Readers Write: Digital Healthcare Needs To Evolve, and the Cloud Is the Catalyst

Digital Healthcare Needs To Evolve, and the Cloud Is the Catalyst
By Kavita Khandhadia

Kavita Khandhadia is Amazon Web Services program manager for Infostretch of Santa Clara, CA.

The continued impact of the connected society means there is an increased need for decision makers to understand not only why digitalization matters, but where it can most benefit their companies. Digital evolution and maturity are key differentiators in most industry sectors, many of which are adapting to the demands of their customers and integrating the technology required.

This ongoing focus on a required digital transformation is hardly breaking news, but the decision to become more cloud-centric has particular significance for the healthcare and life sciences (HCLS) industry.

For organizations that are looking to move the digital journey forward, it’s a case of when and not if. In many cases, business optimization strategies have become increasingly cloud-based, with a consensus among analysts and researchers that HCLS companies that integrate cloud platforms and services into their existing workflows will be best placed to scale, innovate, and launch.

The events of the last 18 months shone a spotlight on where digital healthcare is and where must improve. Over the last decade, the digitalization of legacy processes within the healthcare industry has moved at a steady pace, albeit that patient wellness is more likely to reflect physical as opposed to virtual insights.

The need for effective digital solutions becomes more apparent when you consider that the adoption of recent technologies within the sector as whole can often be labeled as a work-in-progress. HCLS companies, for example, have been both quick to accept the need for change and hampered by what needs to be done.

A research note by Gartner – Innovation Insight for Digital Health Platform (DHP) – applauded the “heroic efforts” that healthcare companies and providers had made to adopt innovative technologies, including virtual care and improvements to monolithic legacy systems such as electronic health records (EHR). The caveat was that the fundamental shift required was some way in the future.

However, the analyst noted that digital expectations of patients would lead to 75% of health providers reducing reliance on “EHR-native applications to deliver better experiences and outcomes, and improve efficiencies.”

That’s great news for digital healthcare, but it’s worth remembering that the technologies required to build a DHP are already part of existing wellness strategies. For example, companies that have integrated cloud solutions have access to data and predictive analytics while digital twins, artificial intelligence, and machine learning are having an impact on clinical and operational decisions.

The question that needs to be asked is whether the increased awareness of cloud-centric healthcare offerings will be the catalyst for the next stage of digital healthcare.

The simple answer is that access to platforms such as AWS Cloud is both changing the conversation over what modern wellness can be and how patient-centric cloud solutions are the future of healthcare itself.

A powerful argument for cloud migration is understanding that a culture of healthcare innovation already exists. Purpose-built HCLS offerings are part of the AWS for Health suite of solutions, for instance.

However, the concerns that have always been part of any cloud migration are often cited as reasons to maintain the status quo.

Healthcare remains not only a very traditional industry but also one that is subject to a plethora of regulatory requirements. And while the need for digital transformation may not seem as pronounced as it would be in, say, retail, the challenges of cloud migration can literally be the difference between life and death.

In many cases, the concerns are the usual suspects – security and governance, cost and time, workloads, solution availability, and cloud maturity.

When you invest in a cloud strategy, you are giving up a certain amount of control. Cloud computing is the on-demand delivery of compute power, database, storage, applications, and other IT services through a cloud services platform.

For instance, AWS is responsible for the security of the cloud (the protection of the infrastructure itself) while the customer provides security in the cloud (platform, applications, identity and access management). Known as the Shared Responsibility Model, this simple arrangement can be a daunting prospect for healthcare companies who have relied on their legacy infrastructure and working processes to maintain compliance and regional regulatory requirements.

Cost and time are also considered to be one of the main reasons for being hesitant about cloud migration. Companies may feel that the expense and potential downtime of cloud migration may not be worth it, despite all evidence pointing to the savings that can be achieved by moving to a cloud-based solution – migration can mean that a company focuses on products and innovations as opposed to maintaining an entire infrastructure and related applications.

And we must not overlook the importance of defined workloads. HCLS relies on data management and regulatory compliance, while the nature of the services companies provide requires low latency and processing requirements on a local level. That provides an additional challenge, even more so when these digital workloads must respond as quickly as possible to a patient or provider requirement.

However, the HCLS sectors are well placed to take advantage of cloud migration. Companies and providers are increasingly data-driven and already looking to digitally transform – the global healthcare market will be worth $11.9 trillion by the end of 2022, a recent industry report said – so it follows that patient wellness will be subject to the digital experiences that are part of the connected society.

Digital healthcare’s evolution has been years in the making. Providers and patients have become more digitally aware in recent years, because the tools required to make health-related decisions are now available.

What matters is how HCLS both integrates the solutions that exist and invests in ones that can make a difference to the physical and virtual services provided.

COVID-19 was not the catalyst for digital transformation that people wanted, but the industry became focused on how digital healthcare could move forward. Cloud migration is one part of the puzzle, the companies that understand this will be able to deliver the right patient and wellness outcomes.

Readers Write: Creating a More Equitable Health System

Creating a More Equitable Health System
By Wylecia Wiggs Harris, PhD

Wylecia Wiggs Harris, PhD is CEO of AHIMA of Chicago, IL.

As a Black woman, I have been aware of the negative impact of health inequities my entire life, long before becoming the leader of the American Health Information Management Association (AHIMA). In the past year and a half, the pandemic has put a spotlight on the inequities of our healthcare system.

AHIMA and our members stand in a unique position to improve health equity. Health information professionals possess the data skills and expertise to make a positive impact, and we often have a bird’s-eye view of our respective healthcare organizations, allowing us to see the big picture and the ripple effects of any decision.

There are tangible actions we can take to improve health equity. It’s vital that we continue to collect patient demographic and social determinants of health (SDOH) data. We must encourage health systems to prioritize the collection of accurate and complete patient demographic and SDOH data. This data will shed light on the socioeconomic factors that impact the health of both individuals and larger populations. Health information professionals treat this data with the respect it deserves.

I’m proud that AHIMA’s advocacy team encourages policies that improve access to care. We believe it’s important for policymakers to guarantee the right for all people to have access to affordable, high-quality health coverage. We must continue to advocate for policies that help our country reach this important milestone.

We’re fortunate that improvements in technology are making it more efficient to address health disparities. Health information professionals promote the use of technology to analyze and improve quality of care and patient outcomes. We encourage the development, piloting, and testing of machine learning and artificial intelligence technologies that identify and address biases in health data; this can help avoid exacerbating existing health disparities and inequities. We are excited and optimistic about how technology can improve health equities in the years to come.

None of this can be done without a capable team of professionals. Investing in and training a diverse, culturally competent workforce is vital to foster an inclusive approach to addressing health disparities and inequities. It’s critical that patients’ demographic data and SDOH data is managed in ways that are culturally sensitive and having a properly trained workforce is critical.

These teams are needed so that we can continue to support efforts to overcome historical mistrust in healthcare institutions. Many communities of color have an understandable mistrust of healthcare institutions, and to counter this we must identify and dismantle policies that support structural racism and discrimination. At a local level, we must also foster positive patient-provider relationships and engage community leaders in decision-making processes.

I thank all the health information professionals who are helping to create a more equitable and just healthcare system and world. Together, we are making a difference.

Readers Write: The Rise in Health IT Valuations and Deal Flow

The Rise in Health IT Valuations and Deal Flow
By Chris McCord

Chris McCord, MBA is managing director at Healthcare Growth Partners of Houston, TX.

In this post-pandemic era, the world is changing at a pace that is nearly impossible to process, which makes decision-making harder and seemingly riskier than ever. With limited data to inform our decisions and understanding of reality, instincts become crucial as we attempt to navigate and make sense of the world. So, let’s take a moment and unpack some of the data so we don’t have to take a leap of faith.

