By Jerry Rankin, strategy director of healthcare interoperability, Infor.
The unrelenting if unpredictable movement of continental plates builds new mountain ranges and reshapes continents, but for the most part, we do not notice their progress. Such a shift has come to healthcare.
This spring two US Federal agencies, ONC and CMS, announced complimentary Final Rules, signaling tectonic movement in healthcare interoperability. These rules are very consequential for the industry, but while no one can claim that they went unnoticed, the industry has been understandably instead fixated on responding to the COVID-19 pandemic. In response, the federal agencies involved have pushed the implementation timelines back by roughly six months.
The Final Rules
On May 1, 2020, the ONC published a Final Rule implementing provisions of the 2016 21st Century Cures Act. Known in the industry as the “Information Blocking and Health IT Certification” Final Rule, the Provider and EHR focused rule requires developers of Certified Health Information Technology (e.g. EHRs) to make standard APIs available for the delivery of individual and population records, as well as defines the data set and transaction standards of the APIs to be United States Core Data Set for interoperability (USCDI) and FHIR, respectively.
In a parallel action, the CMS issued a ruling implementing provisions of the Cures Act, known as the “Interoperability and Patient Access Rule,” leveraging “Conditions of Participation” in Federal Health programs. The finalized rule requires payers to provide a Patient Access API which gives patients access to certain health data including personal data.
These rules represent an important federal nudge to the industry to move in the next few years to implement and adopt standard, digital friendly APIs for the exchange of key patient information, eliminate policies and practices of health IT vendors, providers and other data holders that constrain the free flow of healthcare data, and, importantly, bring payers and consumers into the interoperability discussion, enabling data to flow across the healthcare ecosystem.
These rules are just the tip of the iceberg, though. The industry has been hard at work for years developing the FHIR API standard, and there are abundant examples of voluntary industry led collaborations working to improve and streamline healthcare leveraging FHIR. For example, the HL7 Da Vinci Project sponsors collaboration among payers, providers and HIT vendors working to define standards-based implementations to improve some of the more costly workflows in the industry. In addition to adoption by traditional HIT vendors, even IT “gorillas” are adopting FHIR. We recently saw this with the launch of Microsoft Cloud for Healthcare which extensively leverages FHIR APIs and data standards.
What to expect for payers and providers?
Payers and providers and their health IT vendors have a great deal of work to do on a tight timeline to meet the requirements put in place and to simply keep up with the pace of change in the industry. Given the massive investment in and footprint of legacy systems, there is a vast amount of work to do to connect systems and data to the emerging FHIR API ecosystem.
By Erica Doherty, healthcare industry and solution strategy director, Infor.
You may be familiar with the Gallup study that identified—across industries and organizations—that 68 percent of employees are not engaged in their work. That is not only disheartening, but scary, especially when talking about workers in the healthcare industry.
Overall, the price tag of disengagement is calculated as a $400 billion hit against employers. There is no doubt the health system revenue chain depends on employee attendance, retention and patient satisfaction scores. However, there is something much more important at stake, which is that nurse disengagement puts patient lives at risk.
There are three top indicators of mortality risk in the healthcare setting: nurse engagement level, the ratio of the number of nurses to total patient days, and the percentage of overtime hours per year, according to a Gallup study of more than 200 hospitals. Beyond safety incidents, Gallup also showed that a high level of engagement across all types of workers leads to a 21 percent higher productivity rate and lower turnover rates.
But what is engagement? Put simply, engagement is an emotional commitment to an employer and its mission. That is obviously an important factor for bedside caregivers, who are called on to offer patients more than experience and education, but also the soft skills of compassion and personal attention. Truly, all employees in healthcare impact the patient directly or indirectly. The engaged hospital worker listens, is helpful and conscientious about the entire patient experience and has been found to make fewer errors.
What healthcare leaders can do to improve employee engagement
So how do you, as a healthcare leader, create more engagement and a culture of continuous caring? Identifying the most effective technology for your organization is a key piece in solving the employee engagement puzzle. Using technology, you can discover underlying causes of disengagement.
