After months of uncertainty, hope is finally on the horizon as three viable COVID-19 vaccine candidates are moving closer towards approvals for public distribution. Getting to this stage was extremely labor-intensive, but unfortunately, it’s not the end of the hardships. The coronavirus vaccine will represent the largest vaccine distribution in U.S. history, and manufacturing and distributing the vaccines will have its own fair share of difficulties for healthcare systems. In order to optimize the distribution of vaccines, healthcare providers will need to employ technology and data collection to stay organized. Unfortunately, vaccine approvals are quickly looming, meaning that the necessary technology infrastructure needs to be implemented soon. Healthcare facilities need to understand what solutions can be deployed to facilitate a safe and efficient distribution plan — and how to implement them before it’s too late.
Vaccine Organization and Distribution
With three potential vaccines, each with different vaccination schedules and side effects, managing distribution will be a complicated effort. Patients will need to be matched to the appropriate vaccine, with consideration paid to medical history. Once a patient is matched to their vaccine, healthcare providers need to track side effects, and in the cases of Pfizer and Moderna, when the patient will receive their second dose. This requires significant data collection, which may leave healthcare providers vulnerable to cybersecurity threats. Data breaches have increased by 171 percent this year due to the pandemic, meaning that cybersecurity and secure data storage need to be at the forefront of any healthcare IT strategy.
The CDC is working to implement a data use agreement to determine which information needs to be reported to various levels of government. This will include information on patient matching, which can help determine how much of each vaccine is being used, the remaining supply and what will need to be ordered. Once these guidelines are in place, healthcare facilities will need to start planning and implementing their cybersecurity strategy. Information sharing will be important over the next few months as the vaccines roll out, but this needs to be balanced with access management to reduce the risk of breaches. Ensure that all members of the team, as well as anyone else who has access to important personal data, understand the risks, as well as the protocols that are in place.
Once vaccines are administered, governments will need to monitor both patients and those who chose not to receive a vaccine closely. Shots are voluntary, which means that there may be parts of the population that refuse to get vaccinated. Many governments and businesses are already discussing the implications of that, including restricting access to things like travel and communal spaces. This means that further data will need to be collected and shared that can inform the public of who is not vaccinated. In the U.K., there has been discussion of an app, similar to the contact tracing app, that discloses the status of a person’s vaccination. In Canada, they have discussed an immunity and vaccination passport. It remains to be seen what route the U.S. government will choose, but there are clear implications for data collection with these new technologies.
Vaccine distribution will also cause problems for healthcare providers due to the sheer volume of patients needing access to services. Currently, hospitals are overwhelmed with COVID-19 patients. It is also flu season, meaning that flu vaccine appointments are rising. In order to provide safe distribution of the flu vaccine, many governments have implemented an appointment-only system where all patients have to pre-register to receive their dose. Similar systems will be crucial for the distribution of COVID-19 vaccinations in order to support the observance of physical distancing requirements. With clinics and healthcare facilities already strained, adding more patients that require vaccinations could cause many issues. Appointments need to be closely managed to ensure that healthcare facilities will still be able to operate safely. Healthcare providers will also need to monitor the number of patients during each distribution phase to ensure that they can handle everyone who needs a vaccine.
Vaccine distribution could begin any day, which means that the technology infrastructure to support the initiative needs to be implemented immediately. This doesn’t leave much time to create new solutions, so healthcare facilities will need to work with existing technology providers to create a secure infrastructure that supports distribution. When selecting a technology provider, careful consideration needs to be paid to both the services it provides and the security protocol that it has in place. Choose trusted vendors that have experience in the healthcare industry. With all healthcare providers going through the same experience, information sharing will also be important. Discuss with other healthcare IT departments what solutions and providers they are considering for vaccine distribution.
Preparing for Distribution
There is no doubt that this vaccine distribution plan will be unlike anything the U.S. has ever experienced. With distribution broken down into phases to determine the priority of who receives the vaccines, healthcare providers will be forced to contend with sick patients at the same time that they are distributing vaccines. This will require extra effort to keep everyone safe and healthy. With the vaccines set to begin distribution at any moment, healthcare providers need to act quickly to ensure that the necessary technology and data collection infrastructure is in place to facilitate a safe and efficient distribution.
About Kevin Grauman Kevin Grauman is the President and CEO of QLess, a line management system used by retail, education and government industries. He is no stranger to the world of startups, with a proven track record as a successful U.S.-based executive leader and entrepreneur. Kevin has been recognized as one of the “100 Superstars of HR Outsourcing in the USA” by HRO Today Magazine.
Among the many evolving technologies in the healthcare industry, there may be none more important or impactful than remote patient monitoring (RPM) hardware and software solutions. This technology is opening up new possibilities in extended healthcare – saving patients money, limiting visits to the doctor’s office, and providing healthcare professionals with powerful tools for diagnosing and treating patients. As these tools continue to mature, software and hardware developers are solving critical challenges to enhance their capabilities and impact.
According to a 2019 report published by the Consumer Technology Association, 88% of healthcare providers have invested in, or are evaluating investments in, RPM technologies and services. Increased demand is driven primarily by the rising age of the baby boomer generation and an increase in chronic disease among the American population.
Medical device manufacturers are helping healthcare providers gather data on patients everywhere they go using wearable technology. These connected health monitoring devices come in the form of smartwatches, wearable heart monitors, blood pressure kits, and more. They’re developed with mobile communication technology that sends data using a patient’s smartphone or directly from the wearable device to software platforms that make the information available to healthcare providers and first responders, notifying them in real-time of accidents and/or healthcare concerns.
The need to monitor patients outside of a clinical setting, especially during the pandemic, has become extremely important and demanding. We’re witnessing limited capacity in hospitals, significant challenges related to social distancing and other pandemic-related stressors. RPM technology can be a tremendous help in mitigating these issues.
Despite significant advancements in the art of the possible, RPM is still in its infancy in terms of the potential impact it could have on health and safety. Data security, data accuracy, and systems integration are core challenges that developers of the next generation of innovative RPM devices need to address. This includes overcoming technological and regulatory barriers preventing patient data from being received, making use of machine learning algorithms, and combining real-time data with medical histories.
Developers of RPM devices must also move beyond model-building and into operationalization for the real potential of technology to be realized and create value for healthcare professionals. Specifically, abstract concepts need to be turned into measurable observations. In its blog “Operationalization of Machine Learning Models,” Open Data Science opines, “Data scientists create beautiful models that no one can understand, and the models don’t usually translate to real business value. If a process is isolated from the enterprise, the insights won’t feed into the overall process.”
To make significant advancements in RPM innovation, software developers must build a digital framework that includes:
– Data storage
– Machine learning and artificial intelligence
– User interface and user experience
It begins with a data storage framework that organizes legacy data and real-time data in the cloud and feeds it into the algorithm. Volumes of data can be huge and the types of data can be various, yet they need to be monitored and managed by a single system.
The next layer of the framework is data security. The challenge is developing a security framework that keeps data confidential for unauthorized users. At the same time, patients must be allowed to establish clear boundaries of ownership over the data, whether that access is given to family members or primary care providers. In the case of an emergency where the patient is incapacitated and unresponsive – the authorized user must be able to quickly access the data to treat the patient.
Next is the middleware, which is software that provides common services and capabilities to applications outside of what’s offered by the operating system. The middleware is customized to meet the needs of the user, in this case, the healthcare provider.
All of the organized and secure data is then funneled into AI and ML algorithms which will learn and recognize patterns derived from a wide range of data points. There needs to be a high level of trust in the data derived from RPM devices. This is achieved through the collection and proper management of data from large and diverse demographic groups. For example, if AI and ML algorithms are fed significant amounts of data from African American females between the age of 50-65, the algorithm can begin to recognize patterns that lead to more informed diagnoses and patient care plans.
The final piece of framework is the user interface and user experience. One of the most significant challenges to developing a healthcare platform for RPM devices is engineering how the data is presented to a healthcare provider. These professionals don’t have time to learn how to decipher data points on a screen –designers and engineers need to create a user interface that translates patterns in the algorithm into valuable and easy to read information that can improve patient outcomes.
When it all comes together, the results are rewarding. Let’s take a look at one of the most promising examples of RPM in the real world today. Lark Health, a chronic disease prevention and management company that uses a cognitive behavioral therapy framework, conversational A.I., and connected devices to help people stay healthy and in control of their conditions. Lark’s A.I. is continuously learning how to personalize the experience for the member and communicates via text-message-like interactions to monitor patients remotely, 24/7, while live nurses and health coaches are available when issues need to be escalated such as severe readings or medication changes.
The challenge of getting the most out of RPM technology is not an easy one. It takes high-level expertise in design, software engineering, and data science, as well as knowledge of AI and ML algorithms to learn how to operationalize it. But with the right framework and data, RPM will continue to revolutionize the healthcare industry.
Roberto Martinez, president, Encora, MexicoRoberto Martinez has been working in the software nearshoring industry for 20+ years. As a senior executive, he is familiar with the needs, obstacles, and challenges faced by small startups as well as big teams. As a leader at Encora, Roberto has helped the company acquire important clients such as OpenTable, Siemens, ZED Connect (Cummins), and others. Roberto has a software engineering background from the prestigious Tecnologico de Monterrey and strategic direction from IPADE.
The COVID-19 pandemic, which has taken 270,000 American lives to date, has shined a light on another crisis — the U.S. currently has no standardized system for reporting public health data. Health departments all over the country resort to using paper, fax, phone, and email to transmit and receive critical information, and essential healthcare workers are spending precious time retyping data into systems from printed reports and PDFs.
At the heart of this lack of a centralized infrastructure for reporting public health data is the 10th Amendment of the U.S. Constitution, which says, “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.” Because of this amendment, the federal government — including the CDC — is not able to mandate that states, providers, or public health entities use a centralized reporting mechanism for managing all public health data. Further, the 10th Amendment also allows states to set up their own IT systems independently of other states and the federal government. The CDC then has to beg for data that sits in bespoke, disparate information systems in each state andterritory.
Congress has tried three times in the last fourteen years to fix the issue. In 2006, it passed the Pandemic and All Hazards Preparedness Act (PAHPA), which required the CDC to establish the near-real-time, electronic, nationwide, public health data-sharing capability. Four years later in 2010, the U.S. Government Accountability Office (GAO) reported that not even the most basic planning steps were taken to establish the network.
Then in 2013, Congress passed the Pandemic and All Hazards Preparedness Reauthorization Act (PAHPRA), which unsuccessfully called for a near real-time interoperable public health data exchange network. Finally, just months before the current pandemic, Congress passed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI), and our need for such a system is now greater than ever.
An Interoperable Public Health Data System
The U.S. Department of Health and Human Services (HHS) needs to lead the creation of a modern public health data approach on behalf of all public health agencies throughout the country, including the CDC. HHS was given $1 Billion for public health data infrastructure modernization in the recently passed CARES Act.
A modern approach to public health data would cost a fraction of that and must consist of three things: the creation of a gateway to link and securely move data between public health entities, the adoption of and adherence to widely accepted health data standards, and the creation of a cloud-based data hub for transparent analysis and reporting of data.
Creation of a Data Gateway
Data must be complete, timely, and accurate. A single federal data gateway would allow for the secure, two-way flow of data between all of the components of the public health ecosystem. The idea is not to create new, custom systems as we have done in the past, but to create a single gateway system at the federal level that stitches all existing data systems together using modern application programming interfaces (APIs). Such a system will allow data to timely flow between jurisdictions and up to the CDC so that we can collectively inform public health decision-making and public policy.
We should leverage recently adopted interoperability standards to connect data from existing Electronic Health Records (EHR) and insurance claims systems wherever possible to avoid duplicate entry of data by essential workers.
Adoption of a Standardized Data Model
We need to encourage state and local health organizations to use and promote a standardized approach to collecting data at the points of care, testing, and immunization.
Fortunately, the public health data interoperability challenge can be solved by supporting the private sector’s move to a standardized data model for healthcare data. Congress spent billions of taxpayer dollars over the past several years incentivizing healthcare providers to adopt electronic health record systems and data interoperability standards, most recently as part of the 21st Century Cures Act, which just saw its regulations go into effect this year. Healthcare providers are busy preparing to accommodate the Cures Act’s updated standards and requirements. The federal government should eat its own dog food by adhering to the same standards when creating the new gateway.
The two main standards to pay attention to are Fast Healthcare Interoperability Resources (FHIR) and the United States Core Data for Interoperability (USCDI). Major IT and EHR companies like Google, Amazon, Microsoft, IBM, Oracle, Salesforce, and Cerner have pledged to support these standards meaning they can immediately begin supporting a new gateway and helping America’s public health system quickly modernize.
A Cloud-Based Data Hub
Once the data is available, flowing, and standardized, we need a national, cloud-based data hub to begin gaining insights from COVID infection rates, vaccinations, and many other key indicators important to recovering from the pandemic.
Led by HHS with support from OMB and the White House, this new system could be set up within months. There are well-known tools and virtual computing environments that could be put to use right away. A modern data hub would benefit not only the federal government but also the research community and academia, as these organizations play very important roles in helping us further understand and respond to the pandemic.
Most importantly, such a hub would provide transparency and accountability, giving confidence in the data being reported by providing independent reproducibility of conclusions from data analysis.
About Ed Simcox
Ed Simcox is the chief strategy officer of LifeOmic, the creator of LIFE mobile apps, JupiterOne cloud compliance and security operations software, and the Precision Health Cloud platform in use at major medical and cancer centers. Prior to joining LifeOmic, Ed served as the Chief Technology Officer (CTO) at the U.S. Department of Health and Human Services (HHS), the largest civilian government agency in the world. He led efforts at HHS to effectively leverage data, technology, and innovation to improve the lives of the American people and the performance of the Department’s 29 agencies and offices. While CTO, he also served as Acting Chief Information Officer at HHS, where he oversaw the Department’s IT modernization efforts, IT operations, and cybersecurity
In the face of COVID-19, healthcare witnessed how crises can become the long-awaited push for creativity and innovation that the industry needs. When our healthcare infrastructure’s weaknesses were exposed, telehealth helped to stitch them up, with the number of telehealth claims increasing 8,336% nationally from April 2019 to April 2020. Out of need, patients quickly turned to telehealth as a new model of care delivery; clinicians adapted to a new avenue for engaging with patients, policymakers began to improve incentives for its use; and home became our hospital.
As we continue the fight to control the virus in 2021, the industry is at a pivotal moment in ensuring this year’s telehealth momentum continues post-pandemic. Healthcare organizations should take time now to strategize how best to hardwire telehealth, so it is embedded into care delivery models long-term. In order to achieve this, leaders need to consider their collaboration with other stakeholders, longitudinal integration strategies that go beyond piecemeal solutions and transform the perception of what “home” means in healthcare to meet consumers where they are.
Step 1: Collaborate to advance technology
If we’ve learned anything from healthcare’s digitization over the years, it’s that technology for technology’s sake is not enough – solving healthcare’s issues is a systems problem, not a disease problem. For telehealth to last, there needs to be a clinical transformation where workflows are rewritten, policies strongly incentivize its use and companies and hospitals partner on outcome-based models that support its scalability.
In the last six months, we have seen more innovation and adoption in healthcare than we’ve seen in the last decade, with typical innovation timelines of years becoming weeks or days. In many ways, this creativity and open innovation saved the U.S. healthcare system from collapsing and helped us survive the initial surge. We also saw the collaboration of all sorts reach new heights, with organizations, federal agencies, private and public companies from different industries coming together to manage surge capacity while maintaining quality care. Another benefit of these partnerships is the emphasis on long-term policy changes that will empower lasting change and adoption of these innovative approaches. Industry efforts, like ours with the ATA, aim to promote telehealth’s growth and support hospitals, payers, and patients across care settings. The pandemic’s productive collaboration cannot stop here. Instead, we should continue to bring dimensions of policy, clinical experience, and consumer voices to imbed telehealth into our everyday systems.
Step 2: Determine avenues for seamless data integration across settings
Telehealth’s power is not in its technical claims, but in the power of presenting caregivers with actionable, meaningful patient data so they can make data-driven care decisions with confidence. This is only made possible with interoperable, cloud-based solutions that collect, digest, and analyze data to inform care. With constant transfer of key patient data through connected devices, such as hospital-grade wearables and biosensors, and translating the data into useable insights, remote patient monitoring empowers care teams with the knowledge needed to intervene earlier and keep patients healthy at home.
Telehealth’s power expands beyond the home, supporting a continuum of care no matter what setting a patient is in. Remote monitoring within the hospital is the crux of minimizing infection risk, handling sudden increases in patient volumes and allocating resources appropriately. These include solutions such as centralized clinical command centers to achieve remote, holistic patient views, or technology that activates scalable patient monitoring for ICU ramp-ups. The solutions we deploy need to be enablers of seamless data transfer – from the ED to ICU, to post-acute and home setting. We now must ensure our informatics backbones mature with these solutions, eliminating gaps in care while ensuring a secure flow of data where and when it’s needed. Deploying cloud-based platforms that bring together the right information across the care continuum will make for a powerful, integrated system that enhances patient and staff safety improves outcomes, and reduces costs.
Step 3: Transforming what “home” means in healthcare
2020 has transformed how we view “home.” Home has become the center of life operations for people across the globe – we work from home, we educate our children at home and we exercise at home. Healthcare is now becoming another cornerstone of the home. With a growing volume of telehealth offerings and household names providing care services, consumer behavior is changing to expect customization, convenience, and instant gratification. The consumer’s voice is loud, and tomorrow’s healthcare will move it from a whisper to a shout – We must be prepared to deliver care when and where patients want to receive it, increasingly let go of healthcare’s brick-and-mortar blueprint, and enable healthcare to match the ease and convenience of other areas of a patient’s life.
However, just like all these other ‘at-home’ activities that require getting used to or training, we need to support health literacy and engagement for all users. The pandemic has made the inequalities in our health system raw. Even before the pandemic, 5% of the patients account for about half of U.S. healthcare spending. This is a sign that they are not receiving the proactive care and support they need. We have an opportunity to change this equation with virtual care and bridge the digital divide by tailoring solutions to meet each patient’s needs and ensuring equitable availability to all patients.
Transforming telehealth into a standard of care
Technology isn’t the answer to telehealth’s success alone – it is virtualizing care where it is needed most and ensuring it is fully integrated across an institution. Healthcare organizations should reflect on where their greatest challenges and populations are, and look for systematic solutions for telehealth so that virtualization can scale efficiently and build from existing technology and workflows. With productive collaboration across sectors, robust data integration infrastructures, and an evolved perception of how we view healthcare, these tools have the power to influence how patients view and engage with their health, pushing the industry toward more proactive care that will have long-term benefits on outcomes and cost.
About Karsten Russell-Wood
Karsten Russell-Wood, MBA, MPH is the Portfolio Leader for Post-Acute and Home at Philips where he is responsible for Innovation and cross-business platform strategy and portfolio optimization. Prior to joining Philips, Karsten held global product management roles within GE’s healthcare businesses with an orientation to targeted patient populations and continues to be active in venture capital and startups in the digital health space.
The Internet of Medical Things (IoMT) is changing the face of healthcare and has the potential to significantly improve patient access as well as system efficiencies. The adoption of telemedicine, for example, spurred on by the Covid-19 pandemic, has spread rapidly. Forrester revised its forecasts to predict that virtual care visits in the United States will soar to more than one billion this year—including 900 million visits related to Covid-19 specifically. Likewise, in the United Kingdom, 40% of doctor’s appointments now consist of phone or video calls.
Even before the pandemic, the adoption of IoMT was already growing rapidly, with the market valued at US$44.5 billion in 2018 and predicted to reach US$254 billion in 2026. There are more than 500,000 medical devices on the market, helping to diagnose, monitor, and treat patients – and more and more of these can, and are, becoming connected – not to mention innovations yet to enter the market. The connected medical devices segment specifically is expected to exceed $52 billion by 2022.
The COVID-19 Effect
The COVID-19 pandemic has changed the healthcare landscape more than any other single event in recent memory. The urgent and widespread need for care, coupled with the challenge of physical distancing, has accelerated the creation and adoption of new digital technologies as well as new processes to support their adoption and implementation across healthcare. The MedTech industry is emerging as a key apparatus to combat the virus and provide urgent support.
A simple example demonstrating the potential benefits of IoMT can be seen even within a hospital setting, where monitoring COVID-19 patients is costly in terms of time and PPE (personal protective equipment) consumption, since simply walking into a patient’s room becomes a complex process. IoMT technologies enable medical devices to send data to medical practitioners who can monitor a patient’s condition without having to take readings at the bedside. The same technologies can enable patients who do not require hospitalization to be safely monitored while remaining at home or in a community setting.
From the patients’ perspective, many are embracing virtual healthcare as an alternative to long waits or having to go to a clinic or hospital altogether. And given the growing number and scope of connected medical devices and services, such as remote patient monitoring, therapy, or even diagnosis, there will be even more options in the future.
Catalyzed by the pandemic, the IoMT genie is fully out of the bottle, and it is unlikely to go back.
This is good news for healthcare and good news for patients and families. Patient access is improving as telehealth, supported by connected devices to enable the collection of health-related data remotely, is helping to lift barriers. This increase in accessibility has the potential to improve the convenience, timeliness, and even safety of access to healthcare services for more people in more places.
IoMT is lifting geographic barriers that have impeded access to healthcare since its very inception. Individuals with transportation or mobility challenges will no longer need to travel to receive routine care if they can be safely monitored while at home. Historically underserved rural or remote communities can gain access to medical specialists without needing to fly or drive great distances, while services can be delivered more cost-effectively.
Furthermore, with fewer clinic or hospital-based appointments required for routine monitoring of patients who are otherwise doing well, doctors would be able to concentrate their in-person time and clinic resources on those most in need of care.
The capacity for specialized medicine enabled by IoMT could also have a dramatic impact. The vast quantities of health data becoming available (with the requisite permissions in place), can enable sophisticated AI-driven health applications that can, for example, predict complications before they occur, better understand the health needs of specific populations, or enable stronger patient engagement and self-care. These models can also equip healthcare practitioners with better sources of information, ultimately leading to better patient outcomes.
That said, while technology capabilities expand, innovation must take into consideration the needs of all the stakeholders within healthcare – from patients and caregivers to healthcare practitioners to administrators and payors/funders. Internet access, infrastructure, and comfort with technology, for example, can pose significant barriers for patients and health practitioners alike.
One approach is to minimize the technological burden facing end-users. Devices should be user friendly and “ready to go” right out of the box, taking into consideration the circumstances and abilities of the potential range of users (patients and practitioners alike). Relying on the patient’s home Wi-Fi to provide connectivity is not ideal from either a usability or security perspective – not to mention availability and affordability. It is better for medical devices to have a cellular connection that can be immediately and securely connected to the network from any location, while also being remotely manageable to avoid burdening the user with network and setup requirements, or apps to download.
Another barrier is the concern that both patients and healthcare providers have about security and data privacy risks. According to the 2016 edition of Philips’ Future Health Index, privacy/data security is second only to cost in the list of top barriers to the adoption of connected technology in healthcare across the countries surveyed.
The Cybersecurity and Infrastructure Security Agency, FBI, and U.S. Department of Health and Human Services have warned of cybercrime threats against hospitals and healthcare providers. The WannaCry ransomware attacks affected tens of thousands of NHS medical tools in England and Scotland. The enthusiasm in rolling out new digital health solutions must not overlook security principles or create systems that rely on ad hoc patches.
One way of meeting the stringent security requirements of healthcare is to ensure that connected medical devices have security literally built into their hardware, following the most recent guidelines set out by the GSMA for IoT security, including the GSMA IoT SAFE specifications. In accordance with this globally relevant approach, connected devices have a specially designed SIM that serves as a mini “crypto safe” inside the device to ensure that only authorized communication can occur.
Similarly, new medical devices and software that are difficult to implement or cannot communicate with other systems such as electronic health/medical records risk being “orphaned” in the system or simply not used. The latter is a matter of both developing the necessary integrations and ensuring the appropriate access and permissions are managed. More easily said than done, fully integrated systems take time, and some of the pieces may be added incrementally – the key is that the potential to do so is there from the beginning so future resources can be invested in enhancements rather than replacements.
Early Collaboration is Key
Accessibility and usability must be designed right into IoMT solutions from the outset, and the best way of ensuring that is for developers and healthcare stakeholders to have plenty of interaction long before the product enters the market. Stakeholders are many and healthcare systems are complex, so innovators can look to startup accelerators and other thought leaders to help navigate the territory. The time and effort spent by innovators and healthcare stakeholders in collaborating is a sound investment in the future, ensuring that technology is designed and then applied in meaningful and equitable ways to address the most pressing issues.
The telehealth genie, powered by IoMT, is indeed out of the bottle and is set to revolutionize healthcare. By ensuring that IoMT technologies are developed and implemented with security, accessibility, and ease of use for all stakeholders as priorities, we can make sure that the full benefits of this new dawn can be enjoyed by all.
Heidi Sveistrup, Ph.D. Bio
As the current CEO of the Bruyère Research Institute and VP, Research and Academic Affairs at Bruyère Continuing Care, Heidi Sveistrup, Ph.D. is focusing on increasing the research and innovation supporting pivotal transitions in care; meaningful, enjoyable and doable ways to support people to live where they choose; and creating opportunities to discover and create new approaches to identify, diagnose, treat and support brain health with individuals with memory loss. Fostering new and supporting existing collaborations among researchers, policymakers, practitioners, civil society and industry continues to be a priority.
Elza Seregelyi Bio
Elza Seregelyi is the Director for the TELUS L-SPARK MedTech Accelerator program, which offers participants pre-commercial access to a secure telehealth platform. L-SPARK is currently working with its first cohort of MedTech companies. Elza has an engineering and entrepreneurship background with extensive experience driving collaborative initiatives.
The majority of industries have decreased or eliminated their use of the traditional fax machine over the past decade, including aviation, retail, and even finance. While the healthcare industry is at the forefront of disease research and treatment, however, it is still heavily reliant on this aging technology.
Traditional fax has become ubiquitous in healthcare. It worked for health systems for many years, but the overwhelming volume of patient data and paper documents the healthcare industry is now processing makes traditional faxing more challenging. In today’s environment, fax is no longer the most convenient, safe, or secure communications format but it is still an ingrained part of practice workflows. The good news is, there is no need to “axe the fax” in order to improve office communications and alleviate paper overload. By transitioning to electronic fax, healthcare providers can maintain their workflows and the benefits of fax, while incorporating it into their overall virtual communications strategy – further simplifying the business of healthcare.
The Traditional Fax Challenge
The challenge with traditional fax isn’t new. In fact, in 2008 the Obama administration allocated nearly $30 billion to incentivize American hospitals and doctor offices to switch from paper to electronic systems. Since then, the industry has made small steps towards a more digitized system via fax servers and virtual patient communications such as secure text and broadcast messaging. While this solved part of the problem by making documents electronic and streamlining communications, it did not address the issue of inefficiency at its core, as practices are still printing, signing, and scanning paper documents. This inefficiency is causing a bottleneck when it comes to getting information transferred quickly, creates unnecessary costs for practices, and causes a lack of integration between health technologies across our healthcare system.
This fragmented, outdated way of communication is not only inefficient and costly, it also impacts patient privacy and safety. At the onset of the COVID-19 pandemic, one Texas health department received so many test results via fax in one day that it simply couldn’t keep up with the amount of paper being spit out – resulting in hundreds of confidential results being dumped on the floor. In addition, the vast differences between old and new technology being blended together are making it difficult to keep track of patient records, share data between practices or report to the government, and more, including important racial, ethnic and geographic data that the Trump administration required for COVID tests. In addition to these challenges, traditional fax eats up staff time that could instead be spent on patient care.
Addressing Outdated Systems and Driving Transformation
While on the surface the solution seems simple, actually addressing this challenge at its core is not as easy as it seems. Many providers and large health systems face barriers when it comes to implementing this technology, such as:
Compatibility between systems
Fear of competition and/or losing patients to other health systems if e-fax enables patients to easily share data with other physicians
Regulatory issues around the transfer of data between providers/EHRs through electronic fax
Despite these challenges, the pandemic has highlighted the delayed, disjointed communications that exist within our healthcare system – and underscored the need for practices and health systems to adopt electronic fax technology. For example, a CNBC survey found that due to COVID-19 tests results coming in via fax in such large amounts, almost 40% of Americans had to wait more than three days for their results, which was too late to be clinically meaningful.
It’s time to address this challenge industry-wide. Last year’s MGMA 2020 virtual conference theme, Rise Above, focused on giving providers actionable tools to navigate through the challenges COVID-19 has presented. The importance of virtual care solutions, including communications tools like electronic fax and forms, are unprecedented. Electronic fax technology can help alleviate the bottlenecks and inefficiencies that currently exist in healthcare. These solutions can:
Reduce costs spent on traditional fax hardware, such as paper, ink, toner, etc.
Increase accessibility, allowing providers to view documents via mobile, etc. at their convenience
Improve practice workflow and efficiency, allowing practices to edit, organize, assign and complete patient forms online
Additionally, electronic fax should integrate seamlessly with other patient management solutions that practices are leveraging, such as video chat, SMS text, electronic forms, and a virtual waiting room, ultimately streamlining the entire patient experience.
Healthcare has transformed dramatically this year and will continue to do so — there’s a new expectation of patient care post-COVID. In order to improve patient communications, practice efficiency, system interoperability, and data sharing, practices must adopt an entire virtual care strategy, including electronic fax. Offering telehealth but still communicating via traditional fax will hold your practice back. It’s time for our healthcare system to ditch outdated systems and go completely paperless. This is how we will tap into the true power of the inbox, drive practice profitability and efficiency, and better serve patients.
About Michael Morgan, CEO of Updox With a successful track record in helping organizations use technology to transform the way healthcare is delivered, Mike has more than 25 years of healthcare leadership within software, behavioral health, and HIT organizations. Updox was named to the Inc. 5000 list of fastest-growing companies in America for the past six consecutive years.
As healthcare spending continues to rise, so too does the inherent risk for bad actors to take advantage. Today, the United States is estimated to spend nearly 18 percent of its GDP, or $3.6 trillion, on healthcare, and is expected to increase to one-fifth of GDP within the next decade, according to the latest data. This alone provides ample motivation for fraud and abuse. While the full extent of healthcare fraud is difficult to measure,
The National Health Care Anti-Fraud Association (NHCAA) conservatively estimates that 3 percent – $68 billion – of all healthcare spending is lost to fraud each year. Others, such as the Federal Bureau of Investigation (FBI), estimate fraud accounts for up to 10 percent of healthcare expenditures.
Unfortunately, the COVID-19 pandemic has only accelerated the motivation for fraud and abuse amid the increased fear, confusion, and a relaxed regulatory environment. From fake cures to malware and illegitimate charities, fraudsters are taking advantage. Telehealth, which has experienced exponential growth aided by regulatory accommodations to facilitate its widespread adoption, is an area of particular concern. In turn, states and healthcare organizations must optimize their program integrity operations and telehealth strategy to stay protected amid healthcare’s new normal.
Greater Access Brings Greater Risk
The pandemic-driven expansion of telehealth has been profound in terms of enabling care access and continuity while reducing the risk of infection. When the Centers for Medicare and Medicaid Services (CMS) temporarily expanded telehealth coverage at the start of the pandemic, adoption soared to unprecedented levels.
According to a McKinsey report, providers have seen 50 to 175 times more patients through telehealth appointments compared to any year prior. At the same time, once-strict regulations governing telehealth services have been relaxed during the COVID-19 emergency, and the federal government has proposed to make permanent many of the regulatory changes initially meant to temporarily increase access to telehealth.
In parallel and perhaps unsurprisingly, there is a growing sentiment that telehealth is here to stay. According to a recent CynergisTek survey, 70 percent of consumers plan to continue using telehealth post-pandemic. From a provider perspective, new research from Bain & Company found that more than 80 percent of providers will continue to use telehealth as much or more than they do now.
All this considered, we must acknowledge the inherent risks of this technology. Telehealth has a poor track record for fraud, waste and abuse, with some of the largest healthcare fraud schemes involving telehealth providers. This September, for example, the Department of Justice announced the largest case of healthcare fraud in history, involving more than 300 individuals who submitted over $6 billion in fraudulent claims, with telehealth accounting for $4.5 billion of those claims.
With providers struggling to meet fluctuating demand amid unprecedented revenue shortfalls, improper billing practices — both intentional and inadvertent — are, to some degree, inevitable. Factor in hundreds of new telehealth codes and coding considerations as well as the overall stress on the healthcare system, and it is clear we must examine existing risk mitigation measures through a new, post-pandemic lens.
Strategies for Mitigating Telehealth Fraud & Abuse
For healthcare organizations and, specifically, special investigation units (SIUs) tasked with combatting fraud and abuse, the shift to telehealth adds an additional layer of complexity. Fortunately, there are strategies healthcare organizations can implement to successfully navigate the evolving landscape while strengthening the integrity of their operations for healthcare’s new normal.
Data visualization is a key component of an effective fraud investigation. Charts and graphs provide a clear representation of trends and outliers, including connections that could indicate a kickback or collusion scheme. Critical to the success of these tools, however, is the quality of the data that underlies them. Collecting sample data based on the appropriate modifiers and conducting thorough background research provides an accurate portrayal of events from which SIUs can clearly identify and pursue potential fraud schemes.
Integrating qualitative research into telehealth strategies is a great way to capture fraud at the source. When appropriate, conducting interviews with patients can validate whether services were in fact rendered as billed. For instance, a provider may bill for audio-only services as if they were delivered in an audio-visual capacity, resulting in an unjustifiably higher reimbursement rate. Similarly, using data visualization techniques to identify suspect trends, such as blanket billing or an implausibly high volume of services during a known low-demand period, can inform pointed questions for patients.
As we traverse this unprecedented territory, being on high alert for potential indicators of fraud and abuse is critical to protecting healthcare organizations and consumers. If something doesn’t make sense, whether clinically or in the context of the larger healthcare landscape, it is worth investigating. Understanding the limitations of telehealth and other key considerations surrounding its use will help to ensure we are maximizing the benefits of these services while mitigating their inherent risks.
Healthcare providers and patients alike have embraced telehealth during the COVID-19 crisis and, in doing so, confirmed what advocates have been saying for years — that telehealth promotes greater access to care. While ultimately good news for stakeholders across the healthcare spectrum, the environment we find ourselves in today has also created new avenues for fraudsters to take advantage. As telehealth becomes an inseparable part of the healthcare ecosystem, we are quickly learning how to identify telehealth fraud schemes, and, more importantly, strategies to mitigate the risks they post to integrity and security in the space.
About Gary Call, M.D.
Gary Call, M.D., is senior vice president and Chief Medical Officer at HMS, where he leads the company’s clinical program development and execution. Dr. Call has more than 25 years of experience in the practice of medicine and managed care. Dr. Call graduated from the University of Washington School of Medicine and completed his residency training at the University of Utah. He is a board-certified family physician.
A century ago, X-rays transformed medicine forever. For the first time, doctors could see inside the human body, without invasive surgeries. The technology was so revolutionary that in the last 100 years, radiology departments have become a staple of modern hospitals, routinely used across medical disciplines.
Today, new technology is once again radically reshaping medicine: artificial intelligence (AI). Like the X-ray before it, AI gives clinicians the ability to see the unseen and has transformative applications across medical disciplines. As its impact grows clear, it’s time for health systems to establish departments dedicated to clinical AI, much as they did for radiology 100 years ago.
Radiology, in fact, was one of the earliest use cases for AI in medicine today. Machine learning algorithms trained on medical images can learn to detect tumors and other malignancies that are, in many cases, too subtle for even a trained radiologist to perceive. That’s not to suggest that AI will replace radiologists, but rather that it can be a powerful tool for aiding them in the detection of potential illness — much like an X-ray or a CT scan.
AI’s potential is not limited to radiology, however. Depending on the data it is trained on, AI can predict a wide range of medical outcomes, from sepsis and heart failure to depression and opioid abuse. As more of patients’ medical data is stored in the EHR, and as these EHR systems become more interconnected across health systems, AI will only become more sensitive and accurate at predicting a patient’s risk of deteriorating.
However, AI is even more powerful as a predictive tool when it looks beyond the clinical data in the EHR. In fact, research suggests that clinical care factors contribute to only 16% of health outcomes. The other 84% are determined by socioeconomic factors, health behaviors, and the physical environment. To account for these external factors, clinical AI needs external data.
Fortunately, data on social determinants of health (SDOH) is widely available. Government agencies including the Census Bureau, EPA, HUD, DOT and USDA keep detailed data on relevant risk factors at the level of individual US Census tracts. For example, this data can show which patients may have difficulty accessing transportation to their appointments, which patients live in a food desert, or which patients are exposed to high levels of air pollution.
These external risk factors can be connected to individual patients using only their address. With a more comprehensive picture of patient risk, Clinical AI can make more accurate predictions of patient outcomes. In fact, a recent study found that a machine learning model could accurately predict inpatient and emergency department utilization using only SDOH data.
Doctors rarely have insight on these external forces. More often than not, physicians are with patients for under 15 minutes at a time, and patients may not realize their external circumstances are relevant to their health. But, like medical imaging, AI has the power to make the invisible visible for doctors, surfacing external risk factors they would otherwise miss.
But AI can do more than predict risk. With a complete view of patient risk factors, prescriptive AI tools can recommend interventions that address these risk factors, tapping the latest clinical research. This sets AI apart from traditional predictive analytics, which leaves clinicians with the burden of determining how to reduce a patient’s risk. Ultimately, the doctor is still responsible for setting the care plan, but AI can suggest actions they may not otherwise have considered.
By reducing the cognitive load on clinicians, AI can address another major problem in healthcare: burnout. Among professions, physicians have one of the highest suicide rates, and by 2025, the U.S. The Department of Health and Human Services predicts that there will be a shortage of nearly 90,000 physicians across the nation, driven by burnout. The problem is real, and the pandemic has only worsened its impact.
Implementing clinical AI can play an essential role in reducing burnout within hospitals. Studies show burnout is largely attributed to bureaucratic tasks and EHRs combined, and that physicians spend twice as much time on EHRs and desk work than with patients. Clinical AI can ease the burden of these administrative tasks so physicians can spend more time face-to-face with their patients.
For all its promise, it’s important to recognize that AI is as complex a tool as any radiological instrument. Healthcare organizations can’t just install the software and expect results. There are several implementation considerations that, if poorly executed, can doom AI’s success. This is where clinical AI departments can and should play a role.
The first area where clinical AI departments should focus on is the data. AI is only as good as the data that goes into it. Ultimately, the data used to train machine learning models should be relevant and representative of the patient population it serves. Failing to do so can limit AI’s accuracy and usefulness, or worse, introduce bias. Any bias in the training data, including pre-existing disparities in health outcomes, will be reflected in the output of the AI.
Every hospital’s use of clinical AI will be different, and hospitals will need to deeply consider their patient population and make sure that they have the resources to tailor vendor solutions accordingly. Without the right resources and organizational strategies, clinical AI adoption will come with the same frustration and disillusionment that has come to be associated with EHRs.
Misconceptions about AI are a common hurdle that can foster resistance and misuse. No matter what science fiction tells us, AI will never replace a clinician’s judgment. Rather, AI should be seen as a clinical decision support tool, much like radiology or laboratory tests. For a successful AI implementation, it’s important to have internal champions who can build trust and train staff on proper use. Clinical AI departments can play an outsized role in leading this cultural shift.
Finally, coordination is the bedrock of quality care, and AI is no exception. Clinical AI departments can foster collaboration across departments to action AI insights and treat the whole patient. Doing so can promote a shift from reactive to preventive care, mobilizing ambulatory, and community health resources to prevent avoidable hospitalizations.
With the promise of new vaccines, the end of the pandemic is in sight. Hospitals will soon face a historic opportunity to reshape their practices to recover from the pandemic’s financial devastation and deliver better care in the future. Clinical AI will be a powerful tool through this transition, helping hospitals to get ahead of avoidable utilization, streamline workflows, and improve the quality of care.
A century ago, few would have guessed that X-rays would be the basis for an essential department within hospitals. Today, AI is leading a new revolution in medicine, and hospitals would be remiss to be left behind.
About John Frownfelter, MD, FACP
John is an internist and physician executive in Health Information Technology and is currently leading Jvion’s clinical strategy as their Chief Medical Information Officer. With 20 years’ leadership experience he has a broad range of expertise in systems management, care transformation and health information systems. Dr. Frownfelter has held a number of medical and medical informatics leadership positions over nearly two decades, highlighted by his role as Chief Medical Information Officer for Inpatient services at Henry Ford Health System and Chief Medical Information Officer for UnityPoint Health where he led clinical IT strategy and launched the analytics programs.
Since 2015, Dr. Frownfelter has been bringing his expertise to healthcare through health IT advising to both industry and health systems. His work with Jvion has enhanced their clinical offering and their implementation effectiveness. Dr. Frownfelter has also held professorships at St. George’s University and Wayne State schools of medicine, and the University of Detroit Mercy Physician Assistant School. Dr. Frownfelter received his MD from Wayne State University School of Medicine.
Interoperability is a big discussion in health care, with
new regulations requiring interoperability for patient data. Most approaches
follow the typical RESTful API approach that has become the standard method for
data exchange. Yet Health Level Seven (HL7), with its new Fast Healthcare Interoperability
Resources (FHIR) standard for the electronic transfer of health data, is
leading to a rash of implementations that, to date, are not solving core interoperability
Data is still insecure, users can’t govern their own health
records, and the need for multiple APIs for different participants with
different rights (human and machine) in the network is adding unneeded
expenditures to an already burdened healthcare system. The way out is not to
add more middleware, but to upgrade the basic tools of interoperability in a
way that finally brings healthcare
technology into the 21st century.
A Timely Policy
Doctors, hospitals, pharmacists, insurance providers,
outpatient treatment centers, labs and billing companies are just a few of the
parties that comprise the overcomplicated U.S. healthcare system.
In digitizing medical files, as required by the 2009 Health
Information Technology for Economic and Clinical Health (HITECH) Act, providers
have adopted whatever solution was most convenient. This has led to the mess of interoperability
issues that HL7 seeks to remedy with FHIR.
Existing Electronic Medical Records
(EMR) systems do not easily share data. Best case, patients have to sign
off to share data with two incompatible systems. Worst case, information must
be turned into a physical CD or document to follow the patient between
providers. Data security is also notoriously poor. Hackers prioritized the healthcare sector as their main target in 2019; breach
costs exceeded $17.7 billion.
The New Infrastructure Rush
When common formats, by way of FHIR and HL7, provided
standards and solutions to empower global health data interoperability, the
industry erupted into a flurry of activity. Thousands of healthcare databases
are now being draped in virtual construction tarps and surrounded by digital
Building a new, interoperable data ontology for the entire
healthcare system is a massive undertaking. For one, 80% of hospital data is
managed using the cryptic, machine-language HL7 Version 2. Most of the rest
uses the inefficient, dated XML data format. HL7 FHIR promotes the use of more
modern data syntaxes, like JSON and RDF (Turtle).
Secondly, databases have no notion of the new FHIR schema.
Armies of developers must build frameworks and middleware to facilitate interoperability.
This is why Big Tech incumbents including Google Cloud Healthcare, Amazon AWS
and Microsoft for Healthcare are jumping into the fray with their own
The outcome, once HL7’s 22 resources are fully normative, will
be seamless information sharing, electronic notifications, and collaboration
between every player in the giant web of patients, providers, labs, and
middlemen. But it will come at a steep cost in the current traditionally RESTful
API-based manner that is being broadly pursued.
The Problem with APIs
The new scaffolding is expensive, takes data control away
from patients, and is not inherently secure. The number of unique APIs required
to support the access, rights and disparate user base in the healthcare network
are the reason.
Interoperability requires a common syntax and “language” to
enable databases to talk to each other. The average traditional API costs up to
$30,000 to build, plus half that cost to manage annually. That is not to
mention the cost to integrate and secure each API. A small healthcare
organization with only 10 APIs faces costs of $450,000 annually for basic API
When you consider that most big healthcare organizations will
need to connect thousands of APIs, HL7’s interoperability schema really is the
best way forward. The traditional API tooling to manage the interoperability of
the well-framed data structures, however, is the problem.
Moreover, the patient, the rightful owner of their own
health record, still doesn’t have the ability to govern their own data. Because
change only happens in the database itself, the manager of the database, not
the patient, controls the data within.
In the best case, this puts an additional burden on patients
to give explicit permission every time health records move between providers.
In the worst case, a provider sees an entire medical history without a
patient’s consent–your podiatrist seeing your psychiatric records, for
Finally, each API enables one data store to talk to the
next, opening opportunities for bad actors to make changes to databases from
the outside. The firewalls that protect databases and networks are penetrable,
and user profiles are sometimes created outside of the database itself, making
it possible to expose, steal and change data from outside the database.
