Aggregating Patient Data in an Ocean of Healthcare Information

PSQH: Patient Safety & Quality Healthcare, December 16, 2021

With digital care delivery in the mix and the complications of a pandemic, burnout has become a major problem for physicians. How can the industry make sure that technological advances help physicians make the best use of their time with the patient and look for the most important data points during each visit?

This article was originally published December 8, 2021 on PSQH by Matt Phillion.

With advances in how data is managed and communication is handled in healthcare, it might seem like the time physicians spend with patients has become more streamlined than ever. Instead, physician/patient time has remained relatively constant, while new technology has in many ways added to the physician workday.

According to the Medscape Physician Compensation Report 2017, primary care physicians spend about 15 minutes with each patient, and what they cover is extensive—an average of six health concerns per visit. Now, with digital care delivery in the mix and the complications of a pandemic, burnout has become a major problem for physicians. So how can the industry make sure that technological advances help physicians make the best use of their time with the patient and look for the most important data points during each visit?

“One of the things that was not accounted for as we moved into a more digital age is that we have more access to data, but how [physicians] interact with that data and how they get to it is clunky, requiring multiple clicks to get to anything,” says Celia Whatley, vice president of product management at Lightbeam Health Solutions. “Nothing is in the same place. It seems like everything is digital so it should be so much easier, but the reality is it’s in disparate locations.”

Health systems can subvert this challenge by bringing key information into one area that’s easily referenceable for the provider or care manager, as opposed to asking them to navigate to different locations for the information they need.

“Healthcare administrators are more bullish about technology and how it will ease the burden at the provider level,” says Shelley Davis, vice president of clinical strategy with Lightbeam. “Even with the rise of electronic health records (EHR), it has tremendous value, but the promise to providers was that it would significantly improve their ability to deliver care.”

Some EHRs remain clunky, requiring the provider to navigate through multiple screens, which can add rather than streamline work. Because of that experience, Davis notes, the technology can be an obstacle for physicians required to interact with it. Add to this the constant stream of information and interactions interrupting the physician’s day, like pagers going off (yes, they’re still in use) and being pulled aside for sidewalk consults by concerned nurses or other physicians, and it’s easy to see where the fatigue stems from.

“There’s an incredible amount of stimulation coming at them on a day-to-day basis,” says Davis. “And often they spend hours going back through the record to make sure they’re doing everything they need to do.”

Lightbeam’s platform brings much of that information into a single source of truth, where physicians can see everything they need in one place, so it “becomes very actionable,” says Whatley.

Fatigue and burnout

From a physician standpoint, Davis says, “What’s intended is for all professionals to be working at the top of their licensure. We specifically look at nurses and paraprofessionals. Nurses are expensive: How can we best use those folks at the top of their skills?”

Physicians have the same goal in mind—they want to impact the patients, but don’t want to be bogged down unnecessarily by administrative tasks.

Alert fatigue plays into this issue in a specific way. “The liability for the nurse is if I alert a physician of an issue, the physician now has to do something about it,” says Davis. “If someone didn’t show up for an appointment, the physician needs to step in and act on that. It’s information overload and compassion fatigue.”

Adding to the problem is the increased focus on value-based contracts. “They illuminate the journey to getting better outcomes for patients, but on a day-to-day basis the things you have to complete” as part of those contracts add time and energy drains to practitioners’ days, says Davis.

“They involve so many more things physicians have to check a box on. They’ve been doing this all along with patients, making sure they have the appropriate care, but now there is an additional administrative burden,” says Whatley. “Now tie into this how much more information physicians have available to them.”

In the past, providers generally only had to deal with the clinical documentation from their office and potentially office visits, says Whatley. Now, population health has opened up the door for data from all sides of the patient’s journey. “Providers and caregivers have so much more data they need to review and act upon for the best care,” she says.

“Even just the way the retail space has moved into healthcare—we never would’ve thought that Amazon would move into the pharmacy market or CVS would deliver urgent care in stores,” says Davis. “Before, patients would go to the family doctor, and now patients are getting care in places that are not healthcare centered, which gives us the ability to pull data from so many different locations.”

Use of face sheets

Loaded with information from an ever-widening array of sources and more formalized checkboxes than ever, practitioners can benefit from a centralized location to manage all of this data.

“We get data from many different sources and aggregate it into a point of care tool called a physician face sheet,” says Whatley. “The provider really has one single place to go to view everything that has happened with the patient.”

The tool offers a quick-access, more longitudinal care record for physicians and care managers.

This can benefit specific arenas, like management of chronic conditions, by allowing physicians to view the entirety of a patient’s data without having to go into the EHR.

“We have an estimated one in four patients with two or more chronic conditions, and we need to prevent poor health and costly hospital visits for those patients,” says Whatley. “When we look at the population as a whole, 2022 to 2031 will be a peak for baby boomers, and there are concerns about how we’re going to take care of all those patients and do it adequately.”

“I think Lightbeam does a tremendous job capturing all that information and mapping it,” says Davis.

A patient might be seeing a cardiologist, pulmonologist, and rheumatologist, which is complicated enough to track. But then add consumers getting their medications, dermatology supplies, or any number of care-related items through Amazon or other retail services, and the overall picture grows even more complex.

“There can be very real side effects and interactions from the medications these patients are obtaining from different sources,” says Davis. “I can’t stress enough the benefits of getting all that information into a single view.”

That single-pane view also enables tracking things like missed appointments so physicians can follow up and discuss these things while the patient is in front of them, surfacing the most important information instead of burying it in a sea of documentation.

“At the heart of care management is the premise that you’re doing the right thing at the right time and in the right place for the right patient,” says Davis. “It’s ensuring all those things come together.”

“One of the key things is finding that right patient inside the system,” says Whatley. “Because we aggregate all the disparate sources of data, de-dupe and clean it up, we have the ability to go in and identify the right patient. It’s not just looking at the clinical record of this patient and seeing they have diabetes—they might have an anxiety medication prescribed from outside that organization we need to know about.” The face sheets pull those key points to enable optimal management of the patient’s needs.

Future impact on patient care

Lightbeam has a clinical transformation team of RNs who engage with users, thought leaders, and decision-makers as well as providers. Team members strive to “find out what’s working, how they use the system, so we can bring it back to the team,” says Davis. “It’s a constant evolution.” Focus groups help uncover means to further streamline the system for physicians and care managers.

“If 2020 taught us anything, it’s that nothing replaces the human touch, but it also taught us about the ability for false information to cascade very quickly,” says Davis. “One of the things we solve for is how do we keep the real-time actionable picture for care teams, so they can educate the patient as quickly as possible so [the patient isn’t] following advice that isn’t evidence-based.”

Removing the barrier of disparate data sources opens the door to future improvements on the care side, Whatley says.

“Where we go from here from a tech standpoint is incorporating more machine learning,” says Whatley. “We already have the ability to look at outcomes and which interventions have been most effective, but we want to take that to the next level. Now that we have more of a streamlined approach and a quick and easy way to access data around the patient, I want to do more with that data to know what works best.”

Tying Health Equity to Quality

PSQH: Patient Safety & Quality Healthcare, December 16, 2021

As many of healthcare organizations are finding, setting health equity as a strategic priority holds leadership accountable for results and is a critical first step in driving resources toward these programs, including support frameworks and training for staff.

By Megan Headley

More healthcare leaders than ever are setting health equity as a strategic priority for their organization, according to the Institute for Healthcare Improvement (IHI), but not all see a clear path forward. There is still a tremendous lack of data, both on inequity and on the impact of initiatives to make improvements, and healthcare organizations are certainly burdened with their fair share of challenges. However, the biggest barrier to stronger progress on health equity may be that few healthcare organizations see it as directly connected to quality.

“I think there’s some hesitation from quality and safety leaders about whether or not this is in scope, and whether or not equity work is part of the work around quality,” says Dr. Kedar Mate, president and CEO of the IHI. However, as Mate, the IHI, and the Institute of Medicine (as it defined 20 years ago in its report Crossing the Quality Chasm: A New Health System for the 21st Century might argue, there is no quality without equity.

