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

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

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

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

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

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

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

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

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

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

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

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

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

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

It’s important to remember that:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prioritize the Clinician As Your End User

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

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

Invest in Ongoing Education and Coaching

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

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

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

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

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

Cultivate a New Work Culture

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Readers Write: Creating Resiliency Among the Newest Generation of Clinicians

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

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

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

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

Support distracted, fatigued minds with “peripheral brains”

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

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

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

Reduce clinical decision time through quick-access mobile solutions

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

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

Increase patient face-time with mobile technology

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

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

The future role of mobile medical apps in supporting resiliency

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Readers Write: Inside the Most Challenging Data Problem in Healthcare

Inside the Most Challenging Data Problem in Healthcare
By Navdeep Alam

Navdeep Alam, MS is CTO of Abacus Insights of Boston, MA.

Payer data is one of the most exciting assets in healthcare, holding the most promise for dynamic, meaningful change to the way care is delivered and paid for. It’s also the most challenging data problem to exist in the industry. 

We may not always realize it, but payer data is often the center of discussion around dinner tables across the country. Whether we’re talking about which treatments are covered by our health plan, how much our prescriptions cost, or how our specialists and primary care physicians interact — or fail to interact — we’re actually talking about payer data. When we have questions about our care, the first call we make is to our health plan, and we hope they have the wisdom and expertise to point us in the right direction. 

Payers are the hub of healthcare. Our health plan is where we as consumers begin when we’re trying to navigate the healthcare landscape. Where do we go to receive care? What treatments are best for us as individuals? Which pharmacies can fill our prescriptions?

As we interact with the healthcare system over our lifetimes, our experiences are eventually filed as insurance claims. Health plans hold treasure troves of rich, complex data about the patient journey, information that is critical to understanding how we as individuals experience healthcare. 

This is why healthcare can be so complicated: We have barely scratched the surface in realizing the potential of payer data. 

Healthcare data does not come from a single source. It comes from electronic health records, primarily used for documenting clinical data. It comes from pharmacy records, which were designed primarily for inventory management. And it comes from insurance claims, which lack detail about the patient journey but are necessary for tracking our experiences across the healthcare system. All of this data is growing at an exponential rate. Over 1.2 billion clinical documents are produced annually in the United States, and that figure is growing at a rate of 48% per year — and it’s all held by health plans. 

Health plans are ingesting millions of data points every day, and all of it is necessary to ensure that we, as patients, are receiving the right care at the right cost. If this data were clean and structured in the same format, it could paint a beautifully elaborate picture of how we experience healthcare every day. But it is not: 80% of medical data, for example, is unstructured and therefore disconnected from the wider healthcare system. 

Ultimately, all data challenges across the healthcare system become payer data challenges. Our health plans are burdened with the responsibility of mediating these challenges and piecing together all of the fragments of our healthcare experiences. When we switch plans, those challenges are exacerbated: all of our information is siloed within our old plans, and our new plans are barred from seeing a full picture of our medical histories. This disjointedness within the system, coupled with prohibitive privacy regulations, is how we end up with multiple sources of “truth” for every patient. The result is wide variations in the quality and cost of care we ultimately receive. 

The healthcare industry has been attempting to confront these issues for decades, despite spending nearly $2.1 billion annually to try to resolve them. These challenges can be boiled down to three major roadblocks. 

• Data capture. There is a longstanding inability among health plans to capture clean, and complete data in a timely manner. This is largely due to legacy systems and the continuation of highly manual data processes as best practice, all of which lead to a bevy of downstream issues. 
• Data cleanliness. Payers receive and ingest millions of messy, mis-formatted data points from different providers, data suppliers, and vendors every day. The lack of standardization of these data creates inaccuracies and inconsistencies. Fragmented data often remains siloed within health plans, non-interoperable and underused.
• Data sharing. The lack of standardization of data within health plans makes data sharing impossible. CMS’s interoperability mandate is a much-needed first step toward addressing this issue and will certainly be a driver toward more efficient data sharing practices, but it is exactly that, a first step.

Overcoming these challenges is not impossible, but it requires the best tools and immediate action. According to a recent PwC survey, only 53% of payers have mapped out their data to see what will be impacted by the CMS interoperability mandate. Even more concerning: only 24% of healthcare executives said they see the mandate as a strategic opportunity. Here’s how payers can act now to unlock and realize the full potential of their data.