In that light, HL7 is paving the wrong road with good
intentions. But there is another way.
Semantic Standards and Blockchain to the Rescue
If you eliminate data APIs, secure interoperability, with
data governance fully in the hands of the patient, becomes possible. Healthcare
data silos will be replaced with a dynamic, trusted and shared data network
with privacy and security directly baked in. The solution involves adding
semantic standards for full interoperability, blockchain for data governance
and data-centric security.
Semantic standards, such as RDF formatting and SPARQL
queries, let users quickly and easily gain answers from multiple databases and
other data stores at once. Relational databases, the ones currently in use in healthcare,
are all formatted differently, and need API middleware to talk to one another.
Accurate answers are not guaranteed. Semantic standards, on the other hand,
create a common language between all databases. Instead of untangling the
mismatched definitions and formatting inevitable with relational databases,
doctors’ offices, for example, could easily pull in pertinent patient records,
insurance coverage, and the latest research on diseases.
Patients, for their part, would use blockchain to regain control
of their data. Patients would be able to turn on aspects of their data to
specific caregivers, instead of relinquishing control to database business
managers, as is currently the case. Your podiatrist, in other words, will not
be able to see your psychiatric records unless you choose to share them.
The data ledger, which lives on the blockchain, will contain
instructions as to who can update (writer new records on) the ledger, who can
read it, and who can make changes. All changes are controlled by private-key
encryption that is in the hands of the patient; only those with authorization
can see select histories of health data (or, as in the case of an ER doctor,
entire histories, with permission).
Data security is controlled in the data layer itself,
instead of through middleware such as a firewall. Data can be shared without
API, thanks to those semantic standards, and data are natively embedded with
security in the blockchain. Compliance, governance, security and data
management all become easier. Data cannot be stolen or manipulated by an
outside party, the way it commonly is by healthcare hackers today.
The interoperability conundrum, in other words, is solved.
Fewer APIs means fewer security vulnerabilities; a common, semantic standard
eliminates confusion and minimizes mistakes. Blockchain puts patients in
control of who sees what parts of their health records. Eliminating the need
for API middleware also saves tens of thousands of dollars, at a minimum.
About Brian Platz
Brian is the Co-CEO and Co-Chairman of Fluree, PBC, a decentralized app platform that aims to remodel how business applications are built. Before establishing Fluree, Brian was the co-founder of SilkRoad technology which expanded to over 2,000 customers and 500 employees in 12 international offices.
Since the onset of the COVID-19 pandemic, hospitals and health systems have pushed forward with innovative technology solutions with great expediency and proficiency. Healthcare organizations were quick to launch telehealth solutions and advance digital health to maintain critical patient relationships and ensure continuity of care. Behind the scenes, hospitals and health systems have been equally adept at advancing technology solutions to support and enhance clinical care delivery. This includes adopting clinical surveillance systems to better predict and prevent an escalation of the coronavirus.
Clinical surveillance systems use real-time and historical patient data to identify emerging clinical patterns, allowing clinicians to intervene in a timely, effective manner. Over time, these clinical surveillance systems have evolved to help healthcare organizations meet their data analytic, surveillance, and regulatory compliance needs. The adaptability of these systems is evidenced by their expanded use during the pandemic. Healthcare organizations quickly pivoted to incorporate COVID-19 updates into their clinical surveillance activities, providing a centralized, global view of COVID-19 cases.
To gain insight into the COVID-19 crisis, critical data points include patient age, where the disease was likely contracted, whether the patient was tested, and how long the patient was in the ICU, among other things. Surveillance is also able to factor in whether patients have pre-existing conditions or problems with blood clotting, for example. This data trail is helping providers create a constantly evolving coronavirus profile and provides key data points for healthcare providers to share with state and local governments and public health agencies. In the clinical setting, the data are being used to better predict respiratory and organ failure associated with the virus, as well as flag COVID-19 patients at risk for developing sepsis.
What’s driving these advancements? Clinical surveillance systems powered by artificial intelligence (AI). By refining the use of AI for clinical surveillance, we can proactively identify an expanding range of acute and chronic health conditions with greater speed and accuracy. This has tremendous implications in the clinical setting beyond the current pandemic. AI-powered clinical surveillance can save lives and reduce costs for conditions that have previously proven resistant to prevention.
Eliminating healthcare-associated infections
Despite ongoing prevention efforts, healthcare-associated infections (HAIs) continue to plague the US healthcare system, costing up to $45 billion a year.According to the Centers for Disease Control and Prevention (CDC), about one in 31 hospitalized patients will have at least one HAI on any given day. AI can analyze millions of data points to predict patients at-risk for HAIs, enabling clinicians to respond more quickly to treat patients before their infection progresses, as well as prevent spread among hospitalized patients.
Building trust in AI
While the benefits are clear, challenges remain to the widespread adoption and use of AI in the clinical setting. Key among them is a lack of trust among clinicians and patients around the efficacy of AI. Many clinicians remain concerned over the validity of the data, as well as uncertainty over the impact of the use of AI on their workflow. Patients, in turn, express concerns over AI’s ability to address their unique needs, while also maintaining patient privacy. Hospitals and health systems must build trust among clinicians and patients around the use of AI by demonstrating its ability to enhance outcomes, as well as the patient experience.
3 keys to building trust in AI
Building trust among clinicians and patients can be achieved through transparency, expanding data access, and fostering focused collaboration.
1. Support transparency
Transparency is essential to the successful adoption of AI in the clinical setting. In healthcare, just giving clinicians a black box that spits out answers isn’t helpful. Clinicians need “explainability,” a visual picture of how and why the AI-enabled tool reached its prediction, as well as evidence that the AI solution is effective. AI surveillance solutions are intended to support clinical decision making, not serve as a replacement.
2. Expand data access
Volume and variety of data are central to AI’s predictive power. The ability to optimize emerging tools depends on comprehensive data access throughout the healthcare ecosystem, no small task as large amounts of essential data remain siloed, unstructured, and proprietary.
3. Foster focused collaboration
Clinicians and data scientists must collaborate in developing AI tools. In isolation, data scientists don’t have the context for interpreting variables they should be considering or excluding in a solution. Conversely, doctors working alone may bias AI by telling it what patterns to look for. The whole point of AI is how great it is at finding patterns we may not even consider. While subject matter expertise should not bias algorithms,
it is critical in structuring the inputs, evaluating the outputs, and effectively incorporating those outputs in clinical workflows. More open collaboration will enable clinicians to make better diagnostic and treatment decisions by leveraging AI’s ability to comb through millions of data points, find patterns, and surface critically relevant information.
AI-enabled clinical surveillance has the potential to deliver next-generation decision-support tools that combine the powerful technology, the prevention focus of public health, and the diagnosis and treatment expertise of clinicians. Surveillance is poised to assume a major role in attaining the quality and cost outcomes our industry has long sought.
John Langton is director of applied data science at Wolters Kluwer, Health, where artificial intelligence is being used to fundamentally change approaches to healthcare. @wkhealth
One of the biggest challenges for biopharmaceutical companies of rare and orphan disease patient populations is optimizing disease management in a way that enhances the patient journey and improves outcomes. As these companies seek innovative solution partners, a patient-first approach that offers specialty Rx pharmacist expertise is critical for securing insurance coverage, coordinating care, ensuring compliance, and, ultimately, minimizing the daily impact of rare and orphan diseases.
In today’s challenging healthcare environment, biopharma companies need to feel confident that their products are properly and promptly distributed, and reimbursements processed quickly and correctly. The best approach is to partner with a pharmacy, distribution, and patient management organization that offers a patient-first strategy for rare and orphan disorders, as well as personalized care programs designed to maximize the benefit of the therapies prescribed for patients. The goal is to improve the quality of life for both patient and caregiver with a dedicated support system for positive outcomes and long-term well-being.
The right patient-first partner can tailorIT, technology, and data-based upon client needs, combined with a high-touch approach designed to improve patient engagement from clinical trials to commercialization and compliance.
High Touch Meets Technology
Rare and orphan disease patients require an intense level of support and benefit from high touch service. A care team, including the program manager, care coordinator, pharmacist, nurse, and specialists, should be 100% dedicated to the disease state, patient community, and therapy. This is a critical feature to look for in a patient-first partner. The idea is to balance technology solutions with methods for addressing human needs and variability.
With a patient-first approach, wholesale distributors, specialty pharmacies, and hub service providers connect seamlessly, instead of operating in siloes. This strategy improves continuity of care, strengthens communication, yields rich data for more informed decision making, and improves the overall patient experience. It manages issues related to collecting data, maintains frequent communication with patients and their families, and ensures compliance and positive outcomes. A patient-first model also hastens time to commercialization and provides continuity of care to avoid lapses in therapy – across the entire life cycle of a product.
Key Components for Effective Patient-First Strategy
A patient-first strategy means that the specialty Rx pharmacist works directly with the patient, from initial consultation, and across the entire patient journey, providing counseling, guidance, and education-based upon individual patient needs. They also develop an individualized care plan based on specific labs and indicators related to patient behavior to help gauge the person’s level of motivation and identify adherence issues that may arise.
The best patient-first partners enable patients to contact their pharmacist 24/7 and offer annual reassessments that ensure that goals of therapy are on track and every challenge is addressed to improve the patient’s quality of life. These specialty pharmacists also play a critical role on behalf of biopharmaceutical partners, providing ongoing regulatory and operations support and addressing each company’s particular challenges.
As the COVID-19 pandemic wanes on, it’s also important to find a patient-first partner that offers a fully integrated telehealth option to provide care coordination for patients, customized care plans based on conversations with each patient, medication counseling, education on disease states, and expectations for each drug.
A customized telehealth option enables essential discussions for addressing patient challenges and needs, a drug’s impact on overall health, assessing the number of touchpoints required each month, follow-up, and staying on top of side effects.
Each touchpoint should have a care plan. For example, a product may require the pharmacist to reach out to the patient after one week to assess response to the drug from a physical and psychological perspective, asking the right questions and making necessary changes, if needed, based on the patient’s daily routine, changes in behavior and so on.
Capturing information in a standardized way ensures that every pharmacist and patient receives the same assessment based on each drug, which can be compared to overall responses. Information is gathered by an operating system and data aggregator and shared with the manufacturer, who may make alterations to the care plan based on the patient’s story.
Ideally, one phone call with a patient can begin the process of optimizing medication delivery, insurance reimbursement, compliance, and education based on a plan tailored for each patient’s specific needs.
About Dr. Brandon Salke, PHARM.D
Dr. Brandon Salke serves as the pharmacist-in-charge and General Manager at Optime Care in Earth City, MO. He previously served as a team pharmacist for Dohmen Life Science Services, where he helped launch several new care programs and assisted in the management of clinical trial activities.
He is specialized in specialty pharmaceuticals, particularly ultra-orphan, orphan, and rare disease. Dr. Salke has been involved in all aspects of operations (planning, process integration, project management, etc.) for pharmaceutical manufacturers. This includes clinical trials to commercialization and assisting in commercial launches (and relaunch) of specialty pharmaceuticals.
Connected Communities of Care Definition: An innovative method for effective population health management using social determinants of health. A way to streamline effective coordination between medical, government, and community-based organizations.
We ask this type of question every day. For example, we may ask― “Is this product that I purchased making a difference?” or “Is this advanced training that I completed making a difference?” Implicit in this common question is the expectation that because we have made an investment in something to achieve a result, the result should be better or more improved than the pre-investment state. So too with a Connected Community of Care (CCC). As I have discussed in previous blogs, establishing a CCC requires a substantial investment in both time and money.
Therefore, it is only natural to ask― “Is this CCC making a difference, and how would I know?” Unfortunately, most CCCs are established with very little forethought given to this exact question. While we expect the CCC will help community residents improve their health and well-being, how will we know conclusively that this has happened? How will we demonstrate its impact to a potential partner or― more importantly― a funder? This is where data, measurement, and evaluation come into play. For most people, these three words cause anxiety levels to immediately rise. But this doesn’t need to be the case; a little planning and forethought can go a long way to assuaging one’s anxiety when asked the question, “Is your CCC making a difference?”
Before we think about what data we will need to answer this question or how we will collect it, we first need to establish what we mean by “making a difference”. Understand, there is no one correct answer to this question. What may constitute a positive difference or impact for one organization may be much different for another, even a similar organization. Many factors contribute to the final answer and each is usually organization-, ecosystem- and situation-specific.
In practice, there are many ways to define making a difference. First, we can look at quantitative or numeric information to make this determination. Are we providing more nutritious meals to indigent residents? Is the number of inappropriate Emergency Department visits declining or, conversely, is the number of residents having visits with a primary care provider increasing?
All of these effects can be counted and judged against some predefined goal (more on this later). Second, we can assess making a difference by asking the people that are being touched by the CCC. Through surveys or brief interviews, community residents can tell you in their own words what impact, if any, the CCC has on their lives.
While this qualitative (non-numeric) information can often be more informative than simple quantitative information because it represents the voice of the individual, to answer the question of whether your CCC is making a difference, you will also still likely need to establish numeric goals. A third way to assess whether your CCC is making a difference is indirect via the financial and non-financial opportunities that arise as a result of having a CCC versus not having one.
For example, having a CCC may make it much easier to perform contact tracing among vulnerable populations during a pandemic like COVID-19. Having a CCC may also enable a healthcare system or a community-based organization (CBO) to apply for a grant that it otherwise might not be competitively positioned to do if it did not have an integrated system of healthcare and social service providers such as a CCC.
Regardless of the approach to define making a difference, the importance of planning for 1) what things will be measured to generate the necessary data, 2) how and when that measurement will take place, and 3) how the resulting data will be analyzed and evaluated, cannot be underestimated. Similarly, these decisions cannot be put off until a later date as is often seen with start-ups, including CCCs. While it is natural to want to focus on the more immediate needs associated with launching a CCC, deferring the question of how we will know if the entity is making a difference can prove costly, both from an operational and financial perspective.
At the Parkland Center for Clinical Innovation (PCCI) we encourage those planning a CCC to devote the necessary time early on to setting performance goals and objectives and determining how and when they will be measured and evaluated. While it is important to explicitly build this step into your CCC planning phase, the scope and scale of the work does not have to be extensive.
In fact, at PCCI we strongly encourage CCCs to start small with a limited set of goals, objectives, and requisite measures and then scale up as the CCC grows and matures. This approach has the dual benefit of providing essential core information early on while also not overwhelming the CCC staff with data collection activities that may be a distraction from more pressing, day-to-day activities.
Based on this author’s work with literally hundreds of healthcare and social service provider organizations, experience suggests that most entities (both new and established organizations) do best if they initially establish 1) a limited number of goals― one or two at most, 2) a similar number of objectives to achieve each goal, and 3) no more than three to four performance measures to support each goal.
While this may seem like an insufficient number of performance elements in today’s data-obsessed world, remember that you can always add additional goals, objectives, and measures as your expertise and comfort levels allow and as your CCC evolves.
Even more important than the numbers, however, it is essential to get the selection of the goals, objectives, and performance measures correct. Each of these three performance elements plays an essential role in helping you answer the question “Is my CCC making a difference?”
Your goals focus on the long-term― what do you ultimately want to happen, while your objectives are the short-term accomplishments that help you achieve your goals. In both cases, you must be sure that what you are expecting is both realistic and appropriate for your CCC’s stage of development. For example, assuming a newly established CCC will reduce ED utilization in its first year or two may not be reasonable and may lead to frustration and disillusionment if the goal is not achieved. If you select a BHAG (Big Harry Audacious Goal), you must allow sufficient time (and then some) for all the necessary pieces to come together.
The rule of thumb for large-scale demonstration projects such as launching a CCC is that they 1) take (much) longer than expected, 2) cost more than budgeted, and 3) generally initially deliver less than expected. These facts should not dissuade you from your journey, but rather help you keep things in perspective as the project evolves to one that in the long-term is viewed as valuable in achieving your goals.
If getting the goals and objectives correct is important, then selecting the correct performance measures and designing a feasible measurement plan is paramount. Here again, quality is more important than quantity. A few well-chosen performance measures, implemented correctly, will generate far more in the way of actionable data than a plethora of randomly selected measures.
To optimize your ability to assess if your CCC is making a difference, your performance measures should be collected at regular intervals following the launch of the CCC. While many established programs collect, analyze, and evaluate performance data on a quarterly basis, for fledgling CCCs, PCCI recommends this data be collected monthly for at least the first one to two years or until the CCC reaches a stable level of operations.
While monthly data collection requires a little more work, the more frequent feedback allows you to make the necessary program or operational modifications more quickly and with fewer disruptions than that afforded with quarterly feedback. If measurement and evaluation is an area where you don’t have a lot of experience, reach out to others that do, especially individuals and organizations such as PCCI that have experience assessing performance in large-scale, multi-sector collaborative projects.
While we all hope that the answer to the question “Is my CCC making a difference” is yes, the answer may be no early on in the life of a CCC. As disheartening as this news may be, it’s important to not give up but to look critically at what is working and what is not and make adjustments where necessary.
Usually, this examination does not necessitate a complete “reboot” of the CCC initiative, but rather requires making minor changes accompanied by paying closer attention to the CCC’s operations. Seek feedback from your staff and those you serve and be open to change, where change is warranted. As indicated, these types of projects take a lot longer to reach fruition than most people believe, but with a solid plan, patience, and flexibility, you will be able to answer, “Yes, my CCC is definitively making a difference in the lives of the community residents it serves.”
As the COVID-19 pandemic has gripped the world, many providers have adopted an all-hands-on-deck approach and mentality for treating COVID-19 patients, stretching their resources to the breaking point.
We have heard about the frontline heroes who have sacrificed their own health and safety to treat patients and, in less-fortunate scenarios, comfort patients in their last moments as they were quarantined from loved ones.
What has been less recognized is the work and sacrifice put forth by providers’ back-office staff. Many back-office workers have had to transform their operational practices after shifting to “work-from-home” mode to avoid potential exposure and minimize traffic to hospitals and physicians’ offices.
In addition to working in new environments, some of these back-office administrators who help process claims, receive reimbursements, check eligibility and manage denials are also seeing a higher volume of claims that are more complicated in nature due to the severity and complexity of managing COVID-19 symptoms in patients. Others are working with bare-bones staff as elective procedure volumes have decreased.
The biggest challenges with COVID-19 claims While many aspects of the pandemic are beyond providers’ control, proper coding of COVID-19 claims is one area they can focus on to help ensure efficient operations and revenues. Of course, that is easier said than done. The following are just a few challenges providers have been facing with COVID-19 claims.
Increased complexity: Due to the complexity of COVID-19 cases, which affect many elderly patients and those patients with chronic conditions and comorbidities, associated claims often take longer to code, file and process compared to more straightforward cases. More complex COVID-19 cases lead to longer hospital stays, which can create delays in submitting claims, resulting in delays in receiving reimbursements.
Continued shift to electronic transactions: While many hospitals and provider groups have shifted to submitting claims electronically, many processes, including prior-authorizations, eligibility and estimation requests and grievances, and appeals, rely heavily on manual intervention. These processes frequently require access to faxed or paper documents. Administrative staff members have had to quickly learn new systems and processes.
Difficulties with reimbursement for the uninsured: Through the Coronavirus Aid, Relief, and Economic Security Act (also known as the CARES Act) and other legislation, the federal government has appropriated funding earmarked for providers that deliver COVID-19 testing and treatment to the uninsured. While this was certainly a welcome gesture at a time when many have lost their health insurance due to unemployment, the support has come with some administrative strings attached that lead to challenges for providers.
For example, before submitting a claim, providers must show they have gone through an attestation process and document their efforts to find other medical coverage for the patient. Then providers essentially have just one shot at submitting a clean claim, as there is no appeals process for denials deemed inappropriate or unjustified. In cases of denials, providers themselves have little recourse for obtaining reimbursement and end up with a loss in revenue and increased costs. Although the efforts to help uninsured patients with COVID-19 testing and treatment are well-intentioned, providers must follow specific steps to realize the benefits.
Processing COVID-19 claims more efficiently It has become clear that COVID-19 claims, though in many ways similar to traditional claims, have unique impediments that create difficulties for hospital and provider administrators. We have observed this in our own data. When comparing COVID-19 claims to non-COVID-19 claims, the COVID-19 claims have demonstrated a greater error rate (9-12% compared with 5-7%) and a longer time to submit (45 days compared to 30 days).
Despite these challenges, providers can implement the following steps to manage the workload, process COVID-19 claims efficiently, and work within the constraints of their new “work-from-home” offices.
1. Leverage technology that identifies errors and provides upfront edits to all COVID-19 claims. Automated revenue cycle solutions should contain updated functionality to properly review claims and flag potential issues prior to the claim being submitted to a payer.
2. Move coverage discovery to the front end of the billing process and ensure it is performed for all patients. There are many solutions that will search for insurance coverage across both commercial and government payers. When identified, the payer information can be reviewed and added to a patient’s billing information.
3. Review analytics within the revenue cycle management system to identify COVID-19 claims. Analyze these claims by payer, claim amount, and number and severity of services rendered. Scrubbing and editing claims in advance will ensure accuracy while also highlighting anomalies to review and fix prior to submitting the claim.
4. Constantly review claims for inpatient stays to ensure that all charges are recorded and all medical records are updated and attached. Getting all documentation ready and prepared in advance will save time on the backend.
Though we all hope that the pandemic winds down and we soon return to some sense of normalcy, it takes more than hope for providers to get their COVID-19 claims reimbursed accurately and quickly. Following the tips above will help keep administrative processes running smoothly and alleviate burdens that will inevitably occur once patients are treated and the billing cycle continues.
About Lillian Phelps
Lillian Phelps is the senior director of product management for Availity, the nation’s largest health information network.
In March 2020, the United States was in the early stages of the Covid-19 pandemic. We shut the entire country down and ground the economy to a halt in an effort to slow the spread of the virus. Think back to March, and how much uncertainty we were living under.
Nine months later, the FDA approved two Covid-19 vaccines under emergency authorization. Before New Year’s Day, millions of Americans had received the vaccine, including front-line physicians and health care providers and nursing home patients, our most vulnerable citizens.
Nine months. Take a moment to let that sink in.
The mainstream media has crafted a narrative around the Covid-19 pandemic that’s almost entirely negative. For the purpose of ratings, they have described the U.S. response to the pandemic as blundering from one mistake to the next. This narrative is false.
There is another way—a more accurate and underappreciated way—to tell the story of the last nine months. It is a story of heroism, innovation, and precise science, performed under unbelievable pressure.
Let’s not mince words: The United States and the world needs to appreciate the role of the pharmaceutical industry—the researchers, physicians and business leaders—who are rescuing the world from Covid-19. It’s the medical breakthrough of our lifetime.
Instead of dwelling on why many in the media are ignoring this, let’s review some facts.
Since the discovery of Covid-19, here is what scientists have accomplished: They identified a novel virus, unlocked and sequenced its genetic code, created new therapies to save lives, and developed multiple safe and effective vaccines using messenger RNA technology, a technology hopefully applicable to future vaccine development. Margaret Liu, MD, a member of the MJH Life Sciences Covid Coalition, called it a breakthrough for mRNA vaccines.
The United States has two vaccines approved for emergency use, one from Pfizer/BioNTech and another from Moderna, and the AstraZeneca/Oxford vaccine has been approved for emergency use in the UK. In addition, there are 64 vaccines undergoing clinical trials at the moment, including 20 in phase 3 trials. In the United States and around the world, the pharmaceutical industry has answered the call and invested heavily in this effort.
This was the fastest vaccine development program in history, and it’s not even close. David Pride, MD, a microbiologist at the University of California San Diego, estimates that vaccines typically take 10 to 15 years to develop. Until the Covid-19 pandemic, the fastest development timeline was four years, for the mumps vaccine.
Many government systems moved quickly to lessen the burden of onerous regulations and provide funding so that vaccines could be developed quickly but with still rigorous standards. Perhaps it should be a lesson to all of us that regulation/innovation can be calibrated more effectively during “normal” times as industry races to develop new therapies for our world’s other pandemics—cancer, diabetes, heart diseases and more.
The next step of the process—distribution of the vaccine—will be as challenging as the development phase, if not more so. But again, the pharmaceutical industry is rising to the occasion. Factories around the world are working in overdrive to produce hundreds of millions of vaccine doses.
Already, less than a month after the Pfizer vaccine was approved, more than 15.4 million doses of vaccine have been distributed across the country, and more than 4.6 million people have received their first dose, according to CDC data. Many patients are already receiving their second dose.
While 15.4 million doses are impressive, some expected 20 million doses. But even that is moving the goal line a bit, as six months ago many observers didn’t think we’d get a vaccine until 2021.
Members of our Covid Coalition told us that the holidays slowed the rollout considerably. Nancy Messonnier, M.D., a physician with the National Center for Immunization and Respiratory Diseases at the CDC, expects a rapid jump in administered vaccines during these first few days of 2021.
Every day, more people will be vaccinated. After health care workers and our most vulnerable citizens, other frontline workers will be next. Teachers will be vaccinated so our children can return to school. And soon, all Americans will be able to go to their doctor or walk into a CVS or Walgreens and receive the vaccine.
Remember, we did all this in nine months, with the help, dedication and expertise of our pharmaceutical industry heroes. Next time you turn on the TV and see negativity, turn it off and imagine instead where we will be nine months from now.
Mike Hennessy Sr. is the founder and chairman of MJH Life Sciences.
But can the EMR alone support all the informatics capabilities required by an ever-evolving healthcare industry? The rapid growth of precision medicine, particularly the use of genetic and genomic information during clinical decision making, is a compelling example that functionality beyond the EMR is required. Not only does genomic data represent a category of information used differently than traditional clinical knowledge, but the volume of data generated through molecular testing alone also requires informatics and management of a higher magnitude than previously required.
The EMR is designed to reflect a snapshot (or collection of snapshots) in time: clinical summaries, annotated lab and test results, operation notes, etc. These are mostly stored as isolated documents, loosely coupled with the rest of the patient chart. They need to remain available for reference over time, in some instances, so providers can chart and contextualize ongoing trends and chronic conditions. However, these views are anchored in time and represent limited actionable value during clinical decision-making months, years, and decades later.
Genomic information, on the other hand, represents a patient’s life signature. DNA rarely changes over the course of an individual’s lifetime. This means the results from germline testing – a patient’s molecular profile – conducted early in life are relevant, meaningful, and actionable during clinical decision making far into the future. They can also deliver insights exposing heritable proclivities that may be life-changing or life-saving for family members as well.
This recognition in and of itself alerts healthcare leaders that they need to adopt an advanced, more sophisticated strategy for data governance, management, and sharing than the approach traditionally applied to other clinical information systems, such as EMRs.
To be successful, healthcare organizations need an accelerator external to the EMR that is built on a data model unique to the management of molecular knowledge so test results and genomic insights can be used and shared across clinical specialties and care settings, as well as overtime. In addition, the rise of precision medicine requires an agile informatics platform that enables the cross-pollination of genomic data with clinical insights and ever-advancing discoveries in genomic science.
Consider these examples of how EMRs fall short of expectations for optimal use of genomic intelligence:
1. Studies have found that, despite ubiquitous availability of molecular tests, providers consistently fail to identify patients most at risk for heritable diseases. The Journal of the American Medical Informatics Association (JAMIA) recently released research showing that half the women meeting national guidelines for genetic screening are not getting the tests they need to determine their breast and ovarian cancer risk.
The reason? “The full story of a patient’s risk for heritable cancer within their record often does not exist in a single location,” says the JAMIA article. “It is fragmented across entries created by many authors, over many years, in many locations and formats, and commonly from many different institutions in which women have received care over their lifetimes.” In other words, no matter which EMRs they use, health systems routinely miss opportunities to improve care for patients they see. To achieve greater success, providers need tools that exceed EMR functionality and span multiple clinical systems.
2. Shortly after birth, Alexander develops a seizure disorder. The neonatologist orders a germline test to help her arrive at a precise diagnosis and begin targeted treatment. This approach is successful and Alexander thrives. In addition to genomic variants identifying the cause of his seizure disorder, the test results also contain information about other heritable risk factors, including cardiovascular disease.
Decades later, in the 70s, Alexander sees his primary care provider (PCP) with a rapid heartbeat and shortness of breath. After doing routine lab work, the PCP diagnoses congestive heart failure (CHF). If, however, the PCP had access to Alexander’s genomic test results – which remain as relevant and accurate as when he was an infant – the PCP would have noted a variation that indicated the CHF was due to dilated cardiomyopathy, requiring a different treatment regime.
It is vital that health leaders immediately begin to plan an informatics strategy that accommodates genetic and genomic data while empowering providers to leverage these insights at the point of care as they make routine, yet critical, clinical decisions. As they evaluate their approach, they would do well to ask the following questions:
– Which providers in my organization are already ordering genomic tests on their patients? How are test results being stored and managed – and can they be easily shared with and accessed by others in the health system?
– As the volume of genetic and genomic testing accelerates – and it will – how will we manage the volume of data generated? How will we apply consistent governance to the ordering process? How can we ensure results will be consumed as discrete data so our organization can optimize its value now and in the future?
– What steps do we need to take so our precision medicine strategy remains current with changing science? Which informatics tools deliver access to up-to-date knowledge bases and clinical guidelines to ensure optimal medical decisions are made?
The advent of precision medicine represents a new standard of care for healthcare providers from coast to coast. Genetic and genomic information supplies a new data set that can be used to arrive at more accurate diagnoses sooner and more effective treatment faster. This, in turn, supports better outcomes, higher patient (and provider) satisfaction, and competitive differentiation for the health system adopting precision medicine first in its market.
But to capture this value, healthcare leaders must look beyond their legacy EMRs, recognizing that they were not developed nor do they have the capacity to properly handle the upcoming data revolution. Instead, industry innovators are looking for platforms agnostic to individual EMRs and integrated with molecular labs to address the next-generation demands of precision medicine.
About Assaf Halevy
Assaf Halevy is the founder and CEO of 2bPrecise, LLC, leading an international team dedicated to bridging the final mile between the science of genomics and making that data useful at the point of care. He joined Allscripts as senior vice president of products and business development in 2013 when the company acquired Israel-based dbMotion. An initial inventor and co-founder of dbMotion, Halevy helped develop the leading clinical integration and population health management platforms in the industry today.
With 13 patents pending in the areas of actionable clinical integration, interoperability, and precision medicine, Halevy leverages his industry expertise by evaluating strategic alliances and partnerships for U.S. and international markets. Halevy was invited to participate in several U.S. government activities and contribute to an HHS privacy committee task force. In 2016, he was part of a small selective group of executives invited to the White House by Vice President Joe Biden to discuss the future of interoperability.
If hackers attack your organization and you’re in an industry such as financial services, engineering, or manufacturing your risks are mostly monetary. But when it comes to healthcare cybersecurity, not only is there significant financial jeopardy, people’s health and wellbeing are also at risk so the stakes are much, much higher.
According to the Department of Health and Human Services, there has been an almost 50 percent increase in healthcare cybersecurity data breaches between February and May 2020 compared to 2019. This is thought to be a result of the COVID-19 pandemic distracting the industry due to the sweeping changes required, putting extra pressure on already inadequate healthcare cybersecurity measures.
Why Are Hackers Attacking Healthcare?
If there’s one thing hackers like, it’s a target that’s “soft” and large, complex organizations in industries that have been slow to adopt and then secure digital technologies are precisely that, soft targets. These organizations usually have broad and mostly poorly defended “attack surfaces,” which provide hackers with many routes to enter and through which they can not only exfiltrate data but also compromise services and hardware.
Healthcare, in general, is one of the most visible and softest targets. Successful hospital cyber-attacks usually cause significant disruption of patient data and routine workflows such as scheduling patient medication, resources management, and other essential services. These hospital cyber-attacks can easily result in what is euphemistically called in healthcare “bad outcomes” … these “bad outcomes” include injury and death.
How Does Healthcare Think About Cyber Risks?
A study by the security consulting firm Independent Security Evaluators concluded:
One overarching finding of our research is that the industry focuses almost exclusively on the protection of patient health records, and rarely addresses threats to or the protection of patient health from a cyber threat perspective … In summary, we find that different adversaries will target or pursue the compromise of patient health records, while others will target or pursue the compromise of patient health itself.
The report argues that protecting patient records has been most of the focus of healthcare cybersecurity planning, and organizations often view threat actors as being “unsophisticated adversaries” such as individual hackers and small hacker collaborations. ISE argues that this framework ignores the potential of far more sophisticated hospital cyber-attacks from political hacktivist groups, organized crime, terrorists, and nation-states who are all highly motivated and well-funded and “As a result, a multitude of attack surfaces are left unprotected, and attack strategies that could result in harm to a patient are not considered.”
The Universal Health Service Hospital Cyber-attacks
In September 2020, Universal Health Services a hospital and health care network with more than 400 facilities across the United States, Puerto Rico, and the United Kingdom, found itself under attack by the Russian “Ryuk” ransomware. This wasn’t the first hospital cyber-attack on UHS. Security firm, Advance Intel’s Andariel intelligence platform, reported that trojan malware-infected Universal Health Services throughout 2020.
UHS has not officially confirmed the details of the attack but reports by UHS employees indicate the attack was the result of a successful phishing expedition. The attack disabled computers and phone systems and forced the hospitals to revert to using paper-based systems to continue operations. Affected network hospitals also had to redirect ambulances and move surgical patients to other unaffected facilities.
As is usually the case with large, complex organizations, cleaning up and restoring the system was neither simple nor quick and a UHS press release on October 12, 2020, announced: “… we have had no indication that any patient or employee data was accessed, copied or misused.” It also stated that operations were mostly back to normal after a total of 16 days. Given that downtime for enterprise security breaches cost upwards of $1,000,000 per day or more this attack will have dealt a serious blow to UHS’ bottom line. Whether UHS paid the ransom is not known.
Cyber Attacks and Murder
When a cyberattack happens to any organization, there are always consequences but when healthcare ransomware is involved there’s a real risk of loss of life. In the case of UHS, there were unconfirmed rumors of four patients dying because doctors had to wait for lab results delivered by couriers instead of by electronic delivery. While those, so far, appear to be just rumors, there is one known case of a patient dying directly due to a hospital ransomware attack.
The University Hospital Düsseldorf (UKD) in Germany suffered a ransomware attack on September 10, 2020. The attackers exploited a vulnerability in the Citrix ADC that had been known since January but the hospital, unfortunately, had not got around to implementing the fix.
As a result of the attack, the hospital immediately announced that “The UKD has deregistered from emergency care. Planned and outpatient treatments will also not take place and will be postponed. Patients are therefore asked not to visit the UKD – even if an appointment has been made” and patients were routed to alternative medical facilities.
The demand note delivered by the hospital ransomware showed that the intended target was not in fact the University Hospital Düsseldorf but rather Heinrich Heine University. The German police contacted the hackers via the instructions in the ransom note dropped by the malware and explained the mistake after which the hackers withdrew their demand and provided the decryption key.
Unfortunately, one patient with a life-threatening illness was diverted to a distant hospital after UKD was deregistered as an emergency care facility. The additional hour’s travel may have been the cause of the patient’s death. On September 18, 2020, German prosecutors launched an official negligent homicide investigation which, if confirmed, would make the patient’s death the first known case of death by hacking.
Protect Critical Systems from Malware
The key to defending your systems from malware and phishing is monitoring and examining all network communications. Now that encryption is becoming the norm for all internet communications, looking “inside” of message streams requires new approaches and technologies so that embedded threats are caught and handled before they can escalate into disasters.
About Babur Nawaz Khan Babur Nawaz Khan is a Technical Marketing Engineer at A10 Networks, a leading provider of secure application services and solutions. He primarily focuses on A10’s Enterprise Security and DDoS Protection solutions and holds a master’s degree in Computer Science from the University of Maryland, Baltimore County.
As we re-examine the healthcare system in the wake of the pandemic, we are continually identifying opportunities to rebuild parts of the system to new and improved specifications. One critical facet is digital health, where we continue to struggle with what should really be table stakes: the ability to integrate data from disparate organizations and systems into a unified view of the whole person and take action.
During the height of the pandemic, telehealth made it possible to deliver care that was personal yet socially responsible. As a direct benefit, the use of digital health tools on both the clinical and consumer side picked up a tremendous and timely head of steam. But what will become of these innovations once we make our eventual return to normal?
Today, many healthcare consumers can talk to a therapist or a counselor through text, monitor glucose levels through a diabetes app and meet with their primary care provider over videoconference. The challenge is that a lot of this patient data is still landlocked in electronic medical record (EMR) systems that do not communicate or coordinate with one another or with payer systems or consumer apps.
The sustainability and applicability of digital health tools are still often questioned despite reports that investors had poured a staggering $5.4 billion into the digital health industry just by June of this year (Rock Health). The key to success is to seamlessly connect these tools with legacy systems and siloed access points to create a truly integrated healthcare continuum. Jumping between systems, each holding only its own limited slice of patient data, and then trying to take action on this data, is neither scalable nor sustainable.
Healthcare consumers have long looked at the seamless nature of apps in other areas of life and asked for a similar level of accessibility and on-demand, high-quality information from the healthcare system. Accenture found in its 2020 Digital Health Consumer Survey that although consumers are interested in virtual services, a cumbersome digital experience turns them off. Additionally, the survey found that concerns over privacy, security, and trust remain, along with difficulty integrating new tools and services into day-to-day clinical workflows.
The good news is that the Office of the National Coordinator (ONC) has made several major data exchange rulings this year that will push providers and payer organizations to update legacy systems to make consumer health data more assessable and sharable across all parties, all for the benefit of the patient.
The Stage is Set: Healthcare Leaders Must Act, Now
The incredible investments in the industry, increasing consumer demand, and data sharing regulation show that healthcare connectivity and interoperability have never been more essential. To ensure that the digital health transformation and remote healthcare delivery models progress optimally beyond the current environment, we must support healthcare organizations in evolving their infrastructure and software capabilities to support this kind of strategy. This is where health tech has a critical role to play in building flexible pipes to connect the full spectrum of repositories and players, including doctors, specialists, nurses, care managers, health coaches, caregivers, and, of course, the healthcare consumer.
What does this look like in practice? Imagine if an unusually high heart rate warning was triggered by a patient’s smartwatch, which then alerted the patient’s care manager to check-in. With a comprehensive view of that patient, the care manager calls the patient to assess if they are okay and learns the patient ran out of their prescription which helps lower the heart rate. Knowing that patient does not have access to a car and is afraid to take public transportation due to COVID-19, the care manager then sets up a prescription delivery straight to that patient’s doorstep.
Through this process, digital health tools, patient data, and social determinants of health all came together to equip that care manager to deliver personalized care to the patient. Sound like sci-fi? This innovative approach can actually be a reality for organizations that manage large populations. The key is educating more healthcare leaders about the benefits of a comprehensive healthcare platform that improves health outcomes, lowers costs and increases member satisfaction.
This all starts with a platform that coordinates and aggregates the siloes of data and tools (clinical and digital) into a central hub. that allows providers to oversee the access points, plans, and processes in a patient’s healthcare journey without the task of building or maintaining the system themselves. This can be a game-changer in the way we assess and treat patients and help the industry to fully realize the dream of truly comprehensive, coordinated care.
About Adam Sabloff
Adam Sabloff is the founder and CEO of VirtualHealth, provider of HELIOS, the leading SaaS care management platform, serving more than 9 million members across the U.S. Prior to VirtualHealth, Sabloff served as VP of Development and Chief Marketing Officer for Midtown Equities, a $7 billion real estate, media and aviation conglomerate, where he also oversaw its technology subsidiary, Midtown Technologies.
Healthcare data security has been a growing concern for CIOs for the last year or so, as hackers are increasingly targeting health information. Now, with a global pandemic forcing a shift to telemedicine and remote work, and new rules from the ONC and CMS introducing more regulatory burden, healthcare CIOs have more to manage than ever. Fortunately, it is possible to roll out new capabilities while simultaneously improving cybersecurity by following these three rules:
Rule 1: Think Like an Attacker
The coronavirus pandemic has forced healthcare providers everywhere to roll out new capabilities, processes, and workflows, such as telemedicine systems and new patient check-in procedures. These measures are being taken in addition to the necessary work being done to comply with the new mandates from ONC and CMS regarding patient data accessibility. Though these changes need to be implemented quickly, it’s important to follow cybersecurity best practices to avoid providing new openings for attackers.
When a hacker sees new systems and processes being implemented, they are thinking about:
– What software is being introduced? Are there known vulnerabilities or frequently unpatched exploits associated with it?
– How are new endpoints being added and are they secure?
– Since the new ONC and CMS rules require publicly exposed FHIR APIs, how can those be attacked? Are there social engineering exploits that can provide a way around security?
– Are there ways to perpetrate identity fraud if a patient does not need to be physically present to receive healthcare?
This approach should lead to a cybersecurity plan that puts measures in place for each identified risk. By thinking like the adversary, it is possible to identify and lock down the possible attack vectors.
Rule 2: Minimize the Attack Surface
Every way into an organization’s network needs to be secured, monitored, and maintained. The best way to make this process as efficient and fool-proof as possible is to minimize the number of ways into the network.
This is especially difficult in light of the ONC and CMS rules, which require that clinical systems must share data through publicly available FHIR APIs. At first, this seems like a mandate to radically expand the organization’s attack surface. Indeed, this is precisely what happens if the straightforward approach of exposing every clinical system through public APIs is followed.
A different approach, which provides the same capabilities and compliance with the rules, would be to route all API traffic through a central hub. Attaching all the clinical systems to a single point of API access provides a number of benefits:
– Most importantly, compliance is achieved while minimizing the new attack vectors.
– All traffic between clinical systems and the outside world can be monitored from a single place.
– The API hub can act as a façade that makes legacy systems compliant with the new rules, even if those systems lack native FHIR API capabilities.
The API hub need not be an expensive new component of the network architecture. Most healthcare organizations are already using a clinical integration engine to move HL7, XML, and DICOM traffic among their internal systems. The same technology can serve as an API hub. This is especially effective if a new instance of the integration engine is placed in an isolated part of the network without full access to other systems.
Rule 3: Have an Expert Review the Defenses
Even for healthcare organizations with cybersecurity experts on staff, it can be worthwhile to bring in a cybersecurity consultant to cross-check new implementations. Novel threats are constantly shifting and emerging, making it nearly impossible for internal IT staff to keep up with the looming threats of ransomware hacks, while also adequately carrying out the day-to-day responsibilities of their jobs. For that reason, it makes sense to bring in a professional who focuses exclusively on security. It is also often useful to have an independent review from someone who is looking at the implementation from an outsider’s perspective. Independent consultants can provide the necessary guidance, risk assessments, and other security support, to set healthcare organizations up for success and operate more securely.
Expanding an organization’s IT capabilities often means more exposure to risk, especially when implementations are subject to time constraints. However, given the value and importance of the data that’s being generated, transmitted, and stored, it is imperative not to let cybersecurity fall out of focus. By following best practices around design, implementation, and testing healthcare organizations can rise to meet the current challenges of the pandemic, address the mandates of the interoperability rules, and simultaneously improve data security measures.
About Scott Galbari, Chief Technology Officer
As Chief Technology Officer for Lyniate, Scott leads the development and delivery of all products and services. Scott has been in the healthcare IT domain for the past twenty years and has experience in developing and delivering imaging, workflow, nursing, interoperability, and patient flow solutions to customers in all geographies. He was most recently the General Manager for multiple businesses within McKesson and Change Healthcare and started his career as a software developer.
About Drew Ivan, Chief Product & Strategy Officer
Drew’s focus is on how to operationalize and productize integration technologies, patterns, and best practices. His experience includes over 20 years in health IT, working with a wide spectrum of customers, including public HIEs, IDNs, payers, life sciences companies, and software vendors, with the goal of improving outcomes and reducing costs by aggregating and analyzing clinical, claims, and cost data.
Industry experts state that orphan drugs will be a major trend to watch in the years ahead, accounting for almost 40% of the Food and Drug Administration approvals this year. This market has become more competitive in the past few years, increasing the potential for reduced costs and broader patient accessibility. Currently, these products are often expensive because they target specific conditions and cost on average $147,000 or more per year, making commercialization optimization particularly critical for success.
This is important because personalized medicine has the capacity to detect the onset of disease at its earliest stages, pre-empt the progression of the disease and increase the efficiency of the health care system by improving quality, accessibility, and affordability.
