By Mark Weber, SVP of healthcare development, Infor.
Mark Weber
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.
By Donald Voltz,MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Donald Voltz, MD
Healthcare is evolving quickly and HIMSS 18 offers a broad range of healthcare issues to explore. New requirements for implementing HIT systems have changed dramatically in the last few years as new health IT priorities and procedures have emerged. Convergence in the health care sector has accelerated the need for interoperability, not just for EHRs, but also across clinical, financial, and operational systems. This need is also challenging and changing one of the biggest traditions in healthcare—the doctor patient medical visit.
In the past, patients would simply make appointments to visit their physicians. Now, we have the popularity of Annual Wellness Visits (AWVs) and the growing need for chronic care treatments caused by the opioid epidemic and other behavioral health issues. This trend is causing physicians to be the ones actively pursuing patients, but with both sides reaping the benefits of this new arrangement. The new approach to the traditional doctor-patient relationship enables patients to receive better care while clinics and hospitals build up a roster of new and potentially long care patients.
Disrupting this office visit tradition are also larger, long-term HIT trends, such as the widespread implementation of electronic health records (EHR) and other healthcare practices. However, these trends spurred many challenges, but also a great deal of opportunities, many of which have yet to be fully capitalized upon. To understand these changes, we need to be cognizant of the increasing opportunities patients and physicians have in accessing and interfacing with the healthcare system.
Patients have a great deal more choices and entry points to the complex and dynamic healthcare system than they had even 10 years ago. When Medicare, Medicaid, organ transplantation and synthetic insulin were coming in vogue 50 years ago, patients had relatively limited access to healthcare. Those that did often choose to enter the system through a single physician who they had built a long-term relationship with and who served as the conductor of any labs, studies or further consultation from specialists. With the implementation of governmental and private healthcare insurance options, patients had improved access to care. Commensurate with this increased access to care, an increased national health expenditure followed.
With increased costs, healthcare responded by changing the way patients interacted with the system. Beginning in the ‘70s and continuing into the ‘80s, the rise of HMOs and capitation attempted to improve national healthcare, but this led to limitations in patients’ choice and began the concept of bundling services, cost sharing, and expansion of preventative care. Other managed care plans and a focus on utilization of care continued to decrease the cost of care.
Although many aspects of these managed care structures benefited patients, such as preventive services and prescription coverage, access to services and specific physicians were constrained as “in” and “out” of network coverage, limiting patient choices. The implementation of EHRs has established the foundation upon which opportunities are and will be found to improve healthcare quality by improving the decisions being made.
Enhanced access of patient data by authorized patients, professionals and algorithms focusing on analytics or artificial intelligence is now a requirement for enhanced patient engagement, improving professionals’ delivery of care, enhancing clinical decision making and optimizing patient outcomes while maintaining choices that are consistent with best practices, patient values and prior empirical experiences.
Evolving Relationship Drives Healthcare Revenue
While the doctor-patient relationship has evolved, hospital systems and physicians must still derive revenue which is still at the core of that relationship. The healthcare industry is now looking at revenue which can be generated through the interoperability of annual wellness visits (AWVs), chronic care and service care transitions between physical and behavioral health services. Hospitals and healthcare clinics that can connect these services with technologies such as bi-directional information flow will benefit by creating new profit centers of revenue through reimbursements by CMS and private insurers.
“Programs such as revenue cycle management are important for any healthcare institution’s bottom line, but when carriers can actually drive revenue using cloud based, bi-directional interoperability technologies that enable doctors to spend more time with patients and therefore provide superior care, then flipping the traditional patient-doctor relationship is a winning trend for the healthcare industry,” said Doug Brown, managing partner, Black Book Research.
Driving this trend are new apps and innovations that address the payment gap caused by medical billing and collections processes with outdated EHR platforms and inoperable systems. New technologies from organizations, such as Core Care Medical and others, fueled by the growth of cloud computing in the healthcare industry are improving real-time communication and data exchange. Here are some examples of how this is working which you might not hear about at HIMSS.
Hospital CEO Drives Revenue with Doctor Patient Visit Apps
A healthcare colleague, David Conejo, CEO, Rehobath McKinley Christian Healthcare Services (RMCHS) is boosting revenue right now using this doctor/patient flipping model as a strategy to help in his effort to improve behavioral healthcare for Gallup, New Mexico’s large Indian Reservation community who suffer from addiction to alcoholism and opioids.
