Readers Write: Why Data Quality Matters in Price Transparency Workflows

Why Data Quality Matters in Price Transparency Workflows
By Cory Deagle

Cory Deagle, is chief product officer of RxRevu of Denver, CO.

As a healthcare technology vendor, we often hear that data quality is critical. It’s true that without access to reliable data, providers will question or even ignore key notifications, patient information, and clinical data. Now more than ever, vendors have a responsibility to both identify and improve the data flowing through their pipes.

Real-time prescription benefit (RTPB) – one example of an integrated tool that brings patient-specific coverage and cost data to EHR workflows – has been adopted by thousands of health systems, hospitals, and clinics across the country. This technology allows patients to understand the cost of their medications, including if lower-cost alternatives are available, while they are sitting with their care provider. I’m sure many of us have experienced the unpleasant surprise of arriving at a pharmacy only to find out the medication prescribed had an outrageous price tag. As more and more providers adopt RTPB, this should become a thing of the past.

While RTPB has incredible power to transform the patient experience, unless the vendor is providing a heavy dose of quality checks against the data, providers will notice inaccuracies or incompleteness, rendering the tool useless when making prescribing decisions. In order to resolve this, RTPB vendors must work closely with PBMs and EHRs to translate indistinguishable codes, ensure clinical relevance, and filter unnecessary noise, all with the goal of providing meaningful information so that providers can have better cost conversations with patients.

Here are a few examples of data quality steps that can be taken to improve provider trust in RTPB:

1. Quantity translations. Providers often enter medication quantities in familiar “clinical” terms (4,500 units of a diabetes injectable, for example) instead of entering quantities in “billing” units. Without a correction of the quantity from insulin units to milliliters (the billing unit for this medication), the cost information displayed could be an astounding $101,000. This is due to the fact that the PBM is pricing based on the quantity of insulin units submitted, which can be 100 to 300 times the billing unit. Vendors must be able to translate intended input quantities to ensure an appropriate covered price of $25 is displayed and communicated to the patient.
   Code Mapping: In many cases, drug costs cannot be determined because the National Drug Codes (NDC) used for pricing are obsolete or not recognized by the PBM. In order to receive an accurate price, solutions must automatically find comparable codes to display relevant pricing information.
2. Clinical logic for improved outcomes. In many cases, solutions cannot display pricing information because of user input error. For example, providers often mis-select the days supply, which can lead to errors such as “maximum dose per day.” Best-in-class vendors are able to leverage intelligence to alter days supply issues and enable transaction success. Clinical expertise and medical literature can also be used to hide erroneous results and prioritize meaningful medication alternatives in the workflow.
3. Message normalization. Providers want to focus on patient experience, but unhelpful error messages in the EHR (e.g. drug not found), slow down the ordering processes and drive mistrust in integrated tools. Standardizing errors codes from payer and PBM partners allows for actionable messaging (e.g. this medication is not covered at the selected pharmacy, please select a different pharmacy) and can improve the care experience.

It is the combination of these quality-focused tactics that can create a truly exceptional  and reliable healthcare experience. Technology vendors can no longer meet the bare minimum when delivering data. If they do, providers will ignore data presented to them, and patients will no longer trust the healthcare system they rely on. However, superior data and technology enable better decisions and drive real value in healthcare.

Readers Write: Unleash Human Capacity – And Leave Time for More Breakfast Burritos – With Better OR Scheduling

Unleash Human Capacity – And Leave Time for More Breakfast Burritos – With Better OR Scheduling
By Michael Bronson, MD

Mike Bronson, MD is an anesthesiologist with Providence Mission Hospital of Mission Viejo, CA; CEO of the Ketamine Wellness Clinic of Orange County of Laguna Beach, CA; and founder and CEO of AnesthesiaGo, which was acquired by PerfectServe in January 2022.

My path to becoming an anesthesiologist was, by all accounts, pretty normal. I went to undergrad, moved on to medical school, completed my residency, then joined a private practice. That was always the goal, and checking each of those boxes was fulfilling.

After I joined the practice, though, I started to wonder what was next. My whole life had been structured around working hard and staying focused on the future, and it felt a bit like I had reached the final phase.

Boy, was I wrong.

Like many other physicians, I was eventually thrust into a position that I never expected to inherit. There was some dissatisfaction in our group with the daily case scheduling process, and before I knew it, I was holding the hot potato in my hands.

As I leaned into this new responsibility, I most often found myself wrapping up daily cases around 5 p.m., only to be handed a stack of papers—representing the next day’s cases—and a pencil that was always topped with one of those old-fashioned detachable erasers. Why, you ask? Well, let’s just say changes, mistakes, and oversights were an inevitable part of the process.

This probably sounds relatable if you’ve ever doled out OR case assignments, but I’ll explain for everyone else. Fundamentally, it doesn’t sound too challenging—just put a name next to every case, make sure they’re not in two places at once, make sure they’re qualified to do every case, and make sure they’re credentialed at all locations.

But then come the other considerations. First, the person on call should get the most complicated cases. Second, you’ll find that surgeons often have preferences about who they want—and do not want—in the OR because of prior experiences. And finally, the patient may have a strong preference for a particular anesthesiologist because they were assigned to them previously. We always try to accommodate those requests when possible.

When you put all of this together, things can get messy. Like clockwork, every time I sent out a proposed schedule, calls and texts from colleagues would begin. Maybe somebody was double booked, or maybe there wasn’t enough travel time to get from one location to another. The reasons varied, but changes were always necessary.

In the end, this almost always took an hour or more, and I’ve seen anesthesiology groups where scheduling—which is typically done by a senior anesthesiologist—can take up to two hours. And remember, this is adding time to the end of the scheduler’s day, preventing them from going home or doing other important non-work activities.

If you’re reading this wondering whether technology can be used to improve this process, you’re asking the same question that popped into my mind several years ago. The short answer is yes, there’s a better way.

Scheduling technology isn’t necessarily new, but for a long time, the only vendors that existed were the ones that could take care of monthly scheduling needs: who’s on call, who’s working every day, who’s on vacation, and so forth. That’s a different animal than building a daily OR case schedule.

With intelligent OR case scheduling technology, you can use automation to quickly generate and distribute schedules that are free of the common mistakes people like yours truly would make when building them by hand. We’re all smart and well intentioned, but in this instance, technology is definitely the answer.

Going a step further, we can even champion provider wellness in a meaningful way. If a surgeon works best with a specific anesthesiologist, why not pair them together as much as possible to create an ideal working environment? As it turns out, technology can do that too.

I want to reinforce that none of this means we need to remove the human touch from healthcare. The best technology will make clinicians’ lives easier every day, but it should also give them a chance to provide meaningful oversight. No system is perfect, after all.

But in the end, shouldn’t we all be hyper focused on identifying and improving dated processes like the one I described? For me, getting home later every day because of scheduling duties meant less time with my family, and I had fewer chances to enjoy a favorite pastime with my son: grabbing a breakfast burrito.

Let’s all continue to think of better ways to unleash more human capacity by freeing ourselves from age-old processes that require too much time and effort. Less time being frustrated, more time caring for patients, and more time getting breakfast burritos with my son.

Readers Write: The Life and Times of Dave Garets, Healthcare IT Evangelist

The Life and Times of Dave Garets, Healthcare IT Evangelist
By Ivo Nelson

Ivo Nelson is an entrepreneur, author, and speaker of Huntsville, TX. Helping with this tribute were Mike Davis, Steve Lieber, and Phil Pead. 

Dave Garets passed Monday morning at the age of 73, having battled Parkinson’s disease for several years. Dave made a huge impact on the healthcare IT industry.

It is hard to separate the man from his mission. For in Dave, he had the goodness of the human being coupled with the mission of improving healthcare. Dave believed that if technology was uniformly adopted in healthcare, then caring for patients would be greatly enhanced and outcomes would improve and become more predictable.

Two ideas formed from his healthcare IT experience. One was that the technology had to meet certain standards, because after all, healthcare IT was affecting people’s lives. The second idea was that healthcare IT had to be universally adopted to obtain the maximum benefit to society.

As a result, Dave left his mark on an industry that has now become almost entirely dependent on technology, the capture of healthcare data that is used in research to improve care outcomes and care safety, and delivering standardized care protocols to support lower cost and higher quality of care.

The early days of Dave’s exploits are told about his nightly guitar playing at local Idaho bars. He used this musical skill at several HIMSS venues over the years to create a unique identity for his presentations. Dave’s introduction to IT was developed by AT&T, where he would tell people that he used to code in assembler. Gartner analysts gave Dave the benefit of the doubt about his programming skills. Dave was an accomplished CIO for Magic Valley Hospital in Twin Falls, Idaho for several years, where he became a thorn in the side of Meditech.

He then moved on to management consulting with Arthur D. Little before joining Gartner as a VP for healthcare research and analytics. At Gartner, Dave demonstrated his executive management skills by successfully managing a group of research analysts who were highly intelligent, accomplished, and opinionated. The research and advisory team he built at Gartner is considered one of the best in healthcare.

Gartner provided the platform for Dave to truly shine. Dave loved being at the front and center of emerging healthcare technologies and regulations. He relished being on stage, presenting well thought out and defensible positions for using healthcare IT to improve healthcare. He promoted healthcare IT across the US and at international venues. Dave’s involvement with driving healthcare research provided him the platform to establish relationships with other powerful healthcare IT executives in provider, payer, and vendor organizations. Many vendor executives considered him a nuisance, especially when then did not deliver what they promised to the market.