This connection between the two may be critical in addressing the barriers keeping more healthcare organizations from prioritizing progress in health equity.

Barriers to health equity

IHI conducted an industry poll in July 2021 to develop a baseline around current attitudes and perceptions surrounding health equity work in the United States and to identify roadblocks preventing healthcare delivery organizations from advancing health equity goals. The survey of more than 500 healthcare professionals found a sizable increase from 2019 to 2021 in the number of healthcare leaders who identify health equity as one of their organization’s top three priorities: from 25% in 2019 to 58% in 2021. It’s significant progress, but a number of challenges seem to remain in terms of broader advancement.

In its report Health Equity: Prioritization, Perception, and Progress, IHI identifies five top barriers standing in the way of health equity programs, as identified by panel participants. These include:

  1. Inconsistent collection of equity-related patient data (38%). Capturing and stratifying data by race, ethnicity, ancestry, language, sexual orientation, and gender identity was selected by 23% of respondents as the most important thing that their organization needs to do to advance health equity.
  2. Lack of resources other than funding, including staff qualified and knowledgeable in the stratification of data and other analysis that can drive health equity programming (38%).
  3. Lack of funding directed specifically to help drive progress in health equity (28%).
  4. Inability to demonstrate impact of health equity efforts (26%). While survey respondents reported a number of actions already being taken to advance these priorities, only 1% could claim their activities as being “extremely effective.” Fourteen percent reported being unsure of the impact, with an additional 6% reporting these activities as being ineffective.
  5. Lack of guidance or know-how on what to do next (26%).

However, Mate challenges that if organizations recognize health inequity as a problem and commit to making it a strategic priority, they will find they can address many of these barriers through the growing body of available resources, from IHI as well as health systems that have made progress.

“I think that what’s missing is the will and motivation to make a difference here,” he says.

A quality-based path forward

As many of these healthcare organizations are finding, setting health equity as a strategic priority holds leadership accountable for results and is a critical first step in driving resources toward these programs, including support frameworks and training for staff.

“If an organization makes equity a strategic priority, then almost by definition resources ought to flow towards those strategies,” Mate says. “Otherwise, why on Earth is it a strategic priority? It doesn’t make operating sense.”

The next step, Mate says, is to mobilize quality teams to create a framework for program progress. “One observation we’ve made in IHI’s Pursuing Equity initiative is that the teams that had the most success around remediating inequities and closing gaps in care were the teams that had the quality infrastructure to work on inequity,” he says.

“The diversity inclusion and equity parts of HR operations within health systems is not enough to move the needle on this work,” he adds. “You have to couple that interest and knowledge with quality expertise, because that’s what actually leads to meaningful clinical improvement around disparity.”

Pushback can drive progress

While health equity initiatives are having a big moment, the poll results themselves make clear that not all healthcare organizations are making it a priority. Of those 42% of IHI survey respondents who report not setting health equity as a priority, 34% indicated that their organization either does not experience deep or persistent disparities related to race/ethnicity, language, sexual orientation, or geographic location, or does not believe prioritizing health equity is necessary based on its context. An additional 18% noted they do not have the right leadership to drive this work.

Mate notes that some pushback should be anticipated, especially in the quality arena, but pushback itself presents an opportunity. “Resistance should be anticipated. Pushback should be anticipated. That is not always bad,” he says. “We can roll with it and actually convert often people that are resistors into activated agents of change with data and story.”

Mate makes the case for this approach with his own data and stories. As he points out, the history of establishing safety and quality metrics in medicine made significant progress through an approach that combined data on harm with patients’ stories of being harmed. “That was extremely powerful motivation for those that didn’t see safety as a priority, and I believe the same will be true around equity,” he says.

He encourages equity advocates to share information about the disparities in the system with storytelling from patients who have been harmed by racism or other examples of structured injustice.

Tying health equity to quality

The IHI has emphasized for some time that there can be no healthcare quality without health equity. “You can’t have high-quality care when you systematically exclude some of the population from the benefits of the service that you’re producing, so there is no quality without equity,” Mate elaborates. A majority of respondents to IHI’s healthcare poll (82%) agreed. However, the inverse—that there’s no health equity without quality—may be true as well, he argues.

This conclusion stems from an observation around how healthcare systems in the U.S. are legislated to produce high-quality care. Regulations ensure that healthcare delivery systems achieve quality and safety goals, and they might also be necessary to drive clear improvements in health equity.

“The idea of tying equity to quality is really important because it gives equity a regulatory basis, a powerful basis for actually being realized,” Mate says. “If the executive leadership teams at health systems are accountable for quality, and they have a fiduciary responsibility for it to their communities, we must indeed tie equity to quality because it will then have that same standing within leadership and governance systems going forward.”

While real progress is likely to take time, there are already clear steps that organizations can take today to begin undoing structured injustices and building a path to health equity. The first step is acknowledging the need to address health equity as a strategic priority and a clear part of the quality team’s scope.

Megan Headley is a freelance writer and owner of ClearStory Publications. She can be reached at megan@clearstorypublications.com.

Addressing Referral Leakage for Post-Surgical Care

PSQH: Patient Safety & Quality Healthcare, December 4, 2021

Consumers might be willing to travel a long distance for a particular procedure, or even drive a distance for a follow-up with a specific doctor, but when it comes to PT, they are more likely to go to whichever clinic is closest.

This article was originally published December 2, 2021 on PSQH by Matt Phillion.

According to a new report, 55% of patients sought rehabilitation services outside of the system or organization following surgery, resulting in $2.5 billion in lost potential revenue. The report, conducted by Luna, examined 3.4 million commercial claims with the assistance of analytics firm Definitive Healthcare.

“Fundamentally, we know that care is expanding beyond the four walls of the hospital,” says Ryan Lewis, head of business development with Luna. “It’s rare that healthcare leaders don’t talk about their at-home strategy.”

Also, a frequent discussion point: Leadership knows that the majority of physical therapy (PT) referrals go to the competition. “We were shocked to discover how high the percentage was,” says Lewis. “It’s often higher than 50%. Some of my colleagues tried to quantify it. We knew leakage was high, but if we add it up, it’s $2.5 billion.”

The next question to ask, of course, is: why?

“There’s 20,000 or 30,000 outpatient rehab clinics out there,” says Lewis. “That’s more clinics than Starbucks. And that concept is similar for rehab clinics.”

Consumers might be willing to travel a long distance for a particular procedure, or even drive a distance for a follow-up with a specific doctor, but when it comes to PT, they are more likely to go to whichever clinic is closest. “The quality of care in or out of network is similar,” says Lewis. “There’s so many clinics, consumers are more likely to go to the closer one even if it’s not affiliated.”

Recapturing those lost rehab patients is a complex endeavor. The simplest way to do it, Lewis says, is the obvious: Build more locations. “If you have more clinics, and they’re closer to the population, if they’re a mile away instead of 14, that helps. But if you speak with any executive and ask what your budget is to build more physical therapy clinics, they’ll laugh. There’s not capital dollars for building locations.”

If money were no issue, building more clinics would be a great way to prevent referral leakage, but short of that, organizations have to find a way to differentiate their network’s care as better, safer, and more convenient than the competition.

A lot of this is also messaging, Lewis notes. “We talk about the concept of stickiness,” he says. “When you, as a system, are able to create a brand that customers gravitate to and feel loyal to, it influences the likelihood they’ll drive an extra six miles to stay in-network. Systems are in the throes of building the idea of brand loyalty right now.”

If you can’t build more locations, your organization will need to build loyalty by identifying why it’s bigger, faster, and stronger, says Lewis.

“But I don’t have an answer for that,” he says. “Our model proposes that when a patient can’t or won’t go to the clinic, bring the clinic to them. How about physical therapy at home to recapture that referral leakage?”

The home concept isn’t just about brand stickiness, either. Reasons for not going to PT can go beyond not wanting to drive, but instead involve transportation issues, work, childcare, and other obstacles. Plus, at-home care leans into patients’ generational preference to have services come to them, not the other way around.

