By Cindy Gaines, chief clinical transformation officer, Lumeon.
Reflecting on the past couple years, it’s become clear that staffing shortages have taken a toll on nursing physically, emotionally and mentally, leading to declining retention rates, inadequate resources, and, at times, concern for their mental health.
Staffing shortages are not just the result of a pandemic, but of an aging workforce. Hospitals are faced with the challenge of addressing the work environment not just in the context of a pandemic, but holistically.
Through the years, we have equipped nurses and care staff with equipment such as computers, pagers, tablets, and zone phones to help them connect with patients, family members, doctors, labs, radiology and outside services. This equipment is necessary for their work but has had unintended consequences. As nurses manage medications and juggle competing priorities, they are constantly bombarded with a world of distraction. This creates safety risks in the care environment.
Additionally, this technology has introduced service expectations created to support the patient and family experience. For example, a phone call must be answered within 3 rings—great customer service for the caller, but it takes the nurse away from the patient currently being cared for. At times, technology meant to support the care process has become a barrier between the nurse and the patient.
This stressful work environment is further complicated by very real staffing issues in our country. Demographic data suggests that the average median age of a nurse is 52 years old and that 20% of RNs are 65 years or older, meaning hospitals can expect gaps in staffing as this age group ages out and begins to retire. While this seems like an opportunity to usher in a new generation of young, fresh-minded nurses, nursing programs are unable to graduate enough people to supply this gap in the industry due to an overwhelming lack of resources.
These factors together have created the perfect storm of a care staff shortage.
By Rick Halton, vice president, marketing and product, Lumeon.
Since it was first recorded late last year in China, the spread of COVID-19 has accelerated around the world, rapidly creating a global pandemic. The number of new cases is increasing exponentially, putting the western hemisphere in particular on a frightening trajectory, as health systems struggle to battle the virus.
Though billions of individuals around the world are undergoing mandated lockdowns and committing to physical distancing, hospitals continue to be engulfed in an onslaught of COVID-19 patients. One of the most significant impacts of this virus is how rapidly it is overwhelming health systems, consuming critical resources including inpatient beds, intensive care ventilators and importantly, care teams themselves.
Fortunately, technology has incredible potential to help automate and coordinate care communication and tasks. By taking advantage of agile technology platforms, health systems can rapidly deploy new use cases to help deal with the crisis – from early risk identification, screening and patient sign-posting, to helping patients reduce anxiety and self-manage their symptoms.
By leveraging automation, health system leaders can control the curve far more efficiently than ever before. The promise of automation is to ease the COVID-19 burden on staff and resources, giving them the arsenal to fight this disease and ensuring that any future outbreaks never get the chance to evolve from an epidemic to a global pandemic. When it comes to applying automation in the fight against COVID-19, four particular use cases come to mind:
Automated Awareness Campaigns
Tech capabilities that are already prevalent in the public-health sector can also play a critical role in controlling the current pandemic and future outbreaks. For instance, most health systems use Population Health Management (PHM) or Business Intelligence (BI) software that can quickly create and segment cohorts of patients. These solutions can help to identify people and communities at highest risk of COVID-19 complications, based on variables that go beyond the patient’s medical history. Different cohorts with varying degrees of risk can be created, such as the elderly, those with a pre-existing disease including respiratory problems, or those residing in high-risk locations.
Campaigns can then be directed at these cohorts and tailored to address their frequently asked questions or wide-spread myths surrounding COVID-19, as well as advising on how to protect against the virus and self-manage symptoms. Campaigns might also include tips for social distancing or advice about the risk in their specific communities. A critical consideration is how effectively the data can be anonymized with respect to the patient’s consent, along with opt-in/out preferences.
Depending on communication preferences – often found in the Electronic Health Record (EHR) system – email, voice and SMS campaigns can be sent out to each cohort. Using these communication tools while targeting specific cohorts of the community can go a long way toward providing reassurance and preventing panic visits to health centers and hospitals.
Automation technology can also enable more comprehensive screening solutions that proactively assess risk. In this use case, a cohort of vulnerable patients is automatically engaged with a survey that screens for symptoms and, depending on the results from the survey, may then be proactively monitored for the next several weeks. If a patient’s symptoms increase in severity or frequency, they might then be directed to a nearby clinic, with the system automatically generating a list of potential locations based on the patient’s zip code.
