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Better Choices Needed to Manage US Healthcare Cost Growth 

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

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


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


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


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


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


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


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


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

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


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

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


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


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


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

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


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

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10 Trends You Can Expect from Healthcare in 2018 

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

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


1. The future of the GOP Healthcare bill

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

2. The ongoing shift to value from volume

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

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

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

4. Blockchain-based systems

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

5. AI and IoT taking on a central role

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

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

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

7. The increasing importance of security

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

8. Payer-provider collaborations

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

9. Possibly stable healthcare costs

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

10. The future of ACA

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

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

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10 Biggest Technological Advancements for Healthcare in the Last Decade

10 Biggest Technological Advancements for Healthcare in the Last Decade | Healthcare and Technology news |

The reach of technological innovation continues to grow, changing all industries as it evolves. In healthcare, technology is increasingly playing a role in almost all processes, from patient registration to data monitoring, from lab tests to self-care tools.

Devices like smartphones and tablets are starting to replace conventional monitoring and recording systems, and people are now given the option of undergoing a full consultation in the privacy of their own homes. Technological advancements in healthcare have contributed to services being taken out of the confines of hospital walls and integrating them with user-friendly, accessible devices.

The following are ten technological advancements in healthcare that have emerged over the last ten years.


1. The electronic health record. In 2009, only 16 percent of U.S. hospitals were using an EHR. By 2013, about 80 percent of hospitals eligible for CMS' meaningful use incentives program had incorporated an EHR into their organizations. "For such a long time we had such disparate systems, meaning you had one system that did pharmacy, one did orders, one that did documentation," says Jeff Sturman, partner at Franklin, Tenn.-based Cumberland Consulting Group. "Integrating these systems into a single platform, or at least a more structured platform, has allowed more integrated and efficient care for patients," he says.

While the EHR has already created big strides in the centralization and efficiency of patient information, it can also be used as a data and population health tool for the future. "There's going to be a big cultural shift over the next several years of data-driven medicine," says Waco Hoover, CEO of the Institute for Health Technology Transformation in New York. "Historically, that hasn't been a big part of how medicine is practiced. Physicians go to medical school and residencies, but each organization has its own unique ways they do things. That's one of the reasons we see varied care all over the country. When data is what we're making decisions off of, that's going to change and improve outcomes of the consistency of medicine delivered."


2. mHealth. Mobile health is freeing healthcare devices of wires and cords and enabling physicians and patients alike to check on healthcare processes on-the-go. An R&R Market Research report estimates the global mHealth market will reach $20.7 billion by 2019, indicating it is only becoming bigger and more prevalent. Smartphones and tablets allow healthcare providers to more freely access and send information. Physicians and service providers can use mHealth tools for orders, documentation and simply to reach more information when with patients, Mr. Sturman says.

However, mHealth is not only about wireless connectivity. It has also become a tool that allows patients to become active players in their treatment by connecting communication with biometrics, says Gopal Chopra, MD, CEO of PINGMD, and associate professor at Duke University Fuqua School of Business in Durham, N.C. "Now I can make my bathroom scale wireless. I can make my blood pressure mount wireless. I can take an EKG and put it to my smartphone and transfer that wirelessly," he says. "mHealth has the opportunity to take healthcare monitoring out of the office, out of the lab and basically as a part of your life."


3. Telemedicine/telehealth. Studies consistently show the benefit of telehealth, especially in rural settings that do not have access to the same resources metropolitan areas may have. A large-scale study published in CHEST Journal shows patients in an intensive care unit equipped with telehealth services were discharged from the ICU 20 percent more quickly and saw a 26 percent lower mortality rate than patients in a regular ICU. Adam Higman, vice president of Soyring Consulting in St. Petersburg, Fla., says while telemedicine is not necessarily a new development, it is a growing field, and its scope of possibility is expanding.

The cost benefits of telehealth can't be ignored either, Mr. Hoover says. For example, Indianapolis-based health insurer WellPoint rolled out a video consultation program in February 2013 where patients can receive a full assessment through a video chat with a physician. Claims are automatically generated, but the fees are reduced to factor out traditional office costs. Setting the actual healthcare cost aside, Mr. Hoover says these telemedicine clinics will also reduce time out of office costs for employees and employers by eliminating the need to leave work to go to a primary care office.


4. Portal technology. Patients are increasingly becoming active players in their own healthcare, and portal technology is one tool helping them to do so. Portal technology allows physicians and patients to access medical records and interact online. Mr. Sturman says this type of technology allows patients to become more closely involved and better educated about their care. In addition to increasing access and availability of medical information, Mr. Hoover adds that portal technology can be a source of empowerment and responsibility for patients. "It's powerful because a patient can be an extraordinary ally in their care. They catch errors," he says. "It empowers the patient and adds a degree of power in care where they can become an active participant."