These factors lay the groundwork for specialty pharmaceutical companies that are developing and commercializing personalized drugs for orphan and ultra-orphan diseases to pursue productive collaboration and meaningful partnership with a specialty pharmacy, distribution, and patient management service provider. This relationship offers manufacturers a patient-first model to align with market trends and optimize the opportunity, maximize therapeutic opportunities for personalized medicines, and help to contain costs of specialty pharmacy for orphan and rare disorders. This approach leads to a more precise way of predicting the prognosis of genetic diseases, helping physicians to better determine which medical treatments and procedures will work best for each patient.
Furthermore, and of concern to specialty pharmaceutical providers, is the opportunity to leverage a patient-first strategy in streamlining patient enrollment in clinical trials. This model also maximizes interaction with patients for adherence and compliance, hastens time to commercialization, and provides continuity of care to avoid lapses in therapy — during and after clinical trials through commercialization and beyond for the whole life cycle of a product. Concurrently, the patient-first approach also provides exceptional support to caregivers, healthcare providers, and biopharma partners.
Integrating Data with Human Interaction
When it comes to personalized medicine for the rare orphan market, tailoring IT, technology, and data solutions based upon client needs—and a high-touch approach—can improve patient engagement from clinical trials to commercialization and compliance.
Rare and orphan disease patients require an intense level of support and benefit from high touch service. A care team, including the program manager, care coordinator, pharmacist, nurse, and specialists, should be 100% dedicated to the disease state, patient community, and therapy. This is a critical feature to look for when seeking a specialty pharmacy, distribution, and patient management provider. The key to effective care is to balance technology solutions with methods for addressing human needs and variability.
With a patient-first approach, wholesale distributors, specialty pharmacies, and hub service providers connect seamlessly, instead of operating independently. The continuity across the entire patient journey strengthens communication, yields rich data for more informed decision making, and improves the overall patient experience. This focus addresses all variables around collecting data while maintaining frequent communication with patients and their families to ensure compliance and positive outcomes.
As genome science becomes part of the standard of routine care, the vast amount of genetic data will allow the medicine to become more precise and more personal. In fact, the growing understanding of how large sets of genes may contribute to disease helps to identify patients at risk from common diseases like diabetes, heart conditions, and cancer. In turn, this enables doctors to personalize their therapy decisions and allows individuals to better calculate their risks and potentially take pre-emptive action.
What’s more, the increase in other forms of data about individuals—such as molecular information from medical tests, electronic health records, or digital data recorded by sensors—makes it possible to more easily capture a wealth of personal health information, as does the rise of artificial intelligence and cloud computing to analyze this data.
Telehealth in the Age of Pandemics
During the COVID-19 pandemic, and beyond, it has become imperative that any specialty pharmacy, distribution, and patient management provider must offer a fully integrated telehealth option to provide care coordination for patients, customized care plans based on conversations with each patient, medication counseling, education on disease states and expectations for each drug.
A customized telehealth option enables essential discussions for understanding patient needs, a drug’s impact on overall health, assessing the number of touchpoints required each month, follow-up, and staying on top of side effects.
Each touchpoint has a care plan. For instance, a product may require the pharmacist to reach out to the patient after one week to assess response to the drug from a physical and psychological perspective, asking the right questions and making necessary changes, if needed, based on the patient’s daily routine, changes in behavior and so on.
This approach captures relevant information in a standardized way so that every pharmacist and patient is receiving the same assessment based on each drug, which can be compared to overall responses. Information is gathered by an operating system and data aggregator and shared with the manufacturer, who may make alterations to the care plan based on the story of the patient journey created for them.
Just as important, patients know that help is a phone call away and trust the information and guidance that pharmacists provide.
About Donovan Quill, President and CEO, Optime Care
Donovan Quill is the President and CEO of Optime Care, a nationally recognized pharmacy, distribution, and patient management organization that creates the trusted path to a fulfilled life for patients with rare and orphan disorders. Donovan entered the world of healthcare after a successful coaching career and teaching at the collegiate level. His personal mission was to help patients who suffer from an orphan disorder that has affected his entire family (Alpha-1 Antitrypsin Deficiency). Donovan became a Patient Advocate for Centric Health Resources and traveled the country raising awareness, improving detection, and providing education to patients and healthcare providers.
Healthcare leaders can continue to wait for the government to enact and enforce IT changes that may or may not serve the needs of clinicians. Or, they can embrace proven solutions today that make their EHRs a bit more like a good butler – and serve the needs of clinicians.
Communication problems and inadequate information flow are two of the most common root causes of medical errors. The potential for miscommunication and faulty exchange of information in healthcare is substantial.
Consider: patient information is dispersed among multiple providers and payers along the continuum of care. Electronic Health Records (EHRs) and other clinical systems do not capture patient information or format medical documentation in a standardized manner. In an environment with incompatible systems, the easiest way for healthcare organizations to exchange records is to generate those records in a document format. It is not surprising then that many healthcare organizations are still heavily dependent on traditional, paper-based fax, which adds its own challenges to the process. Fax hardware and communication equipment are often unreliable, resulting in document delivery failures and delays.
As a result, an inadequate information flow can cause problems that impact the availability of essential knowledge needed for prescribing decisions, timely and reliable delivery of test results, and coordination of medical orders. The ensuing administrative and medical errors raise healthcare costs and may lead to poor health outcomes, including patient harm and readmissions.
The reality of mundane, manual processes
Document-based information exchange processes are highly inefficient. Staff often print and copy documents, creating a risk of accidental exposure of protected health information and resulting in needless costs. Moreover, documents – whether printed or stored on a workstation or server – still require manual data entry into EHRs and practice management systems. The tasks are tedious, prone to error, and negatively impact workflow, staff efficiency, physicians, and patients, and may lead to the following:
– Patient record errors, including filing or documenting information in the wrong patient file, and data entry errors;
– Poorly documented or lost test results; and
– Gaps in communication during transitions of care from one healthcare provider or setting to another.
In addition to these areas of concern that threaten patient safety, inbound documents often contain a lot of information on clinical, administrative, and financial matters that aren’t necessarily relevant to an intended recipient. That means a recipient must review all pages of the document and separate needed information from extraneous ones, which can further delay processing and patient transitions of care.
Smarter, faster document processing with AI
Healthcare providers need a document exchange and processing strategy that enables fully digital, secure, and efficient communication among numerous, highly customized EHRs, each with its own workflows and document processing preferences.
Such a strategy needs to include moving away from paper to fully digital documents. Healthcare organizations can accomplish this easily and without the need to overhaul the entire existing health IT infrastructure. The two main ways of transitioning from paper to digital are using digital fax instead of traditional fax and document imaging when documents are simply scanned into the system. In many cases, the resulting document format will be a TIFF image; and while it is not machine-readable, it enables paperless filing of clinical documents to the EHR.
Alternatively, converting the document into a readable format, such as a searchable PDF, will allow the healthcare organization to add value in document processing at every subsequent step. Making the document readable enables automatic identification of the type of document, data extraction, including patient name, medical record, date of birth, and physician name, as well as more effective management of the overall lifecycle of the document.
This step requires the utilization of AI and natural language processing techniques. Automatic extraction of data replaces the human labor required to manually index the information, which streamlines the triaging of documents to correct systems, teams, or recipients.
For example, if a digital document is clearly labeled as a discharge summary for John Harrison, a staff member can process it much easier and faster than when she has to open and read it to understand the type of the document and the identity of the patient. By mostly automating the receiving, reading, classifying, and triaging of medical documentation, providers are able to save time and ensure information is received and processed quickly by the right person, which typically means that the patient can be better served.
The COVID-19 pandemic has only driven home the need for seamless, 100%-digital exchange of patient information. If healthcare administrators depend on the physical fax machine to do their jobs, they won’t be able to work remotely. Most people don’t have fax machines at home, and especially fax machines routed to the hospital’s number, to be able to print information and then manually scan and enter that information into the patient’s health record. A fully digital document processing approach enables agility and flexibility necessary in the modern healthcare environment.
Moreover, recent ransomware attacks in the form of malware embedded into email attachments sent to users in hospitals lead to providers blocking inbound email attachments altogether. That means providers could not access their own patient data, let alone data from other institutions. As a result, emergency patients may have to be taken to other hospitals, and surgeries and other procedures delayed. Cloud-based platforms enable users to securely access patient information outside of the hospital’s network.
Small steps lead to big results
It’s essential from both a patient safety perspective and provider efficiency perspective that the exchange and processing of medical documentation be digitized. The benefits of digital document processing are significant, enabling fluid information exchange among all stakeholders.
By transitioning to fully digital document exchange, providers can significantly streamline administrative and clinical processes. The key to realizing the benefits of this approach is to take the first step by moving away from paper and then build on that by harnessing the power of AI to fully support the daily work of clinicians and administrators. Outbound and inbound documents can be prioritized, addressed, processed, and delivered appropriately, facilitating timely information exchange for processing prescriptions, medical orders, billing, reporting, analytics, research, and much more.
About John Harrison
As Chief Commercial Officer at Concord Technologies, John is responsible for the company’s revenue growth and brand development, ensuring Concord continues to create the right products to meet the needs of its customers. John brings more than 25 years of document communication and automation experience to the team. Prior to joining Concord, John held executive management positions at OpenText, Captaris, and Goaldata, overseeing business operations across multiple continents.
Shelter-in-place orders related to the COVID-19 pandemic have exaggerated the social exclusion and loneliness of many elderly and vulnerable individuals, thereby increasing their chances of experiencing critical health complications. This trend—combined with societal shifts including reduced inter-generational living, greater geographical mobility, and less cohesive communities—has placed the elderly at heightened risk of being isolated and, consequently, in harm’s way.
Fortunately for senior citizens quarantined or living alone, technology can help detect and alert caregivers, healthcare professionals or family members to elderly persons’ changes in behavior—which can prevent serious issues.
Of the solutions available, the IoT is uniquely positioned to enable caregivers to support the well-being of those at risk when others cannot be at their side. By tracking key health indicators such as dehydration and malnutrition and behavioral changes like decreased mobility, IoT-enabled monitors reduce emergency hospital admissions and allow elders to stay in their homes longer safely.
Preventive fall detection
Falling, which becomes more prevalent with age, is the second leading cause of accidental or unintentional injury deaths worldwide. Therefore, actions for preventing falls must be taken both at home and in care facilities. Recording incidents, identifying risk factors (individual and environmental), and highlighting the preventive and corrective measures are critical steps in fall prevention, prediction, and detection. And they can all be accomplished with the IoT.
With conventional fall-detection technologies, a person must wear or carry the device and press a button upon falling. If the person is unwell but does not fall, nothing is reported, which is why it is important to monitor discomfort by other means, such as an algorithm that detects a change in the patient’s general wellbeing.
Using IoT sensors for this purpose, healthcare providers are able to track progress over longer periods of time (days or months) and determine whether an individual’s health is deteriorating, thereby placing them at future risk of falling. With this knowledge, caregivers can intervene and provide increased care before any injury occurs.
Keeping elders in their homes longer
When used in conjunction with tele-assistance services, IoT solutions can also help reassure families their loved ones are safe living on their own by transmitting critical information indicative of deteriorating health so that early warning signs don’t go unnoticed.
Companies such as SeniorAdom and Vitalbase have already developed remote assistance solutions based on IoT technology, including various motion detection sensors, geolocation pendants, and wrist bands. These solutions are designed to automatically detect any potential behavioral changes due to a fall, physical weakness, or cognitive deterioration (e.g., Alzheimer’s disease).
These innovative solutions make it possible to better protect elderly populations by anticipating risks and acting quickly in the event of an emergency. With a self-learning algorithm and an intelligent box wirelessly connected to sensors installed in the home, SeniorAdom can detect a potentially critical or abnormal situation and warn caregivers or relatives. SeniorAdom’s motion sensors and door open/close sensors learn the daily activities of the monitored individual to “get smart” on their everyday habits. As a result, the sensors can detect and send alerts about any changes in activities, which might indicate a problem.
How the sensors work
Operating on a 0G network—which is optimized to frequently transmit small amounts of information over a large distance—IoT-enabled sensors detect conditions and movement from connected devices, and never pick up personal information. Additionally, these devices consume minimal energy on a 0G network and therefore support communications at a very low cost. This means families can receive effective care without a hefty price tag.
Devices that run on other networks, like cellular, can also use a 0G network as a backup to ensure device users have constant supervision and those vulnerable individuals are able to communicate their health needs immediately. For example, Vitalbase’s Vibby OAK, an automatic fall detector worn on the wrist or neck, connects to a cellular mobile device but uses a 0G network when there is no primary connectivity, either because the user is not near a phone, or there’s no cellular network connectivity. At healthcare facilities, the device can interface with all existing nurse call systems to alert medical staff when an issue arises.
By optimizing automatic and intuitive fall-detection devices with the IoT, older adults can live more independently and maintain autonomy. The ability to remotely monitor seniors, receive alerts in case of emergencies, predict issues based on early warning signs, and intervene proactively offers peace of mind to both healthcare providers and families of senior citizens.
About Ajay Rane
Ajay Rane is the VP of Global Ecosystem Development at Sigfox, the initiator of the 0G network and the world’s leading IoT (Internet of Things) service provider. Its global network, available in 60 countries with 1 billion people covered, allows billions of devices to connect to the Internet, in a straightforward way, while consuming as little energy as possible.
A recent Advisory Board briefing examined the annual Centers for Medicare & Medicaid Services (CMS) Readmission penalties. Of the 3,080 hospitals CMS evaluated, 83% received a penalty for payments to be made in 2021, based on expected outcomes for a wide variety of treated conditions. While CMS indicated that some of these penalties might be waived or delayed due to the impacts of the Covid pandemic on hospital procedure volumes and revenue, they are indicative of a much larger issue.
For too long, patients discharged from the hospital have been handed a stack of papers to fill prescriptions, seek follow-up care, or take other steps in their journey from treatment to recovery. More recently, the patient is given access to an Electronic Health Record (EHR) portal to view their records, and a care coordinator may call in a few days to check-in. These are positive steps, but is it enough? Although some readmissions cannot be avoided due to unforeseen complications, many are due to missed follow-up visits, poor medication adherence, or inadequate post-discharge care.
Probably because communication with outside providers has never worked reliably, almost all hospitals have interpreted ‘care coordination’ to mean staffing a local team to help patients with a call center-style approach. Wouldn’t it be much better if the hospital could directly engage and enable the Primary Care Physician (PCP) to know the current issues and follow-up directly with their patient?
We believe there is still a real opportunity to hold the patient’s hand and do far more to guide them through to recovery while reducing the friction for the entire patient care team.
Strengthening Care Coordination for a Better Tomorrow
Coordinating and collaborating with primary care, outpatient clinics, mental health professionals, public health, or social services plays a crucial role in mitigating readmissions and other bumps along the road to recovery. Real care coordination requires three related communication capabilities:
1. Notification of the PCP or other physicians and caregivers when events such as ED visits or Hospitalization occur.
2. Easy, searchable, medical record sharing allows the PCP to learn important issues without wading through hundreds of administrative paperwork.
3. Secure Messaging allows both clinicians and office staff to ask the other providers questions, clarify issues, and simplify working together.
There are some significant hurdles to improve the flow of patient data, and industry efforts have long been underway to plug the gaps. EHR vendors, Health Information Exchanges (HIEs), and a myriad of vendors and collaboratives have attempted to tackle these issues. In the past few decades, government compliance efforts have helped drive medical record sharing through the Direct Messaging protocol and CCDAs through Meaningful Use/Promoting Interoperability requirements for “electronic referral loops.” Kudos to the CMS for recognizing that notifications need to improve from hospitals to primary care—this is the key driver behind the latest CMS Final Rule (CMS-9115-F) mandating Admission, Discharge, and Transfer (ADT) Event Notifications. (By March 2021, CMS Conditions of Participation (CoPs) will require most hospitals to make a “reasonable effort” to send electronic event notifications to “all” Primary Care Providers (PCPs) or their practice.)
However, to date, the real world falls far short of these ideals: for a host of technical and implementation reasons, the majority of PCPs still don’t receive digital medical records sent by hospitals, and the required notifications are either far too simple, provide no context or relevant encounter data, rarely include patient demographic and contact information, and almost never include a method for bi-directional communications or messaging.
Delivering What the Recipient Needs
PCPs want what doctors call the “bullet” about their patient’s recent hospitalization. They don’t want pages of minutia, much of it repetitively cut and pasted. They don’t want to scan through dozens or hundreds of pages looking for the important things. They don’t want “CYA” legalistic nonsense. Not to mention, they learn very little from information focused on patient education.
An outside practitioner typically doesn’t have access to the hospital EHR, and when they do, it can be too cumbersome or time-consuming to chase down the important details of a recent visit. But for many patients—especially those with serious health issues—the doctor needs the bullet: key items such as the current medication list, what changed, and why.
Let’s look at an example of a patient with Congestive Heart Failure (CHF), which is a condition assessed in the above-mentioned CMS Readmission penalties. For CHF, the “bullet” might include timely and relevant details such as:
– What triggered the decompensation? Was it a simple thing, such as a salty meal? Or missed medication?
– What was the cardiac Ejection Fraction?
– What were the last few BUN and Creatinine levels and the most recent weight?
– Was this left- or right-sided heart failure?
– What medications and doses were prescribed for the patient?
– Is she tending toward too dry or too wet?
– Has she been postural, dizzy, hypotensive?
Ideally, the PCP would receive a quick, readable page that includes the name of the treating physician at the hospital, as well as 3-4 sentences about key concerns and findings. Having the whole hospital record is not important for 90 percent of patients, but receiving the “bullet” and being able to quickly search or request the records for more details, would be ideal.
Similar issues hold true for administrative staff and care coordinators. No one should play “telephone tag” to get chart information, clarify which patients should be seen quickly, or find demographic information about a discharged patient so they can proactively contact them to schedule follow-up.
Building a Sustainable, Long-Term Solution
Having struggled mightily to build effective communications in the past is no excuse for the often simplistic and manual processes we consider care coordination today.
Let’s use innovative capabilities to get high-quality notifications and transitions of care to all PCPs, not continue with multi-step processes that yield empty, cryptic data. The clinician needs clinically dense, salient summaries of hospital care, with the ability to quickly get answers—as easy as a Google search—for the two or three most important questions, without waiting for a scheduled phone call with the hospitalist. X-Rays, Lab results, EKGs, and other tests should also be available for easy review, not just the report. After all, if the PCP needs to order a new chest x-ray or EKG how can they compare it with the last one if they don’t have access to it?
Clerical staff needs demographic information at their fingertips to “take the baton” and ensure quick and appropriate appointment scheduling. They need to be able to retrieve more information from the sender, ask questions, and never use a telephone. Additionally, both the doctor and the office staff should be able to fire off a short note and get an answer to anyone in the extended care team.
That is proper care coordination. And that is where we hope the industry is collectively headed in 2021.
About Peter Tippett MD, PhD: Founder and CEO, careMESH
Dr. Peter S. Tippett is a physician, scientist, business leader and technology entrepreneur with extensive risk management and health information technology expertise. One of his early startups created the first commercial antivirus product, Certus (which sold to Symantec and became Norton Antivirus). As a leader in the global information security industry (ICSA Labs, TruSecure, CyberTrust, Information Security Magazine), Tippett developed a range of foundational and widely accepted risk equations and models.
About Catherine Thomas: Co-Founder and VP, Customer Engagement, careMESH
Catherine Thomas is Co-Founder & VP of Customer Engagement for careMESH, and a seasoned marketing executive with extensive experience in healthcare, telecommunications and the Federal Government sectors. As co-founder of careMESH, she brings 20+ years in Strategic Marketing and Planning; Communications & Change Management; Analyst & Media Relations; Channel Strategy & Development; and Staff & Project Leadership.
Although most organizations have now provided WFH employees with secure computers using endpoint detection and response (EDR) solutions or mandated the use of virtual private networks (VPNs), this does not fully solve the security problem.
These solutions may protect the user and network from future attacks, but if network infiltration has already occurred, threats in the form of advanced persistent threats (APTs) may be lying dormant for weeks, months, or maybe even years, on an apparently secure network. To respond to these threats, a network detection and response (NDR) capability is required. This capability looks for activity or patterns of behavior from users or network servers that indicate attacks may be in progress may have taken place or may be developing.
Ideally, EDR and NDR need to be integrated and used together to provide end-to-end network visibility and security.
Cybercriminals and other bad actors were quick to exploit the COVID-19 pandemic with, for example, phishing attacks. These exploited the fears of healthcare consumers and healthcare workers who, in the early days of WFH, were often accessing corporate networks on secured mobile phones and personal computers from their home networks.
This led to a variety of security issues; for example, Mirai botnet–type attacks that exploited WFH practices to infect healthcare organizations’ networks or dropper-based attacks that loaded malware to steal users’ credentials and ultimately lead to ransomware attacks. While these attacks still continue, most healthcare organizations have taken the measures necessary to secure their networks and their patient and organizations’ data.
A Spike in State-Sponsored Attacks
Beyond threats from financially motivated cybercriminals looms the threat from highly sophisticated and well-resourced state-sponsored attackers. As widely reported in the media, there has been a spike in state-sponsored security attacks on lab and research facilities working on COVID-19 treatments. For example, the Wall Street Journal cited U.S. officials as suggesting that Chinese and Iranian hackers are targeting universities and pharmaceutical and other healthcare firms that are working to find a vaccine for COVID-19, in an attempt to disrupt this research and slow its development.
In addition to direct attacks on research institutions, software vendors that develop the tools used by these institutions are also at risk. Security is becoming a “supply chain” issue that touches not only all of the network users and assets but also all the precursors to these assets, including the network carriers and software vendors on which network users rely.
Lack of Trust
Who can you trust in this expanded threat environment? To take proper precautions, nobody. As healthcare consumers and the workforce want or need to operate on an “access anywhere, anytime” model, adopting what’s called a Zero Trust security architecture not only makes sense, it is close to an imperative for healthcare organizations.
Zero Trust means that, because the network is under constant attack from a huge array of external and internal threats, all users, devices, applications, and resources on the network must be treated as being hostile. These users and devices need to be rigorously and continuously authenticated, while patient, research, and other data and network assets need to be protected at a much granular level than traditional perimeter-based security models allow.
The Rise of IoMT Devices
Healthcare organizations must also find new, more cost-effective ways to deliver high-quality healthcare to their increasingly tech-savvy consumers – and the use of Internet of Medical Things (IoMT) devices is critical to this process. IoMT devices, ranging from simple telehealth and remote patient monitoring to surgical robots and augmented reality technologies, can reduce operating costs and increase the quality of patient care.
COVID-19 has accelerated the adoption of IoMT technology, a process that will further accelerate with the availability of 5G networks over the coming one to three years. Many of the simpler IoMT devices don’t support traditional security models, so their adoption poses significant new threats unless healthcare institutions act to enhance security by, for example, ensuring that their network detection and response tools are ready for this challenge.
Looking ahead, it’s clear that the world is evolving towards a new normal, which will pose more threats and concerns for the healthcare industry. Recognizing this and preparing for the threats discussed, will create a better game plan for what’s to come and allow for necessary growth within healthcare infrastructure.
About Matyn Crew Martyn Crew is Director of Solutions Marketing at Gigamon. He brings a 30-year background in all aspects of enterprise IT to his role where he focuses on a number of initiatives and products including Gigamon’s Application Visibility and Intelligence solutions.
A recent report by Deloitte projects that the artificial intelligence (AI) drug discovery market will grow 53% by 2025, citing the increased investment of labs in AI as a way to boost research but also to collect, analyze, and produce real-time, accurate data. Of course, such information, including when also applied to the health outcomes side to demonstrate drug value—whether we call it real-world evidence, real-world data, predictive modeling/forecasting, etc.—has been, at different levels, part of broader pharma practice for several years now, as the industry, some might say, begrudgingly compelled itself to get on the digital health train.
But pharma and its partners have taken advantage, as we examine in the December issue, focusing on strategies to build and sustain. Yes, the industry has its long-rooted regulations and risk assessments and compliance and data-protection measures, that in the delicate world of medicine, you can’t as easily adapt to next-gen trends and technology as other enterprises; but who can really ignore the strides made today in advanced analytics and digital health? Tools such as natural language processing, data and text mining, data visualization, wearables, system checkers, and so on—and the opportunities they offer in clinical operations, patient and physician engagement and support, and also in health economics and the market access/reimbursement realm.
Which brings us to Covid-19 and how this whole notion of data integration has been reframed. Edward Hensley of AssistRx points out in his guest feature this month that Covid sparked the acceleration of technological change and adoption, as daily routines were altered. A change he says was already afoot but now is requiring, out of necessity, the mass use of existing digital tools. A survey by Optum supports this, finding that 56% of healthcare executives said their companies accelerated AI plans in response to Covid. Generally, however, it seems progress remains in embracing AI. In a survey by MMG, doctors gave a score of 4.65 out of 10 to the level of development of AI; pharma/healthcare executives rate it at 4.79, and medical students at 5.11.
Perhaps acceptance simply comes down to trust, as Aktana’s Derek Choy explores in our December coverage, outlining ways he says AI 2.0, or “explainable AI,” can actually build trust between user and machine. He argues that the complexities of the life sciences “demands more humanity in modern AI.” Doesn’t sound too unreasonable to consider a little bit of “new” in these not-normal times.
Mike Christel is Editorial Director of Pharmaceutical Commerce. He can be reached at [email protected]
While countries around the world continue to flounder with regards to COVID-19 testing, everyone is wondering how national governments could get things so horribly wrong. It’s true that governments have acted incompetently, leaders can make poor judgment calls, and optimistic testing targets are rarely achieved.
But the claims of various ambitious big pharma companies—about their ability to deliver on capacity and accuracy alike—have created a smokescreen for decision-makers, one that has severely undermined crucial efforts to monitor the spread. They say the hunt for profit leads to innovation, but it can also lead to chaos.
As Jonathan Quick, author of The End of Epidemics put it: “Virus biology and vaccines technology could be the limiting factors [to COVID-19], but politics and economics are far more likely to be the barrier to immunization.”
The time it takes for people to get tested and receive results (end-to-end) has been a significant point of contention in the testing sphere. Some solutions, especially in the pandemic’s infant stages, were keen to position themselves as the go-to protocol, particularly at a time when governments were frantically pouring money into testing, hoping it would give people the confidence to return to work and reopen parts of the economy.
In their quest to promote their own protocols in the best possible light, some companies have publicized processing times that don’t span the time it takes to actually complete the entire testing process. Others have shone a light on their own testing advantages.
Disadvantages have not only been obscured but sometimes outright manipulated or fudged to appear more appealing and competitive to the average Joe, whose statistical interests lie more in Fantasy Football than the intricacies of testing methods. For instance, in our test comparison study, Abbott’s RealTime SARS-CoV-2 test took approximately 7 hours of end-to-end processing time. It’s the claim of 90-minute completion, however, had been widely publicized, leading several budding admirers, including the White House staff, to quickly commit to its protocol. This 90-minute-only accounted for one stage of its testing protocol.
Testing companies have also recognized the value of promoting high-capacity protocols. Testing capacity ultimately boils down to the volume capabilities of each testing machine, versus the availability, cost, and a number of these machines required to complete a test.
When some companies promote their testing capacities, the figures produced don’t always mention the cost attached to each machine or the number of machines required for the full testing process. PCR tests tend to have low throughput, laborious process, and often false-negative results, making it overwhelmingly challenging to meet testing needs even in industrialized countries. But, as the world has come to know all too well, statistics can be massaged when presented in a preferred light.
Initially, testing companies prioritized promoting low-turnaround times and enhanced sensitivity. It was only after the preliminary stages of the pandemic when capacity became more of a trait to consider. This has led some test makers to highlight testing capacity in rather vague terms, presented as daily output as opposed to capacity per machine. As a result, certain companies utilizing PCR protocols have veered away from disclosing their throughput numbers.
False negatives pose an enormous problem because they literally mean people who have COVID-19 will go out into the world in full confidence that they don’t have the disease, and infect others. Such people are less likely to self-isolate or even exercise very basic precautions, such as wearing a mask because they are convinced they aren’t contagious.
In its own COVID-19 testing policy for labs and commercial manufacturers, the FDA says a diagnostic test should correctly identify at least 95 percent of positive samples. Yet, even 95 percent does not give us the scientific precision we might require to truly quell the spread. It gives us a probable threshold, but false negatives are still likely to leak through, causing further potential spread as a consequence.
When the White House itself began screening its staff using a rapid coronavirus test made by Abbott Laboratories, they didn’t expect post-analysis studies to conclude the test may return a high percentage of false-negative results. In mid-May, the Food and Drug Administration issued a rare public warning about an Abbott Laboratories COVID-19 test: test results could be wrong. The lower 80 percent threshold for the Abbott and other point-of-care tests’ sensitivity proved insufficient. As such, governments fell into the trap of buying into solutions with plenty of initial hype, but less verifiable agency.
For some of us, much of this information can seem completely contradictory, just like the old “Coffee is good for you… no, wait it’s bad for you… no, wait, it’s good for you again,” repeated ad nauseam. Understandably, media coverage of the COVID-19 pandemic has continued on full blast since the onset, this has inevitably led to a sense of informational fatigue for certain sections of society.
Tidal waves of medical statistics and information crash over us each and every day. During a global pandemic, this vulnerability to medical gossip only intensifies, meaning health authorities, as well as providers, should be re-doubling efforts to create clarity with regards to prevention; safety restrictions, testing protocols, and limitations. More clarity must be prioritized by competent legislators making vital decisions regarding institutional/national testing protocols.
More needs to be done to separate state and big pharma medicine, that’s because medical research is often financially backed by private entities. E.g. Antidepressants can be life-savers for some people. But drug company-funded studies have overplayed their benefits and downplayed their harms, contributing to overuse and unnecessary side effects.
It would be naive to think that financial gains are not a factor for budding testing companies, it would also be naive to expect that when testing companies recognize their own protocol shortcomings in the market, they will readily disclose it. Their aim is to move their product forward, not necessarily by deception, but also not always by full disclosure either. While this might be common ground for many industries, life-saving testing companies need to do better.
As Gerald Posner, author of Pharma: Greed, Lies, and the Poisoning of America, puts it: “Pharmaceutical companies view COVID-19 as a once-in-a-lifetime business opportunity,” adding that, “the worse the pandemic gets, the higher their eventual profit.” With potentially lucrative government contracts up for grabs, the clamor to present your testing solution as the answer to COVID-19 grew.
What many testing companies seem to have forgotten is that initiatives focusing on the protection of the public from a potentially terminal virus should, in no way, shape, or form, be employing misleading statistics and marketing tactics when the alternatives to effective prevention are so grave.
These companies carry a crucial responsibility: They are not simply providing the public with non-essential products for which you can choose to enjoy or not, the product here is medically crucial, and the fate of the health and livelihoods of millions of people across the globe depend on it.
About Pawel Czech
Pawel has led market entry for three global tech companies into 45 countries. Pawel specializes in helping prepare companies to scale into multiple markets with a full stack offer. Pawel founded Nex.D to be the company he would have wanted to work with as a founder. Pawel has held three global roles in the technology sectors in the last 15 years working extensively in business development, operations, and sales capacity actively serving in a governance and leadership role with those founders and management teams.
The plain truth is that rural America has always had a market failure problem.
In the 1930s, the problem manifests as woefully inadequate telephone and electrical service. The spaces were just too wide open, the potential customers too few, for companies to invest in America’s in-between places.
In response to this market inefficiency, a federal government led by Franklin Roosevelt stepped in and created the Rural Electrification Administration (REA). Within 20 years, phone service was available to 65 percent of rural residents, and electricity extended to 96 percent. With the help of Washington, DC, modernity was extended to the heartland.
And now, when market orthodoxy is almost an unassailable truth and the federal government is less trusted than ever, another market failure stares us in the face. This time the technology is fast internet service (broadband), which was a concern before Covid-19 and is now a need arguably on par with electricity in 1936.
“The strength of High-Performance Broadband is that it will—if fully accessible to all in America—help solve some of our most critical challenges and help people overcome key barriers regardless of where they live and who they are,” reads an editorial published by the Benton Institute for Broadband and Society this past October.
It’s not that the federal government has simply entrusted rural internet service to companies that don’t provide it, though there is some of that. Since 1995, the Rural Utilities Service (successor to the REA) and Federal Communications Commission have doled out billions in subsidies. What the feds have not done is replace stop-gap funding mechanisms with a comprehensive plan that solves particular problems associated with inadequate rural broadband almost all urban dwellers never have to face.
At the time of the Benton Institute editorial, the most obvious critical challenge was Covid-19 and it remains so, even with the prospect of a vaccine on the horizon. It’s worth looking specifically at the ways Covid-19 has elevated the importance of broadband, particularly with regard to healthcare.
Most obviously and importantly, the pandemic has boosted the importance of telehealth as a means of bringing clinicians and patients safely together. What was an industry experiencing modest growth is now a healthcare sector boosted by rocket fuel.
“Between April 2019 and April 2020, national privately insured telehealth claims’ increased by 8,336 percent (as a proportion of total medical claims),” says the Health Affairs Blog. “While those ratios eventually tapered in the proceeding months as in-person visits rebounded, there’s no doubt that more patients and providers are relying on telehealth than ever before.”
Of course, safety is only the most pressing concern when it comes to telehealth. Before the pandemic, remote patient visits were driven by the pursuit of lower costs and greater convenience—factors that will once again rise to the top when Covid-19 is managed. The difference, when we arrive at that longed-for future date, will be that telehealth will have proliferated and wormed its way more deeply into common clinical practice.
All of that seems like progress, except that true progress doesn’t exclude millions of Americans. With limited broadband in rural areas, the blessings of telehealth will currently not fall on a large segment of the population.
According to Health Affairs, “The lack of broadband in rural areas is one of the most striking inequalities in US society. Due to the lack of broadband availability, tens of millions of rural Americans aren’t able to ‘see’ their doctor over the internet in the same way urban Americans can. Making matters worse, financially strapped rural hospitals are being shuttered by the dozens.”
It would be a mistake to see the failure of rural hospitals as uniquely a healthcare issue on either the cause or effect side of the technology equation. On the one hand, slow internet makes telehealth visits more difficult and sometimes impossible. On the other, slow internet also makes living in rural areas and earning a decent living very challenging, which dramatically limits the rural hospital’s potential patient base.
According to Alex Marre, a regional economist for the Federal Reserve, access to broadband improves wages, lowers unemployment, grows the population, and boosts home values, all of which creates a more stable base of support for local hospitals.
So, is there a market solution for what to date is a market failure? In a word, no. Well, not yet, at least. While the government may not be the broadband provider in the short or long term, some government involvement is probably a necessary component of the overall solution, especially with regard to money.
Another solution might be cooperatives, which helped extend the reach of electricity in the 1930s and have seen some broadband success in the modern era.
As CEO of Oklahoma Electric Cooperative, Patrick Grace leads an effort started in 2018 to extend fiber broadband to cooperative members. Working toward providing broadband to all 43,000 members, OK Fiber currently offers 100 Mbps speeds for $55 a month and 1 Gbps speeds for $85.
But what was true of electricity access also holds for broadband. Absent sufficient dollars, fiber networks take a long time to implement, regardless of how well managed the cooperative. For rural areas, time is of the essence, and concerted action may create a rural renaissance where there is currently a steady decline.
Returning to the Health Affairs Blog:
“Federal investment in rural electrification helped ignite investment across the country. Manufacturers didn’t have to locate near big cities, instead, they could build factories in rural areas where land was cheaper. Electric machinery and refrigeration made farms and ranches more productive. Today, in an era where remote work is increasingly common, rural and urban Americans alike need broadband to stay connected and productive.”
Again and again, we see that public health is an interrelated web of contributing factors. It’s education, and it’s housing, and it’s family support, and it’s job security. In the 1930s public health could undoubtedly be tied to electricity. In modern times, the equivalent is access to high-speed internet. The market has had sufficient time to provide a solution. Time for the public sector to come up with a comprehensive plan that includes private industry.
Medical device design has been going through sweeping
changes over the last decade. Ten years ago,
medical device companies weren’t concerned with delivering consumer-level
design: Devices that are both attractive and intuitively easy to use by a wide
variety of users. Then the Affordable Care
Act was passed, and adherence and healthy behavior change became a
Our firm, which has been a long-time proponent of the
“consumerization” of medical product design, saw a steady uptick in business
based on our ability to deliver product experiences that a consumer expects
while also meeting regulatory requirements of the FDA. And yet we still had to do a fair amount of
convincing to engineering teams about the importance of design that not only
works for physicians, but also makes life easier for caregivers and
Our goal has always been to make design a priority for and
deliver great experiences to every voice in the ecosystem. As tragic as COVID-19 has
been for millions of people, it has accelerated the consumerization of medical
device design: the pandemic has
radically changed medical products for the better, forever.
In the last six months, we have had many traditional device
companies and startups approach us to design COVID-19 testing products. They want clinically effective medical
devices that are as easy to use as at-home pregnancy tests. Companies are also coming to us with
non-COVID medical device ideas, and even the conversations around those
products have changed: there is a
realization that medical devices must address a multi-layered audience.
While all medical products must integrate the emotional,
physical and cognitive needs of the health consumer to create a holistic
experience, to really achieve consumer-level design companies need to go well
beyond human factors and useability studies and truly push the design
boundaries. Medical device companies
that can’t integrate these four elements into their medical products are not
making scalable products, and will underachieve in today’s marketplace:
1. Improve Convenience: Consumers today are accustomed to
convenience. We expect the world to operate at the speed of a Google search,
with the customizability of meal planning on sites like Plated or Blue Apron,
and the responsiveness of booking a ride on Uber. Healthcare rarely works this
way so a medical device must integrate it into the design. In the medical world, the laws of consumer
design also apply: with Axonics
Modulation Technology system, we
transformed an innovative technology into a complete ecosystem of physical
and digital products that improve the experience and work hard in the background
to return normal daily lives to people suffering from incontinence.
2. Aim to Delight:
Creating delight can transform an experience and build relationships
that keep customers engaged with your brand.
Most medical solution providers look at users in terms of physical and
cognitive usability. But this is only the beginning. We believe there are four
additional dimensions that will help companies develop a qualitative
understanding of health consumers and their motivations—emotional, social,
contextual, and developmental. Exploring these dimensions at the front end of
the product development process will reveal what patients need and desire from
a health experience and enable companies to respond with meaningful innovation
that gains adoption and changes health outcomes. We use these motivations to create delight in
the medical device.
3. Provide Personalized Experiences: Personalization
is a growing trend in the consumer product world, and it needs to become one in
healthcare. Those at the forefront are using data to make predictions that
anticipate customers’ needs and desires. Entertainment platforms, like Netflix,
make recommendations that introduce users to new content based on their
previous consumption. Virgin America’s in-flight screens address their
passengers by name and provide personalized information about their itinerary,
in addition to personalized dining and entertainment recommendations. In
healthcare, targeted, personal experiences can be a tipping point to meaningful
behavior change. Information has the power to engage health consumers in
moments where their decisions have a direct impact on their health and
wellbeing. With a majority of people carrying or wearing smart devices, it’s
possible to have continuous data about their location. This data can be used to
generate relevant, real-time recommendations.
With COVID-19 or any future pandemic, real-time information can save
4. Be Emotional:
The goal of consumer-driven product innovation is to create an emotional
connection between users and brands—a delightful experience or perception that
keeps people coming back. This is an important goal in healthcare as well, as
more complex factors start to influence choice, and continued engagement plays
a growing role in health outcomes. Although the medical product development
process is more burdened by engineering, technology, and regulation, medical
solution providers can adopt some best practices from consumer companies to
help their products connect. Consumer giants apply numerous resources toward
developing a deep understanding of their user. To capture health consumers’
interest and loyalty, it’s necessary for medical device makers to develop a
knowledge that goes deeper than a medical record or hospital survey. This
holistic understanding of consumers and their health journeys will breed
empathy—something that only comes from first-hand emotional transactions—and
help companies uncover many opportunities for meaningful innovation and
About Stuart Karten
Stuart Karten is the principal of Karten Design, a
product innovation consultancy creating positive experiences between people and
products specializing in health technology.
As 170 research teams race to develop a vaccine for COVID-19, some that are in late-stage approvals have seen recent progress, but it is still not yet clear when a vaccine will become widely available. Until then, healthcare organizations continue to rely heavily on data analytics to try to improve COVID-19 outcomes and public health.
Since the novel coronavirus became widespread in the U.S., healthcare data scientists have leveraged clinical and claims data to pinpoint which underlying conditions put patients at higher risk of complications from COVID-19. Health systems are mining clinical data to predict surges in COVID-19 cases and looking at key factors—including increases in hospital website traffic, such as searches for emergency department (ED) wait times and physician page clicks—to understand how COVID-19 is ramping up locally in real-time. Meanwhile, risk-based modeling has helped health plans address social determinants of health that could impede recovery.
Now, providers and health plans are refining their approach. The more they learn, the greater the benefit to public health and long-term outcomes. Three evolving use cases for using claims and clinical data to combat COVID-19 stand out.
Reduce disparities in care. Early in the pandemic, lack of complete information around patient demographics prevented the identification of members in communities that were most vulnerable to COVID-19 infection. The impact: severe differences in mortality rates. In Chicago, the rate of mortality among Black residents was alarmingly high—70% of COVID-19 deaths—even though these residents comprise just 29% of the city’s population. Meanwhile, Spanish-speaking residents account for 18.3% of the nation’s population, yet comprise 34.3% of coronavirus cases.
One of the reasons demographic data was often missing from COVID-19 lab tests is that laboratory and hospital staff were too overwhelmed with cases to have time to input all of a patient’s non-clinical information. Today, data scientists are working to fill in the gaps using clinical history and medical claims. With these analyses, healthcare organizations are closing gaps in care, such as by expanding access to COVID-19 testing for the nation’s most vulnerable populations and increasing access to professional interpreters to more effectively gather key patient details. They are also addressing social determinants of health that heighten risks, such as food insecurity and lack of access to prescription medications.
Alleviate reliance on spotty testing. Not everyone who contracts COVID-19 has a healthcare encounter. For instance, if one member of the household tests positive for the coronavirus, other members may decide not to undergo testing if their symptoms are mild. These are instances where analyses of clinical and claims information already in the system—both emerging and historical data—can help spot unconfirmed cases of COVID-19. Such analyses give public health officials the information they need to contact, test,s and quarantine individuals that have contracted the virus, helping to limit the spread of the disease.
On a wider scale, data analysis can also provide early warning surveillance of potential COVID-19 cases, strengthening the pandemic response. For example, by observing increases in medical claims for telemedicine, rapid flu tests, and chest X-rays, data scientists can detect patterns in claims that suggest a COVID-19 outbreak is likely to occur. From there, they can forecast demand for hospital care up to 10 days in advance, ensuring that facilities have sufficient staff, supplies, and beds available to meet their community’s needs. Similarly, disruptions to seasonal flu trends, which remain fairly consistent within a region year over year, could alert public health officials to a potential COVID-19 outbreak.
Avoid preventable deaths. Information regarding patients’ underlying medical conditions can be hard to come by during a public health crisis as overwhelming and widespread as the current pandemic. In fact, just 5.8% of medical records for patients hospitalized with COVID-19 in Q1 2020 had data available related to their underlying health conditions and other risk factors. Today, it is known that certain chronic conditions raise the patient’s risk for severe complications from COVID-19—and that list of conditions is growing. The insight gained from these analyses not only informs how healthcare providers treat an individual’s illness, but also gives those with chronic disease the ability to make informed decisions based on their risk level for infection.
Moreover, the availability of actionable, real-time intelligence to improve health can set the stage for increased care collaboration. During COVID-19, healthcare providers across geographies are sharing their knowledge, especially regarding treatment protocols. Such learnings include the value of using high-flow nasal oxygen in treating severe cases of COVID-19. Early results show that this technique has a positive impact on patients with mild to moderate respiratory failure. It also reduces intubation rates and improves clinical prognosis for patients with acute respiratory failure. By sharing data-driven insights, organizations can work together to improve COVID-19 outcomes and reduce avoidable deaths.
Improving Outcomes and Reducing Risk
Clinical and claims data analysis helps healthcare organizations respond proactively to COVID-19. With the race toward a COVID-19 vaccine well underway, these analyses will help identify which populations should receive the vaccine first, assess reactions to the vaccine by demographic group and spot trends that could affect vaccination protocols. They also give healthcare organizations up-to-date contact information to engage patients, which will be critical to clinical efficacy if a second dose of the vaccine must be administered. In 2020 and beyond, continued focus on clinical and claims data analysis will be key to facilitating a robust response that enhances outcomes and saves lives.
About Emad Rizk, M.D.
Emad Rizk, M.D., is President and CEO of Cotiviti and brings a 30-year, well-documented track record of delivering improved quality and financial performance to healthcare organizations through forward-thinking leadership, business acumen, and clinical expertise.
