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Reimbursements red herring, trust, and key infrastructure needs for Telemedicine success  

Reimbursements red herring, trust, and key infrastructure needs for Telemedicine success   | Healthcare and Technology news | Scoop.it

Telemedicine is a growing part of modern healthcare and could play a pivotal role in the U.S.’s efforts to streamline and expand preventative services. Virtual, video-based doctor’s appointments can help alleviate the general practitioner shortage and encourage preventative care. They also offer a cheaper, more convenient alternative to in-person appointments for many patients. Unfortunately, there’s a lot of hype and misinformation being reported so I was pleased to see that TechnologyAdvice (TA) surveyed 504 U.S. adults about telemedicine and their willingness to use such services. I think the results shed important light on where healthcare providers and telemedicine vendors still need to gain acceptance with patients so I reached out to Cameron Graham, Managing Editor at TA to see if he can give us the facts on the ground. Cameron heads market research for healthcare IT, business intelligence, and other emerging technologies and is uniquely qualified to help shed some light on the subject. Here’s what Cameron said:

 

1. It’s not just about reimbursements

Despite the promise of telemedicine, the vast majority of Americans still aren’t using such services. One oft-cited reason for this is the lack of insurance reimbursement for many telemedicine procedures. While some private insurers will cover telemedicine, many only cover select types of visits or specific applications. Medicare, for instance, covers face-to-face interactions, but only when the originating site (point of care, not the patient’s home) is in a Health Professional Shortage Area (HPSA). Although coverage is slowly improving in many states, the American Telemedicine Association gives just five states (plus DC) an A grade in coverage and reimbursement.

 

However, the current hodgepodge of reimbursement rules is not the only thing holding back telemedicine from widespread use. An equally important factor is likely Americans general comfort with video-based platforms and their trust in remote appointments. According to our study, less than half of adults (44.9%) said they would be comfortable conducting a doctor’s appointment over video. Only 35.3% of respondents said they would choose a video appointment over an in-person one. Until patients are more comfortable with the notion of remote care, it is unlikely that telemedicine will gain significant traction.

 

In order to facilitate acceptance of telemedicine among Americans, providers and vendors need to work on educating patients about the benefits of such systems. Telemedicine vendors, in particular, should help patients navigate the complex reimbursement rules currently in place, and promote the cost-savings of remote appointments. By doing so they will not only gain brand awareness among patients but will be able to recruit patients as advocates for more comprehensive insurance reimbursement policies.

 

2. Trust is a key component of effective telemedicine

Americans are not only hesitant about scheduling telemedicine appointment, they are also sceptical about diagnoses made through video platforms. Forty-five per cent of respondents said they would trust a virtual diagnosis less than one made in person. An additional 29.3% said they simply would not trust a virtual diagnosis. This suggests there is a distinct lack of trust among Americans in the quality of medical services that telemedicine platforms can provide.

 

Much of this scepticism is likely due to a lack of familiarity with the services. It also reinforces the fact that telemedicine providers must earn patients trust before they can effectively increase adoption rates. Once that trust is established, it appears people are far more likely to consider using remote appointments. While initially, only 35.3% of respondents said they would choose a virtual appointment over an in-person visit, 65% of respondents said they would be more likely to conduct a virtual appointment if they have first seen the doctor in-person.

 

It’s unlikely that providers or vendors will be able to dramatically change such preferences given the personal nature of many medical visits. However, increased awareness about the qualifications of physicians could make potential patients more comfortable about conducting preventative care via video. Incorporating a rating system, or minimum quality threshold for participating physicians is one potential solution.

 

3. Personal and professional infrastructure is key

The personal infrastructure for telemedicine is already in place across much of the United States, in the form of video-enabled smartphones. According to the latest PEW research, 64% of Americans own a smartphone. In theory, this provides them with the basic means to access remote, video-based health care. Smartphones will likely serve as first means of exposure to such services for many people.

 

More advanced, capable systems (such as dedicated telemedicine kiosks) however are far from established. Aside from a few test programs in select areas, there is no nationwide, professional infrastructure or technology for telemedicine. This hinders adoption and limits the use of telemedicine to basic, preventative care that can be conducted entirely remotely. Dedicated kiosks can greatly expand the use-case for telemedicine, by incorporating sensors, multiple cameras, and other advanced technology. Further investment from telemedicine vendors and insurance companies could help to boost the nationwide profile of telemedical services and expand access for many Americans.

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Digitally managed clinical trials will accelerate results and reduce costs 

Digitally managed clinical trials will accelerate results and reduce costs  | Healthcare and Technology news | Scoop.it

Digitally managed clinical trials have the potential to accelerate results report and reduce costs but workflow questions and regulatory questions remain. In many facets of our lives, digital data collection has improved services, eliminated errors, and reduced waste in time and resources. Think about the ticketing and check-in process at airports ten years ago vs. today: when airlines put the information in our hands we were able to do the check-in, seat selection, and other work for them. Plus, we were happy to do it. Also consider ATMs, online banking, and retail banking for how we are able to move money, get cash, and get loans by providing data ourselves and get immediate services. When we think about the medical industry, though, very little of the kind of automation created by self-service digital data collection exists. While we can see some patient portals and self-service triage apps appearing in limited uses, large-scale use seems very far away. One specific area that digital data collection can, potentially, literally save lives is in clinical research. The use of digital collection tools, primarily mobile devices, in clinical studies, is nascent but growing. Evidence indicates that these tools have the potential to significantly improve the quality of research outcomes and reduce the costs associated with such research, but there are still questions about how exactly these tools will work and some of the issues surrounding electronic data collection. To help answer some common questions, I spoke with James Emerson, who is a director of clinical research and helps run a variety of clinical trials.

How are mobile devices being used for digital data collection in clinical research?

For several years now, IT in the enterprise has been moving toward consumerization; that is, people are bringing their own devices to work and many of the same applications are used outside of the office. Clinical researchers have realized that same consumerization of IT that is revolutionizing the way that we work can do the same for research. Trial participants using clinical trial research technology are able to use their own smartphones, tablets, and other mobile devices, which makes it much more likely they will comply with the requirements of the study.

Essentially, depending on the setup of the study, patients simply need to input information into an application, eliminating the need for paper journals or surveys.

 

While research indicates that most patients actually prefer this technology over other forms of data collection, in particular, voice response systems, there are still some challenges. One thing that researchers need to overcome are the differences among devices themselves, and how applications actually function on different devices.  Training trial participants — and providers — in the use of the application is an important task. Connectivity issues are also a concern, as is privacy. Protecting sensitive personal information is of paramount importance, and researchers are cognizant of the need for data protection protocols and security, both in terms of protecting the devices themselves and in the transfer of data.

Why are digitally managed clinical trials ideal for clinical research?

Digital data collection has many significant benefits. For starters, it reduces costs. Major clinical studies often have thousands of participants, all of whom need to be trained in how to record data and submit it to their providers. That data also needs to be collected and analyzed, often manually. Digital data collection reduces or eliminates the need for many of those expensive tasks. When clinical trial participants are allowed to use devices that they already own and are familiar with, the complexity of the training and on-boarding decreases and compliance increases.

 

The simplified data collection process also has a significant impact on the overall quality of the study. Again, compliance is a major benefit. Studies have shown that patients vastly prefer mobile data collection over other options like paper journals or interactive voice response systems. It’s simply much easier to input your data into your mobile device and move on with your day than it is to navigate a complex menu of voice response options or fill out a paper questionnaire.

 

The accuracy of the data collected also improves; when patients use paper journals, for instance, they have a tendency to add additional extraneous information or skip questions, which can affect how the data is analyzed. Not to mention, when the researchers have access to real-time data, they can identify compliance issues earlier on and monitor patient safety more efficiently, improving the overall outcome of the trial.

 

While digital data collection can improve the accuracy of the data collected, there are some obstacles to overcome. Digital data collection protocols require that researchers consider facets of study design that they might not have otherwise. For example, what happens if a device is lost or stolen? How can we protect that data and the integrity of the study? We need to use a technology infrastructure that complies with regulatory protocols, but that is also easy for subjects to use.

 

Many researchers are also concerned about equivalence among the devices being used. In other words, are all of the subjects having the same experience when using the application, and how do differences affect outcomes? These are all questions that researchers are considering in their study design.

Can digitally be managed clinical trials really save that much money?

The short answer is yes. In 2014, the Department of Health and Human Services released a report estimating that using mobile technologies in clinical trials has the potential to save clinical research organizations (CROs) tens of millions of dollars. The greatest savings come in the later stages of trials, but even in the early stages, mobile saves money.

Are there regulatory issues related to the use of digital collection tools that CROs face?

The FDA is actually encouraging CROs to do as much electronically as possible. That being said, yes, there are some stringent regulations that CROs must adhere to that ensure the accuracy and protection of the data. The FDA has issued guidance on how CROs can capture and use data to maintain those protections.

Are there times when digital data collection isn’t ideal? What about barriers to participation?

While it might seem like everyone on the planet has a smartphone these days, the fact is that there are some people who either do not have access to the technology necessary to participate in a research study via a mobile device or have the skills to do so correctly. It’s important to carefully assess the target population of the study to determine whether digital data collection is appropriate or if more traditional methods would be a better choice.

 

For example, many older adults either do not have or do not use smartphones and aren’t interested in learning how to use the application to participate in the research. For someone who isn’t a digital native, using an application to record data could be intimidating or confusing.

 

Another issue is a lack of access to the internet or cellular service. In many rural areas of the country, access to broadband is still limited, and cell service is limited or nonexistent. Relying solely on digital data collection via smartphone has the potential to exclude viable candidates from research studies, simply because they cannot provide data efficiently. We need to be very careful in how we design studies, and the technological requirements, or risk inadvertently creating disparities within the study population based on economic or geographic situations.

 

And of course, not all studies lend themselves to self-reporting — and as with any self-reported data, there will always be a margin of error. Researchers need to carefully consider their reasons for choosing digital data collection, and evaluate whether they are ideal for an individual study.

Are digitally managed clinical trials really the future of clinical research?

Yes, we believe so. The fact is, the old ways of doing things are no longer infallible. Using digital tools has the potential to solve many of the long-standing problems within clinical research, including low study recruitment numbers, gender bias, accuracy, compliance, and more. By incorporating digital tools, new, more effective treatments can get to market faster while keeping patients safe and improving their overall health.

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Apple’s EHR: Why Health Records on Your iPhone is Just the Beginning? 

Apple’s EHR: Why Health Records on Your iPhone is Just the Beginning?  | Healthcare and Technology news | Scoop.it

Americans on average will visit a care provider about 300 times over the course of their lives. That’s hundreds of blood pressure readings, numerous diagnoses, and hundreds of entries into a patient’s medical record—and that’s potential with dozens of different doctors. So it’s understandable, inevitable even, that patients would struggle to keep every provider up-to-date on their medical history.

 

This issue is compounded by much of our healthcare information being fragmented among multiple, incompatible health systems’ electronic health records. The majority of these systems store and exchange health information in unique, often proprietary ways—and thus don’t effectively talk with one another.

 

Fortunately, recent news from Apple points to a reprieve for patients struggling to keep all of their providers up-to-date. Apple has teamed with roughly a dozen hospitals across the country, including the likes of Geisinger Health, Johns Hopkins Medicine, and Cedars-Sinai Medical Center, to make patient’s medical history available to them on their phone. Patients can bring their phone with them to participating health systems and provide caregivers with an up-to-date medical history.

 

Empowering patients with the ability to carry their health records on their phone is great, and will surely help them overcome the issue of fragmented healthcare records. Yet the underlying standardization of how healthcare data is exchanged that has made this possible is the real feat. In fact, this standardization may potentially pave the way for innovation and rapid expansion of the health information technology (HIT) industry.

 

Growing agreement upon a standard way to store and exchange electronic healthcare information is what made Apple’s foray into health records possible in the first place. Fast Healthcare Interoperability Resources (FHIR) emerged four years ago as an interoperability standard for electronic exchange of healthcare information. It is a standard framework for the sharing, integration, and retrieval of clinical health data and other electronic health information. Enough agreement upon such a standard for health information exchange has promoted modularity.