I recruited Dave to my Healthlink consulting company to help drive consulting services for providers. Once again, Dave recruited the best and the brightest to join Healthlink during a pivotal point in the company’s growth. Under his leadership, Healthlink built one of the best strategy practices in the healthcare IT industry.

It was during his time at Healthlink that Dave was asked to be the chairman of the largest association in the healthcare industry, HIMSS, a byproduct of a merger between CHIM (healthcare IT vendors) and HIMSS (healthcare IT provider members).

Two major components of the deal struck from the CHIM-HIMSS negotiations were to change the formal membership structure to include a corporate member category (vendor companies) and to change the volunteer leadership succession in such a fashion that guaranteed that a CHIM (vendor representative) board member would become the next HIMSS chair. While this would not be the first time an employee of a vendor served as the volunteer chair of HIMSS, it would be the first time under the new membership structure.

The planned CHIM succession, which would determine who that new HIMSS chair would be, wasn’t the best approach for the organizations’ strategic objectives for the merged association. To solve this, Dave was instead elevated within CHIM leadership rotation and thus setting the stage for him to serve as HIMSS chairperson.

Dave was instrumental during his HIMSS leadership tenure in gaining widespread acceptance of the corporate community as full-fledged members of HIMSS. As both a former CIO and vendor, Dave was able to speak to both audiences and helped reinforce the strategic concept of HIMSS as a big tent, a place that was open and welcome to all points of view to get to the right answers for the American health systems and the patients they served.

It was during his term as HIMSS chair that HIMSS acquired survey research and data assets from The Dorenfest Group and set into motion a series of events that took Dave, HIMSS, and the entire health information technology sector in new directions that shaped HIT adoption trends and federal HIT policy for more than a decade.

Upon the acquisition of Dorenfest by HIMSS, a national search was conducted for the management head of the new initiative, which became HIMSS Analytics. Dave resigned as HIMSS chair and was hired to lead this group. Dave again demonstrated his executive management skills by converting a demoralized and toxic employee base into an empowered and progressive culture that generated an accurate and highly respected provider IT market database solution.

It was at HIMSS Analytics that Dave helped develop the EMR Adoption Model (EMRAM) that was used to objectively identify acute care EMR capabilities in hospitals. This model provided a simple and accurate assessment of provider EMR capabilities for supporting healthcare delivery.

In the early days, the model was challenged, and at times, maligned. Dave’s relentless promotion of the EMRAM in the US and internationally was the key factor in its market adoption, success, and impact on the EMR market and federal health policy. Much of the early dissatisfaction was how the model showed the lack of not only coherent HIT adoption, but also how the healthcare delivery system significantly lagged other business sectors in its technology adoption. The model’s enduring success proved that the thinking behind the model was right, and it ultimately became deeply connected to the US government’s efforts to spur the adoption of electronic medical records.

After achieving success with HIMSS Analytics, Dave was recruited by The Advisory Board Company to create a research and advisory service. Dave recruited several of his old Gartner team members to help create and launch it, the first at the Advisory Board to be completely electronic in format, replacing an outdated and expensive paper publishing research service. Dave also helped promote new consulting services for the company related to Meaningful Use regulations and the emerging ICD-10 coding system.

Dave retired from the Advisory Board, almost. He continued to take on consulting projects that kept him busy working with his wife Claire with their company ChangeGang that kept him connected to the healthcare IT market.

Dave helped drive healthcare IT advancements that resulted in considerable improvements for the market. He is irreplaceable in his zest for driving healthcare IT to enable higher levels of high-quality healthcare services. He created and developed strong corporate teams, he played the politics necessary to keep his team from experiencing corporate disruptions, he was the chair of HIMSS and participated in CHIME’s CIO boot camp training curriculum for several years, and he mentored his teams that generated several successful IT professionals.

Dave lived life large. He once owned three yachts at the same time (not on purpose). He traveled globally and immersed himself in the local cultures. He always had a well-stocked wine cellar that he gladly shared with friends. He married Claire, who was his intellectual match and had the character to keep him on his toes.

Dave slid into the home plate of life with a torn uniform, dirt on his face, bleeding, and missing a few teeth on March 28, 2022. But what a ride he had.

May God bless him and welcome him into heaven.

Readers Write: Thirty Years in Healthcare IT, An Accidental Pilgrimage

Thirty Years in Healthcare IT, An Accidental Pilgrimage
By Jim Fitzgerald

Jim Fitzgerald, MBA is founder and EVP/chief strategy officer of CloudWave of Marlborough, MA.

Friday is my last day at CloudWave, my latest and likely last team in which I labor full time in the healthcare IT space.

Whether you work at a healthcare provider, an industry software vendor, or a managed cloud services company like ours, healthcare IT is by nature a team sport. It is also often as much a vocation as a career. There are darned few deep thinkers, deeply technical people, or talented managers in HCIT who could not make more money outside of it. But on the flip side, could probably not muster the directed passion for the work outside of HCIT.

That has been a recurring theme from the time I entered this business in 1993 by joining a firm weirdly and appropriately called JJWild. Everything along the way needed to be designed, built, and managed so that to the greatest extent possible it could ease and empower the safe delivery of healthcare,while being where possible, “minimally invasive.” You would have to be a heartless megalomaniac (not that we notice many on the world stage these days) not to be able to buy into that mission. After all, short of a handful of blessed protected natives sequestered deep in the Amazon who have never had to read an Explanation of Benefits, we are all healthcare consumers. Some combination of spiritual awareness, concern for our neighbors, and enlightened self-interest continues to drive the space as powerfully as financial motives. At least I hope so.

What was the road like? In 1983 (yeah, I’m that old), I was working in a non-healthcare oriented technical and marketing support role at a modem company called Microcom. Our modems were unique in that the analog / digital conversion and signaling engine was overlaid on a Z8 breadboard with a whopping 64K of RAM that booted its own device OS and loaded code from EPROM that allowed the serial interface to be programmable and also allowed the modems to run their own in-band data communications protocol to protect the data stream.

This caught the attention of a rapidly growing HCIS vendor called Meditech, whose founder, Neil Pappalardo had invented a proprietary color terminal for their Magic OS that would deeply impact the industry. The appealing interface could do block and character color graphics at about 20% of the cost of a PC and almost no maintenance. The catch was that for remote data access, it needed a connection between the terminal and the remote terminal server that had no data communication errors, as the terminal server and the terminal were in constant “chatter,” both to transmit and receive HCIS data and to manage screen formatting and behavior.

That’s how I got to know Meditech, and it changed my path. Nine years later, I joined the team at JJWild at the urging of one of Meditech’s system gurus, Chris Anschuetz, whose simple explanation was, “We are moving from Magic to TCP/IP. Our customers are going to need open networks and we need partners who can build them.”

My personal education on TCP/IP had come from a product manager at Microcom, Eugene Chang, an MIT engineer with a gift for making the complex simple. He had helped build DARPANET while at the semi-legendary consulting firm Bolt, Beranek, and Newman. I was excited. Shortly thereafter I found myself counting wires in hospital closets, ceilings, repurposed laundry chutes, and ceiling chases. Lab visits were always the frightening highlight of those network walkthroughs.

One thing led to another. JJWild helped Digital Equipment / Compaq introduce the Alpha to the Meditech community. Data General, Meditech’s larger systems partner, got sold to EMC. JJWild started offering applications, tech consulting, and managed disaster recovery services to hospitals.

Oddly, this tech support guy turned sales engineer turned sales guy (also known by “pure” engineers as the path to the dark side) was kicked into a CTO role at JJ to cap my cost to the organization. It was insane in scope, but could be a lot of fun. I got to work with a large cross section of the company – sales, consulting, engineering, support, and partner management — while still being able to work daily with our hospital customers. A group of us from inside and outside the company constantly debated and schemed to figure out how to build unbreakable systems to support healthcare apps. We got support to launch a private cloud-based disaster recovery service, JSite, at JJWild.

Perot Systems gobbled JJWild up in 2007 and put us to work before the ink was dry on harnessing emerging cloud tech to host legacy healthcare apps. A hosting solution called MSite was introduced by Perot in 2008. Dell bought Perot in 2009 with the intent of becoming more services-oriented, but the Meditech team at Perot barely showed up on their financial radar at the time.

When it became clear we were not a core strategy for Dell at the time (they sold Perot to NTT Data in 2013), 27 of us quietly left Dell from October 2011 to May of 2012 and joined with Park Place International. Its founders agreed to fund a new hybrid cloud managed services venture that would evolve into CloudWave and a suite of secure, highly available managed services called OpSus that today hosts over 125 diverse applications from EHR to enterprise imaging for more than 200 hospitals, securely backing up petabytes of data to both public and private cloud, and disaster recovery protecting over 175 hospitals.

Our services, with a cross-cloud platform sourced from our own secure private cloud data centers as well as AWS and GCP, began to transcend the Meditech realm and are gaining new customers from hospitals running Epic and Cerner, as well as smaller ISVs who need somebody to provide an ops center that can “take them to cloud.”

