Readers Write: CMS: Unlocking Data for Patients

CMS: Unlocking Data for Patients
By Nassib Chamoun

Nassib Chamoun, MS is founder, president, and CEO at Health Data Analytics Institute of Dedham, MA.

The digitization of medicine over the last decade has driven exponential growth in the quantity of medical data, measured in the digital footprints of billions of care events each year. Yet this data explosion has made little difference for patients, who still struggle to access, understand, and share their medical data.

Several barriers have kept patients from the benefits of their data. A lack of commonly accepted and consistently implemented software standards inhibits access to silos of data generated by providers, insurers, and electronic health record vendors. Patients also lack tools for accessing and understanding their data.

Encouragingly, each of these barriers is now crumbling as years of effort by industry, entrepreneurs, and government are beginning to bear fruit.

The Centers for Medicare and Medicaid Services (CMS) has created MyMedicare.gov, which connects 40 million Medicare fee-for-service beneficiaries to any medical claim in the last three years that CMS has paid on their behalf. Although the site provides beneficiaries with valuable information, individual patient records can run to hundreds of pages,  an overwhelming user experience. Equally important, MyMedicare.gov contains patient records only for the last three years.

In recognizing the need for a better patient experience, CMS released Blue Button 2.0, an open Applications Programming Interface (API) that allows developers to build apps to help patients access their medical information and decide which apps – if any – can access their personal data.

CMS is further catalyzing this ecosystem of developers and users with its Interoperability and Patient Access Rule, released in May 2020, whereby millions of people covered by commercial insurance, Medicaid, and Medicare Advantage plans will soon have access to their medical histories. While enforcement is somewhat delayed due to the COVID-19 pandemic, the CMS rule also expands the types of information available by requiring healthcare providers and electronic health record vendors to give patients access to certain clinical information, such as lab values, through the third-party applications of their choice.

Blue Button 2.0 and the Carin Alliance (a non-profit devoted to enabling consumers and their authorized caregivers to access more of their digital health information with less friction) are enabling dozens of third-party apps to extract data from large documents and reformat it in a way that lets users and their caregivers quickly understand their medical histories and conditions.

These apps focus primarily on assembling health information from a variety of sources and presenting it more simply to patients. Other tools offer advanced analytics, including highly personalized risk information, to help patients make more data-enhanced healthcare choices.

For example, a patient in her 80s could ascertain the probability of requiring hospitalization from heart disease in the next 12 months and plan accordingly. In the future, risk profiles may also be combined with data from real-time monitoring tools, such as smart watches and smart speakers, to provide more customized insights and enable deeper, more impactful conversations between clinicians and patients.

What’s exciting is that the combined initiatives of open standards, improved data access, and a thriving app ecosystem have established the foundation for sustained innovation. Add an inrush of entrepreneurial talent and venture capital investment and we will likely see numerous new software innovations that accelerate the transformation of huge quantities of difficult-to-use data into usable insights for patients.

Readers Write: Building Evidence-Based Care Plans That Drive Better Outcomes

Building Evidence-Based Care Plans That Drive Better Outcomes
By Nan Hou, PhD, RN

Nan Hou is managing editor of Zynx Health, part of the Hearst Health Network, of Los Angeles, CA.

Evidence-based care plans play an essential role in guiding interdisciplinary care teams toward the most effective steps likely to yield high-quality care and the best patient outcomes.

For hospital-based interdisciplinary teams in particular, care plans offer several important benefits — including ensuring continuity of care across nursing shifts, promoting interdisciplinary collaboration across clinical and operational teams, improving patient engagement, and helping meet documentation requirements from payers and regulators.

However, too often, evidence-based guidelines either go ignored or take too long to implement. While estimates vary, the most frequently cited figure holds that it takes about 17 years for new knowledge generated by randomized controlled trials to be incorporated into practice. Even then, application is highly uneven, according to the 2001 U.S. Institutes of Medicine’s landmark report “Crossing the Quality Chasm.”

To promote greater adherence to evidence requires getting the right information to the right person at the right time in the workflow. For many hospital-based patients, this process begins with a care plan created by an interdisciplinary team that includes key information such as diagnosis and goals and is updated as the patient progresses. When developed by experienced care team and based on the best available evidence, care plans enable hospitals to standardize care, improve outcomes, and maximize performance.

One useful model for evaluating care plans is the Agency for Healthcare Research & Quality’s “Clinical Decision Support 5 Rights” framework. The model states that providers can achieve clinical decision-supported improvements in desired healthcare outcomes by communicating the following five “rights”:

1. The right information: evidence-based, suitable to guide action, pertinent to the circumstance.
2. To the right person: considering all members of the care team, including clinicians, patients, and their caretakers.
3. In the right intervention format: such as an alert, order set, or reference information to answer a clinical question.
4. Through the right channel: for example, a clinical information system such as an EHR or a more general channel, such as the internet or a mobile device.
5. At the right time in workflow: for example, at time of decision, action or need

Creating evidence-based practices

One of the foremost goals of evidence-based practice is to create standardized care that is supported by data and facts, reducing unnecessary variation in care. According to a report originally published in the BMJ, there are four key steps for creating evidence-based practices:

• Formulate a clear clinical question from a patient’s problem.
• Search the literature for relevant clinical articles.
• Evaluate the evidence for its validity and usefulness.
• Implement useful findings in clinical practice.

By following evidence, treatment is based on research and knowledge rather than tradition or intuition. Providers must weigh the value of evidence-based interventions, which requires critical thinking and an evaluation of the quality of the research and its conclusions. Instead of relying on their own personal beliefs, it is essential that providers select evidence that is centered on what is best for the patient.

Elements of a strong care plan

A well-designed care plan focuses on the whole person, taking into account both clinical factors and social determinants of health, such as economic security, and access to food, shelter, and transportation. While the plan must include interventions to treat the current medical issues, it must also help caregivers anticipate and manage the risk of future complications, including after discharge.

Further, it is essential that care plans foster a team-based, collaborative approach that reaches across disciplines in a variety of roles, including pharmacists, social workers, dieticians, behavioral health specialists, physical therapists, and occupational therapists.

To create care plans for individual patients, interdisciplinary teams use measurements from the latest clinical summaries, physician notes, and other electronic health record (EHR) data, in addition to information gathered directly from patients. For more common conditions such as heart failure, care team members often consult templates that identify the steps patients must take to achieve certain health goals, manage comorbid conditions, and avoid complications.

The importance of current evidence

Evidence, of course, plays a critical role in the development of care plans, but staying current with the best and latest evidence-based practices is a substantial challenge for any practicing clinician. For example, a study published in the Journal of the Medical Library Association estimated the volume of medical literature potentially relevant to a primary care physician published in a single month, and found that a physician trained in medical epidemiology would need 628 hours to evaluate all the articles.

To overcome this limitation, many hospitals rely on regularly updated content libraries that are built on the best available evidence, national guidelines, and performance measures. These content libraries include medical conditions and procedures, summaries of studies, and links to evidence in support of care recommendations. Armed with a source of reliable evidence-based content that can be easily incorporated into care plans, care team members can be confident that the plans they formulate are consistent with the most current and credible standards of care.

While virtually all healthcare stakeholders agree that using evidence-based care plans supports better patient outcomes, putting evidence into practice is often easier said than done. However, by leveraging pre-populated, evidence-based content libraries, hospitals can reduce much of the heavy lifting, empowering their interdisciplinary staff to develop care plans that facilitate communication and collaboration, ease care transitions, and ultimately drive superior patient care and outcomes.

Readers Write: We Need a More Patient-Centric Approach to End-of-Life Decision-Making

We Need a More Patient-Centric Approach to End-of-Life Decision-Making
By Ryan Van Wert, MD

Ryan Van Wert, MD is co-founder and CEO of Vynca of Palo Alto, CA and clinical assistant professor of medicine, division of pulmonary and critical care medicine, at Stanford University.

As a physician with a background in critical care, I have seen scores of patients with serious or life-limiting illnesses such as advanced cancers and dementia receive aggressive treatment in intensive care units, treatments that many of them would not have wanted. I have had heartbreaking experiences where I have put a patient on life support, and then days later, found out that a family member or loved one had uncovered an advance care planning (ACP) document indicating that this care did not align with the patient’s wishes. Far too often, I have witnessed situations in which extreme, invasive measures are taken because the dying patient’s wishes are unknown simply because they never had the important conversations about end-of-life care with their physicians and loved ones.

Today, in the midst of the COVID-19 crisis, these tragedies are unfolding in emergency rooms across the country at an alarming rate. As we enter the darkest days of the pandemic, ACP has been brought to the forefront as a necessity for patients of all ages, not just those in the more mature stages of life. Clinical resources are again being stretched to the limit, and patients are at risk of receiving critical care interventions, such as being placed on ventilators, that may not align with their personal preferences.

In addition to causing significant grief for the patient’s loved ones, this is putting great strain on the physicians who are responsible for caring for them. We need a better system to help individuals, their loved ones, and clinicians navigate the complex process of making choices for future care, along with the programs and tools to ensure they are honored.

