Readers Write: Making the Right Choices for Hospital Virtual Care Technology

Making the Right Choices for Hospital Virtual Care Technology
By Brad Storm

Brad Storm, MS is VP of technology and integrations at Sonifi Health of Sioux Falls, SD.

No healthcare strategy includes adopting a new initiative under duress. But that’s exactly what many hospitals had to do in the face of COVID-19, when clinicians were desperate to communicate safely, quickly, and effectively with patients and their families. Trying to adapt the ideas from at-home telehealth with whatever technology was easy to get — often simply consumer-grade tablets or video monitors — became the hasty foundation for what virtual care in a hospital setting could be.

Those early days of virtual care in inpatient environments brought a lot of good lessons about what’s reliable, what’s scalable, what’s effective, and just as important, what’s not.

In the years since, hospital executives now have a beat to create long-term strategies for virtual care. Here are some critical questions to consider for hospitals to implement the best inpatient telehealth setup.

What do your nurses have to say?

Nurses are frequently the ones tasked with facilitating virtual care calls. Talk with them about how this affects their workflows. Do they feel they’re losing clinical time coordinating calls, or are they being more efficient with their workload?

What kinds of tasks could be shifted to be virtually done from a command center? Examples: admissions interviews, education and medication review, observation rounding, and discharge instructions.

What equipment do they recommend for ease of use and reliability?

Involving your nurses in your virtual care decisions is critical to supporting them and addressing some of the issues that come with staff shortages, burnout, and inefficient processes.

Give them a voice, and listen to their suggestions. They’ll be much more likely to embrace a strategy and adopt initiatives they are part of from the beginning.

What are your patient demographics?

Think about the digital health literacy of the populations you serve, what kinds of technologies they’re familiar with using, and if common physical or mobility issues exist that may affect their ability to interact during a virtual care call.

For many acute care hospitals, more than half of their patients are 60 and older. In children’s hospitals, the pediatric patients’ caregivers tend to be younger and are typically quite tech savvy. Like the staff who will be using your virtual care solution, take the patients who will be using it into consideration, too.

Patient experience professionals will have great insight into the kind of setup that patients, and their families, will be most comfortable with and willing to use.

What equipment and infrastructure are needed?

With input from the people who will be using virtual care, start to narrow down the technology needed to make it successful, sustainable, and within your budget.

If you already have hardware in patient rooms, such as a television, can it be used for your virtual care setup? If you’ve been using tablets, are they working well, or is there a better alternative to think about?

Talk with providers and clinicians about the kind of camera and microphone capabilities they’ll need for the use cases they’ll be part of. Can the camera be controlled to zoom in to specific areas of the room? Is the microphone sensitive enough for ambient listening?

Should there be something permanently mounted in each room, or are mobile carts the best option?

Once the equipment is decided, make sure you have the infrastructure to support it, including access to power and secure network connectivity.

How does the solution integrate with your other systems?

Interoperability is a major part of a successful long-term strategy for virtual care. Like any technology system, virtual care can be most effective if it integrates with workflows your staff already use, especially for EHR, scheduling, education, screenings, and discharge. Integrated systems will make it much easier to scale and standardize enterprise-wide going forward.

For example, if you have an interactive patient engagement system in patient rooms, all the systems can link together on one platform, drastically simplifying where clinicians have to log in for patient care, as well as how patients can access the information, education, and consultations they need.

Virtual care is becoming part of a standard smart hospital room, so creating a cohesive and seamless experience on the user end will vastly improve its value.

How will you track effectiveness and ROI?

Adding technology to a hospital setting is never a small feat. Make sure your virtual care investment is worth it by identifying how you will track its effectiveness, how you plan to roll it out.

Will you have access to data and analytics about virtual care encounters? Professional and anecdotal insights about use cases? Consultations about ongoing optimizations?

Is there a specific unit or use case you will pilot your virtual care technology with first? What’s the go-no go plan for rolling out to other areas? What’s the role of virtual care for both your short-term goals and long-term goals?

Having the right people in the conversations as well as the right technology in the spaces will be key to making sure your virtual care strategy is the most beneficial for your clinicians, patients, and families, both now and in the future.

Readers Write: Reducing Friction in the Healthcare Ecosystem: Why Convenience, Access, and Patient Experience are Key

Reducing Friction in the Healthcare Ecosystem: Why Convenience, Access, and Patient Experience are Key
By Vytas Kisielius

Vytas Kisielius is CEO of ReferWell.

The future of healthcare relies on our ability to adapt and improve how we meet the needs of patients. Despite recent advances in technology, scheduling difficulties, low appointment show rates, siloed information, and obscure reporting continue to hinder access to care, health outcomes, and care quality. To overcome this friction related to getting people to the doctor, it is essential to prioritize convenience, access, and patient experience. Many other industries have made this shift, but healthcare has been a laggard in addressing this friction. Overcoming it is the key to closing care gaps, decreasing visit no-shows, and fostering patient engagement and retention.

Defining Friction and Its Impact on Patient Care

“Friction” in healthcare significantly impacts patient care and satisfaction, manifesting through:

1. Patient expectations versus reality: The gap between high patient expectations and the reality of poor care experiences, scheduling errors, and missed appointments leads to dissatisfaction and revenue losses. In study after study, consumers report that one negative experience trumps several positive ones in their decision-making regarding repeat business (patient retention) and satisfaction with their experience (which affects CAHPS). At the same time, providers complain about patients who no-show for appointments, so rather than risk losing the revenue associated with those visits, many will routinely double-book their schedules and assume it’s okay to make the patients wait if both show up at the appointed time. Lack of understanding and empathy on both sides increases the friction.

2. Access and operational hurdles: Patients often struggle to find providers, schedule appointments, and navigate insurance complexities, leading to a preference for more accessible healthcare options. All too often, once a patient calls three or four offices selected randomly from their health plan’s portal and finds none of them have availability, they declare, “There’s no access from my plan,” when, in fact, there is available capacity spread throughout the provider network. More friction and frustration on the part of both parties – the patient thought there was no availability and the providers with available slots saw the time go to waste. Like an airline seat, once the flight takes off, an unused seat represents revenue that is forever lost.

3. Perception and trust issues: Many patients feel their health history is not fully understood by their providers. This, combined with negative perceptions of support staff (who in most cases don’t view their jobs as providing customer service but rather as providing support to their doctor employer), long wait times, and billing issues, erodes trust and confidence in the healthcare system. For all too many providers who entered medicine “to heal the sick,” the requisite training in bedside manner took a back seat to the study of symptoms and diagnoses and procedures. Another opportunity to create friction.

4. Data hurdles: When a patient is referred to a specialist following a visit to a primary care provider, the onus to find the right provider and schedule the appointment is often on the patient. Simple questions like, “What GI specialists near me take my insurance and have open appointments?” become research projects. And when they finally do find a participating specialist with availability, many a patient’s last thought is to provide a copy of their relevant medical history, including the notes of the PCP visit, in order to aid the specialist in providing the right treatment.

5. Scheduling issues: During an appointment, whether in a provider’s office or a virtual visit, or in a follow-up care call, the patient is commonly ready and willing to schedule their next appointment. Unfortunately, all too often the provider or their staff does not have the necessary information at their fingertips at that critical moment to help. In fact, in many cases the provider doesn’t think it’s their job to get the next appointment (with someone else) scheduled since, historically, the information about who takes what insurance, who performs which specialties/subspecialties/procedures at what locations and who of them has availability hasn’t been easily obtained – hence, the onus is left on the patient.

The Impact of Friction on Patients

As evidenced by these examples, when patients encounter friction, their access to care is impeded, leading to negative consequences for their health, well-being, and satisfaction with the entire process. Remember also that we typically seek care when we’re not feeling our best, shortening patience and empathy further. Have you ever taken an airplane flight when you didn’t feel 100% healthy? Normally acceptable minor inconveniences or delays can become positively irritating.

One of the primary impacts of friction is increased patient dissatisfaction. When patients face long wait times, encounter administrative hurdles, or experience difficulties navigating the healthcare system, their satisfaction levels plummet. This dissatisfaction can result in patients seeking alternative healthcare options or avoiding necessary care altogether, leading to potentially adverse health outcomes.

Friction also affects patient engagement. When patients face obstacles in accessing their healthcare information or participating in their health management, their engagement levels decrease. This lack of engagement hampers the effectiveness of future healthcare interventions and compromises patient outcomes. It’s a vicious cycle.

These challenges underscore the need for payers and providers to streamline processes, improve experiences and foster a more patient-centered approach to care.

Investing in Patient Experience as a Pathway to Improved Healthcare

Investing in the patient experience is not just a moral imperative but a strategic one, which can offer improved healthcare outcomes for patients and financial success for providers. In fact, healthcare organizations that focus on the patient experience as a critical factor in driving economic success can dramatically increase their recurring revenue. With every dollar invested in enhancing patient experience, a significant ROI, ranging from seven to 10 times the initial expenditure, is observed. This dramatic ROI is attributed to repeat visits and retention, positive word of mouth and referrals, better online reviews, and a better reputation and brand loyalty.