 

How modularity fast-tracks innovation

A system is modular when all its components fit together in a standardized way, whether physically, mechanically, chemically or in this case digitally. This standardization enables people to design one component without having to know how everything else in the system works. An everyday example of this is the USB port. It is a standard cable connection interface upon which any number of products can connect—whether it be a keyboard, a charger, external memory, or any other device that can meet the specification. This differs from interdependent systems, in which the design of parts are customized, nuanced, and how they work together is not widely known. Thus, a designer has to know how the whole system works to be able to design any part of it.

 

In the case of the FHIR standard, the manner in which digital healthcare information is exchanged is modularized—the rules of the road are established and easy to follow. Adoption of this bit of digital standardization, by an influential group of healthcare providers, is what allowed the third-party giant, Apple, entry into the modular electronic health records game. Even though their experience in healthcare is limited, the standard lays out the rules well enough for them (and other third parties) to participate in the HIT market.

 

We’ve learned in the past that the creation of and agreement upon standards can expand industries by creating a new ecosystem in which third-party players can add value. In fact, the preeminent example of this type of ecosystem creation is Apple itself, and their AppStore.

 

Along with their AppStore, Apple created a set of standards that specified how third-parties (from companies to individual hobbyists) can more easily create applications that make use of the information on their phone and the Internet. These apps were made available to Apple’s network of users and developers were paid according to the amount of revenue the app generated by Apple (based on usage). Over the span of 10 years, Apple has paid AppStore developers $86.5 billion (paying out $26.5 billion in 2017). The rapid expansion of the market for creating substitutable apps in return gave everyday users the ability to harness information in any number of more convenient, simple, and potentially meaningful new ways.

 

What does this relatively recent and still unfolding story mean for HIT? It means that as opposed to merely viewing your health record, standardization may also allow for the creation of new tools that actually make use of your health record in new, meaningful ways. For example, developers may create an app that helps patients understand their risk of a cardiac event base pulling specific data points from the health record. In short, applications can be created by third party creators for use by the patient that make their healthcare data more accessible, easier to understand, and more actionable.

 

In this way, not only does modularity stand to make healthcare data more accessible to providers, researchers, and public health organizations (current consumers of health data), but to a new market—the patient. Standardization mediated by the adoption of FHIR opens up the market for innovators outside of the traditional health IT industry. These new players can then compete to reach everyday people (just as app creators did on Apple’s AppStore platform), with useful tools that empower them in their struggle for health.

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A Path to Putting Patients at the Center 

A Path to Putting Patients at the Center  | Healthcare and Technology news | Scoop.it

I remember when visiting a city required paper maps and often actual guidebooks. Today, I tap on a map app on my phone, enter my destination and review options for getting from point A to point B. In recent years, these applications have expanded to integrate ride-sharing, bike-sharing, and public transit information. Map apps provide two key real-time data points to help me compare the different options: the time it will take to get to my destination and the cost.

Behind those data points are elegant algorithms that analyze traffic patterns and conditions, as well as the real-time data exchange between multiple apps through modern, Representational State Transfer (RESTful) application programming interfaces (APIs). What makes our smartphones so powerful is the multitude of apps and software programs that use open and accessible APIs for delivering new products to consumers and businesses, creating new market entrants and opportunities. There is nothing analogous to this app ecosystem in healthcare.

ONC’s interoperability efforts focus on improving individuals’ ability to control their health information so they can shop for and coordinate their own care. While many patients can access their medical information through multiple provider portals, the current ecosystem is frustrating and cumbersome. The more providers they have, the more portals they need to visit, the more usernames and passwords they need to remember. In the end, these steps make it hard for patients to aggregate their information across care settings and prevent them from being empowered consumers.

Just as consumers can see the time to destination and costs using their map apps, they should be able to see quality indicators and costs of their care. As Health and Human Services (HHS) Secretary Azar recently stated, “putting the healthcare consumer in charge, letting them determine value, is a radical reorientation from the way that American healthcare has worked for the past century.” I certainly recognize that issues around pricing for healthcare services and measuring quality are complex, but I am confident that ONC’s efforts will complement new policies across HHS to encourage transparency, leverage Medicare and Medicaid to drive value-based transformation, and reduce regulatory burden on the health system.

As part of ONC’s role in coordinating health information technology (health IT) nationally, we are working with innovators to develop modern APIs that support the use of mobile apps to help individuals manage their own health or the health and care of a loved one. A robust health app ecosystem can lead to disease-specific apps and allow patients to share their health information with researchers working on clinical trials to test a drug or treatment’s efficacy, or monitoring outcomes like those in the National Institutes of Health’s All of Us Research Program.

ONC took a practical step to accelerate the use of APIs in healthcare with the 2015 Edition of the certification criteria adopted as part of the ONC Health IT Certification Program. Specifically, the 2015 Edition includes updated technical requirements that were not available in the prior edition and—to the benefit of the provider and the patient—to support further innovation in APIs and interoperability-focused standards. The 2015 Edition includes “application access” certification criteria that require health IT developers to demonstrate their products can provide application access to core medical and patient information via an API.

The 21st Century Cures Act (Cures) builds on ONC’s 2015 Edition and calls for the development of APIs that do not require “special effort” for developers to access and exchange health information. ONC will address this requirement through rulemaking expected to be issued later in 2018. Ensuring that APIs in the health ecosystem are standardized, transparent, and pro-competitive are the central principles guiding our work. These goals should allow new business models and tools that will expand the transparency of all aspects of healthcare. New tools should allow patients to comparison shop for their healthcare needs like they do when hailing a ride.

In recent years, the health IT industry has made positive strides. The HL7 Argonaut Project, a private sector initiative, has been developing a core set of Fast Healthcare Interoperability Resources (FHIR) implementation specifications. These specifications will enable expanded information sharing for electronic health records and other health IT solutions based on modern computing standards (i.e., REST, Javascript Object Notation (JSON), and FHIR). Boston Children’s Hospital Computational Health Informatics Program and the Harvard Medical School Department for Biomedical Informatics have been leading the development of SMART Health IT, an open, standards-based technology platform that already is showing success in enabling innovators to create apps that seamlessly and securely run across the healthcare system.

The convergence of these actions, the new authorities granted to ONC by Congress in the Cures Act, and efforts by HHS, the Centers for Medicare & Medicaid Services (CMS), the National Institutes for Health (NIH), and the Veterans Administration (VA) with the MyHealthEData initiative are helping promote more consistent data flows, inject market competition in healthcare, and return individual control of their care to the American public.

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Empowering Patients through Decentralized Information Governance 

Empowering Patients through Decentralized Information Governance  | Healthcare and Technology news | Scoop.it

Health care will be transformed if we empower patients and physicians through access to information. Don Rucker is right to focus attention on APIs to enable the transformation. A year and a half into the new administration and the massively bipartisan 21st Century Cures Act, the Department of Health and Human Services (HHS) is having to navigate between the shoals of highly unpopular Meaningful Use regulations and the apparent need for regulation to undo the damage of market consolidation that they caused. From my perspective, it looks like HHS is doing a good job.

Prediction is a dangerous game but it’s necessary for investments that depend on health information technology. Nowadays, pretty much everything in healthcare depends on information technology, particularly if we need effective quality measures to enable transition to value-based healthcare.

Based on Verma’s most recent remarks, it’s safe to predict that HHS will use the power of the $900 Billion purse as a way of avoiding regulation as it tries to break down the oligopoly of the consolidated “integrated delivery networks” and their even more consolidated EHR vendors. What’s more interesting is to anticipate how Rucker’s recent remarks about Persistent Access will be translated into decision support information for patients and physicians that will actually drive the practice innovation Verma is talking about.

 

Today, the information available to physicians and patients at the point of care is centrally governed by hospitals and by EHR vendors. A service seeking to present a piece of information such as therapeutic alternatives, quality ratings, out-of-pocket expenses, and research or clinical trials opportunities, must run a gauntlet of censorship by both the hospital and the EHR vendor. A thoughtful paper on how preemptive genomic testing has significant impact on subsequent treatment decisions shows the evolving connection between medical science and information governance.

The barriers to providing independent decision support when it matters most, during the physician-patient encounter, are immense. Let’s list some of them.

An independent information service

  • Must be “certified” by the hospital even if a particular physician wants to get it
  • Must be “certified” by the EHR vendor before it’s even accessible to the hospital certifiers
  • Involves up-front certification costs that are incompatible with open source or other non-profit information sources
  • Can’t access the complete patient’s record in the EHR
  • Requires the physician to sign-in to a separate system with a separate password
  • Is not covered by insurance, or, if covered, is subject to pre-certification delays that the physician won’t put up with
  • Is unaffordable because each EHR and each hospital presents a different integration challengecan’t get investors because the EHR vendors will demand unspecified rent on access to the physician-patie t relationship or, in many cases, actually demand access to the intellectual property itself.

The task ahead for HHS is formidable. Regulation that drives patient empowerment at the point of care (when the physician is about to sign that order that drives $3.5 Trillion of healthcare costs) is inconceivable under the US healthcare system and out of reach for even the nationalized health systems in other rich countries. The proprietary EHR vendor business model means EHRs must control the “app store” as the driver of future growth. Separately, the Accountable Care Organization business model for hospitals drives them to control their physicians and restrict access to “out-of-network” providers regardless of what’s best for a particular patient.

But there is hope, particularly if CMS, ONC, and maybe even the VA orchestrate their actions. The hope lies in the upcoming definition of “information blocking” as mandated by 21stC Cures.

HHS can and should define information blocking in terms of independent decision support at the point of care.

Access to independent decision support at the point of care is an outcome rather than a process. It’s easy to tell if it’s blocked without resort to heavy-handed regulation of the API technology. No new legislation is required because HIPAA, HITECH, and 21stC Cures already enable patient-directed information sharing via API at no significant cost. Patient-directed APIs are also directly accessible to the physician, subject to patient consent.

Technically, what’s required is that *every* API of an EHR be supported as a patient-directed API. That’s not much to ask since the EHR vendors are already building the APIs to use in the app stores they need to stay competitive. What’s also required is what Rucker calls Persistent Access which is what FHIR calls Refresh Tokens and is already widely implemented in the Apple Health APIs. Finally, what’s needed is the ability for a patient to direct information anywhere we choose, without censorship or delay, via the API. (Note that patient-directed exchange is different from patient access rights that require information to flow through personal health records. PHRs have largely failed in the marketplace.) Under HIPAA, patients have this right to patient-directed use for in-person requests to send patient records using paper forms, but this right to uncensored patient-directed exchange needs to be made accessible via the patient portal and linked to the FHIR API. The technical term for this is Dynamic Client Registration and it’s a unimplemented security capability of the FHIR API.

Patient-directed APIs can impact the physician-patient encounter in real time when one or both parties have a smartphone, although ideally the independent decision support will also be available in the EHR as long as the physician and the patient approve.

I’m calling this prescription for empowering patients Decentralized Information Governance. It’s completely consistent with both Verma’s and Rucker’s vision. Because it’s also consistent with current law, it can be implemented by Medicare, Medicaid, VA, and All of US immediately by joining the Health Relationship Trust (HEART) workgroup and implementing our profiles in the VA BlueButton 2.0 and CMS MyHealthEData projects.

The key is for all of us to reject calls for centralized governance of information services by government, academic hospitals, or global corporations (Facebook, Google, etc…) that have all proved resistant to regulation in the digital age. We must also reject the idea that new information governance bureaucracies like DirectTrust, or CARIN Alliance, or some government-controlled Recognized Coordinating Entity can be invented to ensure that our incredibly valuable health information drives open medical science. Decentralized information governance explicitly gives each patient the power to choose which patient interest groups, community organizations, or congregations one trusts to control access to his or her health records for both clinical and research uses.

