Readers Write: AI is Essential to Stopping Further COVID-19 Spread and Limiting Future Pandemics — Here’s Why

AI is Essential to Stopping Further COVID-19 Spread and Limiting Future Pandemics — Here’s Why
By Sally Embrey

Sally Embrey, MSPH, MS is VP of public health and health technologies of DataRobot of Boston, MA.

It is safe to say that 2020 showed us the limitations of the US healthcare structure and a long-antiquated approach to public health and emergency preparedness. Under lockdown, it became clear how unequipped the world was to address the scope of the COVID-19 pandemic. Since the onset of the greatest healthcare crisis in our lifetimes, the strengths and weaknesses of our healthcare system came into clear focus, while the consequences of our failures will be felt for years to come.

But how do we move forward? In the United States, COVID-19 spread has varied widely, from states to cities and counties. This spring, as COVID-19 cases in Michigan, New York, and New Jersey were slowly declining, cases in Oregon were increasing at higher rates than anywhere else in the United States, according to The New York Times.

One thing that has been emphasized time and time again is that the absence of more complete, accurate, and representative data was a key and often missing factor in our ability to effectively respond to the COVID-19 pandemic. We also learned that the systems required to process that data were as equally important to delivering the insights needed. The pandemic has made the role of AI in the healthcare field essential to preventing and mitigating future pandemics.

Research groups worldwide built and deployed various AI-driven systems that sought to fight the pandemic. For example, researchers developed systems that automatically analyzed CT images to provide the probability of COVID-19 infection to rapidly detect COVID-19-related pneumonia. Since AI can locate lesions in seconds instead of hours, it can significantly reduce the workload for already overburdened physicians. Other models were developed and deployed throughout COVID-19 to help understand clinical severity and identify the patients most at risk of serious illness and even death. By deploying AI, healthcare systems could prioritize which patients needed to be hospitalized and provided immediate care, and early care was shown numerous times to help with health outcomes.

At the same time, AI systems gave the federal government and state governments insight into where resources were needed most critically. They utilized AI-driven long-term forecasting models to understand the scope and spread of COVID-19, as well as drive site selection during the vaccine trials by predicting where outbreaks were most likely to occur up to eight weeks before cases increased. This could forever change how we enroll individuals into clinical trials, which are typically constrained to research hospitals or highly manual processes. Improving and streamlining the approval of vaccinations is the golden ticket to infectious disease prevention.

Organizations across the healthcare and technology industries also stepped outside of the box to create at-home COVID-19 antigen tests, many of which have an accompanying gamified platform. By combining physical antigen tests with AI and an accessible digital platform, patients are better able to understand their risk of being contagious with COVID-19. Arming people with information about their COVID-19 risk through innovative solutions powered by AI is the solution for slowing and preventing future pandemics.

As a leading nation in health research and technology, we have a responsibility to do better, and we must ensure we can more quickly contain this type of outbreak in the future. By leveraging the importance of complete, accurate, and representative data and combining it with the power of AI and public-private coordination, we can and will be ready to stop future pandemics.

Readers Write: Providers’ Post-Pandemic Assessments of Telemedicine

Providers’ Post-Pandemic Assessments of Telemedicine
By Amanda Hansen

Amanda Hansen is president of AdvancedMD of South Jordan, UT.

Healthcare delivery has shifted dramatically since March 2020, when the COVID-19 pandemic hit. For many providers, telemedicine had fallen into the category of a “someday, maybe” service, not a practice essential that was regularly requested or required of them. But when social distancing mandates were enacted to reduce the potential for infectious exposures, demand and the subsequent adoption of telehealth skyrocketed.

About 90% of providers say they are conducting some of their patient visits via telehealth. They have rapidly scaled offerings to see 50 to 175 times the number of patients via telehealth than they did before the pandemic. Going forward, it is projected that virtual visits will account for $250 billion, or 20%, of what Medicare, Medicaid, and commercial insurers spend on outpatient, office and home health visits.

Given the rapid and event-specific changes to telemedicine’s applications, we were curious about the impact to independent practices and their impressions that will come to shape the future of remote clinical services. Are practices capitalizing on the promise that telemedicine saves them both time and money? What has the effect been on the patient experience? We were interested specifically in the following aspects of telemedicine provision:

• Effect on time spent with patients.
• Effectiveness in reducing barriers.
• Impact of care costs.
• Impact on quality of care

In early April. we partnered with nearly 200 select physician offices to conduct a survey addressing these very questions.

Access

An overwhelming majority of survey respondents, 75%, find that telemedicine reduces or eliminates barriers to care for their patients. For practices, this access is expanded without increasing staff or marketing costs.

The ability to provide effective care is a largely a function of provider availability and visit timing. In many segments of healthcare — such as mental health, primary care, and various specialties — the shortage of providers results in excessive wait times for appointments. Telemedicine makes providers more available and creates opportunities for additional visits, reducing barriers to care.

Convenience

Telemedicine enables flexibility for patients, streamlining care for those outside the immediate area. It also enables quicker resolution for diagnoses and prescribing. Practices offering telemedicine visits are able to divert patients from more costly and complex care settings like emergency rooms. Chronic care patients, in particular, are much more likely to visit with a care provider before the condition enters a crisis and maintain standard care continuity when it is seamless and simple. Convenience remains integral to reducing both barriers and cost of care.

Quality

Among survey respondents, 38% say they are providing more quality care using telemedicine. In one of our other recent surveys, 59% of providers said they feel they are able to provide higher quality care with telemedicine. In the early months of the pandemic, telemedicine allowed practices to remain open to provide the quality services their patients required. Today, the service allows practices to maintain and grow their patient volumes.

Engagement

Telemedicine enables 24% of responding providers to spend more time with patients, but engagement goes beyond time per appointment. Practices that integrate telemedicine with the EHR and other practice management tools like portals, scheduling, text alerts, and claims processing serve patients who are more engaged in their own care. Solutions that meet patients where they are make care management functions seamless and simple. With telemedicine as part of the engagement strategy, patients are getting the same healthcare experience online that they have in traditional, onsite visits, and can even shop for doctors who provide the service and have availability at set times. Engaged patients are healthier patients.

For providers, telemedicine is serving a new purpose. With 271 telehealth case types (with CPT codes) reimbursable by CMS, there are many opportunities to expand utilization and revenue streams. In the decade prior, physicians often engaged in patient phone or video calls without any reimbursement whatsoever. Now, providers are able to deliver services to those who need it with a technology that has proven effective and advantageous.

By reducing costs and breaking down barriers, telemedicine is improving the quality and efficiency of care delivery.

Readers Write: Sharing Diverse Patient Data to Support Clinical Trials: Can We Afford Not To?

Sharing Diverse Patient Data to Support Clinical Trials: Can We Afford Not To?
By Monica Matta

Monica Matta is head of operations and GM of provider business at COTA of Boston, MA.

Flatly,  we cannot.

