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.

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

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

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

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

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

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

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

How innovative BH technology improves the effectiveness of remote care:

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

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

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

Readers Write: Healthcare Must Embrace Innovation Beyond the Pandemic

Healthcare Must Embrace Innovation Beyond the Pandemic
By Niko Skievaski

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

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

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

How we got here

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

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

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

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

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

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

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

The path moving forward

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

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

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

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

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

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

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

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

Jeremy Harper, MBI is an independent consultant.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Provide Free Online Screening

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

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

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

Bridge the Digital Divide

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

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

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

Understand what Patients Want

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

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

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

Help Providers Focus on Patients

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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