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Readers Write: Technology Can Lift the Veil of Secrecy on Drug Prices

May 24, 2017 Readers Write 1 Comment

Technology Can Lift the Veil of Secrecy on Drug Prices
By Thomas Borzilleri

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Thomas Borzilleri is CEO of InteliScript.

The recent story about the rift over prescription drug prices between insurer Anthem and its pharmacy benefits manager Express Scripts should anger — and frankly, befuddle — any physician or electronic health record (EHR) vendor. Providers and IT vendors should be fed up with payers and patients getting ripped off by inflated drug prices, taking a disproportionate share of the healthcare dollar. They also ought to be puzzled about why, with all of our advances, we are still living in a marketplace where no one knows what drugs really cost.

It’s particularly absurd because technology exists that can put an end to the opacity, overpayment, and oligarchy that characterize prescription drug purchasing today. Providers deserve and EHR vendors can offer tools that deliver the prices for any drug at the five cheapest pharmacies nearby. Doctors can have this data at their fingertips, within a few seconds, at the point of care, integrated into their existing workflow. These technology solutions can also track prescriptions to make sure they are picked up and refilled on a regular basis to gain new insight into which patients are at risk for adverse events due to medication non-adherence.

For years, insurers and patients have just accepted that the price they are getting is the best price, or the only price. However, allegations like Anthem’s — that Express Scripts overcharged the insurer by $3 billion — should make everyone in the healthcare ecosystem skeptical about the fairness of drug prices. But truly lifting the veil on drug prices will take a concerted effort by many stakeholders in the provider and IT vendor communities to take on the PBM juggernaut.

Strangely enough, when PBMs gained widespread popularity in the 1980s, there was an understanding that they worked on behalf of payers to lower prices, both by securing discounts and by steering patients towards lower-cost drugs. The truth, however, is that PBM “discounts” have always included heavy padding in the form of ingredient spreads and per-prescription fees. In fact, while PBMs are typically paying manufacturers 96 percent off the Average Wholesale Price (AWP) —the “sticker price” for drugs —the prices they charge insurers and employers are between 70 percent and 85 percent off the AWP. PBMs are skimming 10-25 percent off each prescription.

Insurers and employers have had little recourse, both because they did not know the true price of prescription drugs and because they did not have a way to easily shop around between competing pharmacies to get the best price on every medication. Instead, complex, opaque package deals with PBMs mean the payer might be getting good deals on some drugs and getting raked over the coals on others.

Drug price transparency and shopping tools are essential for payers to rein in costs and keep both premiums and co-pays from spiking. The urgent need for this data has also intensified recently because an increasing share of prescription drug costs are borne by consumers themselves. Patients simply won’t take their drugs properly, or at all, if they are out of reach financially. Affordability is now the number one reason for non-adherence to medications, which leads to poor outcomes, including avoidable hospital readmissions. A lack of medication adherence is estimated to cause approximately 125,000 deaths, at least 10 percent of hospitalizations, and cost between $100 billion and $289 billion a year.

In the past, some patients have looked to Canadian or other foreign mail-order pharmacies to try to lower drug costs. But these transactions are usually outside the doctor-patient relationship and may cause more harm than good to the patient, either by exposing him or her to dangerous drug formulations or by causing rifts in care continuity.

Doctors and patients, together, must come to the best decision about the right drug for their condition and price must be a part of that equation. We need technology solutions that enable doctors to find the best price on any drug, at local pharmacies that are convenient to the patient. Tools exist to address these concerns. The key is to embed these tools into existing EHR systems. By doing so, we can avoid disrupting doctors’ workflow and can ensure that all e-prescribing information is captured in the patient record.

These solutions must achieve savings for both the payer and the consumer. First, the solution must provide the lowest possible retail price while consumers are still paying off their deductibles, and then provide the lowest negotiated payer price to the insurer or employer once they start picking up the tab. These solutions can also be used to circumvent common PBM strategies, such as excluding low-cost brand and generic drugs from formularies to artificially increase co-pays on these cheaper drugs, which costs insurers and self-insured consumers billions of dollars each year.

Typically, consumers don’t realize that the cash price is in many instances lower than their adjusted co-pay, with the excess going right into the pocket of the PBM. Drug price transparency and shopping solutions should crunch the numbers for the doctor and patient, letting them know when it’s better to pay the cash price and when it’s more cost-effective to pay the co-pay.

Health IT solutions are typically geared towards one healthcare user: hospitals, doctors, patients, insurers, or employers. But drug price transparency technology is one of those rare innovations that will benefit each of those audiences. Doctors and patients, together, will be able to make the best decisions about medication management, at the point of care, during the prescribing process. Hospitals will enjoy better population health management through better medication adherence. Insurers and employers will be able to wring more value from each healthcare dollar.

What we need now is a commitment from EHR vendors to adopt this type of technology. The bottom line is that we can’t succeed in bending the cost curve in healthcare if we don’t know what the costs are in the first place. That includes prescription drugs. We in the health IT industry have the insight and ingenuity to draw the curtain back on drug price secrecy and we have a real obligation to do so.

Readers Write: Celebrate the Milestones, But Keep Your Eye on the Road Ahead

May 17, 2017 Readers Write No Comments

Celebrate the Milestones, But Keep Your Eye on the Road Ahead
by Tonguç Yaman

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Tonguç Yaman is CIO of Advocate Community Providers of New York, NY.

I will turn 50 this year. A few days after my birthday in May, my daughter will graduate from Yale, the second of my two children to earn that distinction. In October, I will graduate from Columbia University’s Executive Master of Public Health program.

I guess you could say it’s a watershed year for me, one of the biggest of my life so far. We all have them. And once the celebrations are over, I imagine we’re all faced with the same question. What’s next?

Here is what I learned as I looked for answers to that question.

It’s never too late for a new beginning

Some of us might feel inclined to stop and take a breather at 50, especially once the kids are out of school. We may think we have reached a high point that we’ll never exceed in our time on earth. As for me, I’m viewing it as a new beginning.

It’s a simple construct. Fifty is half of my life. Sure, it’s a milestone, but it doesn’t scare me. I’ll admit I am tickled to be at a point in my life where I have no dependents. My son and daughter are well on their way to taking their places in the workforce and the world. While I have strong relationships with my children and see them often, there is a level of excitement, a feeling of freedom now that they are adults.

I don’t want to waste that feeling of freedom. I want to channel it in constructive ways and put it to good use.

The opportunity to focus is a gift

There is an even greater excitement in the fact that I recently began a new phase of my career, a phase that I have envisioned for a very long time. I am no longer simply an IT guy, but a healthcare professional, a CIO for a very exciting organization in NYC brimming with possibilities.

When I was a kid growing up in Turkey, I dreamed of becoming a medical doctor, so this move into healthcare feels as if I have come full circle. Our dreams get tweaked as we get older, but I like the way this one has turned out. Though not an exact match, I am still able to use my skills and experience to effect change in the healthcare sector, and probably on a much larger scale.

The transition wouldn’t mean half as much if I weren’t confident that I did everything I could to prepare myself for its challenges. That’s one of the benefits of maturity. They say good things come to those who wait, but I also believe that good things come to those who are prepared. Now I have the time, the skills, and the experience to give my new healthcare position the total focus it demands. This opportunity is a gift and I am eager to embrace it with all the dedication and energy I have.

Maturity and passion are not mutually exclusive

I’ve attended HIMSS healthcare IT conferences in previous years, but at this year’s event, something was different. Instead of observing from the sidelines, I was involved. I was invited to participate in sessions. I was a contributor. I felt respected and connected and I was able to help others make connections, too. One of these connections resulted in CHIME welcoming a new foundation member.

This ability to find the things two professionals might have in common and make a connection happen for their mutual benefit is probably the thing I am best at. While others are inspirational leaders, effective organizers,or  impeccable planners, I’m a connector.

In my work with colleagues and partners, I can find win-win solutions, shape commitments between parties, challenge others to exercise their own good judgment, and solidify their trust in one another. That is very exciting to me. I heard it time and again at the HIMSS conference this year: people notice my passion. It is gratifying to be able to say that at this point in my career.

Here’s to 50

There’s a saying now that 50 is the new 30. I’m not so sure I agree. Physically, I don’t feel that much different from the way I felt at 30. But in terms of what I have learned about my industry and about myself over the past two decades, I’ll take 50 over 30 any day.

Readers Write: Blockchain’s Missing Link

May 17, 2017 Readers Write 1 Comment

Blockchain’s Missing Link
By Frank Poggio

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Frank Poggio is president and CEO of The Kelzon Group.

The IT concept that you hear most about today is blockchain systems design and technology. If you have not, you will very soon. It’s a concept that relies heavily on core Internet communication tools and shared information.

When you mention blockchain, some people automatically think of bitcoin, but bitcoin is just one application of the block chain concepts and tools — it is not blockchain proper. HIStalk posted a good synopsis of blockchain last year .

Blockchain in its simplest form is a virtual ledger. A ledger that is available to all on an instantaneous basis via the Internet.

Let’s look at an example. Say I borrow $100 from my office buddy Joe. If it’s just the two of us involved and no one else cares, then he notes on his paper ledger an asset of $100, with an offsetting entry of his cash decreasing by $100. On my ledger, I note an increase in my cash balance of $100 and a liability to Joe of $100. If an auditor were to check our ledgers, they would see all four entries and all things would be kosher, or in accounting terminology, in balance.

Now assume everyone in our office cares and we all have electronic ledgers and all our ledgers communicate with one another via the Internet, thereby creating one big virtual ledger. Every time one ledger changes, they all change instantaneously. Everyone in our office would see I owe Joe $100. As I make payments on the loan (or fail to), all ledgers would reflect the subsequent activity.

