The healthcare industry plays an important role since it impacts people’s lives in various ways. As innovations continue to evolve, they have brought about significant changes in the quality of health services, particularly in delivering dependable and high-quality patient care.
Apart from advancements, the healthcare industry has faced many challenges. Most of these challenges result from regulatory or legislative mandates, security threats, and process changes brought about by new technology, to name a few.
By Terrence D. Sims, president of strategic growth and marketing, Raintree Systems.
As COVID-19 continues to influence patient behaviors and causes providers to reevaluate how they operate their businesses, healthcare practices all around the world started looking for solutions that emphasize clinical efficiencies, elevate patient revenue cycle management, as well as feature enhanced reporting and analytics tools.
More so, along with facing challenges of the patient intake process during a pandemic, providers have also been put to the test with learning how to meet the sudden demand for virtual care by adapting to digital healthcare technologies that utilize high levels of automation, facilitate more patient engagement efforts and focus on financial sustainability.
Security and Compliance
In the world of healthcare, efficiency doesn’t just matter at the surface-level but rather in every individual aspect of treatment whether it be scheduling, reporting or financing. To ensure your EHR can keep up with regular system updates, it should host an educational database that allows providers to quickly train staff as well as give patients easy access to explanatory articles and videos. Having these resources conveniently available will help foster positive patient outcomes and encourage seamless software maintenance.
Additionally, while compliance laws allow for the protection of patients’ health information (PHI) and the overall safety of practice operations, it is also important to understand that cybersecurity is an extremely high priority. Especially now with the shift to a remote workforce, employees at home are much more vulnerable to hackers’ attempts to cease connectivity and override confidential data, making the use of virtual private networks (VPN) and verified firewall software critical to the safeguarding of vital business information.
By Courtney Tesvich, vice president of regulatory, Nextech.
Data interoperability is once again poised to take a giant leap forward and there are many factors propelling this evolution. For example, the Office of the National Coordinator’s (ONC) March 2020 introduction of the interoperability rule as part of the 21st Century Cures Act is set to advance interoperability regulations. COVID-19’s spotlight on the need for data transparency and seamless information exchange to enable efficient care delivery across diverse settings is revealing a critical use case.
The rapid onboarding and use of telehealth to virtually deliver safe and secure healthcare underscores the importance of modernizing interoperable solutions. Given all these factors, the time is right for healthcare organizations to evolve their thinking around data sharing.
While larger, multi-setting health systems may have teams of people dedicated to advancing their organization’s interoperability strategy, smaller entities (including specialty physician practices) are often left to figure out the right path forward on their own. This can be overwhelming, and it may be tempting for smaller organizations to delay work on this issue. However, it will only postpone the inevitable.
Over the next two years, the capabilities and requirements to exchange electronic health information will change drastically. The ONC is allowing two years to implement the new interoperability requirements and technology will likely change in that time. So, starting the effort now can make it easier to adapt as solutions evolve. The bottom line? To meet this deadline, practices need to develop their strategies, update compliance efforts, understand upcoming changes and begin to update processes to ensure they are fully prepared for the near future.
But how can an organization get started? Here are a few steps to consider.
Educate yourself on the intent and nuances of the ONC rule. The primary goal of the interoperability rule is to give patients greater access to their health information and allow them to share the data more easily with all providers. As electronic health record (EHR) vendors continue to develop their products to meet the updated requirements, more information than ever before will be available electronically both for patient use and for exchange. Factors that providers should be aware of include:
Future availability of free text notes in the patient portal as well as nearly all lab, radiology and pathology results. As EHR vendors develop and certify to the US Core Data for Interoperability requirements, patients will see additional data beyond the previously available CCDA information in their portal, including visit notes.
Patients will be able to seamlessly select independent apps to aggregate their own health records.