Clinical trials are the foundation of innovation in the fight against hard-to-treat diseases, including cancers. For the millions of people living with cancer, and the millions more who will be newly diagnosed this year, clinical trials are critically important for opening up new treatment options and paving the way for improved outcomes.

Cancer may affect everyone, but not everyone has equal access to the resources and research projects designed to combat this complex group of diseases. Certain racial and ethnic groups are systematically excluded and chronically disenfranchised when it comes to screening, testing, and clinical care.  These groups, including individuals affected by the socioeconomic and environmental determinants of health, often experience worse health outcomes and mortality at higher rates.

Black patients, for example, are significantly more likely than members of any other group to die from many cancers, including prostate cancer, breast cancer, and multiple myeloma. While black patients account for anywhere from 15-20% of the national incidence of these diseases, they only comprise 3-5% of clinical trial representation. This is a huge problem.

Clinical trials for new therapies are often not truly representative of the populations the therapies will be treating. Lower participation rates not only leave patients without access to potentially ground-breaking therapies, but also leave investigators with worrisome gaps in knowledge about the efficacy and safety of these treatments in the wider, real-world population.

The ethics are clear. There are also financial arguments supporting the need for increased diversity in clinical trials. If manufacturers and payers cannot verify that new therapies are going to achieve the desired result across all potential populations, why should they invest time and resources in distributing these agents to patients?

We simply cannot afford, both morally and more tangibly, not to focus on architecting more representative and inclusive clinical trials.

We can begin to meet the needs of underserved and underrepresented populations by encouraging more individuals to participate in clinical trials and prioritizing the evaluation of real-world outcomes with an emphasis on privacy and ensuring equitable access to the results. In order to do so, investigators must have access to rich, curated, diverse real-world data that accurately capture the experience and outcome of patients from all backgrounds.

Healthcare providers, including cancer centers, oncologists, and other specialists, remain a critical conduit for facilitating education about the benefits of data sharing and connecting patients with clinical trial opportunities. We must continue to build strong relationships between patients, providers, and clinical trial sponsors to gain the trust and input of diverse populations.

As we look to the future, however, there is much potential in leveraging technology and portals to clinical research marketplaces that allow individuals to grant access to their personal data assets for specific, well-defined use cases. These marketplaces will likely include some type of data dividends as compensation for participation. Patients can then become the direct purveyors and benefactors of their data, creating an entirely new model which reengages the right stakeholders in the conversation once more.

As we develop these ideas and tackle the myriad issues around the creation of such a system, we will need to keep informed, empowered patients at the center of all we do. Privacy, security, and equity must remain paramount to ensure our efforts are transparent, sustainable, and effective.

Whatever the next generation of data sharing will look like, we have opportunities right now to meet our obligations to patients. By pairing technical innovations with clinical expertise, we can lay the foundations for more expansive use of real-world data from traditionally underrepresented populations. We can continue to prioritize de-identification and patient privacy as we grow our data-sharing networks to encourage contribution and participation. We can proactively connect with representatives from underserved groups to provide education about clinical trials. We can keep working across the healthcare enterprise to refine our research approaches, expand access to breakthrough therapies, and support patients throughout their healthcare journey.

This is a moral imperative. For the sake of our neighbors, friends, families, and colleagues, we cannot afford not to be inclusive when it comes to clinical trials for cancer and the real-world evaluation of new protocols. The choices we make now will directly impact the lives of millions as we look to a future where sharing patient data with researchers is empowering and rewarding for all.

Readers Write: Taking the Friction Out of Digital Health Adoption

Taking the Friction Out of Digital Health Adoption
By Manny Fombu, MD

Emmanuel “Manny” Fombu, MD, MBA is founder of Marché Health.

COVID-19 showed the value of digital tools, encouraging a flood of new solutions into the market. The resulting confusion has launched a seemingly unending cycle of pilots, delayed digital health adoption, and hampered progress.

In pandemic-hit America, health organizations are expected to do more with less — less patient volume, less funding, less resources, less staff resources. Having the right tools in place can extend and assist burdened care teams, allowing them to improve patient retention and raise STAR ratings / HCAHPS scores.

Staying ahead of the latest digital health innovations can be challenging. Information is coming from disparate sources, creating noise and hindering the ability to garner any actionable insights. With global digital health companies raising $1 billion a week in March 2021, there is no slowing down yet.

However, there still isn’t one unified digital health focused marketplace and community where all key stakeholders in the ecosystem — including health systems, clinicians, payers, consultants, biopharma, entrepreneurs, and investors — can go to, not only to find out which digital health tools work best, but to actually review products, learn, and connect with key decision makers to quickly adopt them.

Today, more than ever, it is crucial for healthcare organizations to simplify the evaluation and adoption of digital health initiatives by adopting a marketplace that meets community engagement needs to educate, connect, and empower individuals in order to stay safe in the tsunami of tools and one-sided information creating friction and plaguing consumers.

An independent, objective, and trusted marketplace helps health systems innovate and improve healthcare outcomes by:

• Lowering acquisition costs.
• Gaining insight through centralized, unbiased data.
• Learning from buyer recommendations.
• Learning about programs that advance patient care.
• Streamlining the procurement process.
• Gaining objective peer-to-peer feedback.

A marketplace must not only connect buyers and sellers, but also create a community where all sides can come together to actually learn from the other and to identify which solution is the best.

These days, it is all about lowering healthcare costs and achieving IHI’s Quadruple Aim (better outcomes, lower costs, and improved patient and clinician experiences). Innovative health systems must make connections that cut through the “app-pollution” that prevents the customer from making better purchasing and partnering decisions leading to empowerment and advocacy , not confusion and frustration.

This can only be achieved by the ability to:

• Compare vendors based on objective, trusted data.
• Make connections.
• Increase transparency.
• Enhance knowledge.
• Simplify elevations.

It is time to break the pilot merry-go-round and find ways to not just increase, but improve digital health adoption. Then, we can achieve the promise that these innovations offer and discuss lasting results.

Readers Write: Provider Scheduling Matters

Provider Scheduling Matters
By Mary Piepenbrink, RN

Mary Piepenbrink, RN, MBA is SVP/GM of PerfectServe Provider Scheduling powered by Lightning Bolt.

It’s time to vanquish dated provider scheduling methods. This subject is near and dear to my heart, but I think we have finally reached critical mass. The market for provider scheduling technology has matured, and real-world results prove it is safe—and wise—to make the leap.

The scheduling market started from a desire to improve physician scheduling at practices, so it was outpatient centric. Using technology to generate equalized, fair schedules in group practices was the original market opportunity. We didn’t call the central problem “burnout” then, but it was there, and it has gotten progressively worse.