What do I see coming? The 20-year cycle in IT that goes from everything centralized to everything decentralized will continue and perhaps compress. The ongoing migration to cloud is driven by economic, operational, and security forces and will continue, but the cloud edge will also get built thoughtfully to support advances in genomics, analytics, and machine learning. Either PHRs will become real and the consumer will be their own best health data steward, or the vaguely and mostly unintentionally evil government / medical / pharmacy / insurance megaplex that wants no one to really have a private life will win and someone other than you will own your EHR.

Consumers will reassume financial responsibility for their own healthcare with some kind of underlying insurance for big bills or will surrender to a central system that doles out equal misery and lack of excellence for all. Black hat hackers will be heavily prosecuted instead of modestly slapped and sent to abandoned monasteries to do something useful for the rest of their days, like crush wine grapes with their feet. All but the largest integrated healthcare systems will get out of the IT business in a similar fashion to how they got out of the laundry and food service businesses and buy IT services modularly, the way individuals mix apps on their tablets. No matter where you sit in the space, it’s still going to be a wild ride.

What have I learned? Most hospital IT teams I have worked with over the years are understaffed, underpaid, and hugely dedicated to their work. They have capacity for X projects per year, demand for 3x projects, and funding for X/2 projects. They adapt like ADHD chameleons traversing a mosaic. Intended and unintended poop is flung at them by regulators, vendors, colleagues, and customers.

You are collectively some of the best people I could have hoped to serve. Thank you for the privilege.

Readers Write: What We Can Learn from Nurse Mobility

What We Can Learn from Nurse Mobility
By Richard Watson, MD

Richard Watson, MD is the co-founder of Motient of Greenwood Village, CO.

I’ve always been envious of our nursing credentialing and licensing system. I’m not easily given to professional jealousy, but over the years, I’ve worked through the process of becoming credentialed in three states and six hospitals. The mere thought of the effort required is enough to dissuade one from changing locales. Nurses, however, have compact licensing agreements, and a good two-thirds of the states accept licensing across state lines. This is a great idea, and it’s long overdue for the physician credentialing process.

When I applied for licensure in Alaska, I was warned about the protracted time frame. I had long dreamed of working in the remote areas of the state, and I assumed that since the need for healthcare access was significant, the credentialing process would be easy. Au contraire, my friend! Evidently, there is a whole cohort of medical professionals with difficult pasts who expect Alaska will be an easy reentry point into the profession. In any case, the length of time between communications led to an almost nine-month process. In the mean time, my nursing colleagues were freely moving and working from state to state.

During the nascent stages of COVID, nurse mobility became an absolute necessity. While the news reported on the explosion of coastal cases, the rest of the country remained almost free of contagion, yet people were deeply hesitant to seek urgent and emergent care. Emergency room and EMS volumes plummeted, and hospitals experienced record low capacity.

Because of the great disparity in COVID prevalence, hospitals on the coasts were struggling with staffing crises, while most other states were laying off staff. Compact licensing agreements allowed nurses to step in to fill urgent needs in the system. The number of travel nurses expanded rapidly, rising by 40% in 2021. As cases spread nationwide, the need for staff became much more uniform. Now, with nursing attrition rates at an all-time high and nursing staffing levels at an all-time low, agency nursing has moved into position as the primary broker of nursing resources.

To add fuel to the fire, the massive influx of COVID relief funds has only multiplied the problem. Nurses are readily being poached from one state to another—and often back to locations closer to their home base—at several times their original salary. No one could fault nurses for capitalizing on this unique circumstance, and there is a longstanding, valid argument that nursing salaries have lagged far behind even salaries for medical professionals who have no patient contact whatsoever. But where is this really headed?

Surely hospitals are doing the math, calculating the percentage of agency nurses they’re using versus their incoming revenues for floor and ICU beds; presumably, they’re tracking how the influx of agency nursing is impacting overall costs and revenues. Or maybe not. In this artificial world of COVID dollars, where the gates are open and entry is relatively easy, the actual fallout of these short-term relief programs is poorly calculated.

Agency nursing is set to expand by another 40% in 2022. Some healthcare organizations have called for the FTC to examine these practices and policies, but the rate of expansion far outstrips the analysis. Some have called for a moratorium on agency nursing, as well as for a centralized staffing commission and other bureaucratic solutions. But honestly, once the COVID dollars are closed, the revenue incentives for the high staffing costs will be gone. To my mind, three points stand out in this quagmire:

• Nurses are one of the most important components of our healthcare system. Without a doubt, nurses are those in closest proximity to patients experiencing a health crisis. We must provide them with an environment that fosters the genuine compassion and agile intelligence we will all need at our bedside at some point.
• We must begin to understand that every problem in healthcare—from the minor to the pandemic-sized—doesn’t necessarily benefit from sweeping edicts and centralized solutions. The COVID story is rife with examples of unintended consequences.
• Our government agencies must stop throwing money at everything that seems difficult in healthcare. Shoring up a dysfunctional system with an influx of ready cash just solidifies that dysfunction. The difficulty of a strong central regulatory system is the lack of knowledge about what constitutes real solutions at a regional level.

We are rapidly moving toward the time where we will need to rebuild a healthcare system that is begging for renovation. Much of what is good about our healthcare is the direct result of the nurses and other frontline professionals who compassionately care for others. We need to take advantage of these seminal moments to strip away the obstacles for those who are doing that irreplaceable work, so that it becomes easier for them to follow their calling within a sustainable system.

Readers Write: Reimagining Healthcare in 2022 with Personal Emergency Response Services

Reimagining Healthcare in 2022 with Personal Emergency Response Services
By Janet Dillione

Janet Dillione is CEO of Connect America of Bala Cynwyd, PA.

One of the most critical moments in healthcare is the 60 minutes after a catastrophic event, such as a sudden fall, when a person has the greatest chance of recovery if they receive immediate medical care.

Among older adult patients, falls are one of the biggest worries, and for good reason. Falls are the leading cause of fatal injury among older adults. Additionally, one-fourth of US adults aged 65+ fall each year, according to data from the Centers for Disease Control and Prevention.

When stakeholders consider reimagining healthcare to address the challenges facing patients, they often think that innovation must be manufactured out of thin air. But increasingly, leaders recognize that it is usually the most tried and true technologies, like personal emergency response services (PERS), that deliver the most effective results for patients and drive innovation forward.

Given the lingering effects of COVID-19 on healthcare, including the growing preference among senior patients to utilize telehealth and other virtual care services from the comfort of their own homes rather than in a medical facility,these patients will need more than a sensor or button to keep them safe and healthy.

It’s incumbent upon healthcare organizations to develop connective care and digital health solutions for seniors living at home, to do right by the patients they aim to care for and create fail-safe services and technologies that operate consistently. These stakeholders must build reliable and flawless systems that seamlessly integrate non-intrusive services and technologies for aging individuals remaining at home.

One encouraging note is that the industry has a strong foundation of innovative healthcare services and technologies that allow older patients to safely live at home with dignity.

Look no further than PERS, which keeps patients independent by allowing them to push a button that instantly connects subscribers with highly trained emergency response operators. For these vulnerable patients, it’s a benefit to reach someone who can assess the situation and send help if needed, whether it’s caregivers, family members, emergency services, or neighbors. Some PERS devices can even detect a fall and immediately contact an emergency operator.

While these services are both essential and remarkable, PERS provides so much more for patients in need. Behind the button is a complex network of call centers connected to 911 that make sure emergency medical services (EMS) are dispatched to the home when required. These are significant advantages compared to an ordinary watch.

Despite realistic concerns about consumer health technology, as more technology companies enter the healthcare market space, it’s critical to emphasize that no single solution is enough to deliver optimal services and care to the growing population of older adults and vulnerable aging at home.

Subsequently, there must be a system of integrated technologies and services, including traditional PERS, medication management and adherence solutions, remote patient monitoring (RPM), and a fall detection system that all combine to feed a robust analytics engine delivering actionable insights. These include alerts and risk-scoring to payers, care teams, and caregivers.

Consider PERS as the foundation for a system bringing on an increasing number of essential technologies and services into the home. RPM and hospital-at-home models build on and integrate with PERS by allowing senior adults with chronic conditions, as well as more acute illnesses, to receive care at home. These care models use medical-grade wireless devices to transmit vital health information to a virtual dashboard and a medical professional who is monitoring in case of a need to respond. Simultaneously, RPM allows clinicians to analyze aggregated data from the patient portal and electronic medical records, thereby enabling them to monitor results and accordingly update care plans for data collection and analytics.

Healthcare executives understand the entire value chain: delivering products, care, and technology must work as an integrated service. When this occurs, older and vulnerable adults have the best chance of living safely and independently in their home while avoiding costly and disruptive facility-based care.

Most importantly, healthcare organizations don’t need to create new technology or put their trust in unproven solutions. PERS and its extensive technology, communication, and services have a highly reliable track record that can serve as the platform for additional technologies and services delivering consistent, safe, and proactive care within a patient’s home.

Readers Write: It’s Time for the EHR to Give Back to Clinicians

It’s Time for the EHR to Give Back to Clinicians
By David Lareau

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

Recently, a colleague (who just happens to be an MD) relayed a story after accompanying his 93-year-old mother to a routine check-up for wet macular degeneration. She had been recently discharged from the hospital after an episode of atrial fibrillation, for which she was put on an anticoagulant. At the retinal specialist appointment, the patient access / intake representative was told of her A-fib episode and the medication change, which was dutifully entered into the medical record.