We Must Normalize the Discussions Around End-of-Life Care

Most Americans do not want to die on a ventilator in the intensive care unit at the end of life. Most of us would prefer to receive whole-person care that is focused on comfort and well-being. However, if we do not clarify these preferences, we will receive every life-saving medical treatment and intervention possible.

We need to start normalizing discussions around future care preferences that reflect our values, choices, and goals, no matter how uncomfortable these conversations might be. We must be able to ask ourselves, what is really important to me? How do I want to live my final days? Holding these critical conversations with our loved ones, caregivers, and providers enables us to think through our preferences for future medical treatment and allows us to make important healthcare choices before we become ill or incapacitated.

That is not to say that ACP is an easy process. The conversations are inherently emotional and require bravery and compassion. Providers should be supported with the education, tools, and a standardized approach to help them guide these conversations so that their patients feel empowered. A more patient-centric approach to ACP is essential for ensuring quality of care and aligning healthcare utilization with care preferences when patients near the end of their lives.

While both patients and physicians may recognize the importance of ACP, there still lacks a standard method to engage in these conversations and make this vital information available when it is needed. Research shows that 84% of individuals who are 65 and older have not been asked by their physician to have an ACP conversation, and there is a 37% medical error rate in end-of-life care plans. In the past, even when patients have taken the time to record their wishes, in many cases the documents have been inaccurate or inaccessible across the care continuum. When physicians were asked about the confidence of locating an existing advance care plan within the EHR, only 31% of physicians strongly agreed.

Why Healthcare Organizations Must Make ACP a Priority

It is clear that hospitals and health systems need to integrate ACP conversations and digitized documentation into their standard of care, without exception. However, many healthcare organizations are continuing to struggle to implement and scale high-quality ACP, despite the fact that ACP CPT reimbursement codes 99497 and 99498 are already in place for both in-person and telehealth ACP consults. By implementing and scaling ACP, healthcare organizations can:

• Improve the patient experience. Standardized ACP enhances engagement with patients in these conversations and reflects personal goals and values, enabling organizations to provide more personalized, patient-centric care. According to The Journal of General Internal Medicine, 93% of hospitalized patients with an ACP rated their experience five stars compared to 65% without one in place.
• Provide the highest quality care. ACP reduces unwanted, unnecessary healthcare interventions at end-of-life and prevents medical errors, so patients are receiving the best care possible.
• Reduce provider burnout. Very few providers have ACP conversations with their patients, as they are not comfortable or prepared to guide these difficult discussions, resulting in limited documentation available to providers. This leads to providers having to conduct unwanted, invasive interventions, all the while knowing that these patients might be better served with palliative and hospice services versus being hooked up to a ventilator in the ICU.
• Drive success in value-based arrangements. With ACP increasingly becoming a quality measure in value-based care programs, standardized ACP drives potential success in value-based arrangements, such as BCPI Advanced and the upcoming Radiation Oncology Model.

Realizing the Benefits of a Digitized ACP Approach

To achieve the benefits of ACP, healthcare organizations need to implement a streamlined approach that normalizes ACP conversations by providing education and standardizing a system-wide program. ACP education and documents must be digitally available within the patient portal, as this enables individuals to access ACP details, review them with loved ones and make changes when needed, truly putting the patient in control of their future care.

A single source of truth for all ACP documents ensures that they are always available in the clinical workflow and eliminates confusion. It also allows clinicians to view accurate patient information, which guarantees that all future care preferences are accurate, actionable, and in one reliable place within the EHR. Unlike a paper-based approach, digitized ACP enables reporting to provide clinicians with critical business intelligence for realizing ACP utilization, success, and value.

Healthcare organizations have the opportunity to help normalize ACP, prioritize resources, and truly solve for the demand and overload we are seeing at hospitals today. By empowering everyone involved with the necessary resources and tools, you have the opportunity to make an immediate impact, delivering higher quality care at the end-of-life and, as such, ensuring for a truly patient-centric experience.

Readers Write: How COVID-19 is Driving Innovation in our Behavioral Health System

How COVID-19 is Driving Innovation in our Behavioral Health System
By Eric Meier

Eric Meier, MBA is CEO of Owl Insights of Portland, OR.

Our nation was facing a behavioral health (BH) crisis even before the COVID-19 pandemic. According to the National Institutes of Health, 51.5 million American adults were living with a diagnosable mental illness in 2019, with fewer than half having received treatment in the previous year. Interestingly, the Commonwealth Fund reports that as of mid-November, 2020, “states with the lowest infection rates per capita are Medicaid expansion states, where there is better access to care and providers.” Non-expansion states were suffering the highest rates per capita. This highlights one of the biggest issues in BH: lack of access.

Now enter COVID-19 and the crisis has escalated exponentially. In a July 2020 poll conducted by Kaiser Family Foundation, 54% of all adults in the US said the pandemic had negatively impacted their mental health. This is up from 32% from just four months earlier. A survey by the CDC supports this finding. It reports that the number of adults in the US suffering from an anxiety or depressive disorder has quadrupled since before the pandemic. Experts now predict that the economic fallout from COVID-19 may cause tens of thousands of additional deaths by suicide or drug abuse in the years to come. In an article published by The Kennedy Forum, former US Representative Patrick J. Kennedy warns that the pandemic has unleashed “a new wave of mental health and substance use disorders in the US.”

Times of crisis often highlight weaknesses in existing systems. An article published by Harvard Business Publishing says, “The places where things could be done better or more efficiently become glaringly obvious. All of a sudden, opportunities for innovation are staring us in the face.” Telehealth is a prime example. The rollout of social distancing requirements was one of the first challenges brought about by the pandemic. Providers scrambled to implement virtual care technology and associated processes in order to keep themselves, their staff, and their patients safe. Because of recent surges, telehealth is still in use. But not all telehealth solutions are the same. To be effective, providers need more than just a video app, especially when treating individuals with BH whose conditions are often more complex than individuals with non-BH conditions where screening and triage are more straightforward.

This is where innovative BH technology shines, by helping providers perform systematic screening via integrative telehealth solutions across all BH conditions, allowing them to proactively identify, diagnose, and treat those at risk through evidence-based practices. Providers can better match treatment to each patient’s unique symptoms, medical history, social determinants of health, and comorbidities. Not only does this produce improved outcomes, it also helps reduce gaps in care and provides more efficient care pathways.

How innovative BH technology improves the effectiveness of remote care:

• Provides actionable, evidence-based outcomes data within the telehealth session.
• Collects patient outcomes in advance of a telehealth visit to target treatment.
• Supports telehealth billing by providing clinical documentation.
• Screens patients and their care team members before or during telehealth visits.
• Provides access to additional distress and anxiety measures relevant to the BH impact of COVID-19.
• Remotely identifies patients who are not responding, deteriorating, and require immediate intervention.

Innovative BH telehealth technology gives providers the ability to easily screen, track, analyze, and guide treatment while enabling patient reported outcome measures (PROMs) and enhancing clinical confidence.

COVID-19 has had a devastating impact on all populations across our country and experts agree that the mental and economic fallout could last for years to come. Now that mass vaccinations are underway, we can finally see the light at the end of the pandemic tunnel. Healthcare systems and community organizations must act now to implement technology solutions that can help scale resources to meet the urgent needs of a quickly expanding population living with BH conditions. The bottom line is that we would be greatly remiss to allow ourselves to revert to the “old normal” of pre-pandemic BH. This is our chance to make lasting change and innovation will lead the way.

Readers Write: Healthcare Must Embrace Innovation Beyond the Pandemic

Healthcare Must Embrace Innovation Beyond the Pandemic
By Niko Skievaski

Niko Skievaski, MA is co-founder and president of Redox of Madison, WI.

It’s been said that necessity is the mother of invention. However, I’d say 2020 created a permutation of the adage, especially for healthcare: Necessity is the mother of adoption. The COVID-19 pandemic forced healthcare’s hand to embrace technologies that had been used sparingly, if at all, by many providers. While this sudden burst of adoption was positive, the pandemic showed that years of putting off innovation left many healthcare organizations unprepared to smoothly transition into the use of new technology.

The question is this. Will the innovation adoption momentum continue, or is this newfound appetite for tech solutions a bridge over the troubled water of the pandemic? The optimist and realist in me don’t always agree, but, in this case, they’re on the same page. I believe we’re headed toward not only embracing healthcare innovation, but also establishing a foundation to get ahead of demand. Let’s take a closer look.

How we got here

Few healthcare providers would argue against innovation, but tech implementation has typically been viewed as nice to have, as opposed to need to have. Cost, time, resistance to change, and administrative red tape are just a few of the big reasons a healthcare organization might have avoided adopting a particular technology.

However, some healthcare systems, like Providence St. Joseph, have taken a different approach, and had made huge bets on technology and partnerships in the years leading up to the pandemic. Such organizations have looked for experts outside of healthcare and targeted tech executives from Fortune 500 companies, developed innovative apps and funded startups, and created the necessary infrastructure that positioned them to operate in healthcare’s sudden new reality. Once the pandemic hit, these organizations only had to refine what was already in place, as opposed to scrambling to build from scratch.