Identifying a human capital management (HCM) solution that impacts employee engagement will have the biggest impact on your organization’s employee engagement levels. Several factors should be considered. An HCM solution that streamlines and automates key HR data contributes to keeping caregivers focused on the bedside and leaders focused on their employees—not administrative tasks. For example, one way to address disengagement is through a solution that utilizes artificial intelligence (AI) to automate, inform and augment work by answering simple questions like an employee’s PTO balance, or even identifying an employee who may be a flight risk and offering suggested activities about how to retain them.
In addition, what creates a meaningful work environment for one employee may be different for another. Figuring this out starts with the hiring process. Technology can understand the behavioral DNA of an employee and then match them to the best fit position and the culture of their employer. The next step is to provide those behavioral insights to managers so they know how to create an atmosphere that creates happiness for that employee and suggests how to lead them in a way that fosters meaning and appreciation.
Big data has arrived, and in healthcare, it has landed on our desks with a resounding thud. The challenge ahead lies in discerning how to analyze information and use it to effectively improve patient outcomes, costs and efficiencies.
Many of us are already influenced by machine learning and artificial intelligence (AI). For example, if buying hiking boots online, items of a similar nature also appear as suggested purchases, like bug spray or sunscreen. The data analytics behind those recommendations includes a wealth of information about the user, including demographics, such as age, gender, education and income level, as well as location and other factors that influence buying decisions. It will only be a matter of time until we are able to apply the same principles to healthcare data.
Imagine a doctor who can review operational and clinical data in real time for a patient who had knee replacement surgery. After the patient goes home, she is given a Fitbit to monitor her step count. If her steps trend downward, it is probably time for someone to intervene because she is potentially in pain or not ambulating correctly. That same physician could also see where she has received care, the cost of the care, and who performed the surgery. Then, the physician could compare her progress against others with similar demographic and health backgrounds by using machine learning and streaming analytics that not only gather relevant data across the entire care continuum—from hospital to rehab facility to home—but draw inferences from that information in real time to truly influence cost and care outcomes. In addition, if the patient had three MRIs that cost $2,000 each and someone with similar demographics and health conditions had one MRI that cost $500—caregivers can explore why that happened and work toward more uniformity.
This idea is inspiring, but a more practical look can be taken for how AI can support the business operations of healthcare as an achievable first step, along with connecting that operational data with remote care, device data and patient EHRs. Here are next steps for creating efficiencies with the power of AI and interoperability:
Step 1: Unlock Human Potential
As a recent Advisory Board report states, “AI works best when paired with humans.” The goal is to use this technology to create efficiencies across the care continuum that not only help staff in their roles, but that free clinicians, caregivers and office staff to focus on more valued activities. AI can help augment and automate human tasks and functions where appropriate, and sooner rather than later it may be able to offer advice, ultimately allowing caregivers to focus entirely on patient care.
Step 2: Optimize the Supply Chain
AI can quickly answer employee queries, buy supply, such as bandages from a certain supplier, and can also track unused supplies to minimize excess inventory. In addition, AI can help alleviate the amount of time—and frustration—nursing and clinical staff spend searching for supplies by not only providing location, but automating future order and delivery.
Step 3: Enhance and Expand Employee Self-Service
For those healthcare employees without regular access to a computer, such as lab technicians, AI can quickly and accurately empower cross-functional self-service. All employees need to do is ask for answers about anything, from paid time off (PTO) balances to company holidays.
Step 3: Automate Financial Processes
AI can augment the payment process, detecting payment, vendor and invoice patterns, and suggesting automating payments for a specific invoice that is approved 99 percent of the time.
By Mark Weber, SVP of healthcare development, Infor.
With payer models changing, it is time to start thinking of patients as both clients and customers. Are they as satisfied with the cost of service as they are their experience and outcomes? Will they keep coming back?
With high deductible and health savings plans shifting more of the patient cost burden to their own pocketbooks, healthcare consumers are motivated to make more informed care choices. The good news, for them, is that they have a lot more options, as nontraditional players such as retail clinics, online diagnosis sites and others have entered the market. There is more information about those choices available to them, whenever and wherever they need it.
However, all of that creates more competitive pressure among providers. Patients can be an organization’s biggest cheerleaders—or biggest detractors. That means like any brand, healthcare providers must work hard to maintain loyalty to remaining successful—or even sustainable—in the industry. And technology is helping lead the transformation.