Fast forward to 10 minutes later and 50 feet down the hallway in the exam room. The retinal specialist enters and asks if the patient is ready for her regular injection in her eye. Naturally, the patient’s MD son raises the red flag and asks if she had consulted the medical record. The doctor acknowledged that she had, but didn’t see what had changed.

Granted, very few folks have an internist son who can accompany them and act as a personal medical record interoperability specialist. But the message is clear. Here we are, some 40 years into the EMR age, and many of the same old interoperability and usability issues that plague these systems are still with us.

Fortunately, progress has been made and is escalating. It’s been a quiet, behind-the-scenes process, but it’s happening. In 2003, the government approved national terminology standards, including SNOMED and RxNorm, and others have followed. Then, in 2009, with the HITECH Act, some $40 billion were distributed to promote and expand the use of electronic health records. And in 2012, the FHIR standard first emerged as a way to exchange information. The groundwork was laid, and this has accelerated in the last three years with increasing adopting of FHIR. The potential for incremental innovation and the acceptance that things need to change is encouraging.

Over the past few years, the COVID-19 pandemic has shown that clinicians need better data. People have become comfortable with virtual visits. As a result, physicians, particularly those in primary care treating Medicare patients, are losing much of the high-touch environment of the past and need faster access to better data. But the industry has been slow to adopt the sharing of information because there was no mandate. This all changed with the advent of the 21st Century Cures Act.

The widespread adoption of FHIR over the past two or three years has enabled us to diagnostically connect information that has spread throughout disparate systems. And now with the Trusted Exchange Framework and Common Agreement (TEFCA) to establish the infrastructure for information exchange, it’s increasingly possible to find clinically relevant information, transmit it, and access it at the point of care.

Ultimately, dramatic change will be driven by the management of chronic conditions within Medicare Advantage, the government’s move to value-based care. Reimbursing providers for how well they manage conditions and control costs will accelerate the need to provide clinicians with the clinical information connected to the diagnoses they’re trying to treat.

Medicare Advantage now accounts for 42% of all Medicare patients, a figure that the Congressional Budget Office predicts will rise modestly to 50% by 2030 given no changes in policy or structures. Meanwhile, the Centers for Medicare and Medicaid Innovation recently issued a statement saying that their aspirational goal was that 100% of Medicare patients be on these managed plans by 2030. They admit they won’t get reach this goal, but that tells us that they are not completely comfortable with the current policy. They want to accelerate the adoption of Medicare Advantage, which is really all about managing patients’ chronic conditions.

This is important because commercial payers historically have followed the Medicare model for reimbursement.

For all the advances and progress in interoperability and usability, challenges remain. There’s been a lot of talk about AI, machine learning, and letting the computer figure it out. These are promising technologies, and there are initiatives underway involving ambient listening and clinical notes. Despite progress on this front, clinical notes remain just the way they were several years ago––a bunch of text. It may be advancing, and it’s helping the clinician to do their work, but it’s not really giving anything back to clinicians. That is one of the things missing in our industry. Systems have been designed over the years to simply collect billing data, as opposed to giving something back to the clinician that uses them.

This raises the question of usability.

If you think back to the story about my colleague’s mother, the system was so unusable that the clinician had a hard time looking at an updated problem list. Usability is coming to the forefront because clinicians are simply getting tired. They talk about it. There are studies showing that systems that are not usable or clinically relevant, or giving something back, are burning physicians out. We can, and must, do better.

Usability, interoperability, the Cures Act, and TEFCA are all converging along with the accompanying data tsunami (and, yes, it will be a tsunami) to change the way we use healthcare data. Thankfully, we have a FHIR standard that appears to be the platform for interoperability going forward. And there are technologies available and in the works to make the flood of data usable at the point of care. Clinicians to need to be able to see that data and act upon that data.

With the move to value-based care changing the focus of the industry to “How do I best manage this patient and get better outcomes for each of their clinical conditions?” we see a wave of innovation being unleashed. That wave is spreading to existing systems and infrastructures, and it enables the industry to respond.

Modernizing these systems so that they give something back to the provider at the point of care is the goal. We are excited about the possibilities for innovation and the acceptance that things need to change.

Readers Write: What The (Behavioral) Health? Let’s Shift the Focus from Access to Care to Quality of Care

What The (Behavioral) Health? Let’s Shift the Focus from Access to Care to Quality of Care
By Eric Meier

Eric Meier, MBA is president and CEO of Owl of Portland, OR.

Expanding access to care has been a top challenge over the last two years in behavioral health due to a significant increase in demand for treatment services. Fortunately, traditional providers and new market entrants have quickly responded to this need and dramatically increased virtual care through telehealth and digital offerings to improve access for communities across the country.

While expanding access to care should and will remain a priority, the conversation should now include, are we providing quality care to improve outcomes? Are people actually getting better through our behavioral health services?

Delivering quality behavioral health services is focused on delivering the right treatment to the right person at the right time for the right duration. Essentially, quality is defined as effective and efficient delivery of care that improves patient outcomes at the lowest cost of care.

Now that we’ve defined quality, how do you know how to achieve it? That’s where the focus on measurement comes in. Measurement of health outcomes and quality in physical health is the status quo, but it isn’t yet a consistent practice in behavioral health. 

Imagine if the nation had a hypertension crisis and we spent half a trillion dollars to get patients seen by a physician, yet failed to measure their blood pressure on an ongoing basis to confirm they were delivering quality care that improved patient health. That just doesn’t make sense in physical health, and with the availability of advanced and easy-to-use measurement-based care (MBC) technology, it doesn’t make sense for behavioral health either.

MBC incorporates the longitudinal use of evidence-based measurement assessments to gather patient-reported outcomes. This tool captures symptomatology as well as progress throughout treatment. The data from MBC provides clinicians with actionable insights to personalize treatment in real-time to therefore optimize patient care.

Two critical success factors of a MBC strategy are strong patient engagement (i.e. 90% of your patients are completing the assessments at their convenience, on any device, throughout treatment) and consistent, standardized use of MBC throughout the organization as part of patient care regimen. Armed with this critical data, organizations are equipped to screen and triage patients to the right level of care, individualize treatment based on each patient’s unique symptomatology, and guide the treatment plan to know when to step the patient up, down, or out of care. 

Furthermore, behavioral health organizations are starting to recognize the critical role that MBC-derived data will play as the foundation for value-based reimbursement contracting. It is precisely these data insights that will prove how patient populations are improving and how your organization is delivering quality care. This data transparency on patient outcomes enables providers and payers to be on equal footing to create value-based payment contracts.

Readers Write: Why 2022 Will Be the Year of Wide Adoption of Blockchain Technology in Healthcare

Why 2022 Will Be the Year of Wide Adoption of Blockchain Technology in Healthcare
By Stuart Hanson

Stuart Hanson, MBA is CEO of Avaneer Health of Chicago, IL,

To all the HIStalk readers who are skeptical of blockchain in healthcare, this one is especially for you. I look forward to discussing further with each of you!

I believe the inability to lifecycle manage and effortlessly share data (with patient permission) is one of the biggest problems in our health system today. As an industry, we must be able to track clinical insights with administrative data together, in order to maintain a complete view of the individual and their specific needs. As we all know, there is no way to dynamically link data in joint processes with multiple parties at scale that is automated, permissioned, traceable, and highly secure. This must change.

The first step is to view healthcare data as a digital asset. Blockchain makes this possible.

Blockchain technology solves many of the challenges with digital asset management as we’ve seen with cryptocurrency. By viewing patient data as a digital asset, we can shift our view from the technology, processes, and workflows used to manage patient data and begin focusing on how blockchain can become part of the healthcare ecosystem.

While large organizations rapidly identified ways to use blockchain, the technology has shown itself to be disruptive to processes, business models, and competitive environments, resulting in a slow adoption of blockchain in healthcare. However, the industry is learning from its initial efforts and is ready to use blockchain as the following elements become more real:

• Governance. Blockchain enables coopetition in a way that existing technology cannot. The idea of hospitals joining a community of trust with payers is unheard of, but is made possible with a governance structure that can be trusted and powered by blockchain. We’ve seen how Cleveland Clinic and Sentara Healthcare have teamed with payers like Anthem, HCSC, and Aetna to develop a blockchain-enabled network. They formed a consortium and spent several years developing the governance framework, then founded Avaneer Health to use the governance structure and develop its healthcare utility network infrastructure for accessing data, deploying solutions, and creating a marketplace.
• Use cases for permissioned, nationwide blockchain are emerging. Administrative processes in healthcare are burdened with waste and inefficiency. In the midst of this challenge, a blockchain-enabled network eliminates the need for point-to-point connectivity by creating an environment of “connect once to many.” Also, a blockchain-enabled network functions as a verifiable trust layer for joint processes between participants on the network. Because of that agreed, verifiable trust function, counter-party risk of data sharing is significantly reduced. Each participant on the blockchain knows with a certified verification that the other partiers are “good actors” and agree to interact with each other using automatically enforced standards. No other middleman data processing entity is needed to guarantee the integrity of the data or transaction. Only once all the participants can verify trust against the others in how, why, and when they will interact, does truly continuous dynamic data updates and sharing becomes possible. This is the vision for the future state for all healthcare organizations.
• Momentum creates more momentum. Many early blockchain healthcare initiatives struggled with adoption and languished in research and development. They seemed all but doomed because of the lack of collaboration. However, that’s no longer the case with the payers and providers mentioned above. Together, they have created a blockchain network with a collective 80 million covered lives and 14 million annual patient visits. And organizations like PNC Bank are now launching solutions that impact thousands of providers and numerous payers nationwide. This is what momentum looks like and it’s just the beginning as large organizations see they have a vested interest in participating.

