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Healthcare Technology Trends for 2019 and Beyond

Healthcare Technology Trends for 2019 and Beyond | Healthcare and Technology news | Scoop.it

The healthcare industry is moving from products and services to solutions. Just a few years ago, medical institutions relied on special equipment and hardware to deliver evidence-based care. Today is the time of medical platforms, big data, and healthcare analytics. Healthcare institutions are focused on real-time results. The next decade will be focused on preventive care, and here new healthcare technology trends will come into play.

Artificial intelligence

The modern healthcare industry has already introduсed AI-based technologies like robotics and machine learning to the world. For example, IBM Watson is an AI-based system that’s making a difference in several areas of healthcare. The IBM Watson Care Manager was produced to enhance care management, accelerate drug discovery, match patients with clinical trials, and fulfill other tasks. Systems like this can help medical institutions save a big deal of time and money in the future.

 

It’s likely that in 2019 and beyond, AI will become even more advanced and will be able to carry out a wider range of tasks without human monitoring. Here are some predictions of AI trends in healthcare:

Early diagnosis

This healthcare technology trend can accurately and quickly process a lot more data than the human brain. So AI tools can reduce human errors in diagnosis and treatment and allow doctors to work with more patients. For example, image recognition technology will help to diagnose some diseases that cause changes to appearance (diabetes, optical deviations, and dermatological diseases). It’s also likely that in future people will be able to diagnose themselves. DIY medical diagnosis apps will probably ask some questions, process a patient’s care history, and then show possible diagnoses based on the current symptoms. But as this technology isn’t advanced yet, patients should be careful with DIY medical apps and self-medication.

Medical research and drug discovery

The future of drug discovery and medical research lies in deep learning technology. Deep learning is a field of machine learning that’s able to model the way neurons interact with each other in the brain. This allows medical systems to process large sets of data to quickly identify drug candidates with a high probability of success. A Pharma IQ report says that about 94 percent of pharma specialists believe that AI technologies will have a noticeable impact on drug discovery over the next two years. Even today, pharmaceutical giants such as Merck, Celgene, and GSK are working on drug discovery in collaboration with AI platforms, predicting AI to be the primary drug discovery tool in the future.

Better workflow management and accounting

There are a lot of routine and tiresome tasks that medical workers have to do apart from caring for patients. AI can reduce staff overload by automating monotonous tasks such as accounting, scheduling, managing electronic health records, and paperwork.

IoMT

The Internet of Medical Things (IoMT) includes various devices connected to each other via the internet. Nowadays, this technology trend in healthcare is used for remote monitoring of patients’ well-being by means of wearables. For example, ECG monitors, mobile apps, fitness trackers, and smart sensors can measure blood pressure, pulse, heart rate, glucose level, and more and set reminders for patients. One recently introduced IoMT wearable device, the Apple Watch Series 4, is able to measure heart rate, count calories burned, and even detect a fall and call emergency numbers. The FDA has recently approved a pill with sensors called Abilify MyCite that can digitally track if a patient has taken it.

IoMT technology is still evolving and is forecasted to reach about 30 billion devices worldwide by 2021 according to Frost & Sullivan.

  • IoMT will contribute sensors and systems in the healthcare industry to capture data and deliver it accurately.
  • IoMT technology can reduce the costs of healthcare solutions by allowing doctors to examine patients remotely.
  • IoMT can help doctors gather analytics to predict health trends.

 

Technical Dr. Inc.'s insight:
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Rural Health Professions Training: Teaching Medical Students the Benefits of Telemedicine

Rural Health Professions Training: Teaching Medical Students the Benefits of Telemedicine | Healthcare and Technology news | Scoop.it

For medical students with the University of Arizona College of Medicine – Tucson, weeks of suspense will end on March 15. Otherwise known as Match Day, it’s the day the students will learn where they will go for their residency training, in their chosen medical field, after they graduate from medical school in May.

 

Sarah Joy Ring, who has completed the College of Medicine – Tucson’s Rural Health Professions Program and a 16-week Rural Health Distinction Track, is hoping for a residency focused on both pediatrics and emergency medicine, potentially in a rural location.  Her “capstone” paper, an in-depth research project that all Distinction Track students are expected to complete, carries the impressive title of “A Survey of Rural Emergency Medicine and the Discrepancy of Care for Pediatric Patients that Present to Rural Emergency Departments.”

 

During her training, she had opportunities to see how important telemedicine can be in rural communities.

 

“I was at sites that had telemedicine capabilities and spent some time chatting with the physicians about them. "I can specifically remember two experiences, one while on my family medicine rotation in Tuba City (in northern Arizona, where students learn about American Indian healthcare) and one during my RHPP summer in Flagstaff” (also in northern Arizona).

“Tuba City experiences a significant shortage of mental health providers in general, and specifically for children and adolescents," Sarah says.

“As such, they found using telemedicine helpful to connect the children of that region with services that they would otherwise struggle to receive, due to having to travel large distances to receive help, which incurs financial and time burdens for families.

“Moreover, a point that I found particularly enlightening when learning about this service, was with regard to what it means to live in a small population where it is quite likely you know most people living in the region," Sarah says.

“The physicians found that because of this, many adolescents experiencing difficulties often felt uncomfortable sharing with people who lived in the region, out of fear that they may tell someone, or that they were themselves a relative or family friend, which can be a common experience. Having someone to share with who lived out of the region and was not specifically invested in the region and an integral member of the community made many of these adolescents more comfortable with disclosing their experiences.  

“I also worked on writing about how telemedicine can be used to augment pediatric services in rural emergency departments for part of my "capstone" project and found some very positive results from multiple studies. For critically ill patients, one study found that in particular, telemedicine consults improved the access to critical care specialists, resulting in a reduced frequency of physician-related medication errors. Moreover, another study found that parent satisfaction was higher with telemedicine consults than with phone consults, which is a particularly important outcome when caring for pediatric patients and their family. Many of these same findings also translated to the pre-hospital environment, where ambulances that utilized telemedicine resulted in better assessments, more interventions in the pre-hospital environment, and improved outcomes for pediatric patients in pre-hospital care. 

“Overall," Sarah says, I think that we will continue to find that telemedicine is an excellent resource for rural providers that allows patients to have clinically significant access to additional resources and care that would otherwise be difficult or unavailable to the region."

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Top 3 Third Party Risk Management Challenges

Top 3 Third Party Risk Management Challenges | Healthcare and Technology news | Scoop.it

Since the massive Target data security breach in December 2013, third party cyber security stopped being an afterthought and started becoming one of the top security priorities for CISOs and Risk Departments. As a response, Third Party Risk Management (TPRM) underwent a transformation in early 2014, and continues to reverberate today.

 

With attackers finding new ways to break into third parties in hopes of infecting a larger organization, the third party ecosystem is more susceptible than ever before. Meanwhile third party usage is growing fast in large organizations and enterprises. Many critical business services such as HR functions, data storage, and modes of communication are the responsibility of cloud-based third parties.

 

Without a modern TPRM program, many of these third parties are left behind in security risk management, putting organizations in a vulnerable position.

 

Over 60% of data breaches can be linked either directly or indirectly to a third party (per Soha Systems, 2016) but TPRM programs don’t often take a risk-first perspective when it comes to risk management. Security and Vendor Risk departments are often solely focused on compliance. That’s important, but doesn’t get at the heart of the risk posed by your third parties. To shift the approach of your TPRM program to measure true risk, you’ll need to make some adjustments in how you manage third parties.

 

Here are the three top TPRM challenges and the actions you and your organization can take in order to bolster your TPRM program.

 

1. Automate Your TPRM Process to Reduce Unmanaged Risk
With the rise in SaaS, businesses are now using cloud-based third parties more than ever. Gartner predicted that SaaS sales will nearly double by 2019, and that SaaS applications will make up 20% of the growth rate in all public cloud services, a $204B market. Last year, Forrester had already predicted that enterprise spend on software would reach $620B by the end of 2015.

 

As businesses engage in IT and infrastructure digital transformation, the need to manage vendors is more pronounced. Over 60% of respondents from a Ponemon Institute’s survey on Third Party Risk Management believe that the Internet of Things increases third party risk significantly. 68% believe the same is true for cloud migration.

 

However, as more third parties are brought in, they’re often not managed to match the level of cyber security risk they carry. Worse, they may not be managed at all due to a lack of resources. This creates unmanaged security risk. If these third parties have access to your network, your employees’ PII, or your customers’ sensitive data, shouldn’t they be subject to rigorous risk management assessments?

 

Unfortunately, as the number of third parties swell to the hundreds, it’s often not feasible for every vendor to be assessed in the same critical fashion. That’s why having an automated risk assessment tool for assessing vendors is a way to ensure you’re minimizing unmanaged risk from both new and existing vendors.

 

Automating your TPRM process is one of the major steps towards having a mature TPRM department capable. Its benefits include:

 

  • Improved third party management flexibility
  • Standardized processes and thirdparty management
  • Metrics and reporting consistency
  • Improved data-driven decision making
  • Further structuring the TPRM organization
  • Increased third party responsibility
  • Increased overall risk assessment and mitigation

 

By automating the TPRM process, you’re creating a standardized structure that can be applied to all third parties, whether existing or onboarded.

 

You can automate your TPRM process by finding new technologies or tools that will automate the assessment and information gathering process for your third party vendors. This helps to ensure that you’re optimizing your resources and spending company time on what is most impactful.

 

2. Augment and Validate Self-Reported Questionnaires Through Independent Risk-Based Assessments
Third parties are often assessed through questionnaires, onsite assessments, or via penetration tests. Each has its own advantages and disadvantages. Onsite risk assessments and penetration tests are resource-intensive, requiring time, money, and staff in order to carry out the assessments. Because of the costs, these kinds of assessments cannot be used for all third parties, and should be reserved for the most risk-critical third parties.

 

That leaves questionnaires to fill the void for most of the other third parties. However, questionnaires are self-reported, which makes using a ‘trust, but verify’ approach to risk management difficult to accomplish.

 

In a 2016 Deloitte Study on Third Party Risk Management, 93.5% of respondents expressed moderate to low levels of confidence in their risk management and monitoring mechanisms. With numbers like that, it’s easy to see why TPRM programs need increased attention. Without a way to independently verify the security posture of your third parties, you can only rely on the word of your third parties who are, for obvious reasons, incentivized to report positively.

 

Organizations should find independent third parties that can provide risk-based assessments of their third parties to validate that the findings from questionnaires are a realistic portrait of the state of third party security.

 

There are a number of cyber security solutions that provide risk-first third party assessments. To find the right solution, you should research whether or not those solutions:

 

  • are accurately assessing third parties
  • can facilitate communication between you and third parties
  • are focusing on key cyber security areas that are indicative of a potential breach


3. Utilize Continuous Monitoring to Assess Third Parties Beyond Point-In-Time Assessments
The assessment methods mentioned in the previous section all have one glaring flaw in common – they assess third parties at a single point in time. Many times, the information gathered by security risk assessments is outdated by the time it falls into your hands. The speed at which hackers are developing new attacks and exploiting vulnerabilities is too fast for point-in-time assessments or annual reviews to provide any insight into the real security posture of a vendor.

 

A PWC Third Party Risk Management report on the finance industry noted that 58% of companies using ad hoc monitoring experienced a third party service disruption or data breach, compared to only 37% of those that regularly monitor their providers and partners. Without having a way to know the security posture of your third parties on-demand, you’re managing risk with a blindfold on for most of the year. By only having point-in-time information that is quickly outdated, your ability to react to new vulnerabilities, or worse, a potential third party cyber security incident, is negligible.

 

Through continuous monitoring, you’re bolstering the security of your third party by keeping them consistently accountable, which in turn, minimizes your overall risk to a potential security incident.

 

How to Get Started Revamping Your VRM
We covered how to implement continuous monitoring in your TPRM program in part 2 of our How to Revamp Your VRM Program article series. Start by establishing a central TPRM office if you don’t already have one, prioritize and identify your most risk-critical and business-critical vendors, and then define your third parties’ security controls and processes that you’ll monitor on an ongoing basis. If you have the resources, look for automated risk healthassessment tools and solutions that offer continuous monitoring for your third parties.

 

Conclusion
Updating your TPRM program doesn’t have to be a complete overhaul of your department. Instead, you should use a risk-first perspective to define the aspects that are the most criticalto update. The three we highlighted here will yield the most dramatic changes in a TPRM program, reducing your unmanaged risk, and reducing your reaction time should a security incident occur.

 

By automating aspects of your TPRM program, using independent third party assessments, and adopting continuous monitoring, you’re not far from having a mature TPRM program that can easily assess any new third party as it comes, keeping your organization safe.

Technical Dr. Inc.'s insight:
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Top 6 Benefits of Adopting a Phone System 

Top 6 Benefits of Adopting a Phone System  | Healthcare and Technology news | Scoop.it

In the modern medical era of robot surgeries, drones, and telemedicine, it’s easy to overlook basic communication platforms like your phone system. But your phone system is still a critical method patients and providers rely on for communication. If your organization is using a legacy phone system, it’s time to discover the benefits of voice over Internet protocol (VoIP).

 

VoIP is the transmission of phone calls over the Internet instead of traditional telephone lines, and this technology is rapidly transforming how healthcare organizations across the country communicate with their providers, patients, and counterparts.