Such foresight has proven extremely beneficial for practices transitioning to telehealth, as evidenced in a recent conversation I had with David Elkin, MDiv, PhD, founder and executive director of the Center for Advancement of Youth at University of Mississippi Medical Center. Dr. Elkin pointed out that videoconferencing has also allowed mental health providers to maintain regular visits with patients, which has been especially critical given the immeasurable emotional stress many patients are experiencing during the pandemic, especially those in underserved communities.

Many healthcare providers weren’t as prepared, and they found the pivot to telehealth challenging. That’s why, in March, the Health and Human Services Office for Civil Rights loosened telehealth privacy restrictions to allow customer-facing platforms such as Zoom, Google Hangouts, and FaceTime to be used for telehealth visits. Enforcement of potential HIPAA penalties was suspended for healthcare providers using what the announcement called “everyday communications technologies” to serve patients during the pandemic. Additionally, the Centers for Medicare and Medicaid Services expanded services to include telehealth.

This opened up the opportunity for many doctors to start offering video visits and telehealth visits, and, during the last week of March 2020, telehealth appointments increased 154% compared to the same period in 2019. The Zooms of the world served as an appropriate, quick fix to an emergency situation, but they aren’t likely to be viable, long-term telehealth solutions.

The pandemic also exposed the outdated nature of many legacy solutions, like EHRs. Many EHR systems struggled to quickly digest and share new data with disparate systems, as healthcare organizations experienced a dramatic increase in daily patient visits. Given the many benefits of interoperability during a pandemic, the burdensome interop approaches of many EHR systems were never clearer.

The lesson: Many healthcare organizations are realizing that staying ahead of the tech curve is a necessity, and they will take the steps required to integrate innovation.

The path moving forward

The sudden adoption of technology served healthcare well during the pandemic, as it addressed an immediate need. However, long-term success requires a new approach for how innovation will make the patient’s role easier and more in line with the expectations of living in a digital world.

Expanding telehealth services should be a top priority, especially for providers with patients in underserved and rural communities. It’s also time to refine the patient and provider digital experience. Using the mental health example from earlier, Dr. Elkin points out that there are aspects of an in-person visit that don’t currently translate via video, such as subtle movements and gestures that can offer deeper insight into a patient’s feelings. Reexamining the areas where telehealth falls a little short can help create a richer experience for the patient and empower providers to provide the most comprehensive care possible.

This doesn’t mean that such decisions are easy or inexpensive. However, organizations must create an environment where the innovators (software developers) can easily build and deploy the tools required to enhance telehealth capabilities. If rolled out in the spirit of the regulation, the 21st Century Cures rules are a big step in this direction.

One area of innovation that healthcare providers should give great consideration to is artificial intelligence. While the initial deployment of AI in the provider workflow didn’t take off, robotic process automation (RPA) is showing promise at an administrative level, as hospitals and physician practices are trying to do more with less.

AI is generating revenue and cost savings by taking on tasks like scheduling, benefit discovery, invoice processing, vendor management, and other duties, to free up staff to concentrate on more patient-facing needs. But AI also has the potential for helping value-based care and cost sharing efforts by identifying what each patient costs an organization, then identifying ways to keep them engaged in their healthcare.

Though many healthcare providers have been slow to adopt innovative solutions, the industry has reached a turning point for change. The motivation to implement cutting-edge solutions has never been higher, and there are more creative minds than ever before, standing at the ready to arm providers with the tools necessary to improve care and reduce costs. This preparation and approach will help healthcare further navigate the pandemic and position the industry to make unprecedented progress once things are back to normal — whatever normal may look like.

Readers Write: AI and ML – Help Change the Course of the Pandemic and Make Money

AI and ML – Help Change the Course of the Pandemic and Make Money
By Jeremy Harper

Jeremy Harper, MBI is an independent consultant.

Twenty million people in the USA and 75 million people worldwide have tested positive for COVID-19. Public health estimates that six times more people have had the disease and are not aware. A vaccine will slow the rate of growth, but no one is expecting it to eradicate the virus as it mutates and adapts.

Even as we hit a year since the infections began, we know very little about the long-term consequences and impact for those who have had COVID-19. We are looking at how those impacts are different for people who have asymptomatic, symptomatic, or hospitalization issues. The problem is that research study after study has been released on small populations that are seen at local health systems. That information has been better than not sharing at all, but the small populations of patients at local sites have led us down directions that wasted time, effort, and energy.

The National COVID Cohort Collaborative (N3C) is the largest central data repository in the history of the NIH targeted to a single disease. It has over 400,000 records of patients who have been positively identified as being afflicted with COVID-19 out of 2.5 million patients total. Each week as they onboard additional academic medical centers, the patient population grows. This large initiative is supported by academic centers around the nation, bringing together some of the best healthcare minds to identify solutions.

A large national dataset of people who have had COVID-19, which we call a disease cohort, is required because it gives us the opportunity to pool data to create groups of people to reveal patterns and help people cope with long-term consequences of having the disease. This dataset, however, isn’t only useful for NIH-funded research. This dataset will also be transformational for health systems. Models can be quickly built and deployed to predict the business needs we are experiencing, and will experience, at health systems over the next years. Models that may not have captured intellectual property with this freely available resource, but cannot be implemented within the standard health system without experts to explain and deliver specific actions to take from the information and models that are built.

There is so much that we don’t know as we move forward in the healthcare domain with COVID-19, but we have opportunities to make a difference. We are moving beyond the local environments that only leverage standard Structured Query Language (SQL) to a future with large data lakes. Without such pooled data, we may take a decade to understand the extent of the problem and be able to ask questions across health systems to understand the issues. This centralization will allow us to research and implement within months instead of years after the initial data collection.

Even with the multiple vaccines, this disease state isn’t finished. People who have been immunized with the vaccine can still get the disease, though at lower rates. The natural evolution of the disease has been impacted by the changes we have made to our societies and interventions in which we have engaged. We may never fully understand or be able to model with accuracy where we would have been without what has been needed to control the impact, but we do have fantastic natural experiments to compare variables. We know so little today and we must test and implement interventions that have been held back.

Let’s take some examples from the problems that people face after having COVID-19, the three most commonly known long-term impact areas in the lungs, brain, and heart. These are problems that are waiting for ambitious business solutions. 

LUNG: You may know at a local health system how many people have experienced lung scarring, but you won’t have a large enough population to predict the interventions that will be required over the upcoming years. This population is large and diverse enough to have concrete predictions for what will be required.

BRAIN: We have no idea how the widely reported COVID brain impacts will play out, but it’s certainly going to require new interventions. Working with health systems in conjunction with the N3C may help us tease apart genetic, environmental, or disease specific areas that are vital for patient intervention. By being on the forefront for identification of those afflicted, we will be able to package and deliver opportunities to help individuals. Influenza and pneumonia vaccinations have been tied to lower risk of Alzheimer’s Dementia. There is a very real risk that we will see higher prevalence in the future, and monitoring and helping health systems will impact lives

HEART: We have entire hospitals dedicated to this vital organ. We know that myocarditis, which is an inflammation of the heart muscle, is occurring frequently in COVID-19 patients. This has the danger of leading to heart failure in the future. Patients will need to be flagged to be monitored for this going forward. Health systems will need to potentially reach out and notify patients that they need to be vetted for early symptoms of heart failure. As this grows and progresses, health systems will need to pivot to be able to handle the underlying disease states in their patient populations.

The healthcare industry is experiencing disruption as a result of these external forces that is unprecedented. Any time an industry experiences this level of disruption, it provides opportunities for improvement and adoption of third-party solutions. We have the ability to create many metrics, create many perspectives, and work through many issues. The N3C gives us many opportunities to connect and collaborate across organizations. While the N3C will not be appropriate to answer every question, it can answer many urgent scientific and operational questions through its different data access levels.

Examples of the types of questions that can be difficult to tackle include those that look for discrete answers, such as whether someone is asymptomatic or not. There are swaths of people who have been positive without any symptoms. While we can identify the primary cause of some hospital stays, we don’t have a consistent answer over whether someone came into the hospital because of COVID-19 or if they came because of another reason and happened to test positive. There is currently no universal standard to track the new vaccinations and which brand of vaccination may have been administered.

Than N3C has a higher potential for business to partner with research in an agile rapid manner than do most research infrastructures. The N3C team is a team of distributed participants, allowing for communication with the team in real time, while at the same time retaining full opportunity to query the data. The N3C team is also able to work dynamically upon normalizing and rationalizing what is being found within the database. Data can be created and archived in a single location for future analysis, and analysis within a team could provide a new way of communication for your business.

A combination of cloud computing, open data, and hosting ensures that your business can utilize the N3C Data Enclave. This cloud-based platform has taken research from an expensive system that we each need to implement into an inexpensive solution that we can all access. This is the new technology that has replaced outdated and slow research & development (R&D) methods.

It is the time to make it available for your business and your team. The solution ensures the business will eliminate the traditional costs and time associated with large, expensive research facilities. It allows business to do what it does best: rapidly innovate and leverage data to deploy solutions at facilities around the nation.

If you are interested in learning more, onboard to N3C or email me at owlhealthworks@gmail.com.

Readers Write: IT Leadership: An Essential Consideration for M&A+

IT Leadership: An Essential Consideration for M&A+
By Laura Kreofsky

Laura Kreofsky, MHA, MBA is vice president of advisory for Pivot Point Consulting, a Vaco Company, of Brentwood, TN.