Healthcare innovators have developed solutions using blockchain for medical supply chain, health credential validation, provider credentialing, patient data security, and life sciences. It’s time to broaden our scope to look at all healthcare processes as opportunities for transformation using blockchain. The train has left the station. Are you on board?

Readers Write: Five Ways to Increase the Value of Your EMR

Five Ways to Increase the Value of Your EMR
By Jason Friedman

Jason Friedman is VP of sales for EVideon of Grand Rapids, MI.

In a 2021 survey by Stoltenberg Consulting, 59% of hospital CIOs said getting the most out of their IT purchases, such as their EMR, is the biggest financial goal for next year. EMRs and EHRs have given rise to digital transformation in healthcare, and there’s no denying that adopting these tools has forever changed the way clinicians and healthcare staff do their jobs.

Yet, our industry is at a tipping point. The field of nursing is in crisis. Clinicians are burned out. There is a widening gap in health inequity. Trends in healthcare consumerism are putting increased pressure on a strained system. Never has it been so clear that it is time to think differently about the future of healthcare technology.

How can we do this? 

Deliver patient-centered care by personalizing the patient journey

The first step is to shift the focus of the EMR back to the patient by presenting information in an understandable and meaningful manner.

A digital whiteboard, when integrated with your EMR, is a centralized information hub for patients, families, and care teams, providing real-time health information that will improve care coordination as well as the overall care experience. Integration with the EMR and other installed technologies allows hospitals to personalize the patient journey with tailor messaging and targeted patient education.

In a recent research study, Brigham and Women’s Hospital (BWH) in Boston, one of the top-ranked hospitals in the US, partnered with a consortium of companies to research the impact of in-room digital whiteboards on communication and patient satisfaction in the emergency department. The study showed that 96% of participants preferred a room with a digital whiteboard as it improved communication and helped them feel more informed throughout their stay and prior to discharge.

In addition, 70% said the digital whiteboard helped them better understand what was happening during their stay. Beyond keeping patients informed, the whiteboards display patient information seamlessly, leaving little room for human error and allowing clinicians to focus on providing quality care.

Automate clinical workflows to enhance the clinician experience

We all know how overloaded and stressed nurses are, especially during this pandemic. A study published in the Journal of the American Medical Informatics Association found that higher EMR usability scores are associated with lower odds of burnout, and those usability scores have sharply declined. Specifically, researchers found that among 1,285 nurses who responded to a November 2017 survey about usability and burnout, the mean nurse-rated EMR usability score was 57.6. A 2019 study by the Mayo Clinic also supported that finding.

It’s time to make technology work for both patients and the care team. By integrating nutrition services, real-time location systems (RTLS), room controls, and other technology elements, you can automate many administrative tasks. For example, when a digital whiteboard is integrated with the EMR, nurses no longer need to manually update dry erase boards (or chase down a working marker). Advanced technology can turn the patient room into an extension of the care team, enabling clinicians to better focus on direct patient care.

Increase patient satisfaction

Patients naturally feel a sense of unease in a hospital. They’re away from home and feeling a loss of control, all while being worried about their health. Giving patients the ability to control elements in their room such as room temperature, shades, and lights, through an integration with building control systems, is a small thing that can have a big impact.

Giving control and self service back to patients can positively impact their overall rating and likelihood to recommend the hospital on their HCAHPS survey. For example, letting patients order their meals from their TV or other device – through an integration with nutrition services solutions such as Computrition, CBORD, or Morrison – puts patients in control, reminding them of the concierge service they get at home from apps like DoorDash and GrubHub.

A personalized, end-to-end experience and environment can enhance satisfaction. A television that greets patients by name as they enter the room provides easily accessible entertainment (movies and streaming TV), enables video visits with loved ones, and displays relaxation content that helps with stress and sleep can all contribute to a supportive patient environment.

In addition, announcing care team members on the TV as they enter the room, via RTLS integration, provides patients with a sense of security that the person in the room should actually be there.

Hospitals can also automate non-clinical service requests. From their room, patients can request clean linens, a visit from the chaplain, or other available hospital services.

Lastly, hospitals can keep a pulse on patient sentiment using pop-up surveys that unobtrusively collect patient feedback while they enjoy entertainment or education. Real-time insights can be automatically routed to key departments for service recovery, ensuring dissatisfiers don’t turn into HCAHPS issues.

Inform and protect patients, staff and visitors

Technology innovation can have a major impact on patient safety and workforce safety initiatives. One way to reduce harm and avoid preventable errors is using the EMR as the single source of truth to keep team members informed and aware of critical patient information.

Digital door signs that are integrated with the EMR can display critical safety information just outside the patient room. Real-time access to accurate health information can not only save staff time by eliminating the need to log into the EMR, but it also keeps them informed of any and all precautions or life-saving steps they may need to take.

Digitizing broad communications is another great way to keep patients, staff, and visitors safe. Throughout the COVID-19 pandemic, hospitals have leveraged digital signage to automatically disseminate crucial information like hand washing protocols, visitation policies, and other urgent COVID-19 related information.

Automating and digitizing manual processes reduces human error and empowers care care teams by giving them instant access to accurate, reliable, and real-time patient information when they need it most.

Manage your digital front door strategy

Rising trends in healthcare consumerism continue to push hospitals to integrate new technologies and enhance existing technologies to do more. Collecting real-time patient feedback and creating meaningful connections with your patients wherever they are, whenever they need you will help to build brand loyalty and drive utilization.

A tech-enabled experience before, during, and after the hospital stay can not only yield better health outcomes, but also influence hospital choice. Let patients complete forms prior to admission, and help them prepare for a visit and care post-discharge by sending patient care guidelines and education directly to a personal device. Delivering a care experience that is more convenient, meaningful, and effective for patients and their families will make your organization the preferred choice for today’s consumer.

EMRs can work in concert with other technologies to elevate the care experience for patients, families, and clinicians, making it seamless in ways that other industries like travel and banking have already done. Leveraging the EMR and integrating surrounding technologies also future-proofs the technology investments hospitals and health systems have already made.

It’s time to stop thinking about systems in isolation, and instead think about how systems can work together to produce a better net effect. What else is possible now and how can we leverage our current IT investments to do better?

Readers Write: If It’s Not Easy, It’s Wrong: Why Easy Is the Answer for Healthcare

If It’s Not Easy, It’s Wrong: Why Easy Is the Answer for Healthcare
By Arun Mohan, MD, MBA

Arun Mohan, MD, MBA  is president of Relatient of Franklin, TN.

Years ago, as a medical resident, I spent a lot of time in the cardiac stepdown unit. I was caring for patients who had suffered heart attacks or exacerbations of heart failure or had had various cardiac procedures. One of the patients was a 60-year-old woman I’ll call Mary who had hard-to-control heart failure. Due to a rare disease, Mary’s heart didn’t pump like it should.

After a recent hospitalization—her third in as many months—I was determined to break the cycle. I spent time reviewing everything about her case. We prescribed a diet that we thought would keep Mary healthy. We adjusted her medications, adding multiple doses of short-acting drugs to titrate for maximum effectiveness. She was eager to follow the new plan, and I thought this would be the last time I saw her in the hospital.

About a week later, Mary was readmitted, again with swollen legs, trouble breathing, and chest pain. In our desire to maximize benefit, we had created a treatment regimen so complicated that it was almost impossible to adhere to.

Optimizing personal behavior is the holy grail of healthcare. It represents the single greatest opportunity to improve health outcomes since unhealthy behaviors account for nearly 40% of all deaths in the United States. But as anyone who has tried to change behavior knows, it is hard.

In one popular model, behavior is a function of one’s motivation, ability, and a prompt. In many industries, including healthcare, we pay a lot of attention to motivation (just consider the billions that go into advertising), but don’t think enough about ability. Put another way, it’s incredibly difficult to change someone’s motivation, but it’s often possible to make something easier to do.

You don’t have to look far to see how simplicity can drive positive action. Whether it’s retail, entertainment, finance, or travel, consumers are willing to pay more for simpler experiences and are more likely to recommend a brand because it is simple. So how does this look in healthcare?

24/7 Access Boosts Consumer Response

Given changes in how we work and live, consumers are increasingly looking for 24/7 access. Just think about the last time you made a purchase decision. Was it between the hours of 9 and 5? To what extent did lack of availability make you look elsewhere?

Consumer behavior applies just as much to medical appointments. Historically, appointments have been made over the phone when the doctor’s office is open, typically 9 to 5. But when practices offer 24/7 access, consumers follow. In our own data, nearly one-third of patients go online outside normal business hours to schedule appointments.

Consumers Prefer Mobile-First Communication

Each day, the average American spends 5.4 hours on a mobile phone. Mobile-first communication is the easiest way to get a patient’s attention and will elicit the fastest response or action time. Further, patients strongly prefer their mobile devices for communication; 67% of consumers say they prefer to text with organizations about appointments and scheduling and 75% say they are frustrated when they can’t respond to a text message from a business.