 

No matter if your organization is a large medical system, behavioral health group, small doctor’s office, public health department, or rural clinic, VoIP systems can provide numerous benefits that legacy phone services just can’t deliver. Here are the top six benefits of adopting a VoIP phone system.

 

Enhanced Productivity and Efficiency

It’s no secret healthcare organizations are slammed in our current fast-paced climate. Healthcare administrators and providers alike are watching their responsibilities increase while the amount of time to meet them stays the same. According to IT Toolbox, switching gears throughout the day to tackle tasks like managing contacts and voicemail leads to a 40% reduction in staff productivity.

 

With a VoIP phone system, you can get your day back with productivity-enhancing features that legacy phone systems can’t support, and the integration of those features creates seamless, time-saving communications among your staff members. Simple-to-configure call routing and self-routing auto attendant features are easy for staff to navigate, improves staff availability to callers who need them, and decreases time spent on routing calls. And, if your goal is to reduce the time physicians and medical staff spend on voicemails, VoIP systems offer voicemail transcribing features that will automatically transcribe messages and deliver them to your email inbox.

 

Additionally, advanced reporting data gives your team an inside look into the traffic loads of your system. This data is extremely valuable and can be used to make intelligent routing and configuration decisions to balance call loads across your organization.

 

Cost Savings

With costs escalating and reimbursement rates shrinking, it’s more important than ever for healthcare providers to find innovative ways to save money without sacrificing efficiency.

 

VoIP is a cost-effective solution because calls are made and received over your organization’s Internet rather than traditional phone lines. This means your organization isn’t being charged for local and long distance calls on a minute-by-minute basis, cutting down your costs by a huge margin.

 

VoIP systems are also affordable to install. Because VoIP is cloud-based, most of the equipment a healthcare organization needs is already in place, making installation fast and seamless. Typically, the only capital expenditure needed is the cost for the phones themselves. VoIP allows your organization to save time and effort that otherwise would have been spent on additional infrastructure, project management, and staffing. These critical savings can be reallocated to other needed services that directly save lives.

 

Delivers a Better Patient Experience

At any healthcare establishment, the quality of care provided and patient experience delivered is paramount to success. Adopting a VoIP phone system can help elevate the communication experience your patients have with your facility.

 

With a VoIP phone system, you enjoy enhanced audio quality and clarity, making it easier to decipher and respond to a patient’s questions and concerns. Additionally, several features can be implemented to ensure your patients and callers are routed to the correct point of contact. Some of these features include:

 

  • Prioritized calling for medical emergencies
  • Call forwarding
  • Click-to-call
  • Routing calls based on caller ID
  • Routing calls with option sets for billing, scheduling, care, etc.
  • Custom messages based on day and time
  • Custom hold music or announcements
  • Integration with patient account information systems

 

These advanced features work together to ensure your callers are able to reach their destination and gather or relay information quickly and painlessly.

 

Online Portals Put You in Control

With legacy phone systems, changing system settings can be a difficult task and can even require multiple calls to the vendor. That’s time your providers and staff simply can’t afford to waste.

 

Cloud-based VoIP platforms deliver complete organization and control to your staff through easy-to-use online portals. These portals give your staff advanced features that allow easy day-to-day management of your voice services without ever having to call the service provider. Authorized administrators can change call-forwarding settings, manage call groups, update contacts, reset passwords, configure phones, listen to transcribed voicemails, and more, all through their online portal. Your staff can easily and quickly update and configure settings instantaneously anytime from any web browser.

 

Flexibility Allows You to Scale

Another advantage cloud-based VoIP services offer is simple scalability, allowing you to transition as slowly or as quickly as needed. Healthcare organizations vary in size and complexity and your phone system should be able to scale to your needs. With traditional phone systems, this is incredibly difficult and can cost you more money in the long run. Flexible designs enable healthcare organizations to deploy VoIP at one site or multiple sites if you’re looking to consolidate multiple voice platforms. Additionally, VoIP systems allow you to scale your system to only include features your organization truly utilizes.

 

Streamlined Communications on the Go

With a mobile VoIP capability, such as an app on your smartphone, your staff and providers are always reachable on their mobile phones. Missing important calls or information can create a lot of added work and decrease efficiency. Thanks to the mobility provided by many VoIP applications, staff members can stay connected by using their mobile devices to receive and make calls to and from their work extensions, as well as access voicemail, call logs, and contact lists.

 

 

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Compromised logs can hamper IT security investigations 

Compromised logs can hamper IT security investigations  | Healthcare and Technology news | Scoop.it

At the heart of most devices that provide protection for IT networks is an ability to log events and take actions based on those events. This application and system monitoring provides details both on what has happened to the device and what is happening. It provides security against lapses in perimeter and application defences by alerting you to problems so defensive measures can be taken before any real damage is done. Without monitoring, you have little chance of discovering whether a live application is being attacked or has been compromised.

 

Critical applications, processes handling valuable or sensitive information, previously compromised or abused systems, and systems connected to third parties or the Internet all require active monitoring. Any seriously suspicious behaviour or critical events must generate an alert that is assessed and acted on. Although you will need to carry out a risk assessment for each application or system to determine what level of audit, log review and monitoring is necessary, you will need to log at least the following:

  • User IDs
  • Date and time of log on and log off, and other key events
  • Terminal identity
  • Successful and failed attempts to access systems, data or applications
  • Files and networks accessed
  • Changes to system configurations
  • Use of system utilities
  • Exceptions and other security-related events, such as alarms triggered
  • Activation of protection systems, such as intrusion detection systems and antimalware

Collecting this data will assist in access control monitoring and can provide audit trails when investigating an incident. While most logs are covered by some form of regulation these days and should be kept as long as the requirements call for, any that are not should be kept for a minimum period of one year, in case they are needed for an investigation.  However, monitoring must be carried out in line with relevant legislation, which in the UK is the Regulation of Investigatory Powers and Human Rights Acts. Employees should be made aware of your monitoring activities in the network acceptable use policy.

 

 

Log files are a great source of information only if you review them. Simply purchasing and deploying a log management product won’t provide any additional security. You have to use the information collected and analyse it on a regular basis; for a high-risk application, this could mean automated reviews on an hourly basis. ISO/IEC 27001 control A.10.10.2 not only requires procedures for monitoring the use of information processing facilities, but demands the results are reviewed regularly to identify possible security threats and incidents.

 

However, even small networks can generate too much information to be analysed manually. This is where log analysers come in, as they automate the auditing and analysis of logs, telling you what has happened or is happening, and revealing unauthorised activity or abnormal behaviour. This feedback can be used to improve IDS signatures or firewall rule sets. Such improvements are an iterative process, as regularly tuning your devices to maximise their accuracy in recognising true threats will help reduce the number of false positives. Completely eliminating false positives, while still maintaining strict controls, is next to impossible, particularly as new threats and changes in the network structure will affect the effectiveness of existing rule sets. Log analysis can also provide a basis for focused security awareness training, reduced network misuse and stronger policy enforcement.

 

ISO/IEC 27001 controls A.10.10.4 and A.10.10.5 cover two specific areas of logging whose importance is often not fully appreciated: administrator activity and fault logging. Administrators have powerful rights, and their actions need to be carefully recorded and checked. As events, such as system restarts to correct serious errors, may not get recorded electronically, administrators should maintain a written log of their activities, recording event start and finish times, who was involved and what actions were taken. The name of the person making the log entry should also be recorded, along with the date and time. The internal audit team should keep these logs.

 

There are two types of faults to be logged: faults generated by the system and the applications running on it, and faults or errors reported by the system's users. Fault logging and analysis is often the only way of finding out what is wrong with a system or application. The analysis of fault logs can be used to identify trends that may indicate more deep-rooted problems, such as faulty equipment or a lack of competence or training in either users or system administrators.

 

All operating systems and many applications, such as database server software, provide basic logging and alerting faculties. This logging functionality should be configured to log all faults and send an alert if the error is above an acceptable threshold, such as a write failure or connection time-out. The logs should be reviewed on a regular basis, and any error-related entries should be investigated and resolved. While analysing all logs daily is likely an unrealistic goal, high-volume and high-risk applications, such as an e-commerce Web server, will need almost daily checking to prevent high-profile break-ins, while for most others a weekly check will suffice.

 

There should be a documented work instruction covering how faults are recorded or reported, who can investigate them, and an expected resolution time, similar to a service contract if you use an outside contractor to support your systems. Help desk software can log details of all user reports, and track actions taken to deal with them and close them out.

 

No matter how extensive your logging, log files are worthless if you cannot trust their integrity. The first thing most hackers will do is try to alter log files to hide their presence. To protect against this, you should record logs both locally and to a remote log server. This provides redundancy and an extra layer of security as you can compare the two sets of logs against one another -- any differences will indicate suspicious activity.

 

If you can’t stretch to a dedicated log server, logs should be written to a write-once medium, such as a CD-R or DVD-R, or to rewritable media such as magnetic tape data storage or hard disk drives that automatically make the newly written portion read-only to prevent an attacker from overwriting them. It's important also to prevent administrators from having physical and network access to logs of their own activities. Those tasked with reviewing logs should obviously be independent of the people, activities and logs being reviewed.

 

The protection of log information is critical. Compromised logs can hamper IT security investigations into suspicious events, invalidate disciplinary action and undermine court actions.

 

Another point to bear in mind is system clocks need to be synchronised so log entries have accurate timestamps. Check computer clocks and correct any significant time variations on a weekly basis, or more often, depending on the error margin for time accuracy.

 

Clocks can drift on mobile devices and should be updated whenever they attach to the network or desktop. Always record the time of an event in a consistent format, such as Universal Coordinated Time (UTC) across all files. For additional security, add a checksum to each log entry so you can detect if any entries have been tampered with. Controls also need to be in place to ensure there is ample log storage. If your logs can be trusted, they can help you reconstruct the events of security incidents and provide legally admissible evidence.

 

Logging and auditing work together to ensure users are only performing the activities they are authorised to perform, and they play a key role in preventing, as well as in spotting, tracking and stopping unwanted or inappropriate activities.

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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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Connecting the Dots: Referrals between Medical Care and Community Resources 

Connecting the Dots: Referrals between Medical Care and Community Resources  | Healthcare and Technology news | Scoop.it

Policymakers and providers all agree that addressing patients’ non-medical needs will be critical to improving health, health care, and health care costs, but little progress has been made towards integrating traditionally segmented services. What can and should a health care organization do? Realistically, most health care organizations will not build new lines of social services into their core clinical operations. Instead, leading organizations are connecting the dots by optimizing referrals to existing community resources. Based on phone interviews and site visits with executive leadership, frontline providers, and community partners, we highlight the work of nine innovative health care organizations. Here, we offer practical steps to reflect upon where your organization stands and where it might look to be in a referral model for community resources.

 

Starting point: Does your team have a useful resource library?

Useful is the key word here: we’re not talking about a static laundry list that simply names local community resources on a website or a print out. Useful resource libraries not only catalog existing community resources but also include pertinent details such as eligibility criteria. For example, at one organization we interviewed, health coaches use their electronic resource library to match the patient’s age, income, and residence profile with available community resources. To create the most useful resource library for your organization, we suggest querying your care team about what essential pieces of information would help them effectively and confidently refer patients to community resources.

Importantly, a resource library is only as useful as it is accurate and up-to-date. Organizations will need to identify who will monitor and update the resource library at regular intervals by visiting program websites, calling program contacts, or surveying providers about their experiences with listed community resources. For example, one organization we interviewed created a dedicated committee to appraise over 300 community resources that engage with their providers. Clearly, modifications to the resource library are to be expected, so electronic resource libraries (e.g. in a cloud-based platform or in the EHR) will be more dynamic than binders. Two organizations we interviewed are even using or contracting with companies that have created web-based resource libraries (e.g. Aunt Bertha, NowPow).

Next step: Who is responsible for referring patients?

Remember, the resource library is a tool not the solution. Organizations must lay out what roles will best enable referrals to community resources. Depending on your unique organization, referrals to community resources might be done through an entire team, an individual, or outsourced partners. For example, one larger organization we interviewed developed multidisciplinary teams of nurses and social workers, making specialized referrals and handoffs for particular social service domains (e.g. a housing team, transportation team, and nutrition team). In contrast, another organization used a single, centralized point person to make all referrals into the local community. Alternatively, two organizations we interviewed piloted with external partners (such as Health Leads) whose staff executes the referrals to specific community resources.

In addition to defined roles, organizations must not forget to develop associated workflows. What is the workflow to identify the patients with social service needs? What is the provider’s workflow to connect with whomever will make the community resource referrals? Are there workflows in place to follow-up regarding the referrals made to community resources? While developing these workflows, organizations need to consider what the preferred modes of communication are and which documentation platforms will facilitate the workflows. For example, one organization we interviewed built workflows into their EHR by tailoring the existing social service pathways of the Pathways Hub Model to fit the organization’s particular patient needs, staffing structure, and provider network. By strategically designing roles and workflows that support patient referrals to community resources, your organization shares responsibility for the success of the referral model.

Final move: Are you evaluating the impact?

