By Ashley Joseph, senior director of client services, Infusion at LeanTaaS.
Each new year brings about the opportunity to reflect, learn and welcome positive change in our personal lives. This ideology is also embraced by the healthcare industry, as we’re constantly looking to improve workflows and incorporate new technology to boost patient care and operational efficiency.
To say the healthcare industry has learned a lot from 2020 would be a drastic understatement. As we enter 2021, we have an opportunity to make improvements to the vulnerabilities exposed as a result of the coronavirus pandemic. Infusion centers (and their patients) were forced to get creative “on the fly” in 2020. With the new year officially here, we expect to see more change and creativity from infusion centers around the country, in response to yet more new challenges.
Infusion centers may expand their scope
In the past, infusion centers have had occasional times when a chair or two was used for non-oncology treatments. Now, we’re seeing these various treatments pop up in centers more frequently, especially some COVID-19 treatments like monoclonal antibody infusions used to treat coronavirus patients. This not only increases the scarcity of chair resources, but also creates issues around trying to treat COVID-19 patients in the same vicinity as severely immunocompromised patients.
Process bottlenecks may come from new sources
Infusion chairs have traditionally been the limiting factor in how many patients can be treated per day. Today, though, nursing shortages are just as likely to be the limiting asset. These shortages are caused by unexpected, COVID-induced early retirements, quarantines required due to COVID-19 exposure, and the fact that infusion nurses are highly skilled – and thus among those who can easily provide support in inpatient units when those units experience sudden or unexpected nursing shortages.
Some centers have been forced to create/section off infusion areas for cancer patients who have also tested positive for COVID-19. Every time that the overall pool of available infusion chairs needs to be segmented such that any patient can’t go into any chair, efficiency in the center overall will decline.
By Ashley Walsh, senior director of client services, LeanTaaS.
Elective surgeries were hit hard during the initial onset of the COVID-19 pandemic. In fact, 70% of elective surgeries in the country were put on hold to free up staff and resources to care for those infected with the virus. While putting elective surgeries on hold was a necessary precaution as most facilities navigated the uncertainty, patients with scheduled procedures had their care disrupted.
Now, as multiple waves continue to afflict the country and as we head into the flu season, hospitals have been actively seeking ways to build agility into their operating room capacity and better handle the elective case fluctuations.
Operating rooms are the economic backbone of a hospital, frequently generating 50% or more revenue for the institution. In fact, a single block of operating room time can generate $50K to $100K or more in net revenue per day, so when it comes to allocating time, every minute is sacred. Despite the unknowns, hospitals that are able to manage optimal surgical capacity despite the volume reductions followed by an influx of backlogged elective cases by having access to the right information and by adapting strategies that make the strongest impact. Let’s dive in.
Get ahead of seasonal and potential patient volume fluctuations
As a first step, providers should ensure that surgical case information is available that illustrates how many elective surgeries had to be pushed or rescheduled as well as how they have historically done during the flu season. The combination of this information will help predict the upcoming winter.
Although there are online tools available to pull these insights, it’s also important to lean on the skills of data science teams to help analyze this vital information. Here are a few important data points providers should have on file to make informed decisions during these uncertain times:
baseline monthly surgery volume before COVID-19 and the percentage of baseline cases during the pandemic;
the volume of new cases that you anticipate based on COVID-19 (e.g., surgeries resulting from car accidents have likely decreased because of fewer cars on the road);
the volume of cases you expect to lose based on people losing their jobs and/or health insurance; and
historical seasonal fluctuations, particularly during flu season.
Calculate actual surgical capacity
Once you have the project stats on hand, the next step is to consider potential constraints in terms of staffing and available beds in order to calculate true surgical capacity. While doing so, it’s important to consider potential options and workarounds that may be available to expand capacity, whether that be opening up additional operating rooms, staying open for longer hours, having weekend hours and/or even redirecting some procedures to other types of rooms, when possible.
At Electronic Health Reporter, we take innovations from healthcare companies very seriously. For nearly a decade, we’ve featured their work, products, news and thought leaders in an effort to bring our readers the best, most in-depth insight about the organizations powering healthcare. That mission lies at the heart of all we do, for the benefit of our audience.
For the first time, we are officially naming some of the most progressive companies in healthcare technology, in our inaugural class of the best, most innovative brands serving health systems and medical groups. Our call for nominations for this “award” series received hundreds of submissions. From these, we selected the best companies from that class. The work these organizations are doing is forward-thinking; award-worthy, we think. We think you’ll agree with all of our choices.
In each of the profiles to come in this series, we’re share their stories — from their own perspective, through their own responses to our questions about what makes them remarkable. Some of the names featured here you’ll recognize, some you won’t. But we believe you’ll agree – all those profiled are doing innovative, groundbreaking work! That said, here’s a member of our inaugural class:
There is tremendous pressure on health systems to serve more patients, particularly as the need for services rises and insurance disbursements decrease. Adding new facilities to accommodate demand is often not a feasible option due to budgetary/capital constraints nor is adding more doctors with nowhere to put them. As a result, healthcare leaders consistently ask whether they are getting all that they can out of existing resources.