5. Self-service kiosks. Similar to portal technology, self-service kiosks can help expedite processes like hospital registration. "Patients can increasingly do everything related to registration without having to talk to anyone," Mr. Higman says. "This can help with staffing savings, and some patients are more comfortable with it." Automated kiosks can assist patients with paying co-pays, checking identification, signing paperwork and other registration requirements. Mr. Higman says there are also tablet variations that allow the same technology to be used in outpatient and bedside settings. However, hospitals need to be cautious when integrating it to ensure human to human communication is not entirely eliminated. "If a person wants to speak to a person, they should be able to speak with a person," he says.


6. Remote monitoring tools. At the end of 2012, 2.8 million patients worldwide were using a home monitoring system, according to a Research and Markets report. Monitoring patients' health at home can reduce costs and unnecessary visits to a physician's office. Mr. Higman offers the example of a cardiac cast with a pacemaker automatically transmitting data to a remote center. "If there's something wrong for a patient, they can be contacted," he says. "It's basically allowing other people to monitor your health for you. It may sound invasive but is great for patients with serious and chronic illnesses."

An article by Kaiser Health News, National Public Radio and Minnesota Public Radio discussed the effects a home monitoring system had on readmission rates for heart disease patients at Duluth, Minn.-based Essentia Health. The national average rate of readmissions for patients with heart disease is 25 percent, but after Essentia Health implemented a home monitoring system, the rates of readmission for their heart disease patients fell to a mere two percent. And now that hospitals are being financially penalized for readmissions, home monitoring systems may offer a solution to avoid those penalties.


7. Sensors and wearable technology. The wearable medical device market is growing at a compound annual growth rate of 16.4 percent a year, according to a Transparency Market Research report. Wearable medical devices and sensors are simply another way to collect data, which Dr. Chopra says is one of the aims and purposes of healthcare. He says sensors and wearable technology could be as simple as an alert sent to a care provider when a patient falls down or a bandage that can detect skin pH levels to tell if a cut is getting infected. "Anything we are currently using where a smart sensor could be is part of that solution," Dr. Chopra says. "We're able to take a lot of these data points to see if something abnormal is happening."


8. Wireless communication. While instant messaging and walkie-talkies aren't new technologies themselves, they have only recently been introduced into the hospital setting, replacing devices like beepers and overhead pagers. "Hospitals are catching up to the 21st century with staff communicating to one another," Mr. Higman says, adding that internal communication advancements in hospitals followed a slower development timeline since they had to account for security and HIPAA concerns.

Systems like Vocera Messaging offer platforms for users to send secure messages like lab tests and alerts to one another using smartphones, web-based consoles or third-party clinical systems. These messaging systems can expedite the communication process while still tracking and logging sent and received information in a secure manner.


9. Real-time locating services. Another growing data monitoring tool, real-time locating services, are helping hospitals focus on efficiency and instantly identify problem areas. Hospitals can implement tracking systems for instruments, devices and even clinical staff. Mr. Higman says these services gather data on areas and departments that previously were difficult to track. "Retrospective analysis can only go so far, particularly in places constantly changing like emergency departments," he says, but tracking movement with a real-time locating service can highlight potential issues in efficiency and utilization.

These tools also allow flexibility for last minute changes. "If [a physician has] an add-on case today, do they have instruments on hand, and where are [the instruments]?" he asks. At the most basic level, these services can ensure equipment and supplies aren't leaving the building, and for high-cost equipment and supplies of which hospitals may only have one or a few, being able to track their location can help verify its utilization, he says.


10. Pharmacogenomics/genome sequencing. Personalized medicine continues to edge closer to the forefront of the healthcare industry. Tailoring treatment plans to individuals and anticipating the onset of certain diseases offers promising benefits for healthcare efficiency and diagnostic accuracy. Pharmacogenomics in particular could help reduce the billions of dollars in excess healthcare spending due to adverse drug events, misdiagnoses, readmissions and other unnecessary costs.

Before a full-fledged system of pharmacogenomics comes to fruition, the healthcare industry needs a tool that can aggregate and analyze all the big data and digital health information, Mr. Hoover says. "When we really start to have the ability to study a lot of that data, it's going to transfer how we match up that information at the population, individual and macro levels," he says. "The ability to actually compare that information is going to be valuable as we move forward, making sure medications we are taking are going to work for us."