Blockchain software maintains a universal virtual ledger by maintaining constant communication among all participants. All updates and transactions — whether add, change, or delete — are stored forever. Hence the full provenance of any activity is easily viewable. The number of participants is not limited and could be in the billions, limited only by agreed-to privacy and security constraints.

The implications of blockchain technology are enormous. For example; since the blockchain is always in balance (no single entity entries allowed), goodbye auditors, bookkeepers, accountants, financial intermediaries, clearinghouses, many regulators, and so on.

Some industry pundits are predicting that blockchain will transform healthcare and make the interoperability mountain into a mole hill. A deeper understanding of the healthcare landscape with its many non-technical issues makes me a skeptic.

On the business side of healthcare, the impact should be pretty much the same as in commercial business. You can expect a big impact on finance and supply chain management. Operations such as scheduling and resource management will see significant impacts. Many will happen within the next decade. Legacy systems will have a tough time adapting, more so than their adaptation to the Internet, but slowly they will adjust.

On the clinical / medical side, I predict a much longer runway before we see any real impact. There are two reasons. First, blockchain is highly dependent on definition and structure. Terminology must be consistent and procedures must be standardized. Generally Accepted Accounting Standards (GAAP) have been in place for centuries, and as they have changed over the decades, multiple oversight groups have hashed out agreed-to changes. On the supply side, UPC codes have been around for almost 50 years and go down to almost the molecular level.

Not so in medicine. A practitioner’s understanding and use of terminology and protocols is highly dependent upon where they went to medical school and who they trained under. Studies have shown that even today, after the federal government has paid out over $30 billion in EHR incentives, still over 70 percent of a patient’s medical record is entered into the EHR as free text.

The second reason is that blockchain cannot work without absolute accurate identification about the transaction initiator and the information target. Identifying the initiator is easy. The target is the person / patient and that’s another matter. Still today after decades and trillions of dollars spent on healthcare IT we do not have a unique person / patient identifier.

As I have noted in my past writings on HIStalk and other blogs, this is not a technology problem, but a political one. If blockchain is to be the savior of healthcare interoperability, as the technocrats suggest, then it’s Congress that will have to forge the most critical first link in the chain.

My prediction is that systems developers will continue to jury rig solutions around this missing link. Providers would do well to remember that a chain is only as strong as its weakest link.

Readers Write: The Value Proposition of Optimizing Clinical Communication

May 10, 2017 Readers Write No Comments

The Value Proposition of Optimizing Clinical Communication
By James Jones and Wayne Manuel

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James Jones, BSN, MBA, MSN, NEA-BC is VP of patient care services and nursing operations at University of Washington Medicine’s Valley Medical Center. Wayne Manuel is senior VP of strategic services at University of Washington Medicine’s Valley Medical Center.

A few years ago, Wayne was on an airplane when he came across a magazine article about how Texas Children’s Hospital switched to Apple iPhones to improve clinical communication and reduce noise. With some due diligence, he found that Cedars-Sinai Medical Center and several other hospitals had also switched from old ways of communicating to iPhones, and they experienced similar positive results. As our senior VP of strategic services, Wayne recognized the opportunity for UW Medicine’s Valley Medical Center to replace our old, noisy phones with smartphones.

Around the same time, James attended a dinner event for chief nursing officers in Seattle. Again, smartphones were a main topic of the discussion, representing a solution to some common clinical communication challenges.

With both of us having technical backgrounds, we started sharing ideas on how to transition from our disparate communication systems to a more modern solution. We approached our CNO and CMO with research on the value proposition of implementing a mobile communication strategy. It was easy to see how a new way of communicating would bring us additional value. Some of the improvements we hoped to achieve included:

  • Improving the clinician and patient experience.
  • Reducing interruptions.
  • Gaining workflow efficiencies.
  • Saving time for clinicians.
  • Improving communication between interdisciplinary teams.
  • Meeting The Joint Commission’s National Patient Safety Goals for alarm management.

At that time, we had recently deployed a new electronic health record (EHR), which gave us the opportunity to improve many other systems and workflows. Our senior leadership team felt that to get the most out of our EHR, we needed a mobile app to close the gap and provide real-time access to clinical information, allow for mobile documentation, and offer an easy way for nurses and other staff to communicate.

Our staff were already using smartphones in their personal lives and were frustrated with the multiple communication devices they were juggling (two-way radios, legacy phones, pagers, and overhead paging). We met with many of our nurses to get their input, and one said, “Anything you can do to lighten the load would be greatly appreciated.”

We started with a phased approach, rolling out iPhones to one pilot unit, then to all inpatient units and several ancillary departments for calling; secure text messaging; and notification of alarms and alerts from patient monitoring, patient elopement, and the nurse call system. This was done via Voalte and Connexall applications.

We conducted before and after analysis so we could measure the outcomes from the new clinical workflows. One area we looked at was hospital-acquired pressure ulcers and skin integrity events. Using the iPhones, our wound care nurses saw an immediate improvement in workflow by using the Epic Rover application to take a photo of the wound, which uploads the photo for documentation into the patient medical record. The physician or wound care nurses can see it immediately and even show it to the patient and their family when rounding with a physician.

With only two dedicated wound care nurses on our team, their time is extremely limited. Rather than spending time walking around looking for a physician or nurse to discuss a patient, they can now find the appropriate physician in the smartphone directory, send a photo via Rover, and ask the physician to call when he or she is available to discuss treatment. The result has been better communication among our interdisciplinary teams, more efficient use of time for our wound care team, real-time documentation to the medical record, and improved communication with patients and families.

Another area where we have made great headway with the iPhones is in reducing medication errors. Using our new workflow, a nurse changes his or her status in the directory from “available” to “busy” and types in a status message, such as “administering meds.” This lets the rest of the care team know not to interrupt that nurse until their status changes back to “available.” New workflows escalate alerts to a backup while that nurse is busy.

Today, we are using iPhones for communication on all clinical inpatient units for nurses, physicians, respiratory therapists, discharge planners, environmental services managers, and administration. We are communicating more efficiently, with about 70 percent of all communication now taking place via text message versus 30 percent via voice calls. Our very tech-savvy staff loves the new solution and has adapted well to the workflow changes. One nurse said her unit is much quieter and that the hospital “feels like a hotel, so patients can get some rest.”

In our first year using smartphones, we are still learning where we can make adjustments in our workflows to make the most of our new way of communication. Going forward, we will be analyzing workflow efficiencies, adjusting alarm settings, and managing notifications from nurse call, physiological monitors, and the EHR.

The authors presented an HIStalk webinar titled “Improving patient outcomes with smartphones: UW Medicine Valley Medical Center’s story.”

Readers Write: An Uncomfortable Truth About Hospital Revenue and an Overlooked Way to Gain It Back

May 10, 2017 Readers Write 4 Comments

An Uncomfortable Truth About Hospital Revenue and an Overlooked Way to Gain It Back
By Crystal Ewing

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Crystal Ewing is manager of data integrity at ZirMed.

In a video message from last year that he surely never intended for public and regulatory scrutiny, Mayo Clinic CEO John Noseworthy, MD appeared to advise employees to prioritize patients with commercial insurance in order for the famed hospital to remain financially strong.

Months later, Mayo is still explaining exactly what Dr. Noseworthy meant. Many healthcare leaders need no further explanation, even if they personally dislike any suggestion of favoring the commercially insured over Medicare and Medicaid patients. With government reimbursement continuing its decline, most hospitals are straining to hold on to their profitability.

Still, placing hope in commercial insurance to make up the difference is misguided, especially with the rising dominance of health plans that are not only high deductible, but also require high co-payments and high co-insurance. Touted as a means of covering more Americans, these plans often put more of the financial burden on patients than simply paying for healthcare in cash at a discount.

As such, many patients with these plans may claim they have no coverage when it comes time to pay for a procedure or service. It’s hard not to empathize with their motivation for doing so, but it’s a practice that can put the hospital in a precarious position.

With self-pay patients, things become more complicated, especially since there can be a lag of 30 or more days between the time that they are treated and the time the invoice comes due. When faced with a choice between paying for housing, utilities, food for their families, auto repairs, etc. – all of which affect the present and future – or paying a hospital bill for an event that occurred in the past, the decision is easy.

When this thinking is spread across a large patient population, bad debt accumulates quickly. Additionally, patients are unlikely to pay medical bills that are greater than 5 percent of household income, according to the Advisory Board, a consulting firm for hospitals. Median household income in the U.S. is at about $53,000, suggesting that when out-of-pocket charges exceed $2,600 hospitals can forget about collecting, according to Spencer Perlman, an analyst with Height Securities in Washington.

Given the above realities, more hospitals are using automated coverage detection technology, which also finds insurance coverage that patients legitimately aren’t aware of or are unable to communicate. When patients are brought to the hospital in the grips of a heart attack, for example, or while unconscious, they’re hardly able to convey their levels of coverage. Some fully conscious patients even may forget they have coverage, or provide information on secondary rather than primary coverage, or become confused about which carrier covers them. This isn’t uncommon with elderly patients.

No matter the reason it is problematic , it is imperative that coverage verification becomes a more streamlined process at our nation’s hospitals. It can be done in a way that respects the patient and in a timely fashion to protect the hospital’s finances. The most feasible method is to pair automated coverage detection with automated eligibility verification, the latter of which is already in place at many hospitals. However, coverage detection can also be an independent, standalone process. Either way, it makes quick work of checking with thousands of healthcare payers to determine if any are the primary or secondary insurer for a given patient.

Often, as much as 15 percent more instances of billable insurance are uncovered with superior processes and technology. Even just some quick mental calculation can see how this would recoup millions of dollars for many large hospital systems. It’s also significantly over the 1 to 5 percent rate achieved by manual and legacy coverage detection.

