The Workgroup for Electronic Data Interchange and the Confidentiality Coalition have written a letter to federal officials calling for more protections for patient information accessed through third-party mHealth apps.
Two organizations focused on protecting patient data are urging federal officials to take several steps to protect that data from unsafe third part mHealth apps.
The Workgroup for Electronic Data Interchange (WEDI) and Confidentiality Coalition have written a letter to Health and Human Services Secretary Xavier Becerra and Commerce Secretary Gina Raimondo offering five recommendations for protecting patient information on third party apps, much of which isn’t covered by the Health Insurance Portability and Accountability Act (HIPAA).
“Some CEs, including health plans, physician practices and inpatient facilities have already built or have contracted with business associates to develop patient access APIs and apps and are actively promoting their use,” the letter points out. “Specifically, these apps deployed by providers and health plans are typically covered under HIPAA and therefore the individual’s accessing data have assurances that their information is being kept private and secure. We are concerned, however, regarding the lack of robust privacy standards applicable to the large percentage of third-party app developers not associated with CEs and therefore not covered under HIPAA and the fact that there currently is no federally recognized certification or accreditation for these apps.”
“The potential exists for PHI gained via the apps to be inappropriately disclosed to the detriment of patients and their families,” the letter states. “While we strongly support patient access to their PHI via apps, we assert that a national framework is required to ensure that health care data obtained by third-party apps is held to high privacy and security standards.”
In response, the two groups are urging Becerra and Raimondo to:
Release additional guidance on the types of third-party app security and privacy verification that will be permitted and allow CEs themselves to undertake an appropriate level of review of a third-party app before permitting it to connect to their APIs;
Require entities that are not HIPAA CEs or business associates to clearly stipulate to the individual the purposes for which they collect, use, and disclose identifiable health information and require that these individuals be given clear, succinct notice concerning the collection, use, disclosure, and protection of individually identifiable health information that is not subject to HIPAA;
Work with the private sector in the development of a privacy and security accreditation or certification framework for third-party apps seeking to connect to APIs of certified health IT. Once established, CEs should be permitted to limit the use of their APIs to third-party apps that have agreed to abide by the framework. Such a program would not only foster innovation, but also establish improved assurance to patients of the security of their information;
Apply similar security requirements in the private sector as CMS applies to its Blue Button 2.0 and DPC initiatives, requiring all third-party apps seeking to access PHI via provider or health plan APIs to prove adherence to a strict set of privacy and security guidelines or successfully complete a CMS-approved security certification; and
Partner with groups like the Confidentiality Coalition, WEDI and other professional associations in the development and deployment of education aimed at a wide range of consumers and CEs. Enhanced consumer and CE education will lead to significant improvement in the ability of the consumer and the CE to understand their rights and responsibilities under the law.
According to the two groups, recent evidence indicates mHealth third-party apps are vulnerable to unauthorized access and use. They applaud efforts to update HIPAA to account for new technologies and tactics, but say more needs to be done now.
“While we are supportive of increasing data exchange for patients via third-party apps, there is a clear potential that using these apps could result in patients having their information inappropriately disclosed,” the letter states. “We also assert that it is inappropriate to put the burden of warning the individual solely as the responsibility of the CE. CEs will typically not be experts on app data privacy and security protocols and will have little time to warn patients of the potential dangers associated with transmitting ePHI to third parties not covered by the HIPAA protections. Under current regulation, CEs are not permitted to require formal verification checks on individual third-party apps before allowing the application to connect to its API.”
“We believe that for health care data exchange to occur in an interoperable manner as called for under the 21st Century Cures legislation, there must be a consistent and high level of trust among all participants, including entities that are not legally a CE or bound by a BAA,” it concludes. “The deployment of effective federal policies is critical to assist in facilitating this trust framework.”
WEDI was formed in 1991 by then-HHS Secretary Dr. Louis Sullivan to “identify opportunities to improve the efficiency of health data exchange.” The Confidentiality Coalition is a broad group of healthcare organizations formed by the Healthcare Leadership Council to focus on advancing effective patient confidentiality protections.
Researchers at the Los Angeles health system have developed an algorithm that can reportedly predict a patient's chances of having a heart attack over the next five years by analyzing plaque deposits in coronary arteries.