A global health crisis has thrust us into a scenario in which lives quite literally depend on the ability to virtually connect. Telehealth has rapidly emerged as a vital tool, enabling continuity of care, allowing vulnerable individuals to access their physician from home, and freeing up resources for providers to treat the most critical patients. The acceptance of telehealth and expansion of covered services for the senior population demonstrate that this technology will endure long after COVID-19 subsides.
Prior to the pandemic, just 11% of Americans utilized telehealth compared to 46% so far this year, and virtual healthcare interactions are expected to top 1 billion by year’s end. While the technology has been a life-saver for many, usage depends heavily on the availability of audio-video capabilities, internet access, and technological prowess – potentially leaving vulnerable patients behind.
Seniors Face Physical, Technical and Socioeconomic Barriers to Telehealth
Despite telehealth’s surge, there is growing concern that the rapid shift to digitally delivered care is leaving seniors behind. Telehealth is not inherently accessible for all and with many practices transitioning appointments online, it threatens to cut older adults off from receiving crucial medical care. This is a significant concern, considering older adults account for one-quarter of physician office visits in the United States and often manage multiple conditions and medications, and have a higher rate of disability. This puts an already vulnerable population at a higher risk of severe complications from COVID-19.
Research published recently in JAMA Internal Medicine found that more than a third of adults over age 65 face potential difficulties accessing their doctor through telehealth. Obstacles include familiarity using mobile devices, troubleshooting technical issues that arise, managing hearing or vision impairments, and dealing with cognitive issues like dementia. Many of these difficulties stem from the natural aging process; it is imperative for provider organizations employing telehealth and telehealth vendors to improve offerings that consider vision, hearing, and speaking loss for this population.
While barriers associated with aging are a key factor within the senior population, perhaps the greatest challenges in accessing telehealth are socioeconomic. The rapid shift to digital delivery of care may have left marginalized populations without access to the technological tools needed to access care digitally, such as high-speed internet, a smartphone or a computer.
According to the JAMA study, low-income individuals living in remote or rural locations faced the greatest challenges in accessing telehealth. A second JAMA study, also released this summer indicated that “the proportion of Medicare beneficiaries with digital access was lower among those who were 85 or older, were widowed, had a high school education or less, were Black or Hispanic, received Medicaid, or had a disability.”
These socioeconomic factors are systemic issues that existed prior to the pandemic, and the crisis-driven acceleration of telehealth has magnified these pre-existing challenges and widened racial and class-based disparities. Recent initiatives at the federal level, such as the FCC’s rural telehealth expansion task force, are a step in the right direction, though more sustained action is needed to address additional socioeconomic challenges that are deeply rooted within the healthcare system.
Fortunately, Telehealth Hurdles Can Be Overcome
Recognizing that telehealth isn’t a “one-size fits all” solution is the first step towards addressing the barriers that disproportionately impact seniors and work is needed on multiple levels. Telemedicine consults are impossible without access to the internet, so the first step is to provide and expand access to broadband and internet-connected devices. With more than 15% of the country’s population living in rural areas, expanding broadband access for these individuals is especially crucial. In addition, older adults in community-based living environments need greater access to public wi-fi networks.
Access to mobile and other internet-connected devices is also essential. Products designed with large fonts and icons, closed captioning, and easy set-up procedures may be easier for older adults to use. For example, GrandPad is a tablet designed specifically for seniors and has an intuitive interface that includes basic video calling, enabling seniors to virtually connect with their caregivers.
To address affordability, the Centers for Medicaid and Medicare Services (CMS) allowed for mid-year benefit changes in 2020 to allow for payment or provision of mobile devices for telehealth. Many Medicare Advantage organizations are enhancing plans’ provisions of telehealth coverage and devices for 2021.
In addition to increasing access to broadband and internet-connected devices, providing seniors with proper educational resources is another crucial step. Even if older adults are open to using technology for telehealth visits, many will need additional training. Healthcare organizations may want to connect older patients with community-based technology training programs. Some programs take a multi-generational approach, pairing younger instructors with older students.
For example, Papa is an on-demand service that pairs older adults with younger ‘Papa Pals’ who provide companionship and assistance with tasks such as setting up a new smartphone or tablet.
From a socioeconomic perspective, careful consideration is needed to address the concerns that telehealth may reinforce systemic biases and widen health disparities. Providers may be less conscious of systemic bias toward patients based on race, ethnicity, or educational status.
In turn, providers must address implicit bias head-on, such as offering workplace training and incorporating evidence-based tools to adequately measure and address health disparities. This includes pushing for policies that enable widespread broadband access funding to better connect communities in need.
Health plans can support expanded access to care through benefit design, reducing costs for plan members. To match members and patients with the right resources and assistance, health plans and providers should launch outreach campaigns that are segmented by demographic group. Outreach initiatives could include assessments to determine each person’s ability and comfort level with telehealth.
The Path Forward
Without question, telehealth is playing a central role in delivering care during the current pandemic, and many of its long-touted benefits have been accentuated by the current demand. Telehealth, along with other digital monitoring technologies, have the potential to address several barriers to care for seniors and other vulnerable populations for whom access to in-person care may not be viable, such as those based in remote locations or with mobility issues.
In the post-pandemic era, telehealth can provide greater access and convenience, but if not implemented carefully, the permanent expansion of telehealth may worsen health disparities. Careful consideration and collaboration will be essential in embracing the value of telehealth while mitigating its inherent risks.
If implemented correctly, telehealth can provide continued access to care for our vulnerable aging population and can significantly improve care as well. Enhancing the ability to connect with healthcare providers anytime, anywhere can give seniors the freedom to gracefully age in place.
About Anne Davis
Anne Davis is the Director of Quality Programs & Medicare Strategy at HMS, a healthcare technology, analytics, and engagement solutions company, where she’s focused on the company’s Population Health Management product portfolio.
When 2020 began, no one anticipated that complying with the Merit-based Incentive Payment System (MIPS)—the flagship payment model of the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP)—would look so different halfway through the year. Like many other things, the COVID-19 crisis has delayed, diverted, or derailed many organizations’ reporting efforts and capabilities. Lower procedure volumes, new remote work scenarios, and shifting priorities have taken attention away from MIPS work.
Despite the disruptions and uncertainties associated with the pandemic, healthcare organizations should not lose track of MIPS compliance and the program’s intent to improve care quality, reduce costs, and facilitate interoperability. Here are a few strategies for keeping a MIPS program top of mind.
Understand the immediate effects of the pandemic on MIPS reporting
Due to COVID-19, CMS granted several 2019 data reporting exceptions and extensions to clinicians and providers participating in Medicare quality reporting programs. These concessions were enacted to let providers focus 100% of their resources on caring for and ensuring the health and safety of patients and staff during the early weeks of the crisis. For the 2020 MIPS performance period, CMS has also chosen to use the Extreme and Uncontrollable Circumstances policy to allow requests to reweight any or all of the MIPS performance categories to 0%.
Clinicians and groups can complete the application any time before the end of this performance year. If practices are granted reweighting one or more categories but submit data during the attestation period, the reweighting will be void and the practice will receive the score earned in the categories for which they submit data
Seize the opportunity to improve interoperability
Interoperability is a key area that organizations were focused on before the crisis, and this work still warrants attention. If an organization is not on the front lines of the COVID-19 response, it should use this time to shore up communications with other entities so, once things return to “normal,” it will be well prepared to seamlessly exchange information with peer organizations.
Establishing processes for sending and receiving care summaries via direct messaging is important for practices to earn a high score in the Promoting Interoperability category. Direct messaging is a HIPAA-compliant method for securely exchanging health information between providers, which functions as an email but is much more secure due to encryption. A regular pain point organizations face is being unable to obtain direct messaging addresses from peer organizations, including referral partners.
To assist providers in this area, the Office of the National Coordinator for Health Information Technology (ONC) and CMS has created a mandatory centralized directory of provider electronic data exchange addresses published by the National Plan & Provider Enumeration System (NPPES). The NPPES directory is searchable through a public API and allows providers to look up the direct messaging addresses for other providers. To meet current interoperability requirements, providers must have entered their direct messaging address into the system by June 30, 2020. If they haven’t done so, the provider could be publicly reported for failure to comply with the requirement, which could constitute information blocking.
Take time now to ensure direct messaging addresses have been entered correctly for all members of your practice. This is also a good time to begin reaching out to top referral sources to make sure they are also prepared to send and receive information.
Look for ways to streamline quality reporting
Over the next few months, the focus will return to quality measure reporting. As such, it’s wise to take advantage of this time to ensure solid documentation and reporting methods. Electronic medical records (EMRs) can be helpful in streamlining these efforts.
For example, dropdown menus with frequently used descriptions and automated coding can enable greater accuracy and specificity while easing the documentation process for providers. Customizable screens that can be configured to include specialty-specific choices based on patient history and problem list can also smooth documentation and coding, especially if screen layouts mirror favored workflow.
Regarding MIPS compliance in particular, it can be helpful to use tools that offer predictive charting. This feature determines whether a patient qualifies for preselected MIPS measures in real-time and presents the provider with data fields related to those items during the patient encounter—allowing the physician to collect the appropriate information without adding additional charting time later on.
With respect to reporting, providers may benefit from using their certified EMR in addition to reporting through a registry. At the beginning of the MIPS program, providers could report through both a registry and EMR directly and would be scored separately for their quality category through each method. They would then be awarded the higher score of the two. This method had the potential to leave some high-scoring measures on the table.
Beginning in 2019, providers reporting through both registry and EMR direct are scored across the two methods. CMS uses the six highest scoring measures between the two reporting sets to calculate the provider’s or group’s quality score, potentially resulting in a higher score than the provider would earn by reporting through either method alone.
A knowledgeable partner can pave the way to better performance
COVID-19 has impacted healthcare like no other event in recent history, and it’s not surprising that MIPS compliance has taken a back seat to more pressing concerns. However, providers still have the opportunity to make meaningful progress in this area. By working with a technology partner that keeps up with the current requirements and offers strategies and solutions for optimizing data collection and reporting, a provider can realize solid MIPS performance during and beyond this unprecedented time.
About Courtney Tesvich, VP of Regulatory at Nextech
Courtney is a Registered Nurse with more than 20 years in the healthcare field, 15 of which have been focused on quality improvements and regulatory compliance. As VP of Regulatory at Nextech, Courtney is responsible for ensuring that Nextech’s products meet government certification requirements and client needs related to the regulatory environment.
Of the $175 billion in federal Provider Relief Funds (PRF) allocated to healthcare providers, $125 billion has been accepted by hospitals and healthcare providers. The cash infusion was designed to cover costs related to COVID-19 related care. These targeted payments were earmarked for preventing, preparing for, and responding to the Coronavirus, solely for reimbursement of healthcare-related expenses or lost revenue directly attributable to COVID-19.
Early on, providers who received PRF funds had to accept or reject the money without information about reporting and auditing requirements. However, Health and Human Services (HHS), the administrator of all PRF funds, has since established reporting and auditing requirements to ensure proper compliance.
Thousands of hospitals and other providers have received and accepted payments from the Provider Relief Fund. As they begin to consider financial reporting and audit requirements, some will find themselves in unfamiliar territory.
Historically, under most circumstances, only non-federal government agencies and nonprofit organizations have been subject to audit requirements under the Single Audit Act. However, Health and Human Services (HHS) recently clarified that for-profit entities that expend $750,000 or more of Provider Relief Funds during the entity’s fiscal year will be subject to an audit as described in section 75.216 of HHS’s adoption of the Uniform Guidance.
Recipients will report the use of their funds in two categories. The first allows the recipient to report any healthcare-related expenses due to COVID-19 that were not reimbursed from another source. The second is for any PRFs received in excess of the healthcare-related COVID-19 expenses. The entity may be allowed to attribute funds in the second category to lost revenue.
Healthcare-related expenses may include supplies, equipment information technology, and facilities. Allowable general and administrative expenses could include rent, insurance, personnel, fringe benefits, lease payments, and utilities. Lost revenue is allowed up to the difference in 2019 and 2020 net patient service revenue.
The HHS reporting system also will require certain non-financial data. Demographic information will include the reporting entity, the tax identification number, the national provider identifier, the fiscal year-end date, and the federal tax classification. Recipients will need to provide, by quarter, personnel metrics, patient metrics, and facility metrics. The personnel metrics may include labor by category, hires and rehires, and terminations. Patient metrics will require information such as a number of patient visits, patients admitted, and resident patients.
If there was a change in ownership for the reporting entity, certain details around the acquisition or divestiture must be disclosed. Finally, the entity should disclose whether it is subject to a Single Audit and whether the auditors have selected PRF to be within the scope of the Single Audit.
The reporting system will become available to recipients in early 2021. Recipients that have expended all funds prior to Dec. 31, 2020, may submit one report. If a recipient has expenditures subsequent to Dec. 31, 2020, a second and final report will be required.
HHS will continue to provide information and updates in webinars and FAQ guidance leading up to the reporting deadlines.
What should healthcare organizations be doing to prepare?
Preparation should begin now. When it comes to expenditures, healthcare organizations should stick to the fundamentals of the purpose of the funding and document, document, document.
1. Follow accounting policies and procedures and retain records for COVID-19 expenses.
– As much as possible, stick to your policies and procedures and document any changes as a result of COVID-19. Manual processes are most likely to be affected. Communicate procedural changes to staff.
– Retain records for COVID expenses as if any of these expenses could be subject to audit because they could. Good record keeping will reduce the possibility for claw-back of funds.
2. Maintain internal controls over compliance.
– Document any changes in internal controls caused by COVID-19 funding. Know what your review and approval process is, who is responsible, and how it is documented.
– Focus on internal controls in these key areas: payroll, non-payroll, and procurement. Payroll should include time and effort reporting requirements for all staff being paid with COVID-19 funding. For non-payroll expenditures, purchase orders should reference COVID and be adequately supported by third party invoices or the like. For procurement ensure federal procurement requirements are being followed. Noncompetitive procurements should be well documented.
3. Understand compliance requirements
– Assign a Program Director to oversee the expenditures of the federal funds. Program Directors need to obtain an understanding of the grant(s) and the compliance requirements to ensure the entity is able to comply.
– With an influx of new money, be sure to obtain the necessary documentation from your granting agency: Also, keep an eye on your expenditures of federal awards. Keep in mind the $750,000 threshold for triggering a third-party audit.
Provider Relief Fund money was intentionally distributed to create as little disruption as possible for healthcare providers as they work on the front lines of this crisis. However, as providers continue to accept these funds, they can help reduce future headaches by keeping current and future reporting and audit requirements in mind.
Telehealth and virtual care are not brand-new phenomena suddenly cobbled together as a rapid response to the onset of the COVID-19 pandemic, but the average US patient could be forgiven for thinking that it is. Indeed, virtual visits to care providers and remote patient monitoring have been available for quite some time, delivering two key benefits:
– Providing a platform to address cost-efficiencies and accessibility to quality healthcare for the populace at large
– Playing a key role in managing a growing population of chronically ill seniors.
Prior to 2020, however, the rules of reimbursement and implementation for associated telehealth services were difficult to navigate, wildly differing at the state and federal level with a host of regulations further complicating matters. Federal reimbursement policies are centered on Medicare, via the Centers for Medicare and Medicaid Services (CMS) – the single largest payer for seniors and chronically ill patients. Additionally, compliance with the Health Insurance Portability and Accountability Act (HIPAA) dictated rigorous standards for direct and monitoring communications between care providers and patients. Complicating matters further, US states offered a patchwork of individual telehealth laws dictating separate Medicaid policies.
The result was a lack of clarity of how healthcare providers could overcome regulatory and financial reimbursement barriers to implement effective telehealth programs as well as a lack of parity in coverage services and payments for patients. To address this at the federal level, CMS released new guidance in 2020 to relax reimbursement restrictions for providers. Now, we’re at the cusp of a new era of telemedicine where providers could widely offer:
– Virtual office visits that address traditionally in-person services such as primary care, behavioral health, and specialty care (e.g. pulmonary or cardiac health rehabilitation)
– On-demand virtual urgent care to address pressing concerns and urgently needed consultations
– Virtual broader home health services such as remote patient monitoring, outpatient disease management, and various forms of therapy (e.g. physical, speech)
– Tech-enabled home medication administration helping patients receive injectable or consumable medication via monitored self-administration
This is all, of course, dependent upon the mobile technology (e.g. tablets, wearables, etc.) and associated services that telehealth providers will rely upon to make these services happen at parity and scale for their patients. Even more importantly, virtual care programs being scaled up to cover a larger percentage of patients will fall apart if providers don’t have the resources to offer robust support and maintenance options for these devices and services. Quality of virtual care is highly dependent on persistent device and service availability and dependability.
Whether providers have already begun purchasing the mobile devices needed or are still struggling with the choice of what devices and services they need and/or can afford, however, they now face a different quandary: How to stand up these virtual care services at scale in a sustainable way that works within current budget resources and doesn’t pass on ballooning costs to your patients?
One way to make complex mobile technology deployments financially manageable is opting for a mobile device as a service (mDaaS) model which allows you to shift from a CapEx-based spending model to an OpEx spending model for purchasing hardware and allows telehealth providers to bundle or roll up a range of devices, accessories, services, maintenance and support into a single, predictable monthly per-device price. With mobile device technology rapidly evolving, telemedicine providers will need the operational agility to pivot to different solutions and quick technology refreshes as the need arises.
When done with the right third-party partner, it offers the additional advantages of outsourcing end-to-end support and lifecycle management to highly trained agents, who can free up precious IT resources. Most importantly, it creates a level of control over technology and spend that makes standing up virtual care programs convenient and stress-free.
There are many options to consider when expanding telemedicine services rapidly to larger patient bases, whether during disruptive events such as the COVID-19 pandemic or in the years to come. The key to making these services sustainable is finding a financing model that will free up internal resources, offer greater spending flexibility, and offer end-to-end support for your healthcare mobile technology ecosystem.
About Don Godbee Senior Mobile Solutions Architect at Stratix
Don brings a unique perspective to mobility in the Healthcare Vertical with over 25 years of consulting and delivery of critical solutions. Don has delivered various solutions from OEM integration of sensors in medical devices to mobile point of care solutions and services with major EHR software solution providers such as Epic, Cerner, GE Healthcare, Allscripts, and McKesson.
Since the beginning of the COVID-19 pandemic, key elements of hospital operations such as managing inpatient bed capacity, and access to ventilators and PPE have taken center stage. The general public got a crash course on what hospitals need in order to function successfully when disaster hits, and daily news and discussions were centered around ICU bed capacity as cases accelerated across the country.
The nightmarish predictions and reality led to the development of creative measures to help meet such catastrophic needs such as popup temporary screening and triage sites, non-medical and medical spaces being repurposed for COVID units, increased patient transfers to hospitals that had more space, and mathematical models to predict upcoming numbers of new COVID-19 cases.
With the latest surge of COVID-19 cases (see figure 1), some states have or will begin opening up field hospitals (Wisconsin, Texas) while others are considering transfers to other locations (both in and out-of-state), and even the concept of ‘rationing care’ has surfaced.
This public health crisis intensified what happens when hospitals and healthcare providers run out of the right space and resources. As alarming as it has been to watch this play out, the reality is that these capacity and resource challenges are not unique to the pandemic; they happen often in hospitals across the country, just on a different scale. Bed capacity is something hospital leaders manage every day – only 1 of 3 hospital beds are available on any given day in the U.S., per research by the Robert Wood Johnson Foundation 2. Of course, there’s further variation when looking at urban versus rural regions. Many systems are forced to go on ‘diversion’ (patients will literally be re-routed to other hospitals) when the reality is that they are bursting at the seams.
Clearly, the pandemic has been devastating, yet it has (finally) propelled healthcare toward innovation and adoption of technology that was much needed in order to improve access to and utilization of quality and cost-effective care. Although the waves continue, organizations are starting to answer the following questions: What newly applied practices do we keep from the pandemic moving forward as we head into additional COVID-19 waves and the flu season? Can we more vigorously apply lessons of the past and present to tackle our future needs? Are our incentives aligned such that the solutions we pursue can be sustained and still “keep the lights on”?
Delayed access to care and, even worse, lack of access to care, have been among the most devastating consequences of the capacity crises during the pandemic. Though many of our systems started to transition back to their usual state of affairs by July, other factors in addition to the current surge continued to highlight the ongoing need for creating and sustaining ‘good patient flow’.
Under “normal” circumstances, daily chaos is anticipated and actually expected, as hospitals experience the inability to move patients from the emergency room (ER) or operating room (OR) due to a “lack of beds” in the hospital. While this inevitably requires hospital leadership to ‘do something’ about it, it is a scenario that plays repeatedly throughout the day, every day.
The chaos that comes from the lack of visibility into available beds, let alone appropriately available levels of care, can have negative downstream impacts not only on the patients but also on the frontline staff. Patients are subject to suffering the consequences of inappropriate levels of care, poor clinical outcomes, and/or poor provider/patient experiences.3 Staff are subject to the stress of caring for patients for whom they are not necessarily appropriately trained to care for.
Despite the known implications, this lose:lose cycle continues. These “risks” plus the impact of significant revenue losses from the pandemic highlight the urgent need to address poor, inefficient patient throughput. We are at a critical point where healthcare systems must do what is necessary to improve existing practices when it comes to bed management.
Some examples of improvement include:
– Create machine learning models for all locations and patient movements within the hospital, and adjust space and schedules accordingly
– Place patients using sophisticated demand-supply model
– Make data-driven internal transfer decisions
– Right-Sized unit capacity
– Look hard at the degree of specialization to pool capacity where possible
– Smooth the patient flow from the OR
Take a magnifying glass to internal operational workflows – Identify practices that work, areas where support is needed, especially when it comes to discharge planning, and whether or not there are financial implications.
– Improve provider workflow
– Don’t let “a dime hold up a dollar”: take a hard look at staffing, hours of operations, and transportation
– Use predictive discharge planning to focus on case teams and social services
Identify clinical workup that can be prioritized according to disposition, treat outpatient setting
– Prioritize discharge patients in queues for labs/clinical procedures
– Transition some procedures to outpatient
With the recent surge of COVID-19 cases across the nation and the impending flu season, hospitalizations will continue to rise. Although health systems will be able to resurface earlier crafted emergency plans from previous surges, set up incident command centers more quickly, and have a more stable supply inventory, they will likely continue to manage their bed capacity through a very manual process. It is imperative that we start to do things differently to achieve better outcomes!
Implementing operational change and deploying new but proven technologies that incorporate both artificial intelligence and lean principles will increase patient access, improve provider, patient, and staff experience, and, of course, smooth inpatient capacity. As a result, terms such as chaos and crisis can, in time, become things of the past.
3. Mohr et al., Boarding of Critically Ill Patients in the Emergency Department. Critical Care Medicine 2020; 48(8): 1180–1187
4. Agrawal S., Giridharadas M., (2020) Better Healthcare Through Math: Bending the Access and Cost Curves. Forbes, Inc.
About Dr. Pallabi Sanyal-Dey
Dr. Pallabi Sanyal-Dey is the director of client services for ‘iQueue for Beds’ Product at LeanTaaS, a Silicon Valley software innovator that increases patient access and transforms operational performance for more than 300 hospitals across the U.S. Dr. Sanyal-Dey is also a visiting associate professor of medicine, providing career mentorship to trainees at the University of California, San Francisco Medical Center (UCSF) where she attends on the internal medicine inpatient teaching service. Prior to joining LeanTaaS, Dr. Sanyal-Dey was at UCSF, as an assistant clinical professor and an academic hospitalist at Zuckerberg San Francisco General Hospital where she directed clinical operations for the Division of Hospital Medicine, and oversaw the faculty inpatient services.
As if 2020 couldn’t be
any more challenging for healthcare providers, new federal rules on
interoperability and patient access, granting patients direct access to their healthcare
data, begin taking effect this November and continue into 2022. These rules,
while ultimately beneficial to patients, bring an additional level of
operational complexity to many revenue-stressed healthcare organizations.
If anything, the 2020 pandemic has illustrated the vast potential of interoperability. For example, consider the huge increase in 2020 in virtual care visits, projected to be more than 1 billion by year’s end, and with an estimated 90% related to Covid-19. Many of these new virtual health patients will move through different care networks, using different health plans, and seeking remote access to their health records. These are precisely the type of patients’ interoperability is meant to help.
What should healthcare providers be doing now to ensure they’re not only compliant with new interoperability rules, but also applying them as optimally as possible to benefit their patients and organizations? In this article, we review the upcoming rules and suggest five key steps providers can take to ensure their interoperability implementations proceed as smoothly as possible.
What’s Ahead with
After several years of discussion on interoperability standards, the Office of the National Coordinator (ONC) for Healthcare IT and the Centers for Medicare & Medicaid Services (CMS) issued their final rules on interoperability in the spring of 2020. The new rules, covering both health systems and health plans, are intended to ensure that patients can electronically access their healthcare information regardless of health system or type of electronic health records (EHR) and covering all CMS-regulated plan types, including Medicare Advantage, CHIP, and the Federally Facilitated Exchanges.
Starting Nov. 2, 2020, healthcare systems must begin complying with interoperability rules preventing information blocking, which means not interfering with patients’ access to or use of their electronic health information. Providers must also attest they are acting “in good faith” regarding preventing information blocking, with any non-compliance flagged on the National Plan and Provider Enumeration System. By May 1, 2021, hospitals, psychiatric hospitals, and critical access hospitals with an EHR must send notification of their patients’ admission, discharge, and transfer (ADT) events to providers.
Interoperability will replace the current fragmented and error-prone ways of exchanging vital healthcare information. Near-term benefits of interoperability include improved care coordination and patient experience, greater patient safety, and stronger patient privacy and security. Longer-term benefits include higher provider productivity, reduced healthcare costs, and more accurate public health data.
For providers, the good
news about interoperability is that they’ve had years to think about and
implement many of its fundamental tenets, based on their work meeting
meaningful use requirements. That’s borne out in a 2019 HIMSS survey of
healthcare organizations which found nearly 75% of respondents past the
“foundational” level of interoperability – “foundational” defined as allowing
data exchange from one IT
system to another, but without data interpretation.
Five Steps for
While healthcare systems
will achieve significant interoperability gains through technology investments,
they should not consider technology as the ultimate sole key to
interoperability success. If anything, financial and political considerations
may be far more important to your organization’s interoperability success. Here
are five critical non-technology factors to consider:
1. Determine your “master”
All pertinent stakeholders in your organization should be on the same page about your interoperability strategy, resources, and timing. Know up-front that those implementing interoperability may not have previously worked with patient-centric analytics, partners, or departments in your organization. Plan your resources and timing accordingly. Your strategy should focus on the value-add of interoperability internally, such as access to additional data points on your patients, and externally, such as how you describe the upcoming benefits of interoperability to your patients.
2. Convey your vision, expectations
and expected return
An interoperability implementation is
a massive change management initiative, which requires continuous, top-down
leadership and championship, and proper expectation-setting. Communicate where
your organization currently stands regarding its interoperability capabilities,
and where you wish to have it go. Convey how the organization plans to get to
its future desired state. And perhaps most importantly, share the likely return
on investment in this effort. Be as specific as possible. For example, if you
believe interoperability gains will ultimately enable a 5% decrease in your
hospital readmissions, state that.
3. Examine workflows and identify
specific use cases
Every type of ADT event in your
organization, and its corresponding workflows and system interactions, should
be under review. Consider all types of clinical use cases, the types of data to
be exchanged, and those involved in providing patient care. This will help
determine your optimal approach to data-sharing and how your organization can
strategically use the additional data you receive from other health
4. Rigorously prep your data
Standardized data collection and reporting
which produces quality data is the heart and soul of successful
interoperability. Be sure your organization’s data is clean and meaningful, and
will ultimately be understandable and useful to your patients.
5. Think big-picture differentiation
There’s nothing in the ONC and CMS
interoperability rules that says you need to stop at mere rules compliance.
Consider your pursuit of interoperability as a singular opportunity to be a
patient-centric leader in your market. Let everyone relevant know of the
success you’ve achieved.
offers a chance for healthcare systems to achieve multiple operational gains,
when handled well, it is ultimately a patient-centric endeavor. Always keep the
needs and interests of your patients at the core when facilitating access to
their personal health data. It’s the ultimate smart long-term interoperability
When doctors know their patients have been to the hospital, they can act fast to provide needed support. Widespread use of hospital event notifications is associated with all kinds of health benefits, including a 10 percent decrease in readmissions for Medicare beneficiaries. These event notifications are one of the simplest, easiest (most-bipartisan!), and most impactful changes we can make to improve patient outcomes in U.S. healthcare.
To this goal, the Centers for Medicare and Medicaid Services (CMS) released new regulations in March that will require hospitals to share event notifications with community providers when a patient is admitted, discharged, or transferred (ADT). Hospitals have to comply by May 2021 if they want to keep getting paid by Medicare and Medicaid.
This policy will improve care, reduce costs, and save lives. It’s also simple and straightforward. CMS explains, “Lack of seamless data exchange in healthcare has historically detracted from patient care, leading to poor health outcomes, and higher costs.” ADT notifications close these gaps and many healthcare organizations have been using them for years, vastly improving care for patients.
Take the Utah Health Information Network (UHIN) which has utilized ADT notifications to reduce costs and readmissions for over a decade. According to the former UHIN President and CEO, Teresa Rivera,
“This level of care coordination quite literally saves both lives and money.” She continues, “This secure and cost-effective method provides the patient’s entire medical team, regardless of where they work, with the important information they need to coordinate care. That coordination is important to reducing readmission rates, and helps health care professionals provide a better experience to patients.”
ADT notifications are a standard set of messages that most electronic health record (EHR) systems can generate with minimal set-up. In fact, in a 2019 letter from the National Association of ACOs in support of CMS’ proposal to require hospitals participating in Medicare and Medicaid to send event notifications, they expressed that new standards efforts are not needed for the successful implementation.
The authors wrote, “In numerous conversations with HIEs, other intermediaries and providers, we were unable to find a single example where a hospital was unable to send an ADT notification today due to lack of standards.”
But you wouldn’t know it if you listened to the misconceptions that are currently being spread to hospitals about this requirement. Here are five myths that I’ve encountered just this month:
Myth 1: The ADT notification policies are strict and difficult to comply with. Not true. CMS listened to feedback that Meaningful Use requirements were too regimented and promoted a “check the box” not “get it done” mentality. CMS purposely worked to keep these ADT requirements broad and non-prescriptive. Hospitals don’t need to comply with any specific technical standard. The CMS regulations released in March are final.
Myth 2: You have to connect to a nationwide network. Wrong. Hospitals can choose from a wide variety of regional and statewide health information exchange (HIE) partners. The policy requires “reasonable effort” to send notifications to providers in your community. An intermediary can be used to comply with the rule as long as it “connects to a wide range of recipients.” Unlike what some nationwide companies are saying, the regulations do not mandate out-of-state alerts.
Myth 3: The policy creates a big technical burden for hospitals. More than 99 percent of hospitals have EHR systems in place today, and most of those can produce standard ADT transactions with relatively minimal effort. While the time to activate ADT notifications varies, it can usually be done in as little as a day by a hospital IT team.
Myth 4: The timing isn’t right. It’s happening too fast. A global pandemic is exactly the moment when we need this kind of data sharing in our communities. With COVID-19, it is even more crucial that care teams are alerted promptly when a patient is seen in the emergency department or discharged from the hospital so that they can reach out and provide support. Regardless, CMS has given an additional six months of enforcement discretion for hospitals, pushing back the deadline to May 2021.
Myth 5: There’s no funding available for this work. Wrong again. In California and several other states, hospitals can take advantage of public funding to connect to regional HIEs that provide ADT notification services. There’s $50 million in funding available just in California.
This new policy is an exciting step forward for patients and providers. It gives primary care and post-acute providers crucial, needed information to improve patient care. Hospitals can meet the requirements with minimal burden using existing technologies. Patients will have a more seamless experience when they are at their most vulnerable.
In healthcare, it’s easy to assume that great impact requires great complexity. But time and again the opposite is true. So let’s bust the myths, get it done, and keep it simple.
About Claudia Williams
Claudia Williams is the CEO of Manifest MedEx. Previously the senior advisor for health technology and innovation at the White House, Claudia helped lead President Obama’s Precision Medicine Initiative. Before joining the White House, Claudia was director of health information exchange at HHS and was director of health policy and public affairs at the Markle Foundation.
The COVID-19 pandemic has shed light on the shortcomings of today’s hospital and healthcare IT infrastructure, with many healthcare organizations quickly adopting the latest and greatest technology to support remote operations. However, in the scramble to adapt, many IT leaders did not ensure that the acquired technology integrated well with legacy systems – resulting in underused components and wasted costs. As we enter into a new era in healthcare, it is paramount that these organizations adopt technologies that support overall digital transformation and are fiscally responsible. The IT acquisition journey has taken us from focusing on the speed of components to the speed of the cloud, but we must work to innovate further. To adopt infrastructure that works at the speed of the business, healthcare IT providers must evaluate legacy IT acquisition efforts, the current models, and how they can evolve in the future.
The historic view of acquiring healthcare IT has been to move at the speed of the components. This lifecycle management approach was born out of the perception that acquiring new IT systems were too expensive for the return on investment. The focus was on the management of equipment, licenses, and contracts, causing IT leaders to spend the majority of their time patching and updating existing systems. The inability to predict a system’s capacity for computing, storage, and data meant less time spent on security, which left health systems vulnerable to outside threats.
Today’s Operating Model
Today, the focus has shifted to ensuring IT infrastructure moves at the speed of the cloud. Many hospitals and healthcare organizations have adopted an on-premise cloud and consolidated their licenses, equipment, and contracts to streamline service and reduce maintenance interruptions. This allows IT departments to proactively manage infrastructure capacity while also gaining security hardened systems. The technology management approach provides application-based cost management for healthcare organizations that require a variety of different needs, adjusting the perception of IT to that of service providers. Healthcare organizations that embrace this model are able to move and house their applications based on need, rather than pre-existing equipment constraints, which was unattainable before.
The Future of IT Acquisition
Looking ahead, there is no doubt that hospitals and healthcare organizations need to continue to evolve to maintain seamless operations. With COVID-19 highlighting infrastructure vulnerabilities, it is paramount that IT adjusts for increased technology, network traffic, and security weaknesses. Healthcare organizations that are working through issues with tools, cloud skills, and other obstacles that impede hybrid cloud adoption believe these problems will soon be resolved. With that in mind, it is likely that within the next decade there will be aggressive hybrid cloud adoption across the healthcare industry.
Additionally, in response to shifting priorities, subscription and consumption-based service models are growing in popularity because of their ability to flex up or down to optimize costs and efficiencies. In the future, healthcare organizations must move at the speed of the business as well as meeting community needs, like COVID-19 data reporting and analytics.
Instead of investing in legacy solutions that have proven difficult to manage, healthcare organizations looking to adjust their IT infrastructure can consider adopting numerous “as-a-service” models. For organizations that have specific software, application management, and full system infrastructure needs, Software-as-a-service (SaaS), Platform-as-a-service (PaaS), and Infrastructure-as-a-service (IaaS) are top considerations. Some organizations may only need access to software for a set number of users, rather than full support for the entire system, pointing them to subscription-based software instead of the as-a-service options. Conversely, consumption-based software models are growing in popularity.
Organizations that prefer to pay for applications or devices based on actual usage of the product may prefer this model because it often implies the user pays a certain amount in advance and then draws down against the pre-payment based on their use (“consumption”) of the application. This option allows systems to better budget from the onset, rather than determining costs as the year progresses.
Historically, projects and supporting product offerings are based on yearly budget and funding allotments. That is until the product offerings changed. Software subscriptions, software-as-a-service (anything-as-a-service), and consumption-based services are dramatically impacting the way that IT is purchased, which helps reduce costs.
When looking at healthcare IT spending more broadly, organizations allocate millions of dollars each year, even though they often have mixed experiences in the success of implementations. Since companies usually pay based on project implementation milestones, there are rarely performance clauses. With this in mind, organizations need to hold vendors accountable for successful implementations and first-year operations. In the future, many healthcare organizations will pursue shared risk cost models as they allow the provider to develop system improvements while mitigating costs for the organization.
The COVID-19 pandemic has forever changed how health systems assess and acquire IT infrastructure. With unprecedented amounts of network traffic, telehealth needs, and sensitive patient data, organizations need to prioritize IT planning and acquisition to avoid procurement delays and exorbitant costs. As 2021 budgets are being determined, hospital decision-makers should consider adopting subscription and consumption-based models to help them the best support and protect their data and meet the demands of tomorrow.
About Cheryl Rodenfels
Cheryl Rodenfels is the Healthcare Strategist for Nutanix. She is a seasoned technology executive, responsible for improving customer success and experience across the entire portfolio of Nutanix products and services. Cheryl’s responsibilities include developing the healthcare practice at Nutanix by identifying market opportunities, creating industry-specific training and documentation, enabling sales, and improving technology adoption and solution delivery. Cheryl can be found on LinkedIn.
The dominant presence of COVID-19 has not meant the absence of cancer, ear infections, heart attacks, chronic pain, or other illnesses that need attention and care. Physicians have continued treatment for all types of maladies, and physician training has continued as well. But this treatment and this training look much different these days. Despite the challenges that came with major COVID shutdowns and changing requirements, the healthcare system and patients have been both creative and resilient in finding robust “temporary” solutions to these challenges. It is now looking like some of these COVID-era transitional steps will be preserved and play a lasting role in the future of medical education and telemedicine. What must be sacrificed to reap the benefits of these new protocols?
The rapid adoption of technology and virtual engagement tools has been both impressive and interesting to watch – Zoom meetings between medical association boards of directors, FaceTime calls between isolated patients and their family members at home, telehealth phone appointments with family practice physicians, or virtual medical conferences through Webex – the increasing reliance on these tools has pushed boundaries and exposed both opportunities and challenges with technology use for the future of healthcare.
As COVID-19 has significantly accelerated the feasibility and acceptance of telehealth care by physicians, patients, and payors, we now see healthcare systems navigating in real-time the complex issues with cybersecurity and patient privacy. Due to waivers, everyday technologies can be utilized right now, including FaceTime, Skype, Facebook Messenger video chat, Google Hangouts, and Zoom, but new regulatory guidance may be needed to develop safe, secure, and patient-friendly telehealth applications for the future. Cyber-security, already an important priority in the healthcare information space, is going to become that much more essential as doctor’s offices and clinics implement even more telehealth protocols faster than they ever would have normally planned or budgeted for.
These changes in practice and patient care have also impacted how controlled substances are prescribed. The Drug Enforcement Agency has modified policies to allow for the remote prescribing of controlled substances during the pandemic. Online counseling, informed consent, and follow-up with patients can be done in a virtual setting. Pill counts can be done in a video call and patients can still have their questions answered regarding their pain therapy, although it is likely that after the crisis, prescribing certain controlled substances may return to in-person visits. It is important that the regulatory climate continues to evolve at the pace needed to address the changing needs and realities of telehealth in the time of COVID.
While we have all become more comfortable on telehealth platforms, there continues to be an important role for in-person visits. Patients may appreciate the convenience of telemedicine; however, they must understand that it can limit a physician’s ability to perform a thorough examination and possibly reduce the chances of a physician detecting an unexpected complication or condition.
Moving forward, I expect there will be much greater reliance on telehealth strategies even post-COVID, but it will always have to be balanced with old-fashioned office visits.
Residency training has also experienced a profound shift this year. Conventional teaching approaches have either been cut back or have been canceled due to COVID risks, and reduced access to personal protective equipment (PPE) has limited the amount of time spent with patients being cared for during residency and fellowship programs. But we can’t stop training for the next generation of physicians or providing quality Continuing Medical Education (CME) for practicing physicians. E-learning techniques, such as webinars and online skills training, certainly play a role – and these may offer ways to actually enhance cross-departmental or multidisciplinary collaborative educational sessions. E-learning may be more cost-effective and easier to participate in than traveling to conferences or symposia, but the hands-on learning and deep discussions that can occur in breakout sessions or clinical training modules will need to be replaced somehow. And there must be careful vetting of online content in order to avoid a proliferation of commercially biased information, plagiarized materials, or simply false information. As we all adjust to new settings and styles for learning, there must be purposeful strategies to ensure online lectures are still supported with opportunities for learning from direct patient contact and collegial support.
Despite these concerns and challenges, new models for CME activities actually pose a great opportunity for increased access, cost-effectiveness, and practicality for busy clinicians.
Even before the first case of COVID-19 was diagnosed, technological innovation had already begun to change education, healthcare, and even social relationships. The COVID-19 crisis has simply accelerated the drive and interest in these new tools. But while the technological tools and platforms to a large extent existed years before COVID-19, they have never been used as purposefully, as rapidly, or with such intentionality as they are being used now.
I am sure the shift toward technology and virtual engagement in medicine will not go away when we finally get past the COVID-19 crisis. There will likely be lasting changes with the reliance on distance-medicine techniques for both patient care and physician training. But we must keep a close eye on regulatory frameworks that need to be updated, and make extra efforts to build and maintain patient-physician relationships.
About Shalini Shah, MD
Shalini Shah, MD is Vice-Chair and Associate Professor, Department of Anesthesiology & Perioperative Care, and Enterprise Director of Pain Services, UC Irvine Health. Dr. Shah completed her residency in Anesthesiology from NYP-Cornell University and a combined fellowship in Adult and Pediatric Chronic Pain at Brigham and Women’s Hospital, Beth Israel Deaconess and Children’s Hospital of Boston, Harvard Medical School.
Healthcare leaders attempting to regain some of the revenue lost during the COVID-19 shutdowns now face a formidable challenge. The American Hospital Association estimates that U.S. hospitals and health systems lost $202.6 billion in just the four months from March 1 through June 30—roughly $50.7 billion per month.
Many variables feed into the overall financial impact for individual healthcare organizations, of course—including geographic location, local ordinances, specialty designations, and speed of service resumption. Regardless, every health system has experienced revenue shortfalls caused by disruptions to their service pipeline. The question now is how to generate enough additional revenue to cover some of those losses without incurring additional operating expenses.
We may be able to take practical inspiration from an unlikely source: the hospitality industry. By solving for something one healthcare organization calls “the motel problem,” health systems can increase workflow efficiency, staff satisfaction, clinic volume, and revenue.
The Motel Problem
Accurately assigning exam rooms with enough flexibility to accommodate continuously changing provider and patient schedules remains a perennial challenge for health systems. In fact, during a recent Porter Research study of 100 executive leaders, roughly two-thirds indicated their health systems lack visibility into exam room utilization.
The leaders of one academic medical center’s 65-physician neurology clinic began referring to this capacity challenge as “the motel problem.” How do motels consistently keep their rooms full of paying customers?. In contrast, their own exam rooms often appeared full on the scheduling spreadsheet but actually sat empty. Staff afraid of accidentally double-booking the space would then let those rooms sit idle.
Despite increasing the administrative time devoted to room management, underutilization in the neurology clinic caused rising patient wait times, lowered physician satisfaction, and decreased revenue. If the Porter Research survey is any indication, this situation is not unique. Approximately 72 percent of the survey’s respondents felt their room utilization rates were significantly subpar. Most said their organizations ran at about 20 points below the 80-89 percent utilization level they deemed optimal.
As the neurology department leadership mused about “the motel problem,” they looked at the similarities between motel and healthcare room management needs. Motels must match each guest to a room with the right accommodations (e.g., two doubles versus one king-sized bed) on the right dates. Health systems must take that same workflow one step further by matching the right patient and the right provider to a properly equipped exam room at the right time. In both cases, empty rooms mean lost revenue. Utilization is key.
Consequently, they came to believe that they needed a system that optimized room capacity with much of the same visibility and flexibility as a hotel or motel reservation system. That would require bringing together data about room availability, room attributes, provider schedules and patient needs—and making the resulting intelligence accessible through real-time displays.
A meaningful solution
When it comes to capacity management within a health system, the real complexity lies with provider and patient schedules. The physical space is always there; it’s the “people” part of the equation that’s fluid. What happens when Dr. Johnson suddenly falls ill, for example? Or Dr. Smith needs to attend a last-minute meeting? Or when patient Mrs. Brown reschedules her appointment?
Clinics typically rely on relatively static spreadsheets or siloed software to track room utilization. But these tools aren’t designed to make such real-time adjustments, especially at the enterprise level—which means the exam rooms assigned to an absent Dr. Johnson or Dr. Smith likely remain empty even as patients wait to be seen by other providers.
On the other hand, an organization’s scheduling system is aware when a provider calls in sick, heads to a meeting, or arrives at the clinic early. With a cloud-based scheduling platform, organizations can achieve near real-time visibility into provider availability across the enterprise.
