By Paul Brient, chief product officer, athenahealth.
On December 14, 2020, less than one year after COVID-19 sent our nation into lockdown and a period of uncertainty, the U.S. began rolling out a new set of vaccines. COVID-19 challenged and stretched our healthcare system, with great strain on our heroic providers, hospitals, and pharmaceutical professionals.
Since the introduction of the COVID-19 vaccine, we’ve improved distribution greatly and as of May 10, 2021, the FDA even expanded Emergency Use Authorization (EUA) for the Pfizer COVID-19 vaccine to include adolescents aged 12-15, further accelerating the vaccine rollout across the nation. As we’ve taken great strides recently to expand immunization to the wider population, we can reflect on the progress we’ve seen across the healthcare industry.
The past year has been filled with healthcare IT innovation which includes the almost instantaneous shift toward telehealth technologies, with utilization increasing from less than one percent to more than one-third of all visits, and new enhancements including virtual check-ins, COVID-19 screeners, virtual waiting rooms, and high-volume vaccine workflows.
One thing that healthcare IT companies were unprepared for was the incredible spike in inbound patient appointment request volumes as testing (and vaccine distributions) ramped up. In the early days of vaccine availability, scheduling systems found their servers crushed by demand. This sudden and unprecedented surge of patients attempting to schedule appointments exposed scalability issues in many scheduling systems, rendering it challenging to book appointments online.
True cloud-based SaaS systems, such as athenahealth, fared better than traditional on premise or remote hosted systems. Even so, the first release of roughly 6,000 appointment inquiries at one of athenahealth’s New Jersey customers in January resulted in an immediate onslaught of traffic and exposed several previously undetected configuration issues. Fortunately, these configuration issues were able to be quickly resolved, and athenahealth was able to support and meet its clients’ vaccine workflow needs and the intensity of the appointment request volume throughout the rest of the vaccination push.
With the high number of COVID-19 cases (currently 33.3 million in the U.S. alone), the COVID-19 vaccination effort has brought forth a new set of administrative challenges. Moderna and Pfizer-BioNTech require two doses and, while this is not a new concept for vaccines, the scale, scope, and importance of ensuring that patients follow-up and receive their second dose required a myriad of steps.
Vaccine registries (and perhaps soon: proof of vaccination or “vaccination passports”) have gone from the domain of a few public health officials to the key to winning the battle with the virus. Complicating this issue, every state across the nation has its own vaccine registry — each with different requirements and approaches. As a result, the vaccine administration process has faced scrutiny and received a bit of an overhaul. These reconstructed processes, much like the incorporation of virtual visits into care delivery options, will pay dividends well into the future.
While the healthcare industry has made great strides in inoculating patients, there are still lessons to be learned, especially when it comes to COVID-19 vaccine workflows and the role EHRs play in supporting providers and patients. Here are the ways in which EHR technologies can and are improving COVID-19 vaccine workflows to heal industry pain points:
By Paul Brient, chief product officer, athenahealth.
Paul Brient
To say that this has been a challenging year for healthcare providers would be a grave understatement. From the financial hardships that the state shutdowns brought, to the need to change traditional processes to create a COVID-19 safe environment, we have proven that while healthcare may be recession proof, it is not pandemic proof. Although we hope that the majority of these immediate challenges are behind us (or will be behind us once we have a widely distributed vaccine), the healthcare industry has gone through momentous changes in 2020 which will no doubt drive lasting transformation for years to come.
No matter the role healthcare providers play or their specialties, all providers have experienced some degree of change. Some of the biggest changes that we’ve experienced in 2020 — that will continue to drive trends in the coming year — include shifts toward value-based care (VBC) models, increased focus on whole-person health, and utilization of digital health tools.
Continued Emphasis on VBC and Whole-Person Care
One of the most unexpected observations that providers have had is that those with VBC financial arrangements saw better results than practices with exclusively traditional fee-for-service (FFS) models. In effect, having both VBC and FFS models provides business model diversification and protection against systemic volume declines. This isn’t something that was considered or talked about pre-pandemic.
VBC has been an accelerating force in the healthcare landscape the past few years and has made us rethink patients as consumers. We’ll continue to see practices want to differentiate themselves by moving to VBC models. Additionally, practices will shift away from the problem-focused approach and practice medicine with a much more holistic, patient-focused strategy. There will be advancement toward whole-person care models and new ways to care for patients outside of the encounter and proactively intervene.