You can make things easy for patients by tying an action directly into a mobile workflow. For example, we recently worked with a large dermatology group that was struggling to get patients scheduled for their annual skin checks. With numerous patients missing appointments due to COVID in 2020, many hadn’t been scheduled for their visits in 2021. Calling, emailing, and even writing letters to patients had limited effect, with response rates under 10%. But simply sending patients a text message and offering them a personalized link to click and start the scheduling process boosted conversion to more than 60%.

To Simplify the Consumer Experience, Minimize Decision-Making

We know that business can increase conversion by minimizing choices. If a person is presented with too many choices, they are actually less likely to buy. In a clever experiment, psychologists Sheena Iyengar and Mark Lepper studied the impact of the number of jams on a display table on conversion. On a regular day at a local food market, customers would find a display table with 24 kinds of jams. On another day, at the same food market, people were given only six jam choices. Guess which display table yielded more sales? While the big table generated greater interest, people were much more likely to actually buy a jar of jam at the smaller table – about 10 times more likely.

We have seen similar results in healthcare, where patients like to be given concrete choices. For example, rather than asking people to schedule a vaccination, simply giving people a choice of one or two days for appointments improves conversion. In a recent COVID vaccination campaign, some patients were asked to schedule an appointment by clicking on a link that came through a text, while others were asked to choose between three appointments, also via text. The results? Patients asked to choose one of three appointments were twice as likely to schedule.

Start Simplifying by Eliminating Duplication

These actions may sound easy, but in healthcare, we make them hard. The good news is that consumers are eager for change that simplifies. If, as healthcare leaders, we reexamine how we’re engaging patients and delivering care, we can create quick wins.

“Easy” is one of the most powerful forces at play in human behavior. Making things easy for people doesn’t have to be a monumental undertaking. Healthcare leaders can start small by identifying where patients and staff are duplicating efforts for no benefit and eliminating those redundancies. Delivering ease and simplicity will improve health outcomes and the bottom line.

Readers Write: The EHR is (Still) Dead, But I’m Optimistic

The EHR is (Still) Dead, But I’m Optimistic
By Rob Dreussi

Rob Druessi is chief information officer of HCTec of Brentwood, TN.

In May, HCTec CEO Bill Grana published a company article on the evolution of the EHR entitled, “The EHR Is Dead. Long Live the EHR.” In August, digital health strategy consultant Seth Joseph published a similarly titled article, “Long Live the EHR Platform” on Forbes.com.

The key distinction in the headline encompasses his argument for the future of EHRs. Joseph’s two-part article is both comprehensive and detailed. He provides compelling analysis and research, sourced from industry experts to assert that while the government-backed investment (ARRA, HITECH ACT) into EHR adoption did, in fact, achieve the goal of wider physician and hospital adoption of EHRs based on government Meaningful Use (MU) criteria, EHRs collectively have been a disappointment and have not lived up to the hype.

For the most part, I agree with his points and appreciate his arguments, but drawing on 25 years of healthcare IT leadership as my lens, I politely disagree with a few of them.

To compete in a subsidized marketplace, vendors couldn’t just be best-of-breed for specialized focus areas. They needed robust capabilities to survive. In effect, they grew to be” a mile wide, but an inch short in the most important ways.”

In the short term, EHR vendors certainly focused on becoming certified by the US Department of Health and Human Services (HHS) to be MU-compliant. However, hospitals still had the ability to continue using the best-of-breed approach, as modular certifications allowed systems to be certified using a subset of criteria intended for their specific use. Examples of best-of-breed areas include laboratory, surgical, radiology, pharmacy, decision support, oncology, home health, and revenue cycle.

Many hospitals continue to use specialty systems for all the above. But more frequently, they are looking to decrease the overall complexity of running multiple EHRs. If anything, the MU era accelerated the move from full best-of-breed solutions to a modified hybrid approach, where hospitals use a primary EHR with select departmental solutions as necessary. Then, if and when the EHR vendor can provide a sufficient solution with functionality on par with the independent solution, the supplementary solution is often phased out.

In my experience, best-of-breed systems are difficult to manage and costly to maintain. In instances that my company has seen, many health systems agree with me. To illustrate, a Southeastern-based health system recently migrated one of its markets onto Epic from a combination of Cerner (acute side), a third-party home health system, multiple ambulatory systems, and over 50 related third-party applications. Similarly, we have supported many Epic-based organizations move from their independent departmental solution to Epic’s Beaker module this year.

EHRs went from competing on the value of their product to competing on the breadth of functions they offered. Epic achieved its dominant market share for this reason. It offered hospital CIOs a one-stop shop at a time when the CIO’s job was dependent upon helping the organization achieve Meaningful Use of EHRs, no matter how much physicians detested the actual software.

Introduced in 2009, MU can’t take credit for the complete success of EHRs. Epic, for example, was already long thriving as an EHR market leader for hospitals with 400 or more beds by then. Kaiser Permanente became an Epic client in 2003 as part of a $1.8 billion deal, and by 2005, their client base included the likes of Cleveland Clinic Foundation and Sloan-Kettering Cancer Center. This shows that while MU may have accelerated the move to Epic for many health systems, Epic wasn’t just competing on the MU compliance to win deals. They were winning deals due to their ability to not only provide a solution that handled both the inpatient and outpatient areas, but one that was developed 100% in-house, without the need for mergers or acquisitions.

Normally, CIOs selecting Epic were not dealing with physicians who detested the Epic EHR. Epic was even known in the marketplace for “selecting” its clients. Commonly, in my personal experience with many Epic organizations, the deciding factor was Epic’s ability to provide multiple reference sites running their full product suite, whereas competitors struggled to do the same.

“EHRs have been more than a disappointment: they have largely turned into a national nightmare…. Additionally, while EHRs may improve safety in some areas, they also introduce new risks that are systemic in nature.”

There are undoubtedly drawbacks to EHRs, and we certainly have not yet fully realized the potential of these digital systems, but to say they are a sweeping disappointment suggests that they have not offered any societal benefit. Before EHRs, providers struggled to have a clear picture of a patient’s health background, even within the same organization. A patient could go to the ER and later visit a primary care physician, who had no record of that visit or what occurred during it.

Our nation would have had a difficult time shifting to telehealth during the COVID-19 pandemic without the currently deployed EHRs. With EHR systems, we can now better share critical patient data across a healthcare organization and even across other healthcare systems when required. For those populations who spend different seasons in different parts of the country, the ability for their separate health systems to “talk” and share health information is an invaluable component in their health journey. With an EHR, providers can access real-time, up-to-date patient information, regardless of where treatment was provided. This element alone is vital for patient safety and care.

“By virtually every financial and operational metric, the business prospects for EHRs have gone in one direction over the past decade: down.”

Joseph is correct that EHR vendors have seen a downturn in the number of net new EHR implementations. Recent implementations appear to be driven by mergers and acquisitions or the routine replacement life cycle when the current EHR is not meeting organizational needs, with a traditional selection process to identify a new solution. More commonly, smaller, specific modules are being introduced as opposed to the full EHR implementations. While EHR vendors have seen declining revenues post MU, which is not totally unexpected, their futures are ripe with opportunity. They will adapt to the changing environment and will take steps (or have already taken steps) to size their workforce accordingly based on the future demands for maintenance / support and new implementations.

I share Joseph’s curiosity as to the future of EHRs. For now, Meditech is seeing more traction with its Expanse solution, with HCA most recently announcing they are implementing the solution at three HCA hospitals in the New Hampshire market. Meditech will realize tremendous growth with HCA if they are able to move the system’s vast footprint of hospitals running the Meditech Magic EHR onto their Expanse solution. Meditech would also realize a significant loss of business if HCA moved away from Meditech altogether.

Epic has chosen a strategic route in developing a web-based client (Hyperdrive) to generally replace the desktop client (Hyperspace). Hyperdrive clients should experience cost savings from the reduced manpower and related technologies necessary to support a web-based client. These savings could also open the door for new adoption at smaller organizations by finally making the ongoing TCO of running Epic feasible. During the pandemic, Epic was also able to deliver their clients a solution, including the underlying technology, for patient telehealth visits representing an unexpected boost in revenue, which luckily for Epic, is here to stay for the foreseeable future.

Perhaps the next boom for major EHR providers will be international growth as opposed to domestic. Whatever the next big break is, I’m curious to see what Joseph sees in his crystal ball for the future of EHRs.

Readers Write: COVID-19 Drastically Cut Lung Cancer Trial Participation. What Can We Do to Reboot?

COVID-19 Drastically Cut Lung Cancer Trial Participation. What Can We Do to Reboot?
By Miruna Sasu

Miruna Sasu, PhD, MBA is chief strategy officer at COTA, Inc. of Boston, MA.

COVID-19 has had a devastating effect on the nation’s health. In addition to hundreds of thousands of deaths directly caused by the virus, millions more patients have been unable to access crucial healthcare services due to lockdown orders, economic stress, and fear of illness.

During the early days of the pandemic, primary care visits declined by nearly 60% before rebounding later in 2020. Screenings for common cancers, including breast, colon, and cervical cancer, dropped by an average of 91%, prompting fears of a wave of advanced cancers in the coming months. 

A new study from the University of Memphis shows that the clinical trial ecosystem has not been exempt from this trend. The pandemic has prompted a 43% decline in enrollment for lung cancer trials, forcing researchers to delay, postpone, or cancel their initiatives.