Tools for big data analysis for pharmacogenomics are still being developed, but data analytics and data aggregation for the purpose of population health may be the next big advancement on the horizon. "Understanding and connecting all these variables is going to be profound as it relates to moving forward in healthcare and designing interventions and analyzing patient populations and ultimately improving the lives and health of the American population," Mr. Hoover says.

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New Efficient Techniques for Health Monitoring Using Multiple Wearables 

New Efficient Techniques for Health Monitoring Using Multiple Wearables  | Healthcare and Technology news |

As body-worn sensors are becoming cheaper and easier to use, there arises the possibility of complex continuous health tracking using numerous devices all at once. Because they can use quite a bit of power as well as computing resources, to really make them practical one has to limit their energy and resource expenditure. Researchers at North Carolina State University have been working on making sure that such sensors only transmit important readings and organise these readings within data structures that will provide the most utility to clinicians.

Their approach is to continuously classify different states that the wearer is in, whether it be walking, running, or sitting, and to then transmit only data that doesn’t seem to fit what the person seems to be doing. So an increase in one’s heartbeat while sitting may be a sign of arrhythmic tachycardia, but if the same thing happens as a person starts running then the same heart readings can be ignored.

The researchers had grad students wear suits full of sensors and tested different data capture schemes to minimize power and data consumption while gathering interesting readings. For example, they identified that six seconds is enough time to classify what the person is doing at any one time. This means that every six seconds the system should update its readings and focus on spotting changes relevant to the new state.

The team will be presenting their research titled “Hierarchical Activity Clustering Analysis for Robust Graphical Structure Recovery,” at the 2016 IEEE Global Conference on Signal and Information Processing, Dec. 7-9 in Washington, D.C.

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HealthIT Can Benefit From Internet of Things

HealthIT Can Benefit From Internet of Things | Healthcare and Technology news |

Healthcare technology is growing leaps and bounds and with the inclusion of Internet of things in the equation, both patients and providers will benefit from it.  In a report by Forbes, by 2020, 40% of IoT-related technology will be health-related, more than any other category, making up a $117 billion market.  Internet of things can make a huge impact on the healthcare industry by increasing efficiency, focusing on patient care and also reducing costs. Internet of things in healthcare can help create an intelligent system that can capture real time, life critical data.


How internet of things has benefited Healthcare


The potential of internet of things in healthcare is wide; there is already a huge market for fitness tracking and soon the patients will be able to take more responsibility of their health. With the use of IOT devices, there will be a focus on taking hold of preventive measures thereby disrupting current care delivery and also help shape the future of healthcare.


Below are the three most important uses of IoT in Healthcare


  • Chronic care management: Internet of things in healthcare has made a major impact especially in the chronic care management sector.  Healthcare technology has helped increase longevity with the tracking of health and chronic care conditions. Any change in vital or any questionable change in the health can quickly be reported to eth provider. Newer applications are now easily connected to wearables that can help transmit information to the a mobile application and thereby help stay connected to the provider. There are many new applications in the market like Healthkey that help in the management of chronic conditions.  Health Key monitors & tracks blood pressure, heart rate, blood glucose, BMI, body fat and a host of other measures using home health devices from FitBit, Withings and iHealth. Providers get real-time alerts and allow timely intervention.
  • Assisted living and remote monitoring: Assisted living and costs in nursing homes are rising and therefore pushing the providers to help encourage elderly to live independently while being monitored . This can be done in the comfort of the home and also helping in reducing the risk of staying alone. With the advent of sensors attached to the skin, clothing and other wearables. As per BCC Research  , in 2010 the healthcare global market for biosensors was $15.4 Billion and is expected to grow due to a rise is demand for point-of-care diagnostics and monitoring, aging of the population with its concomitant increase in the prevalence of chronic disease, increasing healthcare costs and unmet healthcare needs. It is predicted that this number is bound to increase, and the demand for biosensors in the United States alone will grow by 7.7% annually. 
  • Preventive care: The preventive healthcare is another benefit of Internet of things in healthcare . A lot of diseases and ailments can be managed with the touch of button, diseases like chickenpox; measles etc. can be easily managed with software applications setting reminders about the same. Also since the vitals are being constantly monitored, a lot many chronic diseases can also be prevented.
  • The only issue and problem at hand is the security of data that is being captured from devices connected to the patient monitoring system. The security of IoT is serious enough that a contractor for the Department of Homeland Security spoke about it at HIMSS 2015.

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Health risk assessments may benefit elderly

Health risk assessments may benefit elderly | Healthcare and Technology news |

When healthy elderly people fill out health risk questionnaires and get personalized counseling, they have better health behaviors and use more preventive care, according to a new study.