Mergers and acquisitions (M&A) has been a blanket term for the massive industry consolidation in healthcare over the last several years. Challenging operating conditions and shrinking margins, the shifting regulatory landscape, and the move to value-based care have spurred provider organizations to acquire typically smaller systems, independent hospitals, or provider groups. It has also led healthcare organizations that don’t have the capital to acquire assets outright to craft arrangements and relationships that are less than full asset mergers offering more autonomy to both parties.

In 2021 and beyond, M&A models are not going to be binary. Joint ventures, affiliations, and countless innovative options will change the operational landscape of healthcare, creating what could be called M&A+. The industry is rapidly creating new organizational types and service models that are designed to meet healthcare’s dynamic challenges and opportunities. These new business structures will spur IT innovation and also introduce new complexity.

While traditional M&A activity can be incredibly complex, the technology side is straightforward in its execution, at least in theory. The basic model is that the acquiring partner migrates the acquired entity to their technology, systems, and processes over a defined period. The goal is to create one big, happy family. Like all blended families, there are always compromises, but there is some conformance in the end.

With joint ventures, affiliations, and other hybrids, often the relationships and technology strategies are far less definitive. Each side may seek to continue to use their technologies and processes to some extent. The two entities must then decide which systems and processes to use in the new partnership.

The result is often hybridization and harmonization that meets the needs of both sides equitably. In some cases, the goal is a minimum value product (MVP) that is “just enough” to meet the relationship’s needs. In other cases, the new partners will co-create solutions that far exceed either party’s capabilities individually.

IT has a critical role in system and process integrations to bring measurable value to the partnership. However, IT teams are repeatedly brought in late in M&A. Critical IT decisions often go unaddressed at the strategic level. The individuals making the decisions may lack deep health IT insight. IT is often left to determine how to execute, not innovate or optimize.

In the M&A+ world, IT leaders must be engaged early to support initial assessment and planning. They can offer guidance regarding the best approach to building the new entity’s technology ecosystem encompassing the infrastructure, software, and services driving greater value and speed to execution.

In the M&A+ era, healthcare consolidation agreements will be more diverse, data more valuable, and technology more critical and complex. IT leadership engagement in assessment, planning, and overall transaction execution will help organization be better positioned for success.

Readers Write: Technology: An Essential Element of Holistic Revenue Integrity Strategies for Future Sustainability

Technology: An Essential Element of Holistic Revenue Integrity Strategies for Future Sustainability
By Vasilios Nassiopoulos

Vasilios Nassiopoulos is vice-president of platform strategy and innovation with Hayes of Wellesley, MA.

Healthcare organizations are facing a perfect storm of financial challenges. US hospitals and health systems entered 2020 with razor-thin operational margins that were exacerbated by substantial and ongoing losses related to COVID-19.

Amid a dramatic drop in healthcare spending during the first quarter of 2020, financial executives found themselves with limited means for countering ongoing pandemic-related impacts, touching everything from supply chain costs to lost billing opportunities and compliance issues. Notably, the industry acknowledges that federal incentives related to the COVID-19 pandemic will not provide enough relief to surmount the far-reaching financial impact.

The heightened role of technology, especially as it relates to use of analytics to inform operational decision-making, proved a key differentiator for keeping many balance sheets in the black and stabilizing the bottom line. In contrast, manual efforts to audit claims and understand potential revenue cycle liabilities and bottlenecks left many organizations reacting to issues late, opening the door for cash flow problems that quickly spiraled out of control.

The advantages of using advanced technological frameworks to inform sound revenue integrity strategies should not be lost on today’s C-suite in their quest to a sustainable, profitable outlook. If healthcare organizations do not act now to proactively capitalize on all appropriate reimbursement opportunities as well as avoid future penalties from audits, the future stability of hospitals in communities across the nations is uncertain.

Progressive revenue integrity strategies bring together all billing and compliance functions in a collaborative way to address billing issues before claims leave an organization as well as via ongoing process improvement. Optimal programs consider:

• People, through cross-functional steering committees.
• Processes, by combining the strengths of both retrospective and prospective auditing.
• Metrics, through established performance-based goals.

Sound revenue integrity processes rely on technology-enabled workflows to speed identification of risks, perform targeted audits, identify and address root causes, and monitor the impact of process improvement tactics. When the right combination of automation, analytics, and artificial intelligence (AI) exist, billing and compliance teams can overcome the barriers of manual auditing processes to gain visibility into patterns and issues, which in turn inform process improvement and corrective action tactics.

Technology can be a game-changer when it comes to minimizing financial risk, improving revenue retention, and often identifying dollars that might otherwise be left on the table. Foundationally, data-driven infrastructures should be designed to promote shared monitoring and auditing processes between members of a revenue integrity team.

A framework of automation should support both continuous and proactive auditing (prospective) of claims before they are submitted and immediate and ongoing monitoring of delayed or denied claims (retrospective). Analytics tools can extract key charge and payment data to provide instant visibility into all prospective and retrospective data sources, eliminating the manual preparation time that often bogs down revenue integrity strategies.

Prospective auditing of claims for proper coding and clinical documentation minimizes denials by ensuring accurate, compliant submissions. Automation that supports ongoing monitoring and analytics can be a critical enabler of these processes in terms of staying abreast of updates and changes across payer reimbursement policies. They can also better enable risk-based auditing practices that prioritize an organization’s greatest risk areas.

For example, telehealth reimbursement has become an important driver of revenue over the past year, as healthcare organizations find ways to safely support care continuity. Advanced solutions that automatically release new ICD-10 codes and telehealth guidance streamline the ability of billing teams to operationalize changes and support ongoing monitoring.

When supported by automation and analytics, retrospective auditing speeds root cause analysis, ensuring rapid implementation of an optimal corrective action strategy to promote submission of clean claims. Analytics can be used to automatically generate key metrics around identified risk areas, allowing revenue integrity teams to benchmark against peers.

Use of advanced AI tools such as natural language processing can further elevate the strategies to improve management of a healthcare organization’s overall financial performance. These solutions can be used to track case mix index, elective surgery trends, and average lag days from denial resubmission to adjudication. Revenue integrity teams can analyze year-over-year and year-to-date trends for Medicare and commercial payers, detecting data anomalies and outliers that barriers to revenue integrity.

Use of AI can deliver a depth of understanding of denial attributes over large volumes of historical data that is typically a non-starter with manual processes. These systems learn from trends over time and can then, in turn, automatically apply identifiers or changes to future claims submitted to various payers. For example, denials related to medical necessity account to almost 10% of total denials. Identifying the root case and applying the necessary edits or process changes will prevent similar denials.

The value proposition of advanced tools, especially when integrated into a single platform, has increased over the past year as healthcare organizations try to maximize reimbursements to counter revenue shortfalls and rapidly changing regulations associated with COVID-19.

Readers Write: Prioritize the Patient Experience to Turn Short-Term Telehealth Solutions into Long-Term Ones

Prioritize the Patient Experience to Turn Short-Term Telehealth Solutions into Long-Term Ones
By Ray Costantini, MD, MBA

Ray Costantini, MD, MBA is co-founder and CEO of Bright.md of Portland, OR. This article recaps a recent video conversation he had with Ries Robinson, MD, SVP/chief innovation officer of Presbyterian Healthcare Services of Albuquerque, NM.

When the coronavirus first spread through the US, fears of exposure and lockdown mandates kept patients at home and forced providers to pivot almost exclusively to deliver care virtually. I don’t know of any health systems that navigated that process smoothly and easily, though for the healthcare systems that had already implemented a robust digital strategy, that transition was less painful than for others.

Systems rushed to implement telehealth tools, often repurposed consumer video platforms like Zoom, FaceTime, or Hangouts. This was a reasonable solution for the short term. But after more than seven months of quarantine, doctors and health systems are more comfortable using digital tools for care, and it’s clear that patients will use and expect virtual care options beyond the pandemic. 

So how does a system turn a short-term solution into a long-term one? By prioritizing the patient experience. Here are four ways you can use digital tools to support patients through their journey to receive care, beyond a quick implementation of video tools. 

Provide Free Online Screening

To keep both patients and healthcare workers safe by keeping as many people as possible out of high-contagion areas like the ER and urgent care clinics, one large healthcare system made a free, high-quality, online coronavirus-screening tool available to anyone in the state. Patients who showed potential COVID-19 symptoms or exposure would then be advised to take a test. Everyone else received guidance and education about the virus and any other steps they should take for self-care at home. 

At drive-through testing sites, there were billboards with a QR code that, when scanned, led patients to the online screener they could take while waiting in their cars. One executive at the system noticed many cars leaving the line. Assuming the patient had grown frustrated with the long wait, he approached a few cars to ask why they were leaving. Many of them said after taking the online exam and receiving feedback from a provider, they felt comfortable their symptoms were not COVID-related.

It’s a great example of using a digital tool ahead of an in-person appointment, providing real value for patients and minimizing any frustration for those who didn’t need to wait for a full test.

Bridge the Digital Divide

For some patients, connecting with healthcare providers via video was reassuring and convenient. For many others, though, the digital divide has only grown larger during the pandemic. 