Lung cancer leads to a quarter of all cancer deaths: more than colon, breast, and prostate cancers combined. Clinical trials are essential for helping to save and extend the lives of lung cancer patients.

My own life is a perfect illustration of how important clinical trials can be. After immigrating from Romania as a child, my grandfather helped to raise me in America. Soon after, he was diagnosed with advanced metastatic lung cancer and given three months to live. We did not have the resources for conventional treatment, but he enrolled in a clinical trial that offered experimental care we could afford.  

Instead of living for three months, he went into remission and got to spend another 30 years with his family. We were lucky to have access to this life-altering program. We knew that the option existed. We lived close enough to the trial site for regular visits. We were able to provide a strong network of support at home. Not every family is so fortunate.

The care access issues of COVID-19 have compounded existing challenges with clinical trial enrollment, including proximity to centralized trial locations and the ability to completely mold one’s life around the demands of constant clinical visits, treatment side effects, and emotional self-care.

We now have the opportunity to rethink how we approach these problems and restart the momentum that has been lost during COVID-19. I believe that three things could potentially be solutions to care access issues and substantially improve trial recruitment and retention for patients:

• Increasing enrollment. We can start by ensuring that patients from all walks of life are aware that clinical trials may be an option for them. Clinical trials perennially fall short when recruiting diverse and representative populations, excluding far too many underserved individuals from medical research. By using emerging data strategies, such as leveraging multifaceted real-world data to identify new research sites serving representative populations, we can educate more providers and patients about the positive potential of clinical trials. Real-world data from electronic health records, claims, and other sources can also help us match individuals with the most appropriate trials to maximize their odds of better outcomes.
• Maintaining patients on trials. We also need to make sure that patients have the day-to-day resources they need to stick with the program from start to finish. Non-clinical services, including transportation to appointments, childcare, meal delivery options, and other assistance to mitigate social determinants of health are critical for enabling patients to stay adherent to complex trial protocols.
• Patient understanding of trial opportunities. Continued trial interest is important for both healthcare providers and patients. We need to work hard to ensure that everyone within the care ecosystem understands their options for clinical trials. As such, building a community of care around clinical trial participants can improve quality of life while making sure that researchers can keep their enrollment numbers where they need to be. To do this, we have to get very good at things such as being able to showcase trial options and providing educational materials to doctors and patients that are tailored for each of these audiences. We also need ask patients questions about life style and quality of life at the right times and provide a variety of easy ways to not only treat but also connect with clinicians and care teams.

Making the investment in these and other strategies could save untold lives and give lung cancer patients, like my grandfather, many more happy moments with their family and friends. 

As we work through the ongoing challenges of the pandemic and continue to design and implement innovative clinical trials, we must commit to enrolling more diverse and inclusive patient cohorts and supporting them holistically during trials so they live their lives to the fullest for as long as possible.

Readers Write: 2022 Trends: How Health Systems Plan to Meet Top Business and Clinical Objectives By Automating Patient Engagement

2022 Trends: How Health Systems Plan to Meet Top Business and Clinical Objectives By Automating Patient Engagement
by Vik Krishnan

Vik Krishnan, MBA is general manager of Intrado Digital Workflows of Omaha, NE.

With hospitals and health systems continuing to face both staffing and supply shortages, many experts are hoping that 2022 will provide some relief, especially if the COVID pandemic finally enters its endemic phase. This will allow healthcare leaders, including health IT executives, to address other crucial priorities. And when it comes to next year’s objectives, enhancing the patient experience ranks at the top of the list, according to 91% of respondents in a recent Intrado survey administered to College of Healthcare Information Management Executives (CHIME) members. Other financial and operational priorities included increasing visit volumes (cited by 68%) and reducing burdens on personnel (49%).

Given these priorities, it isn’t surprising that in the same survey, 51% of healthcare IT executives stated they planned to invest in systems that make it easy to communicate with patients via SMS for different workflows including scheduling, reminders, recalls, referrals, and other patient engagement needs. This can be accomplished using automated, digital technology. The most advanced engagement platforms have deep EHR integration, include chat bot technology, and enable two-way SMS communications in real time between health systems and patients. Chat bot technology, in particular, delivers human-like interaction to patients seeking answers to commonly asked questions without requiring the direct engagement of a staff member. Two-way communication via text message allows patients to schedule, confirm, and/or reschedule appointments when it is most convenient for them.

The majority of respondents (83%) also report that they already use their patient engagement solution to automate basic appointment reminders. However, less than one-third (30%) offer two-way, SMS-based self-scheduling to their patients. This is significant for two reasons. First, SMS is the patient-preferred communications channel, providing a simple, convenient means of engaging with patients. In addition, offering self-scheduling via SMS can positively affect each of the health system leaders’ top objectives, including improving the patient experience and bolstering revenue through increased visit volumes, fewer no-shows, and reducing the burden on call center staff. Perhaps that’s why 47% said they plan to automate appointment self-scheduling or rescheduling directly from SMS messages in the future.

Given the latest advancements in automated patient engagement technology, health systems need to raise their expectations of these platforms and how they can meet their goals. Healthcare organizations will realize gains by leveraging their patient engagement solution for more than appointment scheduling and reminders. This includes a wide variety of tasks that address gaps in care and boost revenue. For instance, just 19% of surveyed executives currently use their engagement tool to manage referrals, even though this area contributes heavily to revenue leakage, impacts quality of care and consumes vast call center resources. And only 38% use digital engagement for pre-procedure patient communications, including, for example, sharing instructions on how patients should prepare for procedures like colonoscopies.

Knowing that providers and support staff devote significant amounts of time to inputting patient data and maintaining EHRs, healthcare IT executives are looking for opportunities to streamline these efforts. In fact, of the respondents who did not plan to automate patient engagement in 2022, 37% expressed concerns that doing so would place even more of a burden on the end user and IT resources. However, certain digital engagement platforms deeply integrate with the EHR the health system already uses. This eliminates the need for manual input by writing patient engagement activities from and directly back into the EHR.

Eighty-seven percent of those surveyed stated that the level of EHR integration offered is among the three key factors they consider when evaluating a potential IT investment. This answer ranked higher than other important considerations like cost, ROI and ease of deployment. Plus, 85% of responding executives said they want the EHR to serve as the “single source of truth” for all patient data, including the documentation of patient engagement activities, responses, and reporting.

Hospitals and health systems have invested heavily in patient portals in response to government mandates requiring transparent access and sharing of healthcare data with patients. This explains why 60% of surveyed healthcare IT professionals reported their institution relies on a portal for all patient engagement needs. And while patient portals do contain valuable information for patients, low portal adoption rates make them a poor choice as a sole communication method. A better solution is complementing the portal with a robust, EHR-integrated patient engagement platform that delivers information and education when and where it is most convenient for the patient—through SMS, email, or phone.

Here’s a practical example that demonstrates the value of having a complementary engagement solution. During the height of the pandemic, in early 2021, demand for the COVID-19 vaccine was so high that the patient portal of one New York-based health system crashed due to the number of patients logging on at the same time to schedule a vaccine appointment. Since the health system also deployed an automated patient engagement tool using two-way SMS outreach, it was still able to bridge the gap and continue to offer patients the ability to schedule and reschedule their COVID-19 vaccines.

This two-pronged approach gives healthcare providers and patients ultimate flexibility. Patients can use the portal for activities like reviewing their health records or downloading test results, while healthcare organizations can deploy automated patient engagement technology to reach patients in real time and in the patient’s preferred communication channel.

The use of automated, digital engagement not only improves the patient experience, it also promotes better health outcomes. Patients are far more likely to engage, schedule an appointment, and adhere to the recommended care plan when they can self-schedule their appointment and easily text a question to providers. SMS patient engagement featuring live chat, in particular, puts an end to cumbersome phone trees and waiting on hold, creating efficiencies for staff, too.

Based on these findings, healthcare IT executives clearly understand the advantages of automating patient engagement and plan to invest in these solutions in the future. Whether it is accomplished via a new solution or applying new workflows to an existing platform, automation of many patient communication tasks can benefit health systems and patients alike.

Readers Write: Improvements in Content Quality, Regulations Highlight 2021 Interoperability Trends

Improvements in Content Quality, Regulations Highlight 2021 Interoperability Trends
By Jay Nakashima

Jay Nakashima, MBA is executive director of EHealth Exchange of Vienna, VA.

Once again, the COVID-19 pandemic grabbed many health IT headlines in 2021. But interoperability was a major topic in 2021 as it truly turned a corner during the last 12 months. More providers are connecting into data sharing networks, and this is good for everyone. This momentum should continue in 2022, but definite challenges will arise.

As someone who heads the oldest and largest nationwide health information network in the United States, I continually monitor trends in healthcare technology. While the past 12 months have been packed with major developments, the following are what I deem are the most significant interoperability trends in 2021.

Public health emphasis. The COVID-19 pandemic spotlights the digital disconnect between healthcare systems and public health agencies. Much work remains in this area, but now it is recognized as a major issue and helped to drive the conversation around health IT this year. The EHealth Exchange partnered with the Association of Public Health Laboratories (APHL) to enable automated generation and transmission of case reports from electronic health records (EHR) to the necessary public health agencies, increasing accuracy while reducing reporting burdens of providers. This electronic case reporting (eCR) service is available to EHealth Exchange network participants, as well as those outside the network but connected via Carequality. The EHealth Exchange – APHL connections can be used for any reportable disease or condition, not just COVID-19.