This form of automated proactive screening can significantly improve detection of the highly contagious virus and eliminates exposure by allowing doctors to evaluate patients’ symptoms and triage without direct contact. It also limits hospital intake to patients who are most likely to be diagnosed with COVID-19, instead of flooding providers unnecessarily and straining limited resources.
When you think of an industry that’s mastered the creation of a seamless, digitally integrated experience for the customer journey, the airline and travel sector is unlikely the first that comes to mind. The experience has become so seamless as to be practically invisible, and any breakdown in that seamlessness is highly painful and disruptive for the customer.
The airline industry is the perfect example of one that has succeeded in orchestrating the customer journey and improved customer experience. Rather than calling a travel agent to book or manage one’s travel itineraries, passengers now research, book and manage flights on their own – and do so digitally. Not only do these digital tools allow passengers to check-in, upgrade and receive loyalty benefits, but they also keep passengers current with real-time flight status – from check-in times and cancellations or delays, to re-booking and satisfaction surveys.
What used to be a highly fragmented journey for travellers is now seamlessly connected thanks to online services that deliver the sort of automatic, digital experience that today’s consumers have come to expect in every aspect of their lives, from online retail shopping to booking travel accommodations.
Healthcare is not exempt from that expectation. In fact, consumers – Millennials and Generation Z, in particular – who are accustomed to this new world of always-on, instant service are causing the healthcare industry to undergo its own consumerization. Patients want the ability to manage their healthcare digitally the same way airline passengers automatically manage their travel.
Evidence of this industry wide shift has been steady. For example, mail-order prescriptions have been around since the 1990s, slowly increasing in popularity over the years and are more prevalent now than ever before. Just within the past year, we’ve seen new startups like NowRx and Capsule emerge while tech giants (the originators of today’s consumer experience) snatch up others as they foray into healthcare, such as Amazon’s acquisition of PillPack.
In fact, Amazon’s entry into the healthcare market alone is proof of the industry’s broader consumerization. Amazon’s business model has completely disrupted the retail industry and been a primary driver in creating today’s consumer expectations for seamless, digital experiences. Most recently, Amazon announced that its Alexa device is now HIPAA-compliant, allowing health organizations to use the voice-enabled speaker to help patients book appointments, access hospital post-discharge instructions, check the status of a prescription delivery, and much more.
This recent development is further proof of patients’ desire for convenience through using digital tools in their healthcare – something the industry has been slow to adopt.
Prepare for takeoff
Healthcare today consists of a broken, fragmented patient experience. The industry, however, stands at a turning point, where vast amounts of digital patient data are already available. By leveraging this data, healthcare organizations have an opportunity to differentiate their brands and create a seamless care journey – just like airlines keep passengers continually engaged, and ultimately deliver better service at a lower cost.
How can healthcare use available data to take off and further consumerize the patient experience? Real-time health systems, which Gartner considers “a management and operating paradigm…for the next-generation healthcare provider,” will play a pivotal role in transforming the way providers deliver care. Not only can real-time health systems orchestrate the care journey, but they also deliver real-time situational awareness about the patient’s history, as well as current and future care needs. Embracing real-time health systems will be key to unlocking a truly digital consumer experience, ensuring that computer systems execute best-practice behind every care journey.
By Rick Halton, vice president of marketing and product, Lumeon.
For the past decade, EHR investments have been touted as the key to unlocking a transformative, cost-effective, and efficient healthcare industry. A recent study found that spending on EHR systems will continue to dominate healthcare’s technology spend in 2019. But if budgets continue to be prioritized towards optimizing EHR systems, why are there still so many issues related to delivering coordinated care? EHR vendors often do not clearly explain that new issues can arise after implementation, and even make certain processes more complex.
Despite significant investment of EHR systems over the years, care processes continue to be inconsistent and labor intensive. Not only does this result in overwhelming operational costs for hospitals, but it also leads to massive variance in outcomes.
EHR investments are important, but they aren’t a silver bullet. EHRs can only go so far towards improving care outcomes and operations, as they do not address the true problem: disjointed care process issues. Hospitals must consider the broader context that EHRs play into, including investing in greater orchestration and automation of patient care.