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Adults use Online Health Resources instead of Primary Healthcare 

Adults use Online Health Resources instead of Primary Healthcare  | Healthcare and Technology news | Scoop.it

A recent survey of 2,201 US adults, conducted by University of Phoenix® College of Health Professions, found that almost 59 percent of the population is choosing to use online health information sites, such as WebMD, instead of primary care. The survey also found that though online health resources are being preferred by people, other health technologies are not getting adopted at the same rate.

 

Doris Savron, Executive Dean for the College of Health Professions, noted that “The healthcare industry is shifting to a patient-centered model that harnesses technology to both open communication channels and create a platform for patient engagement. Given this shift, it is crucial that patients not only have access to these technologies but also view them as important resources for improving their health and overall care experience.”

 

Merely a quarter of US residents who have access to technology utilize resources such as appointment booking, accessing health records and e-prescription filing.

 

In traditional care settings, Americans expect a certain level of quality from their healthcare professionals team. As per this survey, most of the respondents value the presence of interpersonal skills amongst their care teams, which includes listening, verbal communication and bedside care.

 

Savron further added, “The data shows that technology is just one piece of the puzzle when it comes to patient care. Although new technologies are resources that we should lean on to help improve communication, interpersonal skills are the foundation for ensuring patient trust and better care. Communication and empathy are vital skills for health professionals seeking to improve adherence and drive positive outcomes for patients.”

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Physicians warm to value-based pay models, but skepticism runs deep 

Physicians warm to value-based pay models, but skepticism runs deep  | Healthcare and Technology news | Scoop.it

Though significant barriers still stand in the way of the transition to value-based reimbursement, a new study offers encouraging signs that physicians are getting more comfortable with new payment models.

 

The study, a joint effort between the American Academy of Family Physicians and Humana, follows up on a similar study they conducted in 2015. Representatives from both organizations—plus Health Care Transformation Task Force Executive Director Jeff Micklos—participated in a briefing Wednesday on to discuss the findings.

 

Amy Mullins, M.D., medical director of quality improvement for AAFP, said one of the data points that stood out the most was that 37% of those surveyed said payments based on quality measures were distributed to physicians at their practice—a “huge jump” from 2015, when it was just 18%.

 

Micklos also highlighted that finding, noting it’s a good sign that shared savings are trickling down to frontline doctors.

“Without that financial incentive, it’s really hard to convince a medical professional that there’s a sustainable business model there,” he said.

 

Mullins said it’s also promising that significantly fewer physicians said they were “not at all familiar” with the concept of value-based payments—7% in 2017 versus 12% in 2015. In addition, the study found that more practices are also hiring care management, care coordinators and behavioral health support to prepare for value-based care.

 

A variety of barriers

It is not all positive news, however. In 2017, only 8% of family physicians agreed with the statement that “quality expectations are easy to meet in value-based payment models,” compared to 13% in 2015. Plus, 62% cited “lack of evidence that using performance measures results in better patient care” as a barrier to adoption.

 

Even the finding that little more than half of physicians said their practice participates in value-based care models shows there is still work to be done.

 

“If you didn’t already know, physicians are a skeptical bunch,” Mullins said, later adding, “we are slow adopters for lots of things.”

And while the share of family physicians who have contracts with 10 or more payers remained about the same, Mullins said it’s still noteworthy that it’s as high as 37%. That illustrates how “frustrating and exhausting” it can be for physicians to deal with the myriad quality measures and systems associated with each payer, she added.

 

One potential barrier not covered in the survey is the uncertainty over what will happen with the Center for Medicare and Medicaid Innovation, Micklos said, noting that Medicare has long been the driver of what happens with the rest of the industry. The Trump administration has asked industry stakeholders for input on an effort to take the innovation center in a “new direction.”

 

The panelists were less concerned, though, with the administration’s move to end mandatory bundled payment models. Regardless of what specific policy levers are pulled, the move to value is smart for the private sector, as fee-for-services has a “tremendous amount of demonstrable inefficiencies,” said Roy Beveridge, M.D., Humana’s chief medical officer and senior vice president.

 

Micklos agreed, adding that bringing people “screaming” into certain payment models isn’t the most sustainable concept anyway.

 

The IT factor

A little more than half of the physicians surveyed said their practices were updating or adding IT infrastructure to prepare to participate in value-based care models. The same share—54%—said as much in 2015.

 

As important as that is, though, physicians still must have better, easier-to-understand and more timely data to truly move forward on connecting payment to health outcomes, Mullins pointed out.

In that effort, insurers can be a crucial partner, Beveridge said. They have a tremendous amount of analytics and other supports to offer physicians, he said, and thus have the responsibility to share that with physicians so that they can act upon it.

 

One of the biggest issues that both payers and providers continue to face, however, is the lack of interoperability between electronic health records systems.

 

From Humana’s point of view, “some of the barriers for interoperability really should not exist,” Beveridge said. But Mullins added that “I don’t know if there is a light at tend end of the tunnel or not,” on fixing the issue.

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Formdox's comment, April 20, 5:33 AM
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Formdox's comment, April 20, 5:33 AM
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Is Your Hospital Technology Killing Time And Productivity?

Is Your Hospital Technology Killing Time And Productivity? | Healthcare and Technology news | Scoop.it

For community hospitals with small operating margins, clinician time and productivity are at a premium.

Yet, today, clinicians still lose an average of 78 minutes per day to ineffective technology use.

 

If your hospital's information technology hurts time and productivity, here’s some more bad news: Your patient care and revenue suffer, too.

 

But, don’t despair. We’re here to help you spot troublesome IT symptoms in your organization, diagnose the problems and, most importantly, treat them.

Symptoms: Signs Of Poor IT

If your hospital’s clinicians are raising the hue and cry over your IT, you already know there’s trouble afoot.

But, to restore lost productivity (and profitability), you must take stock of your surroundings and see exactly where your technology and processes are falling short.

Here’s a short list of things to look for:

  1. Paper still dominates. Paper-intensive processes dictate most of your workflow after EHR implementation is complete.
  2. Manual processes abound. Users don’t trust your systems and resort to manual data entry where automation exists, costing you considerable time.
  3. Duplicate or missing data. Patient, medication and billing information is inaccurate or incomplete, leading to mistakes in patient care and/or billing delays.
  4. CPOE delegation is the norm. Physicians routinely delegate CPOE to nurses or other staff, slowing down the entry processes and increasing the risk of error.
  5. Workarounds are commonplace. In general, users are going around your technology and completing tasks based on preference, not protocol.

Do any of these situations sound familiar? If so, your hospital’s technology is likely creating productivity, care and revenue barriers.

Diagnosis: Who (Or What) Is To Blame?

In most cases, these issues can be traced back to people, processes and technology.

People. Frequently, the source of your IT woes isn’t the technology itself, but rather the people using it. If an anti-IT mentality pervades your hospital, the shiniest, most expensive HCIS in the world won’t deliver value. User workarounds are the most common culprit behind poor data and operational delays.

 

Processes. If your infrastructure and applications don’t align with required workflow, users will find other ways to complete their tasks. Implementing an EHR or any other HCIS for a single purpose – such as meeting compliance requirements or acquiring a new system version – inevitably leads to incongruity between your technology and workflow.

 

Technology. Sometimes, your technology is actually to blame. If your organization has implemented IT best practices and disciplines but still grapples with slow systems or downtime, your technology might not be performing. Certain vendors may be slow to provide critical updates and fixes, further exasperating the issue.

Treatment: Make Your Technology Valuable

It’s time to reclaim your hospital’s productivity, time and profitability.

First, implement effective hospital IT governance and make it the driver for any IT-related decision moving forward. Effective governance looks like this:

  • A leadership team committed to the use of IT as a care and business facilitator
  • Technology purchasing and implementation based on a long-term strategy that’s aligned with patient care and business value
  • Endorsement of best practices and user adoption at all levels of the organization

Working with an experienced, qualified healthcare technology consultant is the best way to create effective governance and align people, processes and technology with business goals. A non-biased third party can be useful for assessing your IT budget against business needs and making strategic recommendations.

Once you’ve established strong governance, align your technology and workflow by surveying day-to-day operations and eliminating obstacles wherever possible.

 

By following a physician as he or she works, you’ll learn volumes about the impediments, large and small, that impact productivity and time. Then, you can use IT to drive positive change, producing tangible benefits for clinicians and staff.

Triage Your IT Now

If you recognize red flags and think your hospital’s technology is directly impacting productivity and time, don’t wait until the consequences show up on your balance sheet. Take action today and help your clinicians deliver the best care possible.

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Better Choices Needed to Manage US Healthcare Cost Growth 

Better Choices Needed to Manage US Healthcare Cost Growth  | Healthcare and Technology news | Scoop.it

LAS VEGAS – In a fireside chat at the HX360 conference, Nobel Prize-winning economist Paul Krugman said there are reasons for optimism even as the U.S. healthcare system faces serious financial challenges. 

 

In a fireside chat with HIMSS CEO Hal Wolf, Krugman said the demographic challenge is serious, “but not as serious as one would think.”

 

He said that healthcare has been absorbing about 18 percent of GDP since 2010 but that there has been a flattening of the cost curve. He believes that healthcare’s share of GDP should remain constant for at least a few years.

 

Wolf said that he has concerns that as baby boomers live longer and the financial burden of treating disease kicks up, the population takes on more costs.

 

Though the U.S. still has the highest healthcare costs in the world, there are a few options that could be used to dig out of that -- any of which would be better than the current state, said Krugman, which he described with a quote from Homer Simpson: “The U.S. government is an insurance company with an army.” 

 

To Krugman, “Medicaid looks more like the systems in other countries and is a well-established system. But if the goal was the cheapest care, we’d do something like the NHS -- but I don’t see that happening in my lifetime.”

 

While a single-payer system is expensive, costs can be mitigated by a system that would more carefully scrutinize unnecessary elective treatments.

 

The Veterans Health Administration, which has been working to improve its system since the 1980s, presents a good model for how to overhaul healthcare, said Krugman. They were pioneers, the first to implement EHRs and shifted a lot of their care from hospitals to health centers. It was a precursor to the private sector.

“We have the capacity, but it would require that you have capable leadership,” said Krugman.

 

Krugman also explained that healthcare costs aren’t necessarily in a crisis, “but it still needs improvement.” And that means everyone is going to have to find a solution to limit costs.

“It’s not that the whole structure of healthcare is unsustainable. But it has the historical pattern of ever-rising costs that cannot continue,” he said.

 

Reflecting on the Dot-com bust and the real estate crisis, Krugman said we were able to dig out of those situations, “but right now, we’re still reeling from what feels like a permanent hangover from the last crisis. And it’s not at all clear that we resolved the issues that brought us there in the first place.”

 

Though the country has low interest rates, the private sector debt is still high, said Krugman. But he’s less worried about that,than the fact that “when these crises hit, no one sees it coming.” We’re all set up to do it again one of these days.”

 

Adding to the worry is America’s deficit. “When the next crisis comes along, it’s going to increase debt,” he said.

Krugman called the latest tax cuts passed by Congress a really bad policy that could make things much worse if a trade war breaks out. What’s worse is that the tax cuts were “not designed for anything really. There were a bunch of people that wanted a tax cut, and they were obliged to that.”

 

That might make our current situation worse when combined with the trade wars. Calling it a “really bad policy,” he did specify that it doesn’t necessarily mean “tremendous risk.” It does mean, however, Krugman said he checks Twitter “every 40 minutes to see if the trade war has broken out.”

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Healthcare Compliance

Healthcare Compliance | Healthcare and Technology news | Scoop.it

Developing a comprehensive compliance program is no longer optional for healthcare providers. Successful Compliance programs provide protections for provider entities, and patients alike. There is no single “best compliance” program. Providers with limited resources must still develop and maintain an active compliance program. Larger organizations may have entire departments dedicated to maintaining compliance standards. Healthcare providers compliance programs should be customized to each entity, based on the identifiable areas of risk. The OIG adoption of the underlying principles to provide a baseline of compliance structure that can be adjusted to the specific needs of the organization. At a minimum compliance programs should:

  1. Establish clear internal guidelines in the form of published policies and procedures relative to billing, staff behavior, and patient protections.
  2. Provide an atmosphere in which employees are free to report potential compliance issues in an unfettered risk free environment.
  3. Identify a Compliance Officer who maintains overall responsibility for the entities compliance and reporting processes.
  4. Establish strict management and control over protected patient health and financial records.
  5. Ensure technologies are in place to monitor compliance efforts and programs with the organization.