Ensure your practice understands how to handle requests for information in a timely manner. This includes requests by patients for their data as well as data requests by insurance companies, employers and consumer-facing apps. Develop a policy and train staff before the new Information Blocking deadline of April 5, 2021. Ensure you continue to follow HIPAA guidelines as well.
Practices will also need to regularly update clinician information in federal databases.
These suggestions merely scratch the surface of what the new rule requires. Providers should delve deeper and make sure they are moving towards compliance and not inadvertently standing in the way of information exchange.
Applications have a direct impact on hospital workflows. While the former captures data, the latter passes it along to inform other processes and procedures. If either is impeded by usability, the consequences can have a ripple effect throughout an entire organization. Sending and receiving patient information fast and securely is critical to delivering quality care.
The Healthcare Information and Management Systems Society (HIMSS) defines EHR usability as “The effectiveness, efficiency and satisfaction with which specific users can achieve a specific set of tasks in a particular environment.
In essence, a system with good usability is easy to use and effective. It is intuitive, forgiving of mistakes and allows one to perform necessary tasks quickly, efficiently and with a minimum of mental effort.” Unfortunately, the lack of EHR usability and interoperability are still huge concerns for the healthcare industry.
According to a study conducted by Mayo Clinic researchers, modern electronic health records (EHR) are less user-friendly than Microsoft Excel, Microsoft Excel, and Google. Using the System Usability Scale (SUS), Electronic Health Records were marked with an unsettling “F” and a SUS score of 45.
The results were then cross-referenced with physician burnout using the Maslach Burnout Inventory(MBI). The study clearly showed that SUS scores have a direct impact on emotional exhaustion, depersonalization, and overall burnout within the healthcare sector. As system usability decreased, emotional exhaustion and depersonalization scores increased, as did the risk of burnout.
The coronavirus pandemic in particular has shed a spotlight on the lack of EHR usability and interoperability. With more than two million COVID-19 cases in the United States, hospitals have been overwhelmed with the increase in protected health information (PHI) being exchanged, documented, and managed. Slow transmissions and busy signals associated with limited PSTN-based fax numbers and legacy systems have prevented patient records, test results, prescriptions, and insurance information from being processed efficiently.
By Scott Galbari, chief technology officer and CISO, Lyniate.
For as long as healthcare data has existed, so has the healthcare industry’s challenges with interoperability. The pursuit of healthcare data interoperability has been a longstanding industry challenge, and with the recently finalized interoperability rules from the ONC/CMS going into effect at the end of this month (though deadlines will be extended until mid-2021), interoperability yet again is at the center of many healthcare discussions.
The rules, which aim to provide patients with greater control over their health data and eliminate information blocking, has not been without its critics. Some argue this rule will put patients at risk by inadvertently exposing patient health data to security breaches. However, the spread of the coronavirus pandemic across the United States has underscored the dire need for seamless, bi-directional data exchange. The new rules’ focus on FHIR and APIs to enhance electronic health information sharing are proving to be exactly what we need in the current crisis.
The coronavirus has necessitated all kinds of changes — from rapidly escalating the use of telemedicine, to standing-up temporary testing sites and care centers, to meeting enhanced public health reporting requirements — all of which would have been much more easily addressed if the new rules’ requirements were already in place, and all of which have presented significant challenges amid the COVID-19 crisis.
Because of these unprecedented circumstances, healthcare stakeholders are being required to share health information and data at increasingly high volumes, emphasizing the importance of strengthening the internal infrastructures of these organizations to ensure they can properly send, receive, and analyze health information. However, because of the strain COVID-19 has put on healthcare organizations, the Department of Health and Human Services (HHS) has decided to push out the timeline for meeting the rules’ requirements. While the reasoning for this is understandable, in many ways it is unfortunate that these requirements were not already in place prior to the pandemic.
Healthcare has a new acronym – OBRHI. Quite a mouthful. Perhaps “Aubrey” is a little easier to say.