“Disruptive is an appropriate term—it’s why you keep seeing hospitals with at-home models,” says Lewis. “If you can deliver safe, effective care and keep the patients outside those four walls—especially because of COVID—there’s a level of satisfaction from the customer perspective.”

Companies have been offering this type of service on an urgent care basis, Lewis notes. If it can be done for urgent care, why not PT?

Change acceleration during pandemic

There are limitations to at-home therapy, of course, depending on the care required. Some equipment may require a visit to a clinic. However, in general, “physical therapy is a modality that translates well into at-home care,” says Lewis.

The pandemic has been an accelerant for change across the industry, particularly with treating patients in their homes. Telehealth has been leveraged much more frequently, for example, and “it’s been a magnifying glass on the need to keep patients outside the four walls of the clinic,” Lewis says.

Another accelerant related to the pandemic: the number of elective procedures postponed or canceled, and the missed revenue from those lost surgeries. “A lot of leaders are looking for viable alternatives,” says Lewis. “In some circumstances, PT can be a viable alternative before having a procedure.”

Lewis notes that the pandemic has forced much of the industry to ask: Does care need to happen within the walls of the clinic? “Years ago, the answer was, ‘Of course,’ but now” other options are opening up, he says.

Healthcare reimbursement has also changed during the pandemic. Once difficult to be paid for, at-home and telehealth visits are now reimbursable in ways they were not before.

The customer and the provider experience

There are two sides to the marketplace, Lewis says. “For any at-home model, you have to provide a phenomenal customer experience,” he says. “But on the flip side, you need to drive value for the care providers.”

The industry knows at-home PT will not be appropriate for everyone or for every condition. “But we’re also seeing that the demand for at-home physical therapy services will far outweigh the nation’s ability to deliver that service,” says Lewis.

Luna works with physical therapists who moonlight and set their own schedules, while most still also work in a clinic setting.

“Balancing consumer demand with access to capacity … we’re a technology-driven company,” says Lewis. “I won’t say it’s coincidental that we started with physical therapy—that was very deliberate—but it’s super conducive for matching the right physical therapist with the right patient.”

The future of at-home service isn’t exclusively PT, Lewis says. Occupational therapy, speech therapy, cardiac rehabilitation, and more have come up as potential areas to explore.

Hurdles to at-home treatment

From the patient perspective, Lewis notes the success of at-home care depends on the patient’s comfort with the concept. “We’re not hearing a lot of feedback from patients that they don’t like care at home,” he says. “Quite the opposite, because it’s one-on-one treatment time and we’re able to analyze the environment. We do know that there are some patients who don’t want anyone coming into their homes.”

The friction they have run into, however, is a matter of prioritizing innovative services like PT. There is a great deal of interest, but they must contend with competing priorities, says Lewis.

Tangentially, at-home treatment also addresses the talent bleed in healthcare as the world struggles to climb out of the pandemic.

“We’re tapping into a market of qualified therapists who are already practicing,” says Lewis. “They may work at any number of private brick-and-mortar clinics, while typically doing six to 10 visits in their off-hours. It’s a way to earn additional income.” Others want the flexibility of working full-time in a gig-style role.

“When we partner with a health system, they don’t want to lose the talent they’re already struggling to retain,” says Lewis. “We’re not trying to poach talent. We want to give systems a way to offer the opportunity to moonlight.”

The world-changing impact of COVID-19 has not only affected how organizations offer care today, but how they’ll offer it going forward.

“Looking at different periods in history, it’s always some kind of event that causes a seismic shift in an industry,” says Lewis. “The pandemic will create a significant shift in how systems deliver care and how patients demand they receive care.”

An Orchestra of Care: Transparency for Patients at Home

PSQH: Patient Safety & Quality Healthcare, November 29, 2021

Given the challenges the industry faced in 2020, patients expressed a growing preference for home over nursing care even pre-pandemic, which meant that the industry’s focus had to expand into home health agencies, infusion providers, non-emergency transportation, durable medical equipment and home medical equipment providers, and more.

This article was originally published November 22, 2021 on PSQH by Matt Phillion.

Real-time visibility into patient care beyond the acute care setting is more important than ever. Hospitals are more reliant on ambulatory care providers as part of the patient’s care journey, and the quality of patient outcomes depends on collaboration between hospitals, postacute providers, health plans, and other organizations. So how do we put data into action for better management of patient populations and outcomes?

“There’s been a lot of discussion around the shift to home-based care,” says Lissy Hu, CEO and founder of CarePort. “More patients want to recover in their home, outside the facility. How do we make that happen?”

If we’re seeing more patients who prefer to recover in their own residence versus at a nursing home, asks Hu, what does that mean for physicians, care managers, or other professionals coordinating these services for the patient?

“For the patient coming out of the hospital and going to a nursing home, it’s basically one-stop shopping. Their doctors, nurses, and bed are there. The oxygen they need is there,” says Hu. But home care still requires things like durable medical equipment (e.g., oxygen and an appropriate bed), nurse visits, and follow-up with the patient’s primary care physician.

“How do we do that in a timely manner?” asks Hu. “If we have the oxygen there, and a doctor’s appointment, but don’t have a home health nurse, if the patient experiences symptoms, everything is more high stakes. All of these things need to be coordinated. It’s part of an orchestra.”

As founder of CarePort, Hu has spent the past decade working to connect hospitals with postacute care providers. “Instead of someone at the hospital having to call around to 10 nursing homes in the area, how do we make that process electronic?” she says. “We can book flights across the world but have very little visibility into the nursing home down the street.”

While hesitancy to enter a nursing home during the COVID-19 pandemic was expected given the challenges the industry faced in 2020, patients expressed a growing preference for home over nursing care even pre-pandemic. This meant that the industry’s focus had to expand into home health agencies, infusion providers, non-emergency transportation, durable medical equipment and home medical equipment providers, and more.

In the last year, CarePort has seen its software used not just by nurses in the hospital setting, but also in physician practices. “It’s been really interesting,” says Hu. “One of the reasons we started to see this is that nurses would transition from hospitals to practices and realize they got to use software [for this task] in the hospital, but back in the physician’s office they have to call around. It doesn’t make sense. So we got pulled more and more into the ambulatory space. When you look at national data, 30% or 40% of referrals to nursing homes originate with physician practices, and that number continues to grow.”

The aging boomer population

“As more baby boomers have aged into Medicare, the preference is that they’d rather recover in their own home,” says Hu. “Obviously during COVID we saw an acceleration to this trend.”

Hu says that the baby boomer generation overall is interested in more information about quality of services. “They’re just used to transparency in the quality of hotels, flights, and restaurants, so when choosing home health or nursing homes, they want to have an understanding of the quality of those providers,” she says.

CMS has progressed in this regard as well, Hu notes, with the emergence of Five-Star Quality Ratings for nursing homes and home health agencies, plus public reporting of vaccination rates at nursing homes. “We’ve brought a lot of that data into our tools,” says Hu. “It’s not just connecting the provider with what’s available. Patients are questioning data on those services.”

Bringing that data into the CarePort platform enables doctors and nurses to identify the services that best fit the patient’s needs. “Not all services are created equal. Different patients have different requirements,” says Hu.

The impact of data

Some of the data included is what Hu calls “table stakes criteria”—whether the provider takes the patient’s insurance, for example. “There’s some baseline criteria, like ZIP code, insurance, clinical needs, and availability,” she says.

Based on those criteria, CarePort can then drill down into quality data. “We take into account the CMS quality rating, which is a good start, but as you read up on nursing home quality, there are pros and cons associated with it,” explains Hu. “For example, the score is blended, including patients who live there and those who are there for rehab or short-term care.”

Some nursing homes excel at custodial care but may not be as highly rated for short-term care. “It’s a different skill set,” says Hu—and with that in mind, patients are likely interested in going to the facility that’s right for them. “Coming out of the hospital, the patient may need to know ‘Can they help my hip get better?’ versus ‘Do they treat pressure ulcers?’ ”

With roughly 20 million referrals sent annually, CarePort is better able to triangulate the right match for the patient. They also work alongside health plans, which have their own sets of quality indicators.