Scheduling solutions still solve for those practice and burnout problems, but they have also moved beyond the outpatient office setting, scaling into broader areas to create better workflows and more efficiencies across health systems.  The easiest way for me to demonstrate value—real return on investment—is to create four buckets:

• Value to health system. There are many, but the best scheduling solutions generate real-time, integrated, dynamically updated information for multi-faceted uses across the health system, all leveraged to improve both business and clinical operations.
• Value to care team staff. Simple—speed to care. Scheduling systems must power other applications in the health system so the care team staff can locate and connect with providers in a frictionless way. I was a nurse back in the day, and when I needed an order for my patient, I would check a paper on-call list, hope the needed specialist listed was accurate, hope the pager number hadn’t changed, hope the provider would actually get the page after I dialed it on a landline, then really hope for a fast return call so I could just go deliver care. I also hoped I wouldn’t get pulled away or distracted while waiting only to miss the callback and have to start the whole process over. Today’s clinicians have mobile devices and digital on-call technology, but without accurate, integrated scheduling information, the care team still experiences much of what I used to go through. And there are still lots of pagers! So, scheduling technology helps organizations improve speed to care by facilitating seamless location of (through scheduling information) and connection (via secure communications) with the right provider.
• Value to group practices. Scheduling systems integrated with payroll systems means accuracy in provider pay. The use of advanced technology to auto-generate optimal, fair schedules means greater provider satisfaction. Scheduling issues are the top factor leading to burnout, which is costly for practices. Using scheduling technology that supports capacity / resource management also helps improve patient access, provider utilization, and patient and staff satisfaction. Less burnout means less provider turnover and a better patient experience.
• Value to end user provider. The ability to reduce friction associated with schedule management: accurate pay, ability to easily request time off, ability to easily swap shifts if needed, ability to include preferences that will actually be considered in even the most complex practice, and knowledge that the schedule produced is the most balanced possible and based on proven technology versus the chance of human error. Many providers also actively involve themselves in scheduling, which robs time from patient care.

One of my biggest frustrations is when I see innovative health systems buy the latest technology without articulating what they’re solving for—technology for technology’s sake or “it’s an IT project” instead of realizing the technology’s true value for patients and/or staff and how the other existing IT investments can be exploited (which also makes those systems more valuable). That’s why my healthcare brain and my nurse’s heart were equally joyful when KLAS zeroed in on ROI and found that enterprise scheduling solutions generate tangible outcomes and positive impact. As it turns out, there’s real value to be had if you do this right!

I’ll close with a story . I was chatting with a radiologist who had tried scheduling solutions before but always reverted to manual scheduling. I asked how long it took him to produce his practice’s schedule by hand. “About 20 hours a week,” he said. I replied, “Why on earth don’t you just hire someone, even full-time, to do that for you so you can spend those 20 hours reading films?” His answer was simple: “Because my life matters that much to me, and my partners’ lives matter that much. Unless we can find something as good as me, I’ll keep making the schedules.” In that moment, it became very clear that we need to make what we do in the scheduling world as near-perfect as possible, because it absolutely matters.

Readers Write: Hospitals Shouldn’t Skimp on Meeting May’s ADT Deadline

Hospitals Shouldn’t Skimp on Meeting May’s ADT Deadline
By Claudia Williams

Claudia Williams, MS is CEO of Manifest MedEx of Riverside, CA.

Time is running out. There is now just over a  week to go before the May 1, 2021 deadline for hospitals to meet the Centers for Medicare and Medicaid Services (CMS) regulation requiring hospitals to share event notifications with community providers when a patient is admitted, discharged, or transferred (ADT). If hospitals want to keep getting paid by Medicare and Medicaid, they need to act now.

While it may be anxiety-inducing to compliance and IT departments, this fast-approaching deadline will be a joyful milestone for patients and providers in the community. Studies have shown repeatedly that sending ADT notifications is one of the most impactful ways to enable care coordination and reduce readmissions after a patient is hospitalized. One University of Colorado Hospital study found that patients who didn’t receive follow-up by their primary care provider after discharge were 10 times more likely to be readmitted to a hospital.

The good news is that ADT notifications are easy, especially if hospitals work with a partner that can match and route messages to the right community provider. So easy, in fact, that in a 2019 letter in support of the rule, authors reported they “were unable to find a single example where a hospital was unable to send an ADT notification today due to lack of standards.”

But “meet the mail” approaches won’t cut it. Some hospitals and their vendors are making minimal effort to route notifications to the right community provider. That’s a risky move. This rule is about “delivering” ADT notifications, not just “generating” them, meaning these vital alerts must actually reach the health partners who need them in your community.

Non-profit health information exchanges (HIEs) across the country are a powerful solution for last mile delivery of encounter alerts. Exchanging data for more than 92% of Americans today, these statewide and regional networks have the infrastructure and information to ensure ADT notifications securely and quickly reach the right providers in your community. Hospitals simply share an ADT feed with the HIE. The HIE does all the heavy lifting of matching ADT notifications with the right providers and routing alerts to them in real time. Once notified, providers can act quickly to support patients and ensure they recover safely at home after a hospital stay.

Beyond ADT alerts, HIEs’ roles in care coordination are expanding rapidly. A 2020 report found that nearly all HIEs today have “partnered with one or more of the following community and social service organizations: correctional health, social service agencies, drug and alcohol treatment programs, first responders, school nurses, or blood banks.” With HIEs as partners, hospitals are more effective and efficient hubs of care coordination in the community, improving patient experience, strengthening relationships with referring providers, and resulting in better patient care. COVID-19 has shown just how crucial this collaboration is. New York’s HIEs reported delivering a record-breaking 10 million ADT notifications during the pandemic and doubled the number of patient record look-ups as healthcare leaders there struggled to keep patients safe.

Their report concluded that “Health information exchange (HIE) continues to play a vital role in the delivery and quality of patient care. In 2020, it was demonstrated and verified that the sharing of clinical information can be leveraged even further in support of population health initiatives, playing a role to help predict health outcomes for the coronavirus pandemic and other health care crises that may occur in the future.”

While the May 1 deadline is approaching fast, progress on interoperability is just getting started. HIE partnerships can help hospitals meet new ADT alert requirements but can also help them succeed in value-based care, strengthen community care coordination, reduce paperwork burdens, and improve patient care.

Readers Write: The Disaggregation of Healthcare and Its Implications for Care Coordination

The Disaggregation of Healthcare and Its Implications for Care Coordination
By Dhruv Vasishtha

Dhruv Vasishtha, MBA is director of product management for PatientPing of Boston, MA.

Of all the changes that are taking place in the healthcare industry, perhaps the most important of all is disaggregation – the unbundling of care — into a more open, local, and transparent model that delivers greater control to patients.

This trend towards disaggregation is a positive one, yielding the potential to make healthcare more dynamic, responsive, and innovative. But it poses challenges as well, particularly in the complex areas of care coordination and patient data flow. As Julie Yoo, a general partner at the venture firm Andreeson Horowitz, noted last year, “We are seeing the fundamental topography of the healthcare industry changing before our eyes, and it will impact all the ways that data flows and operations are run.”

This article will look at the following dynamics that are at play in the healthcare industry as it undergoes disaggregation and the implications for care coordination.