Operating rooms are a prime example. They serve as the economic backbone for health systems, and organizations need to maximize the use of OR capacity if they want to achieve their fiscal and patient access goals. Yet effectively managing OR blocks and scheduling in the face of volatile weekly demand patterns can feel like trying to squeeze blood from a stone.
If a significant portion of OR time has been reserved as dedicated blocks for surgeons or service lines, unless time not needed is released efficiently, ORs end up both not being used during business hours and yet working late into the night. Patients wait longer than necessary for scheduling procedures and organizations lose revenue.
Additionally, poor OR utilization makes it extremely difficult to accommodate the new surgeons that health systems want to attract. Current providers have a lock on ORs far in advance, regardless of whether they may need the time or not and/or later release these blocks. Such practices leave few opportunities for new surgeons to secure time when needed.
To remedy the situation, health systems are turning to data to look for insights into what can be done to improve OR utilization. After all, small changes in utilization translate to big differences in patient access, revenue and profitability.
The Role of EHRs
As data insights move to the forefront in organizational decision-making, there is some confusion about what EHR systems do and the role that they play. In a nutshell, EHRs tell you what’s already happened. They are vital systems, absolutely necessary for describing problems within organizations and supplying the data to back up assessments.
Breaking this down further, the purpose of implementing an EHR is threefold:
Reservation system: EHRs provide health systems a way to reserve resources, whether it be rooms, infusion chairs, or clinic time. EHRs do this as well as enable scheduling of specific equipment or providers.
Single source of truth for patient encounters: Organizations need a way to maintain records for every patient encounter — a single instance for each enterprise deployment — and EHRs provide this.
Descriptive reporting: Health systems require reporting. EHRs generate reports based on what was done, sort of like how Charles Schwab tells you how your portfolio performed.
While these functions are all essential to running a successful health system, there are several things EHRs are NOT designed to do no matter how much teams may wish they could. For example:
Everywhere, everyone is building dashboards: Tableau reports, Excel spreadsheets and others. To paraphrase many hospital leaders I meet: “We’ve spent tens of millions of dollars on an EHR implementation. On top of that, we have invested a lot on reporting capabilities; we have lots of dashboards throughout the hospital to keep track of everything. And teams of people dedicated to BI, reporting, data visualization, ETL, and custom report generation. How can we leverage this investment to improve operational performance?”
The issue is we often “admire the problem” and end up with results that aren’t too actionable, resembling what you can do by looking at yesterday’s weather. As an example, for operating room performance, most health systems can track room and block utilization and drill down to individual surgeons to see their metrics: utilization, first-case on-time starts, turnover time, etc. However, making the metric visible isn’t the same thing as improving on it. If a surgeon’s block utilization is, say, 53%, what can we do about it? Can we take away 47% of his or her allocated time? No. Let’s say, hypothetically, that we eliminated all first-case delays. Can we really reclaim those pockets of time and put cases in them? Not likely. So, what exactly is the purpose of measuring block utilization?
Going forward, hospitals will need to go beyond dashboards and describing or diagnosing the problem and actually predict what’s likely and prescribe the action they can take in a data-driven and defensible way. For example, in the above scenario, imagine looking at truly repurposable portions of time being left on the table by block owners; taking into account past case volume and mix, seasonality, and other key factors to predict which ones won’t need all the time allocated; and being able to produce the type of “prescription” that is surgeon-centric and data-driven as well as fully defensible.
Data will drive action based on prediction and prescription — much like Waze, Uber surge pricing, and so many other real-world examples that we all use in our day-to-day lives.
The cornucopia that is the annual HIMSS conference and tradeshow – healthcare technology’s biggest event – is behind us, but what’s left in the wake is wonderful, inspiring even, if not a bit overwhelming. The reactions to this year’s event have been overwhelmingly positive. Interoperability in the form of data sharing and a ban on patient health information blocking by CMS (through proposed rules released the first day of HIMSS) set the tone.
This was followed by CMS administrator Seema Verma taking a strong tone in all of her presentations at HIMSS, with the media and during her keynote speech. The federal body made it clear that data generated from patient care is, unequivocally, their data. While these themes heavily influenced the show, there were other takeaways.
There are many other diverse opinions about what came out at HIMSS19 and the themes that will affect healthcare in the year ahead. For some additional perspective, I turned to healthcare’s thought leaders; people who are a lot smarter than I. Their responses follow. That said, did we miss anything in the following?
Dr. Geeta Nayyar, Femwell Group Health and TopLine MD
After spending a week surrounded by some of the most intellectual and innovative minds globally in healthcare at HIMSS19, I’m even more confident that the shift toward patient engagement mass adoption is well underway and ON FHIR. The new CMS/ONC proposed law around interoperability and penalties for “information blocking,” are both touchdowns for the quarterback, which remains to be patient engagement. The robust discussions during the pre-conference HIMSS patient engagement program, reflected a move to a consumer-centric approach evidenced by the presence of Amazon, Google and Microsoft at the show. The keynote by Premier’s CEO Susan Devore shared a consumer-centered, provider led vision, “with data flowing seamlessly and being analyzed and effectively leveraged to guide decision making at the point of care.” Collaboration in healthcare is the key to everyone’s success. I was inspired to see her and so many women coming together to support each other in HIT, as Dr. Mom remains the healthcare decision maker in the households, we are all ultimately trying to reach.