Much of this improvement is due to the huge data sets that now power some business intelligence engines, encompassing billions of historical health insurance transactions for millions of Americans. As these insights are tested against a pre-identified set of payers, algorithms can match the key data attributes that confirm coverage and the information needed to file the claim.

What has yet to be quantified but surely exists is the reduction in future collections activity with patients. Despite jargon that describes these patients as “empowered consumers,” the reality is they are struggling to pay their bills and rely on hospitals to help them navigate this uncertain terrain. In turn, hospitals must be fully informed about all of a patient’s sources of payment, including if commercial insurance coverage exists.

There is nothing unethical about seeking such information, only for using it to prioritize patients who it turns out are commercially covered. Clearly hospitals should be setting their sights on treating all patients, regardless of source of payment. The ability to do so is greatly enhanced when hospitals can identify all sources.

Readers Write: A Prescription for Poor Clinician Engagement with Health IT: Stop Communicating and Start Marketing

April 26, 2017 Readers Write 10 Comments

A Prescription for Poor Clinician Engagement with Health IT: Stop Communicating and Start Marketing
By David Butler, MD

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David Butler, MD is associate CMIO of the Epic/GO project of NYC Health + Hospitals of New York, NY. 

My first lesson in healthcare marketing came in the spring semester of my junior year at Texas A&M University, when I accepted a prestigious internship with a little company called Merck Pharmaceuticals. Believe it or not, I hadn’t even heard of this company, but I soon found out one of the many reasons for their meteoric rise.

That summer, Merck was releasing a new prostate drug. They posed the question to their young crop of interns: where should we market this drug? Field & Stream! Men’s Health! Cigar Aficionado! We shouted rapid-fire.

Wrong, wrong, and wrong again. Our instructor basked in our ignorance for a moment before he uttered the answer: Good Housekeeping. Targeting the significant others of the drug’s target audience was actually the smarter way to go. They were more likely to notice changes in their partner’s behavior and push them to go to the doctor.

Fast-forward 25 years later and healthcare is approaching physicians and nurses with the non-WIIFM, non-behavioral economics approaches similar to what my intern class suggested.

We spend hundreds of millions of dollars to implement technology for our best and brightest to leverage to care for patients, yet we continue to allow these transformative changes to the software to enter into their workflows without rollout efforts that match the investment and the desired results.

Healthcare needs to stop communicating and start marketing new health IT projects and improvements to existing provider-facing solutions. Too many initiatives fail not on the merit of the technology, but because the organization failed to successfully relay the value to the end users.

Here are five ways to help launch a full-fledged marketing campaign to capture your end users’ attention and effectively roll out new technology and important updates to current systems:

Change the mindset.

Health IT project teams need to think of their communication differently. It should not only inform, it should persuade. If you were going to sell something to physicians to get them to actually buy it, how would you change your communication? That should be a question asked during the creation of every piece of project collateral. How do you find the wife or the Good Housekeeping marketing equivalent from my opening example?

Get docs and nurses to want to do your desired action, or even better in some cases, understand why it would hurt not to do it.

Spotlight the value.

Too often healthcare organizations spend a bunch of R&D resources creating or improving something really cool, and then communicate that in an email with a laundry list of other changes that aren’t as meaningful. If you’ve added technology that will help save lives or otherwise have a profound impact on clinician efficiency, give it the spotlight it deserves.

For example, it used to be a policy at Sutter Health (my former organization) that if a nurse gave a patient insulin, a second nurse had to log in to double-check the dose. The organization finally changed the policy so that second nurse and verification was no longer needed. Some genius asked how much nursing clicks, time, or dollars would this save. We actually took the time to figure it out.

After calculating the size of organization and the insulin doses given each day, we figured that policy change resulted in $400,000 in savings of nurses’ time—and that’s the value we marketed. Not only to the nurses, but also to the board. We told the nurses how much of their time we were giving back to them and told the board about the significant cost savings for the organization.

Once you find the value to spotlight, think about what that value means to different parties and market that ROI.

Devise a catchphrase.

If you want end user attention, you’re going to have to earn it. There are too many competing priorities for a busy physician’s or nurse’s attention. Have some fun and get some eyeballs by devising a catchphrase for your campaign.

For example, when I was helping roll out a secure messaging solution to thousands of physicians, we could have promoted it with “New! Secure Messaging” or even “Pagers to Smartphones” messaging. Instead, we used “Safe Text.” It was fun and catchy—there were plenty of good-natured jokes and buzz around the campaign—and it also tapped into their own motivation to protect PHI. Make your catchphrase not only descriptive, but also memorable. That’s marketing.

Include a call to action.

What do you want your audience—physicians, nurses, or whichever group it may be—to actually do after they’ve read your communication? Good marketing always includes a call to action, or CTA. After you create marketing for the group, ask yourself what the CTA should be. Do you want them to download an app or an update? Submit their feedback? Add an event to their calendar? Always make the CTA big, bold, and if possible, frictionless.

For example, include a link that can automatically add the event to their calendar, or seamlessly forward it to a friend or colleague. You can also think about the tools you already have and how you might get innovative with them to drive follow-through.

One prominent health system in the Pacific Northwest used their EHR alerts to creatively capture clinician attention at various workflow points within the EHR. They were greeted by a respected physician leader — their CMO — whose image and quote reminded them to complete certain crucial activities within the EHR. Having his face staring at the clinicians alongside that CTA made it much more influential.

Rinse and repeat.

If a company you already like and engage with introduces a new product, they’re going to be marketing that to you on every channel they can: Direct mail, email, TV commercials, social media ads, display ads. Follow a similar approach for internal projects: Emails, flyers, reader boards, table tents in the cafeteria, digital banners on internal websites, announcements at town halls, free tchotchkes—anything you can think of where your end users might see it.

Physicians rarely understood why drug companies would provide free prescription pads, pens, and other items. They stated, “It doesn’t affect my prescribing patterns.” However, after many years of research on this, it actually does. So let’s wise up and follow other marketing examples from other verticals to keep the messaging in front of them. It may take several exposures for the message to resonate, but you can keep it fresh by switching up the format, colors, and graphics.

Finally, don’t forget to ask for help if you need it. Most healthcare organizations have talented marketing teams that are consumer-facing, but may be willing to help out with internal initiatives. They’re just not always asked.

With these five strategies, you can help your organization’s IT team pivot from communicating new technologies from boring emails to full-fledged campaigns that truly market the value to doctors and nurses and successfully bring them on board.

Readers Write: Deep Neural Networks: The Black Box That’s Changing Healthcare Decision Support

April 26, 2017 Readers Write 1 Comment

Deep Neural Networks: The Black Box That’s Changing Healthcare Decision Support
By Joe Petro

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Joe Petro is SVP of research and development with Nuance Communications.

Don’t look now, but artificial intelligence (AI) is quietly transforming healthcare decision-making. From improving the accuracy and quality of clinical documentation to helping radiologists find the needle in the imaging haystack, AI is freeing clinicians to focus more of their brain cycles on delivering effective patient care. Many experts believe that the application of AI and machine learning to healthcare is reaching a crucial tipping point, thanks to the impact of deep neural networks (DNN).

What is a Neural Network?

Neural networks are designed to work in much the same way the human brain works. An array of simple algorithmic nodes—like the neurons in a human brain—analyze snippets of information and make connections, assembling complex data puzzles to arrive at an answer.

The “deep” part refers to the way deep neural networks are organized in many layers, with the intermediate (or “hidden”) layers focused on identifying elemental pieces (or “features”) of the puzzle and then passing what they have learned to deeper layers in the network to develop a more complete understanding of the input, which ultimately produces a valid answer. For example, a diagnostic image is submitted to the network and the output may be a prioritized worklist and the identification of a possible anomaly.

Like us humans, the network is not born with any real knowledge of a problem or a solution; it must be trained. Also known as “machine learning,” this is achieved by feeding the network large amounts of input data with known answers, effectively teaching the network how to interpret and understand various inputs or signals. Just like showing your child, “This is a car, this is a truck, this is a horse,” the network needs to be trained to interpret an input and convert it to an output.

For example, training a DNN for medical transcription might involve feeding it billions of lines of spoken narrative. The resulting textual output forms a truth set consisting of spoken words connected with transcribed text. This truth set expands over time as the DNN is subjected to more and more inputs. Over time, errors are corrected and the network’s ability to deliver the correct answer becomes more robust.

A key feature of a neural network is that when it gets something wrong, it is corrected, Just like a child, it becomes smarter over time.

The Black Box

Here’s where it gets interesting. Once the DNN has that baseline training and it begins to analyze problems correctly, its neural processes become a kind of black box. The DNN takes over the sophisticated, multi-step intelligence process and figures out how the inputs are connected or related to the outputs. This is a very powerful concept because we may not fully understand exactly how the network is making every little decision to arrive at an output, but we know it is getting it right.

This black box effect frees us from having to contemplate—and generate code for—all the complex intermediate variables and countless analytical steps required to get to a result. Instead, the DNN figures out all intermediate steps within the network, freeing the technologist from having to worry about every single one. And with every new problem we give it, we provide additional truth sets and the neural network gets a little bit smarter as it trains itself, just like a child learning its way in the world.

How smart is smart? One of the biggest challenges with speech recognition is accommodating language and acoustic models, the specific and very individual aspects of the way a person speaks—including accent, dialects, and personal speech anomalies. Traditionally, this has required creating many different language and acoustic models to cover a diverse range of speakers to ensure accurate speech recognition and improve the user experience across a large population of speakers.

When we started using special purpose neural networks for speech recognition, we discovered something surprising. We didn’t need as many models as before. A single neural network proved robust enough to handle a wider range of speech patterns. The network essentially leveraged what it learned from the massive amounts to speech data we used as a training set to improve its accuracy and understand people across the entire speaker population, reducing the word error rate by nearly 30 percent.