As we look ahead, it is important to acknowledge that we are all healthcare consumers who can relate to the struggle of finding and scheduling the care we need at a time and a place that is convenient for us. While it is easy for patients, providers, and healthcare leaders alike to name the usual obstacles – who takes what insurance, overly complicated appointment scheduling processes, and the question of who’s responsible for sharing the information back with the primary care provider – these obstacles are not insurmountable.

To truly deliver on the promise of better healthcare, we must work together to make the process of finding, scheduling, and following through with care appointments as seamless as possible for the patient. That will, in turn, improve provider experience and reimbursement rates while helping to close care gaps – reducing friction for patients and positively impacting HEDIS and CAHPS scores for providers and health plans.

Readers Write: Payment Card Fees Explained

Payment Card Fees Explained
By Heather Randall, PhD

Heather Randall, PhD is chief compliance officer of TrustCommerce, a Sphere company.

The recent comments from HSA Card User and Mr. H on 3/11/24 shine a light on an increasingly common trend on the addition of fees to your invoice, restaurant bill, sporting event, concert, or medical bill. Many businesses are adding new fees in an attempt to cover their operational costs, which continue to increase. These fees can be frustrating for consumers, and if not done in compliance with the Card Brand Operating Rules, can actually expose businesses that are trying to incorporate these fees to fines and penalties.

When discussing card fees, it is important to understand that there are different fees, and card brands maintain different rules for each type of card fee. For example, these three types of fees each have a different purpose.

• Convenience fee. A charge that is added when the business offers the cardholder an alternative payment channel that is, in fact, a convenience. For instance, a healthcare practice may accept payments in office, but may offer patients the ability to pay online. In that case, the ability to pay online is considered a convenience and a fee may be added to that payment channel. Convenience fees may not be charged in a face-to-face transaction or by a business that operates solely online.
• Service fee. A fee that is charged by a merchant or entity in the government or education sector, or a processor that enables payments for such a merchant. The merchant must pass a special identifying value in the transaction message to validate that it is eligible to charge such a fee. Such merchants may include municipal utility providers, tax assessment offices, registrar’s offices, and similar entities.
• Surcharge. A surcharge is a fee that is added to a total invoice amount to cover the entity’s cost of processing the transaction. Surcharges are capped at a certain percentage by the card brands and some states. In addition, there are a handful of states in which surcharges are illegal, and several others in which there are significant regulatory requirements around how a surcharge is to be implemented and communicated. Surcharges cannot be charged on a debit card transaction.

Another important note is that an organization can only charge one of these fees, depending on the card brand. For example, if a patient is paying a medical bill through a portal, the practice can charge either a convenience fee or a surcharge, but not both.

Surcharging in particular is a nuanced process. Maintaining balance between the different card brand approaches to compliant surcharging — and cash discounting, which is also an emerging trend — and state laws is tricky at best. This is particularly true given the recent settlement between Visa/Mastercard and several merchant groups. That settlement included some changes to the ways in which surcharge will be managed by the brands. It remains to be seen what the impact of that settlement will be on the practical realities of imposing such a fee.

The long and the short of it is that merchants can use a number of fees to offset the costs of operations, but they must be used in a way that is compliant with state laws and industry rules. Doing so can be extremely complicated and can court significant consequence if not implemented correctly. Any business investigating leveraging convenience fees, service fees, or surcharges is well advised to speak with their merchant service provider or acquirer before implementation.

Readers Write: Creating a Patient-Centric Practice: How to Minimize Wait Times and Increase Patient Satisfaction Scores

Creating a Patient-Centric Practice: How to Minimize Wait Times and Increase Patient Satisfaction Scores
By Sherilyn Giauque

Sherilyn Giauque is principal product manager at AdvancedMD of South Jordan, UT.

By reducing wait times, healthcare providers elevate the patient experience and improve healthcare outcomes, while also driving greater efficiencies across the practice. 

The amount of time a patient spends waiting to see a healthcare provider has a direct impact on the patient’s perception of the practice and level of care they receive. The longer a patient spends waiting — either to schedule an appointment or to see their healthcare provider once they arrive at the practice — the more likely they are to seek out a new physician or simply stop receiving care. 

When scheduling an appointment, the average wait time to get into a medical office is 26 days. That means that many patients are waiting nearly a month just to see their healthcare provider. Research conducted by Duke Health revealed that every 10 minutes that a patient spent waiting to see their healthcare provider led to a 3% decrease in patient satisfaction scores. 

If you’re searching for new ways to build a patient-centric practice that prioritizes patient care and outcomes above all else, here are five tactics that can help you reduce the amount of time your patients spend waiting to see you. 

#1: Take a strategic approach when managing waitlists that minimizes the impact of no-shows while optimizing daily schedules 

Double-booking and triple-booking appointments with high no-show rates can help eliminate unnecessary downtime for both the admin and clinical staff while keeping your practice operating at full capacity. Be sure that waitlists can be easily accessed and updated by your admin team, with automated notifications built in to alert patients when an appointment slot becomes available. 

#2: Give patients access to digital intake forms that can be completed online to streamline patient check-in processes

By taking advantage of digital intake forms, your practice can eliminate the need for patients to fill out paperwork while waiting to be seen. Online forms also help reduce errors and minimize the amount of time your admin team spends entering patient data—all while providing a smooth patient experience. 

#3: Take advantage of a unified medical office software platform that includes integrative EHR, practice management, and patient engagement solutions

Now more than ever, practices need highly integrative technology solutions that seamlessly connect all sides of the business. An effective all-in-one EHR, practice management, and patient engagement platform comes equipped with key features that can help reduce wait times, including: internal wait-list management capabilities, rooming features to move patients through the office as quickly and efficiently as possible, automated appointment reminders, and customizable intake form templates.

#4: Allow patients to schedule visits and manage their healthcare experience via intuitive self-service tools

Patients who have more control over their healthcare experience and more flexibility when it comes to scheduling appointments tend to be more satisfied with their healthcare providers. Providing your patients with self-service tools and access to an online portal where they can access billing records, make payments, schedule appointments, and review lab results not only streamlines patient-centric workflows, it helps reduce workloads and improves the entire patient journey, shrinking wait times and improving patient satisfaction. 

#5: Prioritize onboarding programs for new staff and keep employees well-trained on the practice’s technology stack and workflow best practices

Making sure your staff understands best practices around workflow processes and is up to date on your technology solutions is key to building a thriving, patient-centric practice. Taking the time to properly train both admin and clinical staff enables efficiencies throughout the practice, removing bottlenecks and ensuring smooth transitions as patients move from a waiting room, to an exam room, to the checkout desk. 

The reality is that long wait times are not only detrimental to the patient experience, they can be devastating for anyone who is suffering from a chronic illness who is in need of prescriptions or advanced treatment programs that require accelerated timelines. Improving wait times not only elevates the patient experience and improves healthcare outcomes, it has a positive effect on your entire practice, driving efficiencies throughout the office.

Readers Write: Navigating the Talent Terrain: Choosing Between Full-Time Employees and Fractional Resources in IT Hiring

Navigating the Talent Terrain: Choosing Between Full-Time Employees and Fractional Resources in IT Hiring
By Eric Utzinger

Eric Utzinger is co-founder of Revuud of Charlotte, NC.

Every day, healthcare leaders are faced with critical decisions regarding their IT staffing strategies. Among the most significant decisions is whether to hire full-time employees or use fractional resources. Both options offer unique advantages and challenges, and IT hiring managers must carefully consider various factors before making a choice that aligns with their organization’s goals and needs.

Full-time employees are individuals who work for an organization on a permanent basis, typically receiving benefits such as healthcare, retirement plans, and paid time off. They are fully dedicated to the company and work a set number of hours per week.

Fractional resources — also known as contract workers, consultants, or freelancers — provide services to an organization on a part-time or temporary basis. They are hired for specific projects or tasks and may work remotely or onsite as needed. Fractional resources offer flexibility and scalability, allowing businesses to access specialized expertise without the long-term commitment of hiring full-time staff.

These are the factors to consider.

Expertise and Specialization

Full-time employees often offer deep institutional knowledge and continuity, which can be invaluable for long-term projects and organizational stability. They can be trained and groomed to align with the company’s culture and values. However, fractional resources bring diverse skill sets and specialized expertise that may not be available internally. They can provide fresh perspectives and innovative solutions to complex challenges.

Cost Considerations

While full-time employees may entail higher initial costs due to salaries, benefits, and overhead expenses, fractional resources offer cost savings in terms of flexibility and scalability. Organizations can hire fractional resources on a project-by-project basis, avoiding long-term financial commitments and reducing overhead costs associated with maintaining a full-time workforce.