The Era of Consumerism Is Here
According to Shafiq Rab, CIO of Rush University Medical Center, “It is all coming together as the ‘day of the patient.’ We call it care where you are. Where you want it. How you want it.”
He then went on to say that while technology continues to support the era of big data, digital innovations and advances also provide healthcare’s biggest opportunity to streamline the care experience across the continuum.
EHR Is Just a Start
One of the biggest evolutions is the implementation and proliferation of the electronic health record (EHR). It has been a catalyst for more efficient, personalized care and is integral to a better patient experience.
However, if the EHR is unable to connect to disparate systems, or across facilities (especially in this era of increasing mergers and acquisitions), or between non-affiliated organizations, its value decreases as the potential for real interoperability is lost.
What healthcare organizations really need is an engine that pulls together the EHR and other systems. To have a single patient data source, organizations need to streamline the exchange and aggregation of clinical data within an organization, and between its facilities and partners. Do not forget that such an engine needs to be built with standards such as FHIR as a top consideration and can create apps that allow patients to schedule appointments via laptop, tablet and phone.
Even efficiencies a patient cannot see are key to patient satisfaction and a positive consumer experience. Such efficiencies include the processes that power everything from claims processing to supply chain to equipment maintenance. If supplies are missing or need to be tracked down, patient care and experience are compromised. Or imagine arriving at your appointment and finding the MRI machine is down. A truly integrated system will provide real-time, role-based insight to minimize risks, issues and service disruption.
As savvy consumers demand more cost transparency, revenue generation must be balanced with the constant need for cost efficiencies. As a healthcare organization, a wise endeavor is to bring accounting and cost analysis to a new level by allocating patient and department expenses, such as procedural and lab test costs. From there, you need to break down expenses by patient cohort, surgeon, procedure or provider. Imagine getting a bill from the hospital that clearly outlines charges in a manner that you, as a consumer, can easily understand. Not only does that help achieve a higher level of consumer satisfaction, but it helps the healthcare organization understand the true cost of patient care.
Guest post by Joel Rydbeck, director, healthcare technology and strategy, Infor.
Healthcare is undergoing rapid “digitization” – a move toward an integrated ecosystem of mobile applications and data exchange that integrate consumer data into the enterprise. For healthcare, this could enhance patient engagement and enable care to become more efficient and “real time”.
Nonetheless, moving to a more digital healthcare enterprise presents a series of challenges:
How will the data be transmitted and is it semantically interoperable?
Where and how much should be persisted?
How can the data be made “actionable” for the clinician?
We’ve all visited a doctor and been asked “How are you sleeping?” and “Are you getting exercise?”. If you are among the growing number of people with a fitness tracker, you may think, “Hold on, I have that recorded”. So, you pull out your mobile phone and respond “I am getting six to seven hours of sleep a night and about 11,000 steps a day. Is that good?” While your doctor may understand your quick synopsis of the data, imagine if they were getting the data real-time. Would they know what to do with it? What if it contains disturbing trends? It would be unfortunate if crucial information wasn’t put to good use. But how?
Interactions like these prompted Washington University’s Olin School of Business and Infor Healthcare to collaborate on improving the usability of personal tracker data. This collaboration included conducting a small survey of 39 physicians from a broad spectrum of specialties asking their thoughts about the use of tracker data for clinical care.
The survey uncovered differing views on what information would actually be useful, showing:
56 percent thought active hours would be useful,
46 percent said miles walked or intensity of movement,
36 percent included steps taken as a useful metric,
and 10 percent the said the degree of upward incline during movement would be useful.
The survey also asked providers what factors would enhance their likelihood of using tracker data for patient care. Majority would like to see better integration with their electronic health record (EHR), more patients using the devices, and additional data, such as blood sugar, being collected.
Physicians reported lack of education as a barrier to effectively using the data. About 50 percent believed that education, in the form of a short presentation or discussion, would be useful while 31 percent thought that a short guide would suffice.