Evaluating your referral model is crucial not only to intelligently decide what to keep, drop, or adapt but also to assess the impact of your work. All of the organizations we interviewed found it challenging to demonstrate that referrals to community resources directly influenced larger outcomes such as total costs of medical care. More immediately, data points that organizations may want to capture include the number of patients with different types of social service needs and the number of complete and incomplete referrals made to each community resource. For example, one organization we interviewed is tracking their rate of unsuccessful referrals to community resources in order to reveal where gaps in the community persist and subsequently inform advocacy efforts.

Furthermore, evaluating your referral model sets the foundation to build a business case for social service partnerships. A few organizations we interviewed were interested in entering financial arrangements with a curated network of community partners based on quality and other performance metrics, although these were generally still in the early stages of development. As organizations look to harmonize data collection and evaluation efforts, partners will need to agree upon the types of data, preferred reporting formats, and interval of reporting requests. In fact, based on interviews with community partners, we learned that many community partners are motivated to collect and exchange data on shared patients in order to improve their value proposition with grant funders and secure future funding.

Following the lead of innovative organizations, there are valuable opportunities for health care organizations to use a referral model with community resources. Health care organizations that leverage their local communities can more effectively match patients with comprehensive services critical to improving health status. Improving the referral model is a key sPolicymakers and providers all agree that addressing patients’ non-medical needs will be critical to improving health, health care, and health care costs, but little progress has been made towards integrating traditionally segmented services. What can and should a health care organization do? Realistically, most health care organizations will not build new lines of social services into their core clinical operations. Instead, leading organizations are connecting the dots by optimizing referrals to existing community resources. Based on phone interviews and site visits with executive leadership, frontline providers, and community partners, we highlight the work of nine innovative health care organizations. Here, we offer practical steps to reflect upon where your organization stands and where it might look to be in a referral model for community resources.
 
Starting point: Does your team have a useful resource library?
Useful is the key word here: we’re not talking about a static laundry list that simply names local community resources on a website or a print out. Useful resource libraries not only catalog existing community resources but also include pertinent details such as eligibility criteria. For example, at one organization we interviewed, health coaches use their electronic resource library to match the patient’s age, income, and residence profile with available community resources. To create the most useful resource library for your organization, we suggest querying your care team about what essential pieces of information would help them effectively and confidently refer patients to community resources.
Importantly, a resource library is only as useful as it is accurate and up-to-date. Organizations will need to identify who will monitor and update the resource library at regular intervals by visiting program websites, calling program contacts, or surveying providers about their experiences with listed community resources. For example, one organization we interviewed created a dedicated committee to appraise over 300 community resources that engage with their providers. Clearly, modifications to the resource library are to be expected, so electronic resource libraries (e.g. in a cloud-based platform or in the EHR) will be more dynamic than binders. Two organizations we interviewed are even using or contracting with companies that have created web-based resource libraries (e.g. Aunt Bertha, NowPow).
Next step: Who is responsible for referring patients?
Remember, the resource library is a tool not the solution. Organizations must lay out what roles will best enable referrals to community resources. Depending on your unique organization, referrals to community resources might be done through an entire team, an individual, or outsourced partners. For example, one larger organization we interviewed developed multidisciplinary teams of nurses and social workers, making specialized referrals and handoffs for particular social service domains (e.g. a housing team, transportation team, and nutrition team). In contrast, another organization used a single, centralized point person to make all referrals into the local community. Alternatively, two organizations we interviewed piloted with external partners (such as Health Leads) whose staff executes the referrals to specific community resources.
In addition to defined roles, organizations must not forget to develop associated workflows. What is the workflow to identify the patients with social service needs? What is the provider’s workflow to connect with whomever will make the community resource referrals? Are there workflows in place to follow-up regarding the referrals made to community resources? While developing these workflows, organizations need to consider what the preferred modes of communication are and which documentation platforms will facilitate the workflows. For example, one organization we interviewed built workflows into their EHR by tailoring the existing social service pathways of the Pathways Hub Model to fit the organization’s particular patient needs, staffing structure, and provider network. By strategically designing roles and workflows that support patient referrals to community resources, your organization shares responsibility for the success of the referral model.
Final move: Are you evaluating the impact?
Evaluating your referral model is crucial not only to intelligently decide what to keep, drop, or adapt but also to assess the impact of your work. All of the organizations we interviewed found it challenging to demonstrate that referrals to community resources directly influenced larger outcomes such as total costs of medical care. More immediately, data points that organizations may want to capture include the number of patients with different types of social service needs and the number of complete and incomplete referrals made to each community resource. For example, one organization we interviewed is tracking their rate of unsuccessful referrals to community resources in order to reveal where gaps in the community persist and subsequently inform advocacy efforts.
Furthermore, evaluating your referral model sets the foundation to build a business case for social service partnerships. A few organizations we interviewed were interested in entering financial arrangements with a curated network of community partners based on quality and other performance metrics, although these were generally still in the early stages of development. As organizations look to harmonize data collection and evaluation efforts, partners will need to agree upon the types of data, preferred reporting formats, and interval of reporting requests. In fact, based on interviews with community partners, we learned that many community partners are motivated to collect and exchange data on shared patients in order to improve their value proposition with grant funders and secure future funding.
Following the lead of innovative organizations, there are valuable opportunities for health care organizations to use a referral model with community resources. Health care organizations that leverage their local communities can more effectively match patients with comprehensive services critical to improving health status. Improving the referral model is a key step in connecting the dots between medical care and community resources, a small move toward systematically caring for the whole person rather than the discreet set of problems bringing a patient into a given provider’s office.tep in connecting the dots between medical care and community resources, a small move toward systematically caring for the whole person rather than the discreet set of problems bringing a patient into a given provider’s office.

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Readmissions Penalties Get Very, Very Real

Readmissions Penalties Get Very, Very Real | Healthcare and Technology news | Scoop.it

It was quite bracing to read the August 3 Kaiser Health News report entitled “Half of Nation’s Hospitals Fail Again to Escape Medicare’s Readmission Penalties.” As Jordan Rau wrote in the article, “Once again, the majority of the nation’s hospitals are being penalized by Medicare for having patients frequently return within a month of discharge—this time losing a combined $420 million, government records show. In the fourth year of federal readmission penalties,” Rau reported, “2,592 hospitals will receive lower payments for every Medicare patient that stays in the hospital—readmitted or not –starting in October. The Hospital Readmissions Reduction Program, created by the Affordable Care Act, was designed to make hospitals pay closer attention to what happens to their patients after they get discharged. Since the fines began,” he added, “national readmission rates have dropped, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month.”


What’s more, Rau noted, “Some hospitals view the punishments as unfair because they can lose money even if they had fewer readmissions than they did in previous years. All but 209 of the hospitals penalized in this round were also punished last year, a Kaiser Health News analysis of the records found.”


As hospital executives already know, the fines for failure to meet the criteria of the Centers for Medicare & Medicaid Services (CMS) focus on five conditions: heart attack, congestive heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), as well as elective hip and knee replacements, and are based on readmissions between July 2011 and June 2014.


And these reimbursement cuts are everywhere—indeed, the penalties will be assessed on hospitals in every state except for Maryland, as that state has a special payment arrangement with Medicare. And the cuts will affect three-quarters or more of hospitals in the following states: Alabama, Connecticut, Florida, Massachusetts, New Jersey, New York, Rhode Island, South Carolina, Virginia, and the District of Columbia.


What’s more, the readmissions-driven reimbursement cuts are hitting hospitals on top of cuts coming out of the mandatory value-based purchasing program and the mandatory healthcare-acquired conditions (mostly hospital-acquired infections) program.


 Meanwhile, the average penalties by state are being found to vary tremendously. Nationwide, 54 percent of hospitals (2,592 organizations) are being penalized, with an average Medicare pay cut of 0.61 percent. But those nationwide averages encompass huge variations. On one end of the spectrum, in North Dakota, where only three hospitals, or seven percent of the state’s hospital organizations, are being penalized this year, the average penalty is just 0.14 percent of Medicare payments. But in Kentucky, where 62 organizations, representing 65 percent of the state’s hospitals, are being penalized, the average penalty amounts to a full 1.19 percent of Medicare revenues—that’s an 850-percent spread.


And as everyone knows, many not-for-profit community hospitals in the U.S. are surviving on operating margins of between 1 and 3 percent; and for those with a majority of their revenues coming from Medicare reimbursement, a penalty of more than 1 percent could potentially be devastating.


Five years ago when the U.S. Congress passed he Affordable Care Act, and President Obama signed it, I predicted that the mandatory readmissions program would be one of the healthcare system reform provisions in the ACA that would be one of its most impactful; and it already has been. As we all know, ten years ago, if you were talk walk into the office of the average CFO in the average inpatient hospital in the U.S. and were to ask that CFO what her/his hospital’s average 30-day readmissions rates were for patients with documented congestive heart failure, diabetes, or COPD (chronic obstructive pulmonary disease), s/he could likely not have told you. Now, that CFO needs to know that number—and needs to be working with all levels and disciplines of leadership in her/his hospital to reduce that number.


What’s more, private health insurers are absolutely moving forward to implement similar programs in their hospital contracts, since, as is nearly always the case with such things, once the Medicare program, the U.S. healthcare system’s proverbial 800-pound gorilla, moves forward in an area, all the major private health insurers quickly follow Medicare’s lead and design their own versions of the same initiative.


Industry experts have long noted that many, if not most, readmissions that occur within 30 days are relatively easily predicted. Research, and the experiences of pioneering hospital organizations, have found that the key gaps in this area have to do with care management on multiple levels—ensuring effective discharge planning, including really robust patient and family member education; and then, very importantly, case manager/care manager nurse follow-up with the discharged patient in a day or two at most following discharge, via phone communication, which must involve the scheduling of a follow-up primary care physician appointment; and then of course, that follow-up PCP visit, along with further coaching, education, and care management.


And all of those processes must be strategically directed, excellently executed, and very strongly facilitated by robust information systems run by hospital and health system leaders with commitment to strategic goals and to success over long periods of time and across large groups of patients. Now, clearly, the leaders of many patient care organizations are moving forward with alacrity to develop accountable care organizations (ACOs), either under the aegis of one of Medicare’s ACO programs, or in collaboration with private health plans; as well as implementing population health management programs, and developing patient-centered medical homes.


But here’s the thing about the Medicare readmissions reduction program: because it’s mandatory, it is forcing action on the part of every hospital that receives regular Medicare payment, regardless of whether or not that hospital is also pursuing ACO, population health, or PCMH strategies, or not.


So the same “blessed cycle” of performance improvement is called for on the part of all regular U.S. hospitals receiving Medicare reimbursement, at this point. And that means creating really good data collection and reporting mechanisms, reporting the data, developing continuous clinical performance improvement processes to reduce predictable 30-day readmissions, making those improvements, and continuously sharing with clinicians, clinician leaders, and administrative executives and managers the ongoing results of those efforts, for further improvement work.


In other words, we’re talking about a continuous learning system in U.S. healthcare. And guess what? It’s no longer optional.

The reality is that healthcare IT leaders are playing and will continue to play, an extremely important role in all of this work; indeed, their contributions will be vital to success, at the data and information level, the process improvement level, and the strategic level, organization-wide. The one thing that neither healthcare IT leaders nor any other leaders can do is to sit any longer in denial about what is happening. Because, along with the mandatory value-based purchasing program under Medicare, and to a lesser extent as well, the mandatory healthcare-acquired conditions reduction program under Medicare, continuous clinical performance improvement is in effect now a core component of federal policy.


In other words, folks, this is happening.


The good news is that leaders at the most pioneering hospitals and health systems are lighting the way for others to follow. The bad news is that anyone waiting for further “clarity” on all this is going to be waiting so long as to potentially endanger the future of their hospital organization. So as the readmissions reduction program under Medicare—and inevitably under many, if not most, private health insurers as well—expands and ramps up, it will be incumbent on healthcare IT leaders and on all healthcare leaders to get ahead of the curve, because the penalties are only going to get more and more real—and won’t ever be reversing.

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7 ways physicians can improve health care quality

7 ways physicians can improve health care quality | Healthcare and Technology news | Scoop.it

Patients want to receive health care that is of the highest quality. Physicians want to provide it. But what is “high-quality health care?” On that, few agree.


Ask most Americans and they’re unsure where to find it. They know they want to be kept healthy, have rapid access to personalized care whenever they need it and be charged only what they can afford.

Ask the leaders of the national medical and surgical societies, and they are likely to define quality as having access to the latest — and often the most richly reimbursed — procedures, diagnostic imaging, and genetic testing.

Ask physicians themselves and, well, they’re already overwhelmed by the exponential growth in clinical measures of quality developed for public and private pay-for-performance formulas.


Even so, medicine is coming closer to a definition of high-quality health care — and also to a system for evaluating how physicians and medical groups perform. The Institute of Medicine (IOM), a highly regarded independent organization established by Congress to advise on health care issues — the gold standard on improving our nation’s health – recently released a report: “Vital Signs: Core Metrics for Health and Health Care Progress.”


The IOM panel of experts identified 15 measures, narrowed down from hundreds, with the best potential for improving health, including reducing the overall rate of preventable deaths.The consensus: If the U.S. systematically raises its performance in each of these 15 domains, the quality of life for millions would improve dramatically.