“There are a lot of ways a physician or nurse can look at the availability, and the quality, and enable the patient to make a tradeoff. Maybe he or she wants to go to a specific provider, but that provider is 50 miles from his or her daughter,” says Hu. “It’s about giving the patient that information.”

CarePort has also seen that final decisions on care are increasingly falling not to patients, but to their adult children. This means the nurses and physicians aren’t just engaging with the patient themselves, but with a caregiver who can benefit from the additional data to help them make this pivotal decision.

“We’ll frequently hear: ‘Can you email this to my adult daughter so they can help me make this decision?’ ” says Hu. “It’s almost like sharing hotel results.”

Closing the loop and increasing visibility

CarePort also aims to leverage its software to close the loop on referrals. “It’s not just enough in our minds to get a patient to a high-performing postacute care provider or home-based care provider,” says Hu. “It’s about ensuring this actually happens.”

This means going beyond referring the patient to a home health agency and ensuring that the agency’s care is on point. For example, did the nurse arrive within the time frame specified? If not, the physician is notified and another referral can be made. “This helps with the staffing challenge we’re seeing on the home health side,” says Hu.

While the focus is often on the primary care physician’s or office staff’s role in these referrals, they may not always be the ones making the referral. For cancer patients, this duty may fall to the oncologist’s office or a healthcare plan management team.

The preference for home-based care also opens up many opportunities for growth and innovation, notes Hu. Five or 10 years ago, postacute home healthcare wasn’t talked about on a daily basis in hospitals or physicians’ offices, she says.

“Over time, people started to think about it more alongside an aging population that is living longer and have more of a need for these services,” says Hu. “Then COVID came, and everything around skilled nursing and nursing homes was in the mainstream press.”

Physicians couldn’t get patients out of the hospital because nursing homes were shutting their doors due to COVID-19, and suddenly the C-suite was newly aware of the dependency between the healthcare system and postacute care.

“Now we’re seeing this even more with staffing shortages in home care,” says Hu. “I think we’re going to see much more collaboration, coordination of care, and interoperability in the next five or 10 years.”

With 10,000 baby boomers aging into Medicare every day, providers are taking on more risk, so they have to be more responsible for patients outside the walls of the office or hospital.

“I think this is an exciting time for healthcare—there are a lot of challenges, but we’re going to see big leaps in terms of innovation,” says Hu. “When faced with those challenges, that’s when innovation happens.”

Improving Remote Monitoring to Care for Isolated Seniors

PSQH: Patient Safety & Quality Healthcare, November 29, 2021

Being homebound puts patients at risk, particularly those with respiratory symptoms either related to COVID-19 or as a result of reactions to treatment.

This article was originally published November 22, 2021 on PSQH by Matt Phillion.

According to a new study from JAMA Internal Medicine, an estimated 4.2 million adults over 70 were homebound in 2020. This number was twice what it was in 2019, impacted by the pandemic and the aging baby boomer generation. Healthcare organizations and providers need to encourage an evolving ecosystem of care for these patients, with a focus on home-based solutions.

“I think social isolation has always been something of a challenge for seniors at home,” says Rosemary Kennedy, PhD, RN, MBA, FAAN, chief health informatics officer with Connect America. This social isolation doesn’t just have an emotional cost—it accounts for an estimated $7 billion in additional Medicare spending as a combination of loneliness and medical conditions bring these patients to the ED.

“COVID put a big spotlight on this and increased it,” says Kennedy. “Seniors didn’t want to leave their homes, didn’t want to go into nursing homes. We saw a reduction in nursing home admissions.”

Being homebound puts these patients at risk, particularly those with respiratory symptoms either related to COVID-19 or as a result of reactions to treatment.

“With the increase in respiratory symptoms in 2020, technology has a role to play,” says Kennedy. “Through technology, we can pick up symptoms and intervene sooner so they’re not deteriorating in the home.”

The use of personal emergency response systems emerged as a way of identifying COVID-related symptoms early on, enabling providers to intervene before conditions deteriorated and these seniors were forced into the ED or ICU. These systems could take some of the pressure off the healthcare delivery model as well as the labor from hospitals and doctor’s offices in those early stages of monitoring.

These systems also have a social benefit for the seniors using them, Kennedy notes. Connect America provides one such service, and the stats show interesting results beyond respiratory intervention. “We saw an increase in seniors who just want to talk to someone,” she says. “They call a response center, hear a human voice, have a conversation, which provides a human element and a human touch to care.”

With physician’s offices overwhelmed and, as a matter of safety, keeping in-office care limited to those who most need it, remote monitoring solutions can pick up signs and symptoms, track blood pressures, and more in the home—and often treat patients in the home as well.

Remote monitoring after treatment

Technology can also play a role even if the patient is admitted, treated, and released. With continued hesitancy to go to a nursing home, some method of tracking progress in the home is pivotal.

“When they leave the hospital and want to go home, not to a nursing home, there’s a tremendous opportunity for remote response to keep an eye on these patients,” says Kennedy. “Home is a big black box. We know what’s going on in the hospital; the physicians and nurses can see what’s going on. But any technology that can give us a window of what’s happening at home—signs and symptoms, conditions—can help connect delivery of care.”

Post-care and monitoring is particularly helpful for seniors as 85% of seniors have at least one chronic condition, and 60% have two. More chronic conditions means more doctor visits, which became even more challenging during the pandemic. “Getting these individuals to the physician’s office can be burdensome,” says Kennedy. “It’s not so much the cost as it’s upsetting to the patient.”

Remote technology isn’t just a matter of convenience of care, Kennedy notes. It’s also a steady stream of data about the patient that allows for more extensive monitoring. “In terms of the broader healthcare ecosystem, think of the physiological data points that can be captured,” she says. “Blood pressure, blood sugar. Those data points can feed dashboards, and those dashboards can go to a clinic or a physician’s office, enabling nurses to see what’s going on with the patient.”

Nurses can review the information within minutes and reach out to the patient or move them up the chain to a higher level of care. “Escalate it to a physician or nurse practitioner and say: ‘The patient seems to be having trouble today.’ The providers can then move the intervention upstream.”

It also allows for assessing emergent situations before they become full-on emergencies. “The patient can push a button to a call center. Maybe they’re having pain, but it may not require EMS intervention,” says Kennedy.

This enables a level of transparency with the patient to not only give them a voice to speak with, but go through their health information—for example, if they’re taking their meds or not—and get that information into a health information exchange, allowing for a continuum of communication throughout the intervention.

“For instance, in an emergency, if EMS shows up at your home and brings you to the ER, the family may not know what ER [you] went to, but the health information exchange knows,” says Kennedy.

A changing attitude toward technology

In many ways, the challenges of COVID-19 prompted technological advancements out of necessity, and at-home monitoring is no exception. “As we’re connecting all the dots with disparate systems, we have a tremendous opportunity to connect in the home as well,” says Kennedy. “There’s a momentum now for all of those systems to collaborate.”

Older patients, too, have grown more positive about the use of technology. Previous hesitation toward using new technology fell away as need for better communication during the pandemic took precedence.

“I think seniors are ready for it,” says Kennedy. “They see the value of it, and I think if we develop a solution so they don’t necessarily need to have a smartphone or be extremely tech-savvy, we can make it easy for them to reach out to the external world.”

But as life begins to return to “normal,” will this new attitude stick?

“Working with groups of seniors, interacting with them, learning what they want from technology and what their experiences were like, I think it forced them to adopt some of the technology” they had previously avoided, says Kennedy. “They learned to use Zoom® and other technologies and saw the positive side and the value of it.”

New levels of comfort and technology don’t just help with healthcare or emergency situations for these isolated patients. They permit patients to stay connected with family and friends.

“Many of them can’t get out, so this concept of interacting with care circles, using technology to stay connected” is a powerful step forward, Kennedy explains. “It might be interacting with a nurse’s aide, with the clinic to help with their medications, or it could be their daughter or friend.”