He integrates data from the hospitals’ three clinics using a cloud application that streamlines data from AWVs and integrates it with any EHR system without data duplication. The Zoeticx ProVizion app also allows for the management of support tracking for wellness visits, provides a physical assessments guide through preventative exams, and maps out the risk factors for potential diseases for patient follow-up visits. He can then enter the relevant data about the patient.
In addition, it includes everything else that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurers billing requirements. RMCHS’ business is growing with full or near-full compliance. And with its ACO in startup mode, RMCHS is also receiving a bonus check for $80,000 from Medicare for containing costs, in addition to the new revenues being generated.
The fact that more patients can be seen is a bonus. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, but if a physician saves 10 minutes per patient, at 18 patients a day that’s an extra 180 minutes. More minutes, more patients.
It’s not exactly a sweater or tie that gets worn once and then relegated to the top of the closet, but it turns out that patient data may have something in common with unloved holiday gifts. Both, it appears, are shared and then seldom used.
At least that’s one takeaway from a recent Health Affairs study on interoperability and how far forward we’ve actually moved the ball. The authors used the most recent available data (2015) and the four interoperability standards established by the Office of the National Coordinator (ONC)—finding, sending, receiving, integrating—to conclude that progress on this measure is lagging, at best.
“… Progress toward interoperability has been slow, with fewer than 30 percent of hospitals engaging in all four domains of interoperability in 2015 and with an increase of only 5 percentage points from 2014,” the authors write.
The low percentage of hospitals using all four standards is particularly significant in that simply sending or receiving data does not guarantee its use. Of those hospitals that said they sometimes, rarely or never use outside patient data in care (55.8 percent), or didn’t know (11.2 percent) how often they used it, the most oft cited explanation was that “clinicians could not view the information in the EHR as part of their workflow.”
“Issues with integrating information into existing EHR systems and clinical workflows were the most commonly cited barriers for hospitals that were not routinely using external information for patient care, which further underscores the need to shift the policy focus from transmitting information to information usability.”
Ah, yes, usability … yet another technological imperative that ends in ‘ability.’ Health Affairs suggests that data usability has a lot to do with EHR sophistication.
But is it having an advanced EHR that improves data usability? Or is it perhaps having the same EHR as the facility you share data with? As Health Affairs points out, those hospitals that most frequently share patient data via HIE are those working with an EHR and HIE from the same source.
“Without strong incentives that would have created market demand for robust interoperability from the start, we now must retrofit interoperability, rather than having it be a core attribute of our health IT ecosystem,” writes Julia Adler-Milstein, also an author of the Health Affairs study, in a recent NEJM Catalyst article. “And, if there had been stronger incentives from the start, we would not now need to address information blocking: the knowing and intentional interference with interoperability by vendors or providers.”
Adler-Milstein argues that policymakers dropped the ball more than any stakeholder group. The EHR vendors and providers, she says, are just working within the boundaries to retain or improve their respective positions.
“Of the stakeholders, only policymakers have a clear, strong interest in promoting interoperability,” she says. “Therefore, it is up to them to ensure that robust, cross-vendor interoperability is a stay-in-business issue for EHR vendors and providers.”
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
A personal health record of any patient, whether it is an aging parent, a spouse or a child with a chronic illness, contains a summary of medications, lab results, visit notes, billing information and more, and interoperability makes it easy to manage all these files and documents with just a few clicks.
Every form of health data makes an entry in an EHR today thanks to the shift towards a digitized healthcare in U.S. Although this has made data entry, storage, retrieval and exchange easier, it has brought with it certain challenges. Integrating and utilizing EHRs is the first baby step; however, if we are to overcome all the hurdles then achieving 100 percent EHR interoperability is the summit where we are yet to reach.
Physicians want to optimize the full potential and promise of EHRs for the simple reason that improved communication between systems will lead to a better and enhanced care. Once all the systems in use nationwide are connected and interacting with each other, patients will find it easier to seek a second opinion as their health information will reach the physician in a matter of seconds.
How interoperability exists today
Today, various interoperability standards have developed for the sake of continuous improvement in this realm. Health Level Seven (HL7) has produced the likes of HL7v2, HL7v3, and the latest FHIR as competent standards that exist in the industry for better streamlining of documentation and care coordination. With the help of FHIR, physicians can access health data on their mobile phones through various API (Application Programming Interface) functions that FHIR supports. This ease of access to complete and accurate patient data, in due course, helps in many ways. As providers and health coaches work together on improving the health of people, it also significant for them to be able to access accurate data from sources other than EHRs. Apart from EHRs, HIEs have popped up in various places that allow for the smooth flow of data across the health care network.
