By Tim Bristol, PhD, RN, CNE, ANEF, FAAN, director of strategic planning, NurseThink, Wolters Kluwer Health.
The ever-worsening nursing shortage is taking the United States by storm, with nearly 800,000 nurses planning to leave their roles or retire by 2027. Unfortunately, nursing education is not immune to this crisis.
The American Association of Colleges of Nursing (AACN) reports that 8.8% of faculty positions are vacant at U.S. nursing schools and additional positions would need to be created to meet student demand. Without enough faculty, this has a serious impact on the capacity and effectiveness of nursing education programs as nursing schools are already being forced to turn away qualified applicants. Fortunately, while faculty shortages won’t be solved overnight, advancements in instructional technology can help fill the gap.
One key challenge facing nursing education is that the curriculum is not set up to teach students in a way that mirrors real-world practice. While new nurses today will often face greater challenges – and often higher caseloads – than ever before, nursing students are not being adequately trained to face this reality. In many ways, today’s nursing classrooms look no different than the classrooms students may have encountered in 1993.
But a lecture hall looks very different than the chaotic hospital setting new nurses will actually experience. To help ensure students build skills and engage in clinical judgement, even if faculty numbers are limited, incorporating electronic health records and virtual simulation into their daily education can make a major difference.
Electronic health records are not optional
While electronic health record (EHR) systems are a highly discussed technology across the healthcare landscape, they have been shown to reduce errors and lower medical costs. Needless to say, EHRs are here to stay across healthcare and something that care teams need to use, every day. However, they can only positively impact healthcare as a whole if nurses are trained to use them effectively and efficiently before they encounter them in clinical practice.
It’s important for faculty to understand how easy it is to implement EHRs into the daily classroom experience. Students could simply login to a basic, blank EHR and enter data based on a case study or challenge given by their instructor. For example, students could be tasked with entering a blood pressure reading that would indicate that they should hold (not give) a patient medication to lower their blood pressure. When faculty allow students to experience this type of activity, they are learning in the same way in which they will be using EHRs in practice. This is something that could easily be incorporated into nursing classrooms, even in a lecture hall of more than 100 students.
By Richard Dion, PharmD, pharmacy clinical program manager for clinical surveillance and compliance, Wolters Kluwer Health.
In recent years, the data collected by health systems has skyrocketed in volume. Unfortunately, studies show that up to 97% of data collected in hospitals is not used to inform or improve care — an issue that could offer new opportunities for both providers and patients. Hot-button topics like inpatient Opioid Stewardship could benefit from an increased utilization of available data.
Institutions looking to leverage existing data to improve quality and safety of opioid use should consider several steps to create meaningful and attainable data-backed goals.
From the outset, it’s important to consider who would drive these programs within hospitals and health systems. Leadership roles, as well as day-to-day drivers of activities, will require thoughtful selection and designation. Leadership plays a critical role in overall organizational buy-in, while pharmacists within a health system can provide the education and support necessary for physicians to optimize electronic healthcare records (EHR) and other data to provide appropriate pain management options. With the recent relaxation of opioid prescribing guidelines from the Centers for Disease Control and Prevention (CDC) to no longer promoting strict thresholds for pain medication doses and duration, developing standardized opioid stewardship programs based on local data is critical.
When it comes to analyzing existing information for care decisions, utilizing local data is vital to a complete understanding of opioid use and patient needs within the health system. Some EHRs and third-party applications may have metrics and dashboards available, but sites may need to curate their own data to fit organizational needs. Technologies such as dashboards that offer a composite view of patient and prescribing data are invaluable to providers to identify patterns and at-risk patients. There may still be several areas where manual processes are prevalent and / or necessary. While individualized care for patients is important to maintain, creating structure using automation that can help identify patterns and insights from data can be invaluable in preventing and treating opioid use disorder (OUD) efficiently and effectively.
While the COVID-19 pandemic forced healthcare into a reactionary crisis state in 2020, 2021 offered an opportunity to rethink traditional care delivery models. Divergent views on vaccines, powerful COVID-19 variants and ongoing capacity issues have shown that providers, and the technology companies that support them, will need to continue to evolve in order to serve patients effectively.
As we look towards 2022, experts at Wolters Kluwer Health, a clinical technology and evidence-based solutions provider, outlined their predictions for next year and what they think it will take to properly equip providers to deliver the best care everywhere.