Healthcare isn’t just connecting with the doctor’s office or clinic, Kennedy notes. Patients stay healthier if they stay connected to the things that they enjoy, like sharing photos, virtual bird-watching, or listening to music. “This connection is so critical,” she says.

Healthcare will need to be vigilant about the segment of isolated patients who may struggle with marshaling even the fundamentals of connective technology, Kennedy says. Dual-eligible patients often do not have access to a smartphone or Wi-Fi. This means involving the payers and broader healthcare community to help build better access.

“There’s a model where to care for this population, we need to involve the payers and the care managers who want to help keep these patients out of the ED. There are significant needs around social determinants of health,” says Kennedy. “We will hear from these patients that their homes are cold or they ran out of medication. If technology can give us insights into those social determinants of health and move that knowledge upstream, we can help those patients stay safe.”

Taking care of these patients in the home can lead to benefits for payers and healthcare organizations as well. Many of the trackable elements at home, such as hypertension and blood sugar, contribute to performance measures. Subscriber engagement is a big initiative as well, and keeping these patients connected and engaged in their health can help them stay healthier and adherent to their plans of care.

Remote monitoring can also help with the growing worker shortage, notes Kennedy. “Anything we can do to help providers be more efficient with their time frees them up to care for the patients most in need of attention,” she says.

Caring for these isolated patients from afar is just part of what Kennedy sees as a growing connectivity between all areas in healthcare. “We’re seeing an explosion of emerging, creative technology, and investment in this technology,” says Kennedy. “I think we’ll be using them in a combined fashion where the sum is greater than the individual parts.”

“Going back to social isolation and loneliness, these patients will often call in just to hear a voice. We see a lot of positive correlation between social interaction and general well-being,” she says. “It keeps them at a higher level. And simply put, as we age, we need each other.”

Report: Building a Smarter Healthcare Facility

PSQH: Patient Safety & Quality Healthcare, October 11, 2021

A new report from Honeywell looks at the challenges, concerns, and priorities of healthcare facility managers in the U.S., China, Germany, and Saudi Arabia, and is the fourth in a series of reports on healthcare building trends.

This article was originally published October 6, 2021 on PSQH by Matt Phillion.

There’s nothing simple about running a healthcare facility. With complex moving parts creating an operationally challenging environment, hospitals can’t afford to be inefficient or lag behind. How healthcare organizations use resources today is key to how they will evolve into the future.

The industry is undergoing a sea change. Healthcare was already working toward integrating systems for better interconnectivity and interoperability, and the COVID-19 pandemic amplified this initiative. Facilities old and new are striving to be more agile, tightly woven, and efficient. Organizations are looking to improve not just medical records, but physical operations as well, from HVAC to physical security and beyond.

But how can facility managers influence the monitoring, alignment, and management of these disparate systems? The pressure is on to move fast and increase efficiency as priorities shift during a global pandemic, even while backlogs of less-urgent procedures have slowed revenue.

A new report from Honeywell gives healthcare facility managers a chance to voice their thoughts and concerns after more than a year of weathering the pandemic. The report found that 94% of healthcare managers said remote management is important for operational efficiency. Only one in four respondents have such a system in place, but 26% said they plan on investing in this technology over the next year to 18 months.

The report, Rethinking Healthcare Facilities as Integrated Entities, looks at the challenges, concerns, and priorities of healthcare facility managers in the U.S., China, Germany, and Saudi Arabia. It’s the fourth in a series of reports on healthcare building trends.

According to respondents, occupational safety also ranked high, with 95% saying robust life safety systems are important for providing value to occupants. Also rated over 90% were the following:

  • Energy efficiency and sustainable solutions (94%)
  • Improved indoor air quality (93%)
  • Flexible spaces converted based on occupant needs (93%)

Returning to the topic of remote management, China and Saudi Arabia almost unanimously said remote management is important, both ranking it at 99%.

As mentioned, only 25% of respondents have remote management in place. Other areas that got the lowest percentage of responses included real-time location tracking of people and assets (26%), contactless building entry (33%), and aspirating smoke detection (34%).

The impact of COVID-19

COVID-19 has left its mark on nearly every aspect of healthcare, and certainly on the management of healthcare facilities.

“The last years [have] been very reactive, and COVID-19 has taught facility operators to be more agile,” said Karen Langstaff, chief of facility planning with St. Joseph’s Healthcare Center in Hamilton, Ontario, Canada. “Moving forward, we really need to share best practices, especially with all the new technology coming at us. If we collaborate and connect, we’ll be better able to sort out what will give us the best return on investment and what will really make a difference to our facilities and patients. We’ll also be in a better position to deal with whatever the next wave of the pandemic throws at us.”

According to the Honeywell report, COVID-19 has raised awareness of predictive maintenance analytics as a means to improve efficiency, cut costs, and reduce the risks of failures and downtime.

Only 30% of respondents have predictive maintenance analytics in place, but another 30% plan to implement them in the next 12–18 months. Also on the improvement list in that time frame:

  • Air quality solutions (28%)
  • Fire systems software providing greater insights (28%)
  • Aspirating smoke detection (28%)

Additionally, of the five improvements respondents selected as most beneficial to occupants (reduced downtime, improved air quality, better prediction or identification of problems, improved occupational productivity, and better monitoring of efficiency), predictive maintenance contributes to four.

Growing interest in integrated capabilities

While managers clearly have the will to improve processes, the survey found that three in four respondents struggle to secure the financial resources they need, especially with COVID-19 shutting down profitable procedures such as elective surgeries. And funding isn’t just a concern with improvements and upgrades—nearly as many (74%) said they worry about keeping up with growing capacity needs.

Additional top concerns include lockdown monitoring, backup system and redundancy preparedness, and air filtration and containment capture.

Respondents in the U.S. specifically voiced concerns about funding, with 84% listing it as their top concern.

Prioritizing need during, and after, a pandemic

Improving patient satisfaction, in spite of other challenges, remains top of mind for respondents, with 31% listing it as their top priority in the next 12–18 months. Improving efficiency was close on its heels at 29%, followed by improved occupant safety (26%), improved automation, efficiency, or sustainability (26%), improved fire and life safety systems (25%), and improved ability to access and act on information (25%).

Looking to the future, survey respondents noted that smart building, with integrated systems and analytics, is necessary to realize their goals for operational efficiency improvements. Sixty-four percent of respondents said they were more willing to invest in smart building technologies now than before the pandemic.

All of these improvements tie together: 56% of respondents noted that, when planning for smart building, improving staff productivity and building operations should be at the forefront. Nearly as many (54%) put sustainable building energy use ahead of staff productivity and building operations.

Efficiency was pivotal to many respondents: 52% listed managing all building systems through a single platform as a top priority.

The rise of smart healthcare

All of these desired improvements add up to a smarter, more connected facility—and these types of facilities have been shown to improve patient care and clinical outcomes, lower healthcare-acquired infections, and increase overall efficiency. The more efficient the facility, the better staff are able to deal with patients and cases—and drive greater patient satisfaction.

The report calls out one specific case: Fiona Stanley Hospital in Perth, Australia. A new project, it ran into many of the same pitfalls as older healthcare facilities, with legacy systems getting in the way of achieving modern technical success.

The hospital, which spans four city blocks, integrated 65 individual systems into a single platform that connected 1,000 card readers, more than 300 closed-circuit cameras, and 200 intercoms in one interface. This wove monitoring and control, reporting, alarm management, and analysis into a single pane of glass—achieving the sort of integrated, smart facility survey respondents are looking for.

“Connected healthcare facilities have been shown to improve patient care, clinical outcomes, and operational efficiency,” said Keith Fisher, vice president, global services, Honeywell Building Technologies. “Increasing operational insight can help them optimize the use of their assets to avoid bottlenecks, cut waiting times, and upgrade the overall patient experience. Many of these goals can be achieved by upgrading an existing building management system without the need to rip and replace. This is important as facilities are increasingly expected to improve day-to-day outcomes and enhance efficiencies with little or no increase in budgets.”

