By Priya Sabharwal, practice leader, network operations, HGS.
Imagine a scenario: A patient looking for a new doctor searches her insurer’s online network directory to find a provider her plan will cover. She selects what seems to be the perfect doctor based on her criteria, which could include gender, office location, languages spoken or other qualifications, in addition to being in-network with her health plan.
But there’s a plot twist: The patient eventually learns the doctor she found is not, in fact, the right option for her – but it took her scheduling and arriving at the appointment for her to realize this. It turned out the entry in her insurer’s directory was outdated, and her doctor had moved offices.
Poor directories are more than just an inconvenience for a member; they also impede their access to necessary care, and can create unexpected medical costs.
A typical health plan is already regularly contacting providers’ offices for many different types of data requests. When they also call to verify provider directory requests, it can create added pain for both sides of the equation. On the payer side, it can create provider abrasion, which could influence whether the provider keeps doing business with that payer. On the provider side, receptionists and office managers are pulled away from their higher-level tasks whenever they stop to answer the phone, leading to short-term frustration and, potentially, burnout.
Payers risk incurring stiff fines and penalties from federal and financial entities, and/or member lawsuits. For example, as of 2016, CMS regulations now permit the agency to fine health plans up to $25,000 per Medicare beneficiary for errors in Medicare Advantage plan directories, and up to $100 per beneficiary for mistakes in plans sold on the Affordable Care Act exchanges.
Poor provider data management hinders effective patient-provider matching, patient satisfaction, and demand conversion through call centers.
If a health plan’s website does not contain thorough, accurate provider information, or reflect correct provider availability, potential patients may go back to the drawing board and select a provider from a different organization.
A lack of complete and reliable provider data about specialists leads to misdirected referrals, and acts as a barrier to patient retention within networks.
So what are some steps payers and health plans can take to create a solid provider data foundation? It starts with fundamentally changing the way we think about, use, enter and maintain data.
Without a doubt, data is the driving force for innovation within healthcare. It has allowed for processes to be streamlined, busy work to be automated, and medical professionals to have more time with their patients. This data within health informatics is giving doctors, nurses, and the like access to better patient information and allowing more precision within their work.
These innovations are disrupting two arenas within the industry: patient care and institutional structure. Not only do these innovations in healthcare informatics better inform doctors and allow patients to receive an improved quality of care, but they can ensure that healthcare facilities run more smoothly. Here are a few ways that innovations from data informatics have been changing the world of healthcare.
More Patient-Focused Care
Data has allowed medical care to become more patient-focused. This means more time and effort is given to patients individually. Doctors have less paperwork to do because a lot of the organizational work is automated. But patients are also able to take care of themselves at home, or at least effectively communicate with doctors about their condition.
There are many applications for telemedicine and remote patient monitoring. We are seeing sexual health, disease symptoms and concerns, heart rate, dietary problems, and mental health counseling being addressed with apps or telemedicine practices.
For instance, rather than waiting for regularly scheduled checkups, some patients are able to take their own blood pressure and report it to their doctor using a mobile app. This is done through a process called computerized provider order entry (CPOE). Some doctors are wary of this practice, which has inspired conversations about the trustworthiness of patients. But it could be incredibly helpful for those with limited means of transportation or who rely on a caretaker.
AI is able to operate with expert precision and analyze patients in a way that doctors have never been able to. For instance, AI can accurately detect skin cancer. In the past, doctors would have to determine this from dermoscopic images. AI is able to analyze patients and provide a more accurate result. This advancement could have incredible consequences for cancer prevention.
It’s no secret that healthcare has greatly improved with the advent of technology. We all know the drill. The usual benefits that we’ve been able to derive from technology comes in the form of better data management, clearer communication, minimized margin of error, and the improved accuracy and efficiency of medical diagnoses.
These are all the usual advantages we hear and read about, and it’s come to a point that these are now part of the norm. Nowadays they are generally integrated into the system of any hospital. But there’s a downside to that. These advancements are sometimes forgotten because they’ve become so common in the healthcare business.
So, as a gentle reminder to appreciate the things that we already have, these are some of the ways that technology has definitely improved the healthcare industry:
The link between doctors and patients has definitely improved because of technology. For example, if you find yourself involved in a vehicular crash, there are two people you’re going to want to call: Car and bus injury lawyers and doctors. Because of their busy schedules and HIPAA regulations, most doctors can prove to be difficult to contact.
There are several platforms on the internet that allow you to get in touch with a doctor to ask for medical advice. There are many apps that are also able to translate spoken word into a language that whomever you’re speaking with is able to understand, which is handy when traveling in a foreign country.
Better Data Management and Sharing
Gone are the days when patient files had to be physically stored in filing cabinets. There was the problem of these files taking up physical space, of course, but there was also the problem of having to organize these files. Human error is always a factor, but as the scope of work increases, so do the chances that an error may be committed. Today, we are able to store medical data in computers, which also means that we are able to recover data when needed. You never know when medical data may be needed by professionals from other fields of study. Whichever the case, data management is far more secure and far more efficient today than it ever was.