Regulations. The information blocking rule clearly expanded access to patient data requested for treatment purposes. Anticipation of the final rule alone propelled EHealth Exchange’s transaction volume to 12 billion transactions annually. The industry continues to anticipate and plan for the Office of the National Coordinator for Health Information Technology’s (ONC’s) new Trusted Exchange Framework and Common Agreement (TEFCA) exchange paradigm.

Content quality. The industry as a whole saw great improvements in content quality in 2021. For example, 98% of EHealth Exchange participants were able to successfully pass rigorous content quality testing. Because of the vast number of participants and their influences in healthcare, there is now a new, universal floor of interoperability inside and outside the network. This means that the network isn’t just moving data; it is moving standards-based, computable data, which is human readable and machine consumable, the gold standard for interoperability.

Adoption of new technology such as FHIR. While exchanging Fast Healthcare Interoperability Resources (FHIR) at scale still requires final new standards, particularly related to security, the industry as a whole worked to implement FHIR in production after successful proof of concept initiatives. In partnership with public health, we expect to see finally see the promise of FHIR in broad, real-world connectivity in 2022.

Of course, these are not the only trends that drove the healthcare IT sector in 2021. We saw a major emphasis on privacy, cybersecurity, controlling healthcare costs, and efforts to address disparities. Look for these and other trends to continue into the new year as the sector continues to evolve and address new challenges that will surely appear.

Readers Write: Filling the Healthcare Data Glass: The Glass Doesn’t Need to Stay Half Empty

Filling the Healthcare Data Glass: The Glass Doesn’t Need to Stay Half Empty
By Alex MacLeod

Alex MacLeod is director of healthcare commercial initiatives for InterSystems of Cambridge, MA.

In recent years, there has been a lot of talk about the unfulfilled promises of artificial intelligence (AI) in healthcare and concerns about how to effectively incorporate it into practice and realize immediate value. There is a real “glass half empty” mentality at play due to false starts and over-ambitious expectations for AI adoption and commercialization. But that doesn’t need to, and shouldn’t, be the case.

Google’s hospital partnership to collaborate on algorithm development using patient records for AI development is a strong sign of healthcare AI’s imminent proliferation. Gone is the barrier of highly fragmented patient data. This is a significant market shift, and other giants in tech and healthcare will follow Google’s lead. The question now is, what can and should the healthcare IT industry do to prepare? We will answer that by looking at three core areas – data, patterns, and areas of caution.

AI in healthcare has had positive growth in recent years, but the meaningful application of AI products (FDA-approved AI products) and the widespread application of data to the decision-making process has lagged, according to a recent study published in the Medical Futurist Institute. There have been major recent advances in sensor technology, allowing for a broad range of devices that help inform patients about their health or fitness and warn about risks. The sensors generate raw data, but the interpretation of it is based on AI analysis, which hasn’t developed at the same rapid pace.

IT departments, payers, providers, and patients are overwhelmed with the high volume of data generated on a daily basis and need to better articulate their end goal for its use. To do so, they need to pay close attention to their current processes and determine what can be done differently and what needs to change in order to be able to analyze data and apply it to future decisions.

The biggest questions those in healthcare face in regard to health information are:

• What do we do with all this data?
• What is most important to analyze?
• How can it be made actionable? (i.e. can it be used to become compliant with regulations?)

To answer those questions, we need to start by understanding what the data represents and asking a few more questions. Is the data set composed of lab results, physician-collected, or patient-submitted data? Why was it generated and collected in the first place?

The answers are typically more straightforward in other industries than healthcare. That’s why it is important to take a close look at the data and identify patterns and similarities. Analysis in healthcare AI is different from other consumer-facing algorithms.

Healthcare AI has less algorithm-friendly base data compared to social media or online shopping, for example. Healthcare algorithms work with complicated inputs of clinical notes, medical imaging, and sensor readings. Outcomes are relatively well defined in non-healthcare AI settings, most commonly in terms of attention or purchase. In healthcare, outcomes have time and severity dimensions on top of opportunity for interference with other effects, not all of which can be stratified through raw statistics.

Current effective applications of AI in healthcare include the use of ML tools in triage practices and administration. For example, what makes it effective in triage is how AI nuances the health system’s basic risk scoring systems as a way to identify patients who need immediate attention or who require higher acuity resources and pathways.

That said, patients must consent to their data to be applied to healthcare AI algorithms, and to provide value, the data must be made actionable. It must be clean, comprehensive, and normalized data where there are no duplicate records, formatting errors, incorrect information, or mismatched terminology. This gives those analyzing the data complete confidence in how and why it was curated.

Collecting data always introduces the risk of the information being “repurposed,” a possibility spotlighted when fitness tracking app Strava released a dataset of 3 trillion distinct GPS readings that inadvertently exposed US military bases in Afghanistan. Modern bots, and to some extent even legitimate social media marketing tools, are making efficient use of analytics and AI to game the platform’s algorithms in order to attract more views, clicks, and likes. But, when such technology ends up in the wrong hands, the focus may be on spreading misinformation rather than the intended use.

As with most technology, discretion is key. Collect and analyze only the minimum necessary. Don’t invite scrutiny over private data or enable access to it. Remain diligent in your data practices.

It’s understandable why people see the glass as half empty, but we have reached an inflection point in healthcare AI, a point at which we can add water to the glass.

To add to the glass and fully benefit from the anticipated results, we should embrace incoming regulation and think hard about self-regulation measures. Healthcare IT practitioners should closely monitor how laws and oversight will adapt in real-time, similar to as we have seen with the FDA Digital Health Innovation Action Plan. As Google’s big step forward in healthcare AI development signals a new level of digitization of health, we can expect changing attitudes towards healthcare AI, including an uptick in trustworthiness and increasing differentiation from other categories of consumer AI.

AI in healthcare has strong potential if we harness it correctly. In the right scenarios, AI augments the work of healthcare providers and doesn’t replace them as long as we maintain a little bit of human intelligence to complement the artificial.

Readers Write: Contactless Tech Surge Supports Healthcare’s Quadruple Aim

Contactless Tech Surge Supports Healthcare’s Quadruple Aim
By John Sola

John Sola is senior product manager for Ascom Americas of Morrisville, NC.

In a matter of months, the COVID-19 pandemic precipitated digital transformation across a wide swath of industries, driven by contactless operations that improve productivity and mitigate the need for physical interaction. Whether it’s curbside pickup, a digital guitar lesson, or delivery of lunch to your front porch with automatic digital payment on receipt, contactless service has become commonplace across so many areas of our lives. It has led to new business models that are yielding innovative and efficient products and services.

We have witnessed its significant impact on healthcare as well. Telehealth usage, for instance, has surged since the pandemic began, allowing providers to deliver safe and timely access to healthcare services.  According to a recent McKinsey & Company Telehealth report, “new analysis indicates telehealth use has increased 38X from the pre-COVID-19 baseline.”

Technology has been a key driver for health systems in attaining performance goals since the Triple Aim concept – patient experience, lower costs, better outcomes – was first developed by IHE in 2007. It was later expanded by many organizations to include a fourth (“Quadruple”) aim incorporating the importance of improving the work life of clinicians and staff.

To support the Quadruple Aim, healthcare’s utilization of technology is evolving rapidly.  Recent advances such as IoT, big data, AI, and wearables enable providers to transition treatment from passive and reactive to predictive and proactive.  The rapid pace of digitalization was aptly highlighted by Mayo Clinic’s Bart Demaershalk, MD: “The COVID-19 pandemic has essentially accelerated US digital health by about 10 years.” Contactless healthcare is positioned to support this shift in care delivery from the emergency room and hospital bed to the patient’s home, linking data-rich health observations to clinical knowledge and decision marketing.

One such example is ASL Napoli 1 Centro, a group of hospitals in Napoli, Italy. A remote monitoring solution for at-home COVID patients offers a level of service halfway between hospital care and the home. A package of wearable medical devices provides monitoring for oxygen saturation, heart rate, and body temperature, along with non-invasive spot-check blood pressure measurements. The service was managed by hospital general practitioners using medical device surveillance and clinical decision support system (CDSS) software. Of the 500+ patients monitored during a certain period, less than 10% required hospitalization. Based on the program’s effectiveness, the hospital intends to continue offering the contactless solution after the COVID emergency for managing patients with chronic conditions.   

As ASL Napoli 1 Centro shows us, the movement to prediction and prevention can be accomplished quickly and efficiently when it’s coupled with contactless technologies, such as wearable medical devices. Acquired vital signs can be analyzed in real time with CDSS-based early-warning scoring and other clinical measures to detect or predict patient deterioration. The data must be presented in a meaningful, understandable way if it is to be useful for decision-making and timely clinical intervention. Such solutions fit squarely in the objectives of the Quadruple Aim. It provides patients peace of mind that their condition is being watched closely.  It helps manage more patients with fewer staff. It improves outcomes by acting sooner.  It supports overburdened nurses by streamlining the process of data collection and validation.

As the way we approach healthcare continues to change, contactless technologies can help address existing and future care challenges, such as pandemics, the wave of aging Baby Boomers, and a looming shortage of nurses. Hastened by COVID, contactless care is here to stay, offering new and transformative opportunities for providers worldwide.