Researchers at Cedars-Sinai have created an AI tool that may help care providers predict a patient’s chances of having a heart attack over the next five years.
The algorithm analyzes the amount and composition of plaque in arteries that supply blood to the heart to determine heart attack risk. In the 11-site, international SCOT-HEART study involving almost 1,611 patients from 2010 to 2019, the tool offered “excellent or good agreement” with expert reader measurements and intravascular ultrasound.
“Coronary plaque is often not measured because there is not a fully automated way to do it,” Damini Dey, PhD, director of the quantitative image analysis lab in the Biomedical Imaging Research Institute at Cedars-Sinai and senior author of the study, recently published in The Lancet, said in a press release issued by Cedards-Sinai. “When it is measured, it takes an expert at least 25 to 30 minutes, but now we can use this program to quantify plaque from CTA images in five to six seconds.”
The study is the latest effort by healthcare providers to apply AI tools to the clinical care process, and it offers a glimpse into how the technology can help healthcare providers treat their patient and improve outcomes.
“A deep learning system that rapidly and accurately quantifies coronary artery stenosis has the potential for integration into routine CCTA (coronary CT angiography) workflow, where it could function as a second reader and clinical decision support tool,” Dey and her colleagues said in the study. “By providing automated and objective results, deep learning could reduce interobserver variability and interpretative error among physicians. Deep learning-based plaque volume measurements have independent prognostic value for future cardiac events, and could enhance risk stratification in patients with stable chest pain who are undergoing CCTA.”
According to the press release, Dey and her colleagues designed an algorithm that outlines coronary arteries in 3D images, then identifies the blood and plaque deposits within them. They found that the measurements corresponded with plaque amounts seen in coronary CTAs, and also matched results with “images taken by two invasive tests considered to be highly accurate in assessing coronary artery plaque and narrowing: intravascular ultrasound and catheter-based coronary angiography.”
Using AI in healthcare was a hot topic at the recent HIMS22 conference in Orlando, but experts are divided on where the hype ends and the reality begins. Some also worried that the potential could lead researchers and providers to overlook bias in AI, or use the technology incorrectly.
In their study, Dey and her colleagues noted that they searched available databases for past research on AI, and found 26 articles exploring the use of deep learning to assess coronary lesions on CCTA. Most of those were proof-of-concept studies, they said, and none were detailed enough to provide evidence of long-term viability.
“More studies are needed, but it’s possible we may be able to predict if and how soon a person is likely to have a heart attack based on the amount and composition of the plaque imaged with this standard test,” Dey, a professor of biomedical sciences at Cedars-Sinai, said in the press release.
Amerigroup Georgia is partnering with Mom's Meals on the program, which addresses social determinants of health and aims to help reduce pregnancy and delivery complications in a medically complex and underserved population.
A Georgia-based health plan is sending two nutritionally customized meals a day to pregnant members living with diabetes in an effort to reduce delivery risks and boost clinical outcomes.
Amerigroup Georgia is partnering with Mom’s Meals on the pilot program, which gives moms-to-be an important source of nutrition for 10 straight days in a bid to reduce chances of preterm delivery and caesarean sections.
“One of the major issues with pregnant members with diabetes is managing food intake,” Dr. John Lue, Amerigroup Georgia’s obstetric medical director, who initiated the study, said in a press release. “Although we already offer nutritional counseling and a blood glucose meter, patients still become hyperglycemic and often require inpatient hospitalization to stabilize blood glucose levels. Our hope is for the provision of up to 140 medically tailored meals and improved behavior management to result in better health for expectant mothers and their developing babies.”
Amerigroup Georgia launched the statewide program in September 2021 with Iowa-based Mom’s Meals, and has so far delivered more than 6,000 meals to 74 members. The program, which runs through September 2022, will now be opening up to obstetric members in the Georgia managed care program.
The program is modeled after the Simply Healthcare Plans in Florida cost-of-care initiative, which helped to reduce both maternal hospital and neonatal intensive care unit (NICU) admissions.
“We hope that this model in Georgia can eventually become a standard benefit and expand to other states, especially those with higher rates of expectant mothers with diabetes,” Tim Conroy, national vice president of government and healthcare partnerships for Mom’s Meals, said in the press release.