To begin, you aren’t fooling yourself if you think that health IT valuations have risen since the pandemic. Using an eight-month average (the shortest period to capture statistically significant data), average health IT revenue multiples in control M&A and buyout transactions increased from 5.1x immediately prior to the pandemic to 7.4x today. The data imply that the exact same company is now worth 47% more today than before the pandemic, an extraordinary realization that highlights the paradox that is the raging bull market amidst the unrelenting pandemic.

While the 47% increase certainly feels like a head-scratcher, we see key drivers behind the madness, one being the mirror-image trend in the Nasdaq, which has risen an astounding 50% in the same time period. The surge we’ve seen in multiples in this post-pandemic period magnifies an almost uninterrupted decade-long expansion of multiples.

It’s important to note that M&A multiples are influenced by survivorship bias, which creates a bias toward the valuations of deals that close versus those that don’t. The deals that close may have characteristics, such as overall higher quality, that make them superior to those that don’t close. In other words, one can’t necessarily extrapolate value simply from multiples without taking many factors into account.

From a health IT perspective, equally pronounced is the spike in investment value. US-based health IT private equity investment historically hovered around $10-15 billion. During the pandemic, this rate increased 141% to more than $30 billion and is just now showing signs of leveling.

US-based health IT M&A, based on deal volume, also surged during the pandemic, peaking at a rate nearly 50% higher than pre-pandemic levels and settling back to a 20% increase. Low interest rates, excess liquidity, and an indisputable digital health investment thesis are all factors driving these surges in M&A volume and investment value. Further, M&A has been fueled by the threat of the capital gains tax hikes, which has motivated sellers to race to an exit by the end of 2021.

What goes up must come down? Barring extenuating circumstances, we may see a leveling, but most likely health IT has entered a new normal. Anecdotally, we see growth equity investment valuations typically priced higher than control M&A transactions (higher than our 7.4x revenue average), and the amount of capital being deployed at these valuations is represented by the 141% increase in private equity investment in our data.

Put another way, there is a substantial amount of capital flowing into the health IT market at historically high valuations. Certainly the investors who are putting capital to work at these high multiples do not expect valuations to drop precipitously, and one could make the argument — albeit a dangerous one because it detaches from fundamentals — that expectations perpetuate themselves.

We will continue monitoring these trends, particularly as we enter 2022 with looming tax hikes, spending plans which significantly impact healthcare, and midterm elections, not to mention the always-uncertain pandemic. Trusting both our instincts and data analysis, we can feel more confident in the direction health IT is taking.

Readers Write: Compliance Reimagined: Transforming the Value Proposition of a Traditional Cost Center

Compliance Reimagined: Transforming the Value Proposition of a Traditional Cost Center
By Peter Butler

Peter Butler is president and CEO of Hayes of Wellesley, MA.

Compliance has gotten a bad rap in healthcare. Traditionally viewed as a necessary cost center, this department is too often viewed as the police force of a health system.

A lot is missing from this simplistic view of the processes that ensure hospitals and health systems aren’t hit with avoidable penalties when the auditors come knocking. Within a rapidly evolving regulatory framework that includes more than a year of fluctuating COVID and telehealth guidance (among other changes), compliance in essence becomes the safeguard to a healthy, sustainable bottom line.

In truth, there is a distinct opportunity for health systems to reimagine a department that has long operated in a silo by embracing forward-thinking revenue integrity models. These innovative strategies bring together billing and compliance teams in a collaborative way to accurately identify, track, and capture all monies owed, transforming the value proposition of compliance in terms of bottom-line impact.

With the right technology-enabled processes, these revenue integrity teams can proactively identify revenue breakdowns on both the front and back end of claim lifecycles and significantly improve revenue capture and financial health.

Compliance is a cost-constrained function inside today’s healthcare systems. While addressing it is a necessary evil, healthcare organizations often struggle to justify allocating extra dollars to optimize this area when faced with so many competing priorities. Yet the business case for investing in the infrastructures and strategies necessary for a technology-enabled revenue integrity model can be an easy one to make in terms of return on investment. Revenue integrity teams can both protect an institution from risk and improve revenue retention. Often, they can also identify dollars that might otherwise be left on the table.

For example, a recent report from the HHS Office of the Inspector General (OIG) pointed to a notable rise in inpatient hospital stays where upcoding was believed to be the culprit, a significant liability for health systems on the compliance front. Revenue integrity processes that integrate systems to create strong partnerships between revenue cycle, billing, and compliance teams can improve this outlook through shared internal monitoring and auditing.

But because revenue integrity is inherently a data-hungry undertaking, manual processes of combing through claims data will not provide the timely insights needed to get ahead of issues. That’s where automation and artificial intelligence becomes a game-changer. Revenue integrity teams equipped with the right tools can conduct real-time monitoring of upcoding risks associated with billing around costly, high-severity cases, significantly minimizing compliance risks that could impact the bottom line.

Compliance professionals are well acquainted with internal auditing practices. On the revenue integrity front, holistic strategies marry the strengths of prospective (front end) and retrospective (back end) auditing. Collaboration between compliance and billing teams can draw on these techniques to make sure claims leave a health system clean from the start. When faced with denials, revenue integrity processes rapidly drill down into root causes to inform process improvement.

From a technology standpoint, here’s how it works:

• AI-backed prospective auditing. Augmented intelligence and natural language search can help healthcare organizations get ahead of potential problems by detecting anomalies in at-risk claims in near real-time. For example, when considering upcoding risks as mentioned earlier, health systems can automatically flag high-dollar claims, and potential problematic cases can be identified and audited from the outset.
• Technology-enabled retrospective auditing. Manual efforts to mine thousands upon thousands of claims lines across denials and identify problematic trends for process improvement are typically a non-starter for most resource-strapped compliance departments. Advanced analytics discovery tools exist that can’t comb through denials within minutes and deliver actionable insights.

It’s time for hospitals and health systems to reimagine how they view compliance in terms of impact to the bottom line. With the right revenue integrity strategy, this traditional cost center has the potential to bring real value to financial health and sustainability.

Readers Write: Engaging Patients with Social Determinants of Health: Is Your Practice Ready?

Engaging Patients with Social Determinants of Health: Is Your Practice Ready?
By Beth Socoski, MBA, MSW, MSCL

Beth Socoski is compliance manager of  InSync Healthcare Solutions of Tampa, FL.

In recent years, the importance of incorporating social determinants of health (SDOH) — the conditions, circumstances, and environmental factors that influence health outcomes — into care delivery has risen to priority status.

Most providers understand that patients with limited access to healthy food, safe living quarters, and income security are higher risk for realizing poor outcomes. They’ve read studies that suggest that SDOH accounts for as much as 90% of an individual’s health.

But although awareness of SDOH’s role in overall health has increased, far too many providers lack actionable knowledge of how to help.

A recent American Academy of Family Physicians (AAFP) survey indicates that 80% of family physicians feel they don’t have adequate time to discuss social determinants during routine consults, and 64% say they lack the staff or resources to do anything even when they identify risk factors.

Therein begs the question facing providers in 2021 and beyond: What can physicians do to improve identification of poor SDOH and do a better job of engaging high-risk patients?

In a recent memo unveiling its Healthy People 2030 initiative, HHS included a list of SDOH that need to be addressed in order to significantly improve quality of life for all Americans. These include everything from racism and domestic violence to polluted air and lack of job opportunities.

Yet many of these underlying social determinants remain unseen during a routine visit and difficult to gauge. The reality is that SDOH often go underreported because physicians are trained to treat acute physical issues, such as an earache, urinary tract infection, or broken arm.

Consequently, opportunities are missed. For example, consider a pediatric asthma patient who is treated only for their condition without insight into their living conditions. If parents are smokers or high levels of air pollution exist, they may be more likely to develop serious respiratory disorders later in life.