Consider, then, what can happen when room management software is layered on top of an enterprise scheduling platform. Providers’ movements are then connected to exam room status. The entire organization gains transparency into how providers’ availability affects room availability. That allows staff to quickly and easily move providers into unused rooms and call patients in for appointments faster. Plus, by “tagging” various room attributes—like whether it’s equipped with oxygen or an ENT chair, for instance—such platforms ensure that the proper clinical accommodations are available when providers and patients need them.
Such real-time visualization of room availability can have a substantial impact on health system revenue. One regional health system, for example, calculated that underutilization in its orthopedic clinic costs at least $2,000 per provider per day in lost revenue.
Another large health system quantified the effect from a different perspective. It contemplated how maximizing capacity would enable increased patient throughput without investing in additional space or staff. With that in mind, the organization determined that every one percent increase in utilization results in an annual operational savings of $140,000.
At the neurology clinic, solving “the motel problem” by implementing a solution to standardize capacity generated both revenue growth and increased provider satisfaction. The organization has captured revenue previously missed through underutilization and has recognized that revenue scales directly proportional to volume.
To that end, gaining visibility into capacity has helped the clinic achieve a 7.4 percent increase in patient visits and a 4.7 percent increase in-clinic session volume. As important, providers now trust that the right exam rooms will be ready for them when needed—just like a reservation at a high-end hotel.
About Rich Miller
Rich Miller is the Chief Strategy Officer of QGenda, a healthcare workforce management provider, enabling organizations to optimize capacity across the enterprise. Leading physician groups, hospitals, academic medical centers, and enterprise health systems use QGenda to optimize their workforce which allows them to provide the best possible patient care.
Each year, Adverse Drug Events (ADE) account for nearly 700,000 emergency department visits and 100,000 hospitalizations in the US alone. Nearly 5 percent of hospitalized patients experience an ADE, making them one of the most common types of inpatient errors. What’s more, many of these instances are hard to discover because they are never reported. In fact, the median under-reporting rate in one meta-analysis of 37 studies was 94 percent. This is especially problematic given the negative consequences, which include significant pain, suffering, and premature death.
While healthcare providers and pharmaceutical companies conduct clinical trials to discover adverse reactions before selling their products, they are typically limited in numbers. This makes post-market drug safety monitoring essential to help discover ADE after the drugs are in use in medical settings. Fortunately, the advent of electronic health records (EHR) and natural language processing (NLP) solutions have made it possible to more effectively and accurately detect these prevalent adverse events, decreasing their likelihood and reducing their impact.
Not only is this important for patient safety, but also from a business standpoint. Pharmaceutical companies are legally required to report adverse events – whether they find out about them from patient phone calls, social media, sales conversations with doctors, reports from hospitals, or any other channel. As you can imagine, this would be a very manual and tedious task without the computing power of NLP – and likely an unintentionally inaccurate one, too.
The numbers reflect the importance of automated NLP technology, too: the global NLP in healthcare and life sciences market size is forecasted to grow from $1.5 billion in 2020 to $3.7 billion by 2025, more than doubling in the next five years. The adoption of prevalent cloud-based NLP solutions is a major growth factor here. In fact, 77 percent of respondents from a recent NLP survey indicated that they use at least one of the four major NLP cloud providers, Google is the most used. But, despite their popularity, respondents cited cost and accuracy as key challenges faced when using cloud-based solutions for NLP.
It goes without saying that accuracy is vital when it comes to matters as significant as predicting adverse reactions to medications, and data scientists agree. The same survey found that more than 40 percent of all respondents cited accuracy as the most important criteria they use to evaluate NLP solutions, and a quarter of respondents cited accuracy as the main criteria they used when evaluating NLP cloud services. Accuracy for domain-specific NLP problems (like healthcare) is a challenge for cloud providers, who only provide pre-trained models with limited training and tuning capabilities. This presents some big challenges for users for several reasons.
Human language very contexts- and domain-specific, making it especially painful when a model is trained for general uses of words but does not understand how to recognize or disambiguate terms-of-art for a specific domain. In this case, speech-to-text services for video transcripts from a DevOps conference might identify the word “doctor” for the name “Docker,” which degrades the accuracy of the technology. Such errors may be acceptable when applying AI to marketing or online gaming, but not for detecting ADEs.
In contrast, models have to be trained on medical terms and understand grammatical concepts, such as negation and conjunction. Take, for example, a patient saying, “I feel a bit drowsy with some blurred vision, but am having no gastric problems.” To be effective, models have to be able to relate the adverse events to the patient and specific medication that caused the aforementioned symptoms. This can be tricky because as the previous example sentence illustrates, the medication is not mentioned, so the model needs to correctly infer it from the paragraphs around it.
This gets even more complex, given the need for collecting ADE-related terms from various resources that are not composed in a structured manner. This could include a tweet, news story, transcripts or CRM notes of calls between a doctor and a pharmaceutical sales representative, or clinical trial reports. Mining large volumes of data from these sources have the power to expose serious or unknown consequences that can help detect these reactions. While there’s no one-size-fits-all solution for this, new enhancements in NLP capabilities are helping to improve this significantly.
Advances in areas such as Named Entity Recognition (NER) and Classification, specifically, are making it easier to achieve more timely and accurate results. ADE NER models enable data scientists to extract ADE and drug entities from a given text, and ADE classifiers are trained to automatically decide if a given sentence is, in fact, a description of an ADE. The combination of NER and classifier and the availability of pre-trained clinical pipeline for ADE tasks in NLP libraries can save users from building such models and pipelines from scratch, and put them into production immediately.
In some cases, the technology is pre-trained with tuned Clinical BioBERT embeddings, the most effective contextual language model in the clinical domain today. This makes these models more accurate than ever – improving on the latest state-of-the-art research results on standard benchmarks. ADE NER models can be trained on different embeddings, enabling users to customize the system based on the desired tradeoff between available compute power and accuracy. Solutions like this are now available in hundreds of pre-trained pipelines for multiple languages, enabling a global impact.
As we patiently await a vaccine for the deadly Coronavirus, there have been few times in history in which understanding drug reactions are more vital to global health than now. Using NLP to help monitor reactions to drug events is an effective way to identify and act on adverse reactions earlier, save healthcare organizations money, and ultimately make our healthcare system safer for patients and practitioners.
About David Talby
David Talby, Ph.D., MBA, is the CTO of John Snow Labs. He has spent his career making AI, big data, and data science solve real-world problems in healthcare, life science, and related fields. John Snow Labs is an award-winning AI and NLP company, accelerating progress in data science by providing state-of-the-art models, data, and platforms. Founded in 2015, it helps healthcare and life science companies build, deploy, and operate AI products and services.
Healthcare can achieve optimum efficiency when patients are at the center of care. When patients have the necessary information to navigate their care journey, they will choose the path to high-quality care at the lowest costs. Cost-sharing and insurance premiums are rising consistently since the last decade for employer plans, which covers nearly half of the country’s population. Plan members are shouldering a part of the healthcare cost burden, so they want to keep it as low as possible. At the same time, they want maximum value for their money with access to quality care.
CMS identified this as an opportunity and issued the Final Interoperability and Patient Access rule. The rule allows patients to access electronic health data through any third-party application of their choice. The rule intends to allow patients to take control of their data and determine who can see which data. It will also make transferring data from provider to provider easier. So that patients can be ensured that their provider is fully aware of their medical history.
The Challenge of Providing Members Access to Healthcare Data
The biggest challenge that health plans will face is to extract data from multiple sources in-house, clean and scrub it, and ensure it is in the appropriate format as required by the Centers for Medicare and Medicaid Services (CMS). Some health plans have been in business for a really long time. Patient data has been accumulating through these years in legacy systems. Providing access to that data through certified third-party applications will require a lot of effort on the part of health plans. The health plans also have to ensure tight authentication standards so that only the people requested by the members have access to their healthcare data.
In addition, there are multiple problems associated with provider data. Incorrect data in the provider database costs close to $3 billion annually. CMS has also issued warnings for inaccurate provider directories, high claim-reprocessing volumes, and substantial encounter-data rejection rates. Payers have been addressing the data issues with short term solutions. But now they have to resolve the provider data problems for good and make health data readily available to the members.
The COVID Crisis Upended The Payer Compliance Initiatives
Payers are in solidarity with providers and patients in this time of crisis. While providers work tirelessly to help an increased number of patients access the required care, payers are providing support through fast track reimbursements and reduced utilization management.
Many health plans are focused on ensuring that their members have access to resources to fight COVID, which is why CMS extended the deadline for the Final Interoperability rule. Utilization patterns are witnessing a significant change. Many members are not receiving scheduled care as some elective surgeries are rescheduled and some provider offices are shut down. There has been a drop in certain kinds of utilization. Conversely, there has been a dramatic surge in telehealth office visits and behavioral health services.
The Road Ahead for Health Plans
Healthcare payers have endured significant claims-based, economic, and operational challenges during the pandemic. While they battle those bottlenecks, they also have to ascertain and prepare for the future and devise ways to ensure that their members have access to quality care.
Health plans will have to try to anticipate what utilization patterns will look like in the future, especially in the next year. Telehealth utilization will not be the same as it was pre-COVID. They will also have to ensure that members have access to care. They will have to reach out to members, especially those who are the most vulnerable. They will have to make sure members are not suffering from social isolation, they are taking their medication and they have access to transportation to get to the doctor.
Provider Alliance for CMS Compliance
CMS is handing over the reins of the care journey to the patients to improve care delivery through the Interoperability rule. Providers will play a key role in enabling access to healthcare data to patients by streamlining data and closing coding gaps. Payers must assist providers with their data needs to ensure compliance with the CMS rules.
As the pandemic ends and CMS comes out with more definitive long term rules and coverages, it is going to be important to ensure that providers are on the same page with payers. Health plans can partner with providers to educate them about the acceptable telehealth codes and what type of services are to be performed using those codes. Providers want to take care of their patients and they want to do it well. They want to leverage technology to ensure patient access to care and ensure their safety, especially for patients who suffer from multiple comorbidities.
About Elizabeth Bierbower
Elizabeth Bierbower is a strategic leader with more than thirty years of executive experience in the health insurance industry. She has experience scaling cost-effective and profitable growth strategies through internal innovation, and a reputation as being one of the industry’s most fiscally responsible and progressive leaders. Bierbower currently serves on the Boards of Iora Health, the American Telemedicine Association, and is on Innovaccer’s Strategic Advisory.
Previously Beth was a member of Humana’s Executive Management Team and held various roles including Segment President, Group and Specialty Benefits, and was an Enterprise Vice President leading Humana’s Product Development and Innovation teams.
As you read this, doctors are on the frontlines fighting a global pandemic. Lives depend on their skills and expertise, but what often gets overlooked is the fact that doctors are still prone to stress. Sure enough, according to a report by Medscape, more than 42% of physicians across various specialties say they are burned out.
Burnout is still a common occurrence among physicians and it’s a matter that practitioners and healthcare institutions should take seriously. After all, doctors are human like us and they deserve a break from their daily challenges. The issue of stress and burnout in the medical field continues to be a critical topic in the midst of the COVID-19 pandemic, so it’s important to explore the options that are currently available to people in the medical field. Here are a few key solutions:
1. Creating a culture of collaboration
At the organizational level, administrators will need to establish a robust program for engaging the needs of physicians and specialists. Initiatives such as mental health interventions and counseling not only encourages productivity but improves personnel retention. These should also involve physicians in the decision-making mechanisms of the organization.
Not all policies are reflective of what’s happening on the ground, so giving physicians a place in “higher up” conversations creates a culture of trust and collaboration. This, in turn, simplifies complex processes and leads to better outcomes for the whole organization.
2. Training for bigger roles
Indeed, much of the occupational stress that doctors experience stems from a lack of professional support. When you have multiple specialists doing the same tasks without giving them an opportunity to expand their horizons, you risk creating an avenue where job dissatisfaction is rampant. One way to correct this is to invest in job enrichment and build an environment where constant learning is emphasized.
This keeps the organization from thinning itself out with only a few specialists capable of handling certain tasks such as administering anesthesia or handling data security. In addition, providing doctors with enough autonomy to apply newly-acquired skills helps enhance productivity and bring innovation to the fore. Through skill development programs and participation in workshops, conferences, and team-building should be considered along these lines.
3. Developing a stress engagement program
Work stress interventions are critical to any organization, and that goes for hospitals and clinics. There is always a need to draft a game plan for knowing how to keep physicians and other practitioners engaged and prevent the onset of stress.
There are a number of ways you can go about this. For one, you may opt for a more workable shift-rotation scheme. Psycho-physiological needs should also be met, so if your organization is based in Washington, you may recommend a Seattle pain relief clinic or pain management center that’s capable of addressing stress-induced conditions such as fibromyalgia.
Stress is rampant in the medical field because practitioners are committed to providing quality life-saving services. Organizations will only need to confront the reality that doctors, nurses, attendants and everyone else down the line require enough support, especially now as healthcare systems are met by unprecedented challenges.
Senior isolation is a health risk that affects at least a quarter of seniors over 65. It has become recognized over the past decade as a risk factor for poor aging outcomes including cognitive decline, depression, anxiety, Alzheimer’s disease, obesity, hypertension, heart disease, impaired immune function, and even death.
Physical limitations, lack of transportation, and inadequate health literacy, among other social determinants of health (SDOH), further impair access to medical and mental health treatment and preventive care for older adults. These factors combine to increase the impact of chronic comorbidities and acute issues in our nation’s senior population.
COVID-19 exacerbates the negative impacts of social isolation. The consequent need for social distancing and reduced use of the healthcare system due to the risk of potential SARS-CoV-2 exposure are both important factors for seniors. Without timely medical attention, a minor illness or injury quickly deteriorates into a life-threatening situation. And without case management, chronic medical conditions worsen.
Among Medicare beneficiaries alone, social isolation is the source of $6.7 billion in additional healthcare costs annually. Preventing and addressing loneliness and social isolation are critically important goals for healthcare systems, communities, and national policy.
Organizations across the healthcare spectrum are taking a more holistic view of patients and the approaches used to connect the most vulnerable populations to the healthcare and community resources they need. To support that effort, technology is now available to facilitate analysis of the socioeconomic and environmental circumstances that adversely affect patient health and mitigate the negative impacts of social isolation.
Addressing Chronic Health Issues and SDOH
When we think about addressing chronic health issues and SDOH in older adults, it is usually after the fact, not focused on prevention. By the time a person has reached 65 years of age, they may already be suffering from the long-term effects of chronic diseases such as diabetes, hypertension or heart disease. Access points to healthcare for older adults are often in the setting of post-acute care with limited attention to SDOH. The focus is almost wholly limited to the treatment and management of complications versus preventive measures.
Preventive outreach for older adults begins by focusing on health disparities and targeting patients at the highest risk. Attention must shift to care quality, utilization, and health outcomes through better care coordination and stronger data analytics. Population health management technology is the vehicle to drive this change.
Bimodal Outreach: Prevention and Follow-Up Interventions
Preventive care includes the identification of high-risk individuals. Once identified, essential steps of contact, outreach, assessment, determination, referral, and follow-up must occur. Actions are performed seamlessly within an organization’s workflows, with automated interventions and triggered alerts. And to establish a true community health record, available healthcare and community resources must be integrated to support these actions.
Social Support and Outreach through Technology
Though older adults are moving toward more digitally connected lives, many still face unique barriers to using and adopting new technologies. So how can we use technology to address the issues?
Provide education and trainingto improve health literacy and access, knowledge of care resources, and access points. Many hospitals and health systems offer day programs that teach seniors how to use a smartphone or tablet to access information and engage in preventive services. For example, connecting home monitoring devices such as digital blood pressure reading helps to keep people out of the ED.
Use population health and data analyticsto identify high-risk patients. Determining which patients are at higher risk requires stratification at specific levels. According to the Centers for Disease Control and Prevention, COVID-19 hospitalizations rise with age, from approximately 12 per 100,000 people among those 65 to 74 years old, to 17 per 100,000 for those over 85. And those who recover often have difficulty returning to the same level of physical and mental ability. Predictive analytics tools can target various risk factors including:
– Recent ED visits or hospitalizations
– Presence of multiple chronic conditions
– Food insecurity, housing instability, lack of transportation, and other SDOH
– Frailty indices such as fall risk
With the capability to identify the top 10% or the top 1% of patients at highest risk, care management becomes more efficient and effective using integrated care coordination platforms to assist staff in conducting outreach and assessments. Efforts to support care coordination workflows are essential, especially with staffing cutbacks, COVID restrictions, and related factors.
Optimal Use of Care Coordination Tools
Training and education of the healthcare workforce is necessary to maximize the utility of care coordination tools. Users must understand all the capabilities and how to make the most of them. Care coordination technology simplifies workflows, allowing care managers to:
– Risk-stratify patient populations, identify gaps in care, and develop customized care coordination strategies by taking a holistic view of patient care.
– Target high-cost, high-risk patients for intervention and ensure that each patient receives the right level of care, at the right time and in the right setting.
– Emphasize prevention, patient self-management, continuity of care and communication between primary care providers, specialists and patients.
This approach helps to identify the resources needed to create community connections that older adults require. Data alone is insufficient. The most effective solution requires a combination of data analytics to identify patients at highest risk, business intelligence to generate interventions and alerts, and care management workflows to support outreach and interventions.
About Dr. Jenifer Leaf Jaeger
Dr. Jenifer Leaf Jaeger serves as the Senior Medical Director for HealthEC, a Best in KLAS population health and data analytics company. Jenifer provides clinical oversight to HealthEC’s population health management programs, now with a major focus on COVID-19. She functions at the intersection of healthcare policy, clinical care, and data analytics, translating knowledge into actionable insights for healthcare organizations to improve patient care and health outcomes at a reduced cost.
Prior to HealthEC, Jenifer served as Director, Infectious Disease Bureau and Population Health for the Boston Public Health Commission. She has previously held executive-level and advisory positions at the Massachusetts Department of Public Health, New York City Department of Health and Mental Hygiene, Centers for Disease Control and Prevention, as well as academic positions at Harvard Medical School, Boston University School of Medicine, and the Warren Alpert Medical School of Brown University.
Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and projected margins will stay in the red for at least half of the nation’s hospitals for the remainder of 2020.
The reality is that an increase in COVID-19 cases will not overcome the pandemic’s devasting financial impact. An internal analysis found that, in the first half of 2020, client organizations documented more than 1.2 million COVID-19 related cases. At least one study suggests that $2,500 will be lost per case–despite a 20% Medicare payment increase. And notably, a positive test result is now required for the increased inpatient payment.
The healthcare industry must face its own “new normal” as the current path is unsustainable, and the future stability of hospitals in communities across the nations is uncertain. If financial leaders do not act now to implement systems and embrace sound revenue integrity practices, they will face unavoidable revenue cycle bottlenecks and limit their ability to capitalize on all appropriate reimbursement opportunities.
The COVID-19 Effect: A Bird’s Eye View
The financial impact of COVID-19 is far-reaching, impacting multiple angles of operations from supply chain costs to lost billing opportunities and compliance issues. Findings from a Physician’s Foundation report released in August suggest that U.S. healthcare spending dropped by 18% during the first quarter of 2020, the steepest decline since 1959.
Already vulnerable 2020 Q1 budgets were met with substantial losses when elective procedures—a sizeable part of income for most health systems—were halted for more than a month in many cases. Many hospitals continue to lose notable revenue associated with emergency care and ancillary testing as patients choose to avoid public settings amid ongoing public safety efforts.
Outpatient visits also dropped a whopping 60% in the wake of the pandemic. While a recent Harvard report suggests that numbers are back on track, the reality is that a resurgence of cases could make consumers wary of both doctor visits and elective procedures again.
In addition, the supply chain quickly became a cost risk for health systems by Q2 2020 as the ability to acquire drugs and medical supplies came at a premium. Meeting cost-containment goals flew out the window as did the ability to create value in purchasing power.
Further exacerbating the situation is an expected increase in denials as healthcare organizations navigate a fluid regulatory environment and learn how to interpret new guidance around coding and billing for COVID-19 related care. For example, while telehealth has proved a game-changer for care continuity across the U.S., reimbursement for these visits remains largely untested. History confirms that in times of rapid change, billing errors increase—and so do claims denials.
While there is little that can be done to minimize the impact of revenue losses and supply chain challenges, healthcare organizations can take proactive steps to identify all revenue opportunities and minimize compliance issues that will undoubtedly surface when auditors come knocking to ensure the appropriate use of COVID-19 stimulus dollars.
Holistically Addressing Revenue
Getting ahead of the current and evolving revenue storm will require healthcare organizations to elevate revenue integrity strategies. Hospitals and health systems should take four steps to get their billing and compliance house in order by addressing:
1. People: Build a cross-functional steering committee that will drive revenue integrity goals through better collaboration between billing and compliance teams.
2. Processes: Strategies that combine the strengths of both retrospective and prospective auditing will identify the root cause of errors and educate stakeholders to ensure clean, timely filed claims from the start.
3. Metrics: Best practice key performance indexes are available and should be used. Clean claim submission, denial rate, bad debt reduction and days in AR are a few to consider.
4. Technology: The role of emerging technologies that use artificial intelligence cannot be understated. Their ability to speed identification of risks, perform targeted audits, identify and address root causes and most importantly, monitor the impact of process improvements is changing current dynamics. For one large pediatric health system in the Southwest, technology-enabled coding and compliance processes resulted in $230 million in reduced COVID-related denials and a financial impact of $2.3 million.
Current manual processes used by many healthcare organizations to assess denials and manage revenue cycle will not provide the transparency needed to both get ahead of problems and identify areas for process improvement and corrective action in today’s complex environment.
About Vasilios Nassiopoulos
Vasilios Nassiopoulosis the Vice President of Platform Strategy and Innovation at Hayes, a healthcare technology provider that partners with the nation’s premier healthcare organizations to improve revenue, mitigate risk and streamline operations to succeed in an evolving healthcare landscape. Vasilios has over 25 years of healthcare experience with extensive knowledge of EHR systems and PMS software from Epic, Cerner, GE Centricity and Meditech. Prior to joining Hayes, Vasilios served Associate Principal at The Chartis Group.
American businesses and their leadership are at a crossroads. COVID-19 has forced us all to re-evaluate how we work and live, while the current protest movements have placed a spotlight on the systemic injustices non-white workers face both in and out of the office. Given that communities of color have been disproportionately impacted by COVID-19, companies serious about doing right by their employees need to act decisively and clearly or risk becoming complicit in the racial and social inequities we so desperately need to correct.
The mass lay-offs and furloughs, erratic work schedules, limited sick leave benefits, and low wages have become a testament of how employers can play a role in the financial fragility and hardship of their employees. Throughout my career as a researcher and educator, I’ve seen institutions successfully make progress around racial/ethnic health disparities. In these instances, leadership has taken decisive action to review how policies and employee regulations—both explicit and implicit—have contributed to the disparities. This process needs to be ongoing, requiring company leadership to have the courage to commit to social change.
In the wake of the current social justice movement, many companies have put out statements of support for the protest movement, highlighting how they are working to address racial injustice. But these statements have been met with skepticism, especially from former and current Black employees, many of whom experienced circumstances where they did voice concerns to managers or leadership, but those concerns were ignored or left in limbo.
We’re seeing this buildup of lack of trust in workplaces across the country, especially in light of the pandemic. Consider this through the lens of reopening. The first step in determining how to open safely for all employees is listening to employees and their unique concerns. If employers truly want to reopen safely, they need to be open to receiving feedback, even when it might be tough to hear.
Once employers have employee opinion and advice, they must devise a plan for addressing their concerns, identifying what arsenal of expertise and partnerships are needed to make sustainable social change and protect employee health. Each company will have a different reopening plan depending on their needs, location, and available resources and will have to use their creativity as employers deal with the pain of serious financial losses while still committing to safeguarding employee health.
Crucially, leadership should evaluate health insurance coverage at every level of the company, as equitable access to healthcare and healthcare information via employers can go a long way in addressing a company’s racial inequalities. Further, access and information are powerful tools for alleviating anxiety, encouraging trust, and diminishing uncertainty, such as:
– Are all your employees covered for medical benefits?
– Do they know what COVID-19 related procedures and treatments are covered under their current plans?
– Can these be expanded to be ready for the next pandemic?
Trust also requires employers to regularly and critically evaluate the solutions they have put into place for employees, especially digital solutions. Digital health evaluations and AI health screening tools can appear to simplify the burden of addressing health or racial concerns. But, these tools also have faced their own issues around racial and gender bias. The guidance provided by these tools is only as good as the data that informs the platform. Employers must ask hard questions about how comfortable employees are disclosing health information, in addition to interrogating what data is informing their guidance and how confidential is the disclosed information. AI and other digital platforms are not band-aids for companies that are looking to reopen, they are part of a larger action plan that must be informed by employees’ needs and the latest expert guidance around how to prevent the spread of COVID-19.
Regardless of the pandemic, companies, and institutions that have historically made any progress around racial diversity and inclusion have actively incorporated social justice into their mission. In the midst of a pandemic, that commitment is even more critical.
The process of addressing disparities can be painful, but if companies are serious about reopening safely, they must face these realities head-on. If the commitment is real, the company evolves to a place with better employee loyalty and a stronger reputation. In today’s world, this progress will literally save lives.
The globalization of the pharmaceutical industry has forced pharma companies to outsource, increasing their reliance on third-party vendors and suppliers. As this supply chain grows in complexity, companies find themselves grappling with a growing amount of cyber risk.
A data breach in the pharmaceutical industry can cost companies upwards of $5 million and costs can rise significantly if a third-party vendor or supplier is the cause of a data breach. For this reason, organizations must ensure the third-parties that exist within their supply chain remain secure.
Challenges in the Pharmaceutical Supply Chain
There are innumerable logistical, compliance, and cost-related issues that organizations must consider as they add third-parties and vendors to their supply chain.
From a logistics view, a growing number of touchpoints between production and consumers, shipments that require refrigeration, packaging coordination, and shipment delays related to third-parties all may increase risk.
This risk is compounded by compliance-related issues. The highly-regulated pharmaceutical industry must comply with a number of healthcare-related regulations, like HIPAA, and must also be sure that their third-party suppliers abide by rules set by supply regulations like Good Distribution Practice (GDP). If these companies and their third-parties do not comply, the organization becomes subject to costly fines – which can range between $10 million and $1 billion depending on various factors.
Pharmaceutical businesses must protect their organizations in this challenging risk environment by working to mitigate third-party cyber risk as they also work to limit their own.
Why Third-Party Risk Management is Critical for Pharma
Due to the high value of the intellectual property they house, pharmaceutical companies are subject to a high-level of cybercrime. In fact, according to a study conducted by Deloitte, the pharmaceutical industry has become the number one target of cybercriminals at a global level, especially in relation to IP theft.
For a pharma organization, data breaches can be devastating, costing companies grief over lost or stolen data and large sums of money to remedy any business hindrances caused by the breach. According to Ponemon’s Cost of a Data Breach report, data breaches cost pharmaceutical companies an average of $5.2 million. When a third-party supplier or vendor causes a breach, the average cost rises by $370,000.
In order to protect drug production and patient well-being, the industry must take care to minimize its cyber risk, specifically when it comes to third-parties.
Best Practices for Third-Party Risk Management in the Pharmaceutical Industry
It is crucial that pharmaceutical organizations work to limit the third-party risk that may stem from vendors and suppliers. Use the following seven best practices for developing your third-party risk management (TPRM) strategy:
1. Identify Your Suppliers
Pharmaceutical companies have a large, outsourced supply chain and it is imperative to understand exactly who your suppliers are at all points on the chain. Cyber risk can stem from any size or type of vendor, so make sure to list each third-party you work with – from small vendors who may work with only one department, to large vendors who develop drug labels and bottle caps.
2. Understand and Qualify Potential Cyber Risks
Each third-party has the potential to introduce numerous risks that must be identified at the start of your business relationship. Make note of the types of software, networks, devices, and data that each of your third-parties access. Then, develop a risk inventory and map them against a standardized risk taxonomy, estimate the likelihood and severity of each risk, and rank each third-party in order of potential risk.
3. Determine a Risk Rating
Once each third-party has been analyzed from a risk-perspective, assign a risk rating to each. Risk ratings generally range from low to high, meaning high-risk vendors receive the most attention when prioritizing risk monitoring strategies and determining your risk appetite.
4. Define Controls
It’s important to make sure that third-parties have the same level of risk tolerance as your organization. When developing a TPRM policy, you need to define the types of controls your third-parties should be using like encryption, regular security patching, and data segregation. If possible, these controls should be worked into your business contracts.
5. Measure Third-Party Compliance
After setting controls, you must set metrics to measure third-party compliance. These metrics may include time to risk detection, time to risk remediation, or time to risk recovery. Monitoring third-party compliance regularly requires a review of security questionnaires or self-audits provided by the third-party.
6. Align with a Risk Management Framework
In order to properly manage third-party risk, pharmaceutical organizations must develop a third-party risk management framework. Common frameworks like NIST and ISO help to identify which third-party vendors pose the greatest risk and require an immediate response.
7. Continuously Monitor Third-Parties
In order to ensure security, pharmaceutical companies must continuously monitor their third-party business partners. Many organizations incorporate platforms that can monitor ecosystem risk, providing real-time visibility into the complex IT risks associated with the rapidly expanding pharmaceutical attack surface.
The supply chain for the pharmaceutical industry is increasing in regulatory complexity, logistics, and costs. Globalization has expanded the threat landscape, leaving many companies forced to upgrade their risk-management capabilities. Now is the time to adopt the best practices highlighted above to protect drug IP and patient lives.
About Dr. Aleksandr Yampolskiy, CEO of SecurityScorecard
Dr.Aleksandr Yampolskiy is a globally recognized cybersecurity innovator, leader, and expert. He is co-founder and chief executive officer of SecurityScorecard and strives to create a new language for cybersecurity by enabling people to work collaboratively across the enterprise and with external parties to build a more secure ecosystem.
Many in the healthcare industry are keeping an eye on the rollout of 5G wireless, which promises to connect people and things at higher speed and lower latency. In the healthcare realm, this means high-resolution images such as CT scans and X-rays can be taken and transmitted instantaneously to doctors. But it also means good things for lower-bandwidth applications, such as the volumes of rich data found in home healthcare applications.
One of the beneficiaries of 5G will be remote patient monitoring (RPM), which helps seniors live independently and transforms their care. With RPM solutions, vital statistics such as blood pressure, oxygen level, blood glucose, weight, temperature, and other metrics are consistently monitored. Reliable connectivity is required to transmit data between the patient and the physician’s office or hospital. RPM solutions can also be two-way, with voice communications-enabled between doctors and patients. Some RPM solutions can also track data over time and spot abnormalities in readings such as low or high blood pressure or oxygen levels and can connect the patient to the doctor to explore solutions. The goal: Keeping patients healthy and allowing them to take a greater role in their healthcare.
By being able to take these vital signs at home and delivering them to their provider automatically and in real-time, the paradigm of care is shifted from episodic to preventative. This gives senior patients and their doctors much more flexibility in patient care and helps to reduce the need to visit the doctor’s office or hospital. With RPM, healthcare providers can:
– Speak in real-time with a patient who might not be feeling well
– Discuss a patient’s status and review their statistics in real-time
– Proactively care for patients so they don’t end up at the doctor’s office or emergency room
– Intervene in the patient’s care to get their health back to normal
RPM solutions usually connect to the internet via WiFi or cellular. As we move towards 5G, which is the best solution to provide connectivity to RPM solutions?
WiFi is the defacto home connectivity option for many people. It is relatively inexpensive, upload and download speeds have been consistently upgraded by service providers, and, in general, it works when needed. But it faces some challenges for home healthcare:
– Lack of ubiquity: According to Pew Research Group, as of 2019, only 59 percent of people over 65 have access to broadband connectivity at home. That makes it challenging to utilize WiFi in RPM solutions, which require a continuously reliable 24×7 data connection.
– Limited ease of use: Wi-Fi can be strongly protected, but that protection comes at a price: the use of complex, multi-variable passwords and other configuration steps, which some seniors may struggle with.
– Lack of 24/7 reliability: WiFi signals drop frequently. If Wi-Fi has a weak signal, loses power, or goes offline for another reason—even if it’s infrequently—it impacts the ability to deliver consistent patient results back to healthcare professionals—and vice versa.
Cellular is a more reliable option for home care providers and the patients they serve. Some of the benefits of using cellular connectivity include:
Ubiquity: People understand how cellular works. For patients aged 65 and older, 91 percent own a cellphone and of those, 53 percent own a smartphone, according to Pew Research Group.
Simplicity of set-up: For many RPM devices, complicated configuration is not required. While some solutions providers retrofit tablets, others have purpose-built RPM solutions that simply need to be turned on.
Consistent real-time data sets: Gathering data sets developed in real-time and over time allows healthcare providers to see trends and take preventative action. Cellular is a stronger fit for this type of application.
Upgrade path to 5G, when available: Some vendors are building 5G capabilities into their devices today to prepare for its arrival. RPM solutions that use cellular have a clear upgrade path to 5G’s high-bandwidth connectivity.
The use of open standards and existing infrastructure. Cellular is well-proven, and RPM can use existing infrastructure as the underlying medium to connect patients and their healthcare providers and help patients take a greater role in their healthcare.
The ability to cover hundreds of devices simultaneously. Cellular macrocells are able to cover a wide area, ensuring connectivity is always available for the patient
Doctors and healthcare providers can now gather patients’ rich health data by including real-time and daily readings. This allows patients to get more involved with their care, assess situations in real-time, and speak with a physician when they are not feeling well, and generally to keep patients healthy and out of the doctors’ office or emergency room. RPM solutions are becoming increasingly easier to use and more feature-rich making connectivity choice imperative. Cellular connectivity will ensure solutions are available 24/7 to help keep seniors safe, and when 5G is more readily available at scale, there is a clear upgrade path for RPM solutions.
About Mark Dennissen
Mark Denissen serves as the president and chief executive officer of Anelto. He has a storied career in the technology sector. Mr. Denissen worked for more than three decades with Texas Instruments (TI), serving in various roles before becoming the Vice President of Worldwide Strategic Marketing. In this role, he was responsible for the startup of businesses such as Medical Devices, LED lighting solutions, and motor control solutions. Additionally, he was responsible for the commercialization of breakthrough technologies developed in Kilby Labs, TI’s long-range research and development center, and worked directly with TI’s Chief Technical Officer to move numerous projects towards commercialization. He holds a BSEE degree from the University of California Los Angeles.
Blockchain technology has somewhat infamously been described as “a solution in search of a problem,” but as the healthcare industry responds to the demands of the pandemic, several valuable use cases have surfaced that could benefit from employing the emerging technology.
Due in large part due to its ability to promote trust, transparency, and privacy, blockchain has emerged as today’s best technology-based option for accomplishing the important objective of delivering real-time access to critical information that is presented in a consistent format from trusted sources.
False positives, duplicate records, and privacy issues make it very difficult to derive actionable intelligence with confidence from the current data-sharing infrastructure that exists in the healthcare industry. Further, lack of trust represents another challenge that hinders the formation of greater transparency, as much of the healthcare industry remains reluctant to pervasively share data due to privacy and competitive barriers.
By design, blockchain allows for competing organizations to come together to share data about their patients in a completely auditable way, while maintaining their competitive independence and privacy concerns. It is these fundamental qualities that have helped blockchain emerge as a viable solution for a number of critical healthcare functions whose importance has grown during the COVID-19 pandemic, such as contact tracing, provider credentialing, and patient records-sharing.
Blockchain: The basics Before delving into the specifics of what blockchain can do for healthcare during the pandemic, it is important to establish a general understanding of blockchain’s basics. By no means is it necessary for most healthcare executives to develop a deep knowledge of the technology, but familiarity with its essential elements will enable business leaders to speak roughly the same language as healthcare technology experts as blockchain continues to gain prominence.
Blockchain is a distributed ledger technology that enables users to share trusted and verified information in a decentralized manner. Combined with security and cryptography technology, blockchain can protect the privacy of users who contribute data while also sharing the provenance of the data, enhancing trust.
Blockchain technology provides a safe, effective way to accurately document, maintain, store, and move data – from health records to financial transactions. With blockchain, people can directly engage with others to receive services, transfer money, and perform other common daily tasks we do in business today.
Blockchain use cases The biggest benefits offered by blockchain are associated with greater trust and privacy due to the technology’s ability to enable better data accuracy and verification. At its most basic level, blockchain changes ownership and control of data from one centralized source to multiple sources that contribute data. Following are three COVID-19-related use cases for blockchain in healthcare.
Contact tracing: To follow the potential transmission of the novel coronavirus, many governments have embarked upon contact tracing, in which infected individuals are asked to list all other people they’ve come into contact with over a certain period of time. Decentralization of data helps facilitate critical healthcare operations such as contact tracing because the process is reliant on using granular, sensitive data to inform public health officials of who may be at risk of exposure based on their movements and contacts. In contract tracing, maintaining individuals’ privacy is critical. Earlier this year, blockchain platform Nodle launched a contact-tracing app called “Coalition,” which emphasized user privacy.
Patient-record sharing: Another valuable use case for blockchain as it relates to COVID-19 is the aggregation of patient records during a crisis or disaster to create a “light” electronic health records system, which disparate groups of providers can use to share patient records while treating unfamiliar patients during the pandemic or other crises and natural disasters. Such a platform will allow providers to work with patients who may not have access to their usual provider, but still receive the full range of needed services and prescriptions. The main concept of the solution is that patients’ electronic health records follow them wherever they go. In other words, regardless of where the patient stays during a disaster, there is always access to their personal medical information and they are able to receive required medical services. This patient data can be delivered through a blockchain digital wallet, providing access, security, and integrity of data.
Provider credentialing: Provider credentialing — which is the process of verifying providers’ skills, training and education — is an often-tedious, time-consuming process for both providers and payers that can lead to delays in care that contribute to poor health outcomes. By using blockchain for the process, providers can maintain control of their own data and give health systems, payers and other authorities access to their credentials as they like. Earlier this year, five organizations announced plans to use a new blockchain credentialing system from ProCredEx with the aim of using distributed ledger technology to reduce time and costs associated with the traditional approach to credentialing.
The right technology at the right time It is important to note that blockchain technology requires a cultural and paradigm shift toward broader collaboration across traditionally disparate and potentially competitive entities. The technology facilitates a framework that allows organizations to contribute to joint efforts without risking their intellectual property or proprietary information. However, it will still require an intentional change in behavior to successfully work across different business interests toward a common goal. Nonetheless, to surmount the challenges posed by healthcare’s manual, time-consuming processes for contact tracing, patient record-sharing, and provider credentialing, blockchain represents the right technology at the right time.
About Brett Furst
A senior executive with nearly three decades of experience in selling and managing technology solutions within the manufacturing, CPG, and healthcare industries, Brett Furst serves as president of HHS Technology Group, a software and solutions company serving the needs of commercial enterprises and government agencies.
Over the past few months, primarily as a result of the COVID-19 pandemic, telehealth has gone from a “nice-to-have” to a “must-have” for healthcare providers. The surge of COVID-19 patients in the spring, coupled with “stay-at-home” orders in many states, meant that many patients in need of care for chronic conditions and other non-emergent health issues were unable to visit their providers face-to-face.
Telehealth became the emergency solution, aided by relaxation of government regulations and improved reimbursement from health payers, led by the U.S. Centers for Medicare and Medicaid Services (CMS). But then a funny thing happened.
As COVID-19 restrictions eased, many patients and providers found they liked telehealth and wanted to keep it around. Patients liked it because they didn’t have to take hours out of their day to travel to an appointment, go through COVID-19 protocols, wait to be called, wait to see their provider, then travel home again.
Providers liked it because they could work more efficiently and, if they were incorporating remote patient monitoring, obtain a more complete view of their patients’ day-to-day health. Both sides also liked telehealth because, quite frankly, it helped them reduce their risk of contracting a highly contagious virus.
While we are not out of the woods yet – many experts are predicting a fall and winter surge that will make the spring surge look like a warm-up act – there are already discussions about whether telehealth was simply a stopgap measure in a crisis or should be viewed as a standard option for care going forward. In order to make telehealth permanent, however, healthcare organizations will want to know exactly what it can contribute once it’s safe to venture to the office once again.
Advanced analytics can help. They can show what worked, and what didn’t, so providers can make data-driven decisions about where, how, and whether to continue using telehealth. The following are eight ways analytics can contribute to present and future telehealth success.
1. Find the patients for whom telehealth visits offer the greatest benefits. Normally, these will be patients who can be diagnosed or assessed without direct laying-on of hands. They may have a condition such as a rash that can be inspected visually or may be able to use consumer-grade devices to take and report biometric readings. Advanced analytics can help discover them, enabling providers to close care gaps while improving Star ratings and HEDIS scores.
2. Prioritize patients by need. Analytics can help identify patients who are most at-risk of deterioration if they do not follow-up after preventive or elective procedures or are not closely monitored. They can also help providers make the appropriate adjustments to those priorities as patient health changes.
3. Get ready for additional surges. The next surge has already begun, and there are likely to be others before the pandemic is fully behind us. Providers need to have measures in place to keep staff safe and avoid the risk of more lockdowns or other changes that will disrupt their operations. Analytics can help them determine how much to invest in additional telehealth equipment and training to ensure uninterrupted service to their patients.
4. Measure telehealth’s impact on patient outcomes and reimbursement. Telehealth is so new, and the pandemic has caused so many shifts in reimbursement, that it can be difficult to determine exactly what effect it has had on outcomes and revenue. Analytics can uncover which changes have been positive and should be continued, and which should either be discontinued or adjusted to produce better health and/or financial result.
5. Uncover and rectify possible coding errors. As the pandemic took hold in March, CMS launched its “patients over paperwork” initiative. The goal was to ensure providers focused on care rather than worrying about coding accuracy, especially as the path to telehealth opened up. At some point, however, accurate coding will again be required. Analytics can help providers uncover and rectify any coding issues to ensure claims are paid fairly and completely.
6. Enable more effective remote patient monitoring. The presence of a global pandemic doesn’t halt chronic or other conditions affecting patient health. These conditions must continue to be managed to prevent them from deteriorating, which will place more of a health burden on patients while increasing long-term costs. Remote patient monitoring delivers the day-to-day data on these conditions. Analytics use that data to spot trends and update providers on the condition of all those patients, making it easier to ensure successful treatment for all of them.
7. Manage timed events more effectively. Risk-adjustment capture of previously documented conditions, which comes through CMS sweeps, retrospective reviews, and other means, can be disruptive to provider operations. Analytics can take the burden off an already exhausted staff by automating and simplifying the process.
8. Use trend and outcome data to inform the future. There is still much we don’t know about the effectiveness – and cost-effectiveness – of telehealth. This type of forward-looking analysis can be used to deliver policy and regulatory guidance for permanent reimbursement and best practices for telehealth-related visits.
As we continue to battle the global pandemic, telehealth does more each day to demonstrate its value. But what happens when the battle is finally won? Should it go back to the background or become fully integrated into a healthcare organization’s standard offerings?
Advanced analytics can be used to answer these questions and many others, helping providers make the decision that best fits their organization.
About Prasad Dindigal Prasad Dindigal serves as Vice President, Healthcare & Life Sciences, with EXL, a leading operations management and analytics company that helps our clients build and grow sustainable businesses.
We’ve all experienced crises in our lives. They may be personal in nature (e.g., involving our interpersonal relationships), organizational (e.g., relating to our employment or retirement income), or nature-made (e.g., floods, tornados, or the COVID-19 pandemic). When crises hit our communities, the impacts can be widespread and far-reaching. Healthcare providers and community-based organizations (CBOs) are called upon to provide more rapid and extensive care and support to the community than is otherwise the norm. A well-established and highly functioning Connected Community of Care (CCC), as is the case here in Dallas, Texas, can provide a tremendous strategic and tactical advantage over non-connected peers.
Since 2014, the Parkland Center for Clinical Innovation (PCCI) has led an effort to bring together several large healthcare systems and a number of regional social-service organizations such as food banks, homeless assistance associations, and transportation service vendors, along with over 100 smaller CBOs (i.e., neighborhood food pantries, crisis centers, utility assistance centers) and area faith-based organizations to form the Dallas CCC. Over time, civic organizations, such as the Community Council of Greater Dallas, Dallas County Health and Human Services (DCHHS), and select academic institutions have begun to participate in various community-wide projects under the Dallas CCC umbrella.
Central to the success of the Dallas CCC are the partnerships that have been formed between the CBOs and a number of local healthcare systems (Parkland Health & Hospital System [Parkland], Baylor Scott & White Health, Children’s Medical Center, Methodist Health System, and Metrocare Services), clinical practices, and other ancillary healthcare providers serving the Dallas metroplex. These partnerships have proved essential in building a truly comprehensive and functional network aimed at improving both the health and well-being of Dallas residents.