Building trust in an age of digital information overload
Digital health investment in 2021 has focused mostly on technology innovation and workflow improvements. What I’m seeing in the digital health space is akin to the implementation of EMRs, which really focused on the technology itself and not the content inside, which creates the experience for both clinical users and consumers. What’s missing from digital health strategy, and what providers will need to focus on in 2022, is increasing access to high-quality, evidence-based health content that consumers and providers alike can trust and understand. This ease of access is crucially important to overcome the infodemic of COVID-19, with an influx of misleading and rapidly evolving information we’ve seen expand across all areas of healthcare. Effective, engaging digital health requires more than the right technology, but a full-fledged experience that informs and motivates consumers towards evidence-based action.
Jason Burum, general manager, Healthcare Provider Segment, Clinical Effectiveness, at Wolters Kluwer, Health
More compliance, less burden
The pressures of COVID-19 spurred USP to issue interim guidance that provided flexibility for compounding pharmacies, but 2022 is likely to represent a return to stricter compliance. In September, USP issued a Notice of Intent to Revise (NITR) for both USP <797> and USP <795>. With COVID-19 cases continuing to surge across the country, I anticipate hospitals and pharmacy staff in 2022 will increasingly rely on expert solutions and technology to automate and standardize compounding operations in accordance with best practices and the latest compliance requirements. Burnout and technician shortages are happening in pharmacies too and software tools will help alleviate burdens pharmacy staff face right now.
Annie Lambert, PharmD, BCSCP, Clinical Program Manager for Compliance Solutions for Clinical Surveillance & Compliance, Wolters Kluwer, Health
Pitting AI against HAIs
Data show that while hospitals have allocated more resources to infection prevention and control efforts to contain the spread of COVID-19, it has largely come at the expense of controlling other far too common healthcare-associated infections (HAIs). It’s true that a larger volume of sicker patients at higher risk of infection and sepsis have been admitted to the hospital over the last year, but the CDC concluded that 2020 increases in HAIs were also a result of lacking surge capacity and other operational challenges. Looking ahead to 2022, as hospitals take aim at controlling all HAIs in addition to COVID-19 with more resilient care teams, they will be looking more closely than ever at AI-powered technology to support proactive and real-time monitoring of patients to empower staff with quick risk identification abilities and opportunities for earlier clinical intervention.
Mackenzie Weise, MPH, CIC, Infection Prevention Clinical Program Manager for Clinical Surveillance & Compliance, Wolters Kluwer, Health
Telemedicine grows up
Contrary to some news stories, telemedicine will prove resilient well past the pandemic and will establish itself as a permanent, significant fixture in the healthcare ecosystem. In 2022, I expect healthcare providers themselves will strengthen and formalize training to research and promote telehealth best practices to their clinicians. It’s already happening, and I expect to see specialties like mental health and urgent care shifting to a predominantly virtual model in 2022. Ultimately, I believe that the rise of telehealth will drive more dialogue around modes of access as an issue not only of tech but also equity in the years to come. This in turn will have big impacts in the future of medical practice.
Vikram Savkar, vice president and general manager, Medicine Segment of Health Learning, Research & Practice
By Vikram Savkar, vice president and general manager of the medical segment at Wolters Kluwer’s Health Learning, Research and Practice business
During the pandemic, nearly every healthcare provider in the country had to execute a rapid, unplanned switch to telemedicine for the majority of their consults and activities. According to one study from the RAND Corporation, there was a 20-fold increase in the rate of telemedicine utilization after March 2020. For the most part, this transition was executed well and successfully, but only due to heroic levels of creativity and dedication by clinicians in every field.
With few established practices to rely on, it fell to each hospital, each department, each clinician to more or less invent ways to conduct virtual consultations in dermatology, cardiology, oncology, and more. There was much trial and error, but a commitment to rapid learning meant that the community as a whole was able to achieve a reasonable level of healthcare delivery quality to patients via the web.
Now, however, it is clear that telemedicine will be a permanent and sizeable segment of healthcare delivery; some estimate that more than 20% of healthcare from 2021 onward will be virtual. As a result, every aspect of the healthcare ecosystem must move out of an “emergency” mindset when it comes to telehealth and focus on establishing scalable, sustainable processes that ensure that a steady shift to telehealth drives equity, access, and quality. Healthcare providers themselves are actively engaged in this effort, and medical schools also now need to evolve to reflect this new normal.