Flexibility and Scalability

Fractional resources provide organizations with the flexibility to scale their workforce up or down based on project demands and business needs. This agility is particularly beneficial in industries with fluctuating workloads or seasonal demands. Full-time employees, while offering stability, may lack the flexibility to adapt to changing circumstances without incurring additional costs or disruptions.

Time-to-Hire and Onboarding

Hiring full-time employees typically involves a longer recruitment process, including sourcing, interviewing, and onboarding, which can delay project timelines and impact productivity. In contrast, fractional resources can be onboarded quickly, allowing organizations to address immediate needs and accelerate project delivery.

Risk Management and Compliance

Full-time employees are subject to labor laws, regulations, and employment contracts, requiring organizations to adhere to various compliance requirements. Fractional resources, while offering flexibility, may introduce legal and regulatory risks if not properly managed. IT hiring managers must ensure that contractual agreements are clearly defined, and compliance standards are met when engaging fractional resources.

When determining whether to use full-time employees or fractional resources, IT hiring managers should carefully evaluate the unique needs and priorities of their organization. It’s essential to assess factors such as expertise, cost considerations, flexibility, scalability, risk management, and organizational culture.

In some cases, a hybrid approach combining full-time employees with fractional resources may offer the best of both worlds, providing the flexibility to leverage external expertise while maintaining core internal capabilities. By leveraging the strengths of each staffing model, organizations can optimize resource allocation, enhance agility, and drive innovation in an increasingly competitive market.

Ultimately, the decision between full-time employees and fractional resources requires a nuanced understanding of the trade-offs involved and a strategic assessment of the organization’s priorities. By weighing the considerations outlined above and aligning staffing decisions with overarching business goals, organizations can position themselves for success in the ever-evolving landscape of IT.

Readers Write: The Countdown Begins: When Will Your Health System Say Goodbye to Traditional Faxing?

The Countdown Begins: When Will Your Health System Say Goodbye to Traditional Faxing?
By Tim Hoskins

Tim Hoskins is VP of solution architecture at Vyne Medical of Dunwoody, GA.

For 145 years, copper wire has been essential in facilitating communication across America, providing seamless nationwide connectivity through the telephone network. However, in 2019, the Federal Communications Commission (FCC) prompted the modernization of this infrastructure by discontinuing the mandate for local phone companies to maintain copper wire services and lifting price cap requirements for customers.

This policy shift led to significant changes in America’s communication networks, forcing the transition of traditional plain old telephone services (POTS) to more advanced systems. Despite this change, some essential services and organizations — including healthcare providers and payers — still use on-premise fax systems. These traditional systems are reliant on the aging and soon-to-be-obsolete copper wire infrastructure. 

To continue providing exceptional patient care, hospitals and health systems that still use traditional fax need to revamp operations and replace their outdated systems. Without this essential update, they risk the inability to efficiently exchange crucial patient information, including referrals, prior authorizations, lab results, and prescription orders.

In cities nationwide, the transition away from copper wire has already begun, and given the substantial costs associated with upkeeping and repairing copper wires, it is welcomed by many. “The copper infrastructure is old, expensive to repair and maintain, and can’t support high-speed Internet connections,” shared Fraida Fund, a research assistant professor at NYU Tandon’s Department of Electrical and Computer Engineering. “Fiber is technically a much better medium for communications; you can transfer data faster over fiber than over copper.”

During severe storms or unexpected line outages, many hospitals and health systems have already experienced the dilemma of not being able to rely on their system’s traditional phone and fax systems, presenting a significant communication challenge for both providers and patients. In 2012, Hurricane Sandy damaged copper lines across New York City, and instead of repairing the lines, fiber optics were installed in their place.

“We lost dial tone on my fax line, so I couldn’t receive or send any faxes. Imagine my patients waiting for their CAT scans, X-rays, their reports of blood, all different kinds of things,” explained Ida Messana, MD, a Queens internist who specializes in geriatric medicine.

Despite its high costs and inconsistent reliability, traditional faxing remains prevalent in healthcare systems nationwide. In 2023, it was estimated that:

• 75% of healthcare still depends on fax.
• 47% of small hospitals and 43% of rural hospitals are most likely to mail or fax medical records.
• On average, a 500-bed hospital loses more than $4 million due to communication deficiencies.

“The problem is abandoning customers in rural areas and small towns who have few if any, choices for broadband,” explained Matt Larsen, CEO of Vistabeam.

As rural health systems navigate this transition, these organizations must advocate for their staff and patients by proactively seeking out replacement solutions to overcome the unique challenges they may encounter.

Cloud fax technology provides a convenient digital faxing solution, removing the need for traditional copper wire transmission within health systems. Beyond resolving the reliance on copper wires, cloud fax brings a host of benefits that can optimize operations and enhance patient care.

When selecting the ideal cloud fax vendor, it’s important to acknowledge that not all vendors are equal. While many provide digital faxing services, the benefits they offer vary greatly. Innovative companies that are eager to collaborate and integrate with an organization’s existing technology can not only address the copper wire dilemma, but also generate time and money savings with a healthcare-centric solution that can provide:

• Outbound faxing for the EMR system.
• Real-time and encrypted exchange networks.
• Remote access capability.

As communication methods evolve, both rural and urban health system technology must adapt accordingly. With solutions available that enable seamless bidirectional cloud faxing, the reliance on copper wire for essential operations can be eliminated. Additionally, the need for printing and scanning is minimized, empowering teams to efficiently manage large volumes of sensitive and urgent communications.

The transformative power of cloud technology in healthcare management is evident in its ability to replace traditional faxing and safeguard patient care from unforeseen disruptions. When one medical center that uses cloud fax technology experienced an incident in their server room, the patient access team feared they would lose their missed incoming faxes. However, following the repair of their server, the inbound fax orders became immediately accessible, highlighting the reliability of cloud-based systems in maintaining seamless operations despite unexpected interruptions.

“That would have been 607 patient orders lost if they weren’t in the cloud. Everything lives in the cloud. Thank you for the cloud!” shared the team’s patient access manager.

As healthcare communication continues to evolve, it’s imperative to equip teams with the right tools to maintain exceptional patient care.

Readers Write: The Vulnerability Few Anticipated

The Vulnerability Few Anticipated
By Darcy Corcoran

Darcy Corcoran, MBA is principal consultant for cybersecurity at CereCore of Nashville, TN.

This healthcare IT security organization takes their job seriously. They secure perimeters, restrict IP addresses from their network (even for IPs that falsify their country of origin), multifactor authenticate access, and protect administrative login credentials. Their access controls are mature and have proven reliable. They’ve thought of everything, right?

Then why were hired hackers able to find their way onto this organization’s network in less than four hours?

It started with something so simple, so seemingly innocuous – and so convenient for so many – that no one even questioned it until the day they learned why they should.

Patient Advocate Olivia wants the best for patients and diligently works to do her part to create great patient experiences. That’s why when she realized that patients needed to contact several departments in the hospital to schedule appointments, ask billing questions, and find out where to park for an imaging appointment, she asked to have a link to the employee directory added to the website. Website Manager Liam added the link right away because he, too, is devoted to patients and wants to make their journey easier.

Days later, he was pleased to see site analytics that showed a few uses of the link. An easy mission accomplished.

Soon after, IT Director Mary received findings of her team’s latest cybersecurity external threat assessment, which alerted her to a publicly available website resource that showed first names, last names, departments, and phone numbers for key employees of the hospital – the employee directory. She acted quickly to have the directory restricted from the website, and network monitoring tools verified that there was no related suspicious activity to investigate.

Why did Mary take such swift action? The information in an employee directory, while convenient for some use cases, contains everything a malicious actor needs to begin a small to large-scale attack by doing any of the following:

• Contact the IT helpdesk to reset a user password or redirect the multifactor authentication to the hacker’s phone number, enabling them to reset the account password manually and gain access to the network.
• Contact the IT helpdesk, impersonating a provider to social engineer information with the aim of figuring out the helpdesk authentication techniques and procedures to better defeat the authentication processes in the future.
• Gather employee lists and emails that allow the hacker to continue to harvest credentials to engage in password spraying and brute force attacks that would assist in gaining access to a user level account or privileged user account.
• Contact a patient as though they are a facility employee in need of personal health information for an upcoming appointment.
• Contact a patient as though they are a member of the facility’s billing department in need of credit card or other information to process a payment
• Contact employees in hopes they will divulge additional seemingly innocuous but powerful information when it’s in the wrong hands, such as email format and locations.
• Gain physical access to the facility.

The people and organization in this story are fictitious, but the vulnerability depicted is a common one. Stories like these help us appreciate how cunning malicious actors can be and how little they need to know to learn more and wreak havoc. It also demonstrates how protecting the organization is difficult and getting harder, given all of the potential vulnerabilities and the numerous gaps to address. Organizations where boards and stakeholders understand, support, fund, and do their part to defend have the best chance in an environment where hackers are looking for their next opportunity.