Eighteen percent of firms ask working-age employees to complete health risk assessments, but the use of these tools in older persons is relatively new, said lead author Andreas E. Stuck of University Hospital Bern in Switzerland.

The personal health risk assessments covered multiple potential risk factors relevant in old age, and participants received individualized feedback and health counseling, lasting two years, Stuck said.

“Thus, prevention in old age is likely effective, but only if risk assessment is combined with individualized counseling over an extended period of time,” Stuck told Reuters Health by email.

In his team’s study, conducted in Switzerland between 2000 and 2002, 874 healthy adults over age 65 filled out questionnaires and received individualized computer-generated feedback reports, which were also sent to their doctors.

Additionally, for two years, nurse counselors visited patients at home and called them every three to six months to reinforce what health behaviors they should be pursuing or preventive care they should be obtaining based on their individualized reports.

About 85 percent of those assigned to the health risk assessment group returned their questionnaires, the researchers reported in PLoS Medicine.

Counselors identified the most important risk factors for each person, and the interaction between risk factors was taken into account. For example, for a person with low physical activity who was having pain, the first step was to intervene on management of pain, then on physical activity, Stuck said.

At the end of two years, the researchers compared the risk assessment group to another 1,000 similar adults who did not get the questionnaires or counseling.

Seventy percent of those who completed the health-risk assessments were physically active and 66 percent had received a seasonal flu vaccine, compared to 62 percent and 59 percent of the comparison group, respectively.

Long-term outcomes like nursing home admission or functional status were not available, but the researchers estimated that almost 78 percent of the adults in the health risk assessment group were still alive after eight years, compared to almost 73 percent in the comparison group.

The health assessment, data entry and individualized feedback report takes patients about one hour to do and costs about $30, Stuck said, not including the cost of individualized counseling by the nurse counselor or a primary care physician.

Health risk assessment should be offered to all older people starting between age 60 and 65, he said.

“The authors report promising evidence that a complex intervention might improve longevity and functioning in older adults,” said Evan Mayo-Wilson of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, who was not part of the new study.

“The team provided many services in addition to standard care, and we cannot tell if all of those services were important or if only certain activities would be necessary to achieve good outcomes,” Mayo-Wilson told Reuters Health by email.

But only half of the people assessed for the trial were enrolled, while many weren’t eligible or refused, and some who were assigned to the health risk assessments didn’t return their questionnaires or otherwise didn’t engage with the program, he noted.

“We should be cautious in interpreting the results of this study because previous studies found inconsistent effects of mortality and other health outcomes,” Mayo-Wilson said.

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How one health system tightened security

How one health system tightened security | Healthcare and Technology news |

St. Elizabeth Healthcare in Northern Kentucky has added security muscle targeted at its network-connected medical devices by rolling out technology that monitors the devices for cyber vulnerabilities.

The health system tapped Tenable Network Security for nonstop network monitoring via the company's SecurityCenter Continuous View, which makes it possible to keep watch over the devices without taking them offline.

Through this deployment, hospital executives say, St. Elizabeth's IT security team has tackled one of the biggest security challenges in the healthcare industry – securing "smart" medical devices that cannot be interrupted for active vulnerability assessments.

"Everything we do at St. Elizabeth, including our security program, is based on the principle of putting patients first," Harold Eder, director of IT infrastructure and security at the hospital, said in a news release. "CT scanners, MRIs, smart IV pumps – any of these endpoint devices may be running on outdated systems that leave the entire network vulnerable to attack, but you can't perform traditional vulnerability assessments because taking the systems offline is risky and could diminish patient care."

St. Elizabeth's security team uses Tenable's SecurityCenter CV to gain complete visibility into medical device security and overall network status through a combination of active and passive scanning as well as advanced analytics. With the technology, Eder and his team assess 9,600 IP addresses and more than 300 medical device endpoints across five main campuses and more than 60 remote facilities.

Continuous network monitoring gives Eder a better understanding of cyber risk for the entire St. Elizabeth enterprise,  and it gives him the opportunity to focus his security team on the tasks that will have the most impact, he added.

With guidance from HealthGuard Security, a cyber risk management provider and a partner that St. Elizabeth has worked with for more than 10 years, Eder said he chose the platform for St. Elizabeth because it delivered the right combination of advanced analytics, real-time reporting and increased visibility into the health system's hard-to-see medical devices.

"When I looked at the challenges St. Elizabeth faced, I knew they needed a comprehensive solution that would help with HIPAA compliance, improve visibility into critical systems and deliver high-level analytics and reporting capabilities," said Apolonio Garcia, founder and president, HealthGuard Security, in a statement. "After seeing the success of Tenable's products with many customers over the years, SecurityCenter CV was clearly the right fit and the best product for St. Elizabeth."