Connecting these various entities and forming a two-way communication pathway is an electronic information exchange platform termed Pieces™ Connect, which allows for real-time, two-way sharing of information pertaining to an individual’s social and healthcare needs, history, and preferences. The information exchange platform is the glue that holds the physical network together and provides one of the mechanisms to disseminate information from public health and healthcare entities to social service providers in the community. It allows the individual community resident, via the CBO, to become better informed about important health issues, such as routine vaccinations or preventive care, such as social distancing and proper mask usage during a pandemic.
Until recently, the primary mission of the Dallas CCC focused on addressing residents’ social determinants of health (SDOH) issues through providing community resources (e.g., food assistance, housing, transportation) to improve the lives of Dallas County residents. While this mission has become even more critical during the COVID-19 pandemic, the work of the Dallas CCChas also evolved to include identifying COVID-19 sites within the County and directing community outreach efforts to help stem the rapid spread of the virus.
The Dallas CCC has provided an innovative model of community governance and cooperation to impact the consequences of the COVID-19 outbreak. From the first days of the pandemic, PCCI has been working with Parkland and DCHHS to help reliably identify and quantify the geographic location and incidence rates of positive COVID-19 cases within Dallas County. This problem is especially challenging when considering vulnerable populations and the transitory nature of these residents in inner-city communities.
Working with data provided by DCHHS, the Dallas-Fort Worth Hospital Council, and CBOs, PCCI built a series of dynamic geo-maps that were able to identify, at the neighborhood and block level, the location of hotspots of positive COVID-19 cases as well as attendant mortality rates. In addition to flagging at-risk patients and populations, the model continues to be used by public health and civic leaders to establish locations for testing sites within the city of Dallas based on COVID-19 incidence and community needs.
With the establishment of the hot-spotting, the next step was to get that information, along with general infection prevention protocols, in the hands of local CBOs to help raise awareness and slow the spread of the virus. With the aforementioned information in hand, public health workers have been able to develop targeted communications and tactical strategies to improve containment efforts through community-wide awareness and educational messaging.
By connecting local CBOs and faith-based organizations with public health workers and clinicians, the Dallas CCC is facilitating effective contact tracing and the implementation of care plans for high-risk individuals in a more efficient and scalable manner.
The value of the CCC communication network linking healthcare providers and CBOs cannot be underestimated, as it represents a highly effective and efficient mechanism to disseminate leading practice information aimed directly at high-risk populations. We have seen first-hand that communications delivered to community residents through familiar food pantries, homeless shelters, and places of worship are much more effective than community-wide public information campaigns broadcast via radio or television.
This increased effectiveness is based on the fact that many of these at-risk individuals frequent the CBOs on a regular basis for essential services and these individuals know and trust the CBO staff delivering the information. From one-on-one conversations to displaying infographic posters and take-away educational leaflets, CBOs provide a ready avenue to communicate with at-risk individuals in the communities they serve.
As mentioned, early work in Dallas County is beginning to demonstrate the value of CCC in facilitating contact tracing. In this case, the challenge is not simply identifying the location of positive COVID-19 cases but having the ability to connect those cases to other individuals within the neighborhood or community who may have come in contact with the infected individual, all while working in an environment where individuals frequently move from one location to another. Having a well-established communication system at the local neighborhood level can be extremely helpful in identifying contacts and potential contacts.
It is well-known that many individuals in impoverished, underserved neighborhoods are reluctant to speak with individuals they don’t know or trust, especially if those individuals are affiliated with government agencies, no matter how well-intentioned the agency personnel may be. Staff members at local faith-based organizations and CBOs frequented by these vulnerable residents are a highly effective resource for identifying inter-personal relationships and connecting with those individuals, which is something that has proved challenging for public health staff when working outside of a CCC environment. In Dallas, CBOs, public health, and civic staffers, as well as medical student volunteers have all been partnering to help facilitate the contact tracing process with positive results.
CCC’s can materially improve the health and well-being of a community’s residents, especially in times of crisis. The take-away lesson is clear. If you already have a CCC, lean on it to help you through crises impacting your community. If you don’t have a CCC, now is the time to begin the process of establishing one in your community. Even with the challenges that the current pandemic is generating, it is possible to begin building your CCC. Start small and gradually increase the CCC’s scope and scale; don’t be in a rush to grow. The most important thing is to take the plunge and begin the journey!
Health authorities need to prioritize delivery and the repurposing of mobile point-of-care ultrasound machines which have proven to be reliable, affordable, and effective in saving the lives of coronavirus patients.
Most Americans are familiar with ultrasound technology from the scans done to check on the status of the fetus during pregnancy.
But far fewer are aware of how valuable mobile versions of these units have also become in America’s emergency rooms where they almost instantly detect and record everything from internal bleeding, abdominal pain to life-threatening infections.
We now need to raise the status of these life-saving diagnostic machines, finding and rushing them to the frontlines of hospitals where coronavirus patients are triaged and cared for.
Even before the COVID-19 pandemic, there had been elevated global demand for these mobile – called “point of care” – units that can be brought to the bedside. Some are small handheld devices that instantly connect to a smartphone.
International relief organizations and national health authorities have issued urgent calls to manufacturers in the last few days for any surplus or underutilized ultrasound equipment capable of performing lung scans. They are also seeking point-of-care ultrasound units that are underutilized or are in “retired” inventory at clinics and hospitals around the world, units that can be adapted for use in lung ultrasound (LU) diagnosis.
Sales and maintenance records from manufacturers may also be used to track down operational LU machines that are already in-country and can be drafted into urgent service during the pandemic.
Because the most desired devices are mobile and move from patient to patient, very strict hygienic procedures must be carefully monitored and managed.
As with so many technical innovations over the past half-century, taking the technology mobile was originally funded by one of the smallest but most consequential units in our U.S. military arsenal: Defense Advanced Research Projects Agency (DARPA).
DARPA didn’t invent ultrasound, but it did help shrink the technology to mobile size so that frontline military physicians could take the technology closer to the battlefield and save the lives of wounded warriors. These mobile units, now ubiquitous in ICUs and in emergency rooms around the world, are much cheaper and lower risk than radiography (x-ray) units which are difficult to maneuver to the bedside of the critically ill especially with diseases as transmittable as a coronavirus.
It turns out that these popular mobile units provide particularly precise views of distressed lungs – important tools to have when doctors need to see the exact progression of the COVID-19 virus in infected patients who are quarantined and unable to be safely moved to a remote radiology suite. COVID-19 often presents as a respiratory invader that causes acute inflammation in the lungs, primarily as a patchy, interstitial infiltrate – a condition recognized with ultrasound imaging.
A small but important study was just published in Radiology by the Radiological Society of North America (RSNA) on March 13 which comes from other doctors also on the coronavirus frontlines in Italy.
That report – covering the records of emergency physicians at Ospedale Guglielmo da Saliceto in Piacenza, Italy – claims a “strong correlation” between lung ultrasound and CT findings in patients with COVID-19 pneumonia, leading the investigators to “strongly recommend the use of bedside [ultrasound] for the early diagnosis of COVID-19 patients who present to the emergency department.”
Pneumonia and respiratory failure are a principal cause of death among COVID-19 patients. What we can assess in a lung ultrasound right now in these patients is the involvement of both lungs with basically patchy findings. Distinctive to the disease is typically ultrasonographic B lines – wide bands of hyperechoic artifacts that are often compared to the beam of a flashlight being swung back and forth.
If there is a significant consolidation, diagnostics may also capture imagery of hepatization of the lung. This information is critical to monitoring, addressing, and curing pneumonia.
For these patients and hospitals in crisis, mobile lung-ultrasound units are also scanning far more patients in a short period of time than more elaborate diagnostic imaging technologies, while delivering an accurate, actionable answer on the presence and degree of infection.
Lung ultrasound is a critical application of the point-of-care mobile units in the emergency rooms battling COVID-19 around the world, but these patients very sick with COVID-19 may also need venous access under ultrasound guidance to administer fluids and medications. Or they may be in shock and need a shock assessment, for which point-of-care ultrasound in COVID-19 resuscitation bays and ICUs are also very useful.
The COVID-19 pandemic is expected to get worse in the U.S. before it gets better. New York, California, and the State of Washington have set up military-style hospitals – 250-bed infirmaries that will be fully functional hospitals for COVID-19 patients – and will be placing point-of-care ultrasound there and elsewhere where it would be much more difficult to put a CT scanner.
The challenge in meeting that urgent goal is whether we can find and deploy enough functional lung ultrasound devices to COVID-19 responders in the next several weeks to save lives that are already in danger and restore COVID-19 patients alive and well to families desperate for medical rescue. I believe we can and will.
About Diku Mandavia, M.D.
Diku Mandavia, M.D. is the Senior Vice President, Chief Medical Officer, at FUJIFILM Sonosite Inc., and FUJIFILM Medical Systems U.S.A., Inc. He completed his residency in emergency medicine at LAC+USC Medical Center in Los Angeles where he still practices part-time. He is a Clinical Associate Professor of Emergency Medicine at the University of Southern California.
COVID-19 terms such as quarantine, flatten the curve, social distance, and personal protective equipment (PPE) have dominated headlines in recent months, but what hasn’t been discussed in length are the hidden costs of COVID-19 as it relates to patient adherence.
The coronavirus pandemic has amplified this long-standing issue in healthcare as patients are delaying routine preventative and ongoing care for ailments such as mental health and chronic disease. Emergency care is also suffering at alarming rates. Studies show a 42 percent decline in emergency department visits, measuring the volume of 2.1 million visits per week between March and April 2019 to 1.2 million visits per week between March and April 2020. Patients are not seeking the treatment they need – and at what cost?
When the SARS outbreak occurred in 2002, particularly in Taiwan, there was a marked reduction in inpatient care and utilization as well as ambulatory care. Chronic-care hospitalizations for long-term conditions like diabetes plummeted during the SARS crisis but skyrocketed afterward. Similar to the 2002 epidemic, people are currently not venturing en masse to emergency rooms or hospitals, but if history repeats itself, hospital and ER visits will happen at an influx and create a new strain on the healthcare system.
So, if patients aren’t going to the ER or visiting their doctors regularly, where have they gone? They are staying at home. According to reports from the Kaiser Family Foundation, 28 percent of Americans polled said they or a family member delayed medical care due to the pandemic, and 11 percent indicated that their condition worsened as a result of the delayed care. Of note, 70 percent of consumers are concerned or very concerned about contracting COVID-19 when visiting healthcare facilities to receive care unrelated to the virus. There is a growing concern that patients will either see a relapse in their illness or will experience new complications when the pandemic subsides.
Rather than brace for a tidal wave of patients, healthcare systems should proactively take steps (or act now) to drive patient access, action, and adherence.
1. Identify Who Needs to Care The Most
Healthcare providers should consider risk stratifying patients. High-risk people, such as an 80-year-old male with comorbidities and recent cardiac bypass surgery, may require a hands-on and frequent outreach effort. A 20-year-old female, however, who comes in annually for her physical but is healthy, may not require that level of engagement. Understanding which patients are at risk for the potential for chronic conditions to become acute or patients who have a hard time staying on their care plan may need prioritized attention and a more thorough engagement effort.
For example, patients with a history of mental health issues may lack motivation or momentum to seek care. Their disposition to be disengaged may require greater input to push past their disengagement.
Especially important is the ability to educate and guide patients to the appropriate venue of care (ER, telehealth visit, in-person primary care visit, or urgent care) based on their self-reported symptoms. Allowing patients to self-triage while scheduling appointments helps them make more informed decisions about their care while reducing the burden on over-utilized emergency departments.
2. Capture The Attention of The Intended Audience and Induce Action
Once you’ve identified who needs care the most, how do you break through the “information clutter” to ensure healthcare messages resonate with the intended audience? The more data points, the better. It is important to understand the age of the patient, their preferred communication channel, and the intended message for the recipient, but effective communication exceeds those three data points. Consider factors like the presence of mental health conditions, comorbidities, or health literacies. Then, think beyond the patient’s channel of choice and select the appropriate channel of communication (text, phone call, email, paid social media advertisement, etc.), that will most likely induce action. As an organization, also consider running A/B tests to detect and analyze behavior. As you collect more data, determine what exactly is inducing patient action.
Of note, don’t underestimate the power of repetition. Patients may need to be reminded of the intended action a few times in a few different ways before moving forward with seeking the care they need. Repetition is also shown to decrease no-show rates, a critical metric. Proactive, prescriptive, and tailored communication will help increase engagement. Moving past the channel of choice and toward the channel of action is key.
3. Engage Patients Through Personalized and Tailored Communication
In addition to identifying the right communication channel, it’s also important to ensure you deliver an effective message. Communication with patients should be relevant to their particular medical needs while paying close attention to where each person is in their healthcare journey. Connecting with patients on both an emotional and rational level is also important. For example, sending a positive communication via phone, email, or text to lay the foundation for the interaction shows interest in the patient’s wellbeing.
A “Hey, here’s why you need to come in” note makes a connection in a direct and personalized way. At the same time, and in a very pointed manner, sharing ways providers and health systems are keeping patients safe (e.g., telehealth, virtual waiting rooms, separate entrances, and mandating masks), also provides comfort to skittish patients. Additionally, consider all demographic information when tailoring communications. And don’t forget to analyze if changes in content impact no-show rates. Low overall literacy may impact health literacy and may require simpler and more positive words to positively impact adherence.
It may sound daunting, especially for individual health systems, to personalize patient communication efforts, but the use of today’s data tools and technological advancements can relieve the burden and streamline efforts for an effective communication approach.
4. Use Technology to Your Advantage (With Caution)
Once you have developed your communication strategy, don’t stop there. Consider all aspects of the patient journey to drive action. A virtual waiting room strategy, for example, can help ease patient concerns and encourage them to resume their care. Health systems can help patients make reservations, space out their arrival times, and safeguard social distancing measures—all while alleviating patient fears. Ideally, the patient would be able to seamlessly book an appointment and receive a specific arrival time, allowing ER staff to prepare for the patient’s arrival while minimizing onsite wait time.
When implemented properly, telehealth visits can also improve continuity of care, enhance provider efficiency, attract and retain patients who are seeking convenience, as well as appeal to those who would prefer not to travel to their healthcare facility for their visit. Providers need to determine which appointments can successfully be resolved virtually. Additionally, some patients might not have the means for a successful telehealth visit due to a lack of internet access, a language barrier, or a safe space to talk freely.
To ensure all patients receive quality care, health systems should make plans to serve patients who lack the technology or bandwidth to participate in video visits in an alternative manner. For example, monitor patients remotely by asking them to self-report basic information such as blood sugar levels, weight, and medication compliance via short message service (SMS). This gives providers the ability to continuously monitor their patients while enhancing patient safety, increasing positive outcomes, and enabling real-time escalation whenever clinical intervention is needed.
It is important we ensure all patients stay on track with their health, despite uncertain and fearful times. Health systems can enhance patient adherence and induce action through the implementation of tools that increase patient engagement and alleviate the impending strain on the healthcare system.
About Matt Dickson
Matt Dickson is Vice President of Product, Strategy, and General Manager of Stericycle Communication Solutions, a patient engagement platform that seamlessly combines both voice and digital channels to provide the modern experience healthcare consumers want while solving complex challenges to patient access, action, and adherence. . He is a versatile leader with strong operational management experience and expertise providing IT, product, and process solutions in the healthcare industry for nearly 25 years. Find him on LinkedIn.
While most of the public’s attention is focused on the horse race for an approved COVID-19 vaccine, another major hurdle lies just around the corner: the distribution of hundreds of millions of vaccine doses. In today’s highly complex and disconnected health data landscape, technologies like AI, Machine Learning, and robotic process automation (RPA) will be essential to making sure that the highest-risk patients receive the vaccine first.
Why identifying at-risk patients is incredibly difficult
Once a vaccine is approved, it will take months or years to produce and distribute enough doses for the U.S.’ 330 million residents. Hospital systems, primary care physicians (PCPs), and provider networks will inevitably need to prioritize administration to at-risk patients, potentially focusing on those with underlying conditions and comorbidities. That will require an unimaginable amount of work by healthcare employees to identify patient cohorts, understand each patient’s individual priority level, and communicate pre- and post-visit instructions. The volume of coordination required between healthcare systems and the pressing need to get the vaccine to high risks groups makes the situation uniquely different than other nationally distributed vaccinations, like the flu.
One key challenge is that there’s no existing infrastructure to facilitate this process – all of the data necessary to do so is locked away in disparate information silos. Many states have legacy information systems or rely on fax for information sharing, which will substantially hamper efforts to identify at-risk patients. Consider, in contrast, the data available in the U.S. regarding earthquake risk– you can simply open up a federal geological map and see whether you’re in a seismic hazard zone. All the information is in one place and can be sorted through quickly, but that’s just not the case with our healthcare system due to its fragmentation as well as HIPAA and patient privacy laws.
There are several multidimensional barriers that make it nearly impossible for healthcare workers employed by providers and state healthcare organizations to compile patient cohorts manually:
– Providers will need to follow CDC guidelines on prioritization factors, which based on current guidelines for those with increased risk could potentially include specific conditions, ethnicities, age groups, pregnancy, geographies, living situations (such as multigenerational homes), and disabilities. Identifying patients with these factors will require intelligent analysis of patient profiles from existing electronic health record data (EHR) used by a multitude of providers.
– Some hospital networks use multiple EHR and care management systems that have a limited ability to share and correlate data. These information silos will prevent providers from viewing all information about patient population health data.
– Data on out-of-network care that could require prioritization, like an emergency room visit, is often locked away in payer data systems and is difficult to access by hospital systems and PCPs. That means payer data systems must be analyzed as well to effectively prioritize patients.
– All information must be shared and analyzed in accordance with HIPAA laws, and the mountain of scheduling communications and pre- and post-visit guidance shared with patients must also follow federal guidelines.
– Patients with certain conditions, like heart disease, may need additional procedures or tests (such as a blood pressure reading) before the vaccine can be administered safely. Guidelines for each patient must be identified and clearly communicated to their care team.
– Providers may not have the capacity to distribute vaccines to all of their priority patients, so providers will need to coordinate care and potentially send patients to third-party sites like Walgreens, Costco, etc.
All of these factors create a situation in which it’s extremely difficult – and time-consuming – for healthcare workers to roll out the vaccine to at-risk patients at scale. If the entire process to analyze, identify, and administer the vaccine takes only two hours per patient in the U.S., that’s 660 million hours of healthcare workers’ time. A combination of analytics, AI, and machine learning could be a solution that’s leveraged by healthcare workers and chief medical officers in identifying the priority of patients supplemented with CDC norms.
How RPA can automate administration to high-risk patients
Technology is uniquely poised to enable health workers to get vaccines into the hands of those who need them most far faster than would be possible using humans alone. Robotic process automation (RPA) in the form of artificial intelligence-powered digital health workers can substantially reduce the time spent prioritizing and communicating with at-risk patients. These digital health workers can intelligently analyze patient records and send communications 24 hours a day, reducing the time needed per patient from hours to minutes.
Consider, a hypothetical situation in which the CDC prioritizes certain risk profiles, which would put patients with diabetes among those likely to receive the vaccine first. In this scenario, RPA offers significant benefits in the form of its ability to:
Analyze EHR and population health data:
Thousands of intelligent digital health workers could prepare patient data for analysis and then separate patients into different cohorts based on hemoglobin levels. These digital health workers could then intelligently review documents to cross-reference hemoglobin levels with other CDC prioritization factors (like recent emergency room admittance or additional pre-existing or chronic conditions ), COVID-19 testing and antibody tests data to identify those most at risk, then identify a local provider with appointment availability.
Automate patient engagement, communications and scheduling:
After patients with diabetes are identified and prioritized, communications will be essential to quickly schedule those at most risk and prepare them for their appointments, including making them feel comfortable and informed. For example, digital health workers could communicate with diabetes patients about the protocol they should follow before and after their appointment – should they eat before the visit, what they should expect during their visit, and is it safe for them to return to work after. It’s also highly likely that widespread vaccine administration will require a far greater amount of information than with other health communications, given that one in three Americans say they would be unwilling to be vaccinated if a vaccine were available today. At scale, communications and scheduling will take potentially millions of hours in total, and all of that time takes healthcare employees away from actually providing care.
While the timeline for approval of a COVID-19 vaccine is unclear, now is the time for hospitals to prepare their technology and operations for the rollout. By adopting RPA, state healthcare organizations and providers can set themselves up for success and ensure that the patients most critically in need of a vaccine receive it first.
About Ram Sathia
Ram Sathia is Vice President of Intelligent Automation at PK. Ram has nearly 20 years of experience helping clients condense time-to-market, improve quality, and drive efficiency through transformative RPA, AI, machine learning, DevOps, and automation.
With its share price falling from more than $66 to less than $24, September was a tumultuous month for Nanox.
On August 25th, the medical imaging start-up closed its initial public offering, having raised $190m from the sale of 10,555,556 ordinary shares at a price of $18 each. Money poured in as investors were sold on Nanox’s cold cathode x-ray source and the subsequent reduction in costs that it would enable, as well as the vendor’s pay-per-scan pricing model that would let the company access new, untapped markets.
A week later the shares were being traded for almost double their opening amount, and by the 11th of September, they had reached a peak of $66.67. This meteoric rise soon came to an end though, as activist short-seller Andrew Left of Citron Research published a report comparing the Israeli start-up to disgraced medical testing firm Theranos and asserted that the company’s shares were worthless.
Other commentators added to Left’s criticism, causing investors to abandon the stock. Class action lawsuits followed, with legal firms hoping to defend shareholders against the imaging company’s alleged fabrication of commercial agreements and of misleading investors.
Nanox defended itself against the Citron attack, insisting that the allegations in the report are ‘completely without merit’, but the extra scrutiny and threat of legal repercussions have left the share price continuing to plummet, falling to $23.52 at month’s end.
– New business and payment models could capture demand from new customers in untapped and emerging markets
– Vendors should be reactive. A successful launch of Nanox’s X-ray system could channel more focus and resources on the portfolio of low-end X-ray systems
– Once established, recurring services are hard to displace
– However, brand loyalty and hard-earned reputations aren’t easily forgotten
– Potential for disruptive technology to expand access to medical imaging and provide affordable X-ray digital solutions, delivering a significant and rapid overall market expansion
– New customer bases could have less expertise and a lack of trained professionals – ease of use becomes a critical feature
– Where X-ray system price is a battleground, and a fundamental factor driving purchasing decisions, Nanox’s proposed ecosystem offers revenue-generating opportunities
The Signify View
Assessing the viability and long-term potential of any business is a dangerous game, doubly so if it depends on a closely guarded game-changing technological innovation as is the case with Nanox. Fortunes are won and lost on a daily basis by investors, speculators, and gamblers trying to get in on the ground floor of the next ground-breaking company after being convinced by slick presentations and thorough prospectuses.
There is likely merit in some of the arguments being put forward by those on either side of the Nanox debate. For example, the lack of peer-reviewed journal articles about new technology is questionable. But, the skepticism around the feasibility of Nanox’s technology seems to ignore that research into cold-cathode x-ray generation, the cornerstone of Nanox’s offering has been ongoing for numerous years, and isn’t as out of the blue as the naysayers may suggest.
Regardless of these and other specifics in the ongoing fracas between short-sellers, Nanox, investors, and lawyers, all of whom have their own agendas, the voracity with which the stocks were initially purchased shows the keen appetite investors have for a company that would bring disruption to the X-ray systems market.
When delving into Signify Research’s data on this market, it is easy to see why. Across many developed and mature regions, the market has become relatively stable. It is one of replacement and renewal rather than selling to new customers and increasing the accessibility of X-ray imaging. Developed markets do continue to drive growth for X-ray manufacturers to some extent, particularly as a result of digitalization and favored reimbursement for digital X-ray imaging. However, by and large, the market remains broadly flat, with a CAGR of just 2.7% forecast for the period 2018-2023.
Figure 1: While there are some growth areas, the X-ray market as a whole is very stable
Nanox has strong ambitions to outperform this underwhelming outlook by utilizing its unique and more affordable technology to offer a relatively feature-rich system, dubbed the Arc, at a far lower price than existing digital X-ray systems. Competing on price is only one part of the equation, however.
After all, there are countries where, despite their economies of scale, the multi-national market leaders in medical imaging are unable to compete with domestic manufacturers, which are able to produce X-ray systems locally, with lower overheads, and no importation costs. Globally, there are also a large number of smaller imaging vendors, which have limited, yet low-cost offerings at the value end of the market, with this increased competition driving down average selling prices.
To differentiate itself further, Nanox also plans to launch with a completely new business model. Instead of traditional transactional sales, which see providers simply purchase and pay the full cost of the imaging system in one installment, use the system for the entire shelf life of the product and then replace with an equivalent model, Nanox plans to retain ownership of its machines, but charge providers to use them on a pay-per-scan basis.
There are some regions and some situations where legislation and other factors make this model unfeasible, so Nanox will also make its products available to purchase outright, as well as licensing its technology to other firms. However, the start-up’s focus is on offering medical imaging as a service.
The company says that this shift from a CapEx to a managed service approach means that instead of competing with established vendors over market share, it will be able to expand the total market, enabling access to imaging systems in settings where they have been hitherto absent, with urgent care units, outpatient clinics, and nursing homes being suggested as targets.
According to the Nanox investor’s prospectus, current contracts already secured (although the legitimacy of these deals is one of the issues raised by the short-sellers) feature a $40 per scan cost, of which Nanox receives $14 – although the exact figure varies depending on regional economics. The contracts feature a minimum service fee equivalent to seven scans a day, although the target is somewhat higher, with each machine expected to be used to produce 20 scans a day, for 23 days a month.
If Nanox’s order book is as valid as the company insists, and it already has deals for 5,150 units in place, each system will consequently be bringing in a minimum of $27,048 dollars per year for a minimum total revenue of $139m. If the systems are used 20 times a day as Nanox hopes, that means almost $400m in sticky recurring revenues annually. To put that in perspective, one of the market leaders for X-ray imaging systems in 2018 was Siemens Healthineers, which turned over almost $2.8bn across its general radiography, fluoroscopy, mammography, mobile, angiography, and CT imaging divisions.
With an order book that is, on the face of it, this healthy, there have been questions as to why Nanox went public at all, but the listing may be required for this business model to work. The Israeli vendor says that the vast majority of the investment will be sunk into producing the Nanox scanners, and the associated manufacturing capacity. This is necessary because unlike other imaging companies selling systems on a CapEx basis, Nanox will receive nothing for delivering scanners to customers. Revenue is generated later as the systems are used.
This means that the company is effectively fronting the initial cost of the systems, so needs to get as many units installed and being used as quickly as possible to recoup its initial costs. Unlike other vendors, it cannot rely on sales of a first tranche to fund the second and so on, in its new managed service model, it is better to mass produce everything at once.
Open to exposure
There is, however, nothing to stop other, established players from switching to a similar model. This should be of concern to Nanox, after all, Siemens Healthineers or GE Healthcare already have the manufacturing capacity and capital ready to offer products in a similar way.
And of course, Nanox, shouldn’t underestimate the difficulty of disrupting a long-established market. Despite ample funding and solid products, other companies are still struggling to make an impact in other markets. For example, Butterfly Network, a vendor offering an affordable handheld ultrasound solution, has a valuation of over $1 billion and has received more than $350m in funding.
In 2019, the company turned over $28m, enough to make it the market leader in the nascent handheld category, but in a global ultrasound market worth almost $7bn, at present, it is little more than a drop in the ocean.
Nanox hopes that its own new business model would be disruptive by opening up the market to a far greater range of customers than are currently served. A nursing home, for example, might not be able or willing to allocate the cost of a CT machine from a single year’s budget, but spreading that cost as the scanner is used, and particularly if that cost is passed on to patients at a time of use, on-site imaging suddenly becomes a far more feasible proposition.
What’s more, if a company was able to increase its product’s user base there is a strong possibility for upselling additional services, software, and tools. These could be things like AI modules that increase workflow efficiency, or, especially pertinent given the pricing model could allow machines to be installed in new settings that lack on-site expertise, tools that aid clinical decision making.
Beyond that, there is also ample scope for an imaging vendor to entice a customer into its ecosystem with a scanner that has no cost at the point of delivery, before getting it to commit to its own PACS and other IT systems. Being able to fully exploit these new customers relies, in the first instance, on being able to get a foot in the door. That is why an imaging service model could be so beneficial, even if the returns on the scans themselves aren’t especially lucrative.
While adopting a new business model and securing revenue from add-ons and upselling would help established vendors countenance the price differential Nanox proposes, if we are to take the start-up at its word, addressing its feature set might be another matter entirely.
As well as just providing imaging hardware, Nanox is offering a service that, at face value, is more complete. The Arc automatically uploads all imaging data to its cloud SaaS platform. This platform would initially use AI systems to ‘provide first response and decision assistive information’ before radiologists could provide final diagnoses that could then be shared with hospitals in real-time.
Figure 2: With teleradiology read volumes increasing, it makes sense that the necessary hardware comes baked into the Arc
There is currently limited information available about the exact nature of the so-called Nanox.CLOUD and its integration with the Arc, although several assumptions can be made:
– Firstly, although built-in connectivity is being touted as a feature with clinical benefits, its inclusion is as likely to be a necessity as a design choice, given that Nanox presumably needs to be able to communicate with the systems in order to find out scan volumes and bill accordingly. Or, more drastically, render the system inoperable if people don’t keep up with payments.
– Another assumption that can be made is that the full suite of tools wouldn’t be included in the basic pay-per-scan fee. Signify’s Teleradiology World – 2020 report found that in 2020, the average revenue per read for a teleradiology platform is, in North America for example, $24.40. As such, teleradiology services would only be able to be offered at an additional cost, creating another revenue stream for Nanox.
– Another sticking point could also be Nanox’s promise to enable the integration of its cloud into existing medical systems, via APIs. While well and good in theory, the competitiveness, complexity, and proprietary nature of many medical imaging workflows, combined with the fact that many vendors have absolutely no incentive to make integration easy for the newcomer, mean that in practice, it is likely to either be a prohibitively expensive, or frustratingly limited offering. This is one area where established vendors, which already offer comprehensive medical imaging packages, have a distinct advantage.
Back down to Earth
The short positions promoted by commentators including Citron Research and Muddy Waters Research postulate that the Nanox.ARC scanner isn’t real. There are some legitimate questions, but running through their papers is also an attitude that Nanox’s claims are simply implausible, whether that is because it has an R&D budget a fraction of the size of GE, or because anonymous radiologists unrelated to the company haven’t seen anything like it before.
It is worth remembering, though, that these short sellers will benefit financially if Nanox slumps. Nanox conversely, is obviously financially incentivized to promote its technology and its potential, and it wouldn’t be the first company, to promote the limited fruits of its start-up labor in a flattering light.
As so often happens in these he said, she said situations, the truth could well lie somewhere between the two extremes. Even in this instance, even if Nanox fails to deliver on some of its more impressive promises, the fact is, it has suggested bringing a whole new customer base into play and laid out a strategy for selling to them.
With that being the case, for a big vendor the issue of whether Nanox is legitimate almost becomes moot, their focus should be what these other customers require, how to get these customers into their product ecosystems, and what add-on products, and additional services they can feasibly sell them at a later date.
If nothing else, the entire Nanox furor shows that to achieve growth in mature markets, a vendor’s innovation needs to extend beyond its products.
About Alan Stoddart
Alan Stoddart is the Editor at Signify Research, a UK-based market research firm focusing on health IT, digital health, and medical imaging. Alan joined Signify Research in 2020, using his editorial expertise to lead on the company’s insight and analysis services.
If you work in healthcare, chances are that the COVID-19 pandemic forced you to quickly scale up or move staff around to manage the onslaught of patients. The demand for clinicians and support staff grew alongside the spread of the virus, making organizations add clinicians or reassign employees with new or modified roles: Ambulatory nurses went down in the Emergency Department or Isolation Ward, revenue cycle folks started doing transport, and so on. In some cases, former staff or retired workers were called back to help with the surge. In the midst of these time-compressed changes, organizations remained rightly focused on their number one priority: patient care delivery. In the background, IT professionals were struggling to manage the slew of new digital identities while ensuring fast-access to new applications, workflows, and devices to accommodate remote work. Giving clinicians this access meant having to quickly provision and deprovision access during the staff ramp-up. Inevitably, access became a problem – whether to the systems or applications needed to do their jobs. In worst-case scenarios, organizations had to balance security and compliance with the delivery of healthcare services to patients. Security protocols were also compromised – a trade-off that should never have to happen.
Pandemic Spotlights Needs for IGA In response to the identity management challenges presented by the COVID-19 pandemic, healthcare IT organizations that had and Identity Governance Administration (IGA) systems came to the rescue. Those that didn’t, well….. IGA systems provide a fast, reliable way to manage digital identities through provisioning, governance, risk and compliance, and de-provisioning for healthcare workers who need access to workstations and applications. This is even more so the case in a crisis environment. A recent study conducted by Forrester Consulting found that an automated system helps organizations manage, streamline, and secure transactions across hypercomplex ecosystems of healthcare users, locations, devices, and locations. What’s more, according to Forrester, automation also saves time and money and results in a higher quality patient experience.
Fact is, even in the normal times, healthcare organizations rarely excel at tracking personnel moves, especially the adds and changes due to the time and system constraints often involved. That leads to what I call a “stacked shares” situation. These typically involve a person with decades of experience in your organization who has worked in multiple administrative or clinical areas within the organization and has access to about 80 percent of your network shares because she/he was never deprovisioned from ANY shares. In these instances, the network shares just kept getting “stacked,” one on top of the other. That’s probably exactly what happens during the COVID-19 pandemic as people move around to adapt to the ongoing crisis.
Another unexpected challenge created by the pandemic relates to furloughs. What is your healthcare organization doing with them? Are you disabling and then re-enabling accounts? Re-provisioning when/if they come back? What if they’ve come back but in a new role? Again, the “stacked shares” situation arises. You will likely regret it if your organization doesn’t have an automated IGA system to help you keep track of these movements through an integrated GRC system.
Moving to a Remote Workforce COVID-19 forced many healthcare organizations to rapidly accommodate a remote workforce. Only a few departments worked remotely before the pandemic, so routers, network, architecting, and bandwidth all had to be upgraded. Most health systems also required additional licensing to successfully ramp up services. Above all, the priority was to prevent any serious disruptions for clinicians.
Here again, health systems faced the challenge of balancing usability with security concerns. Tools like Zoom and Microsoft Teams proved useful, but they created additional risks including diminished safety of our healthcare workers, cybersecurity intrusions, and hacks – like theft of PHI, ransomware, and more. IT staff had to ensure the security of both the devices and the platforms being used, which is also easily managed by solid IGA systems.
In these cases, IGA systems analyze login data in real-time via Login Activity reports. They weave digital identity and access management, single-sign-on capabilities, and governance into workflows to strengthen security without compromising care delivery. This includes remote identity proofing to enable electronic prescribing of controlled substances (EPCS), as well as ensure compliance with DEA regulations while avoiding in-person interactions.
We will no doubt be living in a world of both in-person and remote healthcare for some time given the COVID-19 crisis. One lesson we already learned from the big experiment we just completed is that healthcare organizations benefit from having an IGA system in place to help balance their healthcare delivery, efficiency, and safety, as well as security and compliance. Implementing an IGA strategy no doubt makes it easy for clinicians to securely and seamlessly transition between workstations and applications and have their identity follow them.
About Wes Wright
Wes Wright is the Chief Technology Officer at Imprivata and has more than 20 years of experience with healthcare providers, IT leadership, and security. Prior to joining Imprivata, Wes was the CTO at Sutter Health, where he was responsible for technical services strategies and operational activities for the 26-hospital system. Wes has been the CIO at Seattle Children’s Hospital and has served as the Chief of Staff for a three-star general in the US Air Force.
So long as we could say, “Healthcare is a business,” we could continue to avoid the moral and ethical choices from which such statements shield us.
But then COVID-19 came into the picture and the bottom dropped out of healthcare as a business. Hospitals and health systems are hemorrhaging money; the American Hospital Association estimates total losses will exceed $300 billion by the end of the year.
“The growing number of cases is threatening the very survival of hospitals just when the country needs them most,” writes Bloomberg News. “Hundreds were already in shaky circumstances before the virus remade the world, and the impact of caring for COVID-19 patients has put hundreds more in jeopardy.”
Nowhere are these dire illustrations of American healthcare during COVID more impactful than in the country’s rural areas, most of which struggled mightily even before there was a pandemic. Predominantly white small towns and unincorporated areas are where so-called diseases of despair—alcoholism, drug addiction, suicide—are at their worst. To say the closing of a hospital in these areas adds insult to injury dramatically undersells the devastation.
Since 2005, more than 170 rural hospitals have closed in America; 18 of those shut down in 2019 alone and 14 closed by mid-August of this year. When a rural hospital closes, it doesn’t just make lifesaving care more difficult to get, but it certainly does that. According to a University of Washington study, rural hospital closures drive up mortality rates in the surrounding community by about 6 percent. Comparable urban closures have no discernable impact on mortality.
Immediate access to the care a full-service hospital with specialists provides may have made the difference for Robert Finley. A resident of Fort Scott, Kansas, which lost Mercy Hospital in February 2019, Finley fell and hit his head shoveling snow and then went to sleep with what turned out to be a brain hemorrhage. During a week in the hospital, he never regained consciousness.
“When this kind of trauma happens, time matters,” explains Sarah Jane Tribble on Kaiser Health News’s Where It Hurts podcast. “It takes time for the medevac operator to find a pilot to come for Robert. The pilot then has to get there. Once he’s arrived, he still has to transport Robert to Kansas City.”
Hospital closures also blow a sizeable hole in the surrounding community. These facilities are often one of the largest employers. The hospital itself and employees—well-paid physicians among them—are a crucial part of the tax base. Satellite facilities like clinics and dialysis centers, not to mention other local businesses with which the hospital contracted, often disappear shortly after the hospital shuts down.
The challenges a hospital closure creates are often placed before people who can least afford yet another obstacle.
“By one estimate, socioeconomic factors account for 47 percent of health outcomes,” write George Holmes and Sharita Thomas in the AMA Journal of Ethics. “Poverty and inadequate transportation are two important social factors that make rural residents particularly vulnerable to a hospital closure. Rural residents experience higher rates of poverty than do urban residents and can live in communities of ‘persistent poverty,’ where the poverty rate is at least 20 percent over approximately 30 years.”
Holmes and Thomas, acknowledging that healthcare is a business, suggest that the ethical approach to closing a hospital is to engage the community as a partner throughout the process. Will emergency services still be provided after the hospital is gone? Can transportation challenges be mitigated? What will the closure do to the job base?
These and many other questions are valid. With COVID-19, however, there emerges another question that was less frequently discussed pre-pandemic: To what extent is a hospital a public good more than it is a business?
“Coronavirus is definitely a reminder that health care is, in fact, a public good,” says Dan Mendelson, founder of healthcare advisory consultancy Avalere Health. “We all have a vested interest in making sure that everybody around us is seeking appropriate medical care at the right time.”
That public good, Mendelson explains further, is not limited to the current COVID-19-fueled scenario. When people don’t have insurance or access to care, they tend to wait until their health gets much worse before seeking treatment, which guarantees either very expensive treatment or mortality. Regular exams enable early treatment, which gives clinicians the opportunity to manage illness more efficiently, effectively, and affordably.
Still, nothing illustrates the idea of healthcare as a public good quite so elegantly as a pandemic. And while many people initially thought COVID-19 would mercifully avoid adding to the struggles of rural Americans, it’s become clear that the virus does not discriminate based on geography.
The current scenario in rural America hastens the country’s reckoning with a fractured healthcare system that leaves too many sick or bankrupt or both. This day was always coming, after all.
What’s necessary to ensure the availability of care in America’s rural areas is the resolve to ensure it exists. Calling it a public good may help sell it, but ultimately what it’s called matters less than that it’s there. In many ways, the fate of rural hospitals is a test of America’s commitment to rural life as more than an exercise in economic viability. Certainly, the food produced in rural areas is a public good we’re willing to subsidize. Is not healthcare also?
The good news is that many of the ideas bandied about as solutions for the broader healthcare crisis will lift up both urban and rural hospitals and providers.
Beyond creative payment schemes, resolve manifests as public policy.
“If reduced prepayments nevertheless threaten the availability of critical services, additional public policies may be necessary to subsidize providers whose losses might jeopardize the health of communities,” Blumenthal, et al, write.
If what matters in economics is the numbers, what will ultimately matter in moving away from a predominantly economic approach to healthcare is also the numbers, but in terms of casualties. The economic approach couldn’t keep tens of thousands from dying of COVID-19 in hospital-rich urban areas, so it’s a bad argument for letting the rural poor expire because the local hospital can’t break even.
This will be ugly and sad. Racism has cost this country $16 trillion over the last twenty years according to a recent Citigroup report. Much of this loss ($13 trillion) was attributed to discriminatory lending practices and the 6.1 million fewer jobs created as a result, while disparity in wages ($2.7 trillion) and discrimination in housing policies and lost income due to restricted access to higher education accounted for the balance. The report estimates that if these gaps were to be closed, an incremental $5 trillion can be added to U.S. GDP over the next five years alone. Obviously, this does not even begin to account for the extraordinary pain and suffering racism inflicts on our country, much less the dramatic implications to the health and wellbeing for those impacted by racism.
The dramatic increase in unemployment since the onset of COVID-19 has garnered significant attention. While the overall unemployment rate of 7.9% in September is down from the pandemic-high of 14.7% in April, this improvement masks the dramatic discrepancies in rates for minorities; according to the U.S. Bureau of Labor Statistics, white Americans are 7.0% unemployed while the Black unemployment rate is 12.1%. Somewhat jarring, last week Columbia University published an analysis showing that eight million more people are now living in poverty just since the expiration of the Cares Act three months ago, disproportionally hitting minorities.
The story is even more dire when looking at the “True Rate of Unemployment” as defined by the Ludwig Institute for Shared Economic Prosperity which presumes that one needs to earn a minimum living wage of $20,000 to be deemed employed. Under such a definition, Black unemployment is 30.4%, although an improvement from what was seen for the ten years after the Great Recession of 2008.
It is estimated that 100.6 million Americans are out of the labor force now, many of whom are from disadvantaged segments of the population. In fact, for those earning more than $60,000 annually, the unemployment rate is a mere 1.0% below where it stood at the onset of the pandemic. For those who make less than $20 per hour (equivalent to a salary of approximately $27,000), the unemployment rate is 17.5% below where it was in February 2020 according to Opportunity Insights. Shockingly, America’s billionaires net worth has increased more than $850 billion since April.
The difference in life expectancy between white and Black Americans is criminally high – nearly five years, even when adjusted for gender, according to the Centers for Disease Control and Prevention (CDC) data. While the underlying causes are complex and fraught with political overtones, this issue is now front and center as the country struggles with the pandemic.
Sutter Health recently published COVID-19 data that attributed the 2.7x increase in hospitalization rates in their hospitals for Black patients versus white patients to, in part, more advanced illness at the time of admission, arguably reflecting a cultural aversion to the healthcare system or challenges around adequate access. CDC data are even worse, tabulating a 5.0x higher rate of hospitalization, 2.3x greater mortality rate, and 3.0x greater infection rate for Black versus white Americans, respectively. This is particularly troublesome now with case counts spiking 17% just this past week and as winter sets in.
The Kaiser Family Foundation (KFF) forecasts that Medicaid roles will increase by 8.4% in 2021; in June there were 67.9 million Medicaid beneficiaries. It is quite clear that the pandemic is hitting minority and less educated segments of the population harder, often because they tend to be front-line essential workers and/or struggle with greater levels of unemployment. McKinsey recently estimated that as many as 10 million Americans will lose employer-sponsored health insurance due to COVID-19 by the end of 2021.
KFF also highlights the discrepancies in private health insurance rates by race: in 2018, white, Black, and Hispanic uninsured rates were 7.5%, 11.5% and 19.0%, respectively, which further exacerbates difficulties for minorities to access effective healthcare. The Affordable Care Act had a dramatic impact over the past decade as uninsured rates in 2010 were 13.1%, 19. 9% and 32.6%, respectively. This year the average family health insurance premium rose by 4% to more than $21,000.
While there is a heightened level of concern about the pace of coronavirus vaccine development, and whether there will be inappropriate political pressures applied to compromise long-cherished safety protocols, the Black community is expressing a particularly high level of skepticism. According to another KFF study, just under 50% of Black respondents would not take a free and safe vaccine, while only 17% would “definitely” do so. While further underscoring long-held distrust of the healthcare system, this phenomenon risks perpetuating the relatively poor health conditions experienced in many of those communities.