Anecdotally, I’ve heard from people seated across from a physician dictating with such a thick accent at such high speed that they could not comprehend what was said, yet DNN-driven speech recognition technology understood and got it right the first time.

It’s important to note that neural networks are not magic. DNNs require problems that have clear answers. If a team of trained humans agrees with no ambiguity and they can repeat the agreement across a large set of inputs, this is the kind of problem that neural nets may help to solve. However, if the truth set has grey areas or ambiguity, the DNN will struggle to produce consistent results. The problems we choose and the availability of strong training data is key to the successful applications of this technology.

Putting DNNs to Work in Healthcare

So how are DNNs changing the way healthcare is practiced? Neural networks have been used in advanced speech recognition technology for years, and that’s just the beginning. The potential applications are nearly endless, but let’s look at two: clinical documentation improvement (CDI) and diagnostic image detection.

Clinical documentation includes a wide range of inputs, from speech-generated or typed physician notes to labs, medications, and other patient data. Traditionally, CDI involves having people who are domain experts reviewing the documentation to ensure an accurate representation of a patient’s condition and diagnosis. This second set of eyes helps ensure patients receive the appropriate treatment and that conditions are properly coded so the hospital receives appropriate reimbursement. The CDI process requires time and resources and can be disruptive to physicians’ workflow since the questions coming from CDI specialists are generally asynchronous with the documentation input.

Technology is used to augment the CDI process. Applications exist that capture and digitize CDI processes and domain expertise, creating a CDI knowledge base at the core. This involves processing clinical documentation, applying natural language processing (NLP) technology to extract key facts and evidence, and then running these artifacts through the knowledge base. The output of this complicated process is a context-specific query that fires for the physician in real time as she is entering patient documentation, linking, say, a relevant lab value with key facts and evidence from the case to indicate the possibility of an undocumented infection, for example. This approach to addressing a common documentation gap is a technically arduous and complex processing task.

What if we applied neural networks to change the paradigm? Many institutions have been doing CDI manually for years and we can leverage not only the existing clinical documentation (the input), but also the queries generated (the output) from those physician notes to create a truth set for training the neural network with a repeatable, deterministic process. The application of neural networks allows us to skip over complexity of digitizing domain expertise and processing the inputs through a multi-step process. Remember the black box concept? The DNN essentially determines the intermediate steps, based on what it learned from the historical truth set. In the end, this helps improve documentation by having AI figure out the missing pieces or connections to advise physicians in real time while they’re still charting.

The applications of neural networks are not limited to speech or language processing. DNNs are also changing the game for evaluating visual data, including radiological images. Reading the subtle variations in signal strength associated with identification of an anomaly requires a highly-trained eye in a given specialty. With neural networks, we can leverage this deep experience by training the network with thousands of radiological images with known diagnoses. This enables the network to detect the subtle differences between a positive finding and a negative finding. The more images we feed through it, the more experienced and accurate the DNN becomes. This technology will streamline the busy workflow of the radiologist and truly amplify their knowledge and productivity.

Augmenting, Not Replacing

While the possibilities for neural networks are incredibly exciting, it’s important to note that they should be viewed as powerful tools for augmenting human expertise rather than replacing it. In the case of diagnostic image detection, for example, a DNN can serve as a first line review of films, helping prioritize them so radiologists focus first on those that are most critical. Or it might serve as an automated second opinion, possibly spotting something that might have been overlooked.

Today, AI in healthcare decision support is still in its infancy. But with the exciting possibilities created by DNNs, that infant is poised to transition from crawling to walking and even running in the foreseeable future. That’s good news for providers and patients alike.

Readers Write: Top Health IT Marketing Trends From #HITMC

April 10, 2017 Readers Write No Comments

Top Health IT Marketing Trends from #HITMC
By John Trader

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John Trader is VP of communications at RightPatient in Atlanta.

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I had the opportunity to attend the Health IT Marketing & PR Conference in Las Vegas last week, and thought I’d share some of my top health IT marketing takeaways.

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Content, Content, Content

Content was certainly king in terms of session topics. What works. What doesn’t work. How to establish a sound content-marketing strategy (even if you’re a small company with a shoestring budget). My biggest takeaway on content is that marketers need to start with the end in mind. Understand what content resonates with the demographic you target by listening first, and then developing a strategy that addresses customer needs and is strategically presented to them as they make their way down the sales funnel.

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I enjoyed Sarah Davelaar’s (from the The Signal Center for Health Innovation) session where she outlined the key elements in content strategy. I also enjoyed a panel discussion featuring four physicians who shared their content consumption habits – where they go to find information, what content resonates with them, and what they like versus what they ignore. The million-dollar question for any health IT marketer is: What influences their decision to buy? Most docs said that conferences are a great place for them to discover new products. Those docs on social platforms like Twitter do pay attention to who shares their posts and who interacts with them. Catchy headlines are important, and most of them look for unique perspectives on issues as opposed to extolling the virtues of a product.

Innovation Versus Value

Conference organizer and Netspective founder Shahid Shah’s opening presentation on day two was excellent (although the amount of information on his slides was a tad overwhelming). There was a lot of discussion at the conference about whether marketers should position themselves as innovators, since nothing we do is truthfully going to "disrupt" healthcare. The truth is, customers care a lot more about value than innovation. One of the best quotes from his presentation was, “Do customers care about what you think is innovation or will they care more about you when you care about what their innovation needs are?” 

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Social

Although I didn’t attend any sessions dedicated to social media use or strategy, there were a few that addressed how to navigate the online universe, and how to develop and execute effective social media strategies. “Go where your customers are” seemed to be the general takeaway from attendees of those sessions. Don’t chase the latest shiny social platform just for the sake of having a presence. Again, start with an end goal in mind (create leads and eventually sales), and make sure you are measuring your results (how will you be able to tell if your efforts are successful?) There was also some discussion on how to effectively measure social to gain a better understanding of what works versus what doesn’t work. There was also a lot of chatter moving beyond brand awareness and more into how social efforts are creating leads and sales.

Leveraging the Customer

A recurring theme was how to leverage existing customers to create new business. Kathy Sucich of Dimensional Insight delivered an excellent presentation, where she provided a case study on how she increased her own company’s “share of voice” (a term that was new to me), and gave sound advice on how to successfully leverage customers to create new content and increase brand visibility and messaging. The key takeaway for me here was that capturing and then bringing the customer’s voice to your messaging requires personal relationships with customers. You simply must spend the time to cultivate these relationships by establishing a set of expectations at the outset of the relationship that outlines your plan to work with your customers and get their story in front of others.

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Video

There was lot of buzz about creating more video as part of an effective marketing strategy. It continues to be a hot topic of interest because it’s clear that people want to consume more of it. The key is making it resonate. The key seems to be keeping it simple, short, and focused on addressing a problem instead of extolling the virtues of a product. Christine Slocumb’s (of Clarity Quest Marketing) session was excellent in reiterating the point that in this day and age, videos have to be personalized to be effective.

SEO Isn’t Dead

Kristine Schachinger of The Vetters Agency presented an excellent session covering modern SEO practices, soup to nuts. We talked about ways to analyze SEO performance, online SEO resources, ranking factors, inbound link tactics, do’s and don’ts for SEO, how to add Google Search Console to your site, how content affects SEO, and keyword research – just to name a few topics. There was a great deal of interaction between the presenter and the audience, and directly between audience members, which, in my opinion, is what makes this conference excellent. Questions were asked and topics brought up that were a great supplement to Kristine’s curriculum. This is perhaps what I like best about HITMC. It has a more intimate setting than most conferences I attend.

About That Other Conference

The buzz around the conference seemed to be the forthcoming HIMSS marketing conference (which, by the way, I don’t anticipate being able to offer the intimate setting I mentioned above). Many have said they heard through the rumor mill that it may be frowned upon by the marketing community to attend in lieu of supporting HITMC’s more grassroots efforts. I talked to several people who have already signed up for the HIMSS event but seem to be keeping that information to themselves. Other buzz has been the quality of HITMC – most people agree that it’s an excellent conference and gets better each year by addressing the most relevant topics to marketers.

The only drawbacks I found, aside from freezing temps in the conference rooms, was that the few tough questions I asked during Q&As weren’t answered as thoroughly as I would have liked, and there was a lack of substantial, real-world case studies to back up presenter assertions. Overall, I think the conference was a great investment. It’s always helpful for me to be around likeminded professionals eager to gain insight and tips on how we can do our jobs more effectively.

Readers Write: In a Fog About the Cloud?

March 27, 2017 Readers Write No Comments

In a Fog About the Cloud?
By Alan Dash

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Alan Dash is senior advisor with Impact Advisors of Naperville, IL.

The use of a cloud to symbolize some magical spot where all the answers to the world’s questions are housed and an infinite amount of storage exists has been around since the 1970s. I reflect on my own career, while programming for the US Air Force in the early 1980s, drawing clouds in my diagrams to show that somewhere, out there, beneath the pale moonlight, someone’s thinking of me, and filling the void symbolized by my cloud with meaningful data.

Not exactly how Linda Ronstadt and James Ingram sang it, but that was my visual. Back then we called it what it was – centralized computing; output devices received data from centrally-located applications.

Then came PCs, placing those applications out onto the edge of the computing environment and away from the monster in the data center that threw off a dragon’s amount of heat and occasionally an equal amount of fire and brimstone. We called that de-centralized computing; everyone was free to process at their desk.