The platform, as Eder continued, "gives me a much more holistic view into what my priorities should be, so I spend less time figuring out the problems and more time fixing them," he said. "The best part is that as our network evolves and our security program matures, we will continue to get additional value out of (the platform) along with the continued assurance that our infrastructure and patients are well protected."

St. Elizabeth Healthcare operates six major facilities throughout Northern Kentucky and more than 110 primary care and specialty office locations in Kentucky, Indiana and Ohio. 

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Readmissions Penalties Get Very, Very Real

Readmissions Penalties Get Very, Very Real | Healthcare and Technology news |

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.


7 ways physicians can improve health care quality

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

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 |

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 |

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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Why and Who Should Ensure Quality Health Data?

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

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.

cdebie's curator insight, August 17, 2015 4:32 AM

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

Where big data falls short

Where big data falls short | Healthcare and Technology news |

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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HIMSS18 – What, Where and How HealthIT can impact healthcare1

HIMSS18 – What, Where and How HealthIT can impact healthcare1 | Healthcare and Technology news |

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


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


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


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


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


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


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


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

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

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4 Healthcare Software Trends to Watch in 2018 

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

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


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


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

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

1. Multi-Speciality & Niche Specialty EHR Software

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

2. Patient Portals & Self-Service Software

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

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

3. Blockchain Solutions

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

4. Consumer-Grade UX in Enterprise Software

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


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


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


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

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Barbara Lond's curator insight, January 28, 10:37 AM
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What are the Top Healthcare Industry Challenges in 2017?

What are the Top Healthcare Industry Challenges in 2017? | Healthcare and Technology news |

Healthcare Industry challenges are always going to be evolving alongside the breakthroughs and innovations. In 2017, there are new healthcare industry challenges that go alongside the age-old difficulties.

For doctors, nurses and medical teams, here are 7 of the key healthcare industry challenges they are currently facing in the year ahead for 2017.

1) Retail Care offering increased access

Retail giants like CVS and Walgreens are pushing further into care delivery, continuing to put pressure on traditional providers to increase access to care.

According to Laura Jacobs, writing for Hospitals and Health Networks “The greatest challenge for most organizations will be finding the right pace for adapting to or embracing new [healthcare] payment models.”

Doctors will be required to step up their efforts to optimize the patient experience, beyond measuring patient satisfaction.

2) Behavioral healthcare

The healthcare industry is starting to recognize that Mental Health is important to the well-being of employees and consumers, according to a report from PWC.

The report notes that one out of five American adults experiences a mental illness every year. These conditions cost businesses more than $440 billion each year. Healthcare organizations and employers will look at behavioral care as ‘key to keeping costs down, productivity up and consumers healthy’ the report said.

3) Meaningful Use and Value Based Payments

Eligible providers and eligible hospitals are continuing to work on meaningful use of EHRs.

Value-based purchasing programs are solidly in place, and eligible physicians are starting to experience the penalty phase of CMS’s quality reporting and Meaningful Use initiatives. In fact, CMS revealed that more than 257,000 eligible professional providers who are not meaningful users of certified EHR technology would have their Medicare Fee Schedule cut by one percent.

Eligible physicians also need to comply with CMS’s new Value-Based Payment Modifier program, or face penalties. It’s part of Medicare’s efforts to improve healthcare, but the program adds yet more regulations physicians need to monitor.

All these changes and new reporting requirements can become overwhelming for already busy physicians, which is why the American Medical Association has repeatedly asked for relief.

4) Switching to ICD-10

The much anticipated and maligned change to ICD10 codes in 2015 led to a lot of discomfort for physicians. The increase in codes from 14,000 to 68,000 means a lot of diagnosis criteria must be re-learned.

There is a great deal of planning, re-training and new systems that go along with the upgrade in codes. For doctors, finding the time to do this proved to be a huge challenge, and still is.

5) Data Security

Patient privacy issues, including concerns about data breaches, continue to be a challenge for providers, payers, and consumers.

Providers and payers will need to be aware of the best practices for data security to avoid the type of Health Insurance Portability and Accountability Act (HIPAA) violations that can negatively impact an organization.

6) Managing Patient volume

While new payment models will are aiming to reduce acute hospital utilization, the continued expansion of Medicaid and the insured population through the public exchanges will seemingly keep demand up.

The rise of obesity and chronic disease and population aging are creating a demand for medical services like never before.

Emergency departments will continue to be overworked until efforts to decant volume through urgent care, better care management or redesigned primary care models begins to take effect..

7) Implementing Telemedicine

The idea of a doctor seeing you via a computer screen may no longer be new, but the adoption of the Telemedicine services by doctors with their own patients is still a struggle.

