In rural America, patients often find themselves more than 30 minutes away from hospitals or care facilities, making it extremely difficult to receive consistent quality care. In fact, there are only 39 physicians per 100,000 people in most rural areas, and specialists are often few and far between. With the average rural area income being more than $9,000 less than the average household income in the U.S., there simply aren’t enough doctors or financial means to see a specialist in a rural setting. This leaves patients waiting three to six months to see a doctor with the appropriate expertise and can lead them to receive care from non-physician providers, who may not have the same clinical training that a physician has. As a practicing family physician in Springfield, Missouri, I experience these challenges almost daily and as technology advances I have found new ways to help my patients to significantly decrease their need for a specialist visit.
Some of the most common health issues I face as a primary care physician that fall outside of my normal scope are dermatological, cardiological or gastrointestinal. In urban areas, patients can easily make appointments at respective specialists, but in a rural area like my own, diagnosis and treatment is often left to the primary care physician. While seeing patients for regular scheduled appointments, I typically encounter 20 dermatological cases a week including conditions like eczema, psoriasis, warts and actinic keratosis.
Although these are common skin conditions, when I encounter these types of conditions I take my years of experience and try to assess to make a diagnosis and develop a treatment plan, even if I am not 100 percent certain of the specific condition. Thanks to technology, more and more tools are being developed that can help diagnose the conditions – whether common or more intricate – that primary care physicians may not be expertly trained on. These tools, known as clinical decision support tools, enable us to make more accurate diagnoses at the point of care.
Technology as an aide, not a replacement
When I talk to my colleagues about utilizing technology in our everyday practice, I commonly get pushback because there is fear that technology may put us out of a job. The truth is that clinical decision support tools are becoming essential tools for rural health care providers as the volume of available data increases alongside our responsibility to deliver value-based care. These tools are simply aiding us, not replacing us.
A tool I’ve been using for the past year, VisualDx, allows me to access thousands of medical images that I can use to compare to a patient’s skin rather than referring them to a dermatologist with a long wait time. By looking through multiple examples of the same condition on different body parts and on varying skin tones, I can accurately identify a patient’s condition and recommend a suitable treatment plan. This visual element allows me to be confident in each diagnosis and share my findings with my patients directly in the room.
Earning patient trust with technology use
When a patient comes in with a specialized health issue, they are often hesitant to trust that the diagnoses I’ve made are accurate due to a lack of expertise in a certain area. I recently had a parent bring in their child requesting a referral for dermatologist due to some bumps on her arms. In this case, I already knew the diagnosis as the rash had a very characteristic appearance of molluscum contagiosum. However, the patient’s parent was concerned that I was not knowledgeable enough in this area and was insistent upon a referral. In this case, I was able to use the tool to show her the diagnosis, the time frame that it usually lasted and the recommended treatment. This extra level of reassurance allowed the patient to trust my diagnosis and recognize that a referral was unnecessary.
In the U.S., more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Referrals are the link that make this connection between primary and specialty care. From 1999 through 2009 alone, the absolute number of visits resulting in a physician referral increased 159 percent nationally, from 41 million to 105 million. This volume and the frequency of specialty referrals has steadily increased over the years and will only continue. Yet despite this rise in frequency, the referral process itself has been a great frustration for years.
Specialty referrals are a complicated business. There are many moving parts and players that all have a crucial role to play within the process. By breaking it down and looking at exactly what a referral is, who is involved, and the challenges they face, we can then look to fix what is broken. What needs to be improved? And could there be a digital solution?
Let’s start from the very beginning by looking at the stakeholders and their unique interests and concerns.
Patient – The patient experiences a health concern and needs care to get it resolved. The primary physician doesn’t provide the full solution and refers them to a specialist with more expertise about the patient’s condition. This is where the referral occurs. Currently, the extent of the referral is the physician handing a phone number to the patient to call and schedule the appointment. It’s up to the patient to contact the specialist and follow through with the next step, which explains why 20 percent of patients never even schedule the referral appointment.
Provider –There is more than one provider involved in the referral process. First is the referring (or sending) provider and then the target (or receiving) provider. The referring physician is the provider recommending (referring) them to a specialist. The target provider is the specialist that has been recommended. For a health system or physician group, there are obvious financial and quality of care benefits associated when a patient is sent to a trusted provider within network. When patients don’t go to their referral appointment, the health system or physician group loses in several ways. First of all, they have lost control over providing comprehensive care to the patient. If a patient gets readmitted to a hospital because of their negligence to follow through on a referral appointment, the health system gets penalized for the readmission. The penalty could result in CMS withholding up to 3 percent of the funding provided to the health system. The system also suffers in terms of the perception of their quality of care. If a patient is not secured with a provider within network, they may go to a competing system.