When a healthcare system we work with found that 30% of their patient population was unable to conduct a video visit due to a lack of hardware, bandwidth, affordability, comfort with tech, or language barriers, they implemented digital tools that allowed them to more easily access care. Today, patients need as little as a 3G network connection and can conduct their healthcare interview in Spanish or English.

Ensuring equitable access to virtual care is critical for a successful long-term implementation of digital tools. 

Understand what Patients Want

If 2020 was the year of virtual care, then 2021 will be the year of the patient experience. As the coronavirus crisis changed everyone’s lifestyle and habits, new direct-to-consumer competitors gained traction, and in many cases, the convenience exceeded patient expectations. Health systems are increasingly aware of the need to retain their patients, and re-engage those who they’ve lost to these digitally forward, new-entrant competitors.

The good news for healthcare systems is that patients still trust their own doctor over retail medicine or big tech. As one chief innovation officer at a large health system told me, “If you’re in the business of delivering on patient satisfaction and high-quality care, you’re in a better position of fighting off the competition.”

For the long term, offer care when and how your patients want it: immediately, online, and for not too much money.

Help Providers Focus on Patients

It’s not news that healthcare workers have been severely impacted by the pandemic, whether they are in an ER in a COVID hotspot or struggling to manage a household while delivering care remotely. The stress has led to early retirements and leaves of absence, compounding an already severe physician resource shortage.

Healthcare systems that have managed the crisis well have used digital tools to create elasticity for their providers, giving clinicians more control over their time and from where they can deliver care. Virtual care delivery solutions that automate administrative tasks can also reduce the amount of time it takes to deliver care, so clinicians can help you prioritize the patient experience, instead of focusing on the technology of an appointment. 

It sounds counterintuitive, but a thoughtful implementation of digital tools humanizes healthcare: letting computers or software do the tasks that require repetition, precision, and consistency so that humans are free to do what we’re good at: critical thinking, problem solving, listening patiently, and responding compassionately.

Readers Write: TechQuity: Influencing Health Literacy, Equity, and Disparities in Spanish-Speaking Communities

TechQuity: Influencing Health Literacy, Equity, and Disparities in Spanish-Speaking Communities
By Alejandro Gutierrez, MPH

Alejandro Gutierrez, MPH is team lead, customer success at Activate Care of Boston, MA.

If Hispanics in the United States were a country, they would be the second-largest Spanish-speaking country in the world, and with $1.5 trillion in buying power, the 15th largest consumer economy in the world. According to the latest US Census data, last year marked the first year that more than half of the nation’s population under the age of 16 identified as a racial or ethnic minority. Among this group, Latino or Hispanic and Black residents together comprise nearly 40% of the population. 

The nation is diversifying faster than ever, and Latino and Hispanic communities are at the forefront. Yet we know that language barriers to accessing essential health and social services exist for all non-English speaking populations.

Recently, a study of nearly 20,000 inpatient admissions revealed patients who requested an interpreter were granted access to one only 4% of the time, and that is just for inpatient hospital care. Imagine the situation for outpatient care and social services. As a nation and healthcare system, we must do better. 

These language barriers have a negative impact on the health and well-being of the Hispanic community. Hispanic women contract cervical cancer at twice the rate of white women. Hispanics are more likely to be diagnosed with diabetes and are twice as likely to die of the disease compared to non-Hispanic whites. The stats go on. The outcomes continue. Physicians are less likely to detect depression in Hispanics, and Hispanics are 50% less likely to receive mental health treatment or counseling.

How can the healthcare system work to fix these issues? For starters, with the use of technology, healthcare providers can improve language equity. That will enable the Hispanic patient populations to become part of the majority receiving quality health and social services. 

As a member of the Hispanic community and a current member of a company working to identify SDOH (social determinants of health) in at-risk patients and provide proper care, I understand how complicated navigating healthcare systems can be for native Spanish speakers. I chose to go into public health because of my experience working and living in St. Louis, Missouri. I worked for a non-profit called Athletic Scholars Academy that ran school-based programs in under-resourced communities to promote healthy eating, physical activity, and academic achievement.

For those four years of my life, I listened to the everyday experiences of students, parents, teachers, administrators, and other school community members and learned more than I ever could in a classroom. I was regularly reminded that so many communities around the US do not have access to resources or opportunities for people to be mentally, physically, socially, and economically healthy. I learned that these differences in health are avoidable and are rooted in injustices that disproportionately affect Black and Latino communities. Working to address these avoidable differences in health became my “why” in public health.

My father is Colombian, but grew up in Spain. My mother is Indian, but grew up in Kenya. I am half Indian and half Colombian. My parents were first-generation immigrants when they came to the United States as college students and have been here ever since.

I am a first-generation American, but hearing from my parents and grandparents about the inequities in Kenya, Colombia, and India, I could draw parallels to the inequities – avoidable differences in distribution of resources and opportunities – that disproportionately affect Blacks and Latinos in America. This further reinforces why I wanted to get involved in public health. I continue to use the privilege I have been given from my grandparents and parents to do more to address health inequities in the US.

One of the first things I am lucky to have is my ability to understand and speak Spanish fluently. With that ability, I can help one of the biggest barriers Latinos face. Speaking to Spanish speakers in their native language is the first step in showing Latinos that we in the healthcare industry understand and care about them.  

As a millennial, I see the power that technology can provide in the public health space. We know that many issues of health equity are often embedded in the disconnections between healthcare and social services. Technology can offer a new chance to connect these services across the continuum of care, and can provide a more efficient and secure way of sharing and communicating information across teams that are often disconnected.

Communities across the country are taking ownership of their own abilities to exchange data across sectors. This includes healthcare, but expanding the network to include social services, behavioral / mental health services, schools, jails and courts, government agencies, managed care organizations, and more. These vanguard communities recognize that it is not enough to simply refer individuals back and forth amongst their various organizations; they have to share in the work of the interventions. Screen-and-refer approaches simply move problems from one place to the next. Screen-and-intervene approaches – built around community information exchange, care coordination, and data-driven quality improvement – are key to reducing health disparities, improving health literacy in vulnerable populations, and achieving the health outcomes we all want to see.

Readers Write: Technology Augmented by Behavioral Science Theory Leads to Improved Health

Technology Augmented by Behavioral Science Theory Leads to Improved Health
By Rhea Sheth

Rhea Sheth is a clinical and marketing intern at Carium and an undergraduate student at the University of California, Berkeley studying integrative human biology.

Behavioral science is the study of human behavior. It asks the question: why do we act the way that we do? The simplicity of this question masks a complex science that underlies it.

Understanding human behavior has many invaluable applications in our society. If we can better understand human behavior, we can shape our policies in a way that will better engage individuals or present public health information in a way that will lead to an increased compliance rate.

The intersection of behavioral science and technology is an area of huge opportunity. With the rise of technology, there has also been a rise in the number of opportunities to move healthcare away from a fee-for-service model and instead move towards a value-based approach. The incorporation of behavioral science theory into mobile health platforms can help facilitate the movement towards more patient-centric care and improved health outcomes.

Research-backed behavior change techniques should be intentionally incorporated in digital health platforms to help individuals manage chronic disease. Influencing behavior change in chronically-ill patients is a crucial public health intervention. According to the CDC, 6 in 10 adults in the US have a chronic disease and 4 in 10 adults in the US have two or more chronic diseases.

Smartphone apps are a convenient, cost-effective way to provide behavioral interventions at the appropriate times. In addition, they help reduce healthcare disparities by increasing reach to populations who were previously unreachable due to demographic, socioeconomic, and geographic barriers.

Behavior change techniques can be woven into virtual healthcare tools to help users identify and manage negative behaviors that may be contributing to worsened health outcomes. Self-monitoring is one of the techniques that enable this type of positive behavior change and has been found to lead to reduced hospitalization and readmission rates.

In the context of healthcare, this includes tracking metrics indicative of health-related behaviors such as calories eaten, weight change, and blood pressure levels, often collected through devices such as wearables and fitness trackers. Through digital health platforms, users can track their desired metrics in which they can also see short-term and long-term trends in their health data. This data can be shared with care teams and providers can then keep track of their patients’ health metrics through remote patient monitoring (RPM).

According to the American Heart Association, through RPM, providers can obtain a more holistic view of the patient’s health through data, gain insight into a patient’s adherence to treatment, and develop a deeper patient-provider relationship. RPM can also help reduce healthcare costs by enabling timely health interventions before a patient’s health deteriorates to the point of requiring a costly procedure.

Before the rise of mobile health, self-monitoring was done primarily through paper journal methods, where participants would manually record entries such as calories eaten, blood pressure readings, and blood sugar levels. With recent advances in mobile technology, there are opportunities for more convenient, real-time self-monitoring. Rather than having to carry around a bulky paper journal, individuals can simply enter their data into a mobile device and see their short- and long-term trends.

For an individual with diabetes, taking a daily measurement of blood sugar can help increase awareness about their positive or potentially harmful behaviors. Seeing a huge spike in blood sugar one morning can cause the individual to, first of all, be aware that there is a change in their health, and then reflect on what actions could have caused that. They might remember that they ate three fudge sundaes last night and did not go on their daily walk. The question is, are they now likely to change their behavior?