Lack of time is another challenge. The US medical system is still largely volume-driven, with the demands for doctors exceeding supply in some areas. With only 15 minutes to interact with a patient for a sick visit on average, providers are less likely to prioritize asking about socio-economic issues or risk factors, epecially since there are likely patients in the waiting room with acute needs.

Referrals to social workers help, but what providers truly long for is a better way of identifying SDOH and the ability to contribute toward improving patient health in a more impactful, meaningful way.

On the positive side, more recent efforts on the regulatory and technology front are beginning to address barriers. In late 2020, the National Committee for Quality Assurance (NCQA) proposed introducing race and ethnicity stratification into select HEDIS measures, with the goal “to advance health equity by leveraging HEDIS to hold health plans accountable for disparities in care among their patient populations.”

Time, staff engagement, and cost can be deterrents for meeting health equity goals for organizations of all sizes. To that end, the Department of Health and Human Services is offering free training with some excellent benefits for staff with professional licenses, such as free continuing education credits required for ongoing licensure.

In December, The Gravity Project, a community-led HL7 Fast Healthcare Interoperability Resources (FHIR) Accelerator, unveiled an EHR implementation and recommendation guide for SDOH data and terminology, which emphasizes food insecurity, housing challenges, and access to transportation.

However, most EHRs used by healthcare providers aren’t loaded with pathways that can direct a physician to next steps when SDOH challenges are identified.

To do a better job of addressing SDOH, physicians can strengthen the following areas:

• Awareness. Knowing which patients are more likely to struggle with SDOH is key to establishing trust. The AAFP’s Social Needs Screening Tool offers sample questions that can be included in an intake questionnaire to gauge the challenges patients encounter on a regular basis. But awareness extends beyond questionnaires. Providers need to consider the impact of outside events such as COVID or the escalation of racism on the communities they serve and how trauma might impact the ability for a patient to access care.
• Communication. No small complaint, or comment pertaining to SDOH should go unacknowledged. Physicians and other healthcare stakeholders should engage in more pointed follow-up to determine actual needs. Active listening can encourage a broader dialogue around SDOH and help care partners, such as social workers, connect patients to the most appropriate resources. The ‘Ask me 3” method is an excellent way to engage patients.
• Technology. EHRs need to support with care collaboration between multiple care partners in a patient’s ecosystem to ensure everyone is on the same page. They should also be customized to meet the practice’s informational needs, with care pathways that guide physicians in a new direction when needed. For example, if a patient answers the question, “do you have adequate transportation?” with “no,” the EHR should pre-populate other follow-up questions pertaining to transportation access.

With greater commitment to addressing SDOH, providers have an opportunity to engage their patients in new ways and improve their experience. And by leveraging more targeted communications tactics, coupled with smarter technology applications tailored to SDOH, providers are better equipped to improve outcomes and save lives.

Readers Write: The Next Generation of Intelligent Decision Support

The Next Generation of Intelligent Decision Support
By Carm Huntress

Carm Huntress is founder and chief innovation officer of RxRevu of Denver, CO.

Research has repeatedly shown that Americans trust doctors more than any other professionals they interact with. But what happens when healthcare providers don’t have reliable data at their fingertips? They may prescribe medications that are not covered under the patient’s insurance. They may send the patient to a lab that is out of network. Or they may order care that is costly and requires authorization from the patient’s health plan. In the blink of an eye, trust in providers can be broken.

What’s needed to maintain trust in our healthcare providers is better data at the point of care. New intelligent systems are necessary that can deliver comprehensive, curated, actionable data to provider workflows so that they can select the most clinically relevant, affordable care options for their patients.

Real-time prescription benefit (RTPB) – one type of decision support tool that brings pharmacy coverage data to EHR workflows – has been adopted by thousands of health systems, hospitals, and clinics across the country. However, some RTPB solutions leverage outdated or static files that are not exact. This has caused providers to lose trust in these tools and has slowed progress toward transparency.

We can no longer accept inferior data and inaccurate processes that prevent us from delivering cost-effective care. Patients and providers deserve better.

By working in lock step, EHRs, payers, providers, and RTPB vendors can deliver prescription data that is normalized, actionable, and valuable. Some examples of how intelligence can be used to enhance this type of point-of-care decision support include:

• Real-time delivery. Data displayed must be updated in real time, showing patient-specific cost and coverage information that matches what the claims system would display. This way, patients are not surprised when the find out the actual cost of their care.
• Quantity translations. Providers often enter medication quantities in simple terms (inhalers, pills, bottles), but vendors must be able to translate these quantities into those that the payer/PBM can bill for (mL, grams). Otherwise, no prices will be returned.
• Better data mapping. While providers are often unaware of the drug codes required to identify each medication prescribed, in order to receive an accurate price, solutions must automatically swap inapplicable codes and convert codes to display relevant information.
• Smart filtering. In many cases, solutions display any covered care option. Instead of creating more EHR noise, it is essential that vendors suppress irrelevant alternatives and ensure only meaningful options are shown.

It is the combination of these intelligent features that can create a truly exceptional prescribing experience and drive trust in decision support tools. By augmenting raw patient data with a next-gen intelligence layer, effective decision-making can become the norm.

Delivering prescription data is just the beginning. The industry is quickly moving toward, and providers are often requesting, the transmission of medical benefit data to allow for a more complete picture of patient coverage. With both pharmacy and medical benefit data available, providers can view real-time insights on patient health needs and deliver care in new, meaningful ways.

Technology vendors can no longer meet the minimum delivery requirements for patient coverage and cost data. If they do, providers will ignore data presented to them, and patients will lose trust in their caregivers. However, vendors are leveraging advanced logic to deliver real-time data that is individualized to the patient and intuitive technologies to enable better decisions at the point-of-care. Connecting intelligent systems into payer, PBM, and EHR ordering process allows for visibility into valuable information when it matters most, reducing costs, improving workflows, and getting patients the right care the first time.

Readers Write: Why Patient Control of their Own Data is the Key to Health Equity

Why Patient Control of their Own Data is the Key to Health Equity
By Oleg Bess, MD

Oleg Bess, MD is co- founder and CEO of 4medica of Marina Del Rey, CA.

To enable coordinated care, improve patient outcomes, and better manage costs, it is imperative that providers, payers and other healthcare stakeholders share data. This requires interoperability between authorized members of a healthcare network.

But an often-overlooked stakeholder in discussions about healthcare networks and data sharing is the patient, which is ironic given that the patient really is the ultimate healthcare stakeholder. Yet patients often struggle to access even the most basic digital information about their health.

Patients may have multiple providers, each with their own patient portals and login requirements. They may have a provider that “data hoards” to prevent patients from switching to a competitor. Patients may not be able to access all their medical records. Patients particularly struggle to access diagnostic tests from labs, which is a serious problem since diagnostic test results are the most critical information clinicians use when devising treatment plans.

Ensuring patients can easily and securely access their digital health records increases both data transparency and patient control of their personal health information. Beyond the obvious benefits to individuals who are able to view and manage their health information, the increasing ability of patients to control their own health data is the key to health equity on a larger scale. That’s because segments of the population negatively impacted by social determinants of health (SDOH) such as unemployment, no access to primary care, or lack of health insurance most need access to their health information even as they are less likely to have that transparency.

Consider the patient who uses emergency rooms (ERs) as their provider of primary care. As this patient bounces from one ER to another, invariably getting tests, they often are unable to inform clinicians about where they previously were tested or the results. This typically leaves an ER clinician with little choice but to order a new round of tests, some of which already may have been conducted.