PCs became smaller, applications bigger. Soon we needed gigabits of storage to hold the very applications that were to be fed with an obese amount of data. Ultimately PCs couldn’t handle the power and space needed, so centralized computing came back, only this time we called it “The Cloud” and it was good – good because we learned new acronyms like SaaS, DaaS, IaaS, NaaS, and RaaS.

So now that we understand the Cloud, kinda, manufacturers have introduced something new — very small sensors which can equally communicate and intercommunicate in such a way, justifying a new name, The Internet of Things (IoT), or The Internet of Everything (IoE).

Ostensibly, these little sensors and devices communicate with the Cloud in a two-way format, providing data and receiving instruction. An example of these devices under IoT include sensors designed to control lights and blinds, HVAC systems and appliances, security and energy efficiency systems. More recent additions of IoT devices include wearable medical technologies, wildlife movement monitoring, urban infrastructure monitoring (road and bridge), and even intelligent collision-avoidance sensors in automobiles (both with driver and without driver).

Back to the Cloud. Servers located remotely (in the Cloud) can, and do, communicate with IoT devices out on the edge of the network; centralized computing works for IoT devices. However, propagation delay (another ‘old’ term) has become a serious factor. Propagation delay is the length of time it takes to get a signal from a sender to a receiver and back. Under normal circumstances, while we are impacted by this delay, we don’t really experience it because of our reference point.

Here’s an example. You call a friend who you are meeting at a restaurant, you ask where they are, and then you see them walking around the corner. You see their mouth move, then you hear their voice in your phone. We always have this delay, but our reference point is such that we do not realize it, so it does not bother us.

Not so for IoT devices. These devices need to instantly communicate and intercommunicate between other IoT devices, and the process of these devices speaking to each other in the Cloud, while technically capable, adds way too much propagation delay to the mix. They become ineffective.

This brings a new (old) concept back into play – de-centralized computing. Ahh, remember that? But we can’t call it de-centralized computing because it’s an old term that we were told does not work any longer, so for IoT to IoT device communication a new name had to be created. That name is … The Fog.

And yes, it makes sense. A fog is a cloud at ground level. A billion droplets of water vapor floating around at a low level, not relying on the cloud for existence. And that’s what the idea of intercommunicating IoT devices is. A billion little sensors bouncing around, intercommunicating, and not relying on the Cloud to perform that communication.

In healthcare, IoT is already here and located within wearable technologies monitoring biometric data, in the RFID systems used to track supplies and locate staff, and in mechanical controls for building automation. For hospitals, growth of wearable tech will be seen as the next step, and this growth will be the first impact on architecture from IoT.

Already we are seeing program space being set aside by hospitals to blend clinical engineering, clinical care providers, and IT departments who will work together to choose, fit, configure, and remotely monitor patients wearing sensors, smart clothing, even implants and prosthetics that will communicate back into the hospital network.

While large leaps into IoT and Fog Computing won’t be seen in the typical hospital for a few years, forthcoming IoT devices will route alarms from equipment to care providers, warn of fall risks, automate re-supply of equipment and meds, track clinical process flow, mitigate queuing, and heighten the use of autonomous robots for specimen collection, supply delivery, and remote telemedicine visits. Beyond that, as driverless cars make their way into mainstream, hospital garages and way finding systems will ultimately communicate directly with these vehicles, perhaps even routing cars to appropriate entry points based on the current biometric readings of the passengers within.

The possibilities are, well, still foggy.

Readers Write: What Healthcare Can Learn From My Roofer

March 27, 2017 Readers Write 6 Comments

What Healthcare Can Learn From My Roofer
By Phelps Jackson

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Phelps Jackson is CEO of Sirono of Berkeley, CA.

I had a leaky roof over my kitchen. In the dry season, it wasn’t a problem, but it was something I needed to take care of. I kept putting off the repairs because I dreaded the hassle of bids, estimates, and surprise expenses.

When the rainy season finally came, I started using my pots more for catching drips than for cooking. I had to do something. I looked online for the highest-rated roofing company in my area, got an estimate for repairs, and gave the go-ahead for the work.

About 30 minutes into the job, I got a call from the roofer. The wood beneath the shingles was ruined. It would add $1,200 to the repairs. When I asked why that cost wasn’t included in the initial estimate, he politely reminded me that he had warned about the possibility of additional costs.

When I asked why the price was so high, what I got was modern, high-quality customer service: on-the-spot pictures of the rotten sheathing, an email with the price breakdown, a follow-up phone call to see if I had any billing questions, and more pictures of progress as the repairs went on. Actual pictures!

In the end, I was comfortable paying the higher cost because I understood the real value of the service. Best of all, he kept me well informed throughout the whole process even though I was 1,000 miles away on a business trip.

So, if a guy standing on top of my house can offer omni-channel customer service and high-level billing support, why can’t a multimillion-dollar hospital with teams of representatives do the same?

That’s exactly what frustrated patients ask themselves every day. They don’t care about the complexity of medical claim processes. They just want to know how much they will owe and why. The reality is that 61 percent of patients find themselves surprised by out-of-pocket expenses because they were never told that pre-service estimates aren’t 100 percent accurate or more likely didn’t get an estimate in the first place.

In contrast to the customer billing support I was offered, what if three months after the repair I had gotten a roofing bill $1,200 higher than the estimate? I would have assumed that I was being ripped off, disputed the charges, and most likely left negative online reviews so others could avoid a similar experience.

It’s no different when patients receive unanticipated escalated medical bills, which is so often the case. They become suspicious of the additional charges, question their own financial liability, and delay payment or refuse to pay altogether. Even if patients are happy with their medical care and would be willing to accept additional fees, they probably assume that there was an error.

Proactive outreach to explain balance changes shows patients that they are valued and respected. It clarifies the quality of the care received, expedites payment, and inspires customer loyalty. Fifty-seven percent of patients say their medical bills are confusing.

Improving the patient billing experience is a must for every hospital. Utilizing the patient’s preferred methods of communication makes the process easier and far more patient-centered. In healthcare, as in every other industry, consumers want to interact with businesses the way they prefer, whether it is online, email, text, phone, or through the mail.

The ease of online shopping and service-oriented local businesses have raised customer service expectations and the average hospital doesn’t come close. As patient payments become increasingly critical to the revenue cycle, smart health systems will adapt and prosper. Those who don’t—won’t.

Readers Write: Data Security Comparison: Healthcare vs. Retail, Finance, and Government

March 15, 2017 Readers Write No Comments

Data Security Comparison: Healthcare vs. Retail, Finance, and Government
By Robert Lord

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Robert Lord is co-founder and CEO of Protenus of Baltimore, MD.

In 2016, the healthcare industry experienced, on average, more than one health data breach per day, and these breaches resulted in 27,314,647 affected patient records. Clearly, criminals are targeting patients’ medical information with great frequency and success.

How has the healthcare industry responded to this continuing epidemic? Data suggests there is still a lot of work for healthcare organizations to do in order to improve the security of their patient data. It’s important to look closely at and analyze how healthcare organizations’ security practices and spending compare to retail, finance, and government — three industries known to have proactively advanced their security posture to protect their sensitive data.

Compared to the retail and finance industries, the state of healthcare data security is sorely lacking. Since 2015, 140 million patient records have been compromised, equating to one in three Americans experiencing their health data being inappropriately accessed. Ransomware attacks hit the healthcare industry especially hard, as 88 percent of all ransomware attacks target a healthcare organization.

Criminals are increasingly targeting healthcare because patients’ medical information is incredibly profitable on the black market and it’s more easily accessible when compared to more protected industries, such as finance. Within the finance industry, if a customer’s credit card or bank account number is stolen, that information can simply be changed, rendering it useless to the criminal. Patient data, on the other hand, is a repository of information that can be used to steal an individual’s identity – Social Security numbers, DOB, and addresses.

When combined with sensitive medical information like diagnoses, claims history, and medications, it can create the perfect storm for wreaking havoc in a patient’s life. This kind of information cannot be easily changed, and because of the lagging security in the healthcare industry, this data is incredibly easy to obtain and increasingly vulnerable to criminals’ sophisticated attacks.

There is no question that when compared to other industries, healthcare falls short when it comes to data security. A 2015 survey found that only 31 percent of healthcare organizations used extensive methods of encryption to protect sensitive data and 20 percent used no encryption at all. Another study found that 58 percent of organizations in the financial sector used encryption extensively. These results are concerning because the information healthcare organizations must protect is far more sensitive and potentially damaging than the information retail and finance organizations gather and protect even though the latter group is more proactive in keeping this information safe.

Retail and financial service organizations have more experience protecting customer data from cyber criminals.This gives them an advantage over healthcare organizations, who are relatively new to the game and whose unique security challenges require specially designed solutions. It’s past time for healthcare organizations to invest substantially in protecting patient data. Sadly, according to KPMG, this has not yet occurred at the necessary scale, as IT security spending in the healthcare industry is just 10 percent of what other industries spend on security.

Incentives exist for healthcare organizations to improve their security posture because the cost of a healthcare breach is significantly higher than in other industries. The average cost per lost or stolen record is $158 across all industries. In the retail sector, the cost is $200 per record lost or stolen. In the financial sector, the cost is $264 per record.

Compare this to the healthcare industry, where the average cost per record lost or stolen is $402, double that of the retail sector. Why are healthcare data breaches so much more expensive? In the aftermath of a breach in a heavily regulated industry like healthcare, the breached organization must conduct a forensics investigation and notify any affected patients. These organizations must also pay any HIPAA fines or penalties incurred because of failure to comply with federal or state regulations. This is in addition to legal fees, lawsuits and most importantly, the long-term brand reputation of the affected organization and lost patient revenue.

