with adoption, I’m looking forward to seeing more of what’s to come. I’m excited to see what the data collected tells us and how it can be used to drive care; and
I’m anxious to see what’s next as we begin to enter the post-EHR era.
It’s a good time to be here; an exciting time indeed.