Andrew Schall, Modernizing Medicine
Physician burnout continues to be a hot topic coming out of HIMSS19 and many feel that EHR platforms may be a part of the burnout epidemic. There were several sessions that focused on user-centered design at HIMSS this year including one that focused on the iterative approach to software development and user experience. First, I think that the industry is recognizing that one-size-fits doesn’t work for EHRs. Additionally, I believe that improvements will come in large part from the greater involvement of practicing physicians in designing specialty-specific EHR workflows and interfaces. A combination of powerful technology like AI and augmented intelligence, as well as well-designed EHR solutions with an intuitive user interface and user experience, will help ease the physician burden and automate time-consuming and administrative tasks like coding and billing – ultimately reducing burnout.
Shane Whitlatch, FairWarning
HIMSS 2019 showcased the ongoing digital transformation to make healthcare responsive to patients across a continuum of care. Enabling patients to be able to access, use and own their personal health data, while ensuring privacy and security was the central takeaway of this year’s HIMSS. Notable, critical moves to support this goal included: the Department of Health and Human Services announced proposed rules to enhance interoperability and data access with payor data; ongoing security and privacy efforts to ensure appropriate patient access to their data while mitigating emerging risks from items including medical devices to nation-state attackers; and artificial intelligence and machine learning initiatives to effectively manage the tsunami of data in healthcare while promoting optimal healthcare.
Tripp Peake, LRVHealth
The best part of HIMSS this year was we seemed to get away from a single buzzword. Healthcare is hard, there’s no silver bullet. The Precision Medicine Summit got into the weeds about how to really roll out a program in a provider system. The AI companies stopped talking about AI for AI sake and were more focused on ROI. Everyone seemed more balanced about VBC: yes, inevitable, but also gradual. Consumerism was probably as close to a central theme as existed. And I continue to be excited about the energy, creativity, and commitment of the entrepreneurs in this market.
Don Woodlock, InterSystems
Anytime you bring 43,000 healthcare professionals together in one location, you will never have a shortage of opinions on the future of the industry. We are at the cusp of a revolution in healthcare, driven by technological advancements. Some key trends we saw at HIMSS19 were, no surprise, around artificial intelligence, where people are trying to enhance predictive risk scoring and improve patient engagement. Additionally, there were profound announcements around mandating application programming interface (APIs) to improve the flow of healthcare data across the ecosystem. As interoperability becomes liquid, it will become the critical component of every healthcare system, driving the industry to new heights.
Paddy Padmanabhan, Damo Consulting
On day one of the conference, the HHS sucked the oxygen out of the room by dropping a proposed 800-page rule on data and interoperability. The rule aims to aggressively expand interoperability by making it mandatory for providers and health plans participating in government programs such as Medicare Advantage, CHIP and others to make patient data available to patients as a condition for business. CMS head Seema Verma and ONC Chief Don Rucker drove the message home repeatedly during the conference. Indeed, Seema Verma declared it an epic misunderstanding that patient data can belong to anyone other than the patient. A somewhat sobering counterpoint was voiced by Epic Systems CEO Judy Faulkner in a media interview where she suggested that interoperability challenges go well beyond data sharing by EHR vendors. Regardless of where it may fall, interoperability will continue to dominate healthcare IT agenda for some time to come. Related issues around new and emerging data sources, especially social determinants of health, will gain prominence in the coming months.
Erin Benson, LexisNexis Health Care
The proposed rule on interoperability of health information influenced most conversations at HIMSS. In the context of cybersecurity, the rule served as a reminder that it’s just as important to let “good guys” in quickly and seamlessly as it is to prevent unauthorized access. We want to enable value-based care and give patients the ability to manage their own health by having access to their records. We also want to keep costs low and efficiency high by enabling interoperability and giving partners, vendors and employees necessary access to systems. Therefore, a cybersecurity strategy needs to strike a balance between user engagement and data security.
Mike Morgan, Updox
The power of consumerism is really impacting healthcare and the need for patient engagement is alive and well. Providers across the board must look at new technologies and ways to redefine patient engagement to better communicate with patients and partners but do it via channels that are easy for staff and customers to use. New applications, such as telehealth and secure text messaging, have changed how healthcare communicates and consumers are demanding that immediate, convenient engagement.
Vince Vickers, KPMG
HIMSS19 seemed to have the most decision makers at the conference in five-plus years when a lot of healthcare organizations were still looking at implementing electronic health records. We might be ready for another wave of healthcare IT investment after healthcare organizations digested those investments made in electronic health records. The key is now around optimizing EHRs – interoperability, improving ease of use, enhancing analytics — or dedicating resources to enterprise resource planning (ERP) systems to make themselves more efficient in the back office. We’re also seeing healthcare organizations position themselves to be more consumer-oriented, partly to address new entries from some of the tech companies, such as Google, Amazon, Microsoft, and a multitude of others, that wanted to make a big splash at HIMSS.