Ways in which interoperability facilitates healthcare
Physicians can easily access and share medical information with their patients and perform their tasks with greater efficiency. This could be done by increasing the efficiency of monitoring chronic diseases. Besides saving time and labor cost, physicians and patients with access to interoperable health information can benefit from higher-quality patient outcomes. Interoperable EHRs carry the potential of giving easy and ongoing access to patient’s health records to the physician. For a doctor to have an updated and detailed medical history of his patient cannot just be live-saving, it will mainly help those people who are always on the move. This will empower an individual to move across the continuum of care seamlessly with their clinical record.
Doing more with less
As value-based care and reimbursements stepped into healthcare, the US managed to turn the tide towards a more qualitative and equitable delivery of care. This has made physicians more responsible for better patient health outcomes than ever before. To manage hospital readmission and managed care plans, physicians need to have as much patient information as possible at hand at all times. This is where interoperability comes into play by aggregating and relaying data from disparate regions and bringing it onto a single platform.
For a secure data exchange to take place amongst healthcare organizations and patients, it’s important that both parties are willing and equally involved in the sharing process. This will inevitably lead to shared decision making apart from the fact that the physician will be able to make quick and informed decisions. The ultimate aim is to have a complete understanding of the health status of patients and helping them navigate effectively in their health journey for a better patient experience.
Patient-centric interoperability is the direction in which healthcare is slowly moving. There’s so much that we can do with the availability of data. Ongoing monitoring of patient data can better facilitate the ongoing management of that patient’s health and the physician can intervene where necessary. With this, patients too can track their progress and work towards improving their health hand-in-hand with the physicians.
Challenges that interoperability is yet to solve
One of the issues that interoperability is dealing with today is the vast and disjointed patient data that exists in regional HIEs and independent, transactional databases like EHRs. Along with this, patient privacy concerns and consent are other risk factors that need to be considered when diving through protected health information data. Lack of a common standard, state policy rules, workflow and policy difference and the need for incentives are some barriers in the way of achieving 100 percent interoperability.
Guest post by Joanna Gorovoy, senior director product and solutions marketing, Axway.
Joanna Gorovoy, MBA
The healthcare industry is in the midst of digital transformation. At the same time, heightened government regulation, evolving healthcare policies and a rise in healthcare consumerism are driving a shift toward value-based, outcome-driven care models.
The focus on maximizing value and outcomes requires organizations across the healthcare ecosystem to work together, especially across a variety of different, and often unaffiliated organizations, including hospitals, health insurance companies, pharmacies and wearable health tech companies. Additionally, data silos and interoperability issues make it difficult to derive value from health data across ecosystems, provide quality patient care and optimize health outcomes.
Healthcare IT leaders in today’s digital era face a great opportunity and a daunting challenge: deriving value from massive volumes of healthcare data while meeting heightened demands for data privacy and security. In 2016 alone there were 106 major healthcare data breaches, exposing 13.5 million individuals’ records. As healthcare data breaches continue to rise in numbers, healthcare IT leaders must reevaluate how they approach key initiatives across patient engagement, population health management and care coordination.
They need to provide secure and innovative digital experiences by implementing application program interfaces (APIs), which are a set of routines, protocols and tools for building software applications, and increase awareness of industry standards, such as Health Level Seven International’s (HL7) Fast Healthcare Interoperability Resources (FHIR). Doing these two things will provide assistance in addressing interoperability issues and simplify the exchange of health information across the ecosystem.
But it doesn’t stop there. Moving toward a future where healthcare data is more widely accessible will require greater security management across all organizations that have access to patient data. To create a more secure and scalable foundation for digital innovation in healthcare you must follow these three steps:
At the beginning of their existence, electronic health records (EHRs) were primarily used as a document management system. Now, they have realigned their objectives and value to the physicians and practices they serve, to focus on data intelligence. If specialty practices want to stay independent they need to continue to evolve, prioritize value-based care and stay profitable. Moreover, they need the right partners to help enhance operational efficiency, increase patient engagement and achieve better clinical outcomes. As such, the scope of the EHRs responsibility for the practice’s health, growth, and sustainability has increased exponentially.
How will specialty practices ensure their future? By leveraging the power of clinical and operational data in their EHR and supplemental business applications, working together within the healthcare IT (HCIT) ecosystem. Businesses across all industries analyze data to measure overall industry performance. Metrics are the foundation for any successful business and physician groups are not excluded. Metrics should be the driving force behind every major decision that will boost productivity. However, physicians are not data scientists, but by utilizing the next generation HCIT systems, they can employ technology that will streamline the decision making process.