• Clean up data. Now more than ever, patients have greater control over their data — data which, at the moment, is largely fragmented and incomplete. Payers should strive to achieve a single source of truth for each member. Doing so will allow plans to develop personalized member benefits and give providers a complete view of each patient, allowing them to make more informed clinical decisions and empowering patients to stay healthier, longer.
• Advocate for and improve interoperability. The CMS mandate is a necessary first step, but simply following the mandate is a missed opportunity to innovate and create real change in the ways in which we experience healthcare. It is imperative that payers take up the mantle and champion interoperability from this point forward. We cannot wait for the next iteration of interoperability regulations to improve the quality of healthcare data. Payers should be contemplating ways to ingest quality data, generate new insights, and work with one another to meaningfully engage patients as we experience healthcare.
• Democratize the use of payer data. Payers cannot drive innovation themselves. The promise of interoperability will only be realized once payer data is shared widely, allowing others to drive innovation, improve connectivity, and enhance our interactions with the healthcare system. By giving patients control over their healthcare data, we’re opening a new realm of possibilities. It is upon payers to lead the charge as we step into the future of healthcare.

With the CMS interoperability mandate, health plans have the chance to change the narrative: what has historically been an industry data challenge is now a business opportunity. By taking  action to unlock healthcare data today, health plans can drive efficiency within the industry and innovate to build a more seamless, engaging, and dynamic healthcare system.

Readers Write: Artificial Intelligence Drives a New Medication Management Philosophy

Artificial Intelligence Drives a New Medication Management Philosophy
By Erick Von Schweber

Erick Von Schweber is CEO of Surveyor Health of Foster City, CA.

There are times when advances in technology enable a radical re-envisioning of both what we do and how we do it. Medication management is at that stage, thanks to ongoing developments in artificial intelligence.

Metaphorically, will healthcare use these newfangled mechanical horses to pull its current wagon, or will it open up to radically new possibilities enabled by new technology? Several areas of AI inspire our imaginations. Let’s consider the philosophical inversions made possible.

Clinical pharmacists performing medication management interventions today spend most of their time poring over patient records, mentally integrating what they read. Then, with little time to ponder the patient’s situation, they go on to writing notes and elaborate documentation that few providers will read in entirety, if at all. Yet probabilistic AI reasoning engines coupled with semantic interoperability integrate multifaceted data without glossing over nuances, driving graphical user interfaces providing information visualizations that clinicians understand in seconds – the mental model is on-screen. The clinician can now understand the entire problem space and visually design a solution.  

In this scenario it’s not a matter of man or machine, it’s the collaboration of man and machine, each doing what they do best. Some processes will automate the routine, such as production of documentation, freeing the clinician to spend time doing what only the trained, expert human mind can. Like a financial analyst, they can use that time running what-if simulations to inform their options.

This cooperative interplay between clinician and AI opens up a potential inversion of the customary workflow. Lacking AI, medication optimization today means the clinician attends to each medication in isolation, doing their best to address any issues specific to that therapy and its relational effects with other individual therapies, one at a time (such as duplications and interactions). This traditional workflow leads to Whac-A-Mole, where a considered solution to one issue creates more issues, frequently requiring back-tracking or outright starting over. By visually modeling the entire problem space and assisting the clinician in seeing how to address it fully, AI enables a more productive workflow.

For people outside the AI research community, it’s easy to believe that ML (machine learning) is AI, but the field is far broader. Where ML is about identifying patterns in existing data sets, other areas of AI, such as AI planners, Bayesian probabilistic reasoners, and combinatorial optimization engines, imagine numerous possible scenarios – therapeutic courses of action – then figure out which are viable, which present conflicts, and which make superior tradeoffs for both the patient and the healthcare system. Human cognition inextricably involves both learning and imagination, and in AI circles, imagination, creativity, and metaphor are the vanguard. Indeed, the next steps toward creating an AGI (artificial general intelligence) that operates at near human cognitive levels are focused more on imagination.

We urge those in medication management to free themselves from the bounds that prior generations of technology have restricted them to. It’s time to imagine the future of medication management. 

Readers Write: Addressing the Public “Infodemic” Spurred by COVID-19

Addressing the Public “Infodemic” Spurred by COVID-19
By Denise Basow, MD

Denise Basow, MD is CEO of the Clinical Effectiveness business unit of Wolters Kluwer, Health.