Officials will measure the value of the program in the number of C-sections and other delivery complications, maternal hemoglobin A1C values and random glucose screenings, birth outcomes, and the reduction in other risks associated with diabetes during pregnancy.
Roughly 1 million Georgians, or about 12.4% percent of the state’s population, are living with Type 1, Type 2 or gestational diabetes, according to the American Diabetes Association; many others have been undiagnosed or have health factors that put them at high risk of developing the chronic disease.
Nutrition is considered one of social determinants of health, a non-clinical issue that factors, directly or indirectly, into one’s health and wellness. Many healthcare organizations, from providers to payers, are developing new programs that address those factors, the barriers they may cause to healthcare access and the effects they have on clinical outcomes.
The Department of Veterans Affairs is partnering with Evidation to allow veterans to enroll in a program that helps them monitor their heart health through a smartphone or wearable.
The Department of Veterans Affairs is launching a new program aimed at helping veterans manage their heart health through their smartphones and wearables.
The VA and the Veterans Health Administration Innovation Ecosystem (VHAIE) are partnering with California-based digital health company Evidation to enroll veterans in Heart Health on Evidation, a program co-developed with the American College of Cardiology in 2020. The program will be open to veterans regardless of whether they are living with heart disease.
“Veterans who join Heart Health can track and understand their heart health and chronic conditions outside of the doctor’s office from anywhere,” Arash Harzand, MD, a VHAIE senior innovation fellow, said in a press release. “Daily activity, sleep and mood can have a serious impact on heart health and this program gives Veterans an opportunity to measure and engage with these important personal health metrics.”
The program is one of many to use mHealth technology to expand opportunities for consumers and providers to track and manage chronic conditions outside the hospital, clinic or doctor’s office. The program is accessible through an mHealth app (it’s available via iOS and Android) on a smartphone, and participants can also connect through devices such as a smartwatch.
Programs like that offered by Evidation allow consumers to track relevant data, including activity, weight, diet, moods and symptoms, and access resources on cardiac health and wellness. Users can also get personalized reports that chart their health data over time and share that information with their care providers.
Some programs also partner with healthcare providers as a precursor to remote patient monitoring services, in which providers track patient health on devices over time and use that data to create a care management plan.
HIMSS22 returned to form last week in Orlando with a smaller yet energetic event, and a mission to reimagine health so that it works for everyone.
This year's HIMSS22 conference may have been more about improving the healthcare experience for everyone—healthcare workforce included—than patient care.
The annual get-together of HIMSS made its return to form with a weeklong event last week in Orlando, featuring a smaller but energetic exhibition hall, busy educational sessions, an inspiring closing keynote on mental health by Olympic champion Michael Phelps, and a "let's get back to business" air that recognized the challenges facing the healthcare industry.
And while the theme was "Reimagine Health," the focus was squarely on new technologies and processes that improve workflows and make it easier for providers to deliver care, thus reducing the stress on an overworked and shrinking workforce.
"They can't deliver care if you don't have healthy caregivers," one attendee said in the exhibit hall.
Caused in large part by the pandemic, the healthcare workforce in the U.S. is down to only 450,000, according to Roy Jakobs, chief business leader of connected care for Philips, which opened HIMSS22 at a virtual press briefing. That workforce is expected to be short 3.2 million by 2026, he said, forcing health systems to be creative about how they deliver health and support their employees.
There are many reasons for this shortage, beginning with surging rates of stress, depression, and burnout that are pushing people out of healthcare and causing many others to have second thoughts about joining the workforce. To address these challenges, HIMSS offered dozens of sessions on behavioral health access and innovation for both patients and providers, while several exhibit hall presentations and booths targeted preventive health and wellness, as well as mental health integrations (often through virtual care) with clinical services.
Beyond that, many healthcare companies sought to highlight technology that improves the clinical care process, including AI and digital health tools and platforms that reduce the administrative burden for healthcare providers and improve workflows. The theme running around the convention center was that technology should be used not only to boost clinical outcomes and improve access to care but to make the clinician's job easier.
"The pandemic has fast-tracked how we think about healthcare," said Elise Kohl-Grant, chief information officer at Innovative Management Solutions NY, whose presentation at HIMSS22 focused on how to advance "equitable interoperability" to help underserved communities access behavioral health services that address the social determinants of health.