More importantly from a clinical view, lack of data transparency and control for patients can be dangerous or even fatal. As an obstetrician-gynecologist, I have seen many pregnant women come into the ER bleeding internally and requiring immediate surgery. If clinicians had access to the patient’s records from recent previous visits to other ERs – where she likely had been tested for human chorionic gonadopotropin (HCG), the pregnancy hormone, or given an ultrasound – they would know whether the patient was having a miscarriage or a ruptured ectopic pregnancy, conditions that require entirely different clinical approaches. This right clinical information in the right hands at the right time literally can save lives.

Data transparency for patients can be a powerful catalyst for improving health equity by empowering people lacking primary care or health insurance to access and manage their data. It will require user-friendly health data apps that enable access to aggregated data. I am confident these apps are coming soon because data transparency for providers and patients are essential to achieving the value-based care goals of improving outcomes while reducing costs.

Readers Write: The Key Ingredient to Improving Outcomes in Behavioral Health: Measurement-Based Care

The Key Ingredient to Improving Outcomes in Behavioral Health: Measurement-Based Care
By Jason Washburn, PhD

Jason Washburn, PhD is a professor at Northwestern University Feinberg School of Medicine in Chicago, IL.

The burden of mental disorders is well known. Mental disorders are common, resulting in significant disability and contribute to — and complicate — chronic health conditions. Most mental disorders are untreated, and the COVID-19 pandemic has only further highlighted significant disparities in access to treatment. Effective pharmacologic and psychological treatments are available, yet outcomes in routine practice are often weaker than what is found in randomized controlled trials. 

Measurement-based care (MBC) can improve the outcomes of routine mental health practice. MBC involves routinely and systematically evaluating mental health symptoms, ideally before or during a clinical encounter, to both inform and direct mental health treatment. For example, in 2015, a randomized controlled study of MBC in the treatment of depression found a much higher remission rate among the MBC group compared to usual treatment (73.8% vs. 28.8%). 

What accounts for the impact of MBC on outcomes? MBC can help providers track the response of their patients to treatments, alert providers to when patients need to adjust treatment, and aid clinical decision making. For example, MBC can facilitate changes in dosage and medications, improve case conceptualization, identify the need to change treatment modality and targets, or to increase or decrease service frequency and intensity. MBC can also facilitate communication between patients and providers, improving the therapeutic relationship and shared decision making. 

Patients like MBC. Patients accept MBC practices and report that it improves their care. When implemented correctly, providers also like MBC, recognizing its many benefits and utility in treating patients. Although providers often express fears about the burden of MBC, successful implementation of MBC usually results in little to no barriers or burdens for providers. 

Despite the clear benefits of MBC, routine use of MBC remains rare. The available evidence suggests that less than 20% of psychiatrists, psychologists, and master’s level providers use any meaningful level of MBC. Why do so few providers use MBC? 

Concerns with the practicality of implementing MBC is one of the primary barriers to utilization of MBC. Practical concerns can include the time required to complete measures, the administrative burden of administering measures, and disruptions to patient flow and processes. Another barrier is the reliance of providers on clinical judgment. Even when providers recognize that MBC is likely to improve their treatments, providers may fall back on their clinical judgemnt when the infrastructure for MBC is not available. Unfortunately, clinical judgment is not always accurate: One study found that providers were only able to accurately detect deterioration in their patients 21.4% of the time.  

Although adoption of MBC has been slow, technological solutions hold promise for accelerating the integration of MBC into routine mental health care. Many – if not all – of the perceived and actual barriers associated with MBC can be addressed through technology infrastructure that supports fully automated MBC systems. Automated MBC systems can be integrated into existing clinical workflows, including the electronic health record, providing a seamless experience for both the patient and the provider. 

Accelerating the adoption of MBC, especially through automated systems that provide access to outcome data at the individual and organizational level, will not only improve care, but increase access to care. Given that MBC is associated with faster response to treatment (e.g., 4.5 weeks in MBC group vs. 8.1 weeks in usual care), the increased efficiencies gained in using MBC allows for greater throughput of patients and increased access. By monitoring remissions rates, MBC can also help to identify when patients no longer need a specific level of care, facilitating quicker transitions to lower levels of care and termination, thereby increasing access for new patients to enter the system. 

The available evidence is clear: MBC holds promise in improving mental health care. To actualize the potential of MBC, however, providers and the organizations that support them must make MBC a routine expectation in the provision of mental health treatment.

Readers Write: Obesity and Beyond: How Digital Therapeutics Are Shaping the Future of Managing Chronic Diseases

Obesity and Beyond: How Digital Therapeutics Are Shaping the Future of Managing Chronic Diseases
By Joseph Rubinsztain, MD

Joseph Rubinsztain, MD is CEO and founder of ChronWell of Sunrise, FL.

As the COVID-19 pandemic took a collective toll on patients’ mental and physical health in the United States, our obesity problem only intensified. Even before the pandemic, 42% of Americans were obese, while two in five recently surveyed reported to gaining an average of 29 pounds since the pandemic began.

Despite the risks of serious disease associated with high blood sugar, hypertension, high cholesterol, and excess abdominal body fat, the pandemic’s disruption to daily routine seemed to spark trends of unhealthy eating and inactivity. What’s more, studies show that having a BMI over 30—which defines obesity—increases the risk of being admitted to hospital with COVID-19 by 113%, of being admitted to intensive care by 74%, and of dying by 48%.

Obesity, as it turns out, is the greatest risk factor contributing to the burden of chronic diseases in the US. It is closely linked with metabolic syndrome, a cluster of conditions that increase risk of heart disease, stroke, and diabetes. What’s worse, research suggests that nonalcoholic fatty liver disease (NAFLD), a “hidden” condition that’s strongly associated with obesity, is on the rise. It causes accumulation of liver fat and ultimately inflammation and scarring if left undetected and untreated.

While the burden of chronic diseases in the US has never been heavier, providers are struggling to provide the continuous support patients require to make much-needed lifestyle changes to improve their health. Physicians can suggest interventions like increased exercise and a healthy diet, but patients across the board struggle to maintain lifestyle changes because treatment plans fail to integrate into their lives in any meaningful way. Providers simply don’t have the staff or bandwidth to repeatedly nudge, support, educate, integrate, and encourage new and sustainable habits in such a high percentage of their patients.

There is, however, a solution that can automate and simplify the process with evidence-based outcomes: digital therapeutics (DTx). These technologies deliver interventions driven by high quality software programs to prevent, manage, or treat a range of medical disorders and diseases. Used independently or complementing medications, devices, or other therapies to optimize patient care and health outcomes, DTx is leveraged directly by patients, or, perhaps most optimally, in concert with physician guidance as part of a prescribed care plan.

Using remote monitoring technology and mobile access points, DTx continuously connects patients and their care teams through methods such as text communication / alerts, on-demand education, exercise coaching, diet reminders and advice, digital assistance, general care coordination, and procurement of medical supplies, to name a few. By streamlining these functions and guiding behavioral change, DTx deliver a personalized care plan to fit specific patient needs in between physician visits, encouraging compliance to treatment plans and overcoming hurdles through reliable partnership and continuous motivation.

Quality algorithms process patient information about clinical presentation, medical history, blood biomarkers, diagnostic imaging exams, laboratory tests, and social determinants of health (SDOH), for example, to generate optimal personalized interventions. Built on specific metrics and outreach methods, these evidence-based interventions create tailored goals and guided treatments that drive higher compliance and better outcomes. Through automation and intelligent integration, physicians are alerted to specific concerns and patient needs with minimal friction so the care team can intervene when needed. DTx becomes a digital extender for managing chronic care cases more efficiently and continuously, enhancing the patient-physician relationship.

As we witnessed the increased use of digital health tools over the past 18 months, acceleration of DTx has become prominent, with notable innovation on the certification, reimbursement, and regulation fronts in the US. Digital therapeutics will help build the roadmap to agile, personalized treatment of chronic conditions, presenting opportunities to provide better, smarter care.