This IOM report is important, even though it received surprisingly scant media attention. It should serve as a starting point and a road map about how clinical practice can most effectively lift the quality of care delivered to patients.

But let me come back to the report itself in a minute.


The quality conundrum


A little context about the issue of quality might help here. At last count, the number of health care quality measures in place was in the thousands. The Joint Commission has 57 just for inpatient care at hospitals. The Healthcare Effectiveness Data and Information Set has about 81. The National Quality Forum currently endorses more than 630. The Centers for Medicare & Medicaid Services has no fewer than about 1,700.


That may explain why keeping track is such a challenge for all parties involved.


Perceptions of quality are of course subjective. According to the Merriam-Webster Dictionary, quality is “how good or bad something is; a characteristic or feature that someone or something has; a high level of value or excellence.” The Oxford Dictionary says quality is “the standard of something as measured against other things of a similar kind; the degree of excellence of something” It cites this example: “The hospital ranks in the top tier in quality of care.”


The upshot here is a paradox: a definition that is itself ill-defined – and as such, leaves plenty of uncertainty and doubt.


7 actions physicians can take


That’s why the IOM report is so valuable and welcome. It cites 15 “vital signs,” but let’s focus on the seven that relate to direct health care delivery and better care for patients.


1. Overweight and obesity. Physicians should help their patients exercise regularly, eat a healthy diet and maintain their weight within a normal range. More than two-thirds of Americans are overweight or obese. Specifically, physicians can make diet and weight management a vital sign and counsel every patient on the options available.


2. Addictive behaviors. Eliminating smoking and alcohol abuse, along with reducing the percentage of people who are overweight, would dramatically lower the incidence of diabetes, lung cancer, and cardiovascular disease. Physicians should engage and educate patients about approaches to take to quit smoking and alcohol abuse, and provide advice and resources toward that end. Today, addiction to nicotine, alcohol, opiates and other psychoactive drugs continues at unacceptably high rates.


3. Preventive services. Physicians should urge patients to take the recommended screening tests and stay current on their vaccinations. Preventive screenings alone could dramatically lower the risk of dying from cancer, heart disease, and strokes.


Combining this with smoking cessation and exercise could help avoid 200,000 heart attacks and strokes in the U.S. each year, and reduce the mortality from cancer by tens of thousands yearly, based on an internal analysis done by The Permanente Medical Group’s Division of Research.


Screen for colon cancer in fewer than 50 percent of patients, rather than in 80 percent to 90 percent, and you double the chances of dying from an invasive adenocarcinoma. Smoke at the national average of 18 percent, rather than at under 10 percent, and you dramatically increase lung cancer, emphysema, and heart attacks.


Preventive services present a valuable opportunity for both improving health and reducing health expenditures.


4. Patient safety. Physicians and nurses can, through rigorous practice, help patients avoid hospital-acquired infections, pressure ulcers, medication errors and wrong-site surgery. Even a decade after the 1999 IOM report, “To Err is Human” — with its estimate that 100,000 patients die each year from medical errors, the equivalent of a jetliner crashing each day — these so called “never events” still occur too frequently.


And when patients develop infections like sepsis, or suffer an adverse drug reaction, they face a higher chance of dying in the hospital, and experiencing problems long after hospital discharge. Avoiding harm has been a core value of the medical profession from the time of Hippocrates, and is “first among equals” when it comes to the principal responsibilities of the health care system. Yet medical errors with adverse outcomes are still far too common.


5. Unintended pregnancy. Physicians should take the opportunity to focus on ensuring the health of an expectant mother in order to increase the chances for a healthy baby and safe delivery, whether a pregnancy is unintended or the result of careful planning.


An estimated 50 percent of pregnancies in the US are unplanned, and occur in women across the spectrum of child-bearing years, and among women in every socioeconomic demographic. Unintended pregnancy results from social, behavioral, cultural, and health factors, including — and perhaps most especially — women’s lack of knowledge about and access to tools for family planning.


Research has demonstrated that medical care soon after conception is critical, and identified ways to reduce the risks of a maternal or fetal complication. Good nutrition, along with avoidance of drugs, alcohol and cigarette smoke, are essential. After birth, comprehensive medical care and early diagnosis of problems can prevent longer-term health problems and future complications.


6. Access to care. Access to health care is one of the most powerful determinants of clinical outcomes. The ability to access care when needed is a vital precondition for a high-quality health system.

Physicians in integrated, multi-specialty practices have advantages in ensuring patients get all the care needed thanks to comprehensive electronic health records. But in today’s fragmented health care system, with close to 15 percent of the population still uninsured, health care still remains beyond the reach of all too many Americans. Policy makers are relentlessly pursuing affordable access.


7. Evidence-based care. Physicians should see to it that patients receive medical care based on the most current scientific evidence for what is appropriate and effective, rather than on an anecdote or an “in my experience” approach. Physicians working in hospitals with electronic health records can do so, deciding about care according to scientifically validated protocols for complex problems like heart attacks, strokes, and hip fractures.


In the not-too-distant past, when physicians lacked many of the current diagnostic tools and access to sophisticated information technology, medical practice was far more art than science.


Even today, variation in how physicians treat patients with the same problem is unwarranted, and leads to system-wide under performance and less-than-optimal clinical outcomes.


Fortunately, medical practice today is far more science than art.


What patients should do


The best quality, then, according to the IOM, is not based on using a robot, providing transplantation or completing genetic sequencing. The reality is that, contrary to what some might assume, these often advertised technologies have minimal impact on mortality.


And quality is not a result of individual technical excellence in performing procedures such as heart surgery, neurosurgery or hip replacement surgery. The variation from surgeon to surgeon is far less than people assume. In fact, many health care experts now perceive overuse of these high-intensity surgical interventions to be a problem that sometimes results in associated complications and minimal improvements in clinical outcomes.


The list, in short, is more practical than exotic or “sexy,” offering the interventions which have the greatest impact on human life.

The IOM committee concluded that leadership “at nearly every level of the health care system” will be required to adopt, implement, refine and maintain these core measures. And among the many stakeholders, physician leadership will be key.


Patients should make health choices based on these 15 vital signs from the IOM. They enable people to distinguish the most important quality measures from all the “noise” about what are the newest and most exotic tools and approaches available. More specifically, patients would be wise to select a personal physician or medical group whose practice philosophy incorporates these approaches — and whose clinical results in each area are superior.


We physicians are obligated to heed the IOM recommendations on behalf of our patients, the better to fulfill health care’s promise of easing suffering and extending lives. This is where American health care should invest its efforts. The IOM is a gift to both physicians and patients. Taking our eyes off what will most impact the health of all would be a mistake our nation can ill afford.

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Health insurers working the system to pad their profits

Health insurers working the system to pad their profits | Healthcare and Technology news | Scoop.it

One of the reasons the health insurance industry worked behind the scenes in 2009 and 2010 to derail Obamacare was the fear that changes mandated by the law would cut their Medicare Advantage profits. Medicare Advantage plans are federally funded but privately run alternatives to traditional fee-for-service Medicare. 

Although the industry’s biggest trade group, America’s Health Insurance Plans, said repeatedly that insurers supported Obamacare, the group was secretly financing the U.S. Chamber of Commerce’s TV campaign against reform. Among the companies most concerned about the law were those benefiting from overpayments the federal government had been making to their Medicare Advantage plans since George W. Bush was in the White House.  


Bush and other Republicans saw the Medicare Advantage program as a way to incrementally privatize Medicare. To entice insurers to participate in the program, the federal government devised a payment scheme that resulted in taxpayers paying far more for people enrolled in the Medicare Advantage plans than those who remained in the traditional program. The extra cash enables insurers to offer benefits traditional Medicare doesn’t, like coverage for glasses and hearing aids, and to cap enrollees’ out-of-pocket expenses.


When the Affordable Care Act became law in 2010, the payments to Medicare Advantage plans exceeded traditional Medicare payments by 14 percent. To end what they considered an unfair advantage for private insurers, and to reduce overall spending on Medicare, Democrats who wrote the reform law included language to gradually eliminate the over-payments.  So far, the 14 percent disparity has been reduced to 2 percent.  The final reductions are scheduled to be made next year.


Despite that decrease, the fears by Republicans and insurance company executives that the reductions would lead to a steady decline in Medicare Advantage enrollees have proved to be completely unfounded. In fact, the plans have continued to grow at a fast clip.

In March 2010, the month Obamacare became law, 11.1 million people were enrolled in Medicare Advantage plans—one of every four people eligible for Medicare. That was an increase from the 10.5 million Medicare Advantage enrollees in March 2009. Since then, Medicare Advantage membership has grown by more than 8 percent annually. Now 17.3 million—one in three people eligible for Medicare—are enrolled in private plans.


As Center for Public Integrity senior reporter Fred Schulte has written over the past year, many insurers have discovered that even though the overpayments are being reduced, they can boost profits another way: by manipulating a provision of a 2003 law that allows them to get additional cash for enrollees deemed to be sicker than average.


A risk-coding program was put in place by the government primarily because insurers were targeting their marketing efforts to attract younger and healthier—and thus cheaper— beneficiaries. Under the risk-coding program, insurers are paid more to cover patients who are older and sicker; the idea was to encourage the firms to cover those folks by offering a financial incentive. They get more money, for example, to cover someone with a history of heart disease than they do for someone with no such risk.  Last week Schulte uncovered whistleblower accusations that a medical consulting firm and more than two dozen Medicare Advantage plans have been ripping taxpayers off by conducting in-home patient exams that allegedly overstated how much the plans should be paid.

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Could Well-Implemented IT Help Reverse Primary Care Physicians’ Skepticism Over the New Healthcare?

Could Well-Implemented IT Help Reverse Primary Care Physicians’ Skepticism Over the New Healthcare? | Healthcare and Technology news | Scoop.it

It was fascinating to read a new issue brief from the New York-based Commonwealth Fund published August 5, on primary care providers’ (both primary care physicians’ and mid-level practitioners’) perceptions of new payment models in healthcare.


The Commonwealth Fund, a “private foundation that aims to promote a high performing healthcare system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults,” had issued the brief, entitled “Primary Care Providers’ Views of Recent Trends in Health Care Delivery and Payment,” based on a survey of 1,624 primary care physicians and 525 mid-level clinicians (nurse practitioners and physician assistants).


The abstract to the issue brief notes that “A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment. Providers’ views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers’ experiences under the ACA’s coverage expansions and their opinions about the law.”


The core findings of the survey were that primary care physicians, far more than mid-level practitioners, expressed considerable skepticism about the new healthcare delivery and payment models, in particular the two that were asked about specifically—accountable care organizations and patient-centered medical homes; though those PCPs who had worked under ACO or PMCH arrangements were far more likely to agree that they offered the potential for improving the quality of care delivery to patients being cared for under those types of arrangements.


As to why a strong plurality of primary care physicians have negative perceptions of the potential for the value-based outcomes measures embedded in ACO and PCMH arrangements to improve quality and efficiency, Melinda Abrams, The Commonwealth Fund’s vice president for delivery system reform, told me, “To be honest, we don’t know why they don’t like the quality measures; we only know there’s a fair bit of dissatisfaction with the quality measures. When we asked physicians whether they thought the increased use of quality measures was impacting their ability to provide high-quality care, 50 percent were negative on that, and only 22 percent were positive. We also asked, are you receive quality incentive-based payments? That reflected the entire group, but even among those receiving incentive payments based on quality, 50 percent felt it was negative, and only 28 percent felt it was positive.”


Still, as the issue brief’s abstract noted, “The survey results indicate that primary care providers’ views of many of these new models are more negative than positive. There are exceptions: health information technology gets mostly positive views and medical homes receive mixed opinions with a positive tilt. With regard to HIT, our study indicates that primary care providers generally accept the promise of HIT to improve quality of care even if previous research shows they dislike the process of transitioning from paper-based records.8 Our survey results also may reflect clinicians’ earlier exposure to certain models and tools. National adoption of electronic health records received a boost from the Health Information Technology for Economic and Clinical Health (HITECH) Act of the federal stimulus package of 2009, while the four primary care specialty societies announced a joint statement regarding medical homes in February 2007, several years before passage of the Affordable Care Act.”


“Our results show that 50 percent of primary care providers say that healthcare IT is improving the quality of care they provide,” Abrams told me. “And what we’ve learned from other studies is this: other studies have found that providers generally accept the promise of HIT as a concept, even as they dislike the process of transitioning to electronic from paper. Our specific question was on the impact of their ability to provide high-quality care to their patients. It’s a more general question than about the transition. We weren’t asking about the transition. So half of physicians and two-thirds of mid-level providers see the advance of health IT as having a positive impact,” she noted.

What is inevitable is that clinicians, but most especially primary care physicians, will be demanding a great deal from the clinical and other information systems that are being implemented now to facilitate accountable care, population health management, and patient-centered medical home-based care.


As Abrams put it to me, “There’s nothing in the survey findings that would indicate that increased success with IT would improve their views of ACOs and medical homes; our findings don’t show that. But I would suspect that, to fulfill the promise of ACOs and PCMHs requires ease of use of IT and the data from that technology, the more they learn to use technology effectively to optimize patient care, yes, I believe they will become more positive about ACOs and patient-centered medical homes, yes. And more pieces will help them embrace ACOs and PCMHs.”