However, it’s important to note that healthcare is not the only industry to have fallen behind when it comes to data security. The US government has also struggled to institute effective data security practices. A study by SecurityScoreCard examined the security posture of 600 local, state, and federal government organizations and compared them to other industries. The study found that government organizations had some of the lowest security scores, trailing behind transportation, retail, and healthcare industries. It also found that there were 35 major data breaches of the surveyed organizations from April 2015 to April 2016.

In the summer of 2015, the Office of Personnel Management (OPM) announced that it had suffered a massive data breach. The sensitive information of over 21 million people had been stolen, including fingerprints, Social Security numbers, and sensitive health information. A report from the House Committee on Oversight and Government Reform alleged that poor security practices and inept leadership enabled hackers to steal this enormous amount of sensitive data. OPM immediately began to implement changes aimed at improving their security posture and ensure that such a future massive breach would be prevented. However, one can’t help but consider how much less damage would have been done if OPM had made these changes as a proactive data security measure instead of a reactive one.

While healthcare organizations have had their fair share of data breaches, the OPM breach must serve as a lesson to the industry. Since that incident, the government has prioritized cybersecurity and focused on finding solutions to protect our nation’s sensitive information, data, and assets. Healthcare organizations must follow suit.

Here are five things healthcare organizations can do now to improve their health data security:

  1. Frame security risk assessments as an ongoing process rather than a once-per-year event, ideally, but at the very least ensure they are done annually.
  2. Encrypt data stored in portable devices.
  3. Assess other third-party security risks.
  4. Proactively monitor patient data for inappropriate access.
  5. Educate and retrain staff on how to properly handle sensitive data.

Healthcare must make privacy and security top priorities, learning from the past, applying knowledge from other industries, and creating unique solutions specifically designed for the complicated healthcare clinical environment. This will ultimately provide healthcare organizations with the tools to keep sensitive patient information safe, maintain the organization’s brand reputation, and most importantly, increase patient trust.

Readers Write: Beyond the Buzzword: Survey Shows What EHR Optimization Means to Providers

March 15, 2017 Readers Write 3 Comments

Beyond the Buzzword: Survey Shows What EHR Optimization Means to Providers
By David Lareau

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David Lareau is CEO of Medicomp Systems of Chantilly, VA.

I was intrigued by this recent KPMG CIO survey that found “EMR system optimization” was currently the top investment priority for CIOs. The survey, which was based on the responses of 112 CHIME members, revealed that over the next three years, 38 percent of the CIOs plan to spend the majority of their capital investment on EHR/EMR optimization efforts.

The key word here is “optimization,” since over 95 percent of hospitals already have an EHR/EMR, according to the Office of the National Coordinator (ONC). Given the high level of provider dissatisfaction with their EHRs/EMRs, it’s not surprising that CIOs are seeking ways to make their doctors happier with existing solutions, since starting over with a new system would require a major capital investment that few hospitals are willing or able to afford.

In the KPMG report, the authors suggested a few ways CIOs could optimize their EMRs/EHRs, including providing effective user training and making more technology available remotely and via mobile devices.

Coincidentally, at HIMSS this year, we conducted our own survey to get a better understanding of what providers find most frustrating about working in their EHR/EMR. I am the first to admit our survey wasn’t the most scientific – the primary reason that almost 700 people agreed to participate in the survey was because it allowed them to enter our drawing for a vacation cruise – but nevertheless, the results were compelling.

We asked HIMSS attendees the following question: What is most frustrating about working in your EHR? We then offered the following response choices:

  1. Relevant clinical information is hard to find
  2. Documentation takes too long
  3. Doesn’t fit into my existing workflow
  4. Negatively impacts patient encounters
  5. Doesn’t frustrate me
  6. My organization doesn’t use an EHR

A whopping 44 percent selected the response, “Documentation takes too long.” For the sake of comparison, the next-highest response was, “Relevant information is hard to find” (18 percent), followed by, “My organization doesn’t use an EHR” (13 percent).

What I glean from these results – aside from the fact that CIOs would be well served to invest in solutions that improve documentation speed – is that CIOs and other decision makers may not be focused on the right solutions.

I am a big proponent of user training, but let’s be realistic: if you have a propeller-driven airplane, it’s never going to perform like a jet aircraft. CIOs must accept that even with all the training in the world, the documentation process within some legacy EHR systems will never be significantly faster, nor will it be particularly user friendly.

Rather than investing resources in trying to teach users how to make more efficient use of an inefficient system, why not consider investing in a solution that can easily be plugged into legacy systems and give clinicians the fast documentation tools they desire? CIOs can find technologies that work in conjunction with existing EHRs to alleviate provider frustration because they work the way doctors think, do not get in their way, and do not slow them down.

The KPMG survey confirms what most of us in healthcare IT have long known: EHRs have not yet achieved their full potential, providers are weary of the inefficiencies, and more resources must be spent to optimize the original investments. As CIOs and other decision-makers consider their next steps, I encourage them to assess what they now have and look for solutions that give clinicians what they want and need at the point of care.

Readers Write: Naked Cybersecurity

March 8, 2017 Readers Write 1 Comment

Naked Cybersecurity
By John Gomez

John Gomez is CEO of Sensato of Asbury Park, NJ.

Although the observations in this article are based on my direct experiences over the past four years working with healthcare organizations to secure their systems. I am sure that most of what I am going to share is wrong. I also will apologize upfront for presenting a viewpoint that I am sure is one-sided, and although I believe it to be reflective of the reality of cybersecurity in healthcare, it is probably wrong.

I also want to clarify who I hope will read this article, because it is certainly not meant for everyone. If you are of the belief that academic cybersecurity approaches, checkmark mentality, or putting your faith in things like commercial “trusted” security and privacy frameworks or national cybersecurity information sharing groups is a good idea, then this article is not for you. Reading it will be a total waste of your time.

In fact, if you think that what you have been doing in cybersecurity is right and spot on, this article will just annoy you. And yes, you guessed it, it will be a waste of your time.

On the other hand, if you stay up at night freaked out that despite your best efforts you are losing the battle against a well-armed and informed enemy, then brothers and sisters, you probably will find this article of interest. Yet I warn you — this is more about my opinion (as unqualified as that may be) than any academic, certified, highly-trusted approach you may find in the world of healthcare cybersecurity.

For those who are still reading along, let me drop (in the vernacular of our youth) a truth bomb. A truth bomb that I suspect anyone still reading will not find surprising, but is akin to that small child who once said, “But the emperor has no clothes.” The truth I share with you is that we are losing the cybersecurity war and losing badly. 

There, I said it. And yes, it is rather cathartic to be able to state that in public. Try it with me — I promise you will feel better and empowered. We are losing the cybersecurity war.

Despite our best efforts, despite the beliefs in fancy risk and security frameworks and the latest hyperbole regarding threat intelligence, advanced defenses, and the latest snake oil being peddled by cybersecurity vendors, we are losing ground by leaps and bounds.

If you ever wanted to know what it felt like to be on the receiving end of General Patton’s surge across Europe, just take a job in the world of healthcare cybersecurity. We have some great, passionate, talented people among our ranks, but regardless of how fast they are pedaling, the attacks are overrunning them and taking ground.

In 2016, per a PWC cybersecurity survey, organizations across industries increased their spending on cybersecurity by 20 percent. Yet despite deploying more frameworks, more technology, employing some cool AI stuff, expanding their staffs, and embracing the best practice of the day, we also learned that there was a 38 percent increase in cybersecurity attacks. The cost to remediate an attack rose by 23 percent over 2015.

Talk about a lousy return on investment. You increase spending by 20 percent, and yet you are finding your efforts to not even be closing the gap. In fact, on a cross-industry basis, we are seeing double-digit negative returns on cybersecurity investments.

Years ago, an experiment was conducted where a monkey threw a dart at a list of stocks. The goal was to see if random selection of stocks ended up worst or better than what was selected by professional and well-trained brokers. If I recall, the monkey’s picks fared better. Sadly, for those of us protecting healthcare organizations from attackers, we are seeing similar results. There is no — not one — strategy or best practice that will definitively prevent attackers from gaining access to your systems.

Speaking of attackers, just how painful has life become for their side of the seesaw? I mean, everyone is spending more money; cybersecurity is now a board-level issue; and per HIPAA, it is required that the CEO be intimate with the protection of patient data as it relates to security and privacy. Certainly all this increase in spending, resources, and attention must be making life so very hard for the cyberattacker.

Well, in 2016, the average cost of a highly-sophisticated exploit kit was $1,367, a 44 percent decrease over 2015. Thanks to easy and cheap access to cloud computing (I am looking at you, Microsoft and Amazon), the cost of an attack has dropped 40 percent over 2015. We now have attacker market that include RAS (ransomware as a service), EAS (espionage as a service), and DDoSasS (Distributed Denial of Service as a service). You can contract for any of these attack services from the comfort of your home recliner. We also have learned that the average length of time to successfully execute a breach is now less than 24 hours, a 72 percent decrease over 2015.

Net-net, attackers are winning and probably chilling out, sharing bottles of wine, nibbling on cheese, and laughing their butts off. Yet for those in the trenches, those who get up day to day fighting the good fight, none of this is new. I suspect that the front-line defenders know all of this, yet don’t have the data or podium to yell out, “The emperor has no clothes.”

Ultimately, I believe we all are united (vendors, defenders, management) in understanding that our current approaches are not working over the long term. I also suspect some will have counterarguments, point out that things aren’t that bad, and claim their solution is fault proof. As someone who works with attackers, I can tell you that you would be foolish to believe that your current approaches can thwart attackers. Especially if your approaches date back to 2010, are based on complicated frameworks and tools, and require you to subscribe to checkmark practices.

Here is a final statistical truth bomb that you may find entertaining. About a decade ago, we could detect an attacker in our networks within hours. Over time time-to-detection has evolved from hours to the current average of 265 days. If the attackers keep evolving, soon it will be over a year on average before we can detect an attacker despite our increased spending and advanced defense capabilities.