Plan – Health plans have several important considerations when a referral happens with a vested interest on three fronts to ensure the patient goes to the target provider:
1) The health plan benefits if the patient goes to a target provider within their network. Not only will patients be directed to providers that best meet their needs, but the plan also benefits when patients are referred to the providers in their Smart Network. These providers are trusted for superior care for the patient and reduced costs for the plan.
2) When a plan member doesn’t get the care they need to maintain good health, their likelihood of having major adverse events rises dramatically. This means they will end up in the ER or needing other expensive care, which represents big costs for the health plan.
3) The current approach to referrals often results in long lead times, which makes for a poor patient experience and can increase costs.
A new study from HIMSS, unveiled today at the 2017 HIMSS Conference & Exhibition, reinforces the positive impact health IT has on the U.S. economy while signaling challenges ahead for the expansion of health IT’s footprint.
Weaving together two historically seminal HIMSS research efforts (the annual HIMSS Leadership Survey and the biennial HIMSS Workforce Study), the new HIMSS Leadership and Workforce Survey report details the health IT priorities of key stakeholder groups and their linkages to various strategic initiatives (e.g. employment of select IT leaders) and economic measures (e.g. workforce projections). In an era of maturing EHR adoption, the study finds health IT leaders continue to report positive market growth metrics. Yet, health IT staffing structures and experiences in provider sites outside the hospital, coupled with their unique clinical IT priorities, point to a need to address the challenges faced by these types of providers in order to propel the sector’s growth.
“Health IT continues to be a bright spot in the U.S. economy,” said Lorren Pettit, vice president, health information systems and research for HIMSS. “Health IT workers continue to see strong demand for their skills, as employers across the provider and vendor/consultant spectrum embrace various health IT strategic initiatives. But the specific hurdles faced by some sectors suggest that the health IT field will need to creatively address its expansion outside the hospital walls.”
Key findings include:
Demand for health IT talent leaves employers struggling. The majority of health IT employers (61 percent of vendors/consultants and 43 percent of providers) have positions they are looking to fill. The findings suggest the demand for health IT workers is strong, as evidenced by the fact that only 32 percent of vendors / consultant organizations, and 38 percent of provider organizations, claim they are fully staffed.
The majority of health IT employers grew or at least maintained the size of their IT workforce over the past year. 61 percent of vendors/consultants and 42 percent of providers reported IT staffing increases, and the majority of respondents across both groups expect to further increase or hold steady over the next year.
IT budgets continue to rise. Although projections are not uniform between the two groups, the majority of providers (56 percent) and vendors/consultants (87 percent) project increases in their IT budgets this year.
A significant disconnect exists between providers and vendors/consultants on certain select clinical IT priorities – notably electronic health records (EHRs). Vendors/consultants seem to be “moving on” to other issues, whereas providers appear to be wrestling with how to best leverage their existing EHR investments.
However, the stakeholder groups are generally aligned on the biggest priorities facing those leveraging clinical IT, including privacy/security, care coordination, culture of care and population health.
The 2017 Leadership and Workforce Survey reflects the responses of 368 U.S. health IT leaders between late November 2016 and early January 2017. Download the complete report.
Healthcare is experiencing major breakthroughs in technology with the rise in digital transformation. mHealth – a terminology that combines mobile technology with healthcare is proliferating and bringing up an opportunity to revamp public health.
Mobile technology is playing a vital role in delivering healthcare seamlessly, with ease of access to both providers as well as consumers.
The magnitude and scope of development of mHealth is beyond explanation. As per GreatCall, mHealth is projected to be a $26 billion industry by the end of 2017. Surely, 10 years from now healthcare mobile devices will become smarter than they already are.
This technology has a potential to reduce the risk of errors and save the time and money that is often wasted. As more and more care providers are shifting to mobile health technologies, consumers have a plethora of options to choose from. Its adoption rate is at an all-time high since it has a variety of utilities to offer.
Development of point of care medical devices, fitness and wellness smartphone apps, clinical medication apps, medical resources, journals and patient records is on the surge. Mobile technology is helping increase patient engagement and connected care. Almost, 83 percent physicians believe in the power of mHealth for patients.