So such interpretations of survey data only help to reinforce what seemed apparent already: that healthcare IT leaders are facing a gigantic opportunity/risk proposition ahead of them, when it comes to clinical and other information systems supporting accountable care and population health management. Physicians, and primary care physicians in particular, are looking to those systems to carry them to the “promised land” of greater clinical effectiveness and practice efficiency, and to help them master the intricate challenges of succeeding in carrying out risk-based contracting in a high-pressure, high-stakes environment.


And this is in an environment in which we all know that the IT solutions offered by vendors, both major and smaller, still leave some things to be desired, and that tremendous amounts of customization are being required to make population health, analytics, clinical decision support, and other systems needed to make pop health and accountable care work, are being poured into those systems.


So the next few years inevitably are going to be filled with tension for healthcare IT leaders, as healthcare IT professionals work to get all the foundations, and the details, right, with those systems. But the light at the end of the tunnel is this: that, as primary care physicians become adept at using the increasingly-adept solutions that will be applied to population health- and accountable care-based clinical practice, primary care physicians’ perceptions not only of those tools, but of value-based care delivery and payment itself, will get better over time. And that will definitely significant for all of us, as we pursue the new healthcare in earnest.

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Premier, Inc. acquires healthcare analytics leader Healthcare Insights, LLC

Premier, Inc. acquires healthcare analytics leader Healthcare Insights, LLC | Healthcare and Technology news | Scoop.it

 Premier, Inc. (NASDAQ: PINC), a leading healthcare improvement company, today announced that it has acquired Healthcare Insights, LLC for $65 million in cash. Healthcare Insights is a privately-held,integrated financial management software developer that provides hospitals and healthcare systems with budgeting, forecasting, labor productivity and cost analytic capabilities.


“As the healthcare industry becomes more complex, value-driven, and data-dependent, the need for health systems to clearly understand their performance in every arena is a top concern,” said Keith J. Figlioli, Premier’s senior vice president of health informatics. “It is not enough to have financial, operational and clinical data. Health systems must understand how to translate that information into effective cost containment strategies, as well as superior clinical outcomes.”


The industry’s increased focus on cost is largely driven by the Affordable Care Act, which reduces overall reimbursement, and increasingly holds providers accountable for the total costs and quality of the care delivered. Coupled with the growing movement to value-based payments such as bundling or shared savings, healthcare providers need solutions that can help them understand cost drivers and opportunities for improvement in detail. Healthcare Insights is expected to enable Premier to offer a more complete solution that delivers additional value by adding budgeting, clinical financial management and productivity analytics to existing cost and quality applications, including the company’s enterprise resource planning (ERP) solution.


Thomas Johnston, Healthcare Insights’ chief executive officer, said, “This strategic combination will allow us to offer a more complete ERP solution with an end-to-end view of cost management. We expect this to increase our hospitals’ and health systems’ understanding of their clinical, operational and financial performance, and help them deliver more efficient, higher quality care.”


Founded in 2000, Healthcare Insights’ current customer base includes over 7,500 users across 200 facilities associated with 94 health systems, 49 of which do not currently have a relationship with Premier. KLAS, a leading research firm that provides ratings for more than 900 healthcare products and services, has ranked Healthcare Insights first place in budgeting for the past four years.


The Healthcare Insights acquisition, which was effective July 31, is currently projected to be modestly accretive to Premier’s fiscal 2016 revenue growth and adjusted EBITDA. Expected revenue and adjusted EBITDA contributions from the acquisition will be incorporated into Premier’s fiscal year 2016 guidance, which is scheduled to be announced on August 24, when the company reports fiscal fourth-quarter and full-year 2015 financial results.

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Medicare, Reversing Itself, Will Pay More for an Expensive New Cancer Drug

Medicare, Reversing Itself, Will Pay More for an Expensive New Cancer Drug | Healthcare and Technology news | Scoop.it

The Obama administration has decided that Medicare will pay for one of the newest, most expensive cancer medications, which costs about $178,000 for a standard course of treatment.

Patients, doctors, hospital executives and insurers have expressed concern about the high cost of prescription drugs, especially new cancer medicines and treatments tailored to the genetic characteristics of individual patients. Medicare officials recognized the cost and value of one such product, the anticancer drug Blincyto, by agreeing to make additional payments for it starting Oct. 1. The drug is made by Amgen for patients with a particularly aggressive form of leukemia.

The decision suggests a new willingness by Medicare to help pay for promising therapies that are still being evaluated. It is also significant because Medicare officials reversed themselves on every major scientific issue involved. After receiving pleas from Amgen and a dossier of scientific evidence, the officials agreed that the drug was a substantial improvement over existing treatments for some patients.

At issue are special “add-on payments” that Medicare makes to hospitals for new technology whose costs are not yet reflected in the standard lump-sum amounts that hospitals receive for treating patients with a particular disease or disorder.

In a preliminary decision in April, the Obama administration said it did not intend to pay extra for Blincyto because clinical studies were “not sufficient to demonstrate” that it substantially improved the treatment of Medicare patients with acute lymphoblastic leukemia, a cancer of the blood and bone marrow. Medicare officials said Amgen’s application was based on data from “a small sample group of patients whose age demographic is much younger than the age demographic of eligible Medicare beneficiaries.”

But in a final rule to be published in the Federal Register on Aug. 17, the administration says it received “additional information and input” from Amgen and other experts and now agrees with their arguments.

Blincyto “is not substantially similar” to other drugs available to leukemia patients, the administration said, and it “represents a substantial clinical improvement over existing treatment options.”

Jane E. Wirth, 59, of Reno, Nev., a former preschool teacher, said her cancer was in remission after 28 days of treatment with Blincyto, also known as blinatumomab.

“It was amazing to me that it could work so well so quickly,” Ms. Wirth said in an interview. “I had just spent a month going through standardchemotherapy, which did not make the cancer go away. It seemed so hopeless.”

The drug, engineered from two antibodies, harnesses the body’s immune system to help fight cancer. It brings certain white blood cells close to malignant cells so the blood cells can destroy the cancer cells.

Dr. Anthony S. Stein, a researcher at City of Hope National Medical Center in Duarte, Calif., who has treated more than 50 patients in clinical trials of Blincyto, said, “Its mechanism of action is totally different from that of any other approved drug.”

After the Food and Drug Administration approved Blincyto in December, Amgen said the price would be about $178,000 for the recommended two 28-day cycles of treatment, each followed by a two-week break. Medicare says it will now allow a “new technology add-on payment” to hospitals for a fraction of that amount, up to $27,000. Actual payments will vary based on the length of a patient’s hospital stays.

A cycle of treatment begins with intravenous infusions in a hospital. Patients typically continue treatments outside the hospital — at doctor’s offices, at infusion centers or at home, with the help of specially trained nurses — and Medicare will help pay for the drug at those sites, too.

The prices of new cancer drugs often exceed $100,000 a year.

Health policy experts said that President Obama had personally expressed concern in recent weeks about high drug prices and their impact on consumers and federal programs. In February, he asked Congress to authorize the secretary of health and human services to negotiate with manufacturers to determine prices for high-cost medicines taken by Medicare beneficiaries.

poll by the Kaiser Family Foundation released last month found that 94 percent of Democrats and 84 percent of Republicans support allowing the federal government to negotiate with drug makers to get lower prices on medications for those beneficiaries.

Dr. Steven M. Safyer, president of Montefiore Medical Center in the Bronx, said the Obama administration should use its influence with drug companies to restrain costs. “There are a number of very important breakthroughs with pharmaceuticals that can make a difference between life and death, and the price is too high,” he said.

More than 100 oncologists from cancer hospitals around the country recently issued a manifesto decrying the prices of new drugs.

“Effective new cancer therapies are being developed by pharmaceutical and biotechnology companies at a faster rate than ever before,” they said in a commentary in the journal Mayo Clinic Proceedings. But, they added, “the current pricing system is unsustainable and not affordable for many patients.”

Robert E. Zirkelbach, a spokesman for Pharmaceutical Research and Manufacturers of America, the lobby for drug makers, said that new spending projections issued by the government in July undercut such claims.

“Even with new treatments and cures for hepatitis C, high cholesterol and cancer,” Mr. Zirkelbach said, “spending on retail prescription medicines is projected to remain approximately 10 percent of U.S. health care spending through 2024, the same percentage as in 1960.” In the last two decades, he added, the cancer death rate has fallen 22 percent, thanks in part to new medicines.

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HIPAA Physical Security is Just as Important as Cyber-Security

HIPAA Physical Security is Just as Important as Cyber-Security | Healthcare and Technology news | Scoop.it
HIPAA Physical Security is Just as Important as Cyber-Security

There are many misconceptions when it comes to HIPAA and security controls for covered entities. While security is related to technical measures such as encryption, firewalls, and security risk assessments, it also addresses physical and administrative safeguards that must be in place to protect patient information. In order to comply with HIPAA regulation, healthcare organizations must address each standard and safeguard outlined in the HIPAA Security Rule.

 

The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has now released new information further emphasizing the importance of physical safeguards for healthcare organizations across the country. HIPAA not only requires technical controls to protect the confidentiality, integrity, and availability of protected health information (PHI) but also proper physical security controls.

 

Physical safeguards are generally seen as the simplest and cheapest forms of protecting PHI, yet many organizations tend to overlook this important element of security. There are even some physical security controls that cost nothing- such as simply locking up portable electronic devices when they are not in use (laptops, portable storage devices, and pen drives).

 

Although this may seem like a very basic form of security, it is one of the most effective ways of preventing theft. To illustrate the importance of HIPAA physical security safeguards, OCR focuses on a 2015 HIPAA settlement with Lahey Hospital and Medical Center that affected 599 patients. This breach and subsequent HIPAA fine were triggered by the theft of an unencrypted laptop from the Tufts Medical School-affiliated teaching hospital.

 

The laptop was stolen from an unlocked treatment room off an inner corridor of the radiology department and contained ePHI. Lahey Hospital was fined $850,000 for failing to implement physical controls–a high price to pay for something that could have been avoided if some simple physical security safeguards were in place.

 

Prior to the Lahey Hospital settlement, QCA Health Plan paid $250,000 to OCR in 2014 for potential HIPAA violations. QCA Health Plan neglected to implement physical safeguards for all workstations to restrict access to ePHI to authorized users only. In this case, an unencrypted laptop was stolen from an employee’s vehicle.

 

Massachusetts Eye and Ear Infirmary (MEEI) also settled a HIPAA violation with OCR in 2012 for $1.5 million. Again, this incident was related to the theft of an unencrypted laptop, resulting in the exposure of patients’ ePHI.

 

In 2016, Feinstein Institute for Medical Research settled potential HIPAA violations with OCR for $3.9 million. Feinstein Institute failed to physically secure a laptop that was stolen from an employee’s vehicle containing the ePHI of 13,000 patients.

 

In July 2016, the University of Mississippi Medical Center was fined $2,750,000 for a failure to implement HIPAA physical security safeguards. An unencrypted laptop that contained ePHI of approximately 10,000 patients was stolen from its Medical Intensive Care Unit.

Preventing HIPAA Physical Security Breaches

It is up to covered entities and their business associates to decide on the most appropriate physical security safeguards that will protect their patients’ ePHI. One way organizations can implement these physical security controls is by adopting an effective compliance program.

 

Compliance Group gives health care organizations confidence in their HIPAA compliance with The Guard. The Guard is our HIPAA compliance web-app that covers every element of HIPAA compliance.

 

Our Compliance Coaches will guide users through every step of their compliance program with the help of our HIPAA compliance web-app. The Guard is built to address the full extent of HIPAA regulation, including everything needed to implement an effective HIPAA compliance program that will help safeguard your practice from violations and fines.

 

With The Guard, health care professionals will not only address their physical security safeguards but the technical and administrative safeguards as well, along with the other HIPAA requirements.

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Information Risk Management Still Needs Improvement

Information Risk Management Still Needs Improvement | Healthcare and Technology news | Scoop.it

Cybersecurity threats and attacks across various business sectors are on the rise pressuring for organizations to continuously assess the risks to any information. While the General Data Protection Regulation (GDPR) has garnered a lot of buzz in 2018, many standards and regulations in the United States also require cybersecurity.

 

But what are the technical details and operational steps needed to meet the high level guidance on cybersecurity risk? A recent Advisen survey revealed some interesting statistics:

 

  • 35% of respondents rated data integrity risks as “high risk” versus only 22% that of rated business continuity risks, or cyber related business interruption
  • Only 60% of the risk professionals surveyed said their executive management team viewed cyber risk as a significant threat to the organization, down 23% from the previous year.
  • Only 53% knew of any updates or changes even after the 2017 high profile attack

 

In short, these statistics paint a grim picture over the state of cybersecurity in the United States. While organizations are aware of the high risk of cyber attacks, management team involvement may be decreasing, and organizations may not be evolving their cybersecurity programs quickly enough.

 

Creating a Security First Risk Mitigation Posture
Many organizations have moved to a risk analysis security first compliance posture to enable stronger risk mitigation strategies and incorporate senior management oversight. However, identifying the potential risks to your environment only acts as the first step to understanding your overall risk. In order to identify all potential risks and engage in a full risk analysis that appropriately assesses the overall risk facing your data, you need to incorporate vendor risk as part of your risk management process.