The Information Technology and Innovation Foundation shares a vision of how Telemedicine can reduce patient backlogs. “Imagine a world where patients in rural areas far from a nearby doctor can easily find a health care provider to consult with online from the comfort of their own homes; where doctors living in Pennsylvania can help reduce the backlog of patients waiting to see doctors in Mississippi; and where patients can connect to a doctor over the Internet for routine medical purposes with a few clicks of the mouse—like they do when ordering a book on Amazon.”

Finding a balance between in person visits and telemedicine will require doctors to adjust their approach to care. Learning to diagnose remotely also requires new skills and detailed reporting.

Of course, Healthcare Industry Challenges are nothing new. Technology and legislation will continue to change the landscape. Doctors and their medical teams must evolve their approach and focus to meet them.


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5 Ways Technology Is Transforming Health Care

5 Ways Technology Is Transforming Health Care | Healthcare and Technology news |


How are tech nerds getting involved in health care? Here are five ways:



1. Crunching data to offer a better diagnosis and treatment:


             Just call the computer “Dr. Watson.” Researchers at IBM have been developing the supercomputer known as Watson (which, in February 2011, beat out "Jeopardy" champs Ken Jennings and Brad Rutter to win $1 million, which was donated to charity) to help physicians make better diagnoses and recommend treatments. Doctors could potentially rely on Watson to keep track of patient history, stay up-to-date on medical research and analyse treatment options. Doctors at Memorial Sloan-Kettering Cancer Center in New York are expected to begin testing Dr. Watson later this year.

Recommended by BMO Harris Bank

2. Helping doctors communicate with patients:


                    Science Applications International Corporation (SAIC) has developed Omnifluent Health, a translation program for doctors and others in the medical field. The suite of products includes a mobile app that lets doctors speak into the app — asking, for example, if a patient is allergic to penicillin — and translate the message instantly into another language. Given that there are 47 million U.S. residents who don't speak English fluently, the program could be a boon for doctors who would otherwise need to rely on translators and medical assistants to communicate with their patients.


3. Linking doctors with other doctors:


                  Could social networking help doctors work better together to take care of their patients? That’s the premise behind Doximity, a social network exclusive to physicians. Through Doximity, doctors throughout the United States can collaborate online on difficult cases. It’s received $27 million in funding and counts among its board members Konstantin Guericke, a co-founder of LinkedIn.


4. Connecting doctors and patients:


                 New York City startup Sherpa offers patients medical consultations online and over the phone, potentially saving a trip to the ER. The medical advice doesn’t come from just anyone, but from some of the city’s top medical specialists. Employers such as Tumbler have signed onto the service.



5. Helping patients stay healthy:


           A growing number of mobile apps and gadgets aim to help people stay active, sleep well and eat healthy. Among them are Fit-bit, a pedometer that tracks daily sleep and activity and uses social networking and gaming to motivate its users. Lark is a silent alarm clock and sleep monitor that tracks and analyses a person’s quality of sleep over time, offering suggestions to help the person get better rest (it has since expanded to track daily activity, too). And there are dozens upon dozens of calorie-counting, food-monitoring and menu-tracking apps to aid the diet-conscious.

It's clear that technology is giving the health care industry a much-needed upgrade, from medical translation tools to mobile apps that help patients live healthier lives. Though much is still in the early and experimental stages, the advances in technology could help save money in health care costs and improve patient treatment.

Patients who can connect with their doctors more easily, for instance, won't need to make expensive and perhaps unnecessary trips to the ER or specialists. Doctors will be able to collaborate with other physicians and experts in new ways and use computers to analyse patient and medical data, allowing them to provide better and more efficient treatment for their patients. As technology continues to expand the horizons of medicine and medical interaction, it's becoming clear that we're entering a new era of health care — or as some people are beginning to call it, Health 2.0.

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CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers

CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers | Healthcare and Technology news |

The Centers for Medicare & Medicaid Services (CMS) issued final rules this week detailing how the agency will pay for services provided to beneficiaries in Medicare by physicians and other health care professionals in 2016 that reflects the administration’s commitment to quality, value, and patient-centered care. Payment rules for the 2016 calendar year for End-Stage Renal Disease Prospective Payment System, the Hospital Outpatient Prospective Payment System, Home Health Prospective Payment System, and the Physician Fee Schedule were all finalized this week.

“CMS is pleased to implement the first fee schedule since Congress acted to improve patient access by protecting physician payments from annual cuts. These rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers,” said CMS Acting Administrator Andy Slavitt. “We received a large number of comments supporting our proposal to allow physicians to bill for advanced care planning conversations and we are finalizing this rule accordingly.”