Speaking in a bustling corridor at the Orange County Convention Center prior to her session, Kohl-Grant spoke about the structural determinants that often define healthcare access, and about how new technology, from natural language processing tools that record and summarize conversations to data-mining tools that pull out relevant information, can help care providers improve their interactions with patients. This means the providers spend less time doing administrative work and more time understanding why a patient needs care and how to better provide that care.
"Simple things like appointment reminders can make a lot of difference," she said. And while those reminders help patients remember and plan for their appointments, a digital health platform that automatically sends out those reminders reduces stress on the providers, helps them cut down on missed appointments, and boost patient engagement.
"We've learned to be more nimble and change when we need to," said Don Gerhart Jr., RPh, who works in pharmacy clinical informatics at Pennsylvania-based WellSpan Health, and led a presentation on using AI for smart data migration and EHR consolidation. Gerhart said health systems that can use new technology to fine-tune the EHR and improve clinical functions not only boost efficiency, but also make clinicians more proficient and even appreciative of the EHR.
And that makes the whole healthcare experience better.
Putting a Spotlight on Innovation
To be sure, the pandemic has changed a lot about healthcare. Beyond the staggering and still-growing toll on patients, it cast a spotlight on a health system that had to pivot quickly and become innovative to handle the surge. Hospitals that had never tried telehealth launched new services within weeks, while others saw their 10-year digital health plan accomplished in a year.
There was clear evidence in the exhibit hall, where Zoom—once considered too simplistic for healthcare—now commands a presence as one of the fastest-growing virtual health platforms. Salesforce, a relatively new entrant into the healthcare industry, highlighted services honed in the business world that aim to improve back-end operations, strengthen patient engagement, and allow care providers to spend less time on a computer and more time with their patients.
Hyland Software offered a presentation of its new connected care platform, featuring technology that pulls in and sorts unstructured data coming from outside the EHR. Get Real Health held a press conference at its booth to unveil CHBase Unify, a "digital front door app platform" that represents the evolution of the personal health record and aims to improve patient engagement. Bamboo Health—formerly Appriss Health and PatientPing—talked up care collaboration and integration at its booth, while symplr and Tegria chatted up the benefits of health systems partnering with tech companies and even outsourcing services to reduce the IT burden.
And while health systems have always had a limited presence in a venue designed to focus on vendors, Intermountain Health planted itself squarely in the middle of the floor with a large booth. The Salt Lake City–based health system has always been one of the leaders in digital health innovation, with a virtual care network spanning several states. Its participation in HIMSS22 points to the challenges that hospitals and health systems now face in increased competition from retail health providers and health plans and telehealth companies that have their own networks of providers.
"It is about patient choice now," said Michelle Machon, RN, MSN, DNP, CPHIMS, CENP, director of clinical education, practice & informatics for the Kaiser Foundation Hospitals, who was in town to anchor a presentation on how technology changed pandemic communications.
Machon said that when the pandemic started, health systems launched virtual care services using whatever they could find, including Zoom, Skype, and Google Chat, because that's what their patients wanted to use. And they were innovating in other areas as well, using baby monitors in the ICU and commercial blood glucose monitors to track patients in isolation.
"Now it's becoming the norm," she said.
Like so many others said at HIMSS, Machon says healthcare will change because the public will want it. They've seen what virtual health can do during a pandemic, and how technology has improved their travel, banking, retail, and dining experiences, and they'll demand that of their care providers or look for someone who will offer that experience.
Healthcare leaders, meanwhile, will look at soaring rates of stress and burnout and ever-shrinking workforces and conclude that a healthy workforce is an imperative, and that means not only addressing mental health needs but making it easier and more efficient for care providers to do their job.
The Federal Communications Commission is finishing off its Connected Care Pilot Program, a three-year, $100 million initiative aimed at supporting more than 100 health systems across the country in buying digital health equipment and extending broadband connectivity to improve healthcare access for underserved communities.
The Federal Communications Commission has announced almost $30 million in funding for 16 projects in 15 states through its Connected Care Pilot Program, which supports healthcare organizations in buying technology or extending broadband connectivity for programs aimed at improving access to care for underserved populations.