The novel coronavirus proliferated around the globe with lightning speed, spurring an explosion of new medical information over the last 18 months. Care teams on the front lines were desperate to get their hands on the latest guidelines to treat the influx of patients streaming through their emergency departments, but were also faced with misinformation that could potentially harm their patients.

Similarly, patients struggled to understand which information sources to trust so they could protect themselves and their loved ones. The WHO has identified this deluge of information, or “infodemic,” as a primary concern for global health.

According to the WHO, the definition of an infodemic is “too much information, including false or misleading information in digital and physical environments during a disease outbreak, which can cause confusion and risk-taking behaviors that can harm health; it can also lead to mistrust in health authorities, undermining the public health response.”  

Consider that on January 31, 2020 there were 50 studies published on coronavirus within 20 days, which was remarkable progress. Today, there are more than 150,000 studies on coronavirus, with some estimates as high as 400,000 if we include preprint journals and other gray literature.

It is critical that someone make sense of all this information for it to be useful in treating patients, as there is a significant margin for error when considering the immense pressure to do so as quickly as possible to save lives.

While much of my career has focused on getting the latest evidence-based information into the hands of the clinician community to foster the best care everywhere, we can’t forget that patients are a critically important part of the healthcare team. They need the right information as well, and this information should align with the evidence their care teams are using to make treatment decisions.

Fortunately, there is a clear path for combatting misinformation that can lead to an infodemic, and it is critical that the healthcare community understands and embraces it now to mitigate future occurrences:

1. Listen to communities – of clinicians and patients – for the specific questions and concerns that they have.
2. Get the facts into the hands of those communities so they can accurately evaluate risk, particularly around new vaccines in the case of COVID-19.
3. Foster broad understanding of the internet’s ability to produce good and bad information to build resilience to misinformation.
4. Provide tools that empower communities to act, such as education on how to distinguish fact from fiction and everything in between.

Across the world, everyone from government and public health officials to healthcare providers, community leaders, and individual patients need help determining when it’s appropriate to act (or not act) based on the scientific evidence. Everyone should have access to evidence-based information that informs their decisions, and technology should help facilitate, not hinder, that access. We can and we must learn from the COVID-19 infodemic to improve future public health response.

Readers Write: Don’t Cut Corners in Hybrid Cloud Protection

Don’t Cut Corners in Hybrid Cloud Protection
by Pascal Geenens

Pascal Geenens is director of threat intelligence with Radware of Mahwah, NJ.

In the past few months, several high-profile ransomware attacks on healthcare facilities in Las Vegas, Oregon, and New York have resulted in delayed or suspended surgeries and interruption of other patient care, not to mention the loss of millions of dollars to the facilities themselves.

Ransomware is but one of several attack strategies that malicious actors have employed against healthcare facilities. For example, the number of distributed denial-of-service (DDoS) attacks targeting hospitals has also increased since the beginning of 2021.

Healthcare and security teams face incredible challenges following the pandemic. Although keeping patient data available and secure is critical, it is increasingly difficult due to the array of attack vectors and cybersecurity knowledge required to mitigate them. In addition, several mergers of healthcare providers have introduced additional complexity in networks that can overwhelm security teams.

Remote access and online services, such as streaming doctor/patient consultations and online electronic medical records (EMR), have seen exponential growth. Healthcare organizations have had to manage and secure large volumes of patient data and provide 24×7 access to critical applications to ensure a quality user experience and the ability to protect lives. As a result, healthcare remains one of the highest at-risk industries from cybercriminals.

Much of the issue can be traced to the transition — accelerated by COVID-19 — to public clouds, network-connected devices, and the move towards online and application-based services, which mean more vulnerabilities and data breaches. When healthcare services and applications go down, healthcare providers suffer productivity and operational losses, negative customer experiences, and intellectual property losses.

Based upon the results of several industry surveys, don’t expect this race to the cloud to revert. Hybrid cloud configurations are here to stay. Because of the new reality, IT administrators and hackers now have identical access to publicly hosted workloads, using standard connection methods, protocols, and public APIs. As a result, the whole world becomes an insider threat. Workload security, therefore, is defined by the people who can access those workloads, and the permissions they have.