Readers Write: The New Lifestyle Coach: How AI Can Support Adherence for People with Diabetes

The New Lifestyle Coach: How AI Can Support Adherence for People with Diabetes
By Richard Mackey

Richard Mackey, MBA is CTO of CCS of Dallas, TX.

Living with diabetes is more than a full-time job. It’s a 24/7 commitment to monitoring thousands of tiny details related to diet, exercise, sleep, stress, and overall health.

People living with diabetes end up making nearly 200 extra decisions every day to keep on top of their condition, creating a near-constant risk that a split-second of inattention can snowball into a slide away from healthy habits and appropriate adherence to care.

While much of this conversation around diabetes adherence has historically focused on medications, the modern diabetes care plan now often includes devices such as insulin pumps and continuous glucose monitors (CGMs). These devices are supposed to make self-management of care decisions easier, but sometimes they cause unexpected issues when a patient doesn’t understand how to use their device or struggles with staying on top of their routine.

As the diabetes epidemic continues to grow, health plans and their partners cannot expect people living with diabetes to bear these constant burdens all alone. Instead, they need to surround each and every individual with predictive, data-driven support that accurately flags risks of non-adherence — including that involving medical devices — before they become unmanageable and lead to poor outcomes and higher healthcare spending.

Leveraging artificial intelligence (AI) and machine learning to assess members predictively and longitudinally can help health plans identify emerging risks of non-adherence and proactively reach out with support for members to keep them on the right track with their care.

Data-driven risk stratification has become a core component of chronic disease management in recent years, but health plans still face challenges with identifying when and why certain individuals move up and down the risk ladder. Many plans primarily work with claims data, which can be incomplete from an analytics perspective and offers little insight into why members are straying from their care plans. With limited scope and up to several months of lag time, this claims dataset alone is not sufficient to get ahead of the exact moment a person starts to show potential issues that are likely to lead to non-adherence with recommended care best practices.

Instead of relying too heavily on claims data alone, health plans need to integrate datasets that give a more comprehensive and current view of member activities: socioeconomic data to identify non-clinical barriers; pharmacy data to show medication access and adherence patterns; diabetes supply ordering records to indicate therapy adherence; and device data to highlight continual usage of management tools and control of clinical factors, like blood glucose levels.

Together, these and other datasets paint a powerful, holistic, and timely portrait of a member’s ability to participate in their own care from a clinical and nonclinical perspective, enabling health plans and providers to pinpoint potential trouble spots and dynamically predict rising or falling risks of non-adherence.

AI has quickly become an essential tool for making sense of rich and varied healthcare datasets, but it must be deployed intentionally to maximize its impact. That means developing bundled algorithms and services that can identify accessible patient data while also spotlighting what data is actually missing in a patient’s longitudinal record.

For example, the sudden absence of a monthly diabetes supply order or prescription refill or a sporadic tapering off of data reports from a CGM over time are major red flags on the adherence front. AI tools must be sophisticated enough to know when missing data is a sign of an impending problem, which means designing models and corresponding patient outreach and education strategies that support prevention.

After examining these patterns at scale and over time, AI models can accurately assist health plans with identifying the clinical and socioeconomic factors that most directly correlate with these adherence gaps in their unique populations, allowing care management teams to move closer and closer to the non-adherence trigger point for individuals, and ideally, to also be able to predict likely non-adherence events for members before they occur.

For example, some members are providing care for children and aging parents while working full time and may have more limited opportunities to invest in their own care. Offering these members insights and best practices specific to maintaining therapy under a tight schedule can prove helpful. In other cases, financial uncertainty may be impacting a member. Providing these members with education and coaching on tools that allow for flexibility in out-of-pocket costs for medications and/or medical devices so that they can continue therapy without disruption can mean the difference between adherence and non-adherence.

Considering that the costs of caring for people with diabetes consumes more than 20% of the nation’s annual $4.5 trillion healthcare budget, investing in next-generation tools and partnerships to get ahead of non-adherence and negative member outcomes is essential for altering the trajectory of the ongoing diabetes epidemic.

However, identifying impending problems is only half the battle. Plans must be ready and able to conduct meaningful, individualized outreach to members who show signs of non-adherence as soon as possible. Direct engagement and education with members can often uncover the true obstacles, both tangible and emotional, behind non-adherence issues, including underlying issues of trust in the health system that may stem from personal or community experiences. These conversations with extended care teams can shift that narrative for individuals and become an opportunity for plans to provide compassionate, actionable problem solving for members that help build relationships and prevent future issues.

Information that is gathered during these outreach interactions can be structured and folded back into analytics efforts to enrich future insights and enable health plans to become even more predictive, personalized, and prepared to support their members with community-based resources, tailored diabetes education, and specialized training on how to best use their devices and adhere to a recommended care regimen.

Ultimately, AI can help identify non-adherence issues in people living with diabetes before it becomes a full-blown, costly problem. By diving deeper into holistic datasets and member care patterns, AI tools will soon be able to identify the underlying challenges facing members, empowering health plans to address these issues earlier while fostering meaningful outreach activities that surround people living with diabetes with the support and guidance they need to thrive.

Readers Write: ViVE 2024: Enthusiasm Mixed with Caution Around Interoperability

ViVE 2024: Enthusiasm Mixed with Caution Around Interoperability
By John Blair, MD

A. John Blair III, MD is CEO of MedAllies of Fishkill, NY.

As a first-time attendee of digital healthcare conference ViVE, I wasn’t quite sure to expect prior to the 2024 event in Los Angeles. However, amidst all the inevitable talk of artificial intelligence and the massive chaos caused by the Change Healthcare saga, I found the event to be well conceived to maximize learning and networking with an efficient, upbeat approach. I enjoyed checking out presentations of all types on the floor, then was able to conveniently chat in meeting rooms with leaders of companies following sessions and panels, making the event a great opportunity to meet with people.

As a founder of a Qualified Health Information Network (QHIN), I attended the event to get a feel for the state of interoperability across the industry.

For the unfamiliar, QHINs were created under the Trusted Exchange Framework and Common Agreement (TEFCA), a federal regulation guided by the Office of the National Coordinator for Health Information Technology (ONC). A QHIN is a network of organizations working together to share data. QHINs will connect directly to each other to ensure interoperability between the networks they represent, with the goal of improving patient care through faster, more accurate data exchange.

QHINs achieved a major milestone in late 2023, when ONC announced that they had become operational. After completing the rigorous TEFCA onboarding process, we were one of five initially designated QHINs by the ONC. With QHINs now operational, I was enthusiastic to learn more about how the market is responding. With that, here are five major takeaways from ViVE.

• A focus on interoperability. The interoperability area of ViVE was terrific. There were continuous presentations and panels on one of three small stages that lent themselves to engaged and pertinent discussion. Also, because all the booths were interoperability companies, the interaction and discussions were rich and fruitful.
• QHINs spark a mix of enthusiasm and caution. As a representative of a recently designated QHIN, I was enthusiastically received everywhere, leading to informative and fruitful conversations. Although there is strong interest in and hope for TEFCA, understandable skepticism remains. There was a counterbalance between a high level of enthusiasm for TEFCA as a catalyst to significantly increase and improve interoperability to skepticism about the ability for a public-private effort of such magnitude to move much quickly.
• Privacy concerns. Individuals and organizations are concerned about privacy protections in TEFCA. Understandably, with all of the cybersecurity and privacy incidents happening, TEFCA’s massive scale has privacy and security professionals worried. However, those individuals close to the activity and process tend to agree that planning and adequate measures are taking place.
• Let me stand next to your FHIR. There is strong interest in TEFCA being a catalyst to move FHIR to scale. FHIR has made great progress and holds real promise, but achieving FHIR at national scale will be difficult. TEFCA is seen by many as the best way to address the challenge.
• Wanted: More use cases. Non-treatment use cases under TEFCA are needed, and the sooner the better. I had several conversations with individuals and companies interested in Individual Assess Services and Health Care Operations. They all want this to get live as soon as possible.

Perhaps the most relevant, concise remark I can make about ViVE is that I’m planning to attend next year. See you in Nashville.

Readers Write: Reframing Healthcare at Home

Reframing Healthcare at Home
By Philip Parks, MD, MPH

Philip Parks, MD, MPH is partner and senior advisor at CWH Advisors of Boston, MA.

What is in store for 2024 for healthcare at home? The organizations that will be successful will make progress rethinking healthcare and reframing both the problems we are solving and how we are solving them.