With this announcement, the FCC is effectively closing out the $100 million program, which was launched in January 2021 and now supports 107 projects in 40 states and Washington DC.
FCC Chairwoman Jessica Rosenworcel said the program will help the agency map out a strategy for the future of connected care and federal support.
“Although this is the last set of participants we are announcing in this program, it’s not the end,” she said in a separate press release. “That’s because we will be studying the award recipients in this program, the connections they used, and how they helped facilitate care. In fact, at the start of this effort, we announced we would produce a report when the three-year pilot program is complete. But I don’t think we should wait that long. So that’s why I’m announcing a new study today. By this time next year, the FCC staff will develop an interim report about initial lessons learned from this program and the COVID-19 Telehealth Program, which provided nearly $450 million in support for care during the pandemic. I look forward to this report informing our thinking about telemedicine going forward.”
The Connected Care Pilot Program was seen as a means of supporting healthcare organizations in launching or expanding programs through telehealth and digital health channels that address critical health disparities and access issues. It targeted issues like maternal mortality and pediatric healthcare, veterans’ service, behavioral health and substance abuse programs, and broadband connectivity, which often serves as a barrier to accessing care in both urban and rural areas.
The latest round of award recipients includes the Boston Community Medical Group, which will launch a HIPAA-compliant telehealth platform to serve 22,000 low-income patients across Massachusetts; Children’s Hospital of Denver, which is planning a remote patient monitoring program for roughly 200 low-income patients living with medically complex conditions; Christiana Care Health Services in Delaware, which is launching an RPM and telehealth program for prenatal monitoring for an estimated 5,000 low-income patients; the Council of Athabascan Tribal Governments in Alaska, which is expanding RPM and other virtual care services for almost 6,000 veterans and other underserved patients across the state; and the New England Telehealth Consortium, which is expanding its connected care platform to serve more veterans and other patients in New Hampshire and Maine.
In a separate press release, FCC Commission Brendan Carr said the agency needs to “make sure that these services have a stable, long-term funding model” and that program be studied to determine how to develop and sustain more projects.
“Furthermore, it has become clear that there is bipartisan support for legislative measures that may be necessary to keep the success of telehealth going,” he said. “For instance, there have long been a range of licensing and reimbursement issues that held back telehealth prior to the COVID-19 pandemic. In early 2020, the Department of Health and Human Services, with urging from Congress, helped facilitate greater access to telehealth services through the issuance of key waivers. For example, HHS has allowed more types of providers to bill Medicare for telehealth services and granted waivers for the reimbursement of audio-only telehealth services. While these waivers are set to expire at the end of the COVID-19 public health emergency declaration, we cannot afford a return to the status quo once the pandemic ends. We have made too much progress to move backwards.”
With President Biden’s signing of the 2022 Consolidated Appropriations Act at just about the same time Carr penned his letter, Congress did extend many of the CMS telehealth waivers for an additional 151 days after the end of the PHE. Carr’s point is that Congress needs to set a long-term policy for connected health, and he’s advocating for a pair of bills: the CONNECT for Health Act, which has support from more than half of the Senate and would make many of those emergency telehealth provisions permanent; and the Protecting Rural Telehealth Access Act, which would also permanently extend a number of the CMS waivers.
The state funding will go to OSF HealthCare and four federally qualified health centers that have launched a five-year program to develop new technology platforms and services to help underserved communities access healthcare.
Illinois is spending almost $66 million on a new program aimed at helping underserved communities access care.
The state’s Department of Health and Family Services is funding Peoria-based OSF HealthCare and a group of federal qualified health centers (FQHCs) that have launched the Medicaid Innovation Collaborative (MIC). The MIC will use the money to develop innovative new technologies and services that help people struggling with social determinants of health, such as financial issues, housing and food insecurity, which affect how they access healthcare.
“We learned during the pandemic that virtual care was a game-changer for patients, and the new funding will help us implement the latest technologies to expand access to care for underserved communities and vulnerable populations,” Michelle Conger, CEO of OSF OnCall Digital Health, said in a press release. “As a leader in digital health, we are excited to develop, implement and evaluate innovative, evidence-based strategies that will improve health and wellness for all residents in the communities served by OSF and our partners, regardless of their income level or where they live.”