Creating Compliance Programs

Compliance programs impact the entire spectrum of a facilities financial and clinical operations.  As such it is important to develop an appropriate structure of policies and people to administrate, provide advice and ensure adherence to published compliance regulations.  Creating a compliance structure will not eliminate Audits, but can provide additional levels of protection for the providing facility.  Identifying the correct staff to implement the compliance program is the first of several steps.  Developing a compliance structure includes adherence to CMS billing standards, coding accuracy, and accurate translation of health records to the Revenue Cycle solution.

Maintaining a Compliance Program

As regulations change, facilities must adapt and evolve their internal governance processes.  Billing regulations change frequently requiring providers to stay on top of the latest software revisions, as well as monitoring the changing “code sets” that enhance the billing process.  A good compliance program will include a clearly defined process of systems maintenance and staff re training.  Staying current on the latest compliance trends is an integral part of any compliance program.

Compliance Audits

Compliance audits are among provider’s most stressful activities.  As such providers must have a clearly defined audit process.  The process must include timely provision of requested patient records/charts that are fully completed, uniform in presentation, and clearly and consistently labeled.  Having a solid compliance program in place and in practice will prepare a client well for any audit activity.

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Reporting’s Rising Role in Healthcare Success 

Reporting’s Rising Role in Healthcare Success  | Healthcare and Technology news | Scoop.it

Today’s healthcare market is saturated with hospitals, health systems, and physician practices tackling EHR optimization, cost analytics, and other data-related projects. The industry has made great strides to establish a digital, real-time record of patient care. As that clinical, operational, and financial data piles up, one of the industry’s latest challenges is identifying ways to make that valuable information actionable.

When viewed collectively, data tells a story of what has happened over time. In the healthcare setting, effective data capture helps providers easily assess a myriad of pertinent business metrics, including (but by no means limited to):

How many patients were seen today?

Which patients presented with co-morbidities?

On average, how long was the reimbursement process by payer?

What is the Accounts Receivable impact?

By monitoring business performance, healthcare stakeholders can understand where they stand today relative to past periods and peer organizations. Analysis of that data illuminates areas for improvement and the progress the healthcare organization is making in pursuit of long-term goals. As value-based care initiatives continue to take root, performance reporting also fuels reimbursement under quality payment programs like the Merit-based Incentive Payment System and Meaningful Use.

Hospitals working towards the triple aim of improving population health and patient experience while reducing the cost of care will have to leverage analytics to trend patient outcomes and identify improvement opportunities. With patient health, regulatory compliance, and reimbursement on the line, reporting stakes have never been higher. Amid the proliferation of data-oriented business processes and payment models, reporting expertise and analysts will be among healthcare’s greatest assets.

As your healthcare organization undertakes the complex process of broader clinical and financial reporting, build a successful data management strategy by keeping the following reporting considerations in mind.

Start with your current process.

How are you capturing relevant data now? Analysts should shadow staff members to see what information they are trying to get and how they are presently documenting those details. This can help you identify points in the data capture process that can be improved upon, or are perhaps being overlooked. Help employees understand the “why” behind data capture requirements. Demonstrate how current practices impact the data staff members see in reporting results.

Avoid knowledge gaps by involving reporting stakeholders early on.

In almost every healthcare setting there are gaps in the data being captured. Involve reporting in all implementation initiatives to make sure your organization is consistently capturing the right variables. This is particularly true among clinicians preparing to report on new metrics under MACRA’s inaugural Quality Payment Program period. Set field requirements in your EHR or other healthcare IT platform to ensure the necessary data makes it into the system.

Format reporting data in a manner that highlights actionable insights.

How do you want to see reporting data portrayed? Data may need to be sourced as a dashboard, manipulated in Excel, or sent to a third party, depending on the project at hand. In most use cases, a visual representation of data can help administrators more easily:

  • Compare performance data to other hospitals.
  • Track metric performance over time.
  • Visualize outliers, high-performance areas, and low-performance areas.

Armed with that insight, stakeholders can quickly identify downward trending financial KPIs, clinical quality measures that best support the organizations value-based reporting endeavors, and more.

Develop a data governance strategy.

Avoid common data quality “gotchas” by developing a data governance plan that cultivates consistency in how data is documented. Implement EHR rules that bar duplicate data entry and support field normalization. Establish a data source hierarchy to defer to the highest quality data source in cases where fields may come from multiple sources.

End-users often have not considered the impact that data documentation has on the reporting perspective. Data quality issues revealed during reporting often drive process or policy changes and can shed light on training opportunities. Reporting is a data mining process that supports more effective decision making on behalf of the organization. With reporting and analytics poised to play an expanding role in healthcare initiatives like population health management and improved utilization management, now is an ideal time for healthcare organizations to engage reporting expertise to establish a strong foundation for data-driven success.

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10 Trends You Can Expect from Healthcare in 2018 

10 Trends You Can Expect from Healthcare in 2018  | Healthcare and Technology news | Scoop.it

With 2017 almost in the rear-view mirror, it is time to look forward to 2018 and how healthcare will evolve in this year. The last year has been an eventful one for healthcare, from the uproar in healthcare regulations to potential mega-mergers. Needless to say, it’s a time of transition, and healthcare is in a very fluid state- evolving and expanding. There are certainly going to be new ways to keep healthcare providers and health IT pros stay engaged and excited, and here are our top 10 picks:

 

1. The future of the GOP Healthcare bill

The Republican healthcare reform bill gained immense traction this year. In their third attempt at putting a healthcare bill forward, the senators and the White House officials have been working round the clock to gather up votes, but somehow, the reservations persist. The lawmakers have insisted that Americans would not lose their vital insurance protections under their bill, including the guarantee that the plan would protect those with preexisting conditions. However, as it so happens, even these plans have been put to rest. Perhaps sometime in 2018, the GOP may pass a budget setting up reconciliation for tax reform, and then pass tax reform. Then, they would pass a budget setting up reconciliation for Obamacare repeal, and then pass that- it all remains to be seen.

2. The ongoing shift to value from volume

Despite speculations, healthcare providers, as well as CMS have pushed for more value-based care and payments tied to quality, but it’s been going slow. Although providers have been slightly resistant to take on risk, they do recognize the potential to contain costs and improve quality of care over value-based contracts. And perhaps as data assumes a central role in healthcare, the increasing availability of data and smarter integration of disconnected data systems will make the transition easier and scalable. Notably, with a $3.3 trillion healthcare expenditure this year, there has been slow down the cost growth. 2018 is expected to be much more impactful as it builds on the strong foundation.

3. Big data and analytics translating data into real health outcomes

Big data and analytics have always brought significant advancements in making healthcare technology-driven. With the help of big data and smart analytics, we are at a point in healthcare we can make a near-certain prediction about possible complications a patient can face, their possible readmission, and the outcomes of a care plan devised for them. Not only it could translate to better health outcomes for the patients, it could also make a difference in improving reimbursements and regulatory compliance.

4. Blockchain-based systems

Blockchain could arguably be one of the most disruptive technologies in healthcare. It is already being considered as a solution to healthcare’s longstanding challenge of interoperability and data exchange. Bringing blockchain-based systems will definitely require some changes from the ground up, but 2018 will have a glimpse of by innovation centered around blockchain and how it can enhance healthcare data exchange and ensure security. 

5. AI and IoT taking on a central role

2018 can witness a good amount of investment from healthcare leaders in the fields of Artificial Intelligence and Internet of Things. There is going to be a considerable advancement in technology, making the use of technology crucial in healthcare and assist an already unbalanced workforce. AI and IoT will not only prove instrumental in enhancing accuracy in clinical insights, and security, but could also be fruitful in reducing manual redundancy and ensuring fewer errors as we transition to a world of quality in care.

6. Digital health interventions and virtual care to improve access and treatment

In December 2016, many were suggesting that wearables were dead. Today, wearables are becoming one of the most sought-after innovation when it comes to digital health. And, the market is quickly diversifying as clinical wearables gain importance and as several renowned organizations integrate with each other. Not only wearables- there are several apps and biosensors that can assist providers with remotely tracking patient health, engage patients, interact with them, and streamline care operations. As technology becomes central to healthcare, 2018 will be the year when these apps and wearables boost the patient-physician interaction. 

7. The increasing importance of security

We deal with a tremendous amount of confidential and critical information in healthcare. It’s not just patient health information- it goes from credit card information to digital footprints. As the plethora of devices and systems storing information grows in size, a focus on ensuring becomes extremely vital as a breach could range from something as slight as information being stolen to as dangerous as a person being physically harmed. 2018 may be high time we took a good, hard look at the security of our infrastructure.

8. Payer-provider collaborations

Over the years, healthcare insurers have been stepping into primary care delivery model, encouraging prevention and wellness. At the same time, we have also witnessed the trend of hospitals and healthcare systems getting into the insurance part to take control of the complete patient care process. 2017 saw a lot of merger activity and 2018 will continue to see this synergy focused on value-based care, direct primary care, chronic care management, and patient engagement.

9. Possibly stable healthcare costs

Analysts predict that the healthcare industry will observe a growth of 6.5% in 2018, only half a percentage point higher than in 2017. And, after the changes like copays and network sizes are made to benefit plan design, this growth rate could be as low as 5.5%. Healthcare has long waited for an inflection point, where the spending will take off. But as it so happens, healthcare seems to be settling into a ‘new normal,’ where the fluctuations are more attuned and the growth rate remains in a single digit, with providers seeking strategies that would improve care management, optimize resource utilization and bring the costs down.

10. The future of ACA

There have been several debates and speculations regarding the future of the Affordable Care Act. With a new GOP healthcare bill on the cards, some things will stay the same, but with differences- people can still sign up on healthcare.gov, but the sign-up period would be shorter. They can still get subsidies to help lower their premiums or reduce their deductibles and copays, but some plans will be much more expensive. The future of ACA is still cloudy, and the attempts to repeal and replace ACA have been laid to rest, for now, but one thing is certain- a lot fewer people will enroll for ACA in 2018, fearing a repeal. 

This is definitely an amazing time in the digital health world. There may be complexities and uncertainty, but for any healthcare system deeply passionate about realizing data-driven outcomes, looking for technology that can drive their core processes and help them win with value-based care- 2018 will be the year!

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Hospitals, payers and docs collaborate on prior authorization 

Hospitals, payers and docs collaborate on prior authorization  | Healthcare and Technology news | Scoop.it

Dive Brief:

  • Multiple healthcare stakeholders, including the American Medical Association, American Hospital Association and America's Health Insurance Plans, are coming together to streamline prior authorization processes.

  • Prior authorization can assure appropriate, cost-effective care, but it can also create a burden for hospitals, payers and patients, the group acknowledges.

  • A consensus statement highlights the groups’ “shared commitment to industry-wide improvements to prior authorization processes and patient-centered care,” and calls for selective application and regular review of therapies that may not require such approval.

Dive Insight:

Also included in the group are the American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA), all calling for improving transparency and communication to improve prior authorization processes.

 

Tom Nickels, executive vice president of the AHA, said hospitals and health systems “are committed to delivering the best care for patients in the most efficient manner,” which are “goals we share with our partners in the health field.” “These principles provide a good starting point for providers and health plans to work together toward continuous improvement in quality of care and health outcomes while reducing unnecessary administrative burden,” said Nickels.

 

The consensus statement includes healthcare leaders working together to:

  • Reduce the number of healthcare professionals needed for prior authorization requirements
  • Regularly review services and medications that require prior authorization and remove ones that are no longer needed
  • Improve channels of communications between the stakeholders “to minimize care delays and ensure clarity” on prior authorizations
  • Protect continuity of care for patients
  • Accelerate industry adoption of national electronic stands for prior authorization

Richard Bankowitz, M.D., chief medical officer of AHIP, said the collaboration will improve the “process, promote quality and affordable health care, and reduce unnecessary burden.”