 

That’s a lot of risk discussion, but you also have a lot of places in your overarching ecosystem that create vulnerabilities. Using a risk management process that establishes a security-first approach to your organization’s data environment and ecosystem means that you’re locking down potential weaknesses first and then backtracking to ensure you’ve aligned controls to standards and regulations. This approach, although it seems backward from a traditional compliance point-of-view, functions as a stronger risk mitigation program by continuously monitoring your data protection to stay ahead of hackers. Standards and regulations mean well, but as malicious attacks increasingly become sophisticated the best practices within these documents may be outdated in a single moment.

 

What is an Information Risk Management (IRM) Program?
An information risk management (IRM) program consists of aligning your information assets to a risk analysis, creating IRM policies that formalize the reasoning and decisions, and communicating these decisions with senior management and the Board of Directors. The National Institute of Standards and Technology (NIST) and the International Standards Organization (ISO) both provide guidance for establishing an IRM.

 

For example, the September 2017 NIST update to NIST 800-37 focuses on promoting information security by recognizing the need for organizational preparation as a key function in the risk mitigation process.

 

In fact, the core standards organization, ISO, updated its ISO 27005 in July 2018 to focus more on the information risk management process.

 

Specific to the United States, the Committee of Sponsoring Organizations of the Treadway Commission (COSO) updated it enterprise risk management framework to minimize data threats while requiring organizations to detail potential risks and manage risks more proactively.

 

As risk analysis increasingly drives information security practices, you need to focus on a risk treatment program that begins with risk identification, establishes an acceptable level of risk, defines your risk treatment protocols, and create risk mitigation processes.

 

Create an Information Risk Management (IRM) Team
In order to appropriately manage risk, you need to create an IRM Team consisting of stakeholders across the organization. Relying solely on your IT department may leave gaps in the process. To determine the stakeholders, you should explore the departments integral to risk identification. For example, you might want to ask yourself:

 

  • What departments hire vendors?
  • What departments can help with the overall risk process?
  • What stakeholders are legally required (in the United States) to be informed of the risk process?
  • Who brings unique insights into the risks that affect my data environment and ecosystem?

 

For example, while your IT department sets the controls that protect your information, your human resources department handles a lot of sensitive data. You need to incorporate stakeholders who understand the data risks unique to their role in your organization so that they can work with your Chief Information Officer and Chief Information Security Officer. Additionally, many United States regulations, such as the Sarbanes-Oxley Act of 2002 (SOX) require senior management and Board of Director oversight so they should also be included as part of your IRM team.

 

Begin with Business Processes and Objective
Many organizations forget that businesses processes and organizational business objectives should be the baseline for their risk analysis. Senior management needs to not only review the current business objectives but think about the future as part of the risk identification process. Some questions to ask might include:

 

  • What businesses processes are most important to our current business objectives?
  • Do we want to scale in the next 3-5 years?
  • What business processes do we need to meet those goals?

 

Understanding the current business objectives and future goals allows organizations to create stronger risk mitigation strategies. Many organizational goals rely on adding new vendors whose software-as-a-service products enable scalability. Therefore, you need to determine where you are as well as where you want to be so that you can protect the data that grows your organization and choose vendors who align with your acceptable level of risk.

 

Catalogue Your IT Assets
The next step in the risk analysis process requires you to look at all the places you transmit, store, or access data. This step often becomes overwhelming as you add more cloud storage locations that streamline employee workflows. Some questions to ask here might include:

 

  • What information is most critical to my business processes?
  • What servers do I store information on?
  • What networks does information travel over?
  • What devices are connected to my servers and networks?
  • What information, servers, networks, and devices are most essential to my targeted business processes?
  • What vendors do I use to management my data?

 

Review Your Potential Risks from User Access
Once you know what information you need to protect and where it resides, you need to review the users accessing it. Using multi-factor authentication and maintaining a “need to know” access protocol protects your information.

 

  • Who accesses critical information?
  • What vendors access your systems and networks?
  • Does each user have a unique ID?
    Can each user be traced to a specific device?
  • Are users granted the least authority necessary to do their jobs?
  • Do you have multi-factor authentication processes in place?
  • Do users have strong passwords?
  • Do you have access termination procedures in place?

 

These questions can help you manage risks to critical information because employees lack password hygiene or decide to use the information maliciously upon employment termination.

 

Establish An Acceptable Level of Risk
Once you’ve completed the risk identification process, You need to review what risks you want to accept, transfer, refuse, or mitigate. To determine the acceptable level of risk, you may want to ask some questions such as:

 

  • What is an acceptable level of external risk to my data environment?
  • What is an acceptable level of risk arising out of vendor access?
  • How do I communicate the acceptable level of risk to senior management?
  • How can I incorporate my acceptable level of risk in service level agreements (SLAs) with my vendors?
  • Can I quantify the acceptable level of risk I have assumed as part of my risk analysis?

 

Your information risk management (IRM) process needs to incorporate the full level of tolerances and strategies that protect your environment. In some cases, you may decide that a risk is unacceptable. For example, you may want to limit consultants from accessing your corporate networks and servers. In other instances, you may need to find ways to mitigate risks with controls such as password management or a Bring-Your-Own-Device policy.

 

Define the Controls That Manage Risk
Once you’ve set the risk tolerance, you need to define controls that manage that risk. This process is also called risk treatment. Your data ecosystem can leave you at risk for a variety of data breach scenarios, so you need to create information risk management (IRM) policies that outline your risk treatment decisions. In doing this, you need to question:

 

  • What firewall settings do I need??
  • What controls protect my networks and servers?
  • What data encryption protects information in transit across my networks and servers?
  • What encryption protects the devices that connect to my systems and networks?
  • What do I need to make sure that all vendor supplied passwords are change?
  • What protects my web applications from attacks?
  • What do I need from my vendors as part of my SLAs to ensure they maintain an acceptable level of security?

 

Defining your controls includes everything from establishing passwords to requiring anti-malware protection on devices that connect to your systems and networks. Creating a clearly defined risk treatment program enables a stronger security-first position since your IRM policies focus on protecting data proactively rather than reactively changing your security controls after a data event occurs.

 

Tracking the Risks With IRM Policies
Creating a holistic security-first approach to risk treatment and management means using IRM policies to help create a risk register. A risk register creates a tracking list that establishes a mechanism for responding to security threats. Your IRM policies, which should outline the entire risk management process, help establish the risk register by providing the list of risks monitored and a threat’s impact.

 

Although this process seems intuitive, the larger your environment and ecosystem, the more information you need to track. As you add vendors and business partners, you increase the risk register’s length making threat monitoring cumbersome.

 

How SecurityScorecard Enables the Information Risk Management Process
SecurityScorecard continuously monitors threats to your environment across ten factors: application security, DNS health, network security, patching cadence, endpoint security, IP reputation, web application security, cubit score, hacker chatter, leaked credentials, and social engineering.

 

Using these ten factors, organizations can streamline the risk management process. A primary hassle for those engaging in the risk management process lies in defining risks and establishing definitions for controls that mitigate overall risk. The ten factors remove the burden of identifying both risks to the environment and ecosystem as well as controls that mitigate risk. Moreover, you can use these same ten factors to quantify your risk monitoring and reaction, as well as the security of your vendors.

 

SecurityScorecard’s continuous monitoring tool can help alleviate bandwidth problems and help facilitate a cybersecurity program more in line with the sophisticated cyberthreat landscape.

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Empower Patients With StrongBox Payment Portal & Patient Financing Alternatives

Empower Patients With StrongBox Payment Portal & Patient Financing Alternatives | Healthcare and Technology news | Scoop.it

Customer churn. The phrase refers to the periodic loss of patients and the gaining of new clients. One way to ensure that churn works in your office’s favor is to empower your customers through our online financing portal. StrongBox, a leading platform as a service (PaaS) provider based in Boca Raton, FL, understands that when patients have the freedom to finance their procedures at a time and place of their choosing they are more likely to follow through with timely payments.

 

Why Customer Empowerment Matters
We all live busy lives, and patients are no different. No matter how welcoming and friendly your clinic is, patients are always mindful of their next appointments. One way StrongBox allows your clinic to empower patients is through our online financing portal. Instead of requiring your customers to fill out lengthy forms in the office, they simply need to sign on through our online portal to apply for financing from top lenders. By allowing your patients to choose when they apply, you are showing that you respect their valuable time. Plus, the online platform reduces wait time in your office.

 

A 2016 article in the Journal of Dental Hygiene found that long wait times in office have a measurable “negative effect” on patients’ satisfaction with their dentist and lowers patient return rates.

 

How StrongBox Empowers Your Patients
In addition to our revenue recognition cloud-based platform and our Payment Portal, StrongBox also offers two financing options, Select and Pro, that are accessible at the office or to be completed by the patient when they have the time to complete the less than 5 minute application process. The application process is paperless and offers instant access to an easy to use online financing application form. By partnering with StongBox, your patients will benefit from: 

  • Fixed-rate loans
  • No hidden markups
  • No interest hikes for late payments
  • No impact on credit score
  • Access to top-tier lenders (Discover, OneMain, Ascend)
  • Fast response from lenders
  • Easy application process
  • Hassle-free payments
  • Set monthly payments

 

Small- to medium-sized providers will benefit from our Select financing option. This service gives patients access to 30 lenders simultaneously. Select financing applications are approved at twice the rate as medical credit card applications. Both forms of application take less than five minutes for patients to complete.

 

Larger groups and networks may be best served with our Pro patient financing option. Our cloud-based platform can analyze your patients’ credit characteristics and rank them accordingly. Once approved, your clinic will receive funds within 24 hours.

 

More options for patients means a greater likelihood of compliance with billing, accelerating revenue recognition and reducing collection risk for the provider.  Many patients already experience anxiety over medical bills and non-payment is a healthcare system issue. In fact, a recent survey found that 79 million Americans have trouble paying medical bills and medical debt. Why not turn those worried patients into informed allies. The StrongBox model has a proven track record. Hospitals and clinics that use Pro and Select plans can see their collection rate increase from 15 to 70 percent to best practices 95 percent over the near term.


Learn How Our Online Platform Can Grow Your Business
Once your office begins using our online financing platform and payment portal, you can enjoy the benefits of our prompt customer support and proven return on investment. The freedom delivered by our revenue recognition platform and financing options means that your patients will feel empowered to handle payments on their terms while your team of oral health professionals can spend more time focusing on what you do best — serving patients.

 

If you have questions about StrongBox’s financing services, contact our team online or call our Boca
Raton, FL office at (855) 468-7876.

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4 Things to Know About Telehealth

4 Things to Know About Telehealth | Healthcare and Technology news | Scoop.it

Telehealth has emerged as a critical tool in providing health care services. [1] The practice covers a broad range of medical technology and services that collectively define the discipline. Telehealth is especially beneficial for patients who live in rural communities and other remote areas where medical professionals use the Internet to gather and share information as well as monitor the health conditions of patients by using peripheral equipment and software such as video conferencing devices, store-and-forward imaging, and streaming media. The following information details important factors that are shaping this burgeoning field.

 

The Changing Face of Telehealth Law
Today’s competitive health care marketplace has created an environment where patients demand lower costs, higher service quality, and convenient access to services. [2] Telehealth is an innovative and valuable mechanism that provides patients with efficient access to quality services. Lowering costs and removing barriers to service access, are critical components in promoting patient wellness and population health. Convenience and cost-effectiveness are important commodities in the modern health care marketplace, as patients tend to avoid treatment that is difficult to access or too expensive. As a result, telehealth technology is emerging as a preferred choice among patients and providers. Telehealth has also attracted the attention of US legislators. They utilize this tool for improving the competitiveness of American health care services. This is especially important, seeing as health care represents 17 percent of the nation’s gross domestic product (GDP). In fact, the resource has helped to define the role that lawmakers play in ensuring that patients benefit in a competitive health care market.

 

Reimbursement for Services Delivered by Telehealth
The laws regarding reimbursements change regularly as more service providers incorporate telehealth technology into their practices. Reimbursement procedures can vary by state, practice, insurer, and service. [3] Care providers need to understand several facts, regulations, and laws to navigate Medicare telehealth reimbursements. They must first scrutinize whether the distance between the facility (the originating site) and the patient is far enough to qualify as a distant site. The location must also qualify as a Health Professional Shortage Area (HPSA) per Medicare guidelines. Additionally, the originating site must fall under Medicare’s classification as a legally authorized private practice, hospital, or critical access hospital (CAH). For instance, the Centers for Medicare and Medicaid Services ranks the Harvard Street Neighborhood Health Center as a top facility in need of physician services based on these criteria. Care providers must also use proper insurance coding to be reimbursed for hosting services that use telehealth technologies. For now, collecting reimbursements for telehealth services remains simpler for practitioners who limit the scope to which they apply the technology.