Recognizing this and the other numerous challenges introduced by the pandemic, the Healthcare Anchor Network (HAN) of 39 provider systems (many of whom are Flare Capital LPs) reiterated in September that racism is a public health crisis, putting forth a number of steps to chip away at these issues. First and foremost was a commitment to dramatically improve access to testing in underserved communities, as well as more robust inclusive hiring practices and greater spending with diverse suppliers and vendors.
Importantly, the HAN spotlighted that systemic racism uncouples the public health infrastructure from the private healthcare system, often leading to “generational trauma and poverty.” A profound characterization. A recent Wall Street Journal analysis of CDC data showed a strong link between racism and mental health: in the week following the murder of George Floyd in May, 40.5% of Black adults exhibited symptoms of anxiety and depression (a five-point increase from the week just prior). While somewhat similar to post-traumatic stress disorders, racism is chronic and on-going much like an injury, and should not be considered a disorder. Clinicians have now developed a “Race-Based Traumatic Stress Symptom” scale when evaluating minority patients.
Advances in healthcare technology hold profound promise to improve the health and wellbeing of those most afflicted by racism, particularly during such difficult economic times. According to a provocative analysis by McKinsey (below), many of the most seminal transformative reforms in healthcare have come on the heels of major recessions. Arguably, what has been unleashed on the U.S. economy by COVID-19 may lead to a dramatic restructuring of the healthcare industry, which could usher in a wave of significant innovation to improve conditions for those most disadvantaged.
Entrepreneurship has been one of the great elixirs in the face of such devastating economic conditions and is often looked upon as one approach to reduce economic disparities due to racism. Here, unfortunately, the record is mixed. Given how critical access to capital is, the evidence that racial discrimination compromised many minority groups from accessing emergency funding programs like the Payroll Protection Program (PPP) this past spring is particularly painful. According to the Center for Responsible Lending, 46% of white-owned businesses had accessed bank credit over the past five years (compared to less than 25% for Black-owned businesses) which meaningfully facilitated their ability to secure PPP loans from those same institutions.
Furthermore, a 2016 Federal Reserve Bank study found that only 40% of minority credit applicants secure the full requested amounts of credit when applying as compared to 68% for white-owned applicants. Consistently minority-owned companies pay higher interest rates and have more onerous borrowing terms according to the Department of Commerce’s Minority Business Development Agency. The financial landscape confronting Black-owned businesses is materially more hostile than what white-owned businesses face. Full stop.
Rock Health, a leading seed-stage healthcare technology investor (and partner of Flare Capital), recently conducted an extensive diversity survey. These sober findings further highlight the issues around access to capital for minority entrepreneurs. White and Asian founders were nearly twice as likely to backed by venture capitalists; 48% of Black founders bootstrapped their companies versus 25% of white founders. Of the nearly 250 founder respondents in the survey, 12% identified as Black but only a disappointing 5% of the 425 senior executives in those companies were Black. Just over 80% of Black respondents felt that the digital health sector was either the same or less inclusive from when they initially joined the industry. Obviously, much work is still to be done.
These issues are not at all lost on my partners and our firm. Since we started Flare Capital over six years ago, we have been committed to diversity and inclusion. In addition to simply being the right thing to do, it is the best thing for our business. We will make better investment decisions with a broadly diverse set of perspectives and experiences.
But as inclusive as we felt we were, it is time to do even better. There are systemic causes to these inequities in our industry that we can help address. Over the last four months, we developed a set of new initiatives (summarized below) that we implemented earlier this summer. In summary, we identified two broad dimensions that we are committed to improving upon more equitable access and accelerated career development. Structural challenges exist for many underrepresented entrepreneurs to meet with venture capital firms, much less successfully raise capital. These are fundamental problems that require deliberate, measurable steps from engaging with more diverse founding teams, recruiting more diverse management teams, and partnering with venture firms equally committed to diversity.
BIPOC = Black, Indigenous, People of Color
We recognize that it will take time and significant effort to address these inequities, and that success will be built, in part, upon many small victories. Arguably, Black Lives Matter is the largest movement in our country’s history. The New York Times recently estimated that between 15 to 26 million Americans likely participated in demonstrations since the death of George Floyd in late May. We are proud to be a part of that movement.
About Michael A. Greely
Michael A. Greely is the CoFounder and General Partner at Flare Capital Partners, a venture capital firm focused on investing in early-stage and emerging healthcare technology companies. Previously, Michael was the founding General Partner of Flybridge Capital Partners where he led the firm’s healthcare investments. Current and prior board seats include Aspen Health, BlueTarp Financial, Circulation, Explorys, Functional Neuromodulation, HealthVerity, higi, Iora Health, MicroCHIPS, Nuvesse, PolyRemedy, Predictive Biosciences, Predilytics, T2 Biosystems, TARIS Biomedical, VidSys and Welltok (observer).
The COVID-19 virus is ravaging the planet at a scale not seen since the infamous Spanish Flu of the early 1900s, inflicting immense devastation as the U.S. loses more than 200,000 lives and counting. According to CDC statistics, 94% of patient mortalities associated with COVID-19 were simultaneously suffering from preexisting conditions, leaving a mere 6% of victims with COVID-19 as their sole cause of death. However, while immediate prospects for a mass vaccine might not be until 2021, there is some hope among rural hospital health information technology consultants where the pandemic has hit the hardest.
The fact that four in ten U.S. adults have two or more chronic conditions indicates that our most vulnerable members of the population are also the ones at the greatest risk of succumbing to the pandemic. From consultants laboring alongside healthcare administrators and providers, all must pay close attention to patients harboring 1 of 13 chronic conditions believed to play major roles in COVID-19 mortality, particularly chronic kidney disease, hypertension, diabetes, and COPD.
Vulnerable rural populations must be supervised due to their unique challenges. The CDC indicates 80% of older adults in remote regions have at least one chronic disease with 77% having at least two chronic diseases, significantly increasing COVID-19 mortality rates compared to their urban counterparts.
Health behaviors also play a role in rural patients who have decreased access to healthy food and physical activity while simultaneously suffering high incidences of smoking. These lifestyle choices compound with one another, leading to increased obesity, hypertension, and many other chronic illnesses. Overall, rural patients that fall ill to COVID-19 are more likely to suffer worsened prognosis compared to urban hubs, a problem only bolstered by their inability to properly access healthcare.
Virus Helping Push New Technologies
COVID-19 has shown the cracks in the U.S. healthcare technology system that must be addressed for the future. As the pandemic unfolds, it’s worth noting that not all lasting effects will be negative. Just as the adoption of the Affordable Care Act a decade ago spurred healthcare organizations to digitize their records, the COVID-19 pandemic is accelerating overdue technological shifts crucial to providing better care.
Perhaps the most prominent change has been the widespread adoption of telehealth services and technologies that connect patients with both urgent and preventive care without their having to leave home. Perhaps the most prominent change has been the widespread adoption of telehealth services and technologies that use video to connect patients with both urgent and preventive care without their having to leave home.
Even if COVID-19 were to fade away on its own, the next pandemic may not. Furthermore, seasonal influenza serves as a reminder that healthcare is not a skirmish, but a prolonged war against disease. Rather than doom future generations to suffer the same plight our generation has with the pandemic, now is the time to develop innovative IT strategies that focus on protecting our most vulnerable citizens by leveraging existing healthcare initiatives to focus on proactive responses instead of reactive responses.
On the Right Road
While some of the most vulnerable people are the elderly, rural residents, and the poor, the good news for them is that CMS has long advocated the use of preventive care initiatives such as Chronic Care Management (CCM) and Remote Physiologic Monitoring (RPM) to track these geriatric patients. To encourage innovation in this sector, CMS preventive care initiatives provide generous financial incentives to healthcare providers willing to shift from conventional reactive care strategies to a more proactive approach focused on prevention and protection. This should attract rural hospital CEOs who have been struggling even more than usual because of the virus.
These factors led to the creation of numerous patient CCM programs, allowing healthcare executives and providers to remotely track the health status of geriatric patients suffering from numerous chronic conditions. The tracking is at a rate and scope unseen previously through the use of electronic media. Interestingly enough, the patients already being monitored by CCM programs overlap heavily with populations susceptible to COVID-19. To adapt existing infrastructure for the COVID-19 pandemic is a relatively simple task for hospital CIOs.
As noted earlier, one growing CCM program that could be retrofitted to deal with the COVID-19 pandemic are the use of telehealth services in rural locations. Prior to the pandemic, telehealth services were one of the many strategies advocated by the CDC to address the overtaxed healthcare systems found in rural locations.
Better Access, Funding and User Experience for Telehealth
Today, telehealth is about creating digital touchpoints when no other contact is possible or safe. It offers the potential to expand care to people in remote areas who might have limited or nonexistent access, and it could let other health workers handle patient screening and post-care follow-up when a local facility is overwhelmed. As a study published last year in The American Journal of Emergency Medicineaffirms, virtual care can cut the cost of healthcare delivery and relieve strain on busy clinicians.
Telehealth has also gotten a boost from the $2 trillion CARES Act stimulus fund, which provides $130 billion to healthcare organizations fighting the pandemic. The effort also makes it easier for providers to bill for remote services.
The reason for the CDC and hospital administrators’ interest in telehealth was that telehealth meetings could outright remove the need for patients to travel and allow healthcare providers to monitor patients at a fraction of the time. By simply coupling existing telehealth services with CMS preventive care initiatives focused on COVID-19, rural healthcare providers could detect early warning signs of COVID-19.
Integration Key to Preemptive Detection
This integration at a faster and far greater scale could mean much greater preemptive virus detection through routine telehealth meetings. The effect of telehealth would be twofold on hospitals serving rural and urban health communities. It could slow the spread of COVID-19 to a crawl due to decreased patient travel and improved patient prognosis through early and intensive treatment for vulnerable populations with two or more chronic health conditions.
This integrated combination would shift standard reactive care to patient infections to a new monitoring methodology that proactively seeks out infected patients and rapidly administers treatment to those most at risk of mortality. This new combination of preventive care and telehealth services would not only improve patient and community health but would relieve the financial burden incurred from the pandemic due to the existing CMS initiatives subsidizing such undertakings.
In conclusion, preventative care targeting patients with pre-conditions in rural locations are severely lacking in the context of the COVID-19 pandemic. By leveraging CMS preventive care initiatives along with telehealth services, healthcare providers can achieve the following core objectives.
First, there are financial incentives with preventive care services that will relieve the burden on healthcare systems. Second, COVID-19 vulnerable populations will receive the attention and focus from healthcare providers that they deserve to slow the spread through the use of early detection systems and alerts to their primary health provider. Third, by combining with telehealth service, healthcare providers can efficiently and effectively reach out to rural populations that were once inaccessible to standard healthcare practices.
The COVID-19 pandemic has forever changed patient expectations for healthcare delivery, including offered services and health office operations. Although health systems have remained dynamic in adopting telehealth capabilities, their long-term capital, like real estate and supply chain management (SCM) protocols, have not adapted to match these expectations. Health systems must be aware of current trends in both areas to inform their future decisions.
Divesting in healthcare real estate is also key to reducing unnecessary costs to a health system, especially if optimal use of these spaces is already lacking. The overwhelming costs of ownership and management lock money away in underutilized and obsolete real estate spaces. Divesting provides more capital liquidity, and frees capital to go towards investment in telehealth, diagnostic technology, and emerging specialties, assets that go towards increasing patient and workforce engagement and satisfaction. In addition, eliminating unused real estate assets allows freedom from liabilities and human capital investments, like facility maintenance and upkeep, not to mention the increased frequency of deep cleaning necessary in the post-COVID-19 bi-lateral operations era.
Further, years of mergers and acquisitions in the healthcare industry have left many health systems with the unwanted result of increases in real estate assets. This has led to increased consolidation of these assets, a trend that has been exacerbated by the pandemic pressure on health system funds. Future consolidation and reevaluation of assets should be informed by trends in patient expectations as well as trends in the market.
Here are five emerging trends driving the future of healthcare real estate and assets. Each encourages divestment out of health system real estate ventures or restructuring of existing spaces in order to better cater to forever changed patient expectations.
1. Rise of Telehealth
According to the Department of Health & Human Services, telehealth use is up around 50% in primary care settings since the beginning of the public health emergency and is projected to remain high in the time following. Most recently, in-person visits have increased and as a result, telehealth visits have declined due to the state’s reopening, and thereby some critics posit that this trend may not continue. However, that could not be further from the truth.
Moving forward, despite health system fear regarding long-term reimbursement may be lacking from federal, state, and commercial health plan payers for virtual care delivery, leveraging telehealth to augment traditional healthcare delivery will become a necessity because consumers will demand it and physicians in some studies have shown satisfaction with their video visit platforms. This will no doubt have an impact on office layout and services.
2. Convenience of Outpatient Services
Motivated in part by telehealth utilization, patients seek convenience and accessibility in their healthcare now more than ever. Health system expansion may therefore mean satellite offices in high traffic areas to cater to the patient’s need for accessibility, marking a movement away from the traditional, centralized hospital campuses.
3. Value-Based Care Transitions
As legislation and CMS regulation moves more towards a value-based care system, trends show a natural move towards lower-cost facilities that provide preventive care. These could also contribute to continued trends to more off-campus real estate and planning for alternative care delivery options, for example, mobile vans reaching more vulnerable, at-risk populations for care such as life-saving vaccinations.
4. Pandemic Precautions
Bilateral operations are likely to be maintained for some time even after more normal operations return, and healthcare real estate, especially with consolidation, will need to accommodate this precaution, and others like it in all locations.
New diagnostic and testing tools are constantly being released, forcing health systems to reevaluate their current assets and make room for new ones which contributes to wasted space. Furthermore, remote monitoring apps will continue to proliferate in the market and become more affordable and accessible to consumers while advancing interoperability standards and federal information blocking requirements will allow information to flow more freely.
Strategies to Optimize Healthcare Real Estate & Strategy
In order to unlock money trapped in assets, health systems should look to make their assets work better in response to current trends and patient expectations. To accommodate patient demands and changes to health industry regulation and reimbursement, it makes sense to ensure efficient use of all facilities and optimize real estate and assets using the following strategies:
– Divest underutilized assets of any kind: Begin with real estate and move smaller to reduce unneeded capital investment.
– Remove or reduce administrative spaces: Transition non-clinical workforces to partial or complete work from home status, including finance, legal, marketing, revenue cycle, and other back-office functions. Shared space or “hotel” workspaces are popular.
– Reconfigure medical office or temporary care buildings: As these are often empty several days a week, they must be consolidated.
– Get out of expensive leases for care that can be given remotely or in lower-cost options or by strategic partners: Take full advantage of telehealth capabilities and eliminate offices that have become obsolete.
– Integrate telehealth into real estate only where it makes sense: Telehealth is more applicable to some services and care modalities than others. Offices should reconfigure to meet these novel needs where necessary, even if it means forgoing leases for the near term.
– Assess other expensive assets: Appraise assets like storage and diagnostic tools. Those not supportive of the new post-COVID-19 care model or prioritized service lines and are otherwise not producing revenues should be sold or outsourced to strategic partners.
– Diversify with off-campus offices: Provide convenient access to outpatient care and new outpatient procedures by investing in outpatient medical offices in high foot traffic locations.
– Create space for services in high demand: Services like preventive care and behavioral health should be given physical or virtual space in the system to cater to patient needs.
About Moha Desai
Moha Desai is a Principal of Healthcare Strategy and Transformation where she focuses on driving forward strategic, planning, financial, revenue cycle, operational improvement, and patient engagement healthcare projects for providers, federal government health agencies, and various firms requiring growth, business development, and project implementation and management. She has previously served in leadership roles at Partners HealthCare, Deloitte Consulting, Bearing Point, etc. Moha received her B.A. in Economics and her M.B.A. at Yale University.
While there are encouraging signs of reimbursement falling in step with the move towards a more value-based healthcare system, what is needed now to further encourage healthcare innovators is to properly rationalize approval processes imposed by the FDA and CMS.
Without a doubt 2020 has been a devastating year for many; the impact of COVID-19 on both personal lives and businesses has had long-term consequences. At the end of September, the number of COVID-19 cases fell just short of 350 million, with just over 1 million deaths reported. The expectation of a second peak in many countries exposed to the deadly illness is being handled with care, with many governments attempting to minimize the impact of an extreme rise in cases.
COVID-19 the aftermath will be the new normal?
Despite the chaotic attempts to dampen the impact of a second peak, it is inevitable that healthcare facilities will be stretched once again. However, there are key learnings to be had from the first few months of the pandemic, with several healthcare providers opting to be armed with as much information to tackle the likely imminent surge of patients with COVID-19 head-on. The interest in solutions that offer support to clinicians through data analysis is starting to emerge with several COVID-19 specific Artificial Intelligence (AI) algorithms filtering through the medical imaging space.
Stepping into the ICU, the use of analytics and AI-based clinical applications is drawing more attention. Solutions that collect relevant patient information, dissect the information, and offer clinical decision support are paving the way to a more informed clinical environment. Already, early-warning scoring, sepsis detection, and predictive analytics were becoming a focus. The recent COVID-19 outbreak has also driven further interest in COVID-19 specific applications, and tele-ICU solutions, that offer an alternative way to ensure high-risk patients are monitored appropriately in the ICU.
What does the future hold?
Signify Research is currently in the process of assessing the uptake of clinical decision support and AI-based applications in the high acuity and perinatal care settings. An initial assessment has highlighted various solutions that help improve not only the efficiency of care but also improve its quality. Some of the core areas of focus include:
Clinical Decision Support & Predictive Analytics
Due to the abundance of patient data and information required to be regularly assessed and monitored, the high-acuity and perinatal care settings benefit from solutions offering clinical decision support.
The ICU specifically has been a focus of many AI solution providers, with real-time analysis and support of data to provide actionable clinical decision support in time-critical situations. Clinical decision support solutions can collate data and identify missing pieces of information to provide a complete picture of the patient’s status and to support the treatment pathway. Some of the key vendors pathing the way for AI in clinical decision support in the ICU include AiiNTENSE; Ambient Clinical Analytics; Etiometry; BetterCare; AlertWatch; and Vigilanz Corp.
Early-warning protocols are commonly used in hospitals to flag patient deterioration. However, in many hospitals this is often a manual process, utilizing color coding of patient status on a whiteboard in the nurse’s station. Interest in automated early-warning systems that flag patient deterioration using vital signs information is increasing with the mounting pressure on stretched hospital staff.
Examples of early-warning software solutions include the Philips IntelliVue Guardian Solution and the Capsule Early Warning Scoring System (EWSS). Perigen’s PeriWatch Vigilance is the only AI-based early-warning scoring system that is developed to enhance clinical efficiency, timely intervention, and standardization of perinatal care.
The need for solutions that support resource-restricted hospitals has been further exacerbated during the COVID-19 pandemic. Many existing early-warning vendors have updated their surveillance systems to enable more specific capabilities for COVID-19 patients, specifically for ventilated patients. Companies such as Vigilanz Corp’s COVID Quick Start and Capsule Tech’s Clinical Surveillance module for ventilated patients enables healthcare professionals to respond to COVID-19 and other viral respiratory illnesses with customizable rules, reports, and real-time alerts.
Sepsis is the primary cause of death from infection, accounting for 20% of global deaths worldwide. Sepsis frequently occurs from infections acquired in health care settings, which are one of the most frequent adverse events during care delivery and affect hundreds of millions of patients worldwide every year. As death from Sepsis can be prevented, there is a significant focus around monitoring at-risk patients.
Several health systems employ their own early-warning scoring protocol utilizing in-house AI models to help to target sepsis. HCA Healthcare, an American for-profit operator of health care facilities, claims that its own Sepsis AI algorithm (SPOT) can detect sepsis 18-hours before even the best clinician. Commercial AI developers are also focusing their efforts to provide supporting solutions.
The Sepsis DART™ solution from Ambient Clinical Analytics uses AI to automate early detection of potential sepsis conditions and provides smart notifications to improve critical timeliness of care and elimination of errors. Philips ProtocolWatch, installed on Philips IntelliVue bedside patient monitors, simplifies the implementation of evidence-based sepsis care protocols to enable surveillance of post-ICU patients.
The influx of patients into the ICU during the early part of 2020 because of COVID-19 placed not only great strain on the number of ICU beds but also the number of healthcare physicians to support them. Due to the nature of the illness, the number of patients that were monitored through tele-ICU technology increased, although the complex nature of implementing a new tele-ICU solution has meant the increase has not been as pronounced as that of telehealth in primary care settings.
However, its use has enabled physicians to visit and monitor ICU patients virtually, decreasing the frequency and need for them to physically enter an isolation room. As the provision of healthcare is reviewed following the pandemic, it is likely that tele-ICU models will increase in popularity, to protect both the patient and the hospital staff providing direct patient care. Philips provides one of the largest national programs across the US with its eICU program.
Most recently, GE Healthcare has worked with Decisio Health to incorporate its DECISIOInsight® into GE Healthcare’s Mural virtual care solution, to prioritize and optimize ventilator case management. Other vendors active within the tele-ICU space include Ambient Clinical Analytics, Capsule Health, CLEW Med, and iMDsoft.
Figure 1 Signify Research projects the global tele-ICU market to reach just under $1 billion by 2024.
More and more solutions are targeted toward improving the quality of patient care and reducing the cost of care provision. With this, the requirement for devices and software to be interoperable is becoming more apparent. Vendors are looking to work collaboratively to find solutions to common problems within the hospital. HIMMS 2020 showcased several collaborations between core vendors within the high acuity market. Of note, two separate groups demonstrated their capabilities to work together to manage and distribute alarms within a critical care environment, resulting in a quieter experience to aid patient recovery. These included:
– Trauma Recovery in the Quiet ICU – Ascom, B Braun, Epic, Getinge, GuardRFID, Philips
About Kelly Patrick, Principal Analyst at Signify Research
Kelly Patrick is the Principal Analyst at Signify Research, a UK-based market research firm focusing on health IT, digital health, and medical imaging. She joined Signify Research in 2020 and brings with her 12 years’ experience covering a range of healthcare technology research at IHS Markit/Omdia. Kelly’s core focus has been on the clinical care space, including patient monitoring, respiratory care and infusion.
As you read this, over 200,000 American deaths have been attributed to the virus. The influx of cases continues, while state and local economies are experiencing hardship, children are shuttered in their homes learning remotely, grown children are moving back home and the “new normal” disrupts nearly all of life’s plans.
Yet, these issues don’t reveal all the traumas that Americans are experiencing 10 months into the pandemic. The pandemic’s impact continues to be swift and brutal, showing little sign of slowing down. Loneliness and isolation are gripping many American adults, as the nation settles in for a long fall/winter.
Growing evidence supports the notion that this virus is spread through aerosols, that is, person-to-person transmission by means of inhalation of infectious particles. With the onset of colder weather and the approaching holiday season, conditions are rife for spreading the virus. Flu season is imminent and COVID-19 cases are increasing.
While the safest choice is to isolate until the widespread availability of a vaccine arrives (within the next 6-12 months), this is an unwelcome option for some already suffering from “pandemic fatigue” and not really an option at all for others (like those who work outside the home).
Either way, America’s mental health is at risk. According to the CDC, reports of mental health conditions (anxiety, trauma, substance abuse, suicide) have considerably increased during the pandemic with more than 40% of American adults reporting mental health struggles. Frontline healthcare workers are particularly affected, and over 71% have experienced psychiatric symptoms, including depression, anxiety, insomnia, and distress. Even run-of-the-mill loneliness and isolation contribute to substance misuse and disorders, which, by the way, contribute to an increased risk for COVID-19.
Key Ways Mental Health Providers Can Help
Because mental health threats are now part and parcel of living amid the COVID-19 pandemic, it is important to routinely gauge the health of those close to you, (and this is paramount for those recovering from COVID-19, frontline workers, and first responders.) Consider consulting a mental health provider if you notice any of these characteristics in yourself or someone you know:
– Engaging in high-risk activities, such as heavy drinking, illicit drug use, or self-destructive behavior;
– Exhibiting feelings of overwhelming sadness, hopelessness, grief, or worthlessness
Nearly every American is impacted mentally, financially, and emotionally by the pandemic, and even the fortunate few who aren’t already personally affected are feeling the stress of an uncertain future. Mental health providers aim to improve coping skills, relationships, and self-care regimens to reduce anxiety, depression, or other mental illness. From generalized anxiety to neuropsychology related to recovery from COVID-19, behavioral health specialists are equipped to help in a myriad of ways such as these:
1. Building resilience by introducing coping and stress tolerance activities, such as mindfulness and meditation, or a simple shift in perspective
2. Shoring up social connections and relationships to serve as a layer of protection and diffusion from life stress
3. Ensuring self-care activities, such as adequate sleep, diet, exercise, and more to sustain mood and self-esteem
4. Delivering grief and loss counseling for those who have suffered acute human losses during the crisis
5. Counseling for substance abuse and addiction
6. Initiating a short intervention using cognitive behavioral therapy techniques
Those with pre-existing mental health issues, including depression, PTSD, social anxiety, agoraphobia, generalized anxiety and major depression, may benefit from an increased intensity in treatment, by frequency or duration.
For survivors of COVID-19 who have had significant cardiac and respiratory complications including prolonged periods of dyspnea (shortness of breath), hypoxemia (decreased blood oxygen levels), and hypoxia (decreased oxygenation of organs), neurocognitive screening and ongoing monitoring of mental status will be helpful.
Advances in Telemedicine
Recent advances in computer-administered neurocognitive testing have allowed
clinicians to administer psychological and neurocognitive assessment instruments by telemedicine, and there are now many more neurocognitive assessment batteries available to aid in the detection and quantification of neuropsychological functional deficits.
Historically, psychologists, psychiatrists, and L.C.S.W.s have not done virtual sessions with patients, but COVID is changing that, and increasingly insurers are receptive to this practice. The technology, capability, and compliance aspects of virtual appointments were available prior to 2020, but COVID has brought “distance meeting” into the American vernacular. Medical doctors now treat patients via telehealth in numerous instances, and mental health patients can be treated using similar meeting applications.
Telebehavioral health could not be more timely. In the fight against isolation, virtual technology allows human beings to check on one another and meaningfully connect, at the same time allowing people seeking mental health services to receive treatment safely without risking infection from a devastating disease.
Even as the pandemic presents a common threat like none other we have faced in recent years, it also offers us the opportunity to reach out and check on one another. Everyone is affected in some way by COVID-19, be it the disease itself or simply disruption to our routines and mass anxiety. It’s definitely time to take mental health seriously. Our technology ensures that we do not have to be alone in isolation, and relief may be just a call away. Through mutual understanding and effort, we can focus on the unifying experience of overcoming this crisis.
About Dr. Lazarovic
Dr. Lazarovic, M.D., F.A.A.F.P., has nearly 40 years of medical administration/managed care experience, including 18 years as Chief Medical Officer at Broadspire/CRAWFORD, a global third-party administrator of workers’ compensation, disability, auto and medical product liability claims. Experienced in clinical guidelines, medical cost control and strategic planning, Dr. Lazarovic has conducted and published original research and analytics and presented at multiple industry conferences. Dr. Lazarovic is currently the CMO responsible for the development of advanced, evidence-based clinical applications at MyAbilities Technologies, a medical software and services company in the workers’ compensation and disability sector.
As the COVID-19 pandemic creates surges in acute care, many imaging departments are experiencing a decrease in volume, due to patients deferring or canceling non-urgent appointments and surgeries. The impact of this makes it painfully obvious that — because imaging departments rely on a fee-for-service model – when the volume is down, finances suffer. As an aspect of healthcare that has historically been hyper-focused on volume, adoption of a value-based care approach in radiology has evolved slowly, even before the pandemic. Despite the hurdles COVID-19 has presented, the rationale behind value-based care remains – there is a need to drive improved patient outcomes at a lower cost – and healthcare reimbursement will continue to shift, encouraging quality care and enhanced patient experiences. Radiology can take an important role in realizing this transformation, influencing the entire process of early diagnosis, efficient treatment, and follow-up care.
So how can imaging departments thrive when confronted with a value-based care model? One way is to make sure referrers value radiologists’ expertise as part of the care team. Active participation in care team discussions, as well as case study presentations, can demonstrate the extent to which imaging affects outcomes. Imaging departments can also invest in building referrals for areas where imaging intersects more directly with care, such as oncology. But perhaps the most direct way is to focus on an area over which the imaging department has the most control: the cost-effective use of resources. The strategies chosen today could help or hurt a practice in the future, and departments should look toward reliable technology that delivers consistent results and allows staff to focus less on technical issues and more on patient care.
An efficient department with the right mix of technology can thrive in a value-based healthcare environment. Answering these three questions can guide your technology strategy and help you weather the pandemic disruption and the continuing adoption of value-based care:
Are your imaging systems appropriate for your patient demand?
As it relates to value-based care, you can expect the future to entail less “confirmation” imaging and more investigational, prevention-focused imaging. However, different imaging solutions have different purposes; while confirmation CT studies don’t demand as high performance, investigational imaging will often require more sophisticated systems with the image quality and performance to support complex studies and confident diagnoses, and potentially even spot incidental findings that circumvent health issues down the line. When purchasing new systems, consider the type of studies that make up the majority of your business, as well as new areas in which you’d like to increase expertise and referrals.
How cost-effective are your imaging technology operations?
Consider every aspect of your operation to uncover opportunities to decrease costs without affecting quality. For best results, involve the entire imaging department team in these explorations. One possible budget drain is consumables. Sometimes the easiest way to service your car is by bringing it to the dealer, but that’s not always the most cost-effective option. The same goes for imaging technology; be sure to consider third-party options, in addition to Original Equipment Manufacturer (OEM) parts. Today, alternate parts are available for almost every piece of your organization, even technically sophisticated components such as x-ray tubes.
Is your technology reliable?
Speed to diagnosis may impact patient outcomes. Your referrers are looking for a quick turnaround of imaging studies. Highly advanced technology with reliable uptime can help you become a partner of choice, and reduce time spent maintaining equipment. For example, radiation oncology depends on CT for treatment planning, and oncologists need radiology partners who have CT systems that are dependable, integrate easily into their workflow, and do not distract from patient care. Even a small change, such as CT tubes that use highly reliable liquid metal bearings to eliminate the need to wait for tube cooling between studies, will impact your throughput and thus your ability to meet referrers’ needs.
Are you putting unnecessary stress on your imaging systems?
Educate all system users about manufacturer-recommended procedures for system use and upkeep to keep your systems running at high performance. For example, shutting the system down by turning off the power, rather than by following manufacturer-recommended procedures, places unnecessary stress on components that need time to cool.
While it’s important to take a measured approach as we navigate the repercussions of COVID-19, now is the time to begin adapting to value-based care. As the pandemic has taught us, a nimble imaging department can adapt to changing circumstances and create lasting value. Revisit these questions frequently, because consistent assessment and vigilance is key to a department’s success.
This question initially brings to mind many possibilities such as connection to the latest 5G cellular service, a new super-fast internet provider, or maybe one of the many new energy suppliers jockeying for market share from traditional utility companies. While all of these might represent legitimate opportunities to improve one’s community, here we are talking about a different concept; specifically, whether your community is ready to have a Connected Community of Care (CCC) to advance whole-person health.
The image of a CCC may seem obvious. After all, we all live in communities where we have some connections between hospitals, physician practices, ambulatory care centers, and pharmacies to name just a few. But here we are talking about a broader sense of connected community that includes not just health care organizations, but social service organizations, such as schools and civic organizations and community-based organizations (CBOs) like neighborhood food pantries and temporary housing facilities. A true CCC links together local healthcare providers along with a wide array of CBOs, faith-based organizations, and civic entities to help address those social factors, such as education, income security, food access, and behavioral support networks, which can influence a population’s risk for illness or disease. Addressing these factors in connection with traditional medical care can reduce disease risk and advance whole-person care. Such is the case in Dallas Texas, where the Dallas CCC information exchange platform has been operating since 2012. Designed to electronically bring together local healthcare systems, clinicians, and ancillary providers with over a hundred CBOs, the Dallas CCC provides a real-time referral and communication platform with a sophisticated care management system designed and built by the Parkland Center for Clinical Innovation (PCCI) and Pieces Technologies, Inc.
Long before this information exchange platform was implemented, the framers of the Dallas CCC came together to consider whether Dallas needed such a network and whether the potential partners in the community were truly ready to make the commitments needed to bring this idea to fruition. As more and more communities and healthcare provider entities realize the tremendous potential of addressing the social determinants of health by bringing together healthcare entities and CBOs and other social-service organizations, the question of community readiness for a CCC is being asked much more often. But how do you know what the right answer is?
Before looking at the details of how we might answer this, let’s remember that a CCC doesn’t don’t just happen in a vacuum. It requires belief, vision, commitment― and above all― alignment among the key stakeholders. Every CCC that has formed, including the Dallas CCC, begins with a vision for a healthier community and its citizens. This vision is typically shared by two or more large and influential key community stakeholders, such as a large healthcare system, school district, civic entity, or social- service organization like the United Way or Salvation Army.
Leaders from these organizations often initially connect at informal social gatherings and advance the idea of what if? These informal exchanges soon lead to a more formal meeting where the topic is more fully discussed and each of the participants articulates their vision for a healthier community and what that might look like going forward. This stage in the evolution of a CCC is perhaps the key step in the transformation process, as while all stakeholders will have a vision, achieving alignment among those visions is no small feat. Many hopeful CCCs never pass this stage, as the stakeholders cannot come to an agreement on a common vision that each can support. For the fortunate few, intrinsic organizational differences can be successfully set aside to allow the CCC to move forward.
It’s at this point in the CCC’s evolution that details begin to matter in truthfully answering the question, “Is this community ready to be connected?” While there may be agreement among the key stakeholders on a vision, the details around readiness may still divert or delay the best-laid plans. It is safe to say that the key to understanding a community’s readiness to form a CCC lies in the completion of a formal, comprehensive, and transparent readiness assessment.
A readiness assessment is a process to collect, analyze, and evaluate critical information gathered from the community to help identify actual clinical and socio-economic needs, current capabilities and resources (including technology), and community interest and engagement. Taken together, a comprehensive readiness assessment can help identify a community’s strengths and weaknesses in preparation for establishing a CCC.
A readiness assessment is not a tactical plan for building a CCC, nor is it a governance document that provides how all members of the CCC will relate to each other. Instead, the readiness assessment provides communities interested in establishing a CCC with an honest and unbiased yardstick to measure preparedness. Conducting and using the results of the readiness assessment is one of the best ways to ensure a successful CCC deployment.
A typical CCC readiness assessment covers five areas: (1) community demographics; (2) clinical areas of need (including trends); (3) social areas of need (including trends); (4) technology competency (e.g., what percent of the potential network participants are computer literate?), availability (e.g., what percent of the potential network participants have internet access?), and suitability (e.g., is the internet access, high speed?); and (5) what are the needs of potential network participants and can these be modeled as use cases for the information exchange network? This information is essential to help key stakeholder decision-makers decide to move forward with establishing a CCC and to know what specific challenges may lie ahead.
The collection of this essential information can be done in a number of ways, such as making use of existing publicly reported data or conducting surveys, interviews, focus groups and town hall meetings with community leaders and residents and clinical and CBO leaders and staff. Experience conducting the readiness assessment that provided the foundation for the Dallas CCC showed that no single information-collection method was sufficient to collect the necessary level and robustness of the data. In Dallas, we utilized all five approaches but found that in addition to researching publicly available data, initial surveys, followed by interviews and focus groups, yielded the most voluminous and reliable information to chart the course ahead.
In addition to the various methods to collect this essential information, the key to obtaining useful and reliable information requires a sufficient number of respondents/participants who are drawn from various organizations and organizational levels. Simply put, you must have a large enough sample and you must have diversity within the sample. It’s not enough to just interview leaders of potential network participants, as their understanding of the needs, trends, and capabilities may look very different from that of frontline staff.
Similarly, surveying only one category of potential network participants may not provide enough information to fully understand the socio-economic needs in the community or even the perspectives surrounding the prevalence of chronic conditions. Beyond the qualitative methods involved, it is important to note that if done right, this process takes a lot of time to complete. Cutting corners by reducing the sample size, for example, or doing selective sampling to speed the readiness assessment process along will only cause problems later when this insufficient information results in erroneous decision-making.
Once the data has been collected, it is important to carefully analyze what the data is trying to tell you. Results of the readiness assessment must be shared openly and honestly with all key stakeholders, particularly those serving in a governance capacity. The governance group (a topic for another day) that has formed in parallel with the readiness assessment must be able to evaluate and understand the main messages from the readiness assessment to make an informed decision as to whether to move forward with establishing a CCC.
Like the need for alignment around the key stakeholder’s vision for the CCC, there must be universal agreement by the key stakeholders as to the message of the readiness assessment and its implications for the road ahead. As with the vision alignment stage, substantive disagreements among the group at this stage are a sign of trouble ahead unless differences can be resolved.
At this point, you might be thinking that this all seems very complicated and fraught with potential land mines waiting to derail your effort to answer the original question “Is your community ready to be connected?” Again, I would emphasize the importance of unwavering commitment and alignment to achieve the vision. But I would also offer advice gleaned from working in the CCC space for the last eight years, which is to get help early and don’t wait until the horse is out of the barn!
We have seen first-hand many communities and consultants approach the conduct of a readiness assessment with a cavalier attitude, often exemplified by the statement, “we already know all of this,” only later to have to backtrack their pronouncements at substantial additional cost in time and resources. Fortunately, today there are a number of excellent organizations, including PCCI, with the experience, credibility, and integrity in the CCC space to help you on this journey. Don’t be afraid to seek them out. It will be a wise investment that you will not regret, particularly when you begin to see the results of improved whole-person health and well-being in your community.
Since COVID-19 emerged as a major health threat, virtual care has taken off. As many as 46% of patients reported in late April that they had used telehealth to replace a canceled healthcare visit in 2020, while 48% of physicians said they had started using telehealth to treat patients.
While a shift in care models was necessary to address business continuity amid the pandemic, these trends also represent positive movements as a growing body of evidence supports the real-life benefits of telehealth. Remote models of care are connected to safe and effective consultations across many use cases, low exposure to viruses, and much-needed access to care.
Yet the fact that physician adoption isn’t higher suggests two things:
1) Physicians may be taking a ‘wait and see’ approach in the hopes that patients will want to return to in-person care as economies reopen; or
2) Some physicians haven’t yet figured out their long-term telehealth strategy. In truth, many providers are treating telehealth as a “stop-gap” — or temporary — solution until life returns to normal.
But given the increasingly positive data around telehealth as a safe alternative to in-person care, as well as its track record in successfully treating patients, it’s time for providers to reframe their thinking. In the future, practices will need a healthcare strategy that balances virtual with in-person care.
As recently as ten years ago, telehealth reimbursement was largely limited to patients in rural areas, as payers didn’t yet see the value of compensating doctors for virtual encounters.
Today, most payers and providers recognize the value of telehealth on some level amid rising demand for services and severe professional shortages. In particular, remote care models have proven their worth during the pandemic as an effective means of preventing the spread of disease. Greater acceptance of telehealth is further demonstrated by the recent decision to relax HIPAA requirements by HHS’ Office of Civil Rights (OCR), allowing more providers and patients to virtually connect through FaceTime, Zoom, or other two-way communications systems during the current pandemic.
This is an important first step, although many providers remain resistant to change for a variety of valid reasons. Some of these include discomfort with remote care models, reimbursement concerns, and the cost of deploying telehealth.
Performing medicine in a way that doesn’t align with one’s training feels unnatural, and some providers have said that virtual encounters feel less personal. The fact is that most clinicians weren’t trained to diagnose patients remotely or engage over a screen and are simply hesitant to embrace this approach to care.
Also, providers may have trepidation about not getting paid. While CMS and private payers have expanded coverage, multiple healthcare providers have reported that bills are being delayed or only partially paid by health plans.
With limited insight into the potential return on that investment, concerns over the cost of implementing telehealth are also reasonable. A physician who is consulting with patients remotely through FaceTime, for example, might wonder if the investment in a more secure, robust telehealth platform will make sense in 12 months, should a COVID-19 vaccine materialize.
Yet by not adopting a more permanent telehealth solution, providers may be hurting themselves down the road. Patients increasingly believe virtual care is highly effective, and some even prefer it. According to a SYKES consumer survey administered in March, 60% of 1,441 respondents said the COVID pandemic has increased their willingness to try telehealth.
Also, while HHS has relaxed HIPAA enforcement at the moment, there’s no indication this will continue. Healthcare organizations will need to ensure that the platform or program they’re using is designed to keep protected health information (PHI) safe.
Investing in the Future
Given the upward trajectory of telehealth, it benefits providers to thoughtfully invest in the right strategies and solutions now to extract the greatest value and return on investment down the road. Here are four steps to take, when shifting to a long-term telehealth strategy:
– Identify needs. Many primary-care practices may have seen a bump in interest in telehealth due to COVID-19, while specialty practices may see increases stay steady, even when fears of the coronavirus fade. When planning long-term, put patient needs first: In what ways can telehealth improve care delivery, going forward? Look at data, such as virtual-visit utilization patterns, to see where there are opportunities to grow telemedicine (e.g., expanding chronic care management) based on needs.
– Consider workflows. The ideal telehealth program doesn’t interrupt clinical workflows – it enhances them. If you’re using a ‘stop-gap’ video conferencing solution to provide telemedicine, is it easy to integrate practice notes with your EHR? Or, do you have to take extra steps to document patient encounters for clinical and billing departments?
–Seek supportive partners. You can use any number of technology platforms to conduct telemedicine encounters, but not all platforms are created equal. When looking at implementing a telehealth platform, consider not only ease of use, and interoperability, but also what a particular vendor is offering: How well the telehealth platform in question can accommodate the needs of a particular specialty? What are existing clients are saying about things like training, vendor support, and the patient experience?
– Proactively engage. Your patients have most likely heard of telehealth, but they may not realize that telehealth is multifaceted and can be used to diagnose conditions such as skin disorders or allergies and can be just as effective as in-person visits. Educating patients about telehealth’s benefits, and making it easy for them to try telehealth, is essential to success.
Expanding telehealth’s role in the medical practice benefits everyone, from physicians to patients to payers. Moving past the “stop-gap” mentality now will reap greater benefits in the future, regardless of whether we’re in the midst of a pandemic, or simply trying to provide excellent care on a day-to-day basis.
About Roland Therriault
is the President and Executive Vice President of Sales at InSync Healthcare Solutions, a provider
of integrated EHR and practice management software, revenue cycle management
services and medical transcription to thousands of healthcare professionals
throughout the United States. Roland Therriault manages all operations of the
company, driving its go-to-market strategy and overseeing all sales activities.
His experience in healthcare and technology includes more than 20 years of
direct and channel sales, strategic planning and business development. Prior to
joining InSync, Roland served as Vice President of Sales for MD On-Line, a
provider of acute and ambulatory clinical and practice management solutions.
The coronavirus pandemic accelerated telemedicine exponentially as patients and doctors switched from in-person visits to remote consultations. Health providers rapidly scaled virtual offerings in March and April and traffic volumes soared to unprecedented levels, with practices “seeing 50 to 175 times the number of patients by telehealth than before the outbreak,” according to McKinsey. By early August, the U.S. Department of Health and Human Services expanded the list of allowable telehealth services in Medicare and there was an executive order supporting permanent telehealth provisions for rural areas.
But the surge in telemedicine adoption comes with a host of cybersecurity risks and regulatory compliance requirements unique to the healthcare sector.
As telemedicine traffic increases, so does the volume of hacking attempts. Recent cybersecurity news indicates healthcare organizations are top targets for cyberattacks and “providers remain the most compromised segment of the healthcare sector, accounting for nearly 75 percent of reported breaches.” The consequences are chilling: “The average cost of a healthcare data breach is $7.13 million globally and $8.6 million in the United States.
Further, whenever patient information is involved, HIPAA compliance is required. While HHS temporarily suspended pursuing HIPAA penalties on providers for “good faith provision of telehealth during the COVID-19 nationwide public health emergency,” such permissiveness will not last.
Luckily, most telemedicine providers can utilize managed services and cloud infrastructure to keep pace. Here are some best practices to meet IT compliance and cybersecurity demands for telemedicine.