Remote Observing and Alerting
Thanks to home monitoring systems, doctors are now able to check on their patients without the need to be physically present. This reduces the costs involved with recurring clinic visits and the time spent doing so. Patients will also be able to alert emergency medical personnel if something is wrong. This is especially vital for patients who have a pacemaker put in.
With every sector of the economy feeling the effects of ever-increasing healthcare costs and no relief in sight, it’s no wonder household names outside of traditional healthcare are stepping in and attempting to improve what could only be characterized as a problematic system.
Industry outsiders take an interest in “solving” healthcare
This year began with three modern-day titans of industry declaring they are ready to disrupt healthcare. Jeff Bezos of Amazon, Warren E. Buffett of Berkshire Hathaway, and Jamie Dimon of JP Morgan Chase announced they were forming an independent healthcare company for their employees. By June they named a CEO for this venture: Dr. Atul Gawande. A Harvard surgeon, author, and executive director for Ariadne Labs, Dr. Gawande has built his career on examining how medicine is practiced in the US.
Industry outsiders see data as a key leverage point
What is noticeably apparent with this surge in “healthcare outsiders” is that none of these big players are attempting to remake all of healthcare. To remake a system as vast and complex as the US healthcare system is more than any one company or consortium can reasonably hope to do.
However, they all do seem to be focused on data as the key point of leverage for disrupting and remaking a segment of healthcare. Gathering and processing data into diagnostic, predictive, or operational information is seen as the leverage point for ultimately making healthcare more efficient and effective.
Some of these industry outsiders are focusing their efforts directly on finding and exploiting opportunities for cost savings. Here are some examples.
Optimizing the pharmacy purchasing experience
Making the patient purchasing experience for pharmaceuticals, medical devices, and medical supplies seamless and reliable has drawn the attention of Amazon.
For the patient ordering and refilling prescriptions, the process could be automated and culminate in same-day delivery to the patient’s door. To some extent, patients will be able to comparison shop for non-prescription items and bundle purchases. For the seller inventories and distribution can be centralized and possibly some operational savings can be realized.
Finding a more efficient way of selling and delivering medical supplies will increase convenience for patients. But patients rarely pay the full cost of their prescriptions, so the cost drivers present in optimizing retail sales aren’t present at the pharmacy.
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.
A leader in healthcare data management, BridgeHead Software is addressing the constraints of the traditional vendor neutral archive (VNA) with HealthStore, the first independent clinical archive (ICA).
With 20 years’ experience in data and storage management, BridgeHead Software is trusted by over 1,200 hospitals worldwide. Today, BridgeHead Software helps healthcare facilities overcome challenges stemming from rising data volumes and increasing storage costs while delivering peace of mind around how to store, protect and share clinical and administrative information.
BridgeHead’s Healthcare Data Management solutions are designed to work with any hospital’s chosen applications and storage hardware, regardless of vendor, providing greater choice, flexibility and control over the way data is managed, now and in the future.
Services and Products Offered
BridgeHead HealthStore, is the first Independent clinical archive (ICA) for long-term storage, protection and sharing of hospital data. A modular solution built on top of the BridgeHead Healthcare Data Management (HDM) platform, BridgeHead HealthStore enables hospitals to standardize access to key elements of the patient record while simultaneously freeing them from dependence on any single system to locate the information.
Looks like my suspicions are correct. Most health data breaches are inside jobs. But, what’s surprising, according to a somewhat recent survey from Veriphyr — an access and identity provider – is that the majority of data breaches of medical records is by practice employees.
According to the survey, most of the data breeches of medical records more than 35 percent were of healthcare employees peeking into the files of their co-workers. Another 27 percent of the breeches reported were of a healthcare employee’s family or friends
Also gleaned from the survey is that of the hospitals and healthcare facilities surveyed, 70 percent reported some form of data breech. Data breeches cost healthcare organizations more than $6 billion a year, according to Veriphyr’s CEO, Alan Norquist, so they really are big business.
Some of the report’s key findings include:
Top breaches by type:
Snooping into medical records of fellow employees (35 percent)
Snooping into records of friends and relatives (27 percent)
Loss/theft of physical records (25 percent)
Loss/theft of equipment holding record (20 percent)
When a breach occurred, it was detected in:
One to three days (30 percent)
One week (12 percent)
Two to four weeks (17 percent)
Once a breach was detected, it was resolved in:
One to three days (16 percent)
One week (18 percent)
Two to four weeks (25 percent)
According to Health Data Management, there have been more than 31,000 data breeches in the last two-and-a-half years. Most of these breaches are unintentional, though, according to magazine, with “employee transferring records to a flash drive or sending records to a personal e-mail account to work on them from home, or even sending records to a peer for advice.”
Accordingly, some steps to limiting internal data breeches is to continuously educate your employees about the dangers and consequence of handling HIPAA-protected data appropriately, and in some case, it’s may be necessary to adopt new policies to help manage how data is accessed. For example, if personal devices are allowed to be used in the work setting, you need to establish some rules to protect the data the the devices access, and in some cases, you’re going to have to offer support of the devices.
Nevertheless, the information about data breeches is shocking. The number of employees sneaking peeks at patient’s profiles is like the rest of the world surfing the social profiles of complete strangers. Sure, the information is there, but that doesn’t mean we should take advantage of it.