The unbundling of hospitals

How we access healthcare is changing. In the past, when we got sick, we all traveled a similar patient journey. We went to our doctor, or if our symptoms were more serious,  we went to the hospital. We got diagnosed and treated and either were hospitalized or returned home.

Today, we have many different points of access to this care beyond the hospital walls. We can receive care from retail clinics, community centers, behavioral health clinics, home healthcare providers, and virtual visits, among other options. COVID-19 has accelerated this trend, making it more acceptable for people to seek accessible, convenient, and affordable care wherever it is available.

Payers are encouraging this shift since care is costly in hospitals and patients increasingly prefer to remain in their homes and receive care conveniently via today’s technologies (telehealth, at-home testing kits, remote monitoring systems) or through medical professionals coming to them. Thanks to these and other technological advancements, along with increased public openness to receiving new methods of care, the boundaries of clinical capacity can now extend beyond traditional physical and geographic lines.

Changing care reimbursement models

The accelerating move away from fee-for-service and toward value-based care models is incentivizing the outsourcing of care to independent providers and shifting the emphasis to products and services that put the patient’s whole care experience first. This trend has similarly accelerated due to COVID-19 as healthcare entities saw how dangerous it was to rely solely on fee-for-service revenues at a time when very few Americans were seeking out care, even if it was necessary.

The US government has also leaned into value-based care, one of the few areas with bipartisan consensus, to create new financial mechanisms that incentivize new types of providers to carve out specific niche of care management and delivery and get paid for it. For example, the Centers for Medicare and Medicaid Innovation (CMMI) created the Direct Contracting Model to expand opportunities for more diverse providers and healthcare organizations to participate in value-based care arrangements for Medicare fee-for-service beneficiaries.

The new Direct Contracting Model, which began on April 1, 2021, provides participants with increased risk options and is an integral component of the Centers for Medicare and Medicaid Services’ (CMS) strategy to redesign primary care as a platform to drive reductions in costs. Rather than outsourcing services, contracts are being made directly with physicians to deliver care and get reimbursed. As a result, new physician groups are popping up that are removed from the PCP or hospital, and these groups are catering to specific populations or types of care to deliver more efficient, effective care.

Primary care provider independence

Related to the changing care reimbursement models noted above, there is a move towards greater physician independence. After years of acquisitions by hospital groups, doctors are launching their own practices or joining with other independent providers in a move away from employed positions. While employment offers physicians security and stability, independence provides them greater autonomy and flexibility and an opportunity to focus on each patient’s individual needs without limitations.

For patients, the trend towards more independent providers means greater choice, improved quality, increased access, and more affordability. However, it also means that care coordination becomes more complex, as their data is no longer centralized or easily accessible when these patients move different physicians and physician groups for care.

The impact on care coordination

As a result of these shifting market dynamics, there is a lot more fragmentation in the market, which has created an increased need for improved care coordination —  the ability for provider care team members to collaborate on shared patients to support long-term health, the cornerstone of value-based care. The promise of improved collaboration among providers, overall improvement in care quality, and ultimately successful patient outcomes cannot be realized without a successful patient care coordination program.

Care coordination is also an effective means to reduce wasteful spending. An article in JAMA examining waste in the U.S. healthcare system cited ineffective care coordination contributing up to $80 billion in wasted spend. This is because healthcare is often in silos, which leads to miscommunication, unclear ownership, fragmented patient care, and frequently poor outcomes, particularly among the most vulnerable populations.

An effective care coordination strategy can help to bridge gaps and connect silos among care teams. Key to this is the ability to share real-time information about patients’ care encounters across provider types and care settings. For example, if a patient goes to the emergency department (ED), their healthcare provider should be alerted by admission, discharge, and transfer (ADT) e-notifications that allow them to connect directly with the patient and the hospital care team to share critical details about their medical history. From there, they can determine the appropriate care plan, whether it’s post-acute care (PAC), behavioral health treatment, or visiting with their primary care physician.

In March 2020, CMS finalized the new Interoperability and Patient Access Rule to help hospitals better serve their patients through coordinated and collaborative care and prevent patient readmission. The rule creates a new Condition of Participation (CoP) requiring hospitals, psychiatric hospitals, and critical access hospitals to share electronic ADT based e-notifications with other providers across the care continuum whenever patients have inpatient or emergency department care events. With the May 1, 2021 compliance deadline nearing, this interoperability can not only fill in the gaps in care, but also prevent redundant procedures.

Done correctly, care coordination can drive quality outcomes across the care continuum and lead to other benefits for providers, including:

• Lowering ED utilization.
• Preventing hospital readmissions.
• Preventing unnecessary procedures and tests.
• Eliminating medication errors.
• Treating behavioral health problems holistically.
• Identifying and managing social determinants of health.

Conclusion

The disaggregation of healthcare holds the promise of ushering in a new model of care delivery — one that is cheaper, more personalized, and more cost-effective — while still delivering value. The key to its success lies in ensuring that all participants in the care continuum have access to real-time patient data and the ability to coordinate and collaborate with other providers across care settings during patient encounters. Real-time information can provide participants with a new level of clinical intelligence to successfully prioritize and deploy care coordination services and ensure seamless transitions of care for patients while also creating optimal opportunities to achieve shared savings, delivering on the promise of the new care delivery model.

Readers Write: Mandatory Encounter Notifications Keep Physicians in the Care Huddle

Mandatory Encounter Notifications Keep Physicians in the Care Huddle
By Samit Desai, MD

Samit Desai, MD is chief medical officer of Audacious Inquiry of Baltimore, MD.

Primary care physicians (PCPs) are often compared to the quarterback of a football team, as they understand all of the players involved. With this knowledge, PCPs can execute a proper game plan for their patients and direct them along the right routes in the care continuum process.

But imagine a quarterback trying to run the offense without any knowledge of what yard line the team is on. That’s often the situation PCPs face when they do not have up-to-date information about their patients.

With accurate, real-time information—such as when patients are admitted to the hospital or discharged—PCPs can make the right play calls to provide more efficient care, keep patients healthy, and reduce hospital readmissions. The Centers for Medicare and Medicaid Services (CMS) recognizes the importance of these “electronic encounter notifications” to such an extent the agency took the extraordinary step of issuing a mandate: hospitals must make admission, discharge, and transfer data available to patient-identified PCPs and other practitioners, as a condition of participation (CoP) in Medicare and Medicaid. Hospitals must meet this specific e-notification requirement by April 30, 2021.

This is good news, although it is not a simple process. I suspect many hospitals wonder if this CoP notification ruling is simply another administrative hurdle without impact. The truth is that accurate encounter notifications will improve care for patients and keep PCPs in the loop, but hospitals need to prepare now.

CMS has valued this information-sharing process and has encouraged notifications and follow up for years, including through the creation of the TCM Billing Code. These notifications, plus provider outreach to patients that can be as simple as a follow-up call, can help reduce readmissions, which in turn lowers costs for everyone. As the industry continues its steady transition to value-based care, there’s been a greater focus from government, health plans, and providers when it comes to providing access to patient data for improved care coordination. PCPs and providers are better informed through more opportunities to walk through patient conditions, debrief on procedures, conduct medication reconciliation, and coordinate any necessary next steps and communications with specialists.