Cybersecurity Is Patient Safety

PSQH: Patient Safety & Quality Healthcare, September 15, 2021

Where healthcare and security meet.           

This article was originally published September 9, 2021 on PSQH by Matt Phillion.

Cyberattacks target every industry all the time, and healthcare is no exception. According to a recent IBM study, the average cost per healthcare cyberattack is a hefty $7 million. Despite numbers like this, cybersecurity often isn’t the C-suite’s top priority. How can CISOs in hospitals and other healthcare organizations demonstrate the value of strong cybersecurity while a host of other issues vie for leadership’s attention?

“To me, cybersecurity actually is a patient safety issue,” says Wes Wright, chief technology officer with Imprivata. “The industry did both areas a disservice long ago when they separated them.”

Clinicians and other professionals who see patients on a daily basis aren’t necessarily thinking about cybersecurity from a patient safety standpoint. That makes password requirements, security education and training, and other requirements seem less directly connected to patient care and safety—even though they actually are integral to both.

The way to fix this, Wright says, is to ensure that cybersecurity compliance and clinical efficiency improve together. Without the latter, staff will balk at the former. “Healthcare IT professionals were guilty of trying to make folks jump through some pretty onerous hoops in the name of cybersecurity,” he says. “The key is to make doing the right thing—and the right thing here is ensuring things are cyber-protected—as easy, if not easier, than doing the wrong thing.”

Wright suggests health IT talk directly with clinicians about patient safety. Clinicians should know that the 16-character password they’re being compelled to use, for example, is part of how the organization is keeping patients safe.

This also helps keep staff from looking for workarounds, which they will do if they feel that cybersecurity makes their workflow less efficient. “Clinicians are smart, highly trained, and when they see something that makes them scratch their head and ask ‘why am I doing this?’ most of the time they’re going to stop doing it,” says Wright. “It’s not just clinicians—it’s human nature.”

Cybersecurity is part of the patient safety landscape

Improving cybersecurity in healthcare involves more education and training, of course, but it also comes down to putting the right weight on the topic, says Wright. Clinicians have to know that cybersecurity is “as much of a patient safety issue as wearing a mask or preventing needlesticks,” he says. “Until we get there, we’re going to have holes in the ship.”

The tools clinicians use need to be secure. “I hate to say it, but it has to be built into the software, into the process,” says Wright. “When it’s an add-on, people see it as [having] no intrinsic value.”

Again, it comes down to human nature. When cybersecurity requirements that impact both patient safety and efficiency have clear added value, “you’ve found a strong solution for not only your organization, but one that can likely show strong ROI to your C-suite,” Wright says.

“Making security convenient is not easy, especially if you’re unfamiliar with clinical workflow needs and compliance requirements. Healthcare organizations need a partner that understands the healthcare landscape,” he adds.

The ever-growing presence of the internet of things (IOT), web-enabled and web-connected devices across the hospital spectrum, may have added more security touchpoints, but they’ve also helped with education and awareness, Wright says. “The general user population for healthcare IT has become far more cognizant of how important security is. I think we’re right on the cusp of things coming together.”

Prior to COVID-19, Wright says he might have pointed to multifactor authentication (MFA) as a common trouble area, but with the increase in working from home there’s been a big uptick in MFA, which has improved the cybersecurity posture for many organizations. “It’s hard to phish someone who has MFA,” he says. “That was a big hole in health IT.”

The importance of digital identity has improved over the past year and a half, not just in healthcare but overall, Wright says. In its simplest form, digital identity is the user name and password.

“What we’re starting to realize is that the firewalls and VLANs and VPNs, all that hardware-based cybersecurity stuff out there to protect us, is still relevant but isn’t as pivotal as digital identity is,” explains Wright. “Zero-trust networks are all based on digital identity, knowing that the identity you’re seeing on your network is who you think it is, and verifying that through digital identity events. That monitoring capability is maturing, and I think it’s going to take us to the next level of cybersecurity in healthcare.”

Get out into the field

The first thing information security executives need to do, Wright says, is to go out where the work is being done.

“Stand back and watch how these clinicians are using IT,” he says. “It’s amazing when you have an IT person going to watch clinicians work and can then take these IT tools and tweak them to align better with the workflow the clinicians are trying to get to. That’s the very first step. It’s very actionable. Get out to where the work is being done and observe that work.”

The next step is more tactical. Wright recommends a system, like a single sign-on tool with an access management tool, that will essentially hide the long passwords users are required to have.

“We have to use technology in a way so that users don’t have to remember huge password requirements across a multitude of applications and system logins. The technology does this instead, ultimately decreasing time in administrative processes and [increasing] time spent with patients,” says Wright.

He doesn’t think the industry is lagging behind on single sign-on usage. Where the industry struggles is with legacy applications, which single sign-on systems still need to hook up to. “In healthcare, those legacy apps are going to be out there forever, so we have to keep those in mind when we’re designing software,” he says.

Many horizontal vendors leave healthcare behind because of this challenge. “Application rationalization in healthcare is kind of an oxymoron,” says Wright. “The number of apps a healthcare professional uses during a normal clinical day is astounding.”

Healthcare contains specialties within specialties, each with specialized software that works for those processes. If a pair of neurosurgeons bring in a large income every year and insist on using a particular software system, the organization is going to keep it up and running.

“That’s where we’re at, and why healthcare adopts at a historically slower pace,” says Wright. “Those surgeons don’t care about the software—it’s simply a tool to do the surgeries, and as long as it’s working, they don’t want something new.”

Risk awareness

In healthcare, return on investment always comes into play. But proving that part can be easy: Studies have shown that a single sign-on process can save 25–45 minutes a day of clinician time.

“The real key, though, is ensuring everyone sees cybersecurity as part of patient safety,” says Wright. “Until we get solutions that help them see patients more efficiently, we’re going to have tension between the two.”

Wright relates a story of working as a CIO with a children’s hospital, where cyber risk was an especially concerning topic for him. “The patients we were caring for have a Social Security number, date of birth, and address, and the challenge of protecting that data is stressful,” he says. “These young patients have valuable data a cybercriminal wants, and they aren’t going to use it for another 15 years. Their data could end up being compromised for the rest of their lives. I’ve always had this heightened sense of what could go wrong if somebody’s data was breached, and preventing that is really what we’re trying to do.”

If someone breaks into an organization’s electronic medical records, what can they do with them? There are worst-case scenarios such as deleting allergy information or other grim possibilities, and financial subterfuge like selling demographic information on the black market. But incidents like ransomware attacks have become so common that the fear of the loss of prestige after an attack—once a strong motivator for healthcare cybersecurity—has lessened.

It’s less about whether your organization has experienced an attack, says Wright—everyone is at risk on that front. Rather, if you are cyberattacked, “it says a lot about your IT health in how you recover from it.”

In the end, it’s about getting everyone on the same page: Cybersecurity isn’t separate from patient safety, but actually intrinsic to it. “We’re not focusing on cybersecurity because we think it’s cool,” says Wright. “We’re doing it because it’s just as much a patient safety issue as anything else.”

Messaging is key, Wright says. “It’s a matter of sales; frame the ‘why’ of it. All the security tools you want to bring out of your quiver should have a patient safety story around it. They don’t need to know the technical reasons for it. Instead, take to heart the patient safety reasons and explain it in their language.”

The Role of Digital Transformation in a Patient-Centered Experience

PSQH: Patient Safety & Quality Healthcare, September 15, 2021

Despite all the harm it did, COVID-19 also pushed positive change in healthcare from a digital information perspective. 

This article was originally published September 9, 2021 on PSQH by Matt Phillion.

Digital transformation and patient experience have taken center stage in the present and future of healthcare. Telehealth, while not new, rose to prominence during the pandemic, and technology has gripped the attention of patients and providers alike: According to BDO’s 2021 healthcare digital transformation survey, respondents identified their top three areas of healthcare investment interest as telehealth (named by 75% of respondents, up from 42% in 2019), EHR interoperability (64%, up from 43%), and patient portals and digital messaging systems (56%, up from 50%).