Challenges turn into opportunities
According to the Centers for Medicare and Medicaid Services (CMS), 171,000 physicians who did not collect and use data to comply with government regulations are looking at a three percent Meaningful Use penalty in 2017. Coupled with a new focus on value-based care requirements playing a critical role in care and outcomes, upgrading their data platform and capabilities should be the number one priority to comply with new industry standards. Data driven HCIT solution providers can prepare specialty practices for these coming changes. They help collect and analyze data to ensure effective treatment plans at lower costs.
Bottom line: This helps improve patient health and satisfaction.
Today’s HCIT systems are considered business tools that help physicians analyze data and reveal insights to use for enhanced decision making. Popular “big-box” HCIT systems try to be all things to all providers, yet they are tailored to hospitals and primary care physicians—many who typically see far fewer patients in a day than specialists. This puts a major burden on specialists, who rely on different clinical and operational data to help maximize outcomes.
Specialists potentially see up to 60 patients a day – and cover surgeries, follow-ups and everything in between. Generic HCIT systems fall short in relation to appointment volume. Combined with the fact those systems make data entry inefficient, impede clinical workflows, and lack business metrics, this is the major argument for specialty-focused HCIT solutions. Some groups acquired by hospitals or health systems have not adopted the integrated systems of their new parent companies. Instead, they stay with their specialty HCIT systems—interoperable with their parent companies’ technology—because of their ability to serve existing, proven workflows.
Data insights and a workflow makeover
Specialty HCIT systems that analyze a variety of data and provide practices with the knowledge to improve their performance will deliver the best outcomes for patients and practices. Analyzing operational data provides an understanding of how to deliver the best patient care at the lowest cost, thereby delivering optimal outcomes and increasing patient satisfaction levels.
Specialists should take the opportunity to re-evaluate their EHR and determine if their goals are helped or hindered by their current HCIT ecosystem. A productivity-boosting HCIT system can harness the power of data to deliver clinical and business applications, workflows, and insight through one user interface and make compliance with reporting requirements simple and straightforward.
Guest post by Joel Rydbeck, director, healthcare technology and strategy, Infor.
Joel Rydbeck
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.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
The story of Geraldine Alshamy explains how a minor complication in healthcare network can be catastrophic! The patient started experiencing severe headaches, and she was rushed to an emergency room. Since she didn’t have a primary care physician, she had a previous condition of hypothyroidism. But because of a lack of proper communication channel, her care process wasn’t the best that she could have gotten and, unfortunately, she had a heart attack!
This story might seem unusual but enough to understand that the consequences of uncoordinated health care could be grave. Health care is too critical and margin of error doesn’t exist here, it is imperative that we realize the importance of coordinating the healthcare sector and bridge the gaps in care.
Why Coordinated Healthcare?
When patients are brought in to be treated, the thing that physicians, nurses, assistants and other professionals require are the relevant medical information about them. For such a scenario, healthcare providers need to be well connected to provide coordinated care through smooth information flow.
According to a survey, some 40 percent of physicians believe that their patients undergo problems because of lack of coordination and information exchange between providers. The possibility of repetitive tests, unnecessary visits to the emergency rooms and preventable readmissions increases, giving way to poor health outcomes. Inadequate care coordination is estimated to cost as much as $45 billion to the healthcare industry, tagged as wasteful spending — $8.3 billion are lost every year because of inefficient technology.
What is the aim?
With everything around us changing and healthcare picking up pace, it’s high time we start thinking accordingly. The future of healthcare is smart teams aiding the one-on-one patient-physician interaction for better outcomes. These teams have physicians, nurses, financial advisors, health coaches and even family members and watch over patient’s health, follow-ups, and the insurance matters as well.
We have to move beyond the paradigm of isolated partial care towards integrated teams performing comprehensive patient care by encouraging the development of technology and providing care at hand with the center of our focus being:
1.) Accessible Care Anywhere
There used to be a time where people were not as well-connected to each other, and the only way of staying informed was telephones, letters, and postcards. With the evolution of information technology, we can safely share every ounce of information.
We need to put the rapid evolution of information technology to use and have patients connected with their physicians. Real-time alerts, genome sequencing, and data analytics will help us establish a world where patients won’t necessarily have to travel to a particular building and wait for hours to get treated.
2.) Connected Care Networks
Coordinated healthcare will hardly be possible without interoperable technology: teams connecting providers and specialists everywhere with the aim to deliver quality care. And the primary requirement for creating this team would be health information exchange, followed by notifying the PCPs.