Medical schools have incorporated some telehealth training into their programs in recent years, but it has tended to be ancillary. Now, it will be critical for telemedicine training to be incorporated more structurally into core curricula. What is being called “webside manner,” for instance, is significantly different to “bedside manner” and needs to be taught explicitly ?— in both a classroom setting and during clerkship rotations, as well as residencies.
Clinicians need to be taught how to establish rapport with patients whom they don’t see face to face, how to assess possible domestic abuse threats when the patient may not be able to speak freely, and how to gather emergency contact information in case there is a critical event during the consult for which the clinician needs to call emergency services. They also must learn how to take advantage of the unique opportunity that telehealth presents to closely observe and document social determinants of health by, for instance, asking patients to show the contents of their refrigerator. And they must be taught how to navigate the “digital divide” and ensure that patients without access to broadband or smartphones aren’t consigned to a lower quality of telehealth care.
The blockchain is a ledger, a database that keeps everything in one place and cannot be changed without leaving a mark in the ledger in the event of information changing. According to Jacob Kostecki of Blockhead Factor, blockchain makes it perfect for the recording of both research and treatment information, as well as medical histories. “Right now information is siloed and because people know that a lot of the information contained in medical records is false, there is a lack of trust that causes delays in diagnosing and treating patients,” Kostecki said. “In a blockchain-enabled world, patients will hold their whole medical histories in a wallet — from birth to where they are now in life. These EHRs will include medical records, procedures and everything else.”
When a patient visits a doctor he or she will have access to the patient’s full records instantaneously, making diagnosing cancer, for example, much easier. But blockchains mean more to healthcare than providing assistance at the point of care. Blockchain securely shares health data, standardizes formatting and improves healthcare transactions overall. Its impact can affect every major participant in the care cycle, from patient and provider to payer, pharma and even researchers and federal regulators.
It’s not a stretch to say that blockchain is everywhere in healthcare. Its application to healthcare has not reached its full potential, but the results may be profound as it comes of age, according to industry insiders. To better understand blockchain, we asked some insiders – technology experts, investors, professors, vendor reps and physicians – about what the technology may mean to the future of healthcare.
HIMSS organizers, in preparation of its annual conference and trade show and as a way to rally attendees around several trending topics for the coming show, asked the healthcare community how it feels about several key issues. I’ve reached out to readers of this site so they can respond to what they see as the future of healthcare innovation, data security, patient engagement and big data.
Their responses follow.
Do you agree with the following thoughts? If not, why; what’s missing?
Innovation
Sean Benson
Sean Benson, vice president of innovation, clinical solutions, Wolters Kluwer Health Future innovations in health IT, big data in particular, will focus on the aggregation and transformation of patient data into actionable knowledge that can improve patient and financial outcomes. The ever-growing volume of patient data contained within disparate clinical systems continues to expand. This siloed data often forces physicians to act on fragmented and incomplete information, making it difficult to apply the latest evidence. Comprehensive solutions will normalize, codify and aggregate patient data in a cloud system and run it against clinical scenarios to create evidence-based advice that is then delivered directly to the point of care via a variety of mobile devices. This will empower physicians with patient-specific knowledge based on the latest medical evidence delivered to the point of care in a timely, appropriate manner, ultimately resulting in higher quality treatment and more complete care.
Susan Reese
Susan Reese, MBA, RN, CPHIMS, chief nurse executive, Kronos Incorporated
Gamification — the trend of creating computer-based employee games and contests for the purpose of aligning employee productivity with the organization’s goals — is currently a popular topic with business leaders and IT. For proof, consider that Gartner recently projected that by 2015, 50 percent of all organizations will be using gamification of some kind, and that by 2016, businesses will spend a total of $2.6 billion on this technology.
With numbers like these, it is clear that that gaming is serious business and that it is here to stay. But at this point, you may be asking yourself, “Could gamification work in my healthcare environment? What potential benefits could it have?””
Today, many healthcare organizations are looking to the future and considering gamification as a way to increase employee engagement, collaboration, and productivity as well as to align their behavior with larger business goals – but they don’t know how to do it quite yet. Also, gamification can be a delicate decision, complete with advantages and risks. After all, employees’ day-to-day work responsibilities and careers are not games and can’t be trivialized. Healthcare organizations must be careful to avoid sending the wrong message to their workforce, or the whole program could backfire, or even lead to more negative consequences.