Healthcare organizations across the country are using digital health platforms to address those barriers to care often found in Medicare and Medicaid populations. Without that access, consumers often avoid or skip needed healthcare services, exacerbating chronic conditions, reducing healthy lifestyles and leading to costly healthcare services and reduced clinical outcomes down the road.
OSF OnCall, the health system’s digital health platform, will be working with four FQHCs – Heartland Health Services in Peoria, Chestnut Health Systems in Bloomington, the Eagle View Community Health System in Oquawka, and Aunt Martha’s Health & Wellness in Danville – to equip community health workers and medical care teams with digital health tools to help assess and treat patients, including giving them resources and access to virtual care opportunities.
Those services will include chronic care management, behavioral health treatments, maternal and child health services, cancer screenings, and dental services. In addition, the program will support additional staff at community health clinics, EHR implementations, mobile health units and digital health connectivity in underserved areas.
The project will also create about 100 new healthcare jobs, potentially affected about a third of the state. The MIC is partnering with Illinois Central College in East Peoria to train people to fill those community health worker positions.
Officials says the program’s goal is to provide 1 million episodes of care for Medicaid patients over the next five years, especially targeting the state’s most vulnerable and marginalized communities.
As the conference kicks into gear this week in Orlando, Gartner vice president analyst Mandi Bishop offered five jarring predictions for healthcare and five steps that healthcare leaders should take to address those trends.
Lack of access to virtual care is killing people.
That stark pronouncement was delivered this week by Gartner vice president analyst Mandi Bishop during a virtual presentation by Philips at the HIMSS22 conference in Orlando. It underscores the rapidly shifting healthcare landscape caused in part by the global pandemic and the importance of integrating virtual care with in-person services.
Bishop, called in by Philips to set the tone for its unveiling of the new Philips Healthcare Informatics platform, described "an industry that has been truly disruptive." Affected in no small part by COVID-19, healthcare organizations are adopting digital health technologies at a rapid pace to meet consumer demand and counter growing staffing shortages. At the same time, they're dealing with competition from telehealth companies and retail giants like Amazon and Google, countering cybersecurity threats, and accommodating a trend that sees more services delivered outside the hospital, clinic, or doctor's office and in places like the home.
The industry is learning that the fee-for-service structure that has been in place for decades "is not resilient," Bishop said, and value-based healthcare is finally gaining traction. The challenge lies in making that sustainable.
Bishop outlined five Gartner predictions for the healthcare industry:
By 2025, 40% of the nation's care providers will have shifted 20% of their hospital beds to the home, driven by remote patient monitoring (RPM) platforms and AI services that allow more services to be delivered virtually. Part of this shift is fueled by the hospital at home concept, which sees some intensive care services moving over to the home setting.
By 2025, a digital commerce platform and marketplace for healthcare will connect one quarter of the nation's consumers, payers, and providers. That platform will enable these groups to search for, and in many cases, access or deliver healthcare on demand, bypassing hospitals, clinics, and offices.
By 2025, 10 major employers will be contracting with a major retailer to deliver healthcare services to their employees. Many companies, in fact, are already using health plans that see virtual care as a convenient and less costly alternative to in-person care, and those services will expand as the preventive health and wellness industry builds steam.
By 2025, three quarters of the top 20 life sciences organizations will have dealt with a cybersecurity issue, resulting in roughly $10 billion in revenue losses. Alongside a growing shortage of healthcare providers, cybersecurity is one of the most prevalent concerns among healthcare executives. And the increasing value of healthcare information and the growing complexity of threats to privacy and security isn't making things easier.
And finally, by 2023 some 5% of global deaths will be attributed to a lack of virtual care access. This points not only to the value of virtual care but an ever-growing challenge to accessing care in underserved communities. Simply put, consumers are having problems finding the care they need, and those barriers are putting their lives in danger.
To address these concerns, Bishop laid out Gartner's five recommendations for healthcare leaders:
Invest in so-called hospital at home technologies and strategies to set the groundwork for more RPM and virtual care services.
Prioritize real-time, on-demand data technologies that allow care providers to access the information they need when they need it.
Establish specific values and advantages that one's healthcare organization can focus on in an increasingly competitive marketplace.