Readers Write: Curating Information to Reduce Physician Burnout

Curating Information to Reduce Physician Burnout
By Nele Jessel, MD

Nele Jessel, MD is chief medical officer of Athenahealth of Watertown, MA.

No one in healthcare would dispute that it’s an enormous job to manage and distill all the patient data and clinical notes that are available with modern-day technology. Of course, technology has delivered many innovations and improvements to both the physician and patient experience. Yet sometimes even the most well-intentioned technology tools end up creating more challenges, with the unintended consequence of greater administrative burden, leading to provider dissatisfaction and burnout. I don’t know of any physicians who wanted to devote their career to the practice of medicine and are happy that they instead find themselves spending much of their time on administrative tasks.

A decade ago, my frustration with EHR technology – which made my life harder, not smarter – inspired me to open my own practice with the aim of using technology to automate workflows wherever possible. My goal was to spend more time with my patients and practice old-fashioned medicine in a high-tech setting. Over the past several years, my passion for the use of technology to drive advancements in healthcare and patient access, while facilitating the physician-patient relationship, led me deeper into the technology realm, resulting in my recent transition to Athenahealth, where I was once a client.  

At Athenahealth, we fielded a survey in late 2020 to a broad sampling of physicians about technological challenges and physician wellbeing. More than half of the physicians surveyed agreed or strongly agreed that technology supports their ability to deliver high-quality care to patients. However, the physicians also said the more they feel information overload (i.e., poorly curated information), the more it causes them stress in day-to-day practice, and the more often they feel burned out.

The irony here is obvious. We need technology to address physician burnout that is caused by technology. From the physician responses, it’s clear that the legacy technology to help with this issue has some room to grow.

Additionally, EHR technology has sharpened the focus on provider documentation, and therefore electronic notes can be voluminous compared to paper notes. With nonsensical coding and billing requirements to count the number of bullets in sections of the documentation, a rampant use of copy and paste has resulted in bloated notes. New coding guidelines for 2021 have shifted the focus away from bullet points to managing the illness and/or making medical decisions. It remains to be seen whether this change will translate into shorter and more succinct notes that capture all the relevant clinical information and tell the patient’s story without any extraneous information. 

With so much patient data available, managing the information and distilling it into exactly what is necessary to make decisions is a job unto itself. These burdensome administrative tasks are a serious problem when they take a physician’s focus away from direct patient care.

Practices looking to help with information overload should identify technologies that not only capture and store information, but also curate and translate data back into clinically meaningful terms. The increasing use of artificial intelligence and machine learning has the potential to transform how physicians work and interact with their patients.

For example, voice and ambient solutions integrated into the EHR enable automated messaging and speech-enabled applications that offer human-like interactions designed to help clinicians quickly locate key patient information and execute clinical tasks like navigating the exam and entering orders. Implementing the right technologies can help curate both the quantity and quality of information that a clinician must process, as well as minimize the manual effort required to integrate information from multiple sources.

We can do better for physicians to get the quality information they need for superior patient care.

Readers Write: Achieving Health Equity through Improving Diversity in Nursing

Achieving Health Equity through Improving Diversity in Nursing
By Karen E. Innocent, DNP, RN, CRNP

Karen E. Innocent, DNP, RN, CRNP is executive director of CE-CME for Wolters Kluwer, Health.

In meetings among nurse leaders, one of them expressed pride in only hiring nurses who have played contact sports, because nurses who were involved in sports were good “team players.” As the group praised that nurse executive’s selection criteria, I thought back to when I was growing up and remembered that my sisters and I didn’t play team sports. It was not by choice, but that my parents emphasized academic study and college preparation.

I jumped into the discussion and said that only hiring athletes could result in lack of diversity because everyone is not able to participate in contact sports. Some families value academic achievement, some may have financial limitations, and others may discourage sports because of gender norms in their cultures. We should all consider that teamwork and leadership skills can be acquired from non-athletic activities including having a part-time job, community service, or scouts.

Diversity is often associated with race, ethnicity, religion, gender, sexual identification, or disability. In addition, diversity could be viewed more broadly as political views, interests, hobbies, or lifestyle. Nurse leaders and other hiring managers in healthcare have the human tendency to hire employees who have similar characteristics as themselves. When there is homogeneity among workers, the employees have similar perspectives, beliefs, and behaviors. While this is not inherently bad, it does present a serious concern in healthcare. Creating a diverse healthcare workforce is an essential strategy for improving the quality of patient care.

Unconscious bias and structural racism have been linked to healthcare disparities. Variability in patient care can result from a lack of representation between those patients and the healthcare organizations serving them. Overwhelming evidence points to the benefits of hiring healthcare workers in proportion to the diversity represented in the communities they serve. 

Since the Institute of Medicine report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” was published in 2003, healthcare leaders have recommended increasing the diversity among healthcare professionals. The landmark report synthesized decades of research and concluded that racism, discrimination, and lack of awareness of cultural needs of the patient population resulted in poor health outcomes among various underrepresented ethnicities and sexual orientations. Research in the same report demonstrated that physicians of similar ethnic groups as the population had better patient outcomes.

More recently, a United States study from 1992 to 2015 that controlled for socioeconomic status, age, education, and comorbidities found significantly higher mortality in black infants regardless of maternal risk factors (Greenwood,  Hardeman,  Huang, Sojourner, 2020). The authors recommend increasing diversity among nurses and physicians to reduce health disparities.  Patients experience better outcomes with healthcare professionals of the same race, and experience other benefits such as improved communication, empathy with the needs of the community, and development of appropriate interventions and care plans.

Achieving diversity is a process. In order to effect significant change, healthcare leaders must commit to addressing root causes that result in a lack of diversity, including outdated hiring practices and barriers to admission into schools of nursing.  Diversity experts recommend that employers target their recruitment efforts at networks including Black, Hispanic, and Asian & Pacific Islander nursing organizations, community organizations, and online social networks. They recommend improvements in the hiring process to avoid unconscious bias in the hiring decisions. 

Regarding nursing school admissions, many qualified nursing school applicants – including those of underrepresented groups – are turned away because of inadequate nursing faculty. Other barriers include inability to afford tuition and uninformed high school guidance counselors. According to the American Association of Colleges of Nursing, there are more than 80,000 qualified nursing school applicants turned away annually because of faculty shortages (AACN, 2021). As baby boomers are retiring, there are insufficient faculty to fill open positions. Low faculty salaries, lack of awareness of teaching opportunities, and lack of preparation in nursing education need to be resolved to fill this growing void.

Many students who meet academic requirements come from low-income households. They require scholarships and grants to attend nursing school. However, there is difficulty connecting these disadvantaged students with financial aid. Several research studies indicate that high school counselors are unaware of the demand for nurses, the academic requirements, and financial aid available to students. Lack of awareness and misinformation results in qualified students lacking guidance to pursue nursing as a career (Williams & Dickstein-Fischer, 2019).  More should be done to ensure that there is information and access in underrepresented communities to create a pipeline of diverse high school students to enter the healthcare profession. 

Perhaps the presence of healthcare workers who reflect the diversity of the community will not be enough. Therefore, all employees with patient interaction should have continuing professional development on diversity, equity, and inclusion principles and social determinants of health to facilitate delivery of equitable treatment. To build patient trust, there should be hotlines established to enable reporting of observed or suspected discrimination or inequitable care. Because we can’t fix what we don’t measure, health systems should track quality improvement metrics related to equitable delivery of care and implement action plans to help achieve their goals.

Readers Write: What’s Fueling Interest in Healthcare ERP?