Mike Lanciloti
Mike Lanciloti, vice president of product management and marketing, Spectralink
In today’s digital age, healthcare IT needs to come a long way to get up to speed in innovation and connectivity. However, as we begin to see mobile play a larger role in the industry, healthcare is moving the needle on innovation as well.
The mobile revolution has picked up in healthcare for both health IT professionals and in patient care. Primary as healthcare providers find ways to utilize smartphones, mobile devices and Wi-Fi networks to improve the communication and efficiency of their workforce.
Through mobile devices, clinicians have the ability to access what they need, when they need it. Mobile devices ensure nurses and mobile staff are equipped with the right technology to promote timely, efficient and reliable communication. This not only allows healthcare professionals to perform their jobs more effectively but also helps deliver a higher quality of patient care.
The growing mobile trend does present several questions for the industry. Hospital managers are quickly learning that an influx of smartphones into the hospital setting can become a larger problem than anticipated. Not only do personal devices lack the security required for enterprise-owned devices, they pose other risks, calling into question issues surrounding encryption, authorized access and mobile security. Personal phones aren’t designed to be equipped with the same encryption capabilities as enterprise-owned mobile devices.
Guest post by Allison Errickson, CPC-H, director of coding compliance, ProVation Medical, with Wolters Kluwer Health.
Never before have effective revenue cycle management strategies been so critical to future positioning in hospitals and health networks. In today’s lean environment of declining and unpredictable reimbursement, effective oversight of timely billing practices can simply be a make or break element to success.
Because the revenue cycle is dependent on the time-to-bill for procedures and diagnostic care, healthcare organizations must enact processes to support the most efficient coding practices to speed receipt of payment. Success in this area remains an obstacle for many organizations struggling with how to allocate limited resources to ensure the most accurate coding and efficient turn-around.
Denials plague the industry in terms of maintaining consistent cash flow. Inaccurate or incomplete documentation can impact as much as 5 percent of revenues if a healthcare organization is experiencing denial rates of 25 percent or more. Revenue is also negatively impacted when documentation does not support the highest level of acuity, minimizing reimbursement potential.
While accurate documentation remains an ongoing issue, resource allocation to effectively address the issue will likely be further impacted with the introduction of ICD-10. The industry has been granted a reprieve with the recent deadline extension of Oct. 1, 2015, but the reality of the transition will be coming into focus very soon. Coding challenges will be exacerbated as coders will now have 72,000 unique procedure codes to choose from, increasing the complexities associated with specificity and accurately coding to the highest level of reimbursement.
For the ninth year, national health IT week is in full swing, from Sept. 15 – 19, 2014. Those in healthcare, policy makers and stakeholders have come together to “collaborative forum for public and private healthcare constituents to discuss the value of health information technology (IT) for the U.S. healthcare system.”
HIMSS is again hosting a lineup of events and activities centered in the DC. According to the organization, the event is designed as health IT continues its advancement to “improve the quality of healthcare delivery, increase patient safety, decrease medical errors, and strengthen the interaction between patients and healthcare providers.”
For those of us in health IT, NHIT Week is a forum, a conversation starter and an awareness builder that assembles healthcare constituents dedicated to working together to elevate the necessity of advancing health through the best use of information technology. As a brand awareness campaign, the effort is paying off and bringing about deeper conversations with health IT game changers, leaders and those who wish to learn more about the ramifications of the technology on the overall landscape.
That said, and because of the importance of the event, I asked a few folks for their reaction to NHIT Week. Their responses follow:
Arvind Subramanian, president and CEO, Wolters Kluwer Health, Clinical Solutions
Arvind Subramanian
Vision, innovation, hard work and perseverance are foundational to any significant change for the better. These are fundamental components of the health IT movement—an ever-evolving landscape that has experienced tremendous successes, along with its share of challenges.
National Health IT Week offers a platform for celebrating progress and expanding awareness of the tremendous potential of health IT to advance healthcare’s broader goals of improved outcomes and lower costs. It’s an opportunity for those deeply involved in the movement and those watching it unfold from a distance to come together and remember what forms the core of its agenda: improving the human experience and saving lives.
Here at Wolters Kluwer Health, we have the advantage of seeing the outcomes associated with advances in clinical content integration, clinical knowledge management and data analytics every day. Whether it’s a highly effective response to a public health crisis or the ability to mitigate adverse outcomes through real-time patient surveillance, our clients are experiencing a transformation to more highly-effective care delivery.