These notification requirements are new for some hospitals, and compliance is not as simple as flipping a switch. Hospitals are burdened with obstacles and must account for other priorities, including updating registration workflows, supporting new EMR configurations, and preparing for regulatory audits.

To meet these challenges and remain eligible to participate in Medicare and Medicaid, hospitals are increasingly looking for an experienced partner who can help navigate federal regulations and provide the technical capabilities required to deliver effective encounter notifications. For the CoP notification requirement to serve its intended purpose, hospitals should evaluate the options available and look for services that support patient-asserted and provider-attributed alerts.

Transitions of care are among the most crucial moments for patients, and we cannot afford to let anyone fall through the cracks. These new CoP requirements are an encouraging development and will ensure that these critical care coordination technologies are available to patients nationwide.

When hospitals and other providers work from the same playbook and share real-time encounter notifications, patients will benefit from better care coordination, tailored follow ups, and improved health outcomes.

Readers Write: A Proactive Engagement Strategy is Key to Building Patient Relationships and Driving Outcomes and Experience

A Proactive Engagement Strategy is Key to Building Patient Relationships and Driving Outcomes and Experience
By Mike Linnert

Mike Linnert, MBA is founder and CEO of SymphonyRM of Palo Alto, CA.

Each calendar year, we use awareness months to bring attention to different chronic conditions and diseases that affect the lives of millions of people here in the US and around the world. For example, March was National Kidney Month, which highlights the 37 million people in the US – more than 1 in 7 adults – who suffer from chronic kidney disease (CKD). What’s even more alarming: approximately 90% of those with CKD don’t even know they have it. One in 3 American adults is at risk.

CKD is the ninth leading cause of death in the US. Like other chronic conditions, it’s important that we spend time talking about what we, as healthcare innovators and providers, can do to educate those at risk. We need to help those who are suffering manage symptoms and reduce the risk of acute, life-threatening conditions. We also need to increase general awareness of these diseases and their co-morbidities. 

Early awareness and intervention are proven to drive better health outcomes; in fact, early detection is the most effective way to combat CKD.

When we look at the aforementioned statistic – 90% of those with CKD don’t know they have it – the urgency of education and awareness becomes clear. Erkeda DeRouen, MD, a primary care physician and Inlightened expert, reiterates just how critical knowledge can be: “Kidney disease is very important to discuss because it’s one of those ‘silent emergencies,’ what they call ‘silent killers,’ a lot of people think of like heart disease.” According to DeRouen, a lot of people with some degree of CDK can live for years without knowing anything is wrong, given that it doesn’t always have clearly-defined symptoms.

Be proactive with your outreach and communications. Since most patients don’t know they have CKD or potentially other life-threatening conditions, it may be too late by the time they reach out for care. Whether it’s a chronic condition or simply a healthier lifestyle, providers are in a unique position to improve patient awareness about the role they play in their own health, well-being, and outcomes. A well-designed, data-driven engagement strategy that proactively communicates relevant information, such as tips and tricks for eating healthier, can go a long way in furthering their awareness of the conditions for which they are at risk and can drive real change in their own health.

For health systems and providers, one way to do that is through the development and execution of a data-driven engagement strategy. Data and prioritization are key for effective and successful patient engagement. For health systems, it’s not what content a person is likely to consume (think Netflix); rather, it is about the next best action a patient should take for their health and wellness.

Take for example, a patient with several outstanding actions (i.e., Annual Wellness, colonoscopy, cancer screening, glaucoma exam, etc.) that must take place as part of their care journey. How do you effectively reach out to the patient? What’s the most important action for the patient to take right now?

A study from the American Heart Association found that nearly half of patients who received support through a patient engagement tool prior to a cardiology clinic visit had a positive change in their medication therapy compared to less than a third among patients who did not receive the engagement tool. 

The health systems that are able to deliver hyper-relevant and actionable engagement based on data, both during and between encounters, have a great opportunity to drive real impact in reducing the number of Americans at risk of, and suffering from, chronic conditions like chronic kidney disease.

A study conducted by Forrester on behalf of Cedar revealed that more than a quarter of patients switched medical providers because of a poor digital health experience. The research found that in 2020, 28% of patients switched providers because of a poor digital health experience, a 40% increase from 2019.

We can expect these trends to continue as patients expect the convenience of digital healthcare experiences as a result of the pandemic.

Patients’ expectations will continue to evolve as the consumerization of healthcare continues its forward march. As more and more providers and systems recognize the importance of mirroring people’s everyday digital lives, data shows us that patients will make choices to seek healthcare experiences out that fit their lifestyle and meet their expectations. With consumer brands like Amazon expanding their healthcare footprint, the opportunities for patients to seek out the experiences they expect continue to grow.

In order to drive those sought-after experiences, providers and systems should:

• Be proactive. Don’t wait for patients to come to you for information. With the plethora of rich data and insights available in healthcare today, proactively reach out to and engage patients as their health advisor to guide and activate them towards the care they need.
• Be clear. If you want to drive patients to take an action, don’t make them guess why you’re reaching out. Be concise and to the point and then make the action easy to complete.
• Personalize. Personalization extends beyond just email campaigns that include a primary care provider’s name. They have a higher click-through rate than those that are generic or come from the health system, but which channel or medium does each patient prefer to communicate? Will SMS be more effective for some patients? Or perhaps even good old phone calls? What action is the most relevant for the patient now?
• Prioritize with data. Rather than sending blanket messages to every female patient over the age of 50 about scheduling a mammogram and potentially overwhelming radiology, why not prioritize and reach out to those who are most at risk first? Imagine sending a text message with information on breast health and how they can schedule an appointment directly within the text.

Unfortunately, we cannot wave a wand and make all patients healthy no matter how much we wish we could. What we can do is leverage the technology that we have available – that people are already accustomed to using – to drive awareness about patients’ health and wellness that lead to better outcomes and healthier patient populations. In the process, patients might have an experience that makes them want to stick around.

Readers Write: Improving Adherence, Affordability, and Experience with Better Point-of-Care Data

Improving Adherence, Affordability, and Experience with Better Point-of-Care Data
By Christie Callahan

Christie Callahan is chief operating officer of RxRevu of Denver, CO.

As healthcare leaders continue to focus on patient outcomes, preventive care, and total wellbeing, it is essential to keep cost at the center of the discussion. Affordability and access continue to be major barriers to care, with over half of Americans saying they have received a medical bill that they did not have the funds set aside to pay for, and more than 10% of adults reporting delaying or skipping care because of financial reasons.

While there are segments of the population that are uninsured or underinsured (a separate issue to discuss), even those with insurance coverage are unable to proactively manage their healthcare costs. Lack of data and pricing information often causes consumers to forgo care altogether or become frustrated with the burdensome process of researching coverage and cost details.