Creating a positive, consistent patient experience is how healthcare systems can set themselves apart as we begin to see the world beyond the pandemic, says Greg Miller, vice president of industry strategy for healthcare and life sciences at Talkdesk.

“One of the things that has been consistent is the industry is slow to adapt,” says Miller. “It’s common to reference that healthcare lags behind by a significant number of years, but what frustrates me as a healthcare information junkie is people accept the status quo.”

Despite all the harm it did, COVID-19 also pushed positive change in healthcare from a digital information perspective. A recent conversation at a College of Healthcare Information Management Executives (CHIME) event noted that CIOs of healthcare systems were on a 10- to 15-year journey, but COVID sped up that timeline to more like 10 to 15 months.

“COVID cast a bright light on how siloed and fractured healthcare is,” says Miller. “Hospitals and health systems have processes and systems built around the physician, not the patient.” With the need for more active interaction with technology during the pandemic, though, “we’re starting to see innovative organizations talk about digital front door strategies.”

Talkdesk recently released a research report on the patient experience revolution in healthcare in which 78% of polled patients talked about wanting choice in channel.

“What that means is that they’re not willing to stand for the voice-only concept healthcare has been built on and still uses in the majority of its interactions,” says Miller. “We’ve accelerated, and I don’t just mean telehealth—it’s the natural winner in this space, but there are many forms of transformation.”

Healthcare needs to be ready to change and evolve as others get into the same space. Miller points to the recently launched Amazon Care, which focuses on telehealth and virtual primary care visits first.

“I heard an interview with a CEO of one organization, and they were asked: ‘Are you concerned about Amazon Care?’ And they said no,” says Miller. “This is how myopic healthcare can be. When Amazon got into bookselling, I’m sure Barnes & Noble said the same thing. A friction-free experience is something we need to bring into healthcare. It’ll change the game.”

What we’re doing right

The industry has made strides in this direction, Miller notes; not just in technology, but also federal laws, policies, and procedures. “Rules and laws were relaxed around doctors being paid for telehealth—previously they weren’t—and providing care across state lines,” he says.

We’re seeing new care models, some of which are wrapped around value-based care, and tech that is being purpose-built to help manage risk and promote engagement. “If you look at the industry, there are a gazillion patient engagement vendors trying to do their thing: texting, AI chatbots,” says Miller. “We’re going to see a massive consolidation of these.”

Interoperability of systems is also seeing a transformation in the industry. “Interoperability of healthcare data became federal law” this year, says Miller. “It’s just now getting to be mandated at the federal level that they [healthcare organizations] have to share information.”

CMS’ interoperability and patient access final rule took effect July 1, 2021, requiring all healthcare providers to grant patients access to their personal health information.

“If you show up at the emergency department and you’re unconscious, the ED doc needs to know your allergies and medications,” says Miller. “Without them, you could die. Making that happen is a combination of federal law and technology.”

Another step forward: more openness in terms of healthcare pricing. “One of the things that is super valuable—it might not be so much digital transformation—is the federal mandate around price transparency,” says Miller. He notes that this mandate came out in January 2021 but wasn’t enforced until May, and many organizations are still not meeting the requirements.

Miller mentions a company he stumbled across recently that uses technology to pull data from all price transparency tools on websites around the country. “If I need a hip replacement, maybe I want to go to Florida, for example, for a better price or quality,” he says.

Where artificial intelligence comes into play

When Miller started with Talkdesk, he tapped a number of CIOs about their involvement with the contact center. Most said they didn’t own it, but realized they did, in a way, because of the technology involved. Contact centers have proliferated over time, and many organizations have one for each of their clinics or departments.

“Almost all the conversations were identical,” says Miller. “There was so much opportunity for transformation.”

Typically, provider organization interactions are limited to voice conversations between humans, while in other parts of our lives, Miller points out, we’re comfortable having exchanges with virtual agents, chatbots, and other automated systems. “Healthcare is slow to adapt,” Miller says. “But this is the last mile of transformation to re-imagine the patient experience.”

Roughly half his organization is in research and development, and its entire platform is infused with AI. “We leverage AI to automate as many processes and interactions as possible,” says Miller.

An automated response could be the perfect fit for many incoming calls at a call center. “I did some market research, and the top reasons someone calls a provider are to schedule an appointment, refill a prescription, get directions, and inquire about transportation,” says Miller. “These are classic lower-value interactions that can be handled by a digital virtual agent.”

The virtual agent concept allows the patient or the patient’s family to interact with the payer or provider through the channel they choose, be it chat, voicemail, text, email, or some other method.

“AI plays a central role in that,” he says. The AI can be integrated on the back end with EHRs so when someone starts a chat, the AI surfaces who the patient is, authenticates their identity, sees the medications they are on, and can be proactive with the patient. “It’s a simple example of how AI can be super valuable. Patients don’t want to navigate a phone tree and sit on hold.”

AI also can help with one of the more frustrating parts of the patient experience: missed appointments. “The average revenue per doctor for a missed appointment is $200, and for the hospital it’s $500,” says Miller. “And people miss appointments for many reasons.”

By leveraging AI, providers can know which patients are scheduled for a procedure or appointment, communicate via an outbound text to confirm yes or no, or send a voice message as an appointment reminder. “I talked to one provider organization where the move to this kind of capability resulted in a 10% reduction in no-show rates,” says Miller.

This is huge, he says, because of the impact of no-shows: operating rooms that go unused, staff on hand who could be deployed elsewhere, and of course quality-of-life issues for patients who don’t receive their scheduled care.

For some organizations, AI didn’t work out in the past because there wasn’t enough data to properly train the AI. “You need a massive amount of data to train it,” says Miller. “Data scientists are hard to come by, specifically in healthcare—they’re hard to find, and healthcare can’t pay the salaries they can command in other industries.”

Talkdesk has developed a tool called AI Trainer that provides a click-based method for building AI models with a layperson’s technical understanding. “One of the next big playing fields is the democratization of AI,” says Miller.

Data has only become available digitally in recent years; prior to that, hospitals had no incentive to make the switch and remained on paper records. “We’ve been collecting data mostly for business purposes, and the payers use that data well,” says Miller. “But hospitals are still relatively immature in their ability to leverage it.”

The industry is making progress, but what are its next steps? “I think the patient has to be at the forefront and in the middle of every conversation around digital,” says Miller.

AI can be central to getting the patient in the conversation, though it’s not the only fix. Miller points out that the real goal is to identify a problem and use AI to solve it, not to treat AI as a panacea. “AI is everywhere. I think we’re going to see a lot more creativity in internet of things, and much more proactive care management than reactive or encounter-based.”

That change will have to be cultural as well as technological. “One of the biggest barriers to digital adoption and a patient-centric culture is the organization,” says Miller. “Changing the mindset of people is critical to shift to a more patient-centric viewpoint.”

Value-Based Healthcare: How It Expanded During COVID-19

PSQH: Patient Safety & Quality Healthcare, August 9, 2021

Value-based payment models were not only good for business during the pandemic, but also ushered in a new acceptance of telemedicine.

This article was originally published August 9, 2021 on PSQH by Matt Phillion.

The National Alliance of Purchaser Coalitions recently conducted a survey that showed six in 10 employers are considering or already engaged in value-based design approaches, in no small part because of the impact of COVID-19. The new options in comprehensive, advanced analytic platforms that can help track, measure, and drive down cost make this shift increasingly possible. When analytics are combined with proactive care management and coordination through the Center of Excellence model, organizations are finding financial stability not seen during the pandemic.

How did COVID-19 prompt this focus on value-based care models? “When the world shut down in April and May of 2020, fee-for-service models ceased,” says David Snow, chairman and CEO of Cedar Gate Technologies, a value-based healthcare information technology company. “However, providers in value-based care payment arrangements, such as capitation, continued forward—taking care of patients and generating revenue.”

Value-based payment models were not only good for business during the pandemic, but also ushered in a new acceptance of telemedicine. Snow, also the chair of a telemedicine organization, recalls previous struggles with state medical societies for adoption.