Here’s where behavioral science comes in again. The act of self-monitoring has increased the probability of behavior change by making the individual aware that there is a change in their health. However, the act of self-monitoring does not guarantee that someone will change their behavior. The next day, the individual may have a craving for ice cream and engage in harmful behavior again.

While they may be aware now that eating ice cream is affecting their blood sugar in such a drastic manner, there may be other underlying factors that cause the individual to perpetuate a negative behavior. It may be that the individual does not understand the consequences of having high blood sugar because they haven’t received information regarding its risks. It may be that they are lonely and feel like no one cares about their health because they do not have frequent access to a healthcare professional. Or, it may be that the individual has a goal of reducing blood sugar but does not know how to achieve that goal and thus becomes demotivated.

To help mitigate the risk of perpetuated negative actions, mHealth apps can integrate different behavior change techniques with self-monitoring to enhance user engagement and increase the probability of behavior change, such as secure messaging and educational materials. Secure messaging is one way for providers and patients to interact and strengthen their relationship, and learning materials such as diabetes-self management education also help improve health outcomes.

Studies show that self-monitoring is more effective in improving health outcomes when used in conjunction with other behavior change techniques in this manner. Self-monitoring was also found to lead to reduced hospitalization and readmission rates.

Making sure technology caters to the complexity of a human being is imperative. Behavior change techniques help us do that. There is no one-size-fits-all solution for behavior change, but intentionally designing technology based on research-backed behavior change techniques has been shown to improve health outcomes. In this way, we make movement away from episodic transactional healthcare and instead towards mutually beneficial, patient-centered, and holistic healthcare.

Much like having a trainer at the gym can motivate people to reach their fitness goals and feel stronger, more confident, and successful, having a digital health platform with specific behavior techniques such as self-monitoring, health coaching, prompts / reminders to take medication, and motivational messages can help patients achieve their health goals.

Readers Write: Remember the Opioid Crisis?

Remember the Opioid Crisis?
By  Peter J. Plantes, MD

Peter J. Plantes, MD is physician executive with HC1 of Indianapolis, IN.

The last few years have ushered in significant progress on the opioid crisis containment front. Acknowledging decades-long misinformation shortfalls, negligence, and improper prescribing patterns, the healthcare industry took important steps on national and state levels to get out in front of devastating statistics.

A March 2020 report suggested the needle was finally pointing in the right direction. The Centers for Disease Control and Prevention (CDC) reported a 13.5% decrease in opioid overdose deaths from 2017 to 2018.

Unfortunately, that report was quickly overshadowed by the global pandemic that brought the nation to its knees. Opioid misuse, like many other critical healthcare priorities, took a back seat to COVID-19. The fallout is notable. A recent analysis points to a spike in opioid overdose cases by 18% since the start of the pandemic.

It’s not just overdose rates that have many across the industry concerned about the current state of the opioid epidemic. Public health officials also report a surge in relapse rates due to limited access to treatment.

The reality is that 2020 has delivered a perfect storm of factors that are contributing to a problematic front for opioid misuse, including mass unemployment and the isolation created by stay-at-home orders that interrupted existing care plans and contributed to an increase in mental health issues. In addition, studies reveal that opioid prescription rates for procedures such as hip and knee replacements continue to rise. Prescription rule changes aimed at helping patients during the pandemic may also have had negative effects by opening the door to increased fraud and “doctor shopping.”

Amid alarming trends, today’s providers face a complicated front at the intersection of increased addiction and appropriate opioid prescribing. Within what is now a highly regulated framework, healthcare organizations must ensure that they are optimizing patient safety by following prescribing guidelines and adhering to ongoing monitoring processes to detect misuse.

This is especially true for patients covered under a population management program of health insurance (ACOs, Medicare Advantage, and HMOs.) Neglecting this opioid substance abuse patient population can result in poor financial performance as well as regulatory scrutiny. NCQA issued additional opioid abuse management measures that are required to be reported as part of HEDIS 2020 standards. These will encourage both:

• Timely “Follow-up After High-Intensity Care for Substance Use Disorder” (FUI), and
• Sustaining “Pharmacotherapy for Opioid Use Disorder” (POD) patients.

In late 2020 and heading into 2021, there is much at stake with the opioid crisis. Healthcare organizations should reprioritize efforts now and increase their engagement to get the opioid trajectory moving in the right direction. It will not be easy, as accessing the right data and complying with guidance remains complex for the average resource-strapped provider.

At a minimum, healthcare organizations need to address the problem by:

1. Taking into account the public health emergency declared by HHS Secretary Alex Azar. This move on January 31, 2020 subsequently lead to the March 18, 2020 clarification from the US Department of Justice Drug Enforcement Agency (DEA) that healthcare professionals can now prescribe a controlled substance to a patient using telehealth technology.
2. Improving leadership through opioid stewardship committees. The Joint Commission mandated that all healthcare facilities implement leadership teams and performance improvement processes in 2018 to address safe opioid prescribing. Opioid stewardship committees can advance best practices by identifying existing gaps and implementing processes that meet best-practice guidelines that include risk assessment, using state implemented Prescription Drug Monitoring Program (PDMP) data, laboratory testing, and patient education. 
3. Conducting optimal patient risk assessments, monitoring, and education. Comprehensive risk assessments seek answers to the following questions: 1) Was a patient assessed for potential risk of misuse prior to a procedure or prescription? 2) Did the provider and patient have an open and honest discussion about whether opioids were the right choice? 3) Did a patient receive monitoring during follow-up care to ensure appropriate use of opioids? 4) Was a patient counseled on proper procedures for disposing unused opioids? These risk assessment standards should especially be part of telehealth-based opioid prescribing.
4. Accessing the right data in the most efficient way possible. Access to PDMP data is a critical first step, but it doesn’t always provide the full picture, especially in cases where patients are doctor-shopping across state lines. Healthcare organizations can extend the value of this data by combining it with dispensing records from multiple states and intelligent drug consistency assessment via laboratory testing to support precision prescribing.

Smart prescribing and oversight of opioid risk is more important than ever, as is equipping providers with easy access to the right patient data for monitoring. Technology that efficiently brings together the right data and delivers it in an actionable way to providers is improving this outlook. Technology that does not hinder the doctor-patient encounter is especially important for effective delivery of safe opioid prescribing practices. The technology must assist the physician in rapidly and completely engaging all required regulatory expectations without creating an administrative bottleneck in the daily practice setting.

Readers Write: Debunking Price Transparency Myths to Enable True Progress

Debunking Price Transparency Myths to Enable True Progress
By Kyle Raffaniello

Kyle Raffaniello, MSHA is CEO of Sapphire Digital of Lyndhurst, NJ.

For years now, the US has had the highest healthcare costs in the world. While high medical costs are nothing new, these costs, in combination with the financial impact of the COVID-19 pandemic, could turn healthcare from unaffordable to unattainable for many Americans. Now more than ever, we must kick the nation’s price transparency conversations into overdrive to increase industry competition and lower the cost of care.

Increasing price transparency in healthcare is not a new goal by any means. The term has been used for years to not much avail, but has gained headlines in recent months because the Trump administration is making it a health policy focus and has announced multiple rules aimed at increasing transparency. However, confusion and uncertainty still linger around what transparency truly means for healthcare and whether it really works.

The truth is that it’s the foundation to making healthcare more affordable for Americans. Unfortunately, several common transparency myths muddy the waters for all:

Myth #1: Transparency Doesn’t Work

Transparency not only works, it is essential to lowering healthcare prices in our country and saving money for consumers and employers. For example, a hospital in Kentucky recently heard about the success Kentucky Employee Health Plan (KEHP) was having helping members find cost-effective facilities for their care when they used digital shopping solutions. Now the hospital wants to lower its prices and be more competitive in order to keep local business, as consumers had been going to get procedures done at more cost-effective facilities. Market forces will compel high-cost facilities to lower their prices to compete.

Myth #2: Cost Equates to Quality

An age-old adage, cost equating to quality, is simply not true when it comes to healthcare. Through the use of the right digital shopping tools, consumers can compare cost options and quality to find and select low-cost facilities that have high marks on quality, equating to high-value care. It’s time we all understand that quality doesn’t need to be compromised for cost or vice versa – this isn’t an either-or scenario.

Myth #3: Industry Stakeholders Don’t Want to Support Transparency

A common misconception is that not everyone in healthcare supports transparency because it’s not in their best interest. The truth is that most industry stakeholders do support transparency — they simply have differing views on how to achieve it. We must accept that different parts of the industry have different viewpoints when it comes to strategy and focus on the ways we can come together to achieve the common goal.

A recent survey found that nearly half (47%) of Americans age 18-64 surveyed are more concerned about the cost of healthcare now than they were before COVID-19. That same percentage of people also said they plan to change how they access care as part of our “new normal.” It’s clear that consumers want to shop for care and the market wants to increase transparency. In order to align stakeholders and ignite change in healthcare, companies in the transparency space must educate consumers about the right tools, support, and information to compare care options and engage the consumer in actively shopping for that care.