Whether we think about healthcare from the perspective of a patient, caregiver, payer, healthcare provider, or technology provider, it is undeniable that three types of healthcare experiences are here to stay:

1. Facility-based care. In-person care in facilities has an important place for the highest acuity clinical needs and when facility infrastructure is required;
2. Virtual care. Virtual care, ranging from episodic care to primary care to mental health care, may be the best and most effective way to meet patients’ needs and wants.
3. Care in the home. Virtual or in-person care (or a combination of the two) ranging from hospital home, primary care, specialty care, home health, hospice services, to in-home health evaluations for prevention and wellness.

However, the US healthcare system remains largely organized around facilities, even though the mega trends demand otherwise – aging populations with chronic conditions, adoption of technology, rising costs to support facility infrastructure, and healthcare provider staffing challenges. Therefore, many of the challenges that must be solved for moving care to the home are a work in progress. Often adoption and utilization have not been achieved to the extent needed.

While delineating care models by the site of care is practical for reimbursement and delivery of care, we are evolving to a world where patients just need care they need at the right time. The emerging concept and an example of reframing is that care can be thought of as always being on or continuous care being proactively enabled to address prevention, monitoring of treatment or care plans, navigation, and guiding the next best action for patients, caregivers, and providers.

How we accomplish this type of care in the US health system is, shall we say, a wicked hard problem that is being shaped by health and technology policies for standards information sharing (e.g., passing of TEFCA in December 2023), vertical integration (via acquisitions and/or partnerships) of providers, payers, platforms for care beyond facilities’ walls, and continued incremental innovations in care delivery models.

An often-underemphasized discipline is logistics related to healthcare in the home, especially, high acuity care in the home (or hospital-at-home) where nearly 20 types of services, supply, and staffing resources must come together on a daily basis to serve the clinical need of the patient. Factors to consider include timeliness, complexity, safety, quality, and the management and use of clinical and non-clinical data. We need more impactful partnerships between entities that bring together more integrated solutions with more value to impacting total costs of care, better use of data to directly inform evidence-based decisions and actions, and that reduce friction for patients and providers.

Five must- have tenets of a framework for healthcare services in the home should include:

1. Access. Requires making the intending action easier for patients, awareness of services, mechanism for reimbursement, efficient and cost-effective logistics, 24/7 navigation, appropriate staffing, and technology enablement support by data capture and documentation. Some examples to rethink include logistics and processes: waste disposal, reimbursement – attribution to combined service providers, technology – integration with mainstream EHRs, clinician staff that can travel, cancer care in the home, and clinically appropriate 911 diversion.
2. Engagement. A mix of human touch and empathetically designed and implemented technology; very simply, engagement is the trigger for action for human behavior. Engagement must result in activation of motivation and often is a prompt of some type that is educational, motivational, or oriented toward a desired identity of being healthy. Examples of effective marketing campaigns include making the intended action by the patient or member easier by empathetically addressing “what is in it for the patient and or caregiver”. Patient and caregiver voice is critical to getting this right.
3. Actions. These are the evidence-based behaviors by the provider and the behaviors of the patient (and caregiver) to participate in self-care or provided care. An example of options for home care is direct to consumer campaigns for colorectal cancer screening, which provide information based on the member or patient’s preferences and risk for colorectal cancer and in some cases can be done at home.
4. Adherence. Repeated behaviors related to self-care and active participation in provided care. Critical for adherence are literacy, knowledge, motivation, and ability. Making the repeated action as easy and simple as possible is critical. Examples of effective adherence strategies at home include enlisting the caregiver to reinforce self-care, using technology enabled reminders to prompt good habits, and ensuring that resupply of medications and supplies are automated when possible and medically necessary.
5. Health outcomes are a function of proactively creating access to all people and populations, proactively engaging with education and motivation that must lead to action on the part of patients. Adherence or repeatable actions result in outcomes.

Care at home may be the best site to conduct early screenings and pick up on other factors that wouldn’t necessarily happen in traditional settings. Also, with some diseases, the time period of screening and early detection may be much faster when screening can occur at home. For example, for individuals at average risk for colorectal cancer, samples can be collected in the home and mailed in for evaluation.

These tenets are the most important attributes which must be part of patient-centered design of services in the home. Obsessing over the healthcare and lived experiences of patients, caregivers, and their healthcare provider team members is paramount.

Reframing healthcare at home offers immense potential benefits related to quality of care, decreased costs and improved outcomes, elimination of silos across the continuum of care, and high satisfaction for patients, caregivers, and providers. Perhaps one of the most actionable ways for determinants of health to be identified and addressed is through continuous engagement and support to patients via care navigation, coordination, and the provision of clinical and non-clinical services in the home.

Readers Write: HTI-1: A Step Towards Demystifying AI in Healthcare

HTI-1: A Step Towards Demystifying AI in Healthcare
By Ryan Parker

Ryan Parker is a consultant and healthcare informatics graduate student. 

The integration of artificial intelligence (AI) in healthcare has been a double-edged sword, offering the potential for revolutionary advancements in patient care while simultaneously posing significant challenges related to data transparency, algorithmic bias, and the elusive nature of AI decision-making processes. The Office of the National Coordinator for Health Information Technology (ONC)’s latest regulatory effort, the Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1), attempts to address these challenges head on. However, the question remains: Is it enough to solve AI’s most pressing issues in healthcare?

The challenges of implementing AI in healthcare extend beyond the technical sphere, often rooted in what I call “the human problem with artificial intelligence.” This encompasses issues like incomplete or biased datasets, unconscious biases leading to unintended outcomes, and the notorious “black box” problem where the reasoning behind AI decisions remains opaque. While the HTI-1 final rule aims to tackle these issues, its scope and impact merit a closer examination.

A significant hurdle in AI implementation is the siloed nature of patient data across the US healthcare system. This fragmentation hampers the development of AI models by limiting access to comprehensive datasets necessary for training. Although HTI-1 does not directly address data silos, you can see how this final rule aligns with ONC initiatives like the Trusted Exchange Framework and Common Agreement (TEFCA), aiming to foster a more interconnected health information landscape.

The problem of algorithmic bias and unintended outcomes—referred to as the “alignment problem” —is acknowledged tangentially in HTI-1. While the rule doesn’t mandate specific measures to eradicate biases, it underscores the importance of transparency and accountability in AI development and deployment. This approach suggests a recognition of the systemic nature of biases within AI algorithms but leaves the responsibility for addressing these issues largely in the hands of developers and implementers.

Perhaps the most significant contribution of HTI-1 is its attempt to illuminate the black box of AI decision-making. By identifying 31 source attributes that must be accessible to end-users—ranging from input variables and the purpose of the intervention to external validation processes—the ONC aims to increase transparency. This initiative is crucial, as studies have shown that healthcare providers are often reluctant to trust AI systems that lack explainability, regardless of the potential benefits.

The emphasis on transparency aligns with the sentiment expressed by Christian (2020), who noted that “the most powerful models on the whole are the least intelligible,” and Ehsani (2022), who highlighted the significant risk perceived by healthcare providers when faced with unexplainable systems.

It’s important to note that HTI-1 does not create a requirement for health systems to implement any specific technology related to decision support interventions (DSIs). Instead, it sets a framework for how AI should be integrated and evaluated within certified healthcare solutions. This approach allows for flexibility and innovation but also places the onus on health systems and developers to navigate the complexities of AI integration responsibly.

As Borgstadt et al. (2022) aptly put, the implementation of machine learning algorithms supporting clinician workflow can enhance the quality of care and provider experience, ultimately leading to improved patient outcomes. However, the journey toward fully harnessing AI’s potential in healthcare is fraught with challenges that require ongoing attention, intention, and effort. At the end of the day, HTI-1 is offering a new tool to healthcare providers, the real impact of which can only be determined by themselves.

Readers Write: Transforming Nursing Education: Seizing the Opportunity for AI and Technology Advancements

Transforming Nursing Education: Seizing the Opportunity for AI and Technology Advancements
By Julie Stegman

Julie Stegman is vice president of the Health Learning and Practice business at Wolters Kluwer Health of Waltham, MA.

In the ever-evolving landscape of healthcare, the nursing profession stands at a critical juncture. The nursing shortage is a pressing concern, and nursing education faces the challenge of preparing students for the day-to-day demands of clinical practice. The intersection of these challenges presents unique opportunities for the integration of artificial intelligence (AI) and other cutting-edge technologies, like virtual reality (VR), in nursing education to usher in a new era of learning and proficiency.

Nursing students find themselves navigating a learning environment that is vastly different from their earlier educational experiences. The transition from K-12 to nursing school is marked by an overwhelming amount of reading from textbooks, a lack of hands-on clinical practice, and the pressure to perform in a high-acuity clinical setting. Consequently, a staggering 37% of nurses who are under 25 said they were planning to leave their current role in the next six months, contributing to the broader nursing shortage.

Nursing schools are grappling with a lot right now, from how to best train practice-ready graduates and fill faculty openings while also reassessing their teaching methodologies. The goal is clear: combat unsafe practices, graduate clinically confident and competent nurses, and enhance retention rates. The need for innovation in nursing education is more critical than ever.