The question then becomes, should healthcare enterprises focus protection on-premises or the cloud? The answer is unequivocally both.

Part of the reason is because another aspect to consider when moving applications to the cloud is the connectivity and accessibility of those applications. When the internet connection from the hospital is suffering from a degraded or total loss of connectivity, all activities come to a grinding halt. Protecting connectivity only with on-premises equipment leaves organizations too vulnerable. On-premises detection and mitigation alone prevented 85% of DDoS cyberattacks, but the other 15% required cloud DDoS protection. Because of the latency introduced by cloud DDoS protection, enterprises sometimes rely only on on-premises protection.

This is a mistake, because even though only 15% of attacks required cloud protection, those attacks represented 92% of attack volume and 84% of the packets. In hybrid deployments, the cloud handles the volumetric attacks while on-premise will typically handle low-and-slow and low-volume DDoS attacks, as well as anomalies and intrusions.

While healthcare organizations face unprecedented challenges, cutting corners in cyber protection isn’t a viable option. Especially during a rapid and complex transition to the cloud, enterprises can’t afford to neglect either on-premises or cloud protections.

Readers Write: How the New ONC Cures Act Will Transform Patient Access to Healthcare Data

How the New ONC Cures Act Will Transform Patient Access to Healthcare Data
By Ariel Katz

Ariel Katz is founder and CEO of H1 of New York, NY.

On April 5, the non-partisan federal rules mandating Open Notes for healthcare data took effect. Known as the Cures Act, the rules specify that clinical notes are among electronic information that must not be blocked and must be made available free of charge to patients.

This is a game changer for any patient who’s ever had trouble getting healthcare providers to share or exchange information on their care – i.e., nearly every US patient, ever.

Data exchange among healthcare providers has been a vexing problem for patients in the US for decades. Providers make patients pay for hard copies of their own files. They force patients to pick up CDs with copies of scans in order to get the data to another provider. They clearly aren’t up to speed on care that’s been provided elsewhere — even when it’s in the same health network — and repeat tests that have already been completed. Patients often get bounced from provider to provider, answering the same questions repeatedly before any care is even provided. The list goes on and on.

All of the problems people thought EHRs were supposed to fix are finally addressed in the Cures Act.

Here are several health initiatives that the Cures Act will catalyze:

Making apps like Apple Health a central place where a person’s complete health data is stored

Patients will be able to access their own health data at any time in one place. This is great for patients, and also really useful for providers in emergencies. For example, say a person from New York gets into a car accident while in Mexico. ER staff can access their health info easily to quickly learn about the patient’s health status and provide the best treatment. Apple Health appears to be emerging as the frontrunner for this, but there are other options. like Google Fit.

Better international data sharing

Right now, the Cures Act applies only to healthcare data in the US. But I believe other countries will quickly follow with their own legislation and standards that will ease secure international data sharing. Increasingly we’re seeing patients, especially those with rare diseases, seeking treatment in multiple countries. Global data sharing would save time and resources, enabling providers to quickly assess what has and hasn’t already been done, leading to quicker and more efficient healthcare.

Better contact tracing for future disease outbreaks

If the Cures Act had been passed earlier – say, in 2019 – it would have completely transformed contact tracing for COVID-19. If all this technology was in place at the start of COVID, contact tracing would have been incredibly simple, and COVID’s effect could have been far less severe in our country, and maybe in the world. If there is ever another pandemic, contact tracing under the Cures Act should be a much faster and simpler process.

The Cures Act seems to have gone into effect almost unnoticed, with very little fanfare. But healthcare pros who are paying attention will quickly realize the potential here for empowering patients with better access to their own health data. Look for a host of new technology solutions enabled by this capability in the coming months.

Readers Write: Alert: Three Keys to Navigating the Traffic Ahead on the Road to Healthcare Access

Alert: Three Keys to Navigating the Traffic Ahead on the Road to Healthcare Access
by Karly Rowe

Karly Rowe, MBA is VP of patient access, identity, and care management products at Experian Health of Franklin, TN.

For any of us who use GPS when we drive, hearing the robot voice warn “alert, traffic ahead” is all too familiar, and usually followed by suggestions for alternate routes to our destinations. In our industry, however, there is only one road, and it’s about to get more crowded, complex, and nuanced. To help patients navigate their way through healthcare in the future, the industry is going to need to innovate.