Make cybersecurity a priority.
Cultivate digital sensitivity, so that the organization not only adopts virtual care platforms and services but helps consumers who aren't yet acclimated to the digital world.
Adopting—and adapting to—innovation in technology is one of the big themes at HIMSS22 this week. The conference, expected to draw roughly 5,000 attendees over the week to the Orange County Convention Center, is set to the theme of "Reimagine Health," and that's been seen in a flurry of vendor announcements focusing on new connected care technology, ranging from robotics and AI tools to RPM platforms and services that can integrate with the EHR.
From addressing stress and burnout to understanding value-based care, this week's conference asks attendees to reimagine healthcare.
Healthcare leaders are looking for ways to reimagine healthcare at HIMSS22. For many of them, that may begin by looking inward.
Stress and burnout have been a problem in healthcare even before the pandemic, but the COVID-19 crisis has pushed that problem into hyperdrive. Healthcare organizations are dealing with low morale, an exodus of tired and dispirited staff, and a shortage of new care providers to bolster the ranks. And administrators are looking for new ideas to make the workplace better.
Amid the conversations taking place at the Orange County Convention Center this week in Orlando, there is plenty of talk about new technologies and services aimed at identifying stress and burnout in healthcare and giving people on-demand access to care and resources. But a key component to addressing stress might often be overlooked: Collaboration.
"We need to focus on building communities within the hospital," says Jessica Sweeney-Platt, vice president of research and editorial strategy at athenahealth. And that, she says, means bridging the gap between administrators and providers.
Sweeney-Platt and Nele Jessel, MD, athenahealth's chief medical officer, will be giving a presentation this Thursday titled "How the C-Suite and Physicians Can Team Up to Combat Burnout." The session is aimed at pulling executives into the conversation with clinicians so that they can develop strategies that best address why clinicians are stressed out.
And that conversation begins with the electronic health record.
Jessel says the EHR has taken a lot of blame over the past decade for making life miserable for clinicians, and the pandemic's push away from in-person services and toward virtual care has compounded the issue. But the problem may be more one of change management than change itself, and the solution may lie in giving clinicians more time to get used to the technology.
"The negative view of the EHR as adding to their misery clearly has not helped," she says. "That makes it more difficult to see [technology] as an advantage. That point has to be made."
Now, the "technology is good for you" argument might not sit well with a physician population that tends to see the EHR as a billing and regulatory tool, and one that takes them away from their patients and turns them into data clerks. But that technology can be beneficial if clinicians are given the time and support to become comfortable with it.
Jessel and Sweeney-Platt say clinicians should be given protected administrative time to learn how to use the EHR, so that time spent on the EHR is a benefit to clinical care rather than a distraction. That means carving out specific time for training, separate from patient care but not added to the workload, so that clinicians can understand how the technology improves caregiving.
"How can we afford not to do this?" asks Sweeney-Platt, noting the toll that stress and burnout have had on the healthcare industry.
In addition, clinicians are feeling stressed because they're being overwhelmed with data—and again, the blame lies with technology, which allows access to so much unstructured information. Organizations need to prioritize tools and processes that sort through the data and give clinicians what they need, rather than forcing clinicians to do that work, Jessel says.
Jessel and Sweeney-Platt say an important part of addressing stress and burnout in the provider community is understanding why clinicians feel this way and collaborating with them on resources and services that help improve their workloads and mindsets. They also need time and support from the C-suite to adjust to technology.
This goes for virtual care as well. Many healthcare organizations shifted from in-person to virtual care during the height of the pandemic to reduce the burden on hospitals and reduce the spread of the virus. As the pandemic wanes, organizations are trying to find a balance between virtual and in-person care.
Some providers have embraced this shift to telehealth, but many others are wary of the burden on their already-overtaxed workloads, and wondering where virtual care fits in. Jessel and Sweeney-Platt say the C-suite should be highlighting virtual care as a means of improving workflows. Again, that means taking the time to help physicians understand the technology.
"Virtual care has the potential to give autonomy back to physicians," Sweeney-Platt points out. "It can be a better use of your time, and it can save patients time. But it needs to be supported."