When we talk about the right information, this goes well beyond publishing a list of prices for procedures online, as these lists are not true to what patients will pay out of pocket. True transparency involves digital shopping platforms that can present consumers with a look at how much they will individually owe based on their insurance provider and individual health plan. Additionally, the listing of prices does not provide insight into the quality of care at a particular hospital or medical facility.

Digital tools will include the important qualitative information consumers can’t get elsewhere to ensure they’re not only choosing low-cost care, but high-quality care as well. Offering incentives to help consumers go beyond their research and actively shop for their procedures is important, too. Some digital shopping tools offer cash rewards, as a share of the savings, for consumers who choose high-value care.

Everyone needs and deserves access to low-cost, high-quality care, and we need to work together as an industry to make that happen. Through raising awareness of these tools, more consumers will become empowered and incentivized to use them, ultimately making more informed and confident decisions about their care. Additionally, there will be healthy competition among hospitals and medical facilities in the industry, driving down costs for the entire healthcare ecosystem.

The need for robust transparency that presents an easy healthcare shopping and comparison experience for consumers has never been more important following the impacts from COVID-19. As facilities reopen and begin rescheduling appointments, we must put the pedal to the metal and bring true transparency to the healthcare industry. Transparency is no longer an option, but a necessity for the livelihood of the industry and the consumers who power it.

Readers Write: Food for Thought About Apple and Google COVID-Tracing Technology

Food for Thought About Apple and Google COVID-Tracing Technology
By Robin Cavanaugh

Robin Cavanaugh is chief technology officer of GetWellNetwork of Bethesda, MD.

The recent announcement by Apple and Google to move to the next phase of their contact tracing initiative is a positive step for both the general public as well as application developers and data users. Any effort to embed this type of capability directly into the OS of the mobile device — versus relying on a user locating, downloading, and registering an application — will result in a massive increase in the adoption rate of contact tracing. Further, lowering barriers to data exchange will likely have a positive effect on data collection and, in turn, help halt the transmission of current (or future) infections.

Contact tracing in countries like ours, where privacy cannot easily be bypassed by our government, is complicated for those wanting it and suspect for those who are being traced. Tracking and tracing, while preserving anonymity, require carefully architected controls and the lulling of a wary “what’s in it for me” public by extolling the virtues of these large datasets in a way that will clearly benefit them.

The initial phase of this contact tracing API, at least for Apple, was limited to government health organizations or developers who have been endorsed and approved by a government health organization. This was done to ensure the security and privacy of the data collected through this protocol. 

Having just come from a visit to the state of Vermont for a college drop-off, I was witness to the low-tech solution implemented as an alternative to this technology, which was in place at every eating establishment we visited: “Hi, before we can serve you, please fill out your name, email address, and cell phone number on this piece of paper.”

Can I trust this kid earning minimum wage to safely process, store, and dispose of my personal information? Would I like fries with the spam I am undoubtedly going to receive as a result of this disclosure? Which of my enemies’ contact info should I use instead of my own? 

These and many other questions caused me to wonder whether my privacy was worth the “world’s best double bacon cheeseburger?” I could imagine instead that this paper was collected by the staff and likely put in a large pile somewhere for later use. I had serious doubts that this information would be entered into any kind of searchable, accessible database, or that I would actually be notified should one of the many diners in this restaurant present with COVID-19 symptoms. 

Manual processes such as these pose a significant privacy and security concern for all participants. Traceability and accountability for entities like Apple and Google that are collecting this data are critical to gaining the trust of the people, and to avoiding a tremendous amount of manual effort and false data. Instead, embedding this capability ubiquitously in the cell phone of every user with little or no action required by them to support it — coupled with a modicum of additional trust in those entities over an unregulated and ad-hoc process — will be a boon to the entire operation. Leveraging the contact tracing protocol as implemented by Apple and Google would be a significant improvement in a number of ways, including security, expediency, accuracy, and convenience.

As the need for this data evolves, and it can be safely and securely exchanged and leveraged by other organizations and entities, there are hundreds of uses that could be derived. As it relates to this pandemic, we could use the determined potential exposure not only as a data point, but as a trigger to educate people on what to do with this new realization that they could have been exposed. 

We could help mobilize a user’s support and care circle to help ensure that they are following the required protocols. We could predict other likely exposure, not dissimilar to the “Six Degrees of Kevin Bacon” phenomenon, and arm users with means of notifying their community to help keep them safe. The data could be used to get ahead of the transmission model and help with deployment of PPE or planning for spikes in testing or visits to health centers or providers. 

Certainly Apple and Google and others will need to ensure that the appropriate privacy controls are in place to avoid misuse of this information, but this is an important next step in the process. In short, more data, collected with greater ease across a wider base, can only lead to better outcomes.

Readers Write: Five Strategies to Ensure Cybersecurity During COVID-19 And Beyond

Five Strategies to Ensure Cybersecurity During COVID-19 And Beyond
By Patrick Yee

Patrick Yee is chief technology officer of Ensocare of Omaha, NE.

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To quote New Zealand-born novelist and playwright Anthony McCarten, “We’re living in extraordinary times.” To which I’ll personally add, “that call for extraordinary security measures.”

In March, the Office for Civil Rights (OCR) at the US Department of Health and Human Services (HHS) issued COVID-19 HIPAA waivers to promote data sharing and telehealth, relaxing laws over the good faith use and disclosures of protected health information (PHI). The resulting explosion of COVID-19 demonstrates that providers need fast access to tools that identify, collect, track, and exchange data on the flux of infected patients.

Protecting the privacy and security of patient data is the health IT industry’s fundamental civic duty during a nationwide public health crisis. While a hospital’s core competency has never been and will never be information technology (IT), taking care of patients is.

As providers rightfully focus on saving lives, their IT teams have undergone a massive shift to working from home while tackling first-time coronavirus related challenges and juggling data security maintenance. Compounding the situation are short-staffed medical facilities where IT resources are needed the most.

Here are five strategies to help you protect and secure your organization’s patient data and network from cyber attacks.

Make sure your escalation procedures are sound.

A healthcare worker who spots a questionable issue must be free to report their concern so it can be addressed swiftly. Most every IT department has in place a reporting process, either a formal ticketing system or an on-call employee who accepts phone calls. Once the IT staffer quickly escalates the issue to the appropriate leader or medical professional, the healthcare worker can resume their day job. Whether the issues involve coronavirus or basic security breaches, e.g., an email phishing attack from an unfamiliar source, all team members, even those on the clinical side, should be empowered to bring up potential dangers to the appropriate parties.

Instruct your IT team to be extra diligent investigating unknown emails, links, and websites.

Cyberattacks targeting hospitals, practices, and healthcare organizations are on the rise dramatically, which can be at least partially be attributed to the exploitation of the coronavirus.

Unfortunately, remote workers are also being singled out. A recent McAfee report uncovered a correlation between the increased use of cloud services and collaboration tools during the COVID-19 pandemic, along with an increase in cyberattacks targeting the cloud. External attacks on cloud accounts grew 630% from January to April. Cisco WebEx, Zoom, Microsoft Teams, and Slack saw an increase of up to 600% in usage over the same period.

Healthcare staff members working remotely are more vulnerable and understandably distracted supporting COVID-19 patient care, which could make them easy prey for cybercriminals. The pandemic represents a huge opportunity for bad actors to compromise your systems with things like phishing emails that include faulty links and websites, ransomware attacks, and intrusions on sensitive data. Regularly remind your remote workforce to report suspicious activities by following your organization’s security protocols.

Review your intrusion detection strategy (IDS) or continue to monitor if you already have one.

An IDS is a network security technology that was originally built for detecting vulnerability exploits against a target application or computer. Intrusion prevention systems (IPS) add the ability to block threats in addition to detecting them, and have become the dominant deployment option for IDS technologies. More broadly, think of intrusion protection as personal computer security, but in a format that can look between different servers and flag suspicious activity. You should be reviewing and updating your technology and strategy regularly to ensure that you’ve kept up with all applicable best practices.

Ensure that your remote employees have corporate VPN and two-factor authentication services.

This telework protocol should already be part of your business continuity plan. It should be reviewed and updated periodically to ensure traffic is handled securely.

Home internet networks simply are not as secure as your office network. VPN and two-factor authentication services are recommended for remote connection to support the goal of making remote work as seamless as possible. Be aware that, short of completing mission-critical projects, at-home internet outages will not necessarily cause a security issue. A larger issue is whether the remote worker has the right modem installed to handle many different in-home users.

Encourage employees to use corporate laptops with encrypted hard drives that are not shared with family members.

Keep doing all of the good things you were doing before the pandemic.

Everything in your systems security plan is still valid with some possible changes for critical business continuity that should be maintained and exercised. HIPAA compliance might be relaxed, but security protocols remain doubly important in our current health crisis.

Readers Write: CMS’s E-Notifications Condition of Participation: Three Topics to Know

CMS’s E-Notifications Condition of Participation: Three Topics to Know
By Jay Desai

Jay Desai, MBA is CEO and co-founder of PatientPing of Boston, MA.

In March 2020, the Centers for Medicare and Medicaid Services (CMS) finalized the new Interoperability and Patient Access Rule, which creates a new Condition of Participation (CoP) that requires hospitals, psychiatric hospitals, and Critical Access Hospitals to share electronic Admission, Discharge, Transfer (ADT) based event notifications (e-notifications) with other providers across the continuum of care whenever patients have inpatient or emergency department care events.