 

AMA Chair-elect Jack Resneck Jr., M.D., called the consensus “a good initial step.”

 

Prior authorizations have become the norm in healthcare, particularly for pricey procedures and tests. They have helped keep down costs, but at the expense of more work for providers. A December 2016 AMA survey found that physicians were completing an average of 37 prior authorizations each week, which took about 16.4 hours to process.

 

Through this initiative, healthcare stakeholders hope to improve patient care and remove administrative burdens for providers, payers and pharmacists, while maintaining checks in the system to keep costs under control. 

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Could Apple Store-like digital health retail stores be popular? 

Could Apple Store-like digital health retail stores be popular?  | Healthcare and Technology news | Scoop.it

Here’s why I think the time is right. Rumour has it that CVS, Walgreens, Kroger, and many other pharmacies carrying digital health and wearables product draw in-store customers. If that’s the case, could we drive more sales of telemedicine, remote monitoring, chronic care apps, and other digital health products by creating specialty stores in which we had trained sales people that knew how to combine products, services, and solutions from a variety of companies and educate consumers, caregivers, and patients about their use? What if some smart pharmacies, smart health insurers, and smart health systems got together and put together healthcare management retail stores in malls, similar to an Apple Store or a Microsoft Store?

 

In a fee for services (volume-driven) world, selling healthcare products and services to individual institutions is certainly time-consuming but reasonably straightforward. In an outcomes-driven (fees for value) world driven by shared risks and shared rewards, selling healthcare solutions across multiple disciplines, multiple stakeholders, and multiple institutions is much harder and even more time-consuming. That’s because there’s no easy buyer to identify. Population health is all the rage but our current 3+ trillion dollar healthcare industry was never devised nor incentivized to work together as a team for a long-term patient or population benefits (it’s reimbursed mainly for episodic care).

 

Our country’s healthcare industry is more about sick care and episodic transactions rather than longitudinal care. But, since we are moving to population and outcomes-driven care where the patient is more responsible for their own care management and payment, it would seem patient education and digital health tools are more important than ever. So, perhaps we need to get together and innovate around how we’re going to present next-generation solutions from across multiple innovators and showcase them to patients and their caregivers.

 

Using the Apple Store as a model, let’s imagine a Digital Health Store where we can have computers, wearables, tablets, phones, medical devices, remote monitoring, care quality, and other cool devices sitting in one place where shoppers can see how things work together and salespeople are trained to talk about chronic care. Even Amazon, who basically killed the large bookstore retail model, is giving retail bookstores a shot.

 

If the Digital Health retail store idea is reasonable, we could even think about allowing people to shop for insurance — on existing insurance exchanges — through a guided expert in store. There are tons of way of monetizing these stores.

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Health IoT creates huge opportunities for public health and software companies 

Health IoT creates huge opportunities for public health and software companies  | Healthcare and Technology news | Scoop.it

Connecting smart biological sensors to the internet is not a new idea. There are already dozens of products in the market that continuously monitor blood glucose and heart function, for example, and enable secure remote management for clinicians and caretakers. The safety of life implications are enormous, and the commercial opportunities untold. Some analysts predict a $100 billion-plus market for the healthcare segment of the “internet of things” (IoT).

 

What is new and emerging is the physical scale of the devices on the one hand, and the need to aggregate, reconcile, and consolidate those data streams for downstream clinical care services. Advances in semiconductor device manufacturing will relentlessly drive down the price and the size of these electrophysiological sensors, literally to the nanometer scale, which will ultimately be able to do more than detect, they will be able to intervene. At the same time, our ability to make sense of the torrents of information is catching up to our ability to create them.

We believe that these are tremendous opportunities for public health and software companies like ours. It is why we are investing so much of our own resources to promote the open design, secure exchange, and value-added analysis of health data systems. Perhaps the largest inhibitor to a promising future of longer, healthier, less expensive life are the software merchants and device manufacturers who still and astonishingly insist on keeping data closed, isolated, and trapped in proprietary systems. We believe this is about to change too.

 

The interoperability troubles with electronic medical records are legion, and we won’t waste our page space or your attention lamenting the deeply ignorant and the nearly criminal. The immortal words of Forest Gump’s assessment about doing dumb things find purchase here.

 

What we can do, however, is find clever ways leverage of IoT as yet-another, and maybe decisive, the fulcrum of connected care. For what is today true in isolation – progressive plans, concerned parents, engaged patients – will soon-enough be more the ubiquitous standard of coordinated care; that coordination will reach deeply into pocketbooks as well as bodies.

We know that there are legitimate concerns about individual privacy and device safety and that some people would literally rather die than compromise on either. We respect that, even as we actively promote more automation and digital services in health care.

 

Some of us believe that the existential benefits of independence and longevity outweigh the potential risks of intrusion and malfunction, some of us don’t. The point is that everyone should have the choice and that no one should be coerced or manipulated into choosing one side of the argument. Fear mongering (about privacy) and fabrication (about intrusion) are forms of manipulation. In the case of health care, they cost lives and money.

 

Let’s, instead, imagine a world of seamless, secure, and reliable health data interoperability. Let’s find a better way to safely liberate data at its source – labs, pharmacies, hospital and clinics, insurance claims, as well as implantable and wearable devices – pass it through hygienically sealed pipes, and receive it in places where it does the most good. That may be during a clinical care or remote telemedical encounter (to give you the best possible advice based on evidence and your personal health history), it may be when you pick up your medicines (to check for interactions with other medicines), or it may be to help your insurance company help you (because they have always had a bird’s eye view of your services, and they can’t kick you out for pre-existing conditions anymore).

 

Because of changes in the law, it may be with a loved one or trusted caretaker. It may be you.

The data could be as simple as a reminder message about an upcoming appointment, a warning message that a clinical value seems out of range, or an answer to a securely-texted question to your doctor. We have imagined that future and it is, as Ray Kurzweil likes to say, near.

 

There are two challenges, and they are slowly receding.

The first is that the data holders are still reluctant to share, even though it isn’t “their” data.  This will become less of a problem, as forward-looking providers like VA and DoD have shown, as well as payers like CMS, Aetna, and HCSC among many others have demonstrated.  All are outspoken supporters of the Blue Button program, now in its fifth year, and still growing.

 

The second falls squarely on our shoulders:  we need to make the user experience attractive, convenient, and useful.  The health IT community has made terrific strides recently – we-two have worked on the InCircleand a soon-to-be-announced medication management app, for example –  and there are many companies that target data-driven patient-provider interactions, including AmericanWell and covers health.

 

The beautiful thing is that IoT fits so neatly into this conversation. The goal, of course, is to help us achieve our best-possible health. The best way to do this is with data. And the best data is coming at us in ever more granular packages, from patient-hosted sensors that monitor, detect, interact, and intervene. Weaving those into the tapestry of your personal health history is the next vanguard of coordinated and managed care.

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mHealth Scores High With Consumers in Boosting Medication Adherence 

mHealth Scores High With Consumers in Boosting Medication Adherence  | Healthcare and Technology news | Scoop.it

Consumers are looking to mobile health tools, such as mHealth apps and wearables, to improve their medication adherence.

A recent study of some 800 prescription medication users, conducted by Russell Research for Express Scripts, finds that roughly half believe mHealth technology would help them become more adherent – and one-third of those would be more likely to use them if the tools were set up for them.

 

With experts suggesting at least half of the nation’s medication users aren’t taking their drugs as prescribed – costing some $300 billion a year in avoidable healthcare expenses, or $1,000 per person – medication adherence is a significant issue and one that healthcare experts have vowed to tackle more aggressively.

“This survey shows that while patients with chronic diseases know that medication is critical to their treatment and health, they don’t always act on that knowledge,” Snezana Mahon, PharmD, vice president of St. Louis-based Express Scripts Clinical Solutions, said in a press release. “Given the huge cost of nonadherence to an individual patient’s health, as well as to the country as a whole, it’s essential for patients and clinicians to work together to find solutions to help overcome barriers to adherence.”

Those taking medications would seem to agree. Almost half of those surveyed said taking their drugs as prescribed is the most important part of their health regimen, a percentage higher than those selecting a routine check-up (30 percent).

And they seem interested in improving their habits: 56 percent said reminders would more likely help them improve adherence, and 19 percent said those reminders would definitely help them.

That’s where mHealth comes in.

 

“The three main drivers of non-adherence come from cost, clinical or behavioral reasons,” said Kyle Amelung, PharmD, BCPS, a senior clinical consultant on Express Scripts. “All three can be solved for through mobile health tools.”

 

Younger consumers are particularly interested in mobile health technology: 74 percent of those between the ages of 18 and 34 believe such tools would help them, and half would be more likely to use the technology if it was set up for them. Among those age 35-54, the percentages were 62 and 46, respectively.

 

“We believe success comes from getting within the patient’s flow and reminding them about their health when and how the patient prefers,” Amelung said. “Most people view mobile devices as a personal productivity tool that can be used to check the news, connect with friends or get the score of the game. Incorporating these devices into taking better care of yourself is a logical position – but people still don’t want to be ‘nagged’ by family or friends about their health.”

 

That point was also made in the survey: 27 percent said they would most not want to be reminded to take their medications by a health device, while 40 percent said a spouse or partner would be most bothersome and 31 percent said the same of a friend. In each case, respondents felt that they’d be nagged by those prods and end up resenting the reminders.

Amelung emphasized that mHealth alone won’t solve the medication adherence issue.

 

“The key to mHealth tools is partnering them with a live clinician that can oversee the data, flag high-risk patients, and intervene as appropriate,” he said. “Technology is not the solution; technology is the means to an effective solution. To truly affect change, any proposed solution must be partnered with live clinical support to answer any questions and provide specialized guidance to the patient.”

 

The survey also shed some interesting light on prescription habits.

More than half of those surveyed feel they’re doing better at sticking to their prescriptions than others – including 60 percent of seniors. And more respondents were unconcerned about missing a medication (31 percent) than were extremely or very concerned (29 percent).

 

Among other results:

  • 67 percent would be motivated by a reward to take their medications as prescribed.
  • 82 percent would be motivated to take their medications by a financial reward, while 15 percent chose points toward a merchandise purchase and 3 percent selected a charitable contribution.
  • Only 33 percent understand the financial significance of medication adherence; 35 percent believe the annual cost to healthcare runs about $150 billion (or $500 per person), while 19 percent put that figure at $25 billion ($75 per person) and 12 percent said the cost was around $8.3 billion, or $25 per person.
  • 44 percent cited side effects as the primary reason for not taking medications as prescribed; 28 percent picked inconvenience and 21 percent said they stopped taking their drugs because they were feeling better and felt they didn’t need to continue the prescription.

Amelung said some of the survey’s results surprised him.

“One of the most surprising findings was that two-thirds of those polled say they are more likely to take better care of their health and adhere to their medications when rewarded for their efforts,” he noted.  “We all want to be in optimal health, but this data point supports the long-standing belief that only the potential of better health outcomes is not sufficient in getting patients to make the best decisions and take the appropriate actions for their health.”

“In today’s world, the distractions of the moment often get in the way of pursuing what’s in the best interest of our care. We sometimes forgo scheduling or keeping doctor appointments. We skip necessary lab tests or our annual flu shot. Many of us forget to refill our medication or we don’t remember to take it every day.  … For most of us, engaging in the right daily behaviors to improve our health is a challenge because these actions fall out of our normal routines and habits – and so, we skip them. Knowing that there must be something more for the patient to obtain and that financial rewards are an effective way to motivate patients, we can offer specific carrots to incentivize healthier actions and lead to decrease costs in the healthcare system.”