There is a whole new world of possibilities and challenges that mobile has opened for healthcare along with its growing development and support. For instance, end point app security, data breaches and HIPAA violations have sharply increased and there is a need to regulate them. Despite these, mHealth proves to be the most promising industry trend for caregivers and consumers alike.
To understand the general consumer response, usage trends security concerns governing mHealth, Kays Harbor has come up with an infographic. This infographic depicts interesting facts and numbers reported by surveys conducted by firms like SkyCure, Research2Guidance, Great Call, etc.
About two decades ago who would’ve thought of the invention of Nano robots that are able to carry drugs all the way to the human bloodstream?
It’s happening. Technology is revolutionizing the conventional ‘human country doctor’ health care and there’s not much to be surprised of. With modern machines and software taking over the healthcare industry, one often wonders, “What good is technology doing to it?”
Health information technology (HIT – is information technology applied to health and health care. It supports health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors) is the burgeoning specialized combination of information technology, communications, and healthcare and it is altering the course of patient care for the better. Here’s how:
Practicing medicine is a lifelong learning. Doctors need to be on their toes all the time to acquire the knowledge of the latest developments in their field. Not updating themselves can make their practice stagnant – nobody would want to consult a doctor like that. Health IT brings the knowledge about everything, be it patients, therapies, diseases or medicines at their easy disposal. This knowledge can be easily shared between consultants, patients, and can even be updated when needed. That’s a whole new world of medical science for the doctors and patients to explore.
The world is swiftly moving towards specialization. Healthcare is no different. A single hospital stay could mean being under the observation of several different specialists at the same time. These specialists are required to coordinate with each other on every case they deal with. The way forward is paved by health IT. Health IT helps bring everything related to your condition from nutrition to neural complications in tandem with each other. The specialists know which condition can make regular course of treatment difficult for you or which medicine would trigger your skin allergies. The result? There are fewer chances of problems arising in your healthcare.
The most significant way IT is transforming the healthcare industry is in the form of better outcomes. Automation streamlines the operations of a medical facility, making them more effective and efficient. It is easier for different doctors and nurses to coordinate and diagnose a particular case. There are less chances of human error which ultimately leads to higher quality and safer care. With less time wasted in going through physical files and other manual work, doctors and nurses have more time on their hands to spend with patients.
In virtually every context that question might be asked, we struggle to give an honest, accurate answer.
It Works If You Believe It Works
Is the medication working? Difficult to say–it may be the placebo effect, it may be counteracted by other medications, or we may be monitoring the wrong indicators to recognize any effect. Is “working” the same as “having an effect,” or must it be the desired effect?
Alternative medicine confounds the balance of expectations and outcomes even further. Right at the intersection of evidenced-based medicine and naturopathy, for instance, we have hyperbaric oxygen therapy, or HBOT. These devices are as much in vogue among emergency departments (to treat embolisms, diabetic foot ulcers, and burns) as holistic dream salesmen (to prevent aging and cure autism, if you believe the hype). When the metric being tracked is as fluid as the visible effects of aging, answering whether the treatment is working is about as subjective as you can get.
As though the science of pharmaceuticals and clinical medicine weren’t confounding enough, you can hardly go anywhere in healthcare today without politics getting added to the mix. In the wake of Trump’s victory in the 2016 presidential election, you have observers and stakeholders asking of the Affordable Care Act (ACA): is it working?
There’s Something Happening Here
It is definitely doing something. It is measurably active in our tax policy, for instance: 2016 returns are heavily influenced by the incremental growth of the ACA’s financial provisions. Of course, the point of this tax policy (depending on who you ask) is to influence behavior. As to this point, there are some signs that, again, something is happening: among young people, ER visits in general are down, while emergency stays due to mental health illness are up. We changed how healthcare is insured, and that changed, in turn, how we access our care. But is it working?
Guest post by Gaby Loria, analyst for mental health software, Software Advice.
There are certain factors clinicians are constantly working to improve at their practices, such as:
While these three P’s apply to every health care provider, regardless of practice size or specialty, they are especially important for independent physicians.
Solo and small practice doctors face more challenges than their counterparts in group-owned or hospital-affiliated organizations. They shoulder all the responsibility for:
Ensuring care quality
Retaining and attracting patients
Paying the office’s overhead costs
Keeping up with shifting regulatory requirements, which some say favor larger providers
For all of these reasons, it’s wise for small practices to invest in health IT tools that can give them an edge in a competitive and increasingly data-driven industry. The three tech trends we describe below can help improve performance, increase profitability and impact productivity without breaking tight budgets.