To help these organizations prepare for the e-notifications CoP, a recent hospital executive survey was conducted to gauge industry awareness about the regulation (the survey results can be found in an online e-book called “The Route to Compliance. A Simplified Pathway”). Responses from hospital CIOs and compliance executives collected through dozens of conversations, virtual focus groups, and webinars revealed three key areas that need more awareness.

#1: The Requirements

According to the survey, which was conducted in May and June of 2020, just 17% of hospital CIOs or compliance personnel are familiar with the e-notifications CoP. The goal of the new CoP is to increase information sharing across the care continuum as a way to enable better care coordination leading to improved patient outcomes. This compliance requirement will go into effect on May 1, 2021 and adds to the list of CoPs hospitals must fulfill to successfully maintain their CMS provider agreement and certification. The fact that CMS used its most consequential regulatory lever, a CoP, to create the new e-notification requirement underscores the importance the agency places on increasing provider access to needed information.

Hospitals should answer how they or their third party intermediary solution will comply with the following requirements:

• Identify and send e-notifications to post-acutes.
• Meet cross-regional provider notification needs.
• Ensure appropriate data sharing rights, security, and trust.
• Send notifications in real time.
• Manage continuous provider-patient relationship changes.
• Demonstrate compliance to meet survey requirements.
• Ensure community-based providers have excellent user experience.
• Meet compliance by the May 1, 2021 deadline.

#2: Provider-Requested Notifications

This topic is particularly important to health systems with large provider and post-acute referral networks. Hospitals must send e-notifications to community-based providers that have established care relationships with patients and that need the information for treatment, care coordination, or quality improvement activities. This includes primary care practitioners, Federally Qualified Health Centers, Accountable Care Organizations, other entities identified by the patient as primarily responsible for their care, and post-acute providers (skilled nursing facilities, home health agencies, etc.). Identifying which providers have established care relationships is critical and requires that hospitals, or their intermediary, possess two foundational capabilities:

• Ability to collect patient-identified provider information at the point of care.
• Ability to obtain care relationship information from providers through a patient roster and notification request process.

The first capability allows hospitals to determine any providers with whom the patient wants their information shared by giving patients the ability to identify providers at the point of care. The second capability allows hospitals or intermediaries to determine any additional practitioners, groups / entities, or post-acutes that need to receive notifications for treatment, care coordination, or quality improvement activities. The roster and notification request process allows providers to identify their care relationships through rosters, e.g. patient panels or census lists, and receive e-notifications based on hospital care events that match to patients on those rosters. Having both of these capabilities gives hospitals the ability to determine the required providers that need notifications thereby eliminating e-notification gaps that would lead to non-compliance.

#3: Health Information Exchanges (HIEs) as Intermediaries

Hospitals have the option to use an intermediary, such as an HIE or vendor, to fulfill the e-notification function under this CoP. In the survey cited above, 60% of respondents familiar with the rule somewhat agree with the statement, “that their local HIE will ensure 100% compliance with the CoP.” Just 17% fully agreed with that statement. Given that HIE capabilities vary widely by state and region, compliance will depend on whether the HIE can fulfill the minimum requirements specified within the final rule. Those requirements include:

• Event types and timing. Notifications must be sent at the time of patients’ inpatient admission, discharge, and transfer and at emergency department presentation and discharge.
• Notifications recipients. Established PCPs, practice groups / entities, and post-acutes irrespective of geographic location that request notifications for treatment care coordination, or quality improvement activities.Practitioners, practice groups / entities, and post-acutes irrespective of geographic location that are identified directly by patients as primarily responsible for their care.
• Notifications content. Notifications must include, at minimum, patient name, treating practitioner name, and sending institution name.

Notifications also need to be sent in accordance with patients’ privacy preferences and applicable federal and state laws and regulations. Additionally, to minimize security incidents and inaccurate notifications, a high accuracy match rate is needed to ensure notifications are sent to appropriate providers. Ultimately, hospitals are accountable to meet compliance requirements even when e-notification functions are delegated and they should therefore ensure all minimum compliance requirements are met.

Given the significance of the new e-notifications CoP, hospitals should take time to carefully assess and validate internal or third-party capabilities against the new requirements to ensure they can meet compliance by May 1, 2021. With the proper solutions in place, hospitals can share real-time patient data with other community providers to support treatment and care coordination efforts, bolster value-based care initiatives, and, most important, improve health outcomes for patients while achieving e-notifications CoP compliance.

Readers Write: Achieving True Interoperability Transparency May Depend on Adopting a National Patient Identifier System

Achieving True Interoperability Transparency May Depend on Adopting a National Patient Identifier System
By Kevin Hutchinson

Kevin Hutchinson is CEO of Apervita of Chicago, IL.

Let me say one thing right out the gate: I am typically not a fan of forcing industry-wide uniformity via burdensome and overly instructive government mandates. However, sometimes there’s too much at stake in healthcare and the private sector just can’t agree on standards on their own. So was the case with e-prescribing over 15 years ago, and so is the case now with interoperability.

When I was founding CEO for Surescripts and before I was a member of the inaugural ONC-created National Health Information Technology Standards Committee, it was hard to get stakeholders to agree on standards, as the EHR industry was generally slow to adopt anything. However, after we created the initial standards for e-prescribing via the National Council for Prescription Drug Programs (NCPDP), set firm deadlines, and CMS tied e-prescribing to MIPPA incentives, the different factions within the healthcare industry (all of whom had different agendas) came together and abided by a system that largely still works today.

So it makes sense for CMS and ONC to impose strict mandates and timelines — albeit with some COVID-caused relaxation — for interoperability compliance, because the fragmentation of health records is as dangerous as it has ever been to patients. But while each deadline moves us closer to a more integrated and transparent system, it’s not until the payer-to-payer interoperability deadline in January 2022 where we’ll finally be in our best position to eliminate costly problems created by siloed health data. We may finally see some health record consolidation.

However, like all kinds of sweeping reforms, the devil is in the details. I believe that it might not be as “successful” as we expect it to be unless the federal government steps up and mandates a national patient identifier (NPI) system.

Just because one’s health insurer is sharing data with their previous insurer doesn’t ensure a holistic record. It’s not outlandish to think that any American could have up to 10 different health insurers over their lifetime, especially given rising health costs, socioeconomic inequities, and an increasingly volatile job landscape. That’s 10 different organizations with 10 different technology infrastructures, data protocols, and health IT standards. Not to mention the complexity of a patient’s health record strewn across multiple EHR systems, that change over time, as well as patients changing doctors creating new patient chart IDs and no standardized format for those patient chart IDs.

Who is responsible for making sure IDs match up? Who is responsible for identifying potential health record duplication errors? These are small data nuances that can have life-or-death consequences.

I can tell you first hand that even after national standardization, there have been instances in e-prescribing when records for John Doe I were assumed to be a part of John Doe II’s record, which could have resulted in life-threatening medical errors if not caught and corrected. NPIs would make life easier and safer for patients, payers, and providers, but yet they still aren’t part of the interoperability equation.

The NPI debate isn’t new. In fact, it’s been around for more than 20 years. But it seems like now we may actually be moving in the right direction. Late last year, representatives from many NPI-supporting organizations signed on to a letter urging Congress to take action, arguing, “The absence of a consistent approach to accurately identifying patients has also resulted in significant costs to hospitals, health systems, physician practices, long-term post-acute care (LTPAC) facilities, and other providers, as well as hindered efforts to facilitate health information exchange.” As a result, the House of Representatives voted to remove the ban on funding NPI organizations.

As for payers, some would likely argue that NPIs would help them as well. Many within the payer community think NPIs could improve member safety, reduce overutilization and fraud, and help them understand how members performed in previous payer’s quality-based programs.

However, NPI opponents will often counter with concerns over privacy and security, higher costs, and serious medical errors due to human error. The costs, they argue, would be incurred from building a new IT system from scratch while also having to align on policies and standards to govern it. To that argument, I would just remind critics that there have already been huge costs incurred because we haven’t achieved full interoperability yet, and then ask them to imagine the wasted money if all current mandates and compliance initiatives ended up not solving the core problems.

As for the medical errors argument, fragmented health records are much more dangerous. Again, I don’t think we can be as successful with interoperability without an NPI system.

But it’s that last and most prevalent argument on privacy and security that makes me raise an eyebrow. We constantly hear that we can’t have NPIs because if the number is compromised, the patient’s entire health record would be accessible in one location. That argument falls a bit flat for me. There are already medical record numbers on pretty much everything. In today’s interoperability world, we use easily accessible patient information (names, address, gender, dates of birth, etc.) to create a universal patient ID and match disparate patient information the best we can.

The whole argument on NPIs should really be fought on the cybersecurity front. Why not implement data encryption standards that lock data down to the field level, so that each piece of information in an NPI record is its own walled garden? We’ve already seen the mistakes made by other consumer industries such as banking, which many have responded with increasingly deep levels of data encryption. It’s completely logical and viable for the healthcare industry to implement the same level of security available in other industries to ensure our sacrosanct health information is protected. If we did, then that would be good for all and put an end to the security debate on NPIs.