We can attribute this to advanced persistent threats (even though most attacks are not all that advanced), higher complexity of networks, and technology we defend as among the reasons attackers succeed. I am sure there is some truth in all those reasons, but you don’t win wars by pointing out what you are doing. You win wars by gearing up, toughening up, and figuring out how to fight better and more effectively than your enemy.

I guess the foundational question this article will pose is, is this a lost cause? Should we just wave the white flag and throw up our arms? That is one approach, but I have greater faith in all of you. You who stay awake at night wondering what else you can do to fight the good fight. You who take on your boards, push back against the egotistical physician, and fight to be heard for funding and attention — all to make it a little bit tougher for the attacker. I have tremendous faith for all of you who insist, “Not on my watch.”

I believe there is a lot we can do to turn the tide on the attackers. Right now, we are in a ground war, one that can benefit from technology, but that also requires us to really reconsider our core tactics and principles. One major piece of advice I would give you comes from Luke Cage of Marvel Comics — “…sometimes you have to throw out the science.”

A key approach that should be considered, debated, and tested is simplification. Rather than embrace the false of sense of security that complexity may bring, we should focus on tactics that rely on low-tech solutions that work consistently. You should be establishing last lines of defense that are based on securing high-value targets. It is critical that you take an attacker-centric viewpoint and truly understand attacker motivations. Much of this advice comes from my personal experiences in cybersecurity and in training special operation teams to take the fight to the enemy.

Simply stated, you need to embrace an assertive posture related to your cybersecurity. This is not 2010. It is 2017, and we are now dealing with attackers employing 2020 approaches. We have just seen the release of MedJack 3.0, which bypasses antivirus. We are seeing malware that is polymorphic. We are seeing attackers embrace analytics and machine learning. The answer is not a framework that recommends changing your password every 90 days? A signature-based system is not going to keep an attacker out of your network.

We need to stop putting our faith in those solutions and approaches that are complex and increase complexity. Regardless of the technical solution or tactic, your goal should be to embrace simplicity, reduce excuses, and eliminate barriers to security.

Want to practically eliminate phishing attacks? Invest in a solution that adds the word “External:” to the subject line of any e-mail that comes from outside your organization. You would be surprised how this little low-tech investment dramatically drops the success of phishing attacks. Want to reduce the length of time an attacker is in your network? Learn what scares them most and target their fears (if you don’t know that answer, e-mail me). Turn the tables, get practical, fight back.

Practical real-world security doesn’t require huge expense or complicated approaches. The most critical first step is to become like a child. Open your eyes and realize that the emperor which is healthcare cybersecurity is in the buff.

Readers Write: It’s Time to Bring Back the Noise

March 1, 2017 Readers Write 1 Comment

It’s Time to Bring Back the Noise
By Andrew Mellin, MD

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A very memorable moment for me at one of the first go-lives for a hospital EHR was when I stood on the unit and realized there was an eerie silence. While the beeps of the monitors and the drone of the overhead pages continued, the buzz of the caregivers talking to each other was gone as everyone was staring intently at a computer monitor.

As an implementation team, we quickly learned we needed to frequently remind the caregivers to keep talking to each other as part of our go-live training for future sites. But years later, it is clear the EHR has fundamentally changed the dynamics of how providers and care teams communicate.

The impact of this dynamic is well recognized. The change in communication patterns, sometimes called the "illusion of communication," is identified as one of the key unintended consequences of implementing an EHR. With today’s EHRs, we now have all the information we need at our fingertips, yet the ability for care teams to collaborate in an ongoing, continuous dialogue is not well supported by the systems’ encounter, inbox, and order-based models.

We still have noisy hospitals, but now we hear the wrong kind of noise: the sounds that keep patients awake and require caregivers to respond to beeps emitted from devices in stationary locations that make it difficult to find a real signal that requires action.

It’s time to bring the right kind of noise back to patient care. Not the auditory noise that we hear, but the cognitive buzz that is generated when high-functioning teams are communicating in an effortless, asynchronous manner.

Think of how communication models like iMessage, WhatsApp, and SMS have changed the way we communicate in our personal lives. There’s very low effort required to initiate a simple message. We have the ability to share rich information — such as images, videos, or voice — as well as expressive notifications. We even have an ongoing transcript of the conversation and acknowledgement of message receipt.

Healthcare communications benefit from the same communications models, but require HIPAA compliance, message traceability, integration to other initiators of messages (e.g., the hospital operator), and EHR integration.

The actual messaging app, however, is simply the user window into communications technologies that not only improve care team collaboration, but more importantly, drive improved care team efficacy and patient outcomes.

For example, physicians work in shifts that are largely defined by an on-call schedule. When I worked as a hospitalist on weekends when the staff frequently changed, I needed to find an on-call schedule to determine which specialist would see my patient that day (usually I just asked the nurse or HUC to page a person for me because it was too hard to figure out who was on call.)

To solve this problem, a healthcare communications platform needs to support messaging to a role that resolves to their correct on-call individual. And secure mobile messaging is not only about person-to-person communications — rather it is a way to notify an individual of any important piece of information about a patient, whether it is generated by a machine or a human.

For example, when a CDS alert in an EHR is triggered to indicate that a patient may be becoming septic, a rapid response team can be automatically and immediately notified. When a device triggers an alarm, instead of a loud beep that has to be interpreted, the specific, detailed message with patient context is sent to the right person’s device with the appropriate sense of urgency.

All technologies have limited value unless directly leveraged to improve organizational goals, and communication tools are often an underrepresented element of process improvement initiatives due to the limited modes that exist without a modern communication infrastructure. I’ve seen dramatic operational and clinical improvements achieved when these tools are embraced, such as 30-minute reduction in admission times from the ED and material improvement in HCAHPS scores.

These tools do not eliminate the phone call that is essential in a complex situation or the need to document the care plan in the EHR. Rather, these tools augment the EHR and elevate the quality and cohesiveness of the care team collaboration. The magnitude of the value of healthcare communications is under-appreciated: One large academic medical center sends over 150,000 messages to the caregivers and support staff in their organization every week.

It’s time to give caregivers the communications tools they need to improve the patient’s care experiences and outcomes and care team efficacy while eliminating the auditory noise where care is delivered. And it’s time to bring in the kind of high-value noise where caregivers are rapidly interpreting and responding to targeted messages on the go on their mobile device.

Andrew Mellin, MD, MBA is chief medical officer of Spok of Springfield, VA.

Readers Write: Growing Contingent Workforce Benefits Both Healthcare Organizations and HIT Professionals

March 1, 2017 Readers Write No Comments

Growing Contingent Workforce Benefits Both Healthcare Organizations and HIT Professionals
By Frank Myeroff

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There’s high growth when it comes to temporary workers, contractors, independent consultants, and freelancers within healthcare IT. New technologies, cost factors, and a whole new generation of HIT professionals wanting to work in a gig economy are fueling this growth. The rise and growth of the contingent workforce is only expected to accelerate over the next few years into 2020.

This dynamic shift to a contingent workforce makes sense for healthcare organizations and the benefits are well worth it. With a contingent workforce, healthcare organizations experience a big efficiency boost, risk mitigation, and derive a substantial cost savings in these ways:

  • The rise of managed service providers (MSP) enable health systems to acquire and manage a contingent workforce. As contingent labor programs continue to grow, these partnerships will be one of the most important workforce solutions that a health system can adopt to effectively manage risk and decrease healthcare hiring.
  • The use of vendor management systems (VMS) is a fast way to source and hire contingent labor. These systems make it easy to submit requisitions to multiple staffing suppliers.
  • Outsourced expertise will be able to assist healthcare facilities in meeting the January 2018 EHR system requirements. In addition, they often have the extensive knowledge needed when it comes to medical coding. For example, according to the AMA, 2017 ICD-10-CM changes will include 2,305 new codes, 212 deleted ones, and 553 revised ones.
  • Healthcare organizations can dial up or dial down staffing as needed without having to pay FTE benefits.
  • Improved visibility and the provider stays in control through the use of structured reporting, governance processes, and dashboards.
  • Internal resources are freed-up to focus on higher-priority, clinical-facing initiatives such as workflow optimization.

For HIT professionals, contingency work in the HIT space is attractive since opportunities are plentiful, the remuneration is desirable, and the work is rewarding. In addition, work is becoming more knowledge- and project-based and therefore is causing healthcare organizations to become increasingly reliant on their specialized HIT skills and expertise. According to Black Book Rankings Healthcare, this reliance will help to fuel the growth of the global HIT outsourcing market, which should hit $50.4 billion by 2018.

However, making the change from an employee to a contingent worker takes thought and preparation before just jumping in. Here are a few suggestions:

  • Identify the niche where you have skills and expertise. Know your passion. Also, pinpoint what type of HIT services and advice you can offer that healthcare organizations are willing to pay for.
  • Obtain the required certifications. Getting certified is a surefire way to advance your career in the IT industry. Research IT certification guidesto identify which ones you will need in the areas of security, storage, project management, cloud computing, computer forensics, and more.
  • Build your network and brand yourself. It’s important to start building your network once you’ve decided to be a consultant. A strong contact base will help you connect with the resources needed in order to find work. Also, position yourself as an expert, someone that an organization cannot do without. Now combine both a professional network and social network to help you spread with word faster.
  • Target your market and location. Determine what type of facility or organization you want to work with, and once decided, think about location. Do you want to work remotely or on site? Are you open to relocation or a commute via airline to and from work?
  • Decide whether to go solo or engage with a consulting and staffing firm. If you have the entrepreneurial spirit and want to approach a specific organization directly for a long-term gig, you might want to go solo. However, if you’re open to both short-term and long-term opportunities in various locations, a consultant staffing firm might be the answer.