2024 is poised to witness a paradigm shift in nursing education, driven by the integration of AI. Embedded thoughtfully, AI holds the promise of streamlining educational workflows, alleviating the burden on faculty, and enhancing the learning experience for students.

AI offers a solution to the demanding workload faced by educators. By using AI algorithms, faculty members can efficiently assess student knowledge, allowing educators to focus on refining the delivery of content, fostering critical thinking, and providing personalized guidance.

For students, AI provides access to trusted learning materials in a conversational format, making information more accessible and digestible. Educational companies, recognizing the time constraints and expectations of modern students, are early adopters of AI to engage learners and provide personalized study resources.

The convergence of the nursing shortage and the evolving landscape of education creates a unique opportunity for the integration of AI in nursing education. The transformative potential of AI, coupled with innovations like VR and multimedia, can reshape the way nurses are trained and prepared for clinical practice.

At this critical juncture, nursing schools must seize the opportunity to embrace technology and ensure the next generation of nurses is not only clinically competent, but also well equipped to navigate the complexities of modern healthcare. The integration of AI in nursing education is not merely a technological advancement; it is a crucial step towards building a resilient and proficient nursing workforce for the future.

The nursing profession is witnessing a significant exodus of younger nurses, with approximately 15% of those with fewer than 10 years of experience expected to leave the workforce in the next five years. To combat this trend, nursing schools must adapt and incorporate technology to meet the needs of the current generation of learners. Doing so will allow students to be exposed to more lifelike scenarios, helping ease the transition to patient care.

Innovations like VR and virtual simulation can offer a bridge between theoretical learning and real-life clinical practice. Traditional simulation labs often limit students due to the need to share learning experiences. VR technology, on the other hand, enables multiple students to engage in realistic training simultaneously, enhancing the quality of the learning experience.

Combined with AI, these advanced virtual tools can better prepare students for real-world clinical scenarios without risking real patient harm. A startling statistic reveals that only 9% of new graduates are considered within an acceptable range of providing safe patient care, emphasizing the urgency for better clinical preparation. Bringing together VR simulation and testing leveraging AI for personalized learning can play a pivotal role in bridging this gap. This way of teaching and learning allows nursing students to gain practical experience, ensuring they enter the workforce with the skills and confidence needed for safe and effective patient care.

Readers Write: Would We Do It All Again? Insights from a Designated QHIN Regarding the Application Process

Would We Do It All Again? Insights from a Designated QHIN Regarding the Application Process
By Jay Nakashima

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

I was asked recently, “Would we do it all again?” Knowing what we know now, would we still have been among the first organizations to apply to become a Qualified Health Information Network (QHIN) under the Office of the National Coordinator for Health IT’s (ONC) Trusted Exchange Framework and Common Agreement (TEFCA)?

Honestly, the answer is yes. But I’m glad it’s behind us.

There’s no doubt the QHIN process was a necessary step toward achieving nationwide healthcare interoperability. As the nation’s first federally endorsed health information exchange that already exchanges 21 billion transactions annually and in all 50 states, there was never a question whether EHealth Exchange would participate in the process.

But it was not always an easy and straightforward process to becoming one of the first Designated QHINs. As anyone who has developed a new system or process knows, what makes perfect sense in planning doesn’t always work out as intended. Unforeseen challenges pop up, and things need to be tweaked and adapted. We expected that.

Now that we’ve had a chance to take a breath and regroup after achieving QHIN designation, it seemed like a good time to share some thoughts and perspective to help others going through the application process.

The healthcare industry is slow to adopt new technology. After all, we’ve been talking about nationwide interoperability for more than 15 years, and while we have made great strides, it is not ubiquitous. The QHIN application process, by comparison, is incredibly fast. The timeline to accomplish various tasks can be remarkably short, sometimes only a few days or weeks in between deadlines. To keep up, an applicant must be prepared to move quickly because once an application has been accepted for testing, Candidate QHINs have 12 months to achieve designation status.

One thing that helped EHealth Exchange was that our team got started well before we entered the official application process. We looked at the proposed language in the QHIN Technical Framework (QTF), which was published in 2022, and spent more than six months ensuring that we closed any gaps between EHealth Exchange’s technology platform and our policies to ensure compliance with TEFCA requirements, standard operating procedures, and protocols. By the time the application was released, we were ready.

This process — and more importantly, the responsibility of becoming a QHIN — is not for the faint of heart. It was a two-year process for EHealth Exchange, and the work doesn’t stop after designation. For those entering the application process now, it’s worthwhile to review the requirements and begin tackling initial tasks before the clock starts.

Although the applicant QHINs were market competitors, we also were all working to achieve the same thing, which gave us a compelling reason to collaborate. Many applicants turned to each other for assistance, and we even began early testing together, unprompted by the government. Candidly, I thought that competition might hinder our abilities to work effectively together, and I am happy to say that that never surfaced. We were all a team working together toward a collective goal.  As others go through the QHIN application process, we would encourage a similar level of appropriate and compliant cooperation with your fellow applicants and Designated QHINs. After all, we all win with national interoperability. 

It’s always easier to drive on a freshly paved road, and I like to think that, along with our future QHIN exchange partners, EHealth Exchange helped pave the way for the next applicants.  As I said before, any new process – particularly one with the level of technical complexity that health data exchange demands – is going to run into unforeseen problems. And boy, did we encounter a lot of them. Steps have been refined. Some requirements have been clarified or adjusted, and new ones have been added. 

For example, each Candidate QHIN had to create its own terms and conditions. In Common Agreement Version 2.0, the Recognized Coordinating Entity (RCE) is proposing a standard set of terms and conditions that each QHIN, and its participants and sub-participants, must adopt to participate in TEFCA, which is a simpler and more consistent approach. The process is now better documented and defined, and I am optimistic that those changes will make it easier for other applicants. 

While I wouldn’t volunteer to repeat the journey we took, for new applicants, you should have no qualms undertaking the application process. Not only because it has been tried and refined, but also because I believe deeply in its value. I’m excited to see TEFCA come to life and to bring our experience to bear in support of our future QHIN exchange partners, the RCE, and most importantly, the American health system and the patients whose care depends on nationwide exchange.

Readers Write: More Technology is Not Always Better in Specialty Medication Workflows

More Technology is Not Always Better in Specialty Medication Workflows
By Julia Regan

Julia Regan, MBA is founder and CEO of RxLightning of New Albany, IN.

Over the past decade, there has been a consistent promise made that technology would make provider and care team lives easier. However, the proliferation of EHRs, point solutions, manufacturer and vendor portals, and digital devices have made various processes not only more cumbersome, but more confusing and frustrating.

In specialty medication onboarding specifically, an HCP may need to visit upwards of 40 portals or websites throughout their day to check patient benefits, submit prior authorization, find and complete enrollment forms from various manufacturers, collect patient consent, and track enrollment statuses. It’s no wonder that healthcare is facing a burnout crisis.

As technology has become ubiquitous, it has created an additional challenge for biologic coordinators and medication access teams, especially those that work to support patients with complex treatment plans or work across therapeutic specialties. This, in turn, increases cognitive load, screen time, and clicks, slowing the completion of the necessary steps in a patient’s care journey and decreasing overall speed-to-therapy.

As an example of portal fatigue, a medication access team member at a large health system may need to support an oncology patient who is prescribed multiple brand name specialty medications, each of which requires portal access to obtain assistance. One of the drugs may have a manufacturer-sponsored co-pay assistance program, another may be eligible for foundation assistance, while another may need additional approvals via prior authorization. In order to effectively support this patient through their medication access journey, multiple portals and logins are required.

Instead of the common perspective that “more technology = better,” we must shift to a new perspective that says that “unified, purpose-built – even less – technology = better.” Instead of forcing teams to scour the web for up-to-date manufacturer forms, why not house all forms, and enable submission and delivery of those forms, in one solution? Instead of routing a form for patient and provider signatures via a distinct process, why not enable seamless signature collection at the point of care? Instead of manually researching affordability options — foundations, PAP, co-pay, etc. — on a variety of sites, why not integrate those options into the same portal where the forms and signatures live? Creating a uniform, digital entry point that leverages a repeatable process for any drug, any manufacturer, and any patient can significantly reduce cognitive load and burnout.

As I’ve had conversations with providers, care teams, and medication access specialists over the past few years, the more I’ve realized that “more technology ≠ better.” As patients enter and exit their offices, they wish for integrated, intuitive, secure technologies that minimize work and accelerate the speed at which they can deliver quality care. While the specialty medication onboarding process includes a variety of steps to help support patient access  — benefit verification, PA, consent, financial assistance, and fulfillment — there is no reason that these steps cannot be automated, integrated, and fast. An HCP should not have to worry about which manufacturers may or may not have sponsored a program, or if the technology will work for a specific patient. To reduce burnout and create consistency, technology should work the same way every time.