Improve Performance with Population Health Tools
The goal of managing population health is to achieve measurable improvements in the health outcomes of a group of people. In other words, taking steps to help groups of patients get healthier instead of solely focusing on one individual’s treatment plan at a time.
That may sound like a lot of work, but it’s not—if you have the right IT. Nowadays, there are a number of population health-enabled capabilities that are built into electronic health records (EHR) software systems commonly used by small practices. The breadth and depth of these capabilities vary depending on the system, but here are some examples:
Leveraging an EHR’s reporting module to pinpoint the percentage of prediabetic patients at a practice, then specifically sending those patients information about diet and exercise changes to lower their risk of developing Type 2 diabetes.
Setting targeted, automated appointment reminders to women who have not had a breast cancer screening in more than a year, making them more likely to come in for preventive care.
Using software to generate risk assessments grouping patients by the severity of their chronic conditions. These assessments are based on patients’ digitized clinical records, so it’s easier to identify at-risk patients.
This technology makes it feasible for busy physicians to provide extra attention and care to patient populations that need it most, so they can prevent a worsening condition from developing. Such clinical interventions on a group scale can therefore make it possible to improve the overall health of a practice’s patient base.
Increase Profitability via Telemedicine
Telemedicine is the use of technology to support remote medical services. One of the most lucrative ways small practices can adopt telemedicine is by offering video consultations, which are virtual patient-physician interactions enabled by videoconferencing software. This allows doctors to see more patients per day without adding overhead costs (e.g., office space or staffing).
Interested physicians have two main options to capitalize on this trend:
The first is to get an EHR with integrated videoconferencing capabilities. This is ideal for practices that want to offer telemedicine services to existing patients. Depending on their state laws, they may be able to get reimbursed for these virtual consultations.
Alternatively, doctors can sign up to be a provider for a stand-alone platform (e.g., Teladoc, eVisit and American Well). This is better suited for practices looking to attract new patients. Some platforms charge doctors a monthly subscription fee, while others treat practitioners as independent contractors who get a percentage of whatever the patient pays per visit.
Healthcare jobs are plentiful, and at least through 2024, the demand for healthcare professionals such as nurses, anesthesiologists and physicians will only continue to rise.
The Bureau of Labor Statistics has said that healthcare jobs are “expected to have the fastest employment growth and to add the most jobs between 2014 and 2024.” Given the healthcare industry’s propensity for increased growth, hospitals need to embrace scalable IT—for their own sake and for the sake of their patients.
Fortunately, there are options.
Healthcare organizations increasingly rely on cloud-based IT solutions, and SADA Systems has reported that the number of organizations living in the cloud could be as high as 89 percent. There’s a reason for the high percentage—cloud solutions are safe, scalable, and efficient.
Hospital data safety is no small concern.
In 2008, 9.4 percent of hospitals used EHRs. By 2014, the percentage had skyrocketed to 96.9 percent. The switch to digital records was necessary, but in the rush to modernize, hospitals were left more vulnerable to data theft than other industries that had migrated more slowly.
According to Niam Yaraghi, healthcare systems are left with an additional concern. “Hospitals cannot tolerate the consequences of computer lockdowns,” writes Yaraghi. “If Wal-Mart gets attacked, it will likely shut down for a short period of time and fix the issue…Hospitals on the other hand, are dealing with patients’ lives.”
Further arguments for cloud IT include the sheer number of patients hospitals see every year. Hospitals treat 136.3 million patients in the emergency room alone, according to cdc.gov, and believe it or not, that number is growing. Cloud IT accommodates growing demand seamlessly.
Guest post Ken Perez, vice president of healthcare policy, Omnicell.
On October 14, the Centers for Medicare & Medicaid Services (CMS) released a 2,171-page final rule for the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS had issued a proposed rule on April 27 and in the intervening period, more than 100,000 physicians and other stakeholders attended outreach sessions and CMS received more than 4,000 public comments on the proposed rule, with many of the expressed concerns pertaining to the start date for MACRA’s first performance period.
MACRA’s Quality Payment Program replaces the unpopular sustainable growth rate formula and defines how physicians in physician practices—not hospitals—will be reimbursed by Medicare. It features two alternative, interrelated pathways: the Merit-based Incentive Payment System (MIPS) and advanced alternative payment models (APMs). MIPS is designed for providers in traditional fee-for-service Medicare, while the advanced APMs are for providers who are participating in specific value-based care models, such as accountable care organizations (ACOs).