As with the EHR, collaboration between the C-suite and physicians is important, Sweeney-Platt and Jessel say. Executives should work with clinicians to identify how to adapt virtual care and to offer support and training where those processes might be stressful.
And that's where those communities come into play.
"To what degree are we making it easy for [care providers] to find community within the organization?" asks Sweeney-Platt, who's particularly interested in the high rates of stress among women. She says the healthcare setting—particularly during the pandemic—may be doing more to isolate providers from their colleagues, depriving them of a critical means of adjustment and support. This, in turn, makes it more difficult for providers to see the benefit in new strategies.
Sweeney-Platt says health system administrators need to emphasize community, so that providers have a shared sense of purpose and experience. They can lean on and learn from each other.
This, of course, leads to the last and newest leg of the triple—now quadruple—aim in healthcare. The shift to value-based care means that healthcare organizations must rethink how healthcare is valued. And the pandemic has moved the goalposts on how value is defined, placing more of an emphasis on quality and access and less on episodic care and repetitive services.
Sweeney-Platt and Jessel also want to see a shift to better care for the caregivers, and a commitment from the C-suite to invest in tools and services that reduce stress and improve workloads. That includes giving them more time to absorb and master the technology they'll be using to care for patients, as well as better access to resources and their colleagues.
The research finds that benefits like ride-sharing services might not save money or improve outcomes at first, but they're very important for people who face barriers to accessing care.
A new study in Health Affairs finds that transportation benefits like ridesharing services aren’t improving clinical outcomes and may even be increasing costs, but they’re quite popular with underserved patients who face barriers to accessing healthcare.
The study suggests that such programs may need to be evaluated differently, with an ROI based on reducing barriers to access rather than saving money or even improving health, at least until the program has been up and running for a while.
“Qualitative analyses revealed that participants were highly satisfied with the program, reporting that it eased financial burdens and made them feel safer, more empowered, and better able to take control of their health,” the researchers said. “These findings suggest that although transportation programs are commonly introduced as ways to contain health care spending, it may be better to think of them as programs to improve health care access for people facing difficult circumstances.”
The research team was led by Seth Berkowitz, MD, MPH, of the University of North Carolina at Chapel Hill and includes members from the UNC Health System. They analyzed the experiences of Medicare beneficiaries accessing care through the UNC Health Alliance accountable care organization (ACO) from the beginning of 2017 through the end of 2019.
Their work focuses on the growing trend of addressing social determinants of health, which are factors that exist outside the healthcare realm but which can affect delivery and health outcomes. They include social and economic factors such as homelessness, work status, child (or parent) care, transportation and cultural and community norms.
In some cases the impact on healthcare is clear – someone without a job will likely forego health insurance and only access care in an emergency – while other factors may take time to play out. The challenge for healthcare organizations is to identify the barriers and develop programs that address them.
“Although nonemergency medical transportation is a required Medicaid benefit, increasing recognition of transportation barriers faced by people with other types of insurance coverage, such as Medicare, has led to innovative programs that seek to overcome these barriers,” Berkowitz and his team wrote in their study. “These programs often use smartphone application–based ridesharing programs, which are marketed as offering more affordable and scalable implementation than traditional transportation services.”
“The premise for many of these programs is to increase attendance for outpatient medical appointments,” they continued. “As the conventional wisdom is that many inpatient admissions and emergency departments can be prevented through outpatient medical care, improving outpatient visit attendance could reduce inpatient admissions, emergency department visits, and health care costs.”
According to the research, those who used the transportation program ended up increasing per-person per-year outpatient visits and spent more money on healthcare services than those who had their own transportation. Yet that group didn’t show any notable decrease in hospital admissions or ED visits.
The results do touch upon one criticism of digital health services: that patients who have access to them will use them more often because they’re convenient, and that will lead to unnecessary healthcare visits and higher costs. Digital health proponents, meanwhile, say these services allow more people to access care who would otherwise go without that care, and that excessive use and costs can be filtered out through careful management.
Perhaps more important is the value of these services to the patients who use them. As Berkowitz and his colleagues note, patients who have problems accessing healthcare were grateful to have that barrier removed through a ridesharing program. This reduces stress and saves them money, while also giving them more confidence in managing their health. Those factors could translate into better outcomes and reduced costs down the road.
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