While two-thirds of providers were open to discussing personal trackers with their patients, they did express concerns in using the data for care. The data must be proven accurate before physicians will place trust in it. Inconsistent or inaccurate data could lead to unnecessary anxiety and possibly harm. Also noted is that extraneous data can clutter the EHR and complicate patient care. Many of the providers mentioning drawbacks to using device data stated that the devices might work best as motivational tools for patients. More study towards interpreting tracker data for clinical use is needed.
Health IT’s most pressing issues may be so prevalent that they can’t be contained to a single post, as is obvious here, the second installment in the series detailing some of the biggest IT issues. There are differing opinions as to what the most important issues are, but there are many clear and overwhelming problems for the sector. Data, security, interoperability and compliance are some of the more obvious, according to the following experts, but those are not all, as you likely know and we’ll continue to see.
Here, we continue to offer the perspective of some of healthcare’s insiders who offer their opinions on health IT’s greatest problems and where we should be spending a good deal, if not most, of our focus. If you’d like to read the first installment in the series, go here: Health IT’s Most Pressing Issues. Also, feel free to let us know if you agree with the following, or add what you think are some of the sector’s biggest boondoggles.
Michael Fimin, CEO and co-founder, Netwrix
The largest concern of any healthcare organization is protecting patient personal data. Every year healthcare entities of all sizes become victims of data leaks, fresh examples are both Anthem and Premera Blue Cross, and lose thousands of dollars mainly because of employee misbehave or human error. Being not an easy one to prevent, human factor sets IT pros a number of challenges to cope with:
1. Insider threat. Unfortunately, privilege abuse is a primary root cause for many data breaches. No matter if an employee is breaking bad or his credentials were stolen, sensitive data is put at risk. The only way to prevent insider threats is to have visibility into the IT infrastructure and be able to track any changes made to both security configurations and data. Monitor user activity and establish rigorous control over accounts with extended privileges. Regularly review all access rights to ensure that permissions are granted adequately to employees’ business needs.
2. Security of devices. In 2014 healthcare organizations suffered from physical theft or loss of electronic devices more than any other industry, said the Verizon 2014 DBIR. Without proper identity and authentication management personal data stored on these devices can be easily accessed by adversaries, leading to financial and reputational losses. If your employees’ laptop or tablets end up in the wrong hands, encryption, two-factor authentication and ability to manage the device remotely will protect your data, or at least will make hacker’s job much harder.
3. Employees’ negligence. Deliberate or accidental mistakes pose more danger to data integrity than you might think. A simple email with confidential data sent to the wrong address may lead to a huge data leak. Make sure that your employees are familiar with the company’s security policy and are aware of what they should do to maintain security each person in the company should clearly understand that integrity of information assets is their personal responsibility.
Dr. Barry Chaiken, chief medical information officer, Infor Healthcare providers organizations invested billions of dollars purchasing and implementing electronic medical records with this investment driven by the economic incentives provided by the HITECH Act. Now that these systems are installed an up and running, organizations struggle to obtain real value from these investments. These systems were implemented with speed in mind rather than clinical transformation that improved quality and reduced costs. Now, organizations must embrace clinical transformation and change management to redo workflows and processes to effectively impact care. Organizations cannot justify their investment in EMRs unless they rework their EMR implementations to obtain true value from their deployment.”
Guest post By Barry P. Chaiken, MD, FHIMSS, chief medical information officer at Infor.
In many ways healthcare is like a symphony orchestra. Although information technology can enhance care planning, assist in medication administration and reduce duplicative testing, it cannot replace the people required to deliver care services to patients. Nurses are needed to administer medications, therapists are needed to provide treatments, and physicians are needed to diagnose illnesses and provide treatment plans. On average, hospitals devote close to 70 percent of their budget to labor costs. Until robots replace humans in the delivery of patient care, selection of the proper skill mix and number of professionals remains a significant factor that determines cost in provider organizations.
Although information technology cannot replace the staff delivering care to patients, it can assist organizations in choosing the best talent available, help develop that talent and determine the best way to utilize the skills of these professionals.
To identify the best talent, information technology tools allow the extraction of an employee’s “behavioral DNA” – the measurement of behavioral, cognitive and cultural traits. Organizations then compare this prospective employee’s “DNA” to the “DNA” of existing high performing employees within the organization in an effort to identify individuals who possess a high probability of excelling within the organization.