The healthcare industry has acknowledged the impact that behavioral, social and human service needs have on an individual’s health — which is causing primary care providers to adopt new offerings around behavioral health. This starts with assessments and will grow into psychosocial support. Also expect that there will be an increased need for mental health support because of the isolation and reduced social connections to friends and family resulting from the pandemic.
Advances in technology have fundamentally altered and inarguably improved the way we drive, shop and travel. Just ask anybody who uses Google Maps, Foodler or Uber.
Sadly, however, information technology has failed to deliver so far in the most crucial service of all – healthcare. This is at least partly because electronic health records (EHR) systems grew out of the computer systems that run the hospital’s inner workings — patient scheduling, admission and discharge, staff payroll and accounts receivable. For system designers, physicians’ needs were an afterthought, which is problematic because physicians are, after all, the linchpin of the healthcare delivery system.
To begin pulling healthcare IT out of the past, we must first take a look at how it supports physicians. The short answer today is “not well.” In fact, EHRs are creating as much frustration as benefit. Problems include poor presentation of patient data, fragmented information sources and unwieldy user interfaces that require dozens of mouse clicks or screen taps. It’s no wonder more than half of physicians who responded to a recent survey claimed their EHR system had negative impacts on costs, efficiency and productivity – three things IT should help, not hinder. These issues not only affect physicians’ professional satisfaction, they contribute to the phenomenon of physician burnout, which is a growing concern across healthcare. Studies show some 30 percent of primary-care physicians age 35 to 49 plan to leave medicine, and there’s an expected shortage of 25,000 surgeons by 2025. A Mayo Clinic study released earlier this year directly connected the burnout problem to physicians’ use of EHRs.
Today’s EHRs have done little more than “pave the cow paths.” We’ve gotten rid of paper in the hospital and made processes electronic, which is why EHRs can legitimately claim to have reduced transcription errors. But eliminating paper is just table stakes; the critical next phase is to do for healthcare what Uber has done for transportation: Reinvent the process so it’s optimized for and native to the technology that enables it.
Patients and physicians can and should advocate for such change. Today, patients have access to a vast body of information—the notes a doctor took, quality of care rankings, the level of personalization provided—and it’s only going to increase. As Lygeia Ricciardi, former director of the Office of Consumer eHealth at ONC said, “Getting access to personal health information is the start of engaging patients to be full partners in their care.”
Vice President Joe Biden recently took the stage at Health Datapalooza in Washington, D.C. to discuss where healthcare technology currently stands, and he didn’t hold back. Among other things, he chastised the industry for poor health IT system interoperability and the resulting difficulties it causes providers and patients. “We have to ask ourselves, why are we not progressing more rapidly?” Biden lamented.
Biden’s criticism is only the latest high-profile commentary about the unfulfilled promise of information technology in healthcare. AMA leaders and individual physicians have been grousing about it for years. We’ve seen technology increase efficiency, reduce costs and improve productivity in every other industry – but why not healthcare?
Ironically, seven years after the passage of the HITECH Act of 2009, doctors are less productive than they were before, and IT is the culprit. Rather than enabling a better, more streamlined workflow, IT has become a burden.
The drag that IT is placing on healthcare providers is a principal reason why U.S. Health and Human Services (HHS) Secretary Sylvia Burwell announced with great fanfare at the HIMSS16 conference an “interoperability pledge,” which vendors and providers alike are encouraged to take. Its purpose in part is “to help consumers easily and securely access their electronic health information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of their community.”
This call resonates because the promise of better healthcare through technology has been broken. Technology has changed the way we communicate, the way we shop, the way we watch TV, the way we drive, and the way we interact with our homes. As an industry, healthcare is lagging way behind. The consequences are drastic. In order for us to deliver the kind of holistic care that will truly improve people’s health, it’s time not only to talk about the potential, but to make it a reality for users and providers across the healthcare continuum.
Here’s the reality: we have today what 10 years ago was called a supercomputer in front of physicians – a device that knows virtually everything about the patient – but it isn’t helping out in ways that we take for granted in our everyday lives when we shop online, use Google Maps or order an Uber.