It is up to clinical leads, IT teams, and other leaders to sound the alarm and support the launch of solutions that reduce burden and burnout for their teams, instead of those that create more work. A single digital entry point for any patient and any medication is a reality that is within reach. We just need to drive provider adoption of these tools. The only way we can ensure better, faster, more affordable care for patients is to help providers with the work they do every day.

Readers Write: Reducing Medicaid’s Fraud & Waste: Program Integrity Systems

Reducing Medicaid’s Fraud & Waste: Program Integrity Systems
By Gerald Maccioli, MD

Gerald Maccioli, MD, MBA is chief medical officer of HHS Technology Group of Fort Lauderdale, FL.

Medicaid, a cornerstone of healthcare support for low-income individuals and families in the United States, is a vital safety net. With an annual expenditure of approximately $824 billion in 2022, Medicaid ensures access to necessary medical services for millions of vulnerable Americans.

Like any large-scale government program, Medicaid is not immune to the challenges that are posed by fraud and abuse. Estimating the exact extent of Medicaid fraud, though, is challenging due to its clandestine nature and constantly evolving tactics used by perpetrators. However, some reports and estimates provide insights into the scale of the issue. For example, in 2020, the US Department of Health and Human Services (HHS) reported recovering $1.8 billion from fraud and abuse cases in healthcare, including Medicaid.

State Medicaid programs are determined to combat fraud when it does occur, and, ideally, prevent it before it happens in the first place. To that end, many Medicaid programs are looking to invest in robust program integrity systems to comprehensively address fraud, waste, and abuse. In this context, program integrity describes any of various oversight activities to ensure that Medicaid dollars are spent appropriately and accurately.

Like the healthcare industry itself, Medicaid fraud can be complicated, byzantine, and varied. The following is a description of six of the most common types of fraud that is associated with Medicaid.

1. Billing fraud. Healthcare providers, including physicians, clinics, and hospitals, may engage in billing fraud. This type of fraudulent activity involves submitting false claims or inflating bills for reimbursement. Common tactics include billing for services that were never provided, misrepresenting the cost of services, and engaging in other deceptive practices. Billing fraud not only diverts financial resources from the program but also reduces the availability of funds for legitimate healthcare services.
2. Identity theft. Fraudsters may employ identity theft tactics, such as using stolen or fabricated identities, to access Medicaid benefits. Identity theft can be perpetrated by both providers and beneficiaries, resulting in unauthorized use of healthcare services, prescription drugs, and medical equipment. This practice places undue strain on program resources and can lead to significant financial losses.
3. Phantom billing. Phantom billing occurs when providers bill for services that were never provided to beneficiaries. This fraudulent practice not only drains program resources but also can lead to suboptimal care for beneficiaries who do not receive the services they are billed for, putting their health and well-being at risk.
4. Kickbacks and referral fraud. Unscrupulous providers may engage in kickbacks or referral fraud, offering incentives to beneficiaries or other providers in exchange for Medicaid referrals. This unethical practice not only compromises the integrity of patient care but also diverts program resources for personal gain, diminishing the overall quality and efficiency of the Medicaid system.
5. Overutilization. Some beneficiaries may overuse Medicaid services, receiving unnecessary medical treatments or prescription drugs. This results in inflated healthcare costs and can deprive other, more deserving beneficiaries of necessary care.
6. Prescription drug fraud. The abuse of prescription drugs within the Medicaid system is a growing concern. Beneficiaries or providers may engage in the overuse or diversion of prescription drugs, leading to escalating costs and potential health risks.

To effectively combat the extensive scope of fraud and abuse in Medicaid, robust program integrity systems are indispensable for several compelling reasons:

1. Financial sustainability. Fraud and abuse divert scarce financial resources from Medicaid, reducing the program’s ability to provide essential healthcare services to those who genuinely need them. Effective program integrity systems are essential to protect the financial sustainability of Medicaid, ensuring that resources are available for legitimate healthcare needs and program expansion.
2. Quality of care. Fraudulent activities can lead to suboptimal patient care. Phantom billing and overutilization practices, for instance, can result in beneficiaries either not receiving necessary services or receiving services they do not require, compromising their overall health and well-being. Robust program integrity systems are instrumental in maintaining the quality and appropriateness of healthcare services.
3. Preventive measures. Program integrity systems include proactive measures that are aimed at preventing fraud and abuse. By identifying and addressing potential issues early, these systems act as deterrents to fraudulent activities and contribute to preserving the program’s integrity.
4. Legal accountability. Program integrity systems play a crucial role in identifying and prosecuting those involved in fraudulent activities. They ensure legal accountability for individuals or entities attempting to exploit the program, thereby acting as a powerful deterrent to fraudulent practices.
5. Public trust. A transparent and well-monitored Medicaid program is essential in building and maintaining public trust. When beneficiaries and taxpayers have confidence that their contributions are used judiciously and ethically, it enhances the program’s reputation and garners greater public support.
6. Program longevity. Effective program management is essential for the long-term viability and effectiveness of Medicaid. Robust program integrity systems help extend the lifespan of Medicaid, ensuring that it continues to provide essential healthcare services to those in need for generations to come.

In conclusion, the scope of fraud and abuse in Medicaid is extensive and multifaceted, presenting complex challenges that require vigilant attention and comprehensive solutions. Robust program integrity systems are not merely desirable but necessary for safeguarding the financial sustainability of the program, maintaining the quality of patient care, preventing fraudulent activities, ensuring legal accountability, building public trust, and securing the longevity of this crucial lifeline for low-income Americans.

Program integrity systems are a cornerstone in the fight against fraud and abuse, playing an indispensable role in preserving the Medicaid program’s integrity and the health and well-being of its beneficiaries.

Readers Write: The Importance of Well-Managed Patient Identity Queues

The Importance of Well-Managed Patient Identity Queues
By Megan Pruente, RHIA, MPH

Megan Pruente, RHIA, MPH is director of professional services for Harris Data Integrity Solutions of Niagara Falls, NY.

Identity queue management is an important aspect of an effective value-based care strategy. It lays the foundation for establishing an effective person index, minimizing overlays, and facilitating streamlined care coordination. Left unresolved, backlogged work queues can have costly implications for patient care and safety, as well as revenue integrity.

However, many provider organizations are struggling to stay ahead of burgeoning identity error queues, with health system clients reporting that weekly error tasks have more than doubled. At one health system, the volume of potential overlays queue swelled from 2,000 per week to more than 5,000 per week over the course of just a few months, while another organization found itself dealing with a backlog of 100,000 identity interface errors. The health information management (HIM) director at a third health system shared that his team evaluated up to 400,000 potential overlay tasks in the last year to identify just 60 true overlays.

Many HIM departments lack the staff resources and experience that are necessary to address this volume of mismatched data, and the backlog continues to grow. What’s more, many hospitals and health systems may not be catching potential overlays or identity interface errors because their EHR systems lack the functionality or tools that alert end users to such errors.

Blame for this surge in errors can be traced back to several events, starting with the pandemic. The rapid uptick in adoption and use of patient portals, implementation of self-registration processes, and internal workflows to accommodate telemedicine and vaccination appointments led to a sharp increase in overlays, duplicates, and other identity-related errors. Exacerbating this were staffing shortages created by illnesses, caring for sick loved ones, and an exodus of healthcare professionals due to fears of COVID-19 and burnout, an ongoing challenge that has identity management teams stretched to the breaking point.  Another factor involves changes to fields that are used to capture patient identity data, such as expanded options for sexual orientation and gender identity (SO/GI).

Ironically, some of the blame also lies with the EHR workflow tools that were designed to address patient identity management challenges. For example, Epic’s EMR includes a Possible Overlay Queue, a useful workflow tool that identifies and segregates potential overlays until they can be analyzed and either verified or cleared from the queue if it is determined not to be a true overlay. However, its sensitivity to any change to the patient’s demographic information, whether significant (a name change or new Social Security number) or routine (adding a middle initial or completing SO/GI fields) can sometimes lead to an increased backlog volume as every alteration triggers an overlay task to be added to the queue.

Similarly, when data such as order results and documents cannot be filed automatically into a patient’s existing medical record due to a mismatch or fuzzy match on demographic data points, medical record number (MRN), or other patient-level data point, these messages error out and must be manually reviewed and resolved. When left unresolved, these errors can lead to repetitive orders, duplicate tests, and other issues that could result in denied claims.

The challenge for HIM is that some EHRs do not have interface error work queues that streamline resolving such errors. Even when EHRs do offer such functionality, staff often struggle to keep up with the high volume of errors requiring attention.

The reality is that managing identity error backlogs is a time-consuming and resource-intensive task that few HIM departments have the capacity to handle. The intricate nature of these processes requires meticulous attention to detail and often diverts focus from more critical tasks and strategic initiatives. Exacerbating the challenge, new tools and reports being released to HIM designed to help address duplicate, overlays, and interface errors are contributing to the increase in workload with the same or fewer resources to review the errors.