There is no question that a lack of transparency causes a negative healthcare experience, and nearly everyone knows somebody who has been overwhelmed or surprised by medical bills. The challenge is that the work required to effectively diagnose and treat a potential new condition is often extensive, and the costs aren’t understood until the work has been completed.

Many new regulations and solutions center around patient price transparency. But are we approaching the problem in the right way?

Patients on their own are often incapable of making specific choices about care options without the help of a provider.

Let’s use a simple drug order as an example. Common chronic conditions require near-perfect medication adherence to manage the condition appropriately. While costs can be quite low, if the wrong medication is prescribed, or the patient fills the prescription at the wrong pharmacy, costs can quickly escalate. In this case, a new prescription must be ordered by the provider, requiring additional research by the care team, an additional visit to the pharmacy, and additional time when the patient is not on the medication.

Policies like the Hospital and Health Insurance Price Transparency Rules and the No Surprises Act mandate that plans and providers disclose negotiated rates and cost estimates over the course of the next few years. These rules allow patients, and sometimes providers, to view coverage data and have conversations around the cost of available options to improve affordability.

However, in the prescription drug space, CMS created more specific rules for EHR vendors and Medicare Part D plans, mandating the availability of real-time prescription benefit tools for providers and creating a wave of interest and acceptance of point-of-order solutions. By focusing regulation and technology capabilities on driving transparency for the patient and the provider at the point of care, together they can better manage spend and find affordable care options.

It is essential that we give providers the right tools to view a full picture of their patients and allow for condition and cost management conversations to occur. We need different-in-kind solutions that can make a meaningful difference in the exam room and help drive comprehensive conversations and decisions.

What can be done to accelerate implementation, acceptance, and use of solutions like this?

What is most important today is starting a conversation around how we can better support providers, as we continue to ask them to do more in the exam room.

First, we need better tools and data at the point of care.

• Solutions must be fully integrated into care workflows so providers can quickly and easily take action without feeling burdened by cumbersome tasks. There is often value in partnering with clinical system vendors who are instrumental in ensuring a consistent provider experience through the normalization of patient data and their ability to maximize payer coverage.
• Every patient is unique, with unique insurance coverage, financial situations, and conditions. Therefore, the data displayed within the EHR can no longer be inaccurate, incomplete, or estimated. It must be patient-specific, detailed, and displayed in real time.
• Solutions must allow for broader engagement and support from care team members. Payers and PBMs must be willing to allow access to patient data to create an open network for care providers, regardless of role.S

Second, we need to better align incentives across healthcare stakeholders.

• When patients stay healthy, payers are the primary beneficiary. There continues to be an opportunity to shift that value to providers, as they are best equipped and have the most responsibility to impact patient outcomes. Price transparency tools, in particular, can help care teams better manage risk, as well as better participate in cost-based incentive models.
• Interoperability and price transparency policies have seen recent acceleration. But more can be done to create a truly interconnected and open ecosystem where care teams have access to robust, accurate coverage data and, with patients, are able to deliver the lowest-cost care in real-time.

There has been tremendous progress in healthcare through technology and interoperability innovations, improvements in the ways provider teams manage difficult diagnoses, and advancements in personal health tracking. But high healthcare costs continue to be a top issue for many. While the issue of cost is incredibly complex, if we aren’t able to have informed cost conversations at the point of care, we risk delaying the shift to value and perpetuating a pattern of negative healthcare experiences for patients and providers alike.

Readers Write: Medication Decision Support Alerts Don’t Need to Go Away, They Need to Get More Specific

Medication Decision Support Alerts Don’t Need to Go Away, They Need to Get More Specific
By Bob Katter

Bob Katter, MBA is president of First Databank (FDB) of South San Francisco, CA.

It’s no secret that clinicians are inundated daily with alarms and alerts that interrupt their workflows and cause cognitive overload, contributing to the industry-wide problem of clinician burnout. The National Academy of Medicine (NAM) even declared clinician burnout to be an “epidemic,” citing improved usability and relevance of health IT as one of six goals focused on addressing our current healthcare crisis.

While medication alerts are only a portion of a comprehensive clinical decision support (CDS) system, they contribute significantly to clinician alert fatigue. Clinicians are presented with an abundance of low-specificity and interruptive medication alerts and may even overlook critical alerts while sorting through the noise. This contributes to physician burnout and likely compromises patient safety.

We need to do better.

The good news is that given the wealth of patient information now available in electronic health record (EHR) systems, low-value and non-specific medication alerts can become a thing of the past. Medication alerts displayed to clinicians today can be patient- and workflow-specific, resulting in greater relevancy and efficiency.

Health systems and hospitals should focus on replacing non-specific medication alerts with more targeted alerts based on information from the patient’s chart, while delivering these alerts at the most actionable points in the clinical workflow. This approach helps reduce clinicians’ alert burden and fatigue, increases efficiency, and results in better clinical decisions and patient outcomes.

Origins of Alert Fatigue

Drug-allergy and drug-drug interaction alerts were among the first types of CDS alerts introduced in the heyday of EHR implementations. They were required as part of the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Program, commonly known as Meaningful Use, and remain part of the mandatory functionality in 2015 Certified Electronic Health Record Technology (CEHRT). But they can be made better.

The number of data sources and the amount of healthcare information flowing into EHR systems has increased exponentially since the original introduction of these systems in the 2000s. With the level of patient-specific data, clinical guidelines, research findings and other critical information now available, EHRs can and should deliver more relevant and targeted medication information.

Here is how we could flip the script on medication decision support to create greater specificity, reduce alert fatigue, and ultimately improve patient safety and outcomes.

1. Make Alerts More Meaningful and Actionable

Decision support alerts that rely on medication lists alone are helpful but often limited in the insight they offer clinicians. We can create more relevant prescribing guidance by factoring in not only standard demographic information, but also other patient-specific context, including lab values, genetic test results, patient care setting, clinical risk scores, and comorbidities.

Due to advances in diagnostics technology and in IT systems interoperability, this information is more easily accessible than ever, creating opportunities to support more precise guidance and better outcomes. A deeper dive into patient information can help clinicians evaluate risks for complications such as hyperkalemia or QT prolongation. It can also help quantify patient risk for issues such as opioid addiction and a whole host of adverse drug events.

2. Consider the Scenario

Building context around medication alerts should also include the clinical scenario. When a patient has just undergone heart surgery, for example, standard care guidelines typically recommend administering multiple medications post-surgery that would not normally be taken together. Although some of these medications may interact, which could be problematic in another context, these interactions can be monitored and managed in an acute care setting. In this case, surfacing standard interaction alerts would not increase patient safety but would create unnecessary noise.

3. Build it in the Workflow

In another study of CDS usage, one of the obstacles to clinician adoption cited was “disruption to workflow,” a common complaint about medication alerts. When evaluating drug risks, clinicians may need to search through the EHR or log in to a lab results portal to verify the information and to ensure that the alert is relevant. This slows them down and distracts from patient care.