Small physician practices with less than $30,000 in Medicare charges or that see fewer than 100 Medicare patients per year are exempt from MIPS. According to an analysis by the American Medical Association, 30 percent of physicians are below one or both of these thresholds. In addition, providers new to Medicare in 2017 are also exempt (though just for the first year).
The proposed rule specified Jan. 1, 2017, as the start date for the first performance period under MIPS, which would drive calendar year 2019 payment based on performance in 2017 across the four MIPS categories: Quality, Advancing Care Information, Clinical Practice Improvement Activities, and Cost/Resource Use. The final rule allows providers to start collecting performance data anytime between Jan. 1 and Oct. 2, 2017, with data due to CMS by Mar. 31, 2018.
Under MIPS, physicians can earn in 2019 a payment adjustment that is neutral, up to 4 percent positive, or up to 4 percent negative, depending on their level of participation, the amount of data submitted, and the length of the performance period reported. The adjustment increases to plus or minus 5 percent in 2020, plus or minus 7 percent in 2021, and plus or minus 9 percent in 2022. CMS projects that 592,000 to 642,000 clinicians will submit data for MIPS during the first performance year.
Lee Horner serves as Stratus Video’s president of telemedicine, bringing more than 25 years of experience in enterprise software and healthcare IT industry. Most recently, Horner served as the president of CareCloud, a health care technology company specializing in practice management and EHR software. During that time, his core focus was setting the direction and strategy of the company while managing the top- and bottom-line revenues. He also drove both technology excellence and platform growth to meet CareCloud’s clients’ goals. Prior to CareCloud, Lee also held executive roles at Vitera Healthcare (formerly Sage Healthcare, where I worked with him; now Greenway Health) and Eliza Corporation.
You recently joined Stratus as president of telehealth – what motivated your decision and why is this such an important field nowadays?
In today’s mobile and fast-paced world, telehealth is a necessity. Telehealth is healthcare 2.0 – it can cut wait times, costs for both the provider and the patient, inefficiencies. At the same time it can elevate the kind of expertise and quality of the care patients receive, as well as give new opportunities to connect doctors to the patients who need them most. Telehealth is the future of health. It’s not only preserving that face-to-face connection between patients and providers – which is essential to great healthcare – it’s making that connection available to so many more people in so many different contexts. By enabling these essential connections, telehealth expands the probability of people getting the care they need, and is inevitably helping to save lives.
What is your background in health IT?
I have been involved in healthcare IT for the past 10 years. I have experience operating businesses in the payer, ambulatory and health system markets. It is a great field to be in. It’s very progressive and always changing.
Why is health IT where it’s at today? What do you feel has made this industry successful?
This market is expanding rapidly and technological advancement is at the forefront of that expansion. Smart people with extreme passion for improving patient quality care are really what is making this industry successful.
What are some of the things that most inspire you about the space and it’s work?
I am inspired every time I see the changes we are making improve a patient’s quality of care. It is incredible to see our work start to make a difference.
What are the most important areas in telehealth nowadays?
One important area is how telehealth is opening opportunities for more health industry professionals – and this is in turn, leading to a more robust patient experience. Predictable disruption is a huge theme in telehealth. You saw unpredictable disruption with industries like car ride service – when Uber and other apps came out, people who weren’t taxi drivers were suddenly entering that industry. In healthcare, it’s different – apps are creating opportunities for people already within the industry, allowing more providers to help the patients who need them most and more patients to connect with the providers best suited to their needs.
A couple of other important areas are readmissions and urgent care:
The Affordable Care Act penalizes hospital readmissions, because it’s important to incentivize successful treatment. Unfortunately, the nature of healthcare and the nature of life is that you sometimes need to go back in for continued treatment or to inquire about something. But maybe you moved or you’re too sick to keep going back to your treating physician. Discharge solutions are allowing people to reconnect and get the follow-up care they need without the hassle.
Urgent and emergency care solutions are also becoming really important. Imagine a burn victim walks into an ER at 4 a.m. and needs to see a specialist – but the staff is all tied up or there isn’t a specialist working in that particular facility. Without an urgent care app, the patient would be waiting and suffering, while the provider would be struggling to give them the care they need. With an app, they’d be able to pull up a tablet and connect that patient face-to-face with the doctor they need almost immediately.