Healthcare organizations can take a number of actions to reduce the volume of identity errors and prevent backlogs from spiraling out of control. These include:

• Invest in staff training. Provide comprehensive training to enhance HIM professionals’ identity management skills. Keep staff updated on changes in patient data capture fields and the use of EHR workflow tools to reduce errors caused by lack of awareness.
• Prioritize staff resources. Allocate adequate staff resources to address identity queue backlogs and ensure that HIM departments have the capacity to handle the volume of tasks. Also, consider hiring additional staff or redistributing existing resources to focus on resolving identity errors and preventing the backlog from growing.
• Collaborate across departments. Foster collaboration between IT, HIM, and other relevant departments to collectively address identity management challenges. Also, establish cross-functional teams to develop and implement solutions that consider the perspectives and requirements of different stakeholders.
• Outsource MPI management. Evaluate the cost-effectiveness and efficiency of outsourcing MPI management to a vendor or partner with experienced staff overseen by credentialed professionals. Short-term MPI management support should also be considered during M&A activities to ensure integration of clean data and quick turnaround times.
• Implement robust data governance. Establish a strong data governance framework to ensure the accuracy and integrity of patient data throughout its lifecycle, including ongoing quality checks to ensure the accuracy of any automation and other patient matching tools, including AHIMA’s Naming Policy Framework and the Project US@ AHIMA Companion Guide.
• Enhance EHR workflow tools. Collaborate with EHR vendors to fine-tune sensitivity of algorithms to reduce false positives in the identification of potential duplicates and overlays and to customize workflow tools that better align with the organization’s specific needs and processes.
• Use third-party data. Use third-party data like historical addresses and phone numbers that are obtained from outside vendors to help prevent and accelerate remediation of overlays.
• Invest in enhanced patient matching tools. Biometrics and other patient matching technologies can prevent the creation of identity errors by improving accurate identification during front-end registration processes.
• Automate data matching processes. Explore, implement, and closely monitor advanced technologies such as machine learning and AI to automate matching and reduce the reliance on manual reviews. Integrate systems that allow for automatic filing of order results and documents into patient records to minimize errors related to mismatched data.
• Use analytics for insights. Use analytics tools to gain insights into patterns and trends that are related to identity errors and to identify root causes.
• Regularly monitor and evaluate processes. Implement a continuous monitoring system to track the performance of identity management processes and identify areas for improvement. Regularly evaluate the effectiveness of implemented solutions and work closely with IT staff or vendors to optimize processes, as even seemingly minor AI errors can have significant and widespread impacts.
• Don’t overlook the patient’s role in maintaining clean patient identity queues. Implement patient education programs to encourage accurate self-reporting of demographic and other relevant information. Also, promote to patients the importance of maintaining up-to-date and accurate information, including creation of talking points to help staff engage in these discussions.

Unresolved identity errors pose a significant threat to a hospital’s financial health. These errors can lead to reimbursement delays, costly repeat studies, and denied claims, creating unnecessary financial strain. A backlog can also impact patient care by creating gaps in medical histories, unnecessary delays in diagnosis and treatments, and risks to patient safety.

To avoid these impacts, patient identity error queues should be part of an overall MPI management strategy. Whether outsourcing to an outside MPI vendor or increasing internal resources to put in place workflow processes for eliminating the backlog and sustaining ongoing management, hospitals and health systems must prioritize patient identity queue management. Doing so empowers healthcare institutions to optimize operations that are being dragged down by unresolved patient identity errors, generating measurable cost savings, mitigating financial setbacks, and creating room for strategic investments in areas that truly matter.

Readers Write: My Crystal Ball for 2024: PR and Marketing Predictions

My Crystal Ball for 2024: PR and Marketing Predictions
By Jodi Amendola

Jodi Amendola is CEO and founder of Amendola Communications of Scottsdale, Ariz.

2023 will be remembered for a lot of things. Unfortunately, one of them was unpredictable decision-making about investments in HIT solutions and longer sales cycles.

Looking at the year ahead, we may see some continued challenges when it comes to market conditions, but here’s hoping my 2024 public relations (PR) and marketing cheat sheet can help you better navigate uncertain waters.

Bet on LinkedIn

In my predictions for 2023, I shared concerns about the uncertain future of what was then Twitter (now X) when it comes to B2B social media programs. Since then, things have gotten increasingly worse. Under Elon Musk, major advertisers have fled, countless users are deleting their profiles, and even the President of the United States felt compelled to condemn Musk for an anti-Semitic tweet and left X in favor of the emerging social media platform Threads. Companies that remain on X should ask themselves whether the shrinking benefits outweigh the mounting negatives. 

Meanwhile, LinkedIn continues to lead the charge as the business marketing platform to embrace. LinkedIn has strategically added business-friendly features such as product pages, post scheduling, and enhanced content analytics. Businesses that have not embraced LinkedIn for marketing and sales are missing a tremendous opportunity.

To maximize LinkedIn, be authentic and provide relevant information on a consistent basis. No more than 20% of your corporate posts should be about your company. The remainder should focus on third-party content that sparks interesting industry conversations. LinkedIn posts should leverage storytelling for engagement, how-to-guides for interest, and thought leadership for conversations.

Maximizing Conferences: Booths, Networking, and Online Events

In 2022, people flocked back to the big healthcare conferences, eager to gather again in person in the wake of COVID-driven isolation. We saw healthy crowds again in 2023, but many companies are re-thinking this strategy in favor of hosting targeted breakfasts or dinners or attending events for networking purposes only. We will likely see that trend continue in 2024, as many businesses may decide that the cost of sponsorship and exhibiting are too high in a tight economy.

The pandemic forced companies to become creative in marketing through virtual events. At the time, these tactics were driven by safety concerns, but now it’s budget priorities. HIT marketers are realizing that they don’t need an expensive 10×12 booth on a crowded convention floor to get their message across.

If webinars, podcasts, and virtual roundtables are carefully targeted and well marketed, you can even reach more qualified prospects than you can at a live event. Virtual events are not only less expensive, but they can be held more often than in-person happenings. Content from virtual events also can be repurposed for sharing through social media, blog posts, and bylined thought leadership articles that you can place in high-value media outlets.

AI is Here to Stay, But Regs Are Coming (Hopefully!)

After disrupting so many professions in 2023, OpenAI experienced its own chaos and upheaval at the end of the year.

However, that particular situation is resolved and artificial intelligence — whether it’s from OpenAI or a competitor — is too powerful to be stopped by C-suite struggles. AI will continue to disrupt not only health tech, but also marketing and PR.

In 2024, marketing departments and agencies will get a better handle on what they can and should do with this emerging technology. AI, when used correctly in a PR and marketing setting, can be a valuable tool, but it will never be a substitute for human writers and human intelligence. It can be useful for research, ideation, and facilitating the writing and thought process, but not for creating creative, thoughtful, highly targeted content.

I expect 2024 to see greater efforts, both public and private, to regulate the use of AI and require disclosure when it is employed.

Uptick in Rebranding is Here To Stay

The past year was a big one for companies that are rebranding (or doing a brand refresh) and updating messaging. We will likely see more of these efforts ahead.

Sometimes a rebrand is necessary because a company expands, changes its offerings, or decides to enter a new market. In other cases, it’s because the old look and old messaging have gone stale, which can happen without a business even realizing it. While a top-to-bottom rebrand is not something undertaken lightly, it’s a necessary part of most corporate evolutions and can help a company re-position or re-invent itself when appropriate.

Video, Video, and More Videos

Regardless of the platform, video is an increasingly popular choice to provide a welcome alternative to the written word. People often prefer to watch or listen to a video for entertainment, education, or just a needed break from reading. Video on LinkedIn increases linger times and engagement, so the algorithm pushes it to more users. The best part: video doesn’t have to be incredibly high production or sophisticated to be effective. Expect video to assume a larger share of marketing content in 2024.

Shorter, Digestible Content Is Preferred

The days of writing 30-page whitepapers and e-books and expecting your audience to download and actually read them are largely over.

In most cases, audiences don’t have the time or patience for content that long or complex. They want relevant information delivered in shorter format such as issue briefs, LinkedIn articles, blog posts, infographics, and videos.

Key In on Customer Champions

If 2024 proves to be as tumultuous for healthcare as most expect, companies will need PR and marketing more than ever. Staying on brand and on messaging through chaotic times means having a consistent and ongoing share-of-voice to rise above the noise and cut through the chatter. The key is to leverage your customer champions and unique industry data to be relevant and demonstrate your key differentiators over the competition.

Do you agree or disagree with my predictions? Come back in a year and we’ll see how many I got right.

Regardless of your technology, product or service, I hope the New Year provides endless possibilities for growth and success. Here’s to leveraging lessons learned, flawless execution, and advancing healthcare.