Health systems should present relevant alerts with adequate supporting data when and where they are needed in the workflow. For example, when a patient’s potassium levels have reached a specific threshold due to an ongoing drug-drug combination therapy, the EHR should initiate an alert at the right point in the workflow when the issue can be best addressed.

This is not meant to say, however, that alerts presented at the point of ordering cannot be useful in some cases. For example, a general reminder to order a blood test to check potassium levels when ordering a certain drug therapy can be followed by a patient-specific alert later in the workflow to adjust the dosage once the lab results are returned.

4. Focus on Specificity

According to a recent study, clinicians are more likely to accept and act on CDS guidance when presented with patient-specific alerts based on EHR data.

Reducing quantity and repetition of alerts is also important, considering a recent study of clinicians found the likelihood of alert acceptance dropped by 30% for each additional reminder received per encounter. Reducing generic alerts and improving the patient specificity of the remaining alerts would go a long way toward improving the acceptance rate.

5. Optimize the CDS

Health systems should continually analyze how their clinicians are interacting with alerts and whether the alerts are doing more to protect patient safety or to distract providers. By reviewing the data generated during the medication ordering process, health systems can predict how clinicians will respond to specific alerts and strive to generate only those alerts that help clinicians make better decisions and ultimately protect patient safety.

Putting Patients First

The bottom line is that medication alerts do not need to go away, they need to get more specific. By taking a deeper dive into the relevant information about a specific patient, at the appropriate point in the clinician’s workflow, decision support can deliver more meaningful and actionable insights. If such a patient-specific approach were to be deployed across the industry, we could significantly reduce the cognitive burden that these systems place on clinicians while simultaneously improving medication-related patient safety.

Readers Write: Consensus Building: X12’s Cornerstone for Standards Development

Consensus Building: X12’s Cornerstone for Standards Development
By Cathy Sheppard

Cathy Sheppard is executive director of X12 of Arlington, VA.

Josh Kallmer, executive vice-president of the Information Technology Industry Council, said in a July 29, 2019 letter to Financial Times, “The US technology sector has long supported an industry-led, voluntary, consensus-based model of standards development because it works ─ and in the world of standards, the first move is not the last.”

With an incalculable investment of time and resources, it’s true that the world of developing standards to shape new interoperable technologies is a highly structured process. This proven process, albeit time-intensive, involves various mechanisms for creating, vetting, and approving standards supporting an evolving solutions roadmap.

At the center of rigorous standards development is consensus building, defined by the Program on Negotiation at Harvard Law School as a process involving a good-faith effort to meet the interests of all stakeholders. A consensus-building approach allows groups to reach an agreement among relevant stakeholders and maximize the overall gains to everyone.

Appropriately, the first tenet of X12’s six corporate principles is: Publish high-quality, consensus-based standards that are simple, efficient, responsive to the needs of stakeholders, and delivered in a timely manner.

X12 is an ANSI-accredited Standards Developer that has been focusing on the development and ongoing publication of cross-industry interoperable data exchange standards for more than 40 years. X12 develops and maintains its work for use by implementers in different formats that are proven, reliable, efficient, and effective to drive business processes globally. With more than 320 transaction standards, 1,400 data elements, and in excess of 40,000 codes available for use, X12’s body of work can be used to conduct nearly every facet of business-to-business operations.

In fact, billions of transactions based on X12 standards are utilized daily to facilitate rich and consistent standardized electronic exchange across various industries including finance, government, healthcare, insurance, supply chain, transportation, and others.

In the health insurance industry, X12’s activities support transactional standards, processes, and activity reporting used by commercial and government healthcare organizations. For example, X12 standards provide for eligibility and benefit inquiry and information response, claims, and code lists.

The Provider Caucus is an informal industry group comprised of X12 member representatives who advocate issues on behalf of healthcare provider organizations. Provider participation in subcommittee workgroups is encouraged to ensure their important viewpoints and collective knowledge are included in the collaborative discussions.

As the world continues to bravely battle the pandemic in 2021, X12 is proud that healthcare organizations are actively using X12 standards to electronically transport medically necessary information whenever and wherever needed to advance patient care operations.

Voluntary consensus benefits B2B standards development

From batch processing of large amounts of data to the proliferation of digital technology innovations, X12 standards have evolved to allow more people to use standards in different ways. But the wealth of four decades of X12’s strong, collaborative work remains critical to standardized messaging, powering an expansive vocabulary of data elements and constructs that unlock many opportunities to develop creative, interoperable solutions to complex business challenges.

For X12, consensus means that its diverse membership of technologists and business process experts has an equal voice in a non-competitive, safe forum deciding what those business-to-business transactions should comprise and how they should be formatted. Large member companies are not favored over smaller member companies.

X12 members listen to each other’s interests, ask questions, and gather shared knowledge weighing the pros and cons of implications in the decision-making process of developing or updating a standard. These companies are committed to working to find solutions that the majority supports.

As both technology and X12’s ability to support trading partners through different products advance, consensus standards must also evolve. Consensus standards must progress over time to ensure they continue to meet the needs of stakeholders and stay in tune with emerging interoperable technologies. For example, the X12 Unit or Basis for Measurement Codes have changed 600 times over the past 33 years.

X12’s approach to consensus-based standards development

To remain competitive and profitable in today’s economy, a seamless electronic exchange of business data among the company, partners, and customers is necessary. X12 standards establish a common, uniform language that facilitates business transactions.

X12 employs a three-prong approach to consensus building among stakeholders:

1. Open-minded, with vision and insight related to data exchange in both current and developing technologies.
2. Responsive to business requirements presented by other organizations.
3. Collaborates enthusiastically with other SDOs, industry groups, government, and business-focused entities.

X12 members meet regularly to develop and maintain high-quality data standards that streamline and facilitate consistent electronic interchange of business transactions. X12 standards support transactions such as order placement and processing, shipping and receiving information, invoicing, payment, cash application, administrative healthcare, and insurance data.

X12’s open, transparent, and consensus-based environment empowers members to voice comments, recommend changes or updates, and address and vet issues from every point of view. Looking through a technology lens, members take into account the particular business workflows and use cases to create standards supporting e-transactions and enhanced interoperability that crosses industry and company boundaries.

Anyone, including the general public, can submit a request, idea, or suggestion for revising or developing X12 standards or products by completing this form, accessible on the X12 website. X12’s current maintenance request process supports a predictable annual release cycle and is frequently referenced as ARC, as illustrated below.

Supporting a consensus building process, X12 members drive all aspects of standardization work, including defining the scope, content definition, and technical content. In simplest terms, the multi-layered maintenance and stakeholder process involves extensive vetting and negotiation among member representatives and other materially interested parties. Members also have the option to vote whether to approve revisions, and if approved, the revisions undergo both technical and quality assurance reviews prior to publication. X12 publishes new versions of its consensus-driven products annually.

Conclusion

“Change is the only constant in life,” said the Greek philosopher Heraclitus. True, but as technology has brought exponential growth and rapid change, some constants in business must remain in order to help the future thrive.