What’s Fueling Interest in Healthcare ERP?
By Clifton Jay

Clifton Jay, MS is president of HealthNET Consulting of Burlington, MA.

I had to laugh when I Googled “ERP in healthcare” and got “Exposure and Response Prevention (ERP) is a form of psychotherapy!”

ERP stands for enterprise resource planning, which has manufacturing roots, yet is not a common term in healthcare. It covers what we might call general financials, including materials management (aka supply chain since the pandemic), finance (accounts payable, general ledger, etc.), and human resources / payroll. Then there are ERP’s extended functions of customer relationship management (CRM), contracts management, and decision support / analytics.

People have asked me, why would my hospital need customer relationship management? The easiest example would be that a CRM could be used for patient engagement. Now this also starts to create a mixture of what’s considered part of the EHR versus the ERP, which might affect integration or single platform thinking.

But back to my main point — what’s fueling the interest in healthcare ERP today? By my observation, there are three main drivers – age, evolution, and M&A. As you consider what to do regarding ERP, I pose some food for thought.

• Age. Many hospitals and healthcare organizations are still using the general financial systems that they installed 20 years ago, and many of these systems are showing their age, such as old-style report writers, interfaces, and setting up on the chart of accounts that we all started with in 1974 (I still have a copy of the AHA guidebook.) This raises questions, such as, is it time to replace the ERP software? If so some or all? Or, keep doing bolt-on new applications such as business intelligence visualization / dashboard tools and contract management systems?
• Evolution. New generation ERPs (most of the traditional vendors have come out with highly rebuilt systems and there are also new players) tend to be built upon single platforms that eliminate interfaces and redundant master files, making it easier to perform analytics across data silos which resonates like the “one patient – one record” mantra of EHRs. It is a large undertaking to revamp the ERP because it involves everything and everybody, from the EHR (remember that the orders / charge masters drive revenue), IT, and finance / operations. The question is, what’s the value of a single source of truth, access to information, and streamlined operations? I have not seen a tangible ROI. The “value analyses” that the vendors use seem to be too conceptual and vague to me. If someone has some tangible ROI, e.g. time saved in report writing, accounting time, supply chain costs or standardized payrolls, I would love to see it.
• M&A. Mergers and acquisitions and multi-entity organizations create a need for enterprise-wide accounting, contracts for goods, supplies, and services, and standardized pay practices. Again, I had to laugh but was truly impressed when I reviewed a mapping table for multiple GLs with seriously different COAs. I’m not an accountant, but it looked like a cost accountant’s nightmare to me. Additionally, centralizing functions would also lead to having these departments use single software systems. It raises a question of how much are we torturing our users in having to use cobbled-together systems?

I hope these comments might add some perspective as you plan and strategize on systems that support your users, your enterprise, and ultimately your patients.

Readers Write: Embracing a Smarter Future in Healthcare

Embracing a Smarter Future in Healthcare
By Brian Patty, MD

Brian Patty, MD is senior clinical advisor of HC1 of Indianapolis, IN.

A principal issue stalls the mainstream use of precision health in the US. Despite substantial national investment in strategies aimed at advancing high-value care, the industry struggles to establish a standardized and effective manner of bringing data together and sharing it.

Consequently, the healthcare industry continues to suffer from the lack of interoperability of data systems that should be achieving significant ROI through personalized care delivery. Instead, low-value care continues to rack up substantial waste associated with unnecessary services, low-value, high-cost drugs, and missed prevention and therapy opportunities.

Precision health provides immediate relief to this unsustainable course. Yet with the exception of certain specialties, these effective and efficient models of care have remained elusive for the vast majority of providers due to lack of timely data within the provider workflow. There is good news emerging on this front, though, amid rapid technological breakthroughs that enhance access to the unique genetic makeup of individual patients.

Precision Health Insight Networks (PHINs) are advancing personalized medicine by drawing on the latest technological advancements to transform previously disconnected health data into actionable information that drives specific optimal care decisions targeted to each individual patient. This type of infrastructure demonstrated its promise on a focused national scale during the pandemic, when COVID-19 data was leveraged to organize and normalize hundreds of millions of lab test results—including demographic data—from more than 20,000 order locations.

Enabling massive volumes of critical data to flow into a single dashboard, PHINs equipped public health agencies and healthcare organizations with detailed hyper-local lab testing insights that were simply unavailable or excessively delayed through government reporting. Healthcare authorities accessing this dashboard were able to drill down to real-time state, county, and sub-county views of COVID-19 testing rates, de-identified test results, key demographics, a side-by-side view of viral and antibody testing, as well as local-risk and age-group trending.

Similar to the concept of personalized medicine, PHINs enabled optimal decision making and promoted proactive, effective response on the local level by equipping public health officials with granular information such as where local hospital and ER resources would likely be overwhelmed in the coming three to six-week period. Precision Healthcare is now positioned to launch off this initial success by using PHINs to unearth the insights from siloed data (including individual gene mapping) that already exist across multiple EHR, laboratory, and pharmacy systems.

Consider the potential impact of precision prescribing alone:

• Trial-and-error and one-size-fits all prescribing results in more than 2 million adverse drug reactions (ADRs) a year.
• 15.4% of hospital admissions are attributed to drug-related adverse reactions
• 26% of readmissions are drug related (and preventable) 

Plavix perfectly illustrates how precision prescribing can improve patient outcomes and contribute to highly effective, high-value care. The antiplatelet medication is a frequently prescribed post coronary intervention for its ability to reduce clotting, strokes, and recurrent cardiovascular events. However, up to one-third of the population has a genetic makeup that changes how it is absorbed or metabolized, so there is wide variation in its efficacy. Depending on someone’s genetics, dosing may need to be doubled or even tripled the normal dose, or Plavix may not work at all. In others, lower doses are required to prevent life-threatening bleeding, which may occur as a side effect specific to an individual’s genome and the subsequent cellular production of enzymes that metabolize the drug.

PHINs bring together data and deliver patient specific insights to frontline physicians at the point of prescribing. These providers simply don’t have the time to research or access the massive volumes of new data that is continually emerging. Providers also may not know that genomic testing has been done on their patient by another provider, or that those results impact the drug(s) they are planning to prescribe.

When knowledge is infused into the patient care process at the right time to inform physicians, medical outcomes are improved and patient satisfaction increases. Clinicians are likewise relieved of the impossible task of individually staying on top of the latest pharmacogenetic or testing protocols. The data organized by PHINs deliver the right care insights at the right time for the right patient.

Of all the lessons learned from the COVID-19 pandemic, one rises to the top: keeping critical patient and public health data locked away in disconnected databases and data siloes is not only ineffective and inefficient, but potentially deadly. Present-day care models are no different. The good news is that US healthcare can change its unstable trajectory by embracing the power of PHINs and mainstreaming precision health practices.

Readers Write: How Payers Can Leverage Data Pipelines for 5-Star Results

How Payers Can Leverage Data Pipelines for 5-Star Results
By Mike Noshay

Mike Noshay is founder and chief strategy officer of Verinovum of Tulsa, OK.

A Star Rating is the essential number that drives Medicare Advantage payer performance reporting and customer influence. To improve or stay on top of CMS Stars program scores, payers need a firm grasp of how to stay ahead of the game, prepped and ready for changes in the quality data pipeline system as legislation and technology evolve.

Just one single outlier performance can count strongly against a company’s ability to achieve a good score. Did you know that moving from one to two stars is eight times more impactful on rewards than moving a measure from four to five stars? It’s essential that payers understand how to leverage data pipelines to obtain those coveted 5-star ratings.

Let’s look at how payers, providers, and healthcare IT leaders can optimize their data integrity along the entire care continuum to make informed and accurate analytic, clinical, and population health decisions that improve patient outcomes.