 

Telehealth or Telemedicine?
The term ‘telehealth’ is gaining popularity among medical professionals, compared to the original term, ‘telemedicine.’ [4] Some medical professionals use the names interchangeably. However, telemedicine is a term that may apply to the application of any technology in the clinical setting, while telehealth more distinctly describes the delivery of services to patients. Telemedicine is a familiar term, but telehealth more appropriately describes the latest trends in using technology to deliver treatments to patients. Depending on the organization, service providers may use a different definitions of telehealth. Although the basic premise remains similar, the context may change according to factors such as organizational objectives, and the needs of the patient population being served. Medical experts do agree on one point; telehealth is an innovative way of engaging patients, and it is highly beneficial for both providers and patients.

 

The Road Ahead
There are several areas where telehealth medicine could make a significant impact. It could be used as a tool to remotely monitor patients who have recently been discharged. It may also help treat individuals with behavioral health issues who might normally avoid treatment due to its high cost, or to avoid any perceived public stigma. [5] The largest area where technology could advance medicine is in treating the chronically ill. These patients usually require many visits with several specialists who may practice at different and distant originating sites. To move telehealth forward, organizational leaders must present evidence to peers and patients that the technology offers value. In addition, care providers must work to transition patients from using telehealth services only for minor conditions (for headaches, colds, etc.), to accepting the technology as a viable replacement for costly physician office visits. Advocates for telehealth medicine must also develop quality controls, so that this potentially transformational tool can maximize its problem solving capabilities and its service effectiveness. To harness the benefits of telehealth technology, America’s brightest medical professionals (both experienced and up-and-coming) must make a concerted effort to incorporate the tool into their practices and make it a regular service offering. Today’s medical students — as they enter a world where telehealth is becoming more pervasive — can take part in what might be a monumental change in the way health professionals think about medical treatment.

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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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AI must overcome data challenges to reach healthcare potential 

AI must overcome data challenges to reach healthcare potential  | Healthcare and Technology news | Scoop.it

Dive Brief:

  • Rapid digitization of health information in EHRs and other repositories is creating new opportunities for AI in healthcare, but challenges in data accessibility, privacy and security persist, according to a new ONC report.
  • Frustration with legacy medical systems, the omnipresence of networked smart devices and consumer comfort with at-home services offered by Amazon and other tech vendors is driving interest in AI's potential.
  • Smartphone, social and environmental data can all be potential sources to fuel AI's use in healthcare. However, the report concludes such data must be high quality and reliable. Otherwise, AI's promise will not be realized in healthcare.

Dive Insight:

AI is a hot healthcare topic but still needs to be translated into reality, especially in an industry as complex as healthcare. 

During the second quarter of 2017, CB Insights counted 29 investment deals in the healthcare AI space — a record number — and predicted 2017 would set a six-year high.

 

Enthusiasm is expected to stay heated into 2018, with demand for tools that go beyond noting social determinants of health to using that data to inform patient care plans.

 

While investors will continue to fund wearables and biosensors, what grabs their attention are specific clinical use cases these technologies can support, Megan Zweig, director of research at Rock Health, told Healthcare Dive recently.

 

Tech giants including IBM Watson, Microsoft, Google and Apple are staking a claim in the space, too. Last month, Google launched Deep Variant, an open-source tool that uses AI to create a picture of a person’s genetic blueprint using sequencing data. The goal is to pinpoint specific genes or gene mutations that can help providers better manage disease states.

 

But challenges to widespread use of AI in health remain, as the ONC study shows. Among these are the acceptance of AI applications in clinical practice, difficulty leveraging divergent personal networked devices and AI solutions, access to quality training data on AI applications in health and gaps in data streams.

 

The report belies a large obstacle for rampant AI use. White noting the importance of high quality and reliable data, the industry has a data standards problem at the moment which needs to be ironed out. 

 

Currently, different vendors and clinicians send unstructured data in medical records back and forth across EHR systems through continuity-of-care documents, which are format flexible. If the promise of AI relies on reliable data, standards will have to be well-defined to ensure the data are high quality.

 

On the bright side, the industry seems aware that healthcare is close to a breaking point at interoperability. The growing Internet of Things and consumerism in healthcare naturally demands a more networked, connected industry approach. 

 

CMS Administrator Seema Verma in a town hall webcast on Wednesday with American Hospital Association CEO and President Rick Pollack said interoperability will be a topic of interest for the agency. She told listeners they will hear more from CMS in the future.

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Could On Demand Medical Services Be Good for Doctors?

Could On Demand Medical Services Be Good for Doctors? | Healthcare and Technology news | Scoop.it

I’ve been seeing a lot of discussion lately about the peer sharing economy and how it applies to healthcare. Some people like to call it the Uber of healthcare, but that phrase has been applied so many ways that it’s hard to know what people mean by it anymore. For example, is it Uber bringing your doctor to your home/work or is it an Uber like system of requesting healthcare? There are many more iterations.


I’ll to consider doing a whole series of posts on the Peer Sharing Economy and how it applies to healthcare. There’s a lot to chew on. However, most recently I’ve been chewing on the idea of on demand medical services. In most cases this is basically the Skype or Facetime telemedicine visit on a mobile device. These models are starting to develop and it won’t be long until all of us can easily hop on our mobile device and be in touch with a doctor directly through our phone. In some cases it will be a telemedicine visit. In other cases it might be the doctor coming to visit you. I’m sure we’ll have a wide variety of modalities that are available to patients.


Every patient loves this idea. Every insurance company is trying to figure out the right financial model to make this work. Most doctors are scared at what this means for their business. Certainly there are reasons for them to be concerned, but I believe that this new on demand medical service could be very good for doctors.


In our current system practices do amazing scheduling acrobatics to ensure that the doctor is seeing a full schedule of patients every day. They do this mostly because of all the patient no shows that occur. This makes life stressful for everyone involved. Imagine if instead of double booking appointments which leads to all sorts of issues, a doctor replaced no show appointments with an on demand visit with a patient waiting to be seen on a telemedicine platform. Basically the doctor could fill their “free time” with on demand appointments instead of double booking appointments which then causes them to get behind when both appointments do show up.


I can already hear doctors complaining about them being “mercenaries” and shouldn’t they be allowed free time to grab a coffee. I’d argue that in the current system they are mercenaries that are trying to fill their schedule as full as possible. The current double booking scheduling approach that so many take means that some days the doctor has a full schedule of appointments and some days they have more than a full schedule of appointments. If doctors chose to back fill no-shows with on demand appointments, then their schedule would be more free than it is today. Plus, if they didn’t want to back fill a no show, they could always make that choice too. That’s not an option in the double book approach they use today.


In fact, if there was an on demand platform where doctors could go and see patients anytime they wanted to see patients, it would open up a lot more flexibility for doctors much like Uber has done for drivers. Some doctors may want to work early in the morning while others want to work late at night. Some doctors might want to take off part of the day to see their kid’s school performance, but they can work later to make up for the time they took off (if they want of course).


Think about retired doctors. I’m reminded of my pharmacist friend who was still working at the age of 83. I asked him why he was still working at such an advanced age. He told me, “John, if I stop, I die.” I imagine that many retired doctors would love to still see some patients if they could do it in a less demanding environment that worked with their new retirement schedule. If there was an on demand platform where retired doctors could sign in and see patients at their whim, this would be possible. No doubt this is just one of many examples.


Currently there isn’t an on demand platform that doctors could sign into and see a patient who’s waiting to be seen. No doubt there are many legal, financial and logistical challenges associated with creating a platform of this nature. Not the least of which is that doctors are only licensed to practice in specific states. This is a problem which needs to be solved for a lot of reasons, but I think it will. In fact, I think that legal issues, reimbursement changes, and other logistical challenges will all be solved and one day we’ll have this type of on demand platform for healthcare. Patients will benefit from such a platform, but I believe it will open up a lot more options for doctors as well.

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Google Glass Shown Beneficial for Bedside Toxicology Consults

Google Glass Shown Beneficial for Bedside Toxicology Consults | Healthcare and Technology news | Scoop.it

Although Google Glass may have been pulled as a product for the masses, Alphabet plans on continuing to develop the device for professional applications. And it’s certainly proving itself useful in medicine, as a new study in Journal of Medical Toxicology has shown that it’s useful and effective for tele-toxicology consults. The project involved emergency medicine residents who wore Glass during evaluations of poisoned patients while toxicology fellows and attendings in a remote location participated in the consults via a video connection. They essentially set back and reviewed the findings of the emergency docs, offering advice as necessary.


The study looked at how everyone involved accepted the use of the communication medium, as well as how it affected the care provided. Interestingly, the toxicologists changed their opinions of how to treat the patients in 56% of cases after using Glass. In six cases the antidote that was prescribed was accurately selected only after using Glass. In 11 of cases the connection was too poor for usability, but that can probably be attributed to the network used.

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Hospitals work on allowing patients to actually sleep

Hospitals work on allowing patients to actually sleep | Healthcare and Technology news | Scoop.it

It's a common complaint — if you spend a night in the hospital, you probably won't get much sleep. There's the noise. There's the bright fluorescent hallway light. And there's the unending barrage of nighttime interruptions: vitals checks, medication administration, blood draws and the rest.

Peter Ubel, a physician and a professor at Duke University's business school, has studied the rational and irrational forces that affect health. But he was surprised when hospitalized at Duke -- in 2013 to get a small tumor removed -- at how difficult it was to sleep. "There was no coordination," he said. "One person would be in charge of measuring my blood pressure. Another would come in when the alarm went off, and they never thought, 'Gee if the alarm goes off, I should also do blood pressure.'"

"From a patient perspective," he added, "you're sitting there going, 'What the heck?'"

As hospitals chase better patient ratings and health outcomes, an increasing number are rethinking how they function at night — in some cases reducing nighttime check-ins or trying to better coordinate medicines — so that more patients can sleep relatively uninterrupted.

The American Hospital Association doesn't formally track how many hospitals are reviewing their patient-sleep policies, though it's aware a number are trying to do better, said Jennifer Schleman, an AHA spokeswoman.

And, though few studies specifically link quality of shut-eye and patient outcomes, doctors interviewed said the connection is obvious: patients need sleep. If they get more of it, they're likely to recover faster.

    Traditionally, hospitals have scheduled a number of nighttime activities around health professionals' needs — aligning them with shift changes, or updating patient's vital signs so the information is available when doctors make early morning rounds. Both the sickest patients and those in less serious condition might get the same number of check-ins. In some cases, that can mean patients are being disturbed almost every hour, whether medically necessary or not.

    "The reality for many, many patients is they're woken up multiple times for things that are not strictly medically necessary, or...multiple times for the convenience of staff," said Susan Frampton, president of Planetree, a nonprofit organization that encourages health systems to consider patient needs when designing care.

    Changing that "seems like kind of easy, low-hanging fruit," said Margaret Pisani, an associate professor at Yale School of Medicine. She is working with other staff at the Yale hospital to reduce unnecessary wake-ups, using strategies like letting nurses re-time when they give medicines to better match patient sleep schedules, changing when floors are washed or giving nurses checklists of things that can and should be taken care of before 11 p.m.

    Not only is the push for better patient sleep part of a larger drive to improve how hospitals take care of their patients, but it is fueled in part by measures in the 2010 health law tying some Medicare payments to patient approval scores. As more hospitals try to improve those numbers, experts said, more will likely home in on improving chances for a good night's sleep.

    "There's a movement toward patient-centered care, and this is definitely a part of it," said Melissa Bartick, an assistant professor at Harvard Medical School.

    That focus makes sense, since federal patient approval surveys specifically ask about nighttime noise levels. A number of hospitals initially struggled to get good scores on that, said Richard Evans, chief experience officer at Boston-based Massachusetts General Hospital.

    His hospital instituted quiet hours -- a couple of hours in the afternoon and between six and eight hours at night, depending on the hospital unit, in which lights are turned low and staff encouraged to reduce their noise levels. It also encourages staff members to consider whether patients really need particular care at night before waking them. "We're trying to [increase awareness] that patients need to rest, and we need to structure our care as much as possible to allow that to happen."

    It's hard to delineate the degree to which such efforts have affected patient approval scores, Evans said. Anecdotally, though, patients have expressed appreciation, he added.

    The Department of Veterans Affairs New Jersey Health Care System is taking this concern even further. In addition to quiet-time restrictions, in which they try to reduce the use of noisy equipment, staff chatter and things like phone volume, patients can opt to have lavender oil sprayed in their rooms or an evening cup of herbal tea to facilitate sleep.

    All of these kinds of changes can help, said Planetree's Frampton. But they don't get at the real problem for most patients.

    "Low scores on quiet-at-night [questions on patient suarveys] are not because it's overly noisy...but because patients are woken up repeatedly," she said. "Their sleep is disturbed so they're lying awake."

    To address that, hospitals may need to look at less obvious questions. At New York's Mount Sinai Hospital, doctors are rethinking when they prescribe medicines as well as what kind, said Rosanne Leipzig, a professor of geriatrics and palliative medicine and who practices at the hospital. For instance, some antibiotics can be given at six-hour intervals rather than four-hour intervals, reducing the need for nighttime interruptions. And some drugs usually given every six hours can instead be given four times a day during the hours patients are usually awake.

    The hospital is also working to develop a system to classify patients who need repeated checks from the medical staff, such as those who might face imminent health threats or are at risk for serious infections such as sepsis. For those patients, frequently checking vitals is important, even if patients sleep less, Leipzig said. But not every patient's condition requires that they be roused every four hours, she added.