“Prior to the pandemic, virtual care was deemed to be lower quality in comparison to an in-person visit,” says Snow. “It took COVID to dispel this preconceived notion. It is clear now that telemedicine delivers enormous clinical quality, financial value, and efficiencies. Sometimes it takes an earth-changing event to reorient things.”

The impact of COVID-19 on quality of care

Preexisting conditions became newly challenging during the pandemic, as chronic diseases such as diabetes and hypertension risked being untreated. Many patients fell behind on care, avoiding doctor visits and hospital stays out of concern of COVID-19 exposure—which added significant risks to those with preexisting conditions.

“Patient volumes dropped dramatically in the spring of 2020 but have come roaring back,” says Snow. “The challenge is that some people incurred harm and detrimental consequences from the disruption—particularly in the gap between the initial weeks of the pandemic and the full adoption of telemedicine. Motivated by patient outcomes, value-based providers were driven to quickly adapt to telemedicine to avoid disruptions to patient care.”

Moving to value-based care

Staying with fee-for-service may seem like the comfortable option, Snow notes, but that changes once providers experience the benefits of value-based care.

“In value-based models, wellness and the avoidance of the necessity of expensive and invasive treatments becomes the incentive, not the illness,” Snow says. “With new models in value-based care, we’ve solved the technology and data problem. We now have analytics that are very precise about where the opportunities are to perform better in terms of cost and quality. We’re able to solve these issues via the advancement of technology. Care is now well positioned to evolve in alignment with how we’ve evolved technology.”

Snow points to three models of value-based care:

  • Primary care attribution, where plan members as a set become the primary care physician’s responsibility to manage and keep well, with incentives around cost and quality
  • Bundles, where providers package the care inside a clinical pathway, with positive incentives for provider delivery systems; this differs from the model used elsewhere that moves from onset to surgery to postacute care
  • Capitation, which is a set amount per patient over a period of time, regardless of whether the patient seeks care

Snow names global capitation as a central driver of innovation and competition because of its focus on wellness and early interventions.

With all this opportunity for change, what are we doing now that we should carry forward? “Technology has advanced, and healthcare is poised to benefit enormously. Healthcare is in the midst of seismic shifts,” says Snow.

Where we can improve, he adds, is in driving adoption of value-based care analytics, both financial and clinical. This insight and way of delivering care is more cost-effective, with demonstrated improvement in patient outcomes.

Advocates for transitioning to value-based care point to the financial stability it brings, as well as the alignment of incentives for care. “There’s a transparency that’s never existed before within value-based care models,” says Snow. “This transparency applies to providers and payers to gauge risk, patient outcomes, and cost. Everyone can now be aligned while driving real advancements in patient outcomes.”

Fee-for-service lacks this level of transparency, which makes it hard for providers to plan and make decisions based on expected consequences. “When providers work within a risk-based model or value-based model, they are invested in the data and driving strong patient outcomes,” Snow says.

Emerging technologies and next steps

Value-based care technologies are rising fast, and competition in the space has risen with equal speed.

“Value-based care is an area full of innovation. The organizations that can create a high-value stack of analytics, with a meaningful high-touch consumer experience and [an] end-to-end technology experience that drives great outcomes at a reasonable cost, will be the game-changers,” Snow says.

Through adoption and integration of innovative solutions in care management, payers and providers can benefit from the explosive innovations following COVID-19—many of which were already under development but have been catalyzed coming out of the pandemic. Now, healthcare technology with multifaceted solutions that drive preventive and proactive patient care is coming to fruition.

“COVID’s impact resulted in dramatic change and is now part of our healthcare framework. We’re not going back to the old way,” he says. “It’s a positive change. There’s no doubt in my mind value-based care will be the dominant theme in the next 10 years for reimbursement—it’s going mainstream.”

AIHA Voices Concerns About COVID-19 ETS

PSQH: Patient Safety & Quality Healthcare, August 2, 2021

AIHA argued the ETS does not recognize that all healthcare workers are at risk of inhalation exposure given the strong possibility for pre- or asymptomatic transmission in healthcare settings.

This article was originally published July 30, 2021 on PSQH by Guy Burdick

On July 27, AIHA (formerly the American Industrial Hygiene Association) revealed concerns about the federal COVID-19 emergency temporary standard (ETS) in a 13-page letter to the Occupational Safety and Health Administration (OSHA). AIHA urged the agency to closely examine and immediately revise the emergency rule’s provisions dealing with ventilation, physical barriers, and transmission by inhalation of SARS-CoV-2, the virus that causes COVID-19, as well as OSHA’s use of the hierarchy of controls.

The group also suggested that OSHA remove the mini-respiratory protection program provisions from the emergency rule. AIHA stated that workers are not likely to gain any level of protection from non-fit-tested respirators and argued against allowing the voluntary use of respirators outside a formal respiratory protection program under the requirements of 29 CFR §1910.134.

OSHA’s emergency rule only applies to healthcare and healthcare support services. AIHA argued the ETS does not recognize that all healthcare workers are at risk of inhalation exposure given the strong possibility for pre- or asymptomatic transmission in healthcare settings. OSHA should consider the likelihood of aerosol inhalation, as well as droplet transmission of SARS-CoV-2, in its rulemaking, according to the group.

The group questioned the inclusion of requirements for physical barriers, which do not limit aerosol inhalation and increase the turnover time needed to remove SARS-CoV-2 and other respiratory pathogens through ventilation.

Barriers may offer a potential sense of security for workers and members of the public while effectively decreasing the mixing of air in any room where they are erected, according to AIHA. The group said that airflow inside the workplace is important to optimize dilution and reduce concentrated pockets of aerosols at the source of generation, such as near an individual.

Hierarchy of controls

While the agency discussed the importance of applying the hierarchy of controls to preventing COVID-19 in the emergency rule’s preamble, the rule itself never mentions the hierarchy of controls, according to AIHA, even in the context of developing a COVID-19 prevention plan. The group argued the ETS should list and mandate
controls in the order of the hierarchy and highlight the importance of using multiple
controls—a layered approach. AIHA suggested the appropriate order of controls for aerosol transmission should be vaccination, employee health screening, patient screening, physical distancing, ventilation, and then personal protective equipment (PPE), including respiratory protection.

The group also argued that there is no need in the COVID-19 ETS for additional cleaning and disinfection requirements in healthcare settings, as cleaning and disinfection are only important for contact transmission.

AIHA also said respirators with higher protection factors, such as full-facepiece elastomeric or powered air-purifying respirators, should be required for aerosol-generating procedures. The group also expressed concerns about:

  • Requiring the use of face masks only as a means of source control and only on patients or vaccinated and/or frequently tested healthcare workers and not as personal protection from aerosol inhalation for healthcare workers; and
  • Acknowledging that physical distancing requirements do not take into account the distribution of infectious particles that occurs throughout a space over time or the increase in concentration that occurs both near and far from the source over time and that physical barriers are not a replacement for an inability to physically distance.

The emergency rule should not allow the use of face shields, which do not prevent aerosol inhalation, as replacements for respirators or as a solution to an inability to wear a respirator.

The group also suggested new language for testing requirements under the ETS, including:

  • Vaccinated employees do not need to be tested routinely for purposes of screening (unless there was a confirmed or suspected exposure to a COVID-19 case and/or the vaccinated employees are symptomatic).
  • Unvaccinated employees may be tested periodically for purposes of screening.
  • Symptomatic unvaccinated employees should be tested, regardless of whether there is a known exposure.
  • Unvaccinated employees should be tested after an exposure.
  • Vaccinated employees should be tested after an exposure if they develop symptoms.
  • Unvaccinated employees should be tested on an outbreak setting (such as 3 or more employees within a 14-day period).
  • All employees should be tested if there are 20 or more employee COVID-19 cases in an exposed group within a 30-day period. The 30-day period is subject to change to a shorter time period of 15 days based on the evolving nature and virulence of COVID-19 variants.

Pages