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6 Healthcare Trends to Watch in 2018

6 Healthcare Trends to Watch in 2018 | Healthcare and Technology news | Scoop.it

It’s 2018, and the world looks much different than it did a year ago. Go back even further and the differences are even starker. No place is that more evident than in healthcare. As the largest industry in the world, healthcare has weathered the most significant political waves of the last fifteen years. As the costs of healthcare increased unchecked, politicians took notice.

In our pseudo free-market health system, where a considerable portion of costs are covered with public funds, and where the largest public payor initiates changes that are then emulated by commercial payors and, likewise, where government entities heavily regulate healthcare’s techniques and technologies, politicians have intervened to force changes. With healthcare being a major topic of the last several elections and a top priority for President Obama during one of his two terms (as it was for President Clinton, though his primary initiatives in healthcare didn’t pass), it’s no surprise that the current administration also would like to impart change. President Trump is now working to alter some of what the Obama administration put into place. This move creates more uncertainty and requires change. I think everyone agrees on a defined set of goals for the industry, known as the triple aim (better outcomes, lower costs, improved experience), but the path to achieving those goals is wildly variable depending on your political position.

 

Unfortunately, these required changes have placed the industry in turmoil. In an effort to modernize its technology, EHRs have been forced between providers and patients to ensure better, more consistent data collection. Ideally, this move should reduce medical errors and redundant tests, however, the government missed a massive opportunity here when it spent north of $40B on incentives to increase digitization of medical records — EHR software that wasn’t built to reduce medical errors, unnecessary tests or even improve clinician communication or data sharing across providers that would ensure continuity of care. At the same time, government financial incentives prompted a change to healthcare services to ensure quality. Yet, most of these quality initiatives didn’t go far enough and consequently increased data reporting burdens for clinicians. Meanwhile, payments for the majority of healthcare services have been reduced, squeezing provider margins and changing the rules for how providers are paid.

 

Healthcare hasn’t improved for consumers. During appointments, providers struggle to connect because they have screens, not patients, in front of them. Insurance coverage has gotten worse; choices have been reduced and the complexity of bills and payor communications to consumers more complex. How much worse have things become? I have an MD, MBA, and MS. I run a healthcare company with ~50 employees and have been writing and speaking on healthcare and healthcare technology for ten years. My wife and many of my friends are practicing physicians; some are my physicians. Yet, I woefully struggle to understand my medical bills, choices in providers, and generally how to navigate our broken system.

 

Where does that leave healthcare going into 2018? I’d argue that healthcare, if anything, is worse today than it was a year ago. The government, individuals, and private sector will certainly continue pushing for more changes in 2018. Given that, I predict we’ll see a few major healthcare trends as we move through the new year.

Subscription / direct pay / cash-based practices

Consumers, with minimal choice in healthcare, find it difficult to speak with their wallets or their feet. Similarly, providers have even fewer options. It’s no wonder that subscription medicine and cash-based medical practices are growing in popularity for both providers and patients (more on that below). These care models align incentives and are transparent. Geared towards those who have the ability to pay extra for better services, today, the majority of these care models bank on the pocketbooks of the middle to upper class. However, emerging data sets show the success of this model is also possible for underserved populations, as well. Learn more about what I think will happen with cash-pay practices in 2018.

Post-EHR healthcare

The gravy train of meaningful use (MU) is over. The effect of MU was a significant, artificial, driver of adoption for a few EHRs. Today, digital health records are the standard. As we move through 2018, keep an eye on EHRs and how they justify their ROI once massive capital expenditures are written down. Likewise, you’ll want to consider how clinicians adjust to this brave new world. Read more about my 2018 predictions for the post-EHR world.

Clinicians as developers

The EHR wave of health IT left out clinicians. EHR and IT vendors drove those early technology decisions. Now, with software eating the world, clinicians are acting like software developers and corporate innovators in helping to design and, in some cases, build new technology and technology-enabled services for their colleagues and their patients. Read more of my thoughts on clinicians as developers.

The real cloud

HIMSS 2018, the largest health technology conference on the planet, will for the first time see the behemoth booths of EHR vendors challenged by the equally massive booths of public cloud service providers like Amazon, Microsoft, and Google. This is the canary in the coal mine moment for healthcare, not just for the adoption of the real cloud over simple virtualization, but also in the fragmentation of infrastructure and services managed by third parties for healthcare delivery organizations. Learn more about the real cloud in healthcare.

Beyond digital health hype

Digital health has been hyped for a long time as a savior for healthcare. Unfortunately, healthcare is not that simple and no savior exists to untangle us from our current mess of a system. Technology, for technology’s sake, is not going to fix healthcare. While we’ve witnessed incredible enthusiasm around new technologies disrupting healthcare, we’re also now seeing some public failures, like the recent acquisition/fire sale of Practice Fusion, or the Castlight Health initial public offering hype and valuation assumptions compared to the market reality of today. Similar to EHRs, digital health now must prove it’s worth if it’s going to have sticking power. Find out more about getting beyond the digital hype.

Blockchain to the rescue

Speaking of hype, blockchain has made its way into healthcare. Smart contracts, immutability, and a clear audit trail — hallmarks of blockchain technology — hold much promise for healthcare data and exchange. The problem is that technology, especially when it comes to data sharing and interoperability in healthcare is not the dominant roadblock. Layering in new technology, like blockchain, leaves the fundamental organizational and political problems unsolved.

 

I’ll focus on each of these trends in subsequent posts, distilling all of these healthcare trends down into one larger narrative: post-EHR healthcare is finally ready and incented to start making the necessary changes that will align with the triple aim. Massive organizations will vie for their place in this new healthcare world; some will win and others won’t. The winners will be the providers AND the patients.

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ScientificAnimations's comment, May 22, 8:46 AM
Blockchain is a system that makes health information accessible to doctors from anywhere, anytime, and on any electronic medical system. http://sco.lt/5yVeuP
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Major Challenges remain for Health IT Interoperability 

Major Challenges remain for Health IT Interoperability  | Healthcare and Technology news | Scoop.it

The road to the seamless sharing of patient data across the digital health care spectrum is not measured in miles or meters, but in the continued collaborative efforts of the public and private sectors to build and regulate networks for the free flow of information.

 

But for all of its efforts, the Office of the National Coordinator for Health IT concedes that path to interoperability remains winding. That’s why it hosted two panel discussions Tuesday for National Health IT Week to talk about the challenges and successes of the adoption and sharing of electronic health records.

 

“We certainly still have a long way to go with health IT, whether it be usability or interoperability, but we wanted to talk a bit about where we’ve come so far,” said Principal Deputy National Coordinator for Health IT Genevieve Morris.

 

The panels focused on both the interoperability of the digital devices storing EHRs and their usability in an effort to map out where the health sector is and where it still has to go.

Among the takeaways were:

 

It’s not a tech problem — it’s leadership 

Ed Cantwell, president and CEO of the Center for Medical Interoperability—a nonprofit research lab advancing data sharing in medical technology—said that while innovation is being spurred through the health care sector, the gap in information sharing is coming from a lack of collaboration.

 

“I have a hypothesis that you could put 20 executives in a room representing comprehensive interoperability, there would be vendors, hospital CEOs and physicians, but it’s not a technology problem,” he said. “It’s a lack of coordinated leadership. I think the call to action is let’s put those people in a room. Every other industry has done it, they’ve come together and put their differences aside.”

 

Cantwell also said during the panel that while ONC does have the leverage to guide the policy direction of health IT, the private sector will have to lead the move toward greater interoperability.

“I think this is the time where the private market needs to step up,” he said. “Whether it’s for-profit or nonprofit or public or military or [the Department of Veterans Affairs], if we are to start the slurry of digital and set a goal to be on parallel with every other data liquid industry, then I think we need to stop this fantasy of think that ONC can, from the sidelines, impact a $3 trillion market.”

 

There’s no one-size-fits-all

John Kansky, president and CEO of the Indiana Health Information Exchange, said that part of the challenge of interoperability is that it has to serve a diverse range of needs across a wide network, from physicians to hospitals to insurance providers.

 

“I don’t think moving health care data around the country is any less complicated than moving people and stuff around the country,” he said. “Interoperability isn’t one thing. Every organization has complex interoperability needs.”

 

Kansky said that both government and the market have distinct roles in guiding and adapting interoperability and have to collaborate to ensure that they can make it more efficient.

 

Hard-to-build software to meet every need

Andrey Ostrovsky, chief medical officer at the Centers for Medicare & Medicaid Services and the Children’s Health Insurance Program, said it’s very difficult to design a product centered on its ease of use while also delivering functionality that serves the layers of users in health care.

 

“It’s very hard to build software well,” Ostrovsky, the former CEO of predictive insights platform Care at Hand, said. “It’s even harder to build software well when you have multiple end users. When we talk about the federal government’s role in somehow influencing how software gets developed or evolves, we not only have the design constraints of what does the patient need but also what does the physician need, what does the practicing admin need, what does the potential payer need in terms of reporting, and then we’ve got what does the federal government need?”

To try to bridge those gaps, at least when it comes to physician adoption, ONC Chief Medical Information Officer Andrew Gettinger said the office is working with MedStar to develop a usability package to help smooth the rocky process physicians face in implementing an EHR system.

 

“Putting in an EHR is very different than buying an automobile,” he said. “If you are buying an automobile, you have a couple different choices for color and drive off the lot pretty quickly. When you do an EHR, there are hundreds and perhaps thousands of small decisions that the implementation team makes along the way.”

Gettinger said ONC expects the usability package to be out by March 2018, which will hopefully provide doctors with a streamlined process for EHR adoption.

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Interactive text messages improve Medicare members prescription refills by 14 percentage points 

Interactive text messages improve Medicare members prescription refills by 14 percentage points  | Healthcare and Technology news | Scoop.it

new large-scale study shows that interactive, tailored text messages can improve medication adherence by 14 percent.

“The program results far exceed our expectations with 44 percent refill rate in the text message group as compared to 30 percent in the non-text group,” Rena Brar Prayaga, the paper’s corresponding author and a behavioral data scientist at mPulse Mobile, said in a statement. “In addition to the difference in refill rates, the 37 percent response rate by this older Medicare population was higher than expected and patient feedback was very positive with 96 percent of the patients indicating that the solution was easy to use.”

 

The study — conducted at Kaiser Permanente Southern California and using technology from mPulse Mobile — included 88,340 Medicare patients (all over age 65) with multiple chronic conditions. Specifically, patients were taking ora diabetes medications, blood pressure medicines, statins, or some combination of the three. The cohorts were not randomized. All patients were given the option to sign up for text messages, but only 12,272 opted in, leaving 76,068. Both groups received traditional adherence aids like automated and non-automated phone calls reminding them to refill prescriptions.

The mPulse Mobile platform instigated an automated dialogue through which patients could get prescriptions refilled, ask questions, or explain why they had not refilled their prescription. Eighteen percent of text message dialogues resulted in refill requests.

 

Researchers also used natural language processing to parse the tone of patient responses to the automated message. About half were neutral, 41 percent were positive or very positive, and just 9 percent were negative or very negative. When asked directly whether the service was easy to use, 95 percent of those who responded said yes and 5 percent said no.

“It is worth noting that patients in the texting group engaged at a much higher rate than predicted,” researchers wrote in the study. “We had estimated that the patient response rate would be between 10 percent and 20 percent. … Our target refill request rate was 5 percent to 7 percent since we were messaging an older patient population. At the same time, we hoped that the ease of use of the refill dialogue might draw in more patients and nudge them toward completing their refill requests. The program results far exceeded our expectations. Throughout the three-month program, the response rate was around 37 percent, and the three-month average refill request rate was 18 percent.”

Based on the success of the program, Kaiser Permanente intends to deploy it at additional locations.

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How to Grow Your Practice with Personalized Healthcare Marketing 

How to Grow Your Practice with Personalized Healthcare Marketing  | Healthcare and Technology news | Scoop.it

With every New Year, there are new plans and strategies for self and practice’s growth. This year also, you are ought to see new healthcare and marketing developments combined with a higher competition. This makes digital marketing imperative for your practice. But, how to win the race of online marketing? According to Hubspot, “Nearly three-fourths (74%) of online consumers get frustrated by the content they receive that has nothing to cater to their interest. Since one-size-fits-all has become an outdated concept today, you need to go for personalized marketing strategy.