The rise of a contingent workforce and gig economy will only continue to grow, and with it, much opportunity. A consultant or contractor has more freedom than a regular employee to circulate within their professional community and to take more jobs in more challenging environments. For healthcare facilities, a contingent workforce means acquiring the right HIT skills and expertise needed without the overhead costs associated with payroll benefits and administration. No doubt, a win-win situation for both.

Frank Myeroff is president of Direct Consulting Associates of Cleveland, OH.

Readers Write: Automate Infrastructure to Avoid HIPAA Violations

March 1, 2017 Readers Write No Comments

Automate Infrastructure to Avoid HIPAA Violations
By Stephanie Tayengco

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Every other week, news of HIPAA violations comes to light, bringing attention to the challenges of maintaining privacy in the ordinary course of doing business and providing care.

Take, for example, a recent HIPAA violation settlement. Illinois-based healthcare system Advocate Health Care agreed to pay a $5.5 million OCR HIPAA settlement in August after it was found that the company failed to conduct an accurate and thorough assessment of the potential risks and vulnerabilities to all of its ePHI. Earlier this summer, The Catholic Health Care Services of the Archdiocese of Philadelphia agreed to pay $650,000 for failing to implement appropriate security measures and address the integrity and availability of ePHI in its systems.

It is unclear in both cases whether infrastructure configurations were directly to blame. However, addressing the infrastructure-related elements of HIPAA and HITECH take considerable time and effort, time that could be spent addressing the critical application and mobile device-level security standards that result in the vast majority of violations. To refocus engineers away from time-consuming infrastructure compliance, the practices of infrastructure automation and continuous compliance are the key.

Reduce the chance for human error

The foundation for compliant IT infrastructure is implementing strong standards and having guardrails in place to protect against changes that are inconsistent with those standards at the server, operating system, and application level. This is the next evolution of compliance — building a system that can self-correct errors or malicious changes and maintain continuous compliance.

In a recent survey, IT decision-makers shared that 43 percent of their companies’ cloud applications and infrastructure are automated, highlighting that while companies already recognize the tremendous value of system automation, they can do even more.

The road to automation must begin with an IT-wide perception shift — that manual work introduces risk. Any time an engineer is going into a single piece of hardware to perform a custom change, error is possible and system-wide conformity is threatened. This does not mean replacing engineers with robots. It means tasking engineers with creating the control systems. This is an equally challenging (but far less boring) technical task for engineers, but it creates more value.

Part of this control system will be configuration management at the infrastructure level and for application deployment automation. Equally important is the operational shift to train engineers not to make isolated changes to individual machines  and instead to use the control system in place and implement changes as code. Code can be easily changed and tested in non-production environments. Code can be versioned and rolled back. Software deployment tools provide an audit trail of changes and approvals that can be easily read by auditors.

Invest in transparency

One of the main causes that can lead to non-compliance is a lack of transparency, usually in one or both of two key areas:

  • Lack of transparency into where critical data resides
  • Lack of transparency into current state of system configurations (i.e., how/where data is encrypted, who has access to that data, how privileges are maintained, etc.)

Many companies rely on manual processes and spreadsheets to track the configuration of their systems. In a cloud environment that changes frequently, this can be a real headache.

The single biggest change to make today is to improve the visibility of data criticality and system configurations is to implement configuration management. Rather than rely on manual documentation after the fact when changes are made, configuration management tools allow describing a desired state and creating and enforcing it across the infrastructure. Ideal configurations are coded in a single place, providing the current state of all systems at any time. This is a huge leap forward and it is applicable for operating either on bare metal or in the public cloud. Making long-term investments in operational transparency can help avoid HIPAA headaches.

Focus on mission-critical apps, not infrastructure

As healthcare companies improve IT operations, they should be focused on developing or delivering great patient-centered applications and services, not infrastructure maintenance and compliance.

Migrating to the cloud is the first step. Migrating to a public cloud platform like Amazon Web Services (AWS) provides the benefits of a government-grade data center facility that has already been audited for HIPAA and HITECH compliance. Signing a BAA with Amazon means that a portion of the physical security standards is taken care of (note: regular assessments are still required). That is a huge reduction in risk and cost burden right off the bat.

In addition, the cost of change is significantly reduced in the cloud. Adding, removing, or changing infrastructure can mean a few days of work, not months. That means systems engineers can focus on improving software delivery and the configuration management system, not on manually configuring hardware.

Just one word of caution. Beware of any cloud vendor or service provider that describes the cloud as “no maintenance.” It is true that cloud systems are more efficient to maintain, but maintenance is still necessary. The IT team will focus more of their time on maintenance tasks that are more critical to the business, like building a new testing ground for an application development team or refining the code deployment process, not on undifferentiated data center tasks.

It is only a matter of time before the industry witnesses its next HIPAA violation. Automating infrastructure can significantly reduce the cost and effort of maintaining infrastructure compliance, and can refocus IT on higher-impact areas such as device security.

As health IT evolves, expect to see these two key of technologies — cloud and automation — driving the next wave of efficiencies in health IT.

Stephanie Tayengco is SVP of operations of Logicworks of New York, NY.

Readers Write: The Patient Experience Is Clinical

February 1, 2017 Readers Write No Comments

The Patient Experience Is Clinical
By Mark Crockett, MD

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As quickly as healthcare began to focus on patient experience, the law of unintended consequences kicked in. While well received as a tool to help improve care, this situation unintentionally gave rise to a consumer culture around patient treatment. Today’s value-based care arrangements call for providers to take a fresh look at patient experience.

While patients certainly deserve to be treated with dignity and listened to carefully, the top patient experience expectation is receiving safe, quality care. “Patient experience [is] not about making patients happy over quality,” says James Merlino, MD of the Association for Patient Experience. “It’s about safe care first, high-quality care, and then satisfaction.”

The best way to deliver on this expectation is for providers to view these issues of safety, risk, and compliance as a cohesive whole, thus enabling patients to receive the safe, quality care they expect, in the caring and supportive environment they deserve.

The Beryl Group defines patient experience as “the sum of all interactions, shaped by an organization’s culture, that influences patient perceptions across the continuum of care.”

That’s a big job. Most providers lack the tools to make that happen. Where to start?

It begins with developing provider/patient and provider/organization relationships that encourage collaboration.

In 2013, a British Medical Journal review of 55 studies found that patient experience is “positively associated with clinical effectiveness and patient safety, and supports the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness.”

What the BMJ study revealed, and my own anecdotal evidence bears out, is that if a patient experience is positive, the patient feels empowered and can enter into a therapeutic “alliance” with the provider. Patients are motivated to follow treatment plans and are less likely to withhold information if they don’t feel intimidated—or worse, ignored—by their provider and the hospital where treatment was rendered. This supports swifter diagnoses and improved clinical decision-making and leads to fewer unnecessary referrals or diagnostic tests.

Many hospital CFOs don’t need the BMJ study to know a positive patient experience is a clinical indicator that ties to financial outcomes. As outlined in the chart (Figure 1), patient experience is directly associated with a hospital’s Star Rating and patient outcomes:

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Creating a positive patient experience, and better clinical outcomes, begins with an understanding of what patients expect from providers. The primary expectation of any patient is, first and foremost, safety. To the unfamiliar, hospitals are scary places. Patients no doubt have read or heard stories (or watched doctor shows on TV) of medical errors and medication mix-ups or of being treated by an unqualified caregiver. Hospitals and other healthcare settings must communicate clearly that theirs is a safe place where patients can trust their caregivers.

If patients believe they are in a safe, trusted environment, their next expectation is, of course, to get better. To be healed. This requires consistent excellence across a wide variety of performance areas. Finally, patients expect to be treated with courtesy and respect.

How do we establish patient experience as one of the pillars of quality healthcare? Not surprisingly, it’s a judicious combination of technology, effective communication, and employee engagement and physician alignment.

Most patients assume all clinicians are highly qualified and fully credentialed. A robust credentialing platform helps providers deliver on that assumption. Other examples of technology impacting patient experience is the ease of electronically submitting information to a Patient Safety Organization. Participating in a PSO not only enables federal protection under the Patient Safety and Quality Improvement Act (PSQIA) but enables the organization to share and learn from peers as it relates to patient safety initiatives that most certainly impact patient experience.

Effective communication improves not just patient satisfaction, but also physician satisfaction. It boosts patient adherence and compliance and reduces medical errors and malpractice claims. The benefits of a culture that encourages open, honest, and direct communication among patients, providers, and staff go directly to the heart of patient experience.

There is a tremendous benefit to incorporating digital rounding (levering mobile technology to gather information in real-time during the rounding process) into a health system’s employee engagement strategy to generate information from patient rounding, safety rounding, and leader rounding. There is much to be learned from the voices of providers, patients, and employees.

For example, although nurses and physicians generate an equal number of complaints, nurses are three times more likely to have positive reports as compared to MDs. However, physician complaints have higher severity and fewer resolutions.

Patient feedback gathered through a rounding process identifies critical focus areas including peer review events, compliance events (particularly in infection control), and patient and employee safety issues.

For one healthcare system, more than 50 percent of all peer review cases at its 30 facilities actually began in patient relations. In addition, validation audits from compliance organizations (specifically CMS) often stem from a patient complaint. Another reason to centralize data gathered from the feedback of patients, providers, and employees is to identify patterns that allow organizations to transform risk management from a reactive process to a proactive component of healthcare delivery.

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Patient experience is clinical. It matters to value-based care and has direct impact on an institution’s long-term financial survival. Organizations that sideline patient experience, or simply meet the minimum standards required, do so at their peril.

Mark Crockett, MD is CEO of  Verge Health of Charleston, SC.

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