By directing investments toward automated digital care plans that are supported by EHRs, hospitals can more effectively connect patients along their entire care journey, and only engage the care team when necessary. Just as the airline industry found success with their equivalent, the “flight plan,” the healthcare industry must provide its own “care traffic control” to deliver coordinated care. This approach is increasingly recognized as care pathway management (CPM).
Opting for “care traffic control?”
The airline industry has successfully crafted and fine-tuned the entire digital trip experience for passengers, which the healthcare industry can utilize in its own way. For example, airline passengers can find out real-time flight status, receive automated updates about seat availability, find information on airports, and be sent data on flight delays.
Both boarding and takeoff are efficient and seamless procedures, with airlines connecting preflight checklists to central airline and airport IT systems. This gives flight crews current policies, procedures, and alerts, while traffic control systems coordinate which planes can take off at which times.
This same approach can effectively be used in healthcare. Automated protocols throughout the care plan can help providers pull relevant information from all necessary care teams and orchestrate operational processes in the background. Tasks can be completed in an efficient and timely manner, with managed expectations creating a seamless care pathway.
With a “care traffic control” approach, care teams manage by exception. Care plans are digitized, automated, and orchestrated across teams and settings, letting care teams be efficiently tasked at the right time and at the right place. Additionally, care teams can capitalize on virtual patient engagement techniques and will intervene only when manual engagement is needed.
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.
Most likely, in one of the few lucid moments you have in your hectic, even chaotic schedule you contemplate healthcare’s greatest problems, its most pressing questions in need of solving, obstacles and the most important hurdles that must be overcome. And how solving these problems might alleviate many of your woes. That’s likely an overstatement. The problems are many, some of the obstacles overwhelming.
There are opportunities, of course. But opportunities often come from problems that must be solved. And, as the saying goes: For everyone you ask, you’re likely to receive a different answer. What must first be addressed? In this series (see part 2 and part 3), we ask. We also examine some of healthcare’s most pressing challenges, according to some of the sector’s most knowledgeable voices.
So, without further delay, the following are some of the problems in need of solutions. Or, in other words, some of healthcare’s greatest opportunities — healthcare’s most pressing questions, problems, hurdles, obstacles, things to overcome? How can they be best addressed?
Nick Knowlton, VP of strategic initiatives, Brightree
Throughout the healthcare ecosystem, patient-centric interoperability has historically been a huge challenge, specifically throughout post-acute care. This problem results in poor outcomes, unnecessary hospital re-admits, patients not getting the treatment they deserve, excessive cost burden and poor clinician satisfaction. This challenge can be solved through creating better standards, adapting existing interoperability approaches to meet the needs of post-acute care, implementing more scalable interoperable technologies, and involvement with national organizations, such as CommonWell Health Alliance and DirectTrust, amongst others.
Cybersecurity is one of the most pressing hurdles in the healthcare industry. The life and death nature of healthcare and the shift to electronic health records (EHR) creates an environment where hackers that successfully deploy ransomware and other cyberattacks can extort large sums of money from healthcare entities and steal highly sensitive data. To address this challenge, healthcare entities need to continue to increase their investment in cybersecurity and focus on improving their overall security posture by implementing tools and processes that will monitor all devices and assess their compliance with security policies; stop phishing attacks; keep all servers patched and current; ensure third party vendors comply with policies; and train employees on proper security hygiene.
Cyberattacks continue to expose the security vulnerabilities of healthcare institutions, keeping many industry stakeholders awake at night. This is why every organization handling protected health information (PHI) needs to build security frameworks and risk sharing into their infrastructure by implementing risk-mitigation strategies, preparedness planning, as well as meet industry standards for adhering to HIPAA requirements. Hospitals and healthcare systems must keep their focus on strategies and tactics that ensure business continuity in the event of an attack as it’s clearly not a matter of if a breach can happen but when.
The core problem for healthcare isn’t science, technology or caregiving intervention. It’s making sure that the systems of delivery and communications are thought through and actually respond to the way patients need and expect healthcare to be delivered. This means it doesn’t matter how advanced and perfected your health system may be — unless it conforms to culture — the way people think and behave — it will do nothing but confuse and frustrate patient needs, which are psychological and social, as well as physical and mental.