The Centers for Medicare & Medicaid Services (CMS) announced the creation of a new office, the Office of Burden Reduction and Health Informatics. It is designed to reduce friction and regulatory and administrative burden between itself and caregivers – “to further the goal of putting patients first, the organization said in a statement.
PER CMS, this office is an “outgrowth” of its Patients over Paperwork (PoP) Initiative, meant to cut administrative red tape across the health system. Additionally, the agency said it seeks reform through the office to eliminate “duplicative, unnecessary and excessively costly requirements and regulations.”
As part of the PoP Initiative — focused on reducing the unnecessary regulatory burden to allow providers to concentrate on their primary mission – these efforts and the office’s creation hope to save clinicians $6.6 billion and 42 million burden hours through 2021.
“As part of our efforts to date, CMS has heard from over 2,500 providers, clinicians, administrative staff, health care leaders, beneficiaries and their support teams through 158 site visits and listening sessions,” the agency said. “Through more than 10 Requests for Information (RFI) combined with stakeholder interviews, CMS also has over 15,000 comments to assist us in our burden reduction efforts.”
CMS Administrator Seema Verma said in the agency’s statement: “Specifically, the work of this new office will be targeted to help reduce unnecessary burden, increase efficiencies, continue administrative simplification, increase the use of health informatics, and improve the beneficiary experience.”
In its effort to streamline, CMS says it’s seeing “significant results,” including removing unnecessary, obsolete or excessively burdensome conditions of participation for hospitals and other healthcare providers previously spent on paperwork and faster processing of state requests to make program or benefit changes to their respective Medicaid programs through the state plan amendment and section 1915 waiver review process.
“The new office will strengthen CMS’s efforts across Medicare, Medicaid, the Children’s Health Insurance Program and the Health Insurance Marketplace to decrease the hours and costs clinicians and providers incur for CMS-mandated compliance,” the agency said.
OBRHI (or “Aubrey”) may also increase the number of clinicians, providers, and health plans CMS engages, it says, to ensure it gains a better understanding of how various regulatory burdens impact healthcare delivery.
Aubrey also will focus on health informatics development, the use and application of health data and clinical information to healthcare, as well as furthering interoperability innovation.
Time will tell if OBRHI is just another red-tape agency or if it reaches its intended goal of improving communication with caregivers and driving healthcare innovation. Lovers of big government, applaud, Those who feel the government-run programs like the DMV are the pinnacle of customer service, furrow your brow.
Much like the formation of New Year’s Resolutions, the prediction of technology trends for the coming year has become a tradition among pundits, analysts and vendors alike. As the calendar turned to 2020, Hyland, like many, took the opportunity to look into a crystal ball to predict what the future might hold for the software industry at large, as well as many of the key vertical markets in which it operates.
For example, Hyland leadership revealed six overarching trends for enterprise technology as well as key trends to watch for health IT. At the time, none of us could have foreseen that a global pandemic was coming that would turn all of these predictions on their collective ears.
Of course, the healthcare industry has been particularly impacted by COVID-19. Provider organizations have justifiably focused their attention on responding to the new patient care and staffing needs brought about by the virus. That said, all of the health IT trends Hyland outlined at the beginning of 2020 (interoperability, artificial intelligence and cloud adoption) still have relevance in today’s unprecedented landscape. Although, admittedly, the reasons these topics are trending are for vastly different reasons than we originally anticipated.
I want to revisit these trends under the lens of COVID-19 as well as add a few more to the list in light of current circumstances.
Original insight: Secure access to patient information at any facility throughout a care continuum is an imperative for delivering a longitudinal digital record that travels with the patient. The key is to ensure tight integration between disparate IT systems, and to include unstructured data in the interoperability equation. As much as 80% of essential patient information is in an unstructured format – such as digital photos and videos, or physician notes – and not natively included in an electronic medical record (EMR) system. When removed from a clinician’s view, the patient record is incomplete.