    About half of all patients woken up for vitals checks probably don't need to be, according to a 2013 study published in JAMA Internal Medicine. The study suggests waking those patients may contribute to bad patient results and dissatisfaction, and could increase the odds of patients having to come back to the hospital.

    Another study, published in 2010 in the Journal of Hospital Medicine, looked at efforts to encourage patient sleep — particularly by rescheduling activities, nighttime checks and overnight medication doses so as not to wake patients. That paper, co-written by Bartick, the Harvard professor, found a 49% drop in the number of patients who were given sedatives. That can have the added benefit of improving patient outcomes, since sedatives are associated with dangerous side effects such as falling or hospital delirium or confusion.

    "Sleep disruptions are actually not benign as far as patients are concerned," said Dana Edelson, an assistant professor of medicine at the University of Chicago and an author on the 2013 study. "We're putting them at unnecessary risk when we're waking them up in the middle of the night when they don't need to be." And possibly making the recovery a bit more difficult.

    "Patients will tell you, 'I was so exhausted, I couldn't wait to get home and go sleep,'" said Yale's Pisani.

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    National Quality Forum Urges Providers Forward on Data and Analytics in Healthcare

    National Quality Forum Urges Providers Forward on Data and Analytics in Healthcare | Healthcare and Technology news | Scoop.it

    On Aug. 6, the Washington, D.C.-based National Quality Forum released a white paper, “Data Needed for Systematically Improving Healthcare,” intended to highlight strategies to help make healthcare data and analytics “more meaningful, usable, and available in real time for providers and consumers.”


    According to a press release issued on that date, “The report identifies several opportunities to improve data and make it more useful for systematic improvement. Specific stakeholder action could include the government making Medicare data more broadly available in a timely manner, states building an analytic platform for Medicaid, and private payers facilitating open data and public reporting. In addition, electronic health record (EHR) vendors and health information technology policymakers could promote “true” interoperability between different EHR systems and could improve the healthcare delivery system’s ability to retrieve and act on data by preventing recurring high fees for data access.”


    The press release noted further that “The report identifies actions that all stakeholders could take to make data more available and usable, including focusing on common metrics, ensuring that the healthcare workforce has the necessary tools to apply health data for improvement, and establishing standards for common data elements that can be collected, exchanged, and reported.”


    The report emerged out of an initiative supported by the Peterson Center on Healthcare and the Gordon and Betty Moore Foundation, and spurred by a 2014 report by the President’s Council of Advisors on Science and Technology that called for systems engineering approaches to improve healthcare quality and value.


    The press release included a statement by Christine K. Cassel, M.D., president and CEO of NQF. “Data to measure progress is fundamental to improving care provided to patients and their outcomes, but the healthcare industry has yet to fully capture the value of big data to engineer large-scale change,” Dr. Cassel said in the statement. “This report outlines critical strategies to help make data more accessible and useful, for meaningful system wide improvement.” 

    Following the publication of the report, Rob Saunders, a senior director at the National Quality Forum, and one of the co-authors of the report, spoke with HCI Editor-in-Chief Mark Hagland about the report and its implications for healthcare IT leaders. Below are excerpts from that interview.


    What do you see as the most essential barriers to moving forward to capture and correctly use “big data” for clinical transformation and operational improvement in healthcare?

    There are sort of two buckets we looked at through this project. We looked at the availability of data, and we’re seeing more availability of electronic data. Interoperability remains a major challenge. But it wasn’t just about interoperability between electronic health records, but also being able to link in data from elsewhere.


    Does that mean data from pharmacies, from medical devices, from wearables?

    Some of these may be kinds of data from community health centers, or folks offering home-based and community-based services. So, getting a broader picture of people’s health, as they’re living their lives in their communities. And there are exciting things on the horizon, too, like wearable devices. But the first barrier we heard about was just getting more availability of data. Perhaps the harder problem right now is actually using more data, and turning that raw data into meaningful information that people can use. There’s so much raw data out there, but it so often is not actionable or immediately usable to clinicians.


    So what is the solution?

    That is an excellent question. Unfortunately, there’s no silver bullet. We’ve looked at a wide range of possible solutions, but it will take action from healthcare organizations trying to improve their internal capacity, for example, creating more training for clinicians to use data in their practices, or even state governments taking action. I think it will require a lot of action from all the stakeholders around healthcare to make progress.

     

    The white paper mentioned barriers involving information systems interoperability, data deidentification and aggregation, feedback cycles, data governance, and data usability issues. Let’s discuss those.

    I think one of the challenges with all of those is that there are some big strategic issues around all of those, and some large national conversations around all of those, esp. interoperability, but there are also just a lot of large technical details to iron out. And unfortunately, that’s not something we can just solve tomorrow. But there’s opportunity with these new delivery system models, and that will hopefully be helpful.


    How might all this play out with regard to ACOs, population health, bundled payments, and other new delivery and payment models?

    What we’ve heard is that those new models are becoming increasingly more common, and because of those, clinicians and hospitals have far more incentive to look far more holistically at the entire person, and think about improvement, and to really start digging into some of this data.


    Marrying EHR [electronic health record] and claims data for accountable care and population health is a very major topic for our magazine and its readers right now. Let’s talk about those issues.

    We didn’t necessarily go into great depth on that particular challenge. But clearly, that’s one of the big issues in trying to link all these different data sources together, and it also speaks to the challenge in getting this data together.


    Is there anything that healthcare IT vendors need to do better?

    And we actually called out healthcare IT vendors and EHR vendors, because they’re a really important sector here. Promoting interoperability speaks to both policy and technical challenges.


    Are you also concerned about data blocking?

    Yes, that’s how ONC and HHS have characterized it. But yes, we’re really talking about data access. Clearly, that’s a barrier. And then there are still some technical pieces here around how to create APIs that can really start to allow more innovative ways to analyze the data that’s already in a lot of these EHR and health IT systems, and that will allow some customization and capabilities.


    What’s your vision of change for the use of data in healthcare?

    There are a number of folks doing really exciting work using data for systemic improvement. So we showcased Virginia Mason as a model. And some of their work involves manual collection of data. And that can produce really remarkable results; and as you become more sophisticated, you’re able to incorporate that data collection into the EHR [electronic health record]  and other systems. That speaks to what we said earlier, that availability of data is a good thing, but it’s the use of data that seems to be more of an issue. Premier Inc. has done some really good things, collecting data through some of their groups, to share; and oftentimes, that was data people didn’t even have before.  You can also activate clinicians’ professional motivation—many physicians, nurses, really want to make care better for their patients. And data really can make a difference in that.

    And the last point is the fact of the important role that brings this down to patients and consumers, involving the broader public in this. What we’ve talked about so far has been very technical. But patients have a lot of data about themselves, and they’re also able to help out with a lot of this.

     

    So you’re talking about patient and consumer engagement in this?

     

    Yes, I am, but it’s not just that. I’m also talking about patients as an untapped data resource, and an untapped resource in general of folks who are highly motivated and who want to make care better, if they have the tools available and are able to do so.

     

    The “blessed cycle” of data collection, data analysis, data reporting, the sharing of data with end-users and clinician leaders for clinical and operational performance improvement, and the re-cycling into further data collection, reporting, etc., is very important. Any thoughts on that concept?

     

    We didn’t necessarily talk about that concept per se, but we did talk about the general idea of this all being a process. And improvement needs to start somewhere, and oftentimes, you need to start small. And your data will be rough and dirty when you start; and that’s not necessarily a bad thing. The real pioneers in this area started out with rough, dirty data, and learned by using that data, and were able to increase their sophistication over time. So that’s part of the issue—bringing data together, oftentimes, you don’t know what data you need, until you start to use it.

     

    So what should CIOs, CMIOs and their colleagues be doing right now, to help lead their colleagues forward in all these activities?

     

    We really want to encourage more organizations to start doing this type of system improvement work. There’s more that can be done, so we want to encourage that. And the second message that permeated the entire project was not only making sure that more data should be made available, but also building up use, and to encourage more folks to get into systematic improvement.

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    lucy gray's curator insight, 17 August 2015, 16:35

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    Why and Who Should Ensure Quality Health Data?

    Why and Who Should Ensure Quality Health Data? | Healthcare and Technology news | Scoop.it

    Contrary to common belief, technology does not own health data. Data exists as a result of the input of multiple sources of information throughout each patient’s healthcare continuum. The data does not exist only because of the technology but rather because of the careful selection of meaningful data items that need to be captured and at what frequency (ie. instantly, daily, weekly, etc.).


    We in healthcare collect granular data on anything ranging from demographics, past medical, surgical, and social history, medication dosage and usage, health issues and problem lists, disease and comorbidity prevalence, vital statistics, and everything in between. We collect data on financial performance with benchmarks and reimbursement trends using individual data elements from accounting transactions. Healthcare organizations have been collecting the same or similar data for decades but never before have we been able to operate with such efficiency as we do now thanks to advances in technology.


    We have become so data rich in the healthcare environment in a short amount of time and this data continues to multiply daily. But are we still information poor? When we continue to generate data but fail to aggregate the data into quality information, we are essentially wasting bandwidth and storage space with meaningless and disconnected data.


    Every time patients have interactions with healthcare providers and facilities, data is generated. Over time, the data that is generated could (and should) be used to paint a picture of trends in patient demographics, population health, best practices in care, comorbidities and disease management, payment models, and clinical outcomes. This information becomes useful in meeting regulatory requirements, overcoming reimbursement hurdles, clinical quality initiatives, and even promotional and marketing material for healthcare organizations. This data could have opposite effects if not properly governed and utilized.

    It goes back to the saying “garbage in, garbage out.” If the data cannot be standardized or trusted, it is useless. Input of data must be controlled with data models, hard-stops, templates, and collaborative development of clinical content. Capturing wrong or inconsistent data in healthcare can be dangerous to the patients and healthcare quality measurements as well as leading to unwanted legal actions for clinicians.


    So who is the right person for the job of ensuring quality data and information? I have seen bidding wars take place over the ownership of the data and tasks surrounding data analysis, database administration, and data governance. Information Technology/Systems wants to provide data ownership due to the skills in the development and implementation of the technology needed to generate and access data. Clinical Informatics professionals feel they are appropriate for the task due to the understanding of clinical workflow and EHR system optimization. Financial, Accounting, Revenue Integrity, and Decision Support departments feel comfortable handling data but may have motives focused too heavily on the financial impact. Other areas may provide input on clinical quality initiatives and govern clinician education and compliance but may be primarily focused on the input of data instead of the entire data lifecycle.


    When searching for an appropriate home for health data and information governance, organizations should look no further than Health Information Management (HIM) professionals. Information management is what HIM does and has always done. We have adapted and developed the data analytics skills needed to support the drive for quality data abstraction and data usage (just look at the education and credentialing criteria). HIM departments are a hub of information, both financial and clinical therefore governing data and information is an appropriate responsibility for this area. HIM also ensures an emphasis on HIPAA guidelines to keep data secure and in the right hands. Ensuring quality data is one of the most important tasks in healthcare today and trusting this task to HIM In collaboration with IT, Informatics, and other departments is the logical and appropriate choice.

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    cdebie's curator insight, 17 August 2015, 09:32

    As we get inundated with health data from multiple sources,, aggregation, classification and interpretation will require specialised skills and dedicated resources.

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    Where big data falls short

    Where big data falls short | Healthcare and Technology news | Scoop.it

    Big data and analytic tools have not yet been harnessed to bring meaningful improvement to the healthcare industry.

    That's according to a new report from the National Quality Forum outlining the challenges to making health data andanalytics more usable and available in real time for providers and consumers.


    Whereas big data has supported improvement in certain settings, such as reducing ventilator-acquired pneumonia, data analytics has been largely overlooked in the area of healthcare costs, even though this data can inform and assess efforts to improve the affordability and quality of care.


    What's more, effective data management is necessary for the success of other incentives to enhance care, such as payment programs, as providers need timely information to understand where to improve and track their progress.


    NQF found multiple challenges to making better use of health information, such as interoperability and linking disparate data sources, leveraging data for benchmarking, providing the ability to gather data directly from patients and de-identify it to generate knowledge, and the need to ensure that the data itself is trustworthy.


    Then there's the matter of electronic health records software. "While greater EHR adoption is positive, these records do not contain all of the data needed for improvement," the report said. NQF pointed to operational or clinical data not captured in an EHR, such as the time a nurse spends caring for a particular patient or the time to transfer a patient from surgery to a post-operative recovery unit to a hospital room, as common examples.


    The report noted there have been many ongoing attempts to develop interoperability between EHRs and clinical data sources recording patients' experiences and outcomes. Beyond linking healthcare data, however, "there is a need to learn from data spanning other determinants of health, as the most significant and sustained individual and population healthimprovements occur when healthcare organizations collaborate with community or public health organizations."


    NQF also highlighted a widespread need to appreciate the value of nonfinancial incentives, such as peer and public reporting, in improvement initiatives.


    "Overall, there was a desire to move from a retrospective approach of quality metrics and analytics to one that uses real-time data to identify potential challenges and gauge progress," the report said.


    The report was supported by the Peterson Center on Healthcare and the Gordon and Betty Moore Foundation, the initiative was spurred by a 2014 report by the President's Council of Advisors on Science and Technology that called for systems engineering approaches to improve healthcare quality and value.

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