Patient information is the most important and crucial healthcare data. It has got to be right. We’re hearing a lot about the importance of data quality in the healthcare news lately. New legislation and technology are changing the way data is handled as well as payers and providers are upping their commitment to clean, curated quality information for patient safety and positive outcomes. Unfortunately, provider and payer organizations alike understand the value of data quality but may lack a systematic process for establishing and maintaining that quality.

Today’s payer challenges include managing a population across the continuum. Throughout this healthcare journey, payers need quality, curated, and enriched data to assign the member to an appropriate risk category and accurately assess interventions and outcomes.

To support this complex and lifelong member management process, payers must have the capabilities and technical infrastructure to support a data-driven strategy.

Payers need to be intentional in how they create aligned provider incentives for data sharing. Some of the first electronic, cross-organizational interoperability in healthcare was EDI transactions for filing claims, so payers already have a lot of experience in interoperability.

However, their main focus has been administrative and financial transactions. The event-oriented transactions of healthcare interoperability have passed them by, as have the document-style patient record exchanges (CCD and C-CDA), because these formats without quality controls and format interventions don’t meet their needs in terms of transferring patient panels, gaps in care, and coverage information.

Now is the time for payers to refocus attention on solid healthcare data interoperability standards and to remember that interoperability is not just data access – it’s about curated, enriched data that drives quality outcomes.

Having access to data and having actionable data are two different things. Including clinical data in the payer ecosystem offers both direct and indirect benefits. More data helps augment quality measurement scores directly because you can add content to the numerator and denominator. In addition, by having comprehensive clinical data at your disposal, you can create more informed risk models, make better business line and value-focused decisions, and have timely data to engage patient populations.

By vastly improving the accuracy of quality measures, you improve risk assessment accuracy and reduce administrative burden.

It’s important to remember that:

• Clinical data is not one thing. It includes patient demographics, lab results, problem lists, medication lists, immunization records, and more.
• Clinical data can augment claims data to improve Stars, HEDIS, and risk adjustment. And if payers can solve the problems of moving and managing the clinical data, this can be a key benefit.
• The goal is to change the game by using that data not just to tally a more accurate score, but to connect clinical activity and claims data to do better case management, predictive analytics, and population health management.

As a payer, ensuring that you are mapping the outcomes you’re trying to achieve to those individual deployments of clinical data is essential in the context of supporting quality data measures:

• Smart payers will expand their expertise around data, analytics, and risk management.
• Invest in data curation and enrichment tools and practices to ensure your more valuable team members (data scientists and care interventionists) can practice at the top of their licensure.
• Partners can provide expertise and tools related to connecting clinical data to the payer architecture.

The only way to be prepared for the next monumental shift is to have the most comprehensive data at your fingertips. Payers need to:

• Invest in partnerships and a dedicated staffing model to manage the space.
• Proactively learn how to use data as a predictive tool to identify trends and help see where quality measure focus is going.
• Leverage claim data to validate emerging trends.

Organizations need to get a strong handle on the quality of the data driving measurements. We’re going to see an ever-increasing number of those measurements, rules, and scenarios. As more data starts flying around, and with a consumer-led move toward precision medicine, you must have your technology and data science teams practicing at their top license. The only way to do that is to make sure the data you’re using to inform decisions made across your organization is as complete and accurate as possible.

Partnering with experts in data quality, curation, and enrichment can help. Specialists can provide a wide range of data quality tools and governance to assist. It’s also important to provide appropriate training for staff members. Smart payers are going beyond the compliance requirements for data receipt and transfer and are working those APIs into part of their overall strategy for better member engagement. Now is the time to get comfortable with the standards, tools, and processes of exchanging that data and using health care standards. Now is the time to invest in a highly capable workforce to drive those initiatives.

The world of data is ever changing, but with investment and careful preparation, you can stay ahead of the game for your organization and the patients you serve.

Readers Write: Sharing Your Medical Info with Providers from your iPhone – What You Need to Know About Apple Health, Patient Records, and Better Visibility into Patient Data

Sharing Your Medical Info with Providers from your iPhone – What You Need to Know About Apple Health, Patient Records, and Better Visibility into Patient Data
By Daniel Kivatinos

Daniel Kivatinos, MS is co-founder and COO of DrChrono of Sunnyvale, CA.

Apple’s announcement of their new iOS15 feature demonstrates a major step forward in giving patients better control of their own health data in a more seamless, straightforward way. Coming this fall, this update will allow patients to share health app data with providers.

For background, here’s how it will work. When choosing to share health information from their iPhone, the patient’s care team will be able to view the information within the medical record patient chart from the electronic health record (EHR) software. Patients can share a range of information, including physical activity, heart rate, cycle tracking, sleep, irregular rhythm notifications, and falls, as well as certain health record categories like labs and immunizations.

As we move into a new world of digital health, we are tracking more data than ever, and an ever-present question is whether or not physicians will be able to aggregate and use all of this information. With new features like Apple’s, medical care teams have easy access to a more holistic view of their patients’ health information. For example, providers will not only be able to see a patient’s lab results, but their workouts, food tracking, genomics, and more should they opt to share that information.

The overload of data is an understandable concern, and some healthcare professionals wonder whether or not this onslaught of information will only overwhelm practitioners. But the issue isn’t about the amount of data we have around a patient. Rather, it is about having access to the precise information that is best needed for the medical care team, patient, and family members.

While more data is better when it comes to giving precise care, what technology companies must do is work toward ways to better present, manage, and interpret the data in ways that help providers at the point of care. There is only so much time with a patient during a visit, and the data that is reviewed needs to be relevant and clear to understand. As a point of comparison, regardless of what you may think about the Robinhood investment app, they have succeeded at presenting data in a quick, simple way for investors.

Over time in the healthcare industry, insights gleaned from machine learning will be increasingly accurate for care teams. If the technology is leveraged correctly, the most important data trends that need to be shared won’t be lost in the shuffle, and machine learning assistants will eventually become more useful and relevant for providers.

After all, it is better to have 40 years of data on a patient bubble up or emerge with contextual information when needed than not. For example, a 12-year-old patient gets stung by a bee and the provider notes in their chart that the child is allergic to bee stings. Later in life, the patient may not recall this event, but this data should still be available to the care team and patient in their electronic medical chart. With the right user interface, this data will be useful, rather than a nuisance, to a busy provider.

Thankfully, machine learning continues to improve. Think of it as a co-pilot with the provider driving the patient experience and ultimately determining what to do, but with machine learning also helping in giving indications and insights about a specific patient and their needs. The patient’s numerous health factors are always evolving, but understanding more clearly a patient’s overall wellness, genomics, and labs are all critical to giving a precise prescription.

Patients on Medicaid and Medicare with multiple comorbidities would benefit the most from sharing their daily data with a physician, and patients have more access to better devices at a cheaper cost every year. As Moore’s law states, the number of transistors in a dense integrated circuit doubles about every two years. What this means is that as the cost to buy an iPhone is going down, you are getting more for your money. Through hard work across engineering, technology is getting better and better to the point where patients will be able to get more data over time at a cheaper cost. This not only applies to phones, but wearables and all consumer health tech products.

We are also witnessing a renaissance taking place in healthcare data exchange through FHIR and other modern APIs. This is a game changer in the industry and one to keep an eye on. I am excited to see what Apple and other digital health companies do in the future, as Apple’s latest iOS feature is a massive milestone and a bright future for healthcare.

Readers Write: Three Common Email Security Compliance Misconceptions That Are Putting Healthcare Organizations At Risk

Three Common Email Security Compliance Misconceptions That Are Putting Healthcare Organizations At Risk
By Hoala Greevy

Hoala Greevy is founder and CEO of Paubox of San Francisco, CA.