New relevance: Health IT interoperability was important prior to COVID-19, and it’s even more critical now. Providers, patients and public health officials need all-encompassing data in a standardized format to better understand this evolving illness and develop guidelines. The effort to identify risk, control spread and manage the treatment of afflicted patients is a coordinated effort among multiple healthcare providers and external care partners. The easier information can be shared among these varied stakeholders, the better equipped we’ll be to combat the virus.
Artificial Intelligence (AI)
Original insight: Realistic applications of AI are coming into focus in healthcare, showing where the technology will help providers optimize workflows and better analyze the vast amounts of information needed to support improved decision making. Experts view AI technology as complementary and a true asset when it comes to helping physicians analyze the overwhelming amount of patient data they receive daily. Physicians can implement AI to streamline or eliminate tedious tasks, such as manual documentation and data search, or cull information to help them focus on a key area of interest.
The medical imaging space in particular provides a tremendous area for the growth of AI and machine-learning technologies. Clinicians can use them to analyze thousands of anonymized diagnostic patient images to identify and detect indicators of everything from lung cancer to liver disease. These technologies are also being used to accelerate research.
New relevance: AI is being used in a number of ways to address the challenges of COVID-19. For example, AI algorithms have been used to identify the spread of new clusters of unexplained pneumonia cases. Other AI applications are being used to spot signs of COVID-19 infections in chest X-rays and identify patients at high-risk of coronavirus complications based on their pre-existing medical conditions. Still others are scanning the molecular breakdown of the virus itself as well as those of existing drug compounds to identify medications that can potentially target the virus and shorten the span of the illness or lessen the severity of the symptoms. In all of these scenarios, AI is quickly analyzing large segments of data to accelerate research and treatment. This automation is indispensable in an environment where medical staff are stretched to their limits, and the act of saving time could save lives.
More than half of Americans have experienced the sick feeling that comes with opening a medical bill they assumed would be covered by insurance. Surprise medical bills are on the rise, often driven by services administered at an in-network facility using out-of-network providers.
A Journal of the American Medical Association(JAMA)analysis of privately insured patients showed that between 2010 and 2016, inpatient admissions with an out-of-network bill increased 16%, and emergency department (ED) admissions with out-of-network billing went up more than 10 percent.
As alarming as the number of surprise bills is the impact on patients’ pocketbooks. In the same timeframe, potential patient liability skyrocketed from $804 to $2,040 for inpatient services and from $220 to $628 for ED visits.
Price transparency and accurate estimates are critical to preventing surprise bills and giving patients more control over their healthcare spending. Many providers are experiencing increases in self-pay patients, often because patients have a high-deductible plan that requires significant out-of-pocket before coverage kicks in. As such, patients need the ability to compare prices across providers and get accurate estimates of what they’ll owe before making healthcare decisions.
Why healthcare bill estimates are so difficult
Many factors contribute to the historical absence of bill estimates, but it starts with healthcare payment system fundamentals. Unlike other industries where transactions involve a buyer and a seller, healthcare brings in a third party, the payer, who is typically reluctant to reveal publicly what they pay various providers for services. Contracts, discounts, coding and other variables make it inherently difficult to achieve price transparency.
Price transparency progress
A step toward more price transparency came when the Centers for Medicare & Medicaid Services (CMS) required hospitals to publish their chargemasters online, starting January 1, 2019. Unfortunately, neither consumers nor many hospital employees could translate the data into usable, patient-specific bill estimates. In fact, more than half of hospitals in a 2019 survey said the move created further confusion.
In June 2019, President Trump issued an Executive Order to improve healthcare price and quality transparency. CMS later issued a final rule expanding current requirements for hospitals. These include providing a machine-readable file containing negotiated rates for all items and services annually and a consumer-friendly display of gross and negotiated rates for 300 “shoppable” items and services, including 70 defined by CMS. Insurers would also be required to provide members personalized out-of-pocket costs for all covered services in advance. These new rules are planned to take effect Jan. 1, 2021.