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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Readers Write: The Next Generation of Intelligent Decision Support

The Next Generation of Intelligent Decision Support
By Carm Huntress

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Readers Write: Curating Information to Reduce Physician Burnout

Curating Information to Reduce Physician Burnout
By Nele Jessel, MD

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

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

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

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

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

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

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

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

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

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

Readers Write: Achieving Health Equity through Improving Diversity in Nursing

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Readers Write: Embracing a Smarter Future in Healthcare

Embracing a Smarter Future in Healthcare
By Brian Patty, MD

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

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

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

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

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

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

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

Consider the potential impact of precision prescribing alone:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It’s important to remember that:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prioritize the Clinician As Your End User

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

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

Invest in Ongoing Education and Coaching

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

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

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

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

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

Cultivate a New Work Culture

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

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

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

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

Readers Write: When Hospitals Leave Patients in the Wild West, They Turn to Dr. Google

When Hospitals Leave Patients in the Wild West, They Turn to Dr. Google
By Mike McSherry

Mike McSherry is co-founder and CEO of Xealth of Seattle, WA.

Good or bad, everyone has a memorable care experience. This unites us all. The division comes with how it is handled. Viewing the patient as a customer is not a new concept. So why don’t more systems anticipate our needs? Think of your experience with Google or Instagram ads. Scrolling through websites or social media, I think they may know my habits better than the doctor.

I spent 20 years in consumer technology, co-founding companies such as Boost Mobile and Swype, before joining the Providence health system as an entrepreneur in residence. I understand digital innovation in the age of immediacy. With so much information at the patient’s fingertips, it seems like a no-brainer to consult the internet. Why go to an in-person appointment when Dr. Google is just a house click away?

According to Comprehensive Psychiatry, “Googling symptoms results in an escalation of concerns and excessive worrying about symptoms.” It’s our job as healthcare purveyors to ensure the best experience possible for the patient. This experience should be comprehensive, forward-thinking, and, most importantly, conveniently available at 2:00 a.m. when a concerned father wants to know about his child’s fever.

Many times, patients are required to go for an in-person appointment for something they see as simple. Then, wait weeks or longer for that appointment. Once there, physicians have just 15 minutes to address the visit reason, and then … what? If the patient forgets something said or thinks of a question later, there are typically three choices: play phone tag with the office, wait until the next appointment, or consult Dr. Google.

Who is stepping in to fill that information void between appointments? People trust their doctors, but will search online if there is no simple way to get the answers they seek, finding who knows what in their Wild West Web search. Hospitals and health systems would benefit through offering a thorough digital experience. Not only would patients be receiving credible information, it will also give one more touch point, tightening the patient relationship while reducing office phone tag.

Garnering patient trust requires that health organizations update the user experience to accommodate immediacy and convenience. Think of your own care experience. While physically in the office, everything you are told either sounds great or could be confusingly technical. A few hours later, you question certain details or lose the paper print out. It is all too enticing to do a quick search.

Health technology can extend clinical time beyond the office and to the patient. The pandemic drove that point home, along with care options. There are several ways a doctor can be present, along with prescribing apps, health monitors, Ace bandages, diets, or anything that could improve the patient experience. This way, patients can continue receiving clinicians’ recommendations rather than an article Aunt Ada saw on Facebook — thank you, Aunt Ada.

Adding communication channels from the care team, especially digital ones, instantly raises questions from some hospitals. Who will handle the extra workload and will this hurt reimbursement? With the former, automation can handle much of this with triggers based on appointment type and diagnosis codes. Digital tools should be scalable, enhance service lines, and extend care, helping health organizations provide live-saving programs outside their four walls.

Healthcare may be the only industry where the person ordering the treatment is different from the one who uses it, who is also different from who is paying (try that at a restaurant). While no one likes to talk about it, the money for digital solutions must come from somewhere.

CMS now reimburses for several virtual tools, with commercial payers following suit. Further, open lines of communication and accurate, timely information can prevent emergency room readmissions, assisting quality scores and reimbursement.

There are also the more long-term benefits of patient satisfaction, one metric in determining reimbursement rates, and recommendations. As with other areas of our lives, we want to go where people know our names. Meeting people where they are with targeted, accurate health information furthers the patient bond and keeps the Dr. out of Google.

Readers Write: Creating Resiliency Among the Newest Generation of Clinicians

Creating Resiliency Among the Newest Generation of Clinicians
By Acey Albert, MD

Acey Albert, MD is director of clinical content for the Epocrates business of Athenahealth of Watertown, MA.

Healthcare is facing an immediate crisis that threatens to undermine our ability to deliver care: a massive clinician shortage that grows larger with each passing day. If that isn’t enough, the COVID-19 pandemic accelerated an alarming rate of burnout, trauma, and disillusionment. In fact, according to Athenahealth’s recent Physician Sentiment Index, the fiscal responsibilities of practicing compounded by the pressure of delivering high-quality patient care contributed to feelings of frustration, with 46% of the nearly 800 physicians participating in the survey reporting feeling burned out a few times a month or more.

While there’s no magic wand that could suddenly wave away this multifaceted challenge, there are small changes we can make today to address some of the immediate drivers of this trend head-on.