Benefits of personalized marketing

Let’s start with understanding the benefits of personalization. In addition to a quality experience for your patients, your practice also enjoys following advantages

Loyal patients: A personalized care motivates your patient to revisit your practice. Patients, value your treatment and care that meet their needs and go for additional services as well. Subsequently, loyal patients promote your practice among their friends and family.

Strong online reputation: With happy patients, you are likely to get numerous positive reviews for your practice. Personalization helps you request individuals for positive feedback and they won’t mind sparing a few minutes to write well about you and your practice online. But, the story does not end here, instead, you need to respond them.

Check for reviews on all reviews platforms and social media channels and whether positive or negative, respond to reviews. This will make your patients feel valued and inspired to revisit your practice.

How to personalize your marketing message?

  1. Email marketing

One aspect of personalized emailing is launching email campaigns segmented on the basis of gender, age, family, etc. That is

– Gender-specific: Uncheck the male email IDs when launching a health program for women.

– Age-specific: If your email campaign is focused on millennials diet or lifestyle, keep the baby boomers and the elderly out of it. Else, they might consider your email irrelevant and end up unsubscribing it.

– Family-focused: Email campaigns with general health tips, awareness programs, etc. should target the family of the reader. Next time, the reader is likely to bring his/ her family members to your practice for treatment.

– Try sending emails from your name instead of your practice’s name. This adds a value to the reader on being addressed by a human and not a brand.

– The mail should start with the recipient’s name such as “Dear (Patient name)”, “Hi (Patient name), and so on. This will motivate the receiver to read the email and won’t appear as a machine generated message.

  1. Social media marketing

You are very well aware of the popularity of social media sites and the growing number of people joining them. These platforms have become information forums where people discuss anything and everything with a large crowd. So, manage your social media profiles actively. Respond to your patients in a personalized manner. Monitor their activities regularly and design content that matches the needs of your target audience.

  1. Multichannel Marketing

Personalization needs to be accessed via all marketing channels to attract patients of all age groups. From mobile phones to newspapers, you need to get the attention of all your target audience. Where millennials are internet savvy, elderly people can be reached through TV ads and newspapers. Select the channel judiciously according to the age group of your patient.

In addition to the age, patient’s location is also an important consideration. Check your analytics and accordingly plan your activities. You can launch TV ads on local channels or get your articles published in the local newspaper to acquire local patients.

You can also make use of pay-per-click ads and remarket to capture more patients focusing their needs. This way an individual will find your service ads informative for himself and his acquaintance and will approach you immediately.

  1. Greetings

Wish your existing patients and new ones on occasions or life events such as birthdays or anniversaries for a delightful surprise. This will forge a personal connection with them. See you so considerate, you are likely to build a long-term relationship with many of your patients. These messages can be posted on social media accounts or sent in form of emails and text messages to people.

The story does not end here. Organize surveys, informal discussions, and seminars to gather feedback of your existing patients after their treatment. In addition to taking the feedback, you can enhance their knowledge of a treatment or ailment.

Lastly, what matters the most is an amazing user experience a patient gets on visiting your practice. To make your practice grow really big this year, personalize your services and get your patients revisit you in times of any health emergencies.

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Lean Healthcare A Guide For Healthcare IT Directors

Lean Healthcare A Guide For Healthcare IT Directors | Healthcare and Technology news | Scoop.it

Healthcare IT directors face a set of challenges that are unique in the healthcare industry. You’re working to keep patient information secure, nail down IT processes and provide the best equipment and service to bolster patient care – all while reacting to daily IT issues that arise.

 

If you’re looking for a way to streamline your processes, improve operations and ultimately provide your patients with better care, it’s time to consider the advantages of Lean healthcare.

In this hospital IT director’s guide to Lean healthcare, we’ll discuss what Lean healthcare is and how it enables these benefits.

Improving Your Operations Through Lean Healthcare

Lean healthcare relies heavily on philosophy, methodology and process, with some improved or optimized tools. In other words, you don’t have to overhaul your entire IT infrastructure. You just have to start using the tools you already have in the most efficient way possible to maximize their effectiveness. This approach is not centered on you, your nurses, your doctors or your staff members working harder. It’s focused on how all of you can work smarter.

Every workplace has areas of wasted or duplicated effort and time. The key to running an efficient operation is eliminating that waste. For example, Lean healthcare organizations will use value-stream mapping to outline the daily tasks or projects from a hospital staff member or group. As all functions are mapped out within that task or project, waste is identified as a piece that doesn’t directly contribute to delivering patient value or provide the best experience possible. The goal then is to eliminate that waste in the process.

Benefits For Healthcare IT Directors

As your organization's IT director, you’re constantly seeking ways to improve processes, operations and patient care. Lean healthcare enables you to reach those goals. Some of the benefits of Lean healthcare for IT directors include:

  • IMPROVED PROCESSES – For IT directors, processes are everything. You need a streamlined, waste-free, solutions-based process for solving problems in your workplace. Lean healthcare helps you formulate that structure.
  • PROACTIVE SOLUTIONS – Not only does Lean healthcare enable you to ensure process-based solutions, but it also empowers you to identify proactive solutions for your staff needs. Stop putting out fires and start proactively anticipating what challenges you’re likely to face.
  • GREATER EFFICIENCY – When you’re working smarter instead of harder, you’ll find that you have more time on your hands to perform your job. Distancing yourself from reactive IT methods and proactively solving problems frees up more time to play a leadership role in your organization.

Implementing Lean Healthcare

Adopting a Lean approach is about more than just understanding the philosophy. As an IT director, you have to put the right implementation methods in place. Use the following tips to build a solid foundation for successfully integrating Lean healthcare at your organization.

  • ENSURE OPEN COMMUNICATION. One of the most powerful aspects of Lean organizations is open communication. Lead the implementation of Lean healthcare by bringing staff members together to find operational improvement. This roundtable discussion of how to reduce waste – waste of energy, time, money, etc. – comprises representatives of all hospital staff and interested parties, including hospital IT, nurses, pharmaceutical staff and more. It might be the first time a representative of the nurses has discussed these issues with someone from billing or the pharmaceutical staff. As the IT director, you must work to establish a foundation of open communication, allowing parties to address any challenges the hospital is facing. Then, use these different perspectives to find smart, efficient solutions.
  • ELICIT BUY-IN FROM THE TOP DOWN. If a change is implemented in a company but the head of the organization doesn’t buy into the new process, that change is unlikely to have lasting success. The same holds true for Lean hospitals and clinics. One of the keys to a successful implementation of Lean principles is gaining acceptance from the top down. Solicit help from your hospital’s most senior parties to communicate the importance of adopting Lean healthcare. They should consider running a small, internal public relations campaign of sorts, communicating to everyone that your organization is taking Lean healthcare seriously.
  • VIEW IT AS A WAY OF LIFE. Lean healthcare used to be viewed as a passing fad. Over the course of the last few years, however, it’s become more than the next “flavor of the month” for IT solutions. It’s a way of life for many hospitals – not just a temporary fix for some of the challenges your organization faces, but rather a long-term solution that should be part of your organization's DNA. Treat your shift to Lean healthcare as a cultural change in your hospital if you’re looking for the rest of your staff to follow suit.

You have a responsibility to ensure a streamlined, proactive approach to healthcare IT. Take the steps to properly implement Lean healthcare, and you’ll reap the long-term benefits of working in an efficient organization where patients come first.

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HIMSS18 – What, Where and How HealthIT can impact healthcare 

HIMSS18 – What, Where and How HealthIT can impact healthcare  | Healthcare and Technology news | Scoop.it

With the annual #HIMSS18 conference just a few weeks away, most of the industry’s attention is turning to matters relating to technology, cyber security and the regulations around HealthIT. We thought it would be fitting, therefore, to team up with the wonderful folks at @HIMSS for a tweetchat focused on technology and healthcare.

 

I am a fan of artificial intelligence, machine learning and virtual reality (even though I cannot physically use VR for more than 2 minutes at a time). However, the technology that I’m most intrigued by is 3D printing – specifically the 3D printing of organs and organic material.

 

First, there is the impact this technology could have on solving hunger and nutrition. Imagine if we could “print” healthy food in places where growing it is difficult or where shipping it is cost-prohibitive. Imagine also if we could print foods that are personalized to each person’s unique metabolism and dietary needs. The impact on public health would be significant and worldwide.

 

A long time ago I read a science fiction novel that talked about the advent of this type of technology: Gateway by Fredrick Pohl. The novel made frequent mention of something called CHON-food. Pohl imagined a world where CHON machines were able to replicate food by combining four key elements: carbon, hydrogen, oxygen and nitrogen. The advent of these machines helped to solve world hunger and ended many of the wars for water and food that that plagued the Earth. I hope we are at the start of CHON revolution.

 

Second, there is the impact of 3D printing on surgery and transplants. Researchers are very close to being able to print human skin using organic printers that can be used in reconstructive surgeries. The impact this technology could have on burn patients would be incredible. So too could the impact on patients that need a transplant. According to UNOS, every ten minutes someone is added to the national transplant waiting list and on average 20 people die each day while waiting for a transplant. With organ-printing technology these premature deaths might be prevented. Using tissue samples, organs can be printed to exactly match the patient’s physiology. Bonus: no more worries about organ rejection.

 

I’ve got my eye on 3D printing and over the next few years I expect it to have an impact beyond technologies like AI, machine learning and analytics. However, it’s going to take time for this technology to mature. In the meantime, there are certain areas of healthcare that can use a little boost TODAY.

 

Patient engagement and behavior change is an area of healthcare I hope #HealthIT will be able to help. Patients are the most untapped resource available to healthcare. Despite all the trackers, portals and video tutorials, health literacy remains extremely low. Some would argue that the widespread adoption of EHRs had even contributed to patient dis-engagement as doctors and nurses spend more time staring at screens rather than speaking to patients about their health. I see a golden opportunity in healthcare for patient engagement technology.

 

In the early 90s, the field of behavioral economics took shape. Richard Thaler, the University of Chicago professor who recently won the Nobel Memorial Prize in Economic Sciences, began publishing a series of papers that combined psychology and economics. His work led many to begin studying the ways that human behavior influences financial decisions. We need to apply those same theories to healthcare and design #HealthIT systems that nudge patients (and clinicians) into healthier behaviors.

I am incredibly excited about the future of healthcare. I am certain we are making progress towards a brighter day for patients, doctors, nurses, family caregivers and administrators. As I walk the #HIMSS18 exhibit hall I will be on the hunt for companies that share this outlook and whose products show clear signs of patient/provider design input.

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What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration 

What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration  | Healthcare and Technology news | Scoop.it

Participation in pay-for-performance plans like MACRA’s Quality Payment Program (QPP) poses new challenges for resource-strapped healthcare organizations. Many provider sites lack the time and technical expertise needed to retool their EHR implementation to document new metrics under value-based reimbursement models like the Merit-based Incentive Payment System (MIPS).

 

Nonetheless, that is precisely what clinicians must do to deliver on quality reporting requirements. When using EHR documentation tools, many factors must be considered for a provider to get credit on having met clinical quality measures (CQMs). How that information gets stored in the EHR directly affects reporting. Many healthcare organizations are finding that customizing an EHR to recognize when a measure has been met—preferably in a manner that poses as few interruptions to patient engagement as possible—is easier said than done.

Overcoming EHR Limitations

Many outpatient and inpatient settings still struggle with common EHR data management headaches. As clinicians bring new quality measures into the EHR, those underlying data management issues can foil even the best-laid reporting plans.

Discrete Data Capture

The push to better document clinical quality is causing a transition in EHRs to focus more on structured or discrete data that is easier to trend over time. Unfortunately, many healthcare providers still receive patient data from healthcare affiliates via fax. Those faxed documents show up as attachments in the patient chart and are not fully integrated into the patient data file. If that information was sent via HL7 interface instead, details on the care rendered by that hospital or other healthcare entity would flow into the EHR as discreet data variables. For many providers today, capturing that information in a manner that makes it usable in reporting and analytics still requires timely, manual data entry.