Telemedicine Compliance Best Practices
Compliance should be viewed as a real-time process that drives security. Telemedicine tools and technology should therefore reflect significant expertise with all healthcare regulations (HIPAA, HITRUST, HITECH), with compliance functions permeating processes. Recommended compliance best practices include:
1. Automate Remediation
Healthcare applications cannot offer high reliability if every potential compliance problem is remediated manually; there’s just too much that can go wrong and never enough staff to address it when needed. The solution is to automate everything that can be automated, and rely on people to handle exceptions or potential violations that don’t impact reliability. Cloud-based services can integrate AI and operational intelligence to automatically remediate anomalies when possible, present recommendations to operations staff for cases that cannot be resolved automatically, and present clear choices such as:
· Do Nothing: Take no action, delete ticket after [x number of days]
· Fix Now: Implement the recommended actions immediately
· Schedule: Perform the recommended actions during the next maintenance window
This approach speeds resolution and decreases service disruptions, and improves the reliability of telemedicine delivery. The automated response also plays a critical role in security (which will be discussed shortly).
2. Perform Formal Risk Assessments
Understanding the risk level and specific risk issues are critical components for an effective compliance plan. Many providers of healthcare services underestimate their level of risk, in part because it is difficult to quantify. The HHS has published guidance in its Quantitative Risk Management for Healthcare Cybersecurity, which offers insight. There are also cloud solutions that can aid the process. Cloud services providers such as Amazon Web Services (AWS), Microsoft Azure, and Google Cloud offer automated security assessment services that help improve the security and compliance of applications deployed on their cloud hosting platforms. They can generally assess applications for exposure, vulnerabilities, and deviations from best practices. A good inspection service should highlight network configurations that allow for potentially malicious access, and produces a detailed list of findings prioritized by level of severity.
3. Reduce Attack Surface
To provide secure access to sensitive information, hybrid architectures supporting telemedicine applications need a virtual private network (VPN) gateway between on-premises and cloud resources. However, developers, test engineers, remote employees, and others who need access to cloud-based protected health information (PHI) may bypass a VPN gateway by either cracking open the cloud firewall to allow direct unencrypted internet traffic or using peering connections. To prevent such potential exposures, secure desktop-as-a-service (DaaS) solutions provide an elegant way to allow cloud-based access to PHI without exposing connections or records. A DaaS is generally deployed within a VPC providing each user with access to persistent, encrypted cloud storage volumes using an encryption key management service. No user data is stored on the local device, which reduces overall risk surface area without impeding development capability.
Telemedicine Security Best Practices
While the full scope of cybersecurity strategies is beyond the scope of this article, here are three best practices that telemedicine providers can use bolster their security profile:
1. Deploy Proactive Network Security
Modern cyber threats have become steadily more sophisticated in evading traditional security measures and more devastating once they penetrate network perimeters. For that reason, telemedicine providers need a highly proactive, multilayered approach to prevent malware-based outages, theft of intellectual property, and exfiltration of protected health information (PHI).
A combination of network anti-malware, application control, and intrusion prevention systems (IPS) is recommended. Such proactive solutions are generally bundled in managed cloud services that should automatically detect suspicious system changes in real-time, isolate and quarantine affected resources, and prevent the spread of exploits by locking down any server whose configuration differs from the installed settings.
2. Encrypt Data Storage
Data encryption is the last line of cyber-defense for PHI and other critical information. Even if an attacker can penetrate the perimeter and proactive network security and exfiltrate data from the provider, those data are useless to the hacker if encrypted. It’s good practice to encrypt all web and application servers running on cloud instances using a unique master key from a key management service when creating volumes.
Encryption operations generally occur on the servers that host cloud database (DB) instances, ensuring the security of both data-at-rest and data-in-transit between an instance and its block storage. For additional protection, you can also opt to encrypt DB instances at rest, underlying storage for DB instances, its automated backups, and read replicas.
3. Harden Operating Systems
Both Microsoft Windows Server and Linux are ubiquitous operating systems in telemedicine. They are also both attractive targets for cybercriminals because they provide complex capabilities, frequently remediate vulnerabilities, and are so common (increasing attackers’ chances of finding an unpatched system). Hackers use OS-based techniques such as remote code execution and elevation of privilege to take advantage of unpatched operating system vulnerabilities. Hardened images of Windows Server and Linux virtual machines (VMs) should be used, employing default configurations recommended by the Center for Internet Security (CIS). Such hardened images make gaining OS administrative extremely difficult, and coordinate well with proactive security bundles described earlier.
While these best practices are targeted primarily at telemedicine companies, they can also be applied to a wide range of healthcare providers and organizations delivering vital services in the face of 2020’s dramatic swings in demand.
About Gerry Miller
Gerry Miller is the founder and chief executive officer at Cloudticity. He is a successful serial entrepreneur and healthcare fanatic. From starting his first company in elementary school to selling his successful technology consulting firm in 1998, Gerry has always marched to his own drummer, producing a series of successes. Gerry’s first major company was The Clarity Group, a Boston-based Internet technology firm he founded in 1992. Gerry presided over seven years of 100% aggregate annual growth and sold the company in 1998 when it had reached $10MM in revenue.
He was recruited by Microsoft to become their Central US Chief Technology Officer, eventually taking over a global business unit and growing its revenue from $20MM to over $100MM in less than three years. Gerry then joined ePrize as Chief Operating Officer, where he grew sales 38% to nearly $70MM while improving operating efficiency, quality, and both client and employee satisfaction. Gerry founded Cloudticity in 2011 with a passion for helping healthcare organizations radically reshape the industry by unlocking the full potential of the cloud.
Living through a pandemic is stressful and anxiety-inducing. Stay-at-home measures are compounding this stress, resulting in social isolation and unprecedented economic hardship, including mass layoffs and loss of health coverage. Fully understanding the impact of these pernicious trends on overall mental health will take time. However, precedents like the Great Recession suggest that these trends are likely to worsen the conditions driving suicide and substance-related deaths, the “deaths of despair” that claimed 158,000 lives in 2017 and contributed to a three-year decline in US life expectancy among adults of all racial groups.
Even before the emergence and spread of COVID-19, the US was experiencing a behavioral health treatment crisis: 2018 data showed that only 43% of adults with mental health needs, 10% of individuals with SUD, and 7% of individuals with co-occurring conditions were able to receive services for all necessary conditions.
The treatment gap is staggering, and COVID-19 is exacerbating it: an estimated 45% of adults report the pandemic has negatively impacted their mental health, to say nothing of the disruption of essential in-person care and services. In a similar vein, a recent CDC report has highlighted the staggering and “disproportionately worse mental health outcomes, [including] increased substance use, and elevated suicidal ideation” experienced by “younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers.”
Consistent with the CDC report’s findings, the crisis can be felt most acutely by the very workforce that must deal with COVID-19 itself. Hospitals, health systems, and clinical practices – together with other first responders – comprise the essential front line. They bear the burden of their employees’ stress and illness, and must also cope with the many patients who present with a range of mental illnesses and substance use disorder (SUD).
But providers don’t have to face this burden alone: numerous behavioral health-focused digital solutions can support providers in meeting their most urgent needs in the era of COVID-19. Many of these solutions have made select services available for free or at a discount to healthcare providers in recognition of the immense need and challenging financial circumstances. Some solutions also help systems take advantage of favorable, albeit time-sensitive, conditions, enabling them to lay the foundation for broader behavioral health initiatives in the long term. Several of these solutions are described below, in the context of three key focus areas for health systems.
Focus Area 1: Supporting the Frontline Workforce
Health system leaders need to keep their workforces healthy, focused, and productive during this period of extreme stress, anxiety, and trauma. Providing easily accessible behavioral health resources for the healthcare workforce is therefore of paramount importance.
Health systems should consider providing immediate, free access to behavioral health services to employees and their families and consider further extending that access to first responders, other healthcare workers, and other essential services workers in the community.
Many digital product companies are granting temporary access to their services and are expanding their offerings to include new, COVID-19-specific modules, resources, and/or guidance at no cost.
Fortunately, the market is rife with solutions that have demonstrated effectiveness and an ability to scale. However, many of these rapidly-scalable solutions are oriented toward low-acuity behavioral health conditions, so it is important that health systems consider the unique needs of their populations in determining which solution(s) to adopt.
The following are several solutions to consider:
Online CBT solutions. These tools are being used to expand access to lower-acuity behavioral health services, targeting both frontline workers and the general population. MyStrength, SilverCloud and others have deployed COVID-19-specific programming.
Text-based peer support groups. Organizations are using Marigold Health to address loneliness and social isolation in group-based chat settings, one-on-one interactions between individuals and peer staff, and broader community applications.
Focus Area 2: Maintaining Continuity of Care
As the pandemic continues to ripple across the country, parts of the delivery system remain overwhelmingly focused on containing and treating COVID-19. This can and has led to the disruption of care and services, of particular significance to individuals with chronic conditions (e.g., serious mental illness (SMI) and SUD), who require longitudinal care and support. Standing up interventions — digital and otherwise — to ensure continuity of care will be critical to preventing exacerbations in patients’ conditions that could drive increased rates of ED visits and admissions at a time when hospital capacity can be in short supply.
In the absence of in-person care, many digital solutions are hosting virtual recovery meetings and providing access to virtual peer support groups. Additionally, shifts in federal and state policies are easing restrictions around critical services, including medication-assisted treatment (e.g., buprenorphine can now be prescribed via telephone), that can mitigate risky behavior and ensure ongoing access to treatment.
The use of paraprofessionals has also emerged as a promising extension of the historically undersupplied behavioral health treatment infrastructure. Capitalizing on the rapid expansion of virtual care, providers should consider leveraging digital solutions to scale programs that use peers, community health workers (CHWs), care managers, health coaches, and other paraprofessionals, to reduce inappropriate hospital utilization and ensure patients are navigated to the appropriate services.
The following are several solutions to consider:
Medication-assisted therapy (MAT) via telemedicine. These solutions provide access to professionals who can prescribe and administer MAT medications, provide addiction counseling, and conduct behavioral therapy (e.g., CBT, motivational interviewing) digitally. Solution companies providing these critical services include Eleanor Health, PursueCare, and Workit Health.
Behavioral health integration. Providing screening, therapy, and psychiatric consultations in a variety of care settings — especially primary care — will help address the increased demand. Historically, providers have had difficulty scaling such solutions due to challenging reimbursement, administrative burden, and stigma, among other concerns. Solutions like Valera Health and Concert Health were created to address these challenges and have seen success in scaling collaborative care programs.
Recovery management tools for individuals with SUD. WEConnect Health and DynamiCare Health are both offering free daily online recovery support groups.
Focus Area 3: Leveraging New Opportunities to Close the Treatment Gap
As has been widely documented, the pandemic has spurred unprecedented adoption of telehealth services, aided by new funding opportunities (offered through the CARES Act and similar channels) and the widespread easing of telehealth requirements, including the allowance of reimbursement for audio-only services and temporarily eased provider licensure requirements.
Tele-behavioral health services are no exception; the aforesaid trends ensure that what was one of the few high-growth areas in digital behavioral health before the pandemic will remain so for the foreseeable future. This is unquestionably a positive development, but there is still much work to be done to close the treatment gap. Critically, a meaningful portion of this work is beyond the reach of the virtual infrastructure that has been established to date. For example, there remains a dearth of solutions that have successfully scaled treatment models for individuals with acute illnesses, like SMI or dual BH-SUD diagnoses.
Health system leaders should continue to keep their ears to the ground for new opportunities to expand their virtual treatment infrastructure, paying particular attention to synergistic opportunities to build on investments in newly-developed assets (like workforce-focused solutions) to round out the continuum of behavioral health services.
COVID-19 has all but guaranteed that behavioral health will remain a major focus of efforts to improve healthcare delivery. Therefore, health systems that approach today’s necessary investments in behavioral health with a long-term focus will emerge from the pandemic response well ahead of their peers, having built healthier communities along the way.
About Victor Siclovan
Victor Siclovan is a Director on the Medicaid Transformation Project at AVIA where he leads work in behavioral health, chronic care, substance use disorder, and Medicaid population health strategy. Prior to AVIA, Victor spent nearly 10 years at Oliver Wyman helping large healthcare organizations navigate the transition to value-based care. He holds a BA in Economics from Northwestern.
Twenty years ago, technology consultants started advising CIOs to build less. That’s when the movement towards Commercial Off the Shelf (COTS) began.
Today, there are many shops, especially those in small and medium-sized organizations, with few programmers who build new applications from scratch.
Yes, they have programmers who configure, script, and integrate various applications but very little is built. For the provider community, we have a habit of either sourcing our needs from our Electronic Health Records (EHR) application vendor or buying a “best of breed” application from a niche vendor.
Moving to Software as a Service (SaaS) has even reduced the dread of upgrades. No doubt buying commercial software has enabled all of us to have access to better solutions and in some cases, may have reduced the ongoing run rate. Still, it means technology costs have gone up and a lot of our technology goals have not been achieved.
For example, interoperability remains a point to point problem. ONC and CMS are still pushing to remove barriers to interoperability and have mandated data exchange with penalties.
CIOs are struggling with the realities of constraint budgets where new programs are starving while dollars go to pay maintenance, integration costs associated with prior purchases (e.g. tech debt).
Then, in a year of the normal pull-and-tug between maintaining current and delivering new systems, COVID-19 arrived and our planning fell short. Technology teams were challenged as never before. They suddenly needed to:
– Enable teams to work from home – even teams who have never worked remotely.
– Stand up telehealth solutions in days – not months.
– Find a good external data source with statistics to integrate and then discover a newer, better source days later.
– Provide real-time updates on the availability of hospital rooms to leadership.
– Provide rapidly evolving guidance to patients on admissions changes, new requirements for entrance to facilities reduced access to admitted patients.
– Be a trusted, consistent source of guidance to reduce the spread of the disease.
This was all new, unplanned work. Work that took resources from other budget areas and other teams. Work that didn’t always meet our aim for better patient care or patient experience.
For example, we saw some providers advertising the availability of telehealth services but requiring a patient to call their primary care doctor to schedule instead of requesting an appointment online. Then due to staff shortages, the patient would land in voice mail, further delaying access to care.
Patients needing tests have been told to get an order from their physician. The truth is telehealth isn’t integrated and isn’t part of our daily processes.
The story here is the emergence of an unsung hero you can’t find on the nightly news: our IT Teams. We need to arm this group of heroes with better tools. Tools where delivery of new programs, updates to existing processes and integrating new data from external sources can be done in days, not months.
Did your clients link to external data sources such as John Hopkins? Did they need to enable test sources from new partners? Did they need to build new mobile applications to integrate workstations in parking lots and third-party locations?
New approach – Low-Code
Today’s challenges require a new approach that is “low-code.” Low-code is shorthand for an application development environment that is primarily visual and uses simple declarative statements to create applications. The primary goal of low-code is to accelerate program delivery.
This is surely a goal for every healthcare technology team. As enterprise clients embrace low-code, they can ensure readiness by putting these building blocks in place so clients can realize the promised value:
– Authentication Management through APIs (OAuth)
– Standardized access through APIs
– Management and Monitoring
In preparation for the adoption of a low-code application platform (LCAP), it is essential to assess the adoption of authentication best practices.
The technology landscape now spans on-prem, private cloud, and public cloud solutions requiring a standardized, tokenized approach to authentication. Without this, security processes will inevitably fall short of the CISO’s goals or will require additional manpower to monitor and maintain.
OAuth is the building block
Given the number of vendors, environments, and the velocity of human interactions (non-employee clinicians, temporary resources of all types, patients, etc.), OAuth is the building block for scalable secure authentication. OAuth is a delegated authentication framework that replaces the need to send credentials in program calls (APIs).
It has been required by CMS for the interoperability rule as a foundation for data sharing. If you haven’t, invest in a centralized identity management system and move to use OAuth to authenticate service and access requests. Standardizing authentication is foundational. Do it before selecting a low-code vendor.
LCAP platforms deliver a variety of methods to access data from other applications. Typical integration patterns include files, database calls (ODBC, JDBC, etc.), and scripting.
Now is the time to adopt API-First and design thinking. Stop building point-to-point integrations – the velocity of LCAP will result in a proliferation of connection methods if interfaces are not standardized.
Using APIs – fast delivery
Using APIs will enable faster delivery and better performance. Providing a set of standardized interfaces that meet the needs of consumers (a fundamental goal of API-First) will reduce test time, production breakage, and upgrade complexity. Don’t wait.
Doing APIs right requires a culture shift – slapping an API on an enterprise application is not the goal. Delivering APIs that drive consumption and adoption by citizen developers and go-to-market programs will power user experiences that truly do more with less.
Management and monitoring
Last but not least is the management and monitoring of your new agile applications, especially the application interactions with your core enterprise applications and external integrations. We have all seen it, a new program or upgrade is delivered, and performance slows to a crawl.
Monitoring and metering access (limited access to X number of calls per time period) is essential to proactively prevent coding errors and shield your client from bad actors. Knowing who is accessing what, and how the load varies, is necessary to achieve the goals of delivery velocity and efficient use of resources.
API Management vendor leaders include policy engines, management, and embedded analytics in their gateways to protect and scale service integrations.
Better, faster, cheaper is our mantra (once again, some of us mutter under our breaths). Adopting low-code will accelerate delivery and help us meet the demands of the new normal.
LCAP demands standardized authentication, application program interfaces (APIs), and secure, monitoring gateways to accelerate adoption while protecting and securing enterprise resources.
About Ruby Raley
Ruby Raley is VP of Healthcare and Life Sciences at Axway. Axway empowers customers to compete and thrive in dynamic marketplaces using hybrid integration solutions to better connect their people, systems, businesses, and digital ecosystems. More than 11,000 organizations in 100 countries rely on Axway to solve their data integration challenges.
The COVID-19 pandemic is not just a medical crisis. Since the highly contagious disease hit American shores in early 2020, the virus has dramatically changed all sectors of society, negatively impacting everything from food supply chains and sporting events to the nation’s mental and behavioral health.
For some people, work-from-home plans and limited access to entertainment are manageable obstacles. For others, the shuttered schools, lost wages, and social isolation spell disaster – especially for individuals already living with socioeconomic challenges.
The social determinants of health have always been important for understanding why some populations are more susceptible to increased rates of chronic conditions, reduced healthcare access, and shorter lifespans. COVID-19 is throwing the issue into high relief.
Now more than ever, healthcare providers need to gain full visibility into their populations and the non-clinical challenges they face in order to help individuals maintain their health and keep their communities as safe as possible during the ongoing pandemic.
Exploring correlations between socioeconomic circumstances and COVID-19 vulnerability
Clinicians and researchers have worked quickly to identify patterns in the spread of COVID-19. Early results have emphasized the danger posed by advanced age and preexisting chronic conditions such as obesity, diabetes, and heart disease.
Further, data from the Johns Hopkins University and American Community Survey indicates that the infection rate in predominantly black counties is three times higher than in mostly white counties. The death rate is six-fold higher.
Data from the Centers for Medicare and Medicaid Services (CMS) confirms the trend: black Medicare beneficiaries are hospitalized at a rate of 465 per 100,000 compared to just 123 per 100,000 white beneficiaries. Hispanic Medicare beneficiaries had 258 hospitalizations per 100,000, more than double the white population’s hospitalization rate.
Researchers suggest that the social determinants of health may be largely responsible for these disconnects in infection and mortality rates. Racial, ethnic, and economic factors are strongly correlated with increased health concerns, including longstanding disparities in access to care, higher rates of underlying chronic conditions, and differences in health literacy and patient education.
Leveraging data-driven tools to identify vulnerable patients
Healthcare providers will need to take a proactive role in identifying which of their patients may be at enhanced risk of contracting the virus and experiencing worse outcomes from the disease.
They will also need to ensure that person gets adequate treatment and participate in contact tracing efforts after a positive test. Lastly, providers will have to ensure their public health reporting data is accurate to inform local and regional efforts to contain the disease.
The process begins by developing confidence in the identity of each individual under the provider’s care. Healthcare organizations often struggle with unifying multiple electronic health record (EHR) systems and other health IT infrastructure, resulting in medical records that are incomplete, inaccurately duplicated, or incorrectly merged.
Access to current and complete medical histories is key for highlighting at-risk patients. An enterprise master patient index (EMPI) can provide the underlying technical foundation for initiating this type of population health management.
EMPIs help organizations create and manage reliable unique patient identifiers to ensure that records are always associated with the correct individual as they move throughout the healthcare system.
When paired with claims data feeds, health information exchange (HIE) results, and interoperability connections with other healthcare partners, EMPIs can bring a patient’s complete healthcare status into focus.
This approach ensures that providers stay informed about past and present clinical issues and service utilization rates. It can also support a deeper dive into the social determinants of health.
Combining EHR data with standardized data about socioeconomic needs can help providers develop more comprehensive and detailed portraits about their patients’ holistic health status.
By including this information in EHRs and population health management tools, providers can develop condition-specific registries to guide outreach activities. Providers can deploy improved care management strategies, close gaps in care, and connect individuals with the resources they need to stay healthy.
Healthcare organizations can acquire socio-economic data about their communities in a variety of ways, including integrating public data sources into their population health management tools and collecting individualized data using standardized questionnaires.
Once providers start to understand their patients’ non-clinical challenges, including the ability to avoid situations that may expose them to COVID-19, they can begin to prioritize patients for outreach and develop personalized care plans.
Conducting effective outreach and interventions for high-needs patients
COVID-19 has taken a staggering economic toll on many families, including those who may have been financially secure before the pandemic. Routine healthcare, prescription medications, and even some urgent healthcare needs are often the first to fall by the wayside when finances get tight.
Healthcare providers have gotten creative about staying connected to patients through telehealth, drive-in consults, and other contactless strategies. But they must also ensure that their vulnerable patients are aware of these options – and that they are taking advantage of them.
Contacting a large number of patients can be challenging since phone numbers, emails, and home addresses change frequently and are prone to data entry errors during intake. Organizations with EMPIs can leverage their tools to ensure contact information is up to date, accurate, and associated with the correct individual.
Care managers should prioritize outreach to patients with complex medical histories and known clinical risks for vulnerability to COVID-19. These conversations are a prime opportunity to collect social determinants of health information or refresh existing data profiles.
Looking to the future of healthcare in a COVID-19 world
Combining technology-driven strategies with targeted outreach will be essential for healthcare organizations aiming to provide holistic support for their populations during – and after – the COVID-19 pandemic.
By developing certainty about patient identities and synthesizing that information with data about the social determinants of health, providers can efficiently and effectively connect with their patients to offer much-needed resources.
Taking a proactive approach to addressing the social determinants of health during the outbreak will help providers maintain relationships with high-needs patients while building new connections with those facing unanticipated challenges.
With a combination of population health management strategies and innovative technology tools, healthcare providers and public health officials can begin to view the social determinants of health as a fundamental component of the fight against COVID-19.
Andy Aroditis, is CEO of NextGate, the global leader in healthcare enterprise identification.
When food production technology made it possible, wheat flour processors started to eliminate the tough exterior (bran) and nutrient-rich core (germ) of the kernel to get at the large, starchy part (the endosperm) only. The bread produced from this process is white and fluffy, and it makes great PB&Js and takes forever to grow mold, but it is almost totally lacking nutritional value.
Nutrition experts eventually pointed this out, of course, after which commercial bakers tried fortifying their bread by adding back essential nutrients stripped out by processing. It didn’t work. While white bread from refined flour is still available, nutrition experts strongly recommend whole grain products as the healthier alternative.
Opposition to this reductionist approach to nutrition is perhaps best captured by the idea of the sum being the whole of its parts: If inputs are lacking, the end result will fall short also.
Each human being is also a sum of parts, and the reductionist approach to healthcare is essential when it comes to advancing many aspects of medicine and healthcare.
“Historically, the invention of the microscope, the defining of Koch’s four infectious disease postulates, the unraveling of the human genome, and even intelligent computers are salient examples of the dramatic benefits of biomedical reductionism,” explained Dr. George Lundberg.
These successes, however, may have convinced many in both the medical community and society at large that reductionism is a necessary, if not sufficient, approach. The numbers say otherwise.
“Classical medical care interventions contribute only about 10 percent to reducing premature deaths compared to other elements such as genetic predisposition, social factors, and individual health behaviors,” Lundberg goes on to say. “Most contemporary medical researchers have concluded that the chronic degenerative diseases of modern Western humans have multiple contributory causes, thus not lending themselves to the single agent-single outcome model.”
Paging Dr. House. It turns out your particular form of genius just isn’t frequently that useful.
And nowhere is the single agent-single outcome model arguably less effective than in behavioral health and chronic disease management. What many in medicine and healthcare now realize is that a vicious cycle of alternating physical and mental ailments are the norm with both chronic illness and long-term mental health challenges.
“Depression and chronic physical illness are in a reciprocal relationship with one another: not only do many chronic illnesses cause higher rates of depression, but depression has been shown to antedate some chronic physical illnesses,” says Professor David Goldberg of the Institute of Psychiatry in London.
It’s an unsurprisingly intuitive conclusion to reach. A man with depression lacks the desire to eat well, exercise, often practice necessary daily hygiene. As his untreated depression deepens, his physical health declines as well. A woman with chronic, untreated pain feels like it will never end and her life is over. Faced with a seemingly unmanageable challenge, she falls into a funk that eventually metastasizes into full-blown depression.
A reductionist approach to these scenarios might be to encourage more exercise or prescribe antidepressants. While both are necessary, neither will likely be sufficient.
So why hasn’t a more holistic approach to patient care become the norm? In a nutshell, because it’s expensive. Chronic illnesses, generally, are the most expensive component of healthcare.
According to a New England Journal of Medicine study, patients “with three or more chronic conditions (43 percent of Medicare beneficiaries) account for more than 80 percent of Medicare health care costs.”
For this expensive, highly at-risk group, holistic care is what actually works.
The NEJM articles conclude that “an intervention involving proactive follow-up by nurse care managers working closely with physicians, integrating the management of medical and psychological illnesses, and using individualized treatment regimens guided by treat-to-target principles improved both medical outcomes and depression in depressed patients with diabetes, coronary heart disease, or both.”
Of course, the regimen included in the NEJM study is expensive—perhaps more so than what qualifies as holistic care now.
But it requires a certain type of twisted logic to argue for holding down costs by rationing care inputs—by reductively treating only just the most obvious health concerns—when this approach invariably leads to readmissions, more office visits, more disability payments, more days of work missed.
Indeed, a reductive approach to accounting—silos of financial impact across the continuity of a life lived—hides the fact that specific healthcare costs are not alone the measure of how chronic illness detracts from both individual life satisfaction and broader societal efficiencies.
The key, then, is to make holistic health both the norm and affordable. How can that be done? By creating initiatives designed to achieve a core set of goals:
Incentivize primary care: In the last two decades, the number of primary care providers (PCPs) available to patients in the United States has decreased by about 2 percent. This may not sound like a lot, but the decline comes as the population has increased, naturally, which means fewer patients have a PCP. As healthcare shifts to pay for performance, not services, the PCP is the natural quarterback of patient care. The country needs many more PCPs, not fewer, and the federal government has an opportunity to use loan forgiveness incentives and other tools to nudge medical school students in that direction.
Embrace technology: Arguably, holistic care only became possible with the digital age. Chronic disease management requires frequent measurement of patient vitals, which is very expensive without wearables and similar digital age technologies. Now, patients can regularly provide data with no clinical intervention, that data can automatically upload to an electronic health record, and that EHR can alert the clinician when results are alarming.
Make poor choices expensive: Perhaps only because smoking has become so socially unacceptable can the cost of cigarettes be so high ($7.16 per pack in Chicago with all taxes) without creating significant protests. But the data is clear that higher costs equal fewer smokers. The same types of behavioral economics programs can also apply to fast food, soda, etc. Yes, people will get upset and complain about the nanny state, but absent some attempt to change behavior, we may want to consider changing the name to the United States of Diabetes.
Reward smart choices: Healthy people use healthcare and insurance less often, which drives down costs. Duh. Combining technology and incentives (avoiding diabetes), Utah’s Intermountain Healthcare engaged almost 1,500 pre-diabetic employees in a program through Omada Health that collectively yielded 9,162 pounds lost. Omada billed Intermountain based on the level of success, and without speaking to specific numbers, Intermountain felt the cost of the program was a wise investment when compared with the costs of diabetes treatment.
These four bullets are probably just the most obvious suggestions, of course. They don’t account for the complexities of the American healthcare system focused on payment models, the profit motive, or what to do with the uninsured, homeless, and devastatingly mentally ill.
But the benefits of holistic thinking when reductionism is inadequate applies to both individual care and the healthcare system as a whole. Public health, for example, takes a holistic approach to communities by looking at how housing, transportation, and education impact general overall health. Where this approach is done well, the benefits are obvious.
Reductionist isolation will always be necessary when identifying specific genes or determining which natural elements are effective in treating disease. But it’s wise to always bring the right tools for the job.
COVID-19 has put a tremendous burden on hospitals, and the clinicians, nurses, and medical staff who make them run.
Many hospitals have suffered financially as they did not anticipate the severity of the disease. The extended duration of patient stays in ICUs, the need for more isolated rooms and beds, and the need for better supplies to reduce infections have all added costs. Some hospitals did not have adequate staff to check-in patients, take their temperature, monitor them regularly, or quickly recruit nurses and doctors to help.
AI can greatly improve hospital efficiency, improve patient satisfaction, and help keep costs from ballooning. Autonomous robots can help with surgeries and deliver items to patient’s rooms. Smart video sensors can determine if patients are wearing masks or monitor their temperature. Conversational tools can help to directly input patient information right into medical records or help to explain surgical procedures or side effects.
We’ve become familiar with devices in and around our homes that use AI for image and speech recognition, such as speakers that listen to our commands to play our favorite songs. This same technology can be used in hospitals to screen patients, monitor them, help them understand procedures, and help them get supplies.
Screening is an important step in identifying patients who may need medical care or isolation to stop the spread of COVID-19. Temporal thermometers are widely used to measure temperatures via the temporal artery in the forehead, but medical staff has to screen patients one by one.
Temperature screening applications powered by AI can automate and dramatically speed up this process, scanning over 100 patients a minute. These systems free up staff, who can perform other functions, and then notify them of patients who have a fever, so they can be isolated. Patients without a fever can check-in for their appointments instead of waiting in line to be scanned.
AI systems can also perform other screening functions, such as helping monitor if patients are wearing masks and keeping six feet apart. They can even check staff to ensure they are wearing proper safety equipment before interacting with patients.
2. Virtual Nurse Assistant
Hospitals are dynamic environments. Patients have questions that can crop up or evolve as circumstances change. Staff have many patients and tasks to attend to and regularly change shifts.
Sensor fusion technology combines video and voice data to allow nurses to monitor patients remotely. AI can automatically observe a patient’s behavior, determining whether they are at risk of a fall or are in distress. Conversational AI, such as automatic speech recognition, text-to-speech, and natural language processing, can help understand what patients need, answer their questions, and then take appropriate action, whether it’s replying with an answer or alerting staff.
Furthermore, the information recorded from patients in conversational AI tools can be directly inputted into patients’ medical records, reducing the documentation burden for nurses and medical staff.
3. Surgery Optimization
Surgery can be risky and less invasive procedures are optimal for patients to speed up recovery, reduce blood loss, and reduce pain. AI can help surgeons monitor blood flow, anatomy, and physiology in real-time.
Connected sensors can help optimize the operating room. Everything from patient flow, time, instrument use, and staffing can be captured. Using machine learning algorithms and real-time data, AI can reduce hospital costs and allow clinicians to focus on safe patient throughput.
But it’s not just the overall operations. AI will allow surgeons to better prepare for upcoming procedures with access to simulations beforehand. They will also be able to augment procedures as they happen, incorporating AI models in real-time, allowing them to identify missing or unexpected steps.
Contactless control will allow surgeons to utilize gestures and voice commands to easily access relevant patient information like medical images, before making a critical next move. AI can also be of assistance following procedures. It can, for example, automatically document key information like equipment and supplies used, as well as staff times.
During COVID-19, telehealth has helped patients access their clinicians when they cannot physically go to the office. Patients’ adoption of telehealth has soared, from 11% usage in 2019 in the US to 46% usage in 2020. Clinicians have rapidly scaled offerings and are seeing 50 to 175 times the number of patients via telehealth than they did before. Pre-COVID-19, the total annual revenue of US telehealth was an estimated $3 billion, with the largest vendors focused on the “virtual urgent care” segment. With the acceleration of consumer and provider adoption of telehealth, up to $250 billion of current US healthcare spend could potentially be virtualized.
Examples of the role of AI in the delivery of health care remotely include the use of tele-assessment, telediagnosis, tele-interactions, and telemonitoring.
AI-enabled self-triage tools allow patients to go through diagnostic assessments and receive real-time care recommendations. This allows less sick patients to avoid crowded hospitals. After the virtual visit, AI can improve documentation and reimbursement processes.
Rapidly developing real-time secure and scalable AI intelligence is fundamental to transforming our hospitals so that they are safe, more efficient, and meet the needs of patients and medical staff.
About Renee Yao
Renee Yao leads global healthcare AI startups at NVIDIA, managing 1000+ healthcare startups in digital health, medical instrument, medical imaging, genomics, and drug discovery segments. Most Recently, she is responsible for Clara Guardian, a smart hospital ecosystem of AI solutions for hospital public safety and patient monitoring.
Welcome to the first issue of Pharmaceutical Commerce under new ownership. As announced, MJH Life Sciences acquired the multimedia platform in July, after 15 years of careful stewardship by founder Nick Basta. In handing over the keys, Nick mentioned in this space the unique educational role Pharmaceutical Commerce has served—bringing to light useful information on business-impacting practices within an industry that has experienced significant change. You’ve heard that latter part a lot in recent years, but certainly, today, with the influences of a global pandemic, along with sweeping social, cultural, and economic change, it’s not hyperbole. And equally so inside the industry when applied to the not-so-easy task of uncovering what’s truly “needle-moving”—the value from the noise—in a business with so many trigger points in the mix these days, from science and technology, to pricing and policy, to just scratch the surface.
That’s why Pharmaceutical Commerce is not a general studies educator. As we take the helm, much like our predecessor, we will seize on opportunities to educate and enlighten in areas such as pharmaceutical distribution and supply chain management, attempting to fill those knowledge gaps in process and strategy that can cloud the complex path from product packaging….to pharmacy/point of care….to patient. Look no further than our special coverage in this month’s issue on the pharma cold chain. While our cover story and contributed features are all closely linked around the evolving demands for safe storage and transport of temperature-sensitive vaccines and drugs, they all examine differing aspects of these journeys and potential solutions to address the many related challenges, which are magnified today amid pursuits for a COVID-19 vaccine and the steady emergence of cell and gene therapy.
We hope you find this issue a valuable resource as you tackle these challenges in your daily work, or, like many, watch in anticipation how perhaps healthcare’s most ambitious and complicated distribution effort ever will unfold.
As we continue and grow the vision of Pharmaceutical Commerce into the future, feel free to send me tips or ideas on topics worth exploring or ways we can enhance the coverage you’ve come to expect when opening these pages or visiting our website. Consider it an educational investment.
Mike Christel is Editorial Director of Pharmaceutical Commerce. He can be reached at [email protected]
The impact of the coronavirus crisis is shining a bright light on many of the challenges facing the U.S. healthcare system.
So much more than a lack of primary care physicians and hospital beds, the all-hands-on-deck approach to combating the spread of COVID-19 has forced patients fearful of engaging with the healthcare system for needs unrelated to the virus to put elective procedures, routine care and timely treatment for chronic or critical conditions on the back burner.
Compounding these issues, fears surrounding visiting the doctor’s office have forced primary care facilities to lay off or furlough clinicians and staff, deferring or skipping clinician salaries in some cases. When it comes to epidemic illness, primary care professionals serve as the first line of defense, preventing patients from flooding emergency rooms and hospitals when they don’t actually need to be there. However, in spite of the need for access to affordable primary care, many primary care practices will not survive the pandemic.
Despite new CDC guidance showing people with underlying medical conditions like diabetes or hypertension are at increased risk for severe illness from COVID-19, most regular wellness check-ups, cancer screenings, and nonemergency procedures have been put on hold. While COVID-19 is responsible for more than 140,000 deaths in the U.S. alone, experts predict this delay in care for chronically ill patients has resulted in a “silent” death-toll — and one that continues to climb as the world waits for a vaccine.
In the meantime, what can hospitals and clinics in the U.S. do to better serve chronic care patients and ensure no one else falls through the cracks during the pandemic?
Healthcare generates a lot of data for patient records. It’s crucial that hospitals and medical clinics have the ability to analyze that data to identify and categorize vulnerable patients who are either:
– high-risk due to potential coronavirus-related complications or
– require regular check-ups because of care related to chronic illness, mental health, or addiction.
Facing the aforementioned barriers to primary care and treatments, many chronic and crisis care patients are exponentially more vulnerable to the impact of the virus. Even if these patients do not contract COVID-19, the regression that can happen when a condition is not properly managed can be equally dangerous.
Data analysis that allows healthcare providers to stratify patient population risk and engage patients based on care needs provides caretakers the information they need to create personalized treatment plans that ensure the needs of chronic and crisis care patients are not neglected.
Safe and Continuous Outreach
Healthcare clinics that traditionally rely on in-office visits are now scrambling to provide access to their patients through telemedicine and virtual visits while navigating the challenging new landscape of billing codes and payment rules for these services. Previously derided as less than effective medicine, telemedicine, and virtual visits have become necessary to reduce staff exposure, preserve personal protective equipment (PPE) and minimize the impact of patient surges on facilities.
Because systems have had to adjust the way they triage, evaluate and care for patients through the use of methods that do not depend on in-person services, telehealth, and virtual care services are helping provide necessary care to at-risk patients while minimizing the transmission risk of the virus that causes COVID-19 to healthcare personnel and other patients.
From phone calls and telemedicine appointments to apps, surveys, and regular check-ins, advances in technology empower hospitals and clinics to prioritize relationships that build the foundation enabling continuity of care, even using a new channel to communicate. Through proactive communication with patients about helpful resources and the option for virtual visits, providers can see significant success in their commitment to continued engagement with — and care for — patients.
Dedicated Patient Advocacy
Good patient-provider relationships foster better communication, which drives improved health and wellness. As such, it’s important that hospitals and clinics have ongoing and dedicated patient advocates to reach out to high-risk and chronic care patients.
By serving as the link between a patient’s care provider and the real world, patient advocates strive to ensure that patients have access to the care and resources they need. Whether that involves access to prescriptions, medical supplies, food, financial assistance, mental health programs, or workforce navigation, care coordination needs to extend beyond simple community referrals.
In the face of a global pandemic, patients often face complicated decisions concerning their health and overwhelming obstacles to receiving care. Ongoing, dedicated patient advocacy offers guidance that helps patients navigate the complicated health system, ensuring they get the care and support they need throughout the continuing COVID-19 outbreak.
Despite efforts to safely reopen businesses and get employees back to work, the virus itself has not gone away. With practitioners fearing the spread of the disease, patients afraid to keep their in-person appointments and clinicians being redirected to emergency rooms or coronavirus test sites, primary care doctors are seeing their patients far less frequently, and patients are struggling to effectively maintain their health.
That strain on the primary care system will continue. However, by moving to value-based care models, such as advanced primary care, that leverage data, and analytics to identify and categorize vulnerable patients, facilitate safe and continuous outreach to these patients through telemedicine and other virtual means and have dedicated patient advocates reaching out to high-risk and chronic care patients, hospitals and clinics can continuously serve their most vulnerable patients throughout the duration of the coronavirus crisis.
About Dr. Kayur Patel
Dr. Kayur Patel serves as Chief Medical Officer of Proactive MD. A practicing physician with extensive experience in internal and emergency medicine, his specialty lies in bringing physicians and hospital leadership together in order to convert healthcare challenges into opportunities for growth. He is a nationally-recognized authority and a national speaker on the subject of quality in healthcare.
– How the top US acute EHR vendors, namely Cerner, Epic, Allscripts, and MEDITECH (+85% share of US acute market in terms of revenues), have progressed on international expansion.
As highlighted below, there is a significant variance amongst the big four in terms of revenue and share of business outside the US. Cerner has by far the highest revenue at more than $650M in 2019, representing 12% of its business. Whilst MEDITECH has considerably lower revenue than Cerner, its international revenue is broadly similar to a share of its total revenue.
By contrast, Allscripts and MEDITECH each has international business that is comparable in terms of revenues, but as a share of overall revenues, international is much less important for Allscripts.
Allscripts’ international revenue was lower than Epic, Cerner, and Meditech in 2018, however, its growth in 2019 enabled it to overtake MEDITECH and become the third largest of the four vendors in 2019.
Cerner’s international revenues fell marginally as a proportion of its total business in 2019 (11.5%, down from 11.9% in 2018), although revenues grew in absolute terms by 3%. This growth was aided by success in Europe, particularly in the UK and Nordics where it won new contracts. Cerner’s overall revenue suffered a 3% decline in 1H 2020 (versus 1H 2019). Despite the impact of COVID-19, its international business witnessed marginal revenue growth (+1%) and rose as a share of its overall business (11.9%) during this period.
Cerner received a significant boost to its international business in 2015 when it acquired Siemens’ EHR business. This provided it with a broad footprint of deployments in DACH (Germany, Austria, Switzerland), Benelux, France, Norway, and Spain. Since this acquisition, the challenge for Cerner had been to migrate the customer base to Millennium. However, this has not happened to date, particularly in Germany and Spain.
Tough market conditions, especially in Germany which already had a highly competitive acute EHR market, was another factor impacting the market growth. The above challenges faced by Cerner were key drivers behind the deal to sell parts of Cerner’s Healthcare IT portfolio in Germany and Spain to CompuGroup Medical (CGM). Cerner will continue to maintain a presence in Spain and German acute markets via its i.s.h.med solution (originally contracted to SAP/Siemens), which was not included in the CGM agreement. i.s.h.med has also provided Cerner a footprint in several other European, African, and Asian countries such as Russia and South Africa.
In other European countries where Cerner has a Millennium footprint it has had more success, and the additional product support and development costs have been less.
Cerner has a substantial UK presence, in part owing to its legacy relationship with BT and the subsequent contracts given out under the largely failed NPfIT program. These customers do use Millennium and the company has grown this business in recent years. To date, Cerner has an installed base of 26 trusts in the UK, up from 22 in 2019, and has had success upscaling these contracts to include products such as HealtheIntent. It has also grown the number of acute trusts served. For example, in 2018 it won contracts with The Countess of Chester Hospital National Health Service Foundation Trust, previously using MEDITECH, and Sandwell and West Birmingham Hospitals. In 1Q 2020, Cerner was selected by two NHS Foundations Trusts (Ashford and St Peter’s Hospital and Royal Surrey) to implement a shared Millennium EHR system, which should support a more coordinated care approach between the two organizations.
Elsewhere in Europe, Cerner expanded its Nordic business recently with large contracts in Region Skäne and Västra Götalandsregionen (both in Sweden) during 2018 and 2019. Cerner was chosen as the preferred EMR supplier for Central Finland (four of 19 sote-areas) and will have the opportunity to expand the contract to other surrounding regions in the mid-long term. However, it lost its Norwegian footprint to Epic when it chose not to bid when the Helse Midt-Norge (Central region) contract was renewed in 2019.
The company has also seen success in the Middle East, particularly in the UAE, Qatar, and Saudi Arabia. However, growth has been more subdued over recent years. In the UAE, it has large contracts with the Ministry of Health and Prevention (MOHAP) and Abu Dhabi department of health (HAAD). Whilst Cerner already has a significant footprint in Saudi, e.g. King Faisal Hospital, the country is still relatively untapped in terms of deployment of digital solutions and offers Cerner a good future growth opportunity.
In Asia Cerner has been successful in Australia, winning state/territory-wide EHR contracts in both Queensland and New South Wales (the only vendor to win two state/territory-wide contracts), and also had success in other states/territories where procurement is decentralized. Cerner was aiming to add a third centralized Australian contract to its customer base, namely ACT Health (Capital Territory), but was unsuccessful in a head-to-head with Epic, which was selected as the chosen partner in July 2020. Cerner aims to push its PHM solution (HealtheIntent) through its existing state-level contracts where it already has a presence with Millennium.
Most of Cerner’s non-US business in the Americas is in Canada where approximately 100 hospitals are estimated to be using its solution. Here it faces competition from the other leading US vendors such as MEDITECH, Epic, Allscripts, and also local vendor Telus.
In summary, Cerner has broadly made a success of its international business. It tops the market share table in several of its international geographies and it has done this while broadly maintaining the margins achieved with its US business. However, Cerner’s divestiture of the legacy Siemens business in Germany/Spain, and withdrawal from Norway (Central region), will reduce the size of its European business. Cerner also faces an increasing threat from EMEA competitor Dedalus, whose recent acquisitions of Agfa Health’s EHR and integrated care business, and DXC’s healthcare provider business (deal to close in March 2021), could impact Cerner’s position as acute EHR market leader in EMEA moving forwards.