Support distracted, fatigued minds with “peripheral brains”

Early in clinical training, there arises a certain bravado about memorizing every rare “zebra” condition in the textbooks. Students and residents are interrogated in front of their colleagues about the most obscure causes of a symptom, reinforcing this drive. At every career stage, the pressure to know it all persists. Rote memorization of obscure facts can distract clinicians from using their brains for what really matters: critical thinking, creative problem solving, and building the clinician-patient relationship.

When clinicians are mentally fatigued, access to clinical decision support tools, or peripheral brains, is more vital than ever. Medical knowledge is growing exponentially. For drug therapies alone, there is an endless flow of journal articles updating the indications, dosing, drug-drug interactions, and side effects. Keeping up with medical knowledge that doubles, by recent estimates, every 73 days is a Herculean task, even before a novel coronavirus emerged to spread devastation and confusion across the globe.

Trusted technology resources have made it possible to compile all of that practical clinical information onto a mobile device. Practicing clinicians are digital omnivores, leveraging access to their desktop and laptop computers, smartphones, tablets, and smart watches, among others. With these digital platforms at hand, clinicians are increasingly becoming managers of medical information rather than mental repositories of it.

Reduce clinical decision time through quick-access mobile solutions

If you think about a typical 15-minute office visit in a busy practice, clinicians must call on a large knowledge base in just a few brief moments: perhaps a few minutes during the patient history, another minute or two during the exam, and then — most importantly — in the last moments of the visit while making a diagnosis and developing the treatment plan. Positioning easily accessible reference data at a clinician’s fingertips means they no longer have to comb through their bookshelves or scour the internet to search for key information vital to their decision-making.

Any tool used during those moments of care needs to be quick, accurate, and intuitive. Certain user preferences can help clinicians rapidly and efficiently access the most-valued and most time-sensitive information. Time spent clicking, scrolling, and typing, or worse, figuring out some novel interface, is time not spent meaningfully interacting with patients. Through the use of familiar interaction models common in non-medical apps, such as swipe right or swipe left navigation, medical app interfaces could be leveraged to more expeditiously deliver guidance. Simple favoriting functions and other self-curation tools can also speed access and create shortcuts for busy clinicians.

Increase patient face-time with mobile technology

Throughout the COVID-19 pandemic, clinicians have increasingly been using mobile apps, both to maintain contact with their patients and as a source of trusted information that goes wherever they do. Compared with a desktop or laptop computer, mobile devices keep priorities clearer between clinicians and their patients, whether used in person or virtually.

Providers can easily integrate clinical decision support tools into the patient visit — it’s not necessary to hide them out of sight. Patients typically appreciate when clinicians demonstrate that they are using the latest technology on their behalf. Mobile medical reference apps can be used in the exam room or at the bedside, so the clinician and patient can view the screen together to look at drug interactions, pricing information, and even side effects. Time spent using these resources and apps together can enhance the clinician-patient interaction.

The future role of mobile medical apps in supporting resiliency

It’s anticipated that clinicians will continue harnessing technology like mobile medical reference apps long after this global health crisis subsides, since they can be updated more rapidly than non-cloud-based electronic health records or typical institution-based reference resources.

During the current pandemic, a super-rapid updating pace is vital to combating the even faster, ever-evolving misinformation surrounding COVID-19. Mobile medical apps offer opportunities to increase clinician knowledge and productivity in real time. Expanded use of these technologies holds potential for improving clinicians’ experience of practicing medicine, expanding their skillsets, and ultimately enhancing the quality of care delivered to their patients.

Readers Write: Why Healthcare Organizations Can’t Afford A Data Breach Caused by Human Error

Why Healthcare Organizations Can’t Afford A Data Breach Caused by Human Error
By Tim Sadler

Tim Sadler, MA, MSc, MEng is co-founder and CEO of Tessian of London, England.

$9.42 million. That’s how much a healthcare data breach now costs, a staggering $2 million more than it was a year ago. According to IBM’s 2021 Cost of Data Breach report, data breaches in the healthcare industry are the highest across all industries today. 

While ransomware attacks have dominated the headlines in recent months, the leading cause of data breaches in the healthcare industry is actually miscellaneous errors, with the most common of these mistakes involving an email or file attachment being sent to the wrong person.

We’ve all been there. Faced with looming deadlines and overwhelming to-do lists, you think to yourself, “I’ll just quickly send that by email.” But with healthcare professionals now responsible for more data than ever before, the stakes are high. 

Employees are the gatekeepers to highly sensitive and valuable information, such as people’s personal and medical records, intellectual property, and research and development. With many clinics sharing patients’ information among colleagues or with third-party partners via email, a simple typo could result in lost data, a serious cybersecurity incident, and significant reputational damage. 

This was the case with a gender identity clinic in the UK. An employee accidentally exposed the personal details of nearly 2,000 people because they CC’d recipients instead of BCC’ing them. In addition to damaging patient trust, a mistake like this can cause major legal problems, like violating HIPAA and HITECH laws.

