By Ganesh Ramamoorthy, Senior Vice President, Onix.
Today’s digital healthcare professionals face unprecedented complexity. The quality and accessibility of clinical data is vital to delivering the best possible patient outcomes. Yet clinicians often struggle to quickly find and retrieve relevant information.
In fact, the sheer volume of data is staggering. A single hospital can produce 137 terabytes of data every day, or roughly 50 petabytes of data per year. This data tsunami is only getting worse, due to rapid expansion of digital health tools, electronic health records and connected devices.
As a result, healthcare administrative costs continue to skyrocket. In fact, administrative spending is estimated to be between 25 %-30% of the nearly $5 trillion spent annually for U.S. healthcare expenditures. More importantly, failure to tame the data dilemma can substantially impact both regulatory compliance as well as patient outcomes.
The healthcare industry is in dire need of transformation, but change happens slowly. How can healthcare providers navigate this massive, complex system to streamline data management in order to reduce costs, grow revenues and increase efficiencies?
Empower Intelligent Insights
To address this issue, a growing number of healthcare leaders are leveraging the latest artificial intelligence (AI) advancements to transform their legacy data systems into a modern, scalable and agile data platform. In this way, healthcare chief information officers (CIOs) are able to take full advantage of augmented intelligence to unlock predictive data analytics and clinical insights, enabling measurable improvements without adding administrative burden.
Indeed, AI-powered data modernization enables organizations to realize substantial clinical and operational benefits, while improving return on investment (ROI). With the help of enterprise-grade agentic AI and generative AI (Gen AI) technologies, healthcare organizations can achieve measurable results such as 10-25 percent reduction in the cost of care, 15%-20% drop in hospital readmissions, and substantial reduction in mortality rates.
Collaborative Compliance
It’s no secret that administrative friction in healthcare is a significant challenge, with nearly 25% of every dollar spent on paperwork. A primary driver of this cost is the prior authorization (PA) process, which typically requires a significant amount of time to conduct manual reviews, send faxes and make phone calls. This burden not only increases costs, but also delays patient care through a “missing information” loop, where simple administrative omissions trigger denials and appeals.
By leveraging the latest agentic and Gen AI, healthcare professionals can transform their workflow from “Reject and Appeal” to “Detect and Clarify” to greatly improve the speed, precision and outcomes of the PA process. The system works by ingesting unstructured clinical notes and matching them against insurance policies, enabling AI agents to perform a real-time gap analysis.
When information is missing, the AI agent flags the issue and drafts a clarification for the provider in less than a minute, ensuring valid claims are approved on the first pass. This not only streamlines billing, it also allows nurses and doctors to focus on patient outcomes rather than paperwork.
Privacy Protections
Of course, when dealing with sensitive patient data, it’s paramount that hospitals and healthcare organizations have access to reliable, secure data they can trust to ensure regulatory and HIPAA compliance. This means that a key aspect of selecting the best AI solution is to ensure it is an enterprise-grade offering that prioritizes a high level of security, data governance and compliance.
In fact, advanced AI capabilities enable additional privacy innovations as well. For example, with the help of GenAI, hospitals can generate millions of records of synthetic data, allowing them to train and test new AI models without exposing sensitive protected health information (PHI). Plus, by compressing processes that otherwise take hours or weeks into minutes, AI agents return valuable time to medical practitioners.
It’s important to note, however, that healthcare CIOs need to implement robust governance policies when taking advantage of AI technology. As the number of AI agents making autonomous decisions increases throughout the healthcare industry, responsible AI practices will become a mandatory business requirement with decisions being driven by trust and transparency.
Healthcare Transformation Success
Today’s healthcare industry is poised for progress, and responsible AI deployments will be an integral part of this transformation – from building a new level of personalized patient experiences, to realizing substantial gains in productivity for improved patient outcomes.
Armed with the right tools, intelligence and insights, healthcare leaders are empowered to realize this transformation and build a brighter future for their patients. The true differentiator for successful healthcare enterprises will not be if they use AI, but rather how they responsibly manage and fully integrate AI into established processes.
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.
My personal takeaway from HIMSS is “mind the gap.”
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.
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.