Tens of thousands of organizations count on X12 to develop high quality standards upholding business-to-business information exchange. X12 members are confident knowing that X12 transactions are grounded in a consensus-based approach designed to benefit users and satisfy their business needs, today and tomorrow. Having an equal voice is key to achieving fairness in mutually accepted solutions.

Readers Write: Without a Subscription Revenue Model, Hospitals and Health Systems Will Cease To Exist

Without a Subscription Revenue Model, Hospitals and Health Systems Will Cease To Exist
By Matt Lambert, MD

Matt Lambert, MD is chief medical officer of Curation Health of Annapolis, MD.

Two of the most common current topics in conversations with our provider and payer partners are speculating when we might emerge from the pandemic and what effect it might have on the future of value-based care.

With the decreasing number of COVID-19 cases, hospitalizations, and deaths intersecting with the rising number of vaccinations, I think we will be in a manageable place in the very near future. In a similar analysis, the differing trendlines for payers and providers in the last year may give us insight into the future of value-based care.

The providers, with a model based on episodes of care, find themselves challenged by diminished revenue from decreased volume. On the other hand, payer organizations are well poised for the coming years, primarily because their revenue has been consistent since people have continued paying their monthly health insurance premiums during the pandemic.

I find it ironic that providers find themselves behind the payers in recurring revenue or subscription revenue models since that is what hospitals were seeking when they invented health insurance almost 100 years ago. While researching my book, “Unrest Insured,” I learned that Blue Cross was founded by Justin Ford Kimball in 1929 basically to keep the lights on at the hospital. Upon taking an executive role at Baylor, Kimball found himself unable to pay the bills and decided to seek some recurring revenue. He leveraged his relationships as a former education leader and negotiated a deal with the local teachers’ union — 50 cents a month payment in exchange for 21 days of hospitalization annually. Describing it in today’s terms, he established a per-member, per-month reimbursement model between a patient population and a provider that had established its own payer. This desire for steady revenue, which allows for any organization to plan much further ahead, is what created our current healthcare system.

Many things have changed over the passing century. Payers became less aligned with individual hospitals and more judicious in how much they paid for certain services. Reimbursement became increasingly complex and codified. The Baylor model clearly incentivized hospitalization (which explains why early in my career I could still admit patients for exhaustion), while new medical techniques allowed for advanced outpatient treatment. But 90 years of divergence may be corrected by the accelerated pace of change brought on by one year of a pandemic, change that may bring us back to the original intent of health insurance.

Value-based care means a lot of things. It favors value over volume and outcomes over throughput. It puts a premium on information sharing and coordination of care, which can be made even more robust with new technology. But let’s be clear, it also provides recurring revenue, which makes it easier to plan for providing care and weathering the unknown.

COVID-19 taught me, as a clinician, many lessons. The pandemic has also reinforced the very real reality that fee-for-service continues to break healthcare, and in this current antiquated system, healthcare providers continue to be hit hardest. In order to stabilize our healthcare system, providers need more support and resources in order to prioritize the transition to value-driven care. More so, we need to not shy away from the critical need for recurring revenue for providers.

Without this recurring revenue model — or what has been called value-based care now for years — hospitals and health systems will not be able to survive the next storm, and clinicians like me may no longer have a job.

Readers Write: Remote Monitoring is Crucial for Hospital Asset Management — Here’s Why

Remote Monitoring is Crucial for Hospital Asset Management — Here’s Why
By Scott Trevino

Scott Trevino, MS, MBA is SVP of product management and solutions of TriMedx of Indianapolis, IN.

As any health IT professional would know, the ability to remotely monitor hospital devices is critical in ensuring efficient operations. Unplanned downtime, spontaneous device failure, and unexpected maintenance all impact the ability to safely provide care for patients.

A recent example took place at a hospital in Indiana, when a remote monitoring device was used to detect a fault on an MR scanner. During the proactive repair process, technicians ultimately discovered that the pressure relief valve on the roof of the hospital was stuck open, a defect that could have caused countless other problems. Luckily, the remote monitoring system the hospital had in place allowed them to identify this problem before it caused a domino effect of consequences.

Preventing unplanned downtime is the most prominent argument in favor of remote monitoring. By 2025, it’s estimated that 68% of medical devices will be network connected, which only increases the need for ongoing device monitoring. Hospitals are always searching for cost-effective avenues to help improve patient care and safety, and the efficiency and scalability that remote monitoring offers is unrivaled.

Here’s a closer look at why remote monitoring is an essential component of providers’ approach to clinical asset management.

Remote monitoring is getting smarter

Even the smallest of details can make a difference in a clinical device setting. With remote monitoring, device analytics will only continue to evolve and produce predictive insights for each asset, effectively anticipating potential failures and/or optimizing service schedules.

Device failure is costly and leads to unplanned downtime, labor costs, risk to patient safety, and more. Instead of throwing potential solutions at the wall and hoping one of them sticks, utilizing predictive analytics guarantees that hospitals are putting their resources to good use. A robust remote monitoring system uses predictive analytics to produce data that is crucial in making decisions. This system will pose questions like, is a device worth the cost to continue to repair and maintain it? Or, is it time to purchase new equipment? Healthcare providers that lean on these data-driven decisions will be at a considerable advantage when it comes to optimizing acute and non-acute care facilities.

Care in non-acute settings will become commonplace

Over the past few years, healthcare has seen a large push towards non-acute settings. Transitioning care to outpatient centers helps care systems reduce costs, but reimbursements in these facilities are still lower than in a traditional hospitals, meaning that providers are going to face challenges to transition care without breaking the bank.

Where does clinical asset management fit in? Let’s look at an example. If a provider has 3,000 devices in an acute facility, typically an economy of scale is in place for teams to service on site. If the provider takes 1,500 of those devices and moves them around to various care sites, the cost to service each device at a different site will be higher since it will be less efficient and cost-draining for providers to station service teams at each location. However, this problem can be addressed through a remote monitoring system within a comprehensive clinical asset management program to keep locations up and running.

Servicers productivity must improve alongside device growth

Healthcare providers are not alone in their struggles to reevaluate how to manage a larger equipment footprint. Manufacturers are feeling the same pressure. No longer can servicers, such as OEMs, afford to send out a technician for every service call, especially when many arrive to find device problems that cannot be fixed. There’s little choice but for the labor force to improve productivity and reach maximum efficiency to keep up with the growing number of devices.

The best way to do this is to use remote monitoring, which allows technicians to troubleshoot a problematic device without having to physically be on site. Not only do these systems create better efficiency across the service labor force, they add to hospital systems’ ability to reduce unplanned downtime and improve patient care.

All signs point to remote monitoring as the future of the healthcare industry. Device optimization, cost pressures, and the growing number of facilities in a provider’s network have shown us that remote monitoring is no longer nice-to-have, but a need-to-have for healthcare providers who are ready to embrace a new, innovative landscape.

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.