Many IT and security teams may not even realize the scale of the problem that human error poses to their organization. IT leaders surveyed by my company estimated that 480 misdirected emails were sent in their organizations each year. In reality, at least 800 emails are sent to the wrong person in companies with 1,000 employees each year. What’s more, one in five healthcare professionals say they’ve made a mistake that has compromised security while working remotely that no one will ever know about. 

It’s not accidents causing problems. Security leaders know that the vast majority of employees are well intentioned, but there are some people who knowingly exfiltrate data from the organization. In fact, 35% of employees working in the healthcare industry admit to downloading, saving, or sending work-related documents to personal accounts before leaving or after being dismissed from a job. Our platform indicates that at least 27,500 non-compliant, unauthorized emails are sent every year in organizations with 1,000 employees. Security leaders estimated just 720.

Visibility into the threat is sorely needed. You can’t defend against what you can’t see. 

To prevent security incidents caused by human error and avoid the eye-watering costs associated with a data breach, healthcare organizations need to start putting people at the heart of their security strategies and consider how they can best support their riskiest and most at-risk employees. 

Constantly reinforcing security awareness training is an important first step in improving people’s security behaviors. Training can’t be a one-size-fits all, tick-box exercise; it has to be contextual and relevant if it’s ever going to resonate with employees and enforce long-lasting behavioral change. 

Then create and maintain a security culture that empowers employees to make the right cybersecurity decisions. Arm people with the tools and knowledge they need,  in the moment they need it most, to avoid making risky mistakes that can compromise data security. This could mean alerting people to think twice before clicking, rewarding employees for spotting threats, and creating a safe space for people to admit when they’ve a mistake.

Businesses are digitally transforming and ways of working are changing, but one thing remains the same — people are in control of the data and systems. Their behaviors will make or break a company’s security posture. With the cost of a healthcare data breach continually rising year on year and with people being responsible for more data than ever before, IT leaders can’t no longer afford to neglect security at the human layer in their organization.

Readers Write: Green Light: Why Healthcare Providers Need to Migrate to NCPDP’s Updated E-Prescribing Standard

Green Light: Why Healthcare Providers Need to Migrate to NCPDP’s Updated E-Prescribing Standard
By Andrew Mellin, MD

Andrew Mellin, MD, MBA is VP/CMIO of Surescripts of Arlington, VA.

When you see a green traffic light, what action comes to mind? Assumingly, “go.” But as late as the 1920s, a green light meant stop in some American cities and go in others, creating a dangerous driving experience for drivers used to different systems for traffic lights and patterns. As a result, the Federal Highway Administration mandated in 1935 the national standardization of the red, yellow, and green color scheme that we know today.

Although we don’t often think about standards, they are essential for standardizing materials, products, methods, and services, which result in safety, efficacy, efficiency, and quality control. This is especially true across healthcare.

Since 1997, the National Council for Prescription Drug Programs, or NCPDP, has maintained a national standard known as SCRIPT for electronic prescriptions. The NCPDP SCRIPT Standard for e-prescribing facilitates the transfer of prescription data between various healthcare stakeholders and plays an important role in helping reduce administrative burdens for providers and increasing patient safety.

Unlike traffic lights, healthcare technology is constantly evolving and improving. That’s why in 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule adopting the NCPDP SCRIPT Standard v2017071 for E-Prescribing and Medication History for Medicare Part D. This standard sets out to modernize e-prescribing and medication history and improve patient safety and clinician workflows.

Most of the industry has migrated to this new standard, and the tremendous work that thousands of stakeholders across the country have done to upgrade their pharmacies and electronic health records should be applauded. But healthcare providers who haven’t completed this process are subsequently missing out on new features and risk potential disruption to their ability to electronically prescribe medications.

SCRIPT v2017071 makes hundreds of improvements to the e-prescribing process. The enhancements from this version fall into three categories: information sharing, patient safety, and administrative burdens.

The 2017071 standard adds new data segments, elements, and codes to prescriptions that more clearly communicate the prescriber’s intent to the pharmacy. In terms of patient safety, prescribers can now share patient allergies and preferred language with the pharmacy. Finally, the standard helps minimize manual processes that require healthcare providers and pharmacies to step outside their workflows to exchange critical patient care information. For example, it enables pharmacies to request prescriptions for medications they have not previously dispensed electronically versus using fax machines or making telephone calls.

CMS required that healthcare providers sunset the previous NCPDP SCRIPT Standard – v10.6 – by December 31, 2019. With the CMS deadline now more than 18 months behind us, the rest of the healthcare industry is officially retiring SCRIPT v10.6. For healthcare providers who don’t complete their migration by September 1, 2021, their users may begin experiencing service disruptions and will not have access to Surescripts E-Prescribing services.

Migration to SCRIPT Standard v2017071 takes time and work, so healthcare providers must not delay. Organizations can navigate their transition by talking to their EHR or e-Prescribing vendor and by leveraging resources like the NCPDP SCRIPT Implementation Recommendations guide.

NCPDP SCRIPT is more than a standard; it represents our innovative efforts to find better ways to share information and support the health and wellbeing of patients in the United States. The migration light is green, so healthcare providers must hit go.