Documentation and Data Consistency

Provider sites with multiple clinicians may also encounter issues related to the slightly different way that each EHR user documents care. MIPS and other quality programs require consistency and a high degree of specificity in clinical documentation. If a clinician does not get diagnosis specifics into the patient chart, that patient may not be included in the CQM calculation they need to be included in. Many clinicians are having to modify their documentation process during patient encounters so they and the staff can capture all the necessary information in the EHR.

Clinical documentation will have even bigger repercussions under the Cost component of MIPS, which is slated to be factored into performance scores in coming years. Take, for example, a patient that is in for the flu. That patient has a certain anticipated cost impact (the average Medicare spending per beneficiary), calculated based on past medical history and services rendered. If a patient goes to a physician and has the flu but also has diabetes, heart failure, and asthma, that flu patient is probably going to cost more to care for. If the physician only submits the flu diagnosis and fails to document patient co-morbidities then the healthcare organization will not get the same allowance under the MIPS Cost category and could be labeled as “higher cost” than a comparable provider encounter for a patient that required fewer resources to care for.

Clinicians, coders, and staff need to make a mental transition away from “we’re submitting claims” to “we’re submitting data” to better serve clinical reporting initiatives and patient care analysis.

Making Informed CQM Selections

Beyond adapting to new data management processes, clinicians reporting under value-based programs also have a great deal to learn as they layer in additional quality measures under MACRA. One of the biggest challenges clinicians and administrators face is selecting the best measures for their specific healthcare organization. With limited spare time on their hands, many healthcare teams are leaning on outside expertise to help them evaluate the implications of various measure selections.

Measures Without Benchmarks

Many quality measures under MACRA are carry-overs or “relics” from other reporting programs. For these CQMs, providers can look to prior performance averages to evaluate the likelihood of success should the healthcare organization elect to report on those measures. That data does not exist for some CQMs, which are referred to as “measures without benchmarks.” On measures that have no benchmark data available, providers will be limited to a maximum of three reporting points instead of the ten points available on measures with benchmarks established.

To further complicate things, details on the availability of some benchmark data will not be calculated until after the March 2018 QPP reporting deadline. Providers may wish to further diversify or report on additional measures that could help offset low point earnings on measures without benchmarks.

Topped Out Measures

Another CQM caveat that providers should be aware of relates to “topped out” measures. These relic measures from other reporting programs are very engrained in many healthcare settings. Medication reconciliation, for example, was a requirement under Meaningful Use. Widespread adoption and universally high compliance rates on that measure makes it more difficult for clinicians to out-perform peers. Achieving maximum points on such measures requires a perfect or near-perfect score.

Keep average performance thresholds in mind when evaluating CQM selections, not just the healthcare entity’s individual performance track record. Look at a broader set of measures to maximize MIPS score potential. Clinicians could earn more points by scoring 70 percent on a non-topped out measure than they would earn scoring 95 percent on a topped out measure. Some topped out measures will likely be eliminated in future years to help diversify CQMs, as was the case under Meaningful Use.

Understanding the intricacies of CQM selection and EHR data management will be vital to success under value-based payment programs. Healthcare administrators and clinicians who proactively work to better understand the impact of various measures and streamline EHR processes will be best positioned to maximize program incentives.

 

Does your organization have the resources it needs to successfully navigate MIPS

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Healthcare Compliance Consultants 

Healthcare Compliance Consultants  | Healthcare and Technology news | Scoop.it

With the Affordable Care Act going into effect, the sheer number of hospitals, insurance companies, and other healthcare providers, that have struggled to successfully implement major changes in their working – without assistance – has increased drastically. Before that, most of the physicians were comfortable in their working. With the major reforms looming; many doctors decided to join hospitals, and by default – leave their private practice. If only they approached the correct issues by hiring the right team, or even the right person, everything would have been different. This is where a healthcare compliance consultant becomes the most useful.

Healthcare compliance consultants can notice the full potential of a practice, a hospital, or any other health facility. They base their strategies on data analysis, knowledge, professionalism, and dedication – while showing the right way to an efficient, low-cost working. Therefore, many healthcare providers since have decided to hire a healthcare compliance consultant.
The global healthcare consulting market is constantly growing. With a value of over $6 billion in 2014, the market amounts to 7% of the whole healthcare consultant industry. With the aspect of further growth, especially in the U.S. – which holds almost two-thirds (62%) of the whole $6.33 billion because of the reforms – the competition in the field is also rising. Meaning, finding the right consultant, whether an individual or an agency, can be challenging.

What to Look for in Healthcare Compliance Consultants

Due to the consultant’s high level of importance to their client, one might ask – what should you even begin to look for in a healthcare reform consultant? My first response to that question is knowledge, this is essential. You need an individual or a team that understands the emerging healthcare market. Reliable consultants have the tools to monitor trends and factors that influence the industry. They depend on data, but still develop their own view of the way the entire system functions. An independent thinker will always understand things better than anyone else. Look for someone that has a unique point of view. It can be wise to test the person’s or the team’s knowledge by having them around for a while. It is a small investment, but it will eventually pay off. Look for someone that will blend with your team and will be interested enough to see what’s beyond the medical practice. These individuals develop suitable strategies that will help you save, improve your management, and teach you how to stand on your own feet. Always look for a well-educated, experienced person. In the healthcare compliance consulting field, a Bachelor degree is the minimum criteria. In case you decide to hire a consultant company, inform yourself on their latest successful projects. Evaluate their views, approaches, and values. It is important for the company to invest in professional development and growth. Getting references can be helpful during the evaluation. However, consultants only show their success. Digging a little bit deeper, for example, spending time in networking can reveal some unexpected information.

Secondly, look for experience. In consulting, the power of experience can’t be underestimated. Many companies don’t include individuals with a minimum of 10 years of experience as their team members. While the size of the consultant company doesn’t make a huge difference, many years of experience are an advantage in solving big projects.

Finally, you must take into account the overall efficiency of your new consultant.The right consultant will have backup plans, but still get manage to finish the project on time. Simply because the team has failed to finish a project in a timely manner before; doesn’t mean that you should hesitate to hire another consultant now. Additionally, an efficient consultant will approach the problem with long-term goals in mind, offering quality work that will stay with your practice, even after the project is officially over. They will provide you with the necessary guidance that will help you manage your practice in a more profitable and efficient way.

Benefits that come from having the right consultant on-hand.

Now as you could imagine, there’s a vast amount of benefits that can come from having a consultant on your team throughout the healthcare reform and implementation processes. First and foremost, the overall easier managing of large projects is one of the main benefits that’s noticeable almost right away. Have you ever tried to fix a problem without a success? With the consultant’s management skills and technical expertise, your project has higher chances to succeed. It is of great value that a consultant develops a strategy by finding the causes of the problem. They will focus on the major issues that need to be solved and by making the project a priority, you will maintain profitability and improve patient service. The consultant is an outsider. Sometimes the issues you might not know you’ve had, will be revealed by a person that is not familiar with the situation and has a clear point of view. Meaning, you need an individual or a team that will commit and spend their time focusing their attention on a particular field.
The second benefit is huge: the increased ROI. The initial cost of the consultant won’t overweight the saving that you will make in the long run. Consultants develop an in-depth strategy that includes all your costs, research on your competitors, measures that you can take to save, and much more, that contribute to organized, effective, and improved practice. Keep in mind that bringing your practice to that level requires an individual or a team that is able to see the flaws and propose an efficient approach.

Watch your practice grow exponentially.

As well, you begin to learn how to run a practice as it is – a business. Many physicians and hospitals are dedicated and focused on providing the best medical service to their patients. Usually, they don’t think of running their practice as a business. This brings them to the point when they face many problems and hope to solve them on their own, or with a help of their team. Eventually, they realize that their team can’t solve all of those problems. Dealing with a complex issue that requires dedication, plan, and analysis can’t be solved by a non-expert team in the field. Healthcare consultants have the required tools and a team that not only will help you solve your problem, but understand the operating and management your business needs.
Next, you will save time figuring out everything by yourself. Implementing planning strategies in your practice is not your expertise. Even if you think you know the best way to run your business, trust me, there is someone that is much better. Spare yourself of all the struggles. You will save time, energy, and money. And save your team the extra effort of figuring everything out. Let them do what they do best. Serve your patients.
In conclusion, you will also improve the quality of your services and operations. Healthcare compliance consultants pay attention to every detail in your practice. They collaborate with your team, developing a new way to improve everyday operations, which leads to the final goal – helping patients. By improving the quality of your overall working, you have higher chances to reduce medical errors, improve patient safety, improve staff, and create a safe environment. Healthcare compliance consultants provide a plan with realistic goals for your organization, set a reasonable deadline, and finished the project successfully. They are well-informed, knowledgeable, innovative, and great leaders.

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4 Healthcare Software Trends to Watch in 2018 

4 Healthcare Software Trends to Watch in 2018  | Healthcare and Technology news | Scoop.it

Healthcare has always been an industry where innovative technologies transform the way services are delivered and received. It’s also one of those sectors that can be affected by slow movement in innovation, due to the complication of its formalities, tasks, processes and regulations.

 

The good news is that the industry’s innovative side has finally taken off in the last few years, and software is playing a major role in reshaping the healthcare sector.

 

What does that mean for you, the medical professional: dentist, doctor, ER practitioner, risk manager, nurse, etc? It means that both your practice and your patients’ experiences will improve over the course of the next decade with the help of some amazing new technology.

 
In terms of software, the following four healthcare software trends are most likely to impact the healthcare industry in the next few years:

1. Multi-Speciality & Niche Specialty EHR Software

A multi-specialty EHR for software has several benefits for specialty practices spanning to multiple domains. It ensures improved compatibility and prevents a patchwork approach to integrating a separate EHR system for every specialty. This can help bring down the added time and expense of interconnecting different groups of specialists. Healthcare organizations can find the investment costs, financial health and reputation of differentEHR software on software evaluation sites, and make a sound IT software decision based on their needs.

2. Patient Portals & Self-Service Software

With patients rapidly becoming active players in their own healthcare treatment, portal software is on its way to becoming mainstream. It enables patients and physicians to interact online and access their medical records. In addition, portal software can be an extraordinary ally for the patients who use it, helping them catch errors and becoming an active participant in ongoing treatments.

Patient Kiosk software is another interesting development. It can help patients with checking identification, registering with clinics, paying copays and signing official paperwork. However, institutions have to be careful when using it to ensure that human-to-human communication isn’t entirely eliminated.

3. Blockchain Solutions

Healthcare professionals and technologists across the globe see blockchain tech as a means to streamline and secure the sharing of medical records, giving patients greater control over their information and protecting sensitive details from hackers. In order to achieve these goals, custom-built healthcare blockchains are needed. Startups like Patientory, Burst IQ, Hashed Health, doc.ai and others are gearing up to introduce blockchain tech to the EHR software industry, providing a way to store health records. When required, professionals can request to see their patients’ data from the blockchain.

4. Consumer-Grade UX in Enterprise Software

For almost a decade, physicians at the front line of enterprise healthcare delivery struggled with software that’s difficult to use, confusing and downright frustrating. The biggest culprit of poor UX is linked to the purchasing process of the enterprise.

 

Oftentimes, vendors create software for buyers who aren’t end users. If the buyers and end users have the same personas, healthcare software vendors can deliver the same user experience as seen in other B2B industries.

 

Regardless, in 2018, expect more consumer-grade user experiences and buyer-value products. Additionally, enterprise healthcare management will bank on analytics and machine learning to improve visibility into healthcare efficiency for personnel and employers. This will reveal usage patterns and reduce inappropriate and unnecessary care.

 

From detecting fraud to slashing healthcare spending, advanced healthcare software could very well be the silver bullet that eliminates all kinds of healthcare inefficiencies.

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Barbara Lond's curator insight, January 28, 10:37 AM
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