As the economy emerges from the pandemic, there are dramatic changes in people’s lives and many industries are having to transform their operations in significant ways. For healthcare, we are going to see a changed landscape or, to put it more bluntly, there’s serious traffic ahead.

The impact on employment has been no less than stunning. Data earlier this year revealed that 78 million initial jobless claims had been filed with the Labor Department during the pandemic (that’s almost half of the country’s workforce), and that we had lost more than 10 million jobs. For those of us who remain employed, almost fourth-fifths are working differently, mostly notably through working from home.

These dramatic changes create new barriers impacting patients’ ability to access. Their coverages have changed or been lost entirely, as has their willingness to seek care in the face of their financial situations or other barriers, such as language, and their ability to do so is often impeded (this is especially true for underserved populations). Patient needs have and will also change as they contend with long-haul conditions and Americans in general learn to manage the mental health effects (about half of us have experienced such impacts already) of time in isolation and with limited human contact.

The volume of this transformation is itself a change, and a big one.

The impacts of technology on healthcare should no longer be called revolutionary, but rather the norm, as the pandemic has accelerated the transformation that was already underway. The market for wearables is expected to reach $81.5 billion this year, which is an 18% increase from a year ago. Individuals are using these technologies to manage their own health and the data are factored into a majority of wellness programs. The promise and peril of aggregating and applying these new sources of data aren’t news to you, whether in technical, administrative, or compliance terms. My point is that it’s an unavoidable component of that traffic we face going forward.

And the sheer volume of that component, to the tune of thousands of exabytes in growth annually, is a big one, too.

The road ahead is going to be tough since there are no alternate routes we can take. So, I say we embrace that clarity and apply it to three key areas of work that will help us navigate it:

Invest in tech

Challenging times challenge us to innovate, and it is clear that our systems (the “road” in my analogy) aren’t built to accommodate the changes I noted above. Telehealth is one area that shows immense promise, as patients have grown accustomed to remote interaction during the pandemic. Simply put, getting to a website can be far easier than making an office appointment, and relegating certain diagnostics to remote engagement can be more cost efficient. Integrating that data across touchpoints are important, as is exploring ways to make telemedicine available and attractive to vulnerable populations (the traffic is there, thanks to patients added due to COVID-19, so think about adding lights at entrance ramps to highways to ease traffic access and flow).

Use data to drive patient engagement

It might seem counterintuitive but the engagement and resulting data from interactions beyond the four walls of the clinic can be crucial to better health outcomes. To apply my traffic metaphor again, it’s not necessarily the volume of data, or traffic, that is the problem. Rather, it’s that the lines on the road need to be clearer. According to the Sequoia Project, about 12% of demographic data become outdated within a year due to such facts as 70% of married women change their names. Further, almost a third of that data are misspelled, incomplete, or incorrect. The challenges of consistent and reliable patient identifiers are nothing new, but they take on new currency when the challenges dependent on them increase and become more complex. Today’s solution helps preclude tomorrow’s “traffic” problems.

Don’t make the traffic worse

Patients’ healthcare journeys do not all travel the same road, but rather merge and exit at a number of points, many of which aren’t necessarily traditional sources of health services (and therefore new sources of health-related data). The technologies exist to connect patients to food banks, shelters, counseling services, and community programs, which may serve to lessen the overall impact on traffic. Then, by connecting those services, you can learn more about them and their needs. Insisting that there’s only one way to get to a desired destination – as if there were a single express lane – is old thinking, while considering the opportunities to provide patients with multiple routes while connecting the resulting data and insights into a single, overarching view (a GPS picture, if you will), may be the pathway forward.

We have a clear picture of what the road ahead looks like. While we can’t choose a different route, we can use technologies and tools to make the traffic flow better, faster, and more safely. Times of massive change are challenging, but they can also be inspiring.  We can embrace this opportunity to take our industry where it needs to go.

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

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

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

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

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

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

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

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

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

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

Readers Write: Providers’ Post-Pandemic Assessments of Telemedicine

Providers’ Post-Pandemic Assessments of Telemedicine
By Amanda Hansen

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

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

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

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

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

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

Access

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

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

Convenience

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

Quality

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

Engagement

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

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

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

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

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

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

Flatly,  we cannot.

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

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

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

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

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

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

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

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

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

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

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

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