Key policies finalized in the 2016 payment rules include:

  • Finalizing the Home Health Value-Based Purchasing model. This model, authorized under the Affordable Care Act, is designed to improve health outcomes and value by tying home health payments to quality performance. All Medicare-certified home health agencies that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will participate in this model starting January 1, 2016. Compared to the proposed rule, the maximum payment adjustment in the first year of the model was reduced from 5 percent to 3 percent. This was part of the Home Health Prospective Payment System final rule.

  • Finalizing updates to the “Two-Midnight” rule. The rule clarifies when inpatient admissions are appropriate for payment under Medicare Part A. This continues CMS’ long-standing emphasis on the importance of a physician’s medical judgment in meeting the needs of Medicare beneficiaries by providing clearer guidelines and a more collaborative approach to education and enforcement. This was part of the Hospital Outpatient Prospective Payment System final rule.
  • Finalizing the End-Stage Renal Disease Quality Incentive Program. The End-Stage Renal Disease final rule will apply payment incentives to dialysis facilities to improve the quality of dialysis care. Facilities that do not achieve a minimum total performance score with respect to quality measures, such as anemia management, patient experience, infections, and safety, will receive a reduction in their payment rates. 
  • Beginning the new physician payment system post the Sustainable Growth Rate (SGR) formula and supporting patient- and family-centered care. This is the first final Physician Fee Schedule final rule since the repeal of the SGR formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Through the final rule, CMS is beginning implementation of the new payment system for physicians and other practitioners, the Merit-Based Incentive Payment System, required by the legislation.
  • Finalizing provision to empower patients and their families regarding advance care planning. Consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress, CMS is finalizing its proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers.
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Helping Patients Understand Insurance Benefits is Key

Helping Patients Understand Insurance Benefits is Key | Healthcare and Technology news |

Over the past several weeks, I've had the task of helping my own dad through some health issues. The biggest issue that we have run into multiple times is insurance challenges.

I know that I typically give you hints and tips to help lower your accounts receivable, get you paid on time, and manage your billing staff. But I'm going to take a different tack this week; focusing on the patient's viewpoint.

Before I get into the details of our struggle to help dad see the appropriate specialists, I feel it's most important to note that you and I are healthcare professionals. We do this job, everyday. We are immersed in professional jargon that sounds foreign to the typical patient. We understand (for the most part) that the laws are in place to protect the patient. We have to learn how to play nice with the insurance companies so that our practices get paid. Our patients don't really see this. From a patient's standpoint, they simply buy an insurance plan; they ask the practice to file a claim; and the insurance company pays what the practice is due. However, you and I know this is certainly not the case.

There is a huge gap between reality and what the patient thinks happens with their insurance plan. They do not understand that not only is it a plan they purchased, but they must also understand the nuances of that plan. Is outpatient physical therapy a covered benefit? Does the plan have a deductible? Is there a copay or coinsurance associated with some visits and not others? Is the doctor in network? The typical patient is truly not aware that this type of information is their responsibility to know.

So, that said, let me share my story. My dad has a Medicare replacement plan. He still thinks he has Medicare primary and UnitedHealthcare as a secondary insurance. So, lesson one when explaining patients' benefits prior to being seen is that they understand if they have a replacement plan, and not Medicare with a secondary.

Next, his primary physician referred him to a specialist. The specialist was 50 miles away. I'm not kidding. Dad gets to the appointment, and the office manager took him aside and said they do not accept his insurance; but he could pay the $3,000 out-of-network rate if he wanted to. No phone call, no warning about the physician's out-of-network status, nothing. Dad walked out and drove back 50 miles to his house and called me a few hours later. The next morning, Dad and I did a conference call with his medical group. I asked them why there wasn't a specialist in their group that he could see? I also said that if there isn't a physician that fits the requirements of Dad's care, they would have to provide the authorization to see an out-of-network physician, as that was not Dad's problem they didn't fill up their network. A few hours later poof! They found a doctor only 10 minutes from his house that was just credentialed that day. Shocking, I know.

So, the medical group contacted the doctor's office and set up an appointment. They called us back on another conference call and let us know everything was taken care of. I asked, "Okay, I have my pen and paper, can you please provide the authorization number for this visit?" There was silence on the other end of the line. There were four people telling us seconds ago that everything was set up and ready to go and no one could provide the authorization number. They asked for a few minutes to call us back. The phone rang, an authorization for three visits was provided, I took names, phone numbers, etc.