HIPAA violations are rapidly increasing. In 2020 alone, there were 188 PHI related data breaches via email, a 17% increase from 2019. As healthcare organizations look to stay competitive in the rapidly evolving digital landscape, they continuously search for more efficient and secure communication methods between employees and patients. HIPAA’s top priority is to protect a patient’s protected health information (PHI), requiring covered entities to take reasonable steps to accomplish this.

With the proper encryption and well-trained staff, email is an effective method to communicate with patients about their health. However, misconceptions about the difficulties or feasibility of HIPAA-compliant email often keep healthcare organizations using outdated communication tools like fax machines and the postal service to share PHI with patients. Providers shouldn’t let common misconceptions about email deter them from using it.

Misconception #1: You can’t send an email and maintain HIPAA compliance. HIPAA does not prohibit the transmission of PHI via email. In fact, according to the HIPAA Security Rule, healthcare providers may adopt new technologies, including email, as long as they:

• Ensure the confidentiality, integrity and availability of PHI.
• Identify and protect against reasonably anticipated threats.
• Ensure employee compliance with HIPAA.

Email is perfectly acceptable as long as it is encrypted in transit and at rest. Under HIPAA, encryption is an “addressable” way to secure email rather than being required. However, since there is no other effective method to secure email besides encryption, it is de facto a requirement.

Misconception #2: HIPAA compliant email has to be difficult to use. Most email security solutions require employees to take several steps to encrypt a message, such as putting a special keyword in a subject line to trigger encryption. Recipients might also need to jump through hoops to read a message, such as creating an account to log into a patient portal.

These extra steps leave plenty of room for human error. An employee might not remember to encrypt an email containing PHI, or they might simply put a typo in the subject line keyword. A recipient can easily forget their password, requiring them to reset it the next time they have a message waiting from their doctor.

However, there are alternative methods that don’t require any extra steps from a patient or a provider. The safest way to ensure staff uses email in a HIPAA compliant matter is to partner with a HITRUST CSF certified email security provider that encrypts all outbound email by default and sends messages directly to patients’ inboxes. That way, staff doesn’t need to decide which emails to encrypt and recipients don’t need to worry about logging into a portal to read their messages.

By eliminating extra steps, healthcare organizations can easily and safely use email while remaining HIPAA compliant, thus allowing providers to focus on patients rather than encrypting messages.

Misconception #3: Extra steps increase email security. People often think that the harder something is to do, the more secure it must be. However, email solutions that include extra layers of complexity to send and read a message provide people with a false sense of security.

Patient portals, for example, give the appearance of more privacy as they require a separate login and password. However, portals also involve an email component to access messages. Although they might appear to be harder to break into, portals are only as secure as the email address they are associated with. Ultimately the number of steps in a process doesn’t dictate the security it provides.

Misconceptions like these have limited email’s adoption throughout the healthcare industry, but it need not be so. With a clear understanding of how to secure messages and maintain compliance, organizations can partner with a HIPAA compliant email provider that is both easier to use and more secure than other solutions that rely on security theater to lull their customers into a false sense of security.

Readers Write: Healthcare is Failing Overwhelmed Clinicians — Here’s How to Focus on Their Journey

Healthcare is Failing Overwhelmed Clinicians — Here’s How to Focus on Their Journey
By Michelle Davey

Michelle Davey is co-founder and CEO of Wheel of Austin, TX.

Over the last few years, the health tech industry has invested billions into improving the patient experience. Direct-to-consumer healthcare companies raised $1.2 billion in Q1 2021 alone. Now patients can get prescriptions delivered to their door and avoid the pharmacy line. They can skip the waiting room and chat with a doctor from their couch. They can even get their blood drawn without leaving their home.

But it’s been surprising to see the industry pay so little attention to clinicians, especially with the critical role they play in the patient journey. They are setting expectations, determining treatment plans, and listening to patients’ concerns. Yet for some reason, we continue to set clinicians up to fail.

Think about how you feel on your worst day at work. Tired, stressed, and overwhelmed, right? That’s how clinicians feel every day with their patients. Nearly half of clinicians reported alarming rates of burnout before the pandemic. Over the last year, 80% of people said their doctor or nurse seemed burned out during a healthcare visit. Even more concerning, one in three said they believe their quality of care may have been affected by clinician burnout.

That’s why the digital health industry should look at “D2C” through a new lens: direct-to-clinician. It doesn’t matter how much time and investment we spend on improving the patient journey. When clinicians are burned out and overwhelmed, patients won’t feel satisfied. But if clinicians feel supported and set up for success, patients will be motivated to take charge of their health.

Here are three ways to put a D2C(linician) strategy in place:

Prioritize the Clinician As Your End User

When developing a clinician-facing product, get clinician feedback early and often. That includes surveys, interviews, demos, and beta launches, just like any company would do with consumers before launching a product. Feedback is a gift and bringing clinicians along the journey is worth the investment. Clinicians want, need, and deserve user-friendly tech, processes, and workflows.

Also, look for opportunities to hear the clinical voice outside of product development. In our company all-hands meetings, we share clinician feedback about what we’re doing well and where we can improve. This tight feedback loop helps us stay honest and it keeps us focused on clinicians and what they need to do their job well.

Invest in Ongoing Education and Coaching

Remember that clinicians are highly trained and educated. They love to learn and they’re eager to upskill throughout their career. That includes traditional opportunities like continuing medical education (CME), which offers the latest research and best practices in developing areas of their field. But they also want to stay on the cutting edge of technology and care models. Especially in light of the pandemic and the transition towards virtual-first care.

Clinicians now have 50 to 175 times the number of virtual visits compared to before the pandemic. Medical schools have largely failed to provide comprehensive training on virtual care. But it’s also the digital health industry’s responsibility to make it as easy as possible for clinicians to understand how to treat patients remotely.

Before clinicians start seeing patients with Wheel, for example, we provide them with “webside manner” training. This includes:

• Testing their webcam, microphone, and speakers before a patient visit.
• Looking into the camera throughout the visit to make eye contact with the patient.
• Nodding their head during the visit to demonstrate active listening.
• Dressing professionally to set a good impression.
• Picking a neutral background to avoid distraction.

For those who have spent the pandemic on back-to-back Zoom meetings, some of this guidance may feel obvious. But clinicians are used to being in the same room as their patients. We need to help them feel comfortable and confident behind the screen.

Cultivate a New Work Culture

Doctors and nurses are well known for putting up with long shifts and demanding schedules, but they’re fed up, burned out, and overwhelmed. The toll and trauma of the pandemic has led three in 10 clinicians to think about quitting their jobs altogether. Digital health companies not only have an opportunity to create a new work culture for clinicians, they have an obligation. It’s incredibly challenging and expensive to recruit and retain clinicians. If the workforce continues to shrink because we aren’t providing them with the support they deserve, our innovative devices and services will go dark.

One of the ways we focus on retention is by getting to know clinicians as people, just like we do with our engineers and product managers. Our team regularly conducts surveys and interviews to better understand their motivations, their career aspirations, and how the pandemic has affected both their work and personal life. For example, we found the majority of clinicians in our network are the primary income earners for their family. As with many of us, the pandemic had placed them under extra stress to provide for their families. These findings prompted our team to offer free therapy services so they could get support during a tumultuous time without needing to worry about the cost.

The digital health industry should continue to focus on improving the patient experience, but we need to consider all the factors that impact the patient experience. Getting clinician feedback early and often, investing in ongoing coaching and education, and finding opportunities to better understand their career aspirations and motivations should be table stakes for every digital health company. This is our opportunity to address one of the biggest failures of our healthcare system — providing clinicians with the support they need to provide great care to patients.

Investing in a D2C(linician) model now will pay off in the long term, keeping our caregivers engaged, patients healthy, and investors impressed. Now that’s a winning strategy.