My dad was so frustrated and completely confused about why things are so complicated, and wondered how was he supposed to know all of this?! Technically, he is supposed to know these things, but honestly, there is no way he would ever have been able to get this figured out without my help.

I suppose my point is when you have a patient that needs an authorization, or does not understand the difference between in-network and out-of-network status, please take the time to work with them. Be patient. Be kind. They are in pain or sick, and the last thing they want to worry about is their insurance plan.

It would be ideal if the insurance company took the time to explain plan details and teach patients how best to utilize their plan benefits. We know this will never happen, as it would be very costly for the insurance company.

Take it easy on your patients and find it in your heart to spend the necessary time with your patient; remember this likely someone's dad, mom, sister, or brother.

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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 |

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 |

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.


Hospitals work on allowing patients to actually sleep

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

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 |

    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.

    lucy gray's curator insight, August 17, 2015 11:35 AM

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    Study Links Polluted Air in China to 1.6 Million Deaths a Year

    Study Links Polluted Air in China to 1.6 Million Deaths a Year | Healthcare and Technology news |

    Outdoor air pollution contributes to the deaths of an estimated 1.6 million people in China every year, or about 4,400 people a day, according to a newly released scientific paper.

    The paper maps the geographic sources of China’s toxic air and concludes that much of the smog that routinely shrouds Beijing comes from emissions in a distant industrial zone, a finding that may complicate the government’s efforts to clean up the capital city’s air in time for the 2022 Winter Olympics.

    The authors are members of Berkeley Earth, a research organization based in Berkeley, Calif., that uses statistical techniques to analyze environmental issues. The paper has been accepted for publication in the peer-reviewed scientific journal PLOS One, according to the organization.

    According to the data presented in the paper, about three-eighths of the Chinese population breathe air that would be rated “unhealthy” by United States standards. The most dangerous of the pollutants studied were fine airborne particles less than 2.5 microns in diameter, which can find their way deep into human lungs, be absorbed into the bloodstream and cause a host of health problems, including asthma, strokes, lung cancer and heart attacks.

    The organization is well known for a study that reviewed the concerns of people who reject established climate science and found that the rise in global average temperatures has been caused “almost entirely” by human activity.

    The researchers used similar statistical methods to assess Chinese air pollution. They analyzed four months’ worth of hourly readings taken at 1,500 ground stations in mainland China, Taiwan and other places in the region, including South Korea. The group said it was publishing the raw data so other researchers could use it to perform their own studies.

    Berkeley Earth’s analysis is consistent with earlier indications that China has not been able to successfully tackle its air pollution problems.

    Greenpeace East Asia found in April that, of 360 cities in China, more than 90 percent failed to meet national air quality standards in the first three months of 2015.

    The Berkeley Earth paper’s findings present data saying that air pollution contributes to 17 percent of all deaths in the nation each year. The group says its mortality estimates are based on a World Health Organization framework for projecting death rates from five diseases known to be associated with exposure to various levels of fine-particulate pollution. The authors calculate that the annual toll is 95 percent likely to fall between 700,000 and 2.2 million deaths, and their estimate of 1.6 million a year is the midpoint of that range.

    The Chinese government is sensitive about public data showing that air pollution is killing its citizens, or even allusions to such a conclusion. Though the authorities have gradually permitted greater public access to air quality readings, censors routinely purge Chinese websites and social media channels of information that the ruling Communist Party worries might provoke popular unrest. In March, after a lengthy documentary video about the health effects of air pollution circulated widely online, the party’s central propaganda department ordered Chinese websites to delete it.

    Much of China’s air pollution comes from the large-scale burning of coal. Using pollution measurements and wind patterns, the researchers concluded that much of the smog afflicting Beijing came not from sources in the city, but rather from coal-burning factories 200 miles southwest in Shijiazhuang, the capital of Hebei Province and a major industrial hub.

    Promises to clean up Beijing’s air were a centerpiece of the nation’s bid to host the 2022 Winter Olympics. The mayor of Beijing, Wang Anshun, championed restrictions on vehicles in the city, and state news media outlets lauded projects to replace coal-fired heating systems in urban areas with systems that use natural gas and generate far less particulate pollution.

    “We will improve the air quality not only for the Games, but also for the demand of our people,” said Shen Xue, an Olympic gold medalist and ambassador for the 2022 bid, according to a report last month by Xinhua, the state news agency.

    The Berkeley Earth paper showed, however, that to clear the skies over Beijing, mitigation measures will be needed across a broad stretch of the country southwest of the capital, affecting tens of millions of people. “It’s not enough to clean up the city,” said Elizabeth Muller, executive director of the organization. “You’re going to also have to clean up the entire industrial region 200 miles away.”

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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 |

     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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