Healthcare is a business unlike any other. Many economists describe healthcare as an imperfect market, where the consumer is not the one paying for the goods and services; they have limited knowledge on what they are buying, and they have little to no ability to shop for a deal in many scenarios. Healthcare has similar imperfections on the provider side in terms of reimbursement. From service line directors to physicians, many do not fully understand what they are or are not getting paid for. Providers are continuously dealing with multiple nebulous policies across several different payers that can have a material impact.

Currently, nearly every provider in the country is experiencing a similar top-down directive to decrease costs and increase revenue with the ultimate goal of increasing cash in the door. Once again, the idea of an imperfect market in healthcare appears. How can these clinical leaders improve cash flow if their primary source of truth is a revenue and usage report?  

There is value in the collaboration of revenue cycle staff in many committees and initiatives, given the current strain of hospital finances.

Since 2011, when incentives appeared promoting the adoption of electronic health record (EHR) systems, the ability to acquire detailed data has improved significantly. One can extract virtually any clinical or financial data point from these systems, and business intelligence (BI) tools can visualize the data. This financial data has not always been readily available, shared, or interpreted by clinical stakeholders for a multitude of reasons. First, it could simply be company culture, keeping reimbursement and money talk away from clinical practice. Secondly, it could be the fact that reimbursement data can be difficult to interpret and there may be significant manual lifting to get it in comprehensible format for clinicians; as electronic remittance info can make little sense and payers make it intentionally confusing. Because of this, the Revenue Cycle (or their data) may have been siloed from project management and clinical decision-making. 

With these silos in place, service line directors are placed in a poor position to succeed under the direction of increasing cash. Not understanding concepts like the impact of payer mix has enormous strategic implications. Shifts in the payer mix as small as one percent can mean missing revenue targets for the department or for the facility. 

Capital requests for new, high-tech equipment to complete procedures, tests, or treatments have billing implications that should be stamped by the revenue cycle. The pro formas that can be driven by vendor information should be confirmed by revenue integrity for accuracy. Payer policy and national/local coverage determinations should be confirmed by patient financial services. Not understanding the payer policy and billing requirements can utterly derail any value gained by the capital request.

Medicare is the largest payer for many facilities. With Medicare comes the diagnosis-related group payment, and with bundled payments comes the need to manage length of stay (LOS). While moving LOS is multi-faceted, there are ways to quantify the metric. Imagine the impact on physician and case management leadership if you can report how much impact 0.1-day improvement in LOS has on the bottom line. Expected payment-to-charge ratios, cost data, or contractual expected reimbursement can be applied to LOS metrics to drive home the importance of throughput. 

Many bedside and clinical staff have little understanding of the back-end impact of the work they complete on a daily basis. Processes like registration and prior authorization have significant impacts down the line. Meetings with ancillary outpatient departments and clinics to review preventable denials create a sense of value in the work these registration teams complete. The processes in these satellite areas are harder to keep reigns on. Providing this simple data can add allies to your initiatives which improve margins and reduce revenue leakage through denials. 

While not applicable to all facilities, the revenue cycle staff typically have strong knowledge of payer contracts which again can provide valuable insights. Many health systems closely guard what is in their managed care contracts and the rates they contain. It may not be great to share these with all clinicians, but understanding the impacts these agreements could have on operations and reimbursement can be beneficial.

Finally, if clinicians understand their charges, reimbursement, and revenue, they can escalate if a process breaks down or the EHR misbehaves.

There is value in the collaboration of revenue cycle staff in many committees and initiatives, given the current strain of hospital finances. The financial and clinical data is there. It should be time to consider merging this data, as the value may be surprising.

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EHR metadata provides useful objective metrics for assessing the impact of AI and automation on how physicians enter clinical notes and interact with patient records. However, from my perspective, leading a very gifted Wellness Informatics team that implemented an ambient AI transcription solution, a more meaningful measure of success comes directly from the lived experiences of the clinicians using it.

We are a clinical informatics team that prioritizes clinician wellness by living in the narrow yet very important intersection of technology and humanity. After thousands of interactions, our team has identified the main challenges that our physicians and APPs face. We also have corroborated our subjective findings with analytics tools offered by our EHR vendor to develop multiple avenues of personal, practice, and system-level support.

One of the ways we support our physicians and APPs is through direct observation. It gives us the privilege of being with our providers in the exam room with their patients. I remember thinking during one observation how marvelous a particular specialist physician was. Patients love this guy. He also has played a pivotal role in the health of a multitude of patients – including patients we shared.

I distinctly recall a 1:1 support session with him that made me realize we needed to take our advocacy and support to the next level. He confided that he wanted to leave the organization and possibly the profession. This doctor did not need to learn a new skill or technique. Instead, he needed to delegate some of his daily responsibilities to others. As we collected data, it became apparent that we needed a way to reduce our providers’ clinical documentation workloads.

Time previously spent writing notes can now be used for other complex tasks, such as addressing abnormal results.

We began in 2017 with in-person scribes. We still use the service today. The physicians who took advantage of it were extremely pleased. Job satisfaction improved and time available for other important tasks – such as in-basket management – increased. All combined, this decreased overall time in the EHR for these physicians. An unexpected benefit was the ability of these great physicians to mentor the next generation of practitioners. However, the cost of in-person scribes and staffing shortages precipitated by COVID-19 led us to look at AI-based options.

In 2020, we evaluated several vendors and selected one who provided AI transcription that was reviewed by a human before the final note was added to the physician’s preferred note template for review. Users felt that the service was hit-or-miss, with the quality of final note being highly dependent on the human reviewer. Most physicians who stayed with the service appreciated not having to worry about their documentation. Still, the inconsistent quality and cost were major drawbacks.

In 2022, we went live with a newer, fully automated version of the same company’s ambient AI transcription solution and we could not have been more pleased. Objective data show that the attrition rate is significantly lower than the version with human review, notes are delivered within seconds instead of hours, and any editing needed is much simpler and more efficient.

The subjective data obtained directly from the clinicians using the ambient AI solution is even more telling; participants have reported:

• Less burnout or fatigue.
• Reduced cognitive burden
• Better work/life balance
• Higher job satisfaction
• More likely to stay at their current organization
• More likely to remain in clinical practice

Specific comments from our physicians and APPs include:

• “Liberating! More time in the exam room where I can give the patient my undivided attention. I no longer feel like a well-paid data entry clerk!”
• “Much better documentation of historical data to support the level of visit.”
• “It might even give my career a few more years of longevity.”
• “Overall, very happy with this product. It has increased my job satisfaction and improved work-life balance.”
• “Wow! They documented things I would have forgotten.”
• “Very thankful for this service.”
• “I simply will not practice the rest of my career without some form of scribing, no matter the cost.”
• “I used to be working on labs from four to five days ago. Now, I work on yesterday’s labs.”
• “Another important part is that it allows me to look at my patients more and be more present to them during their appointments. I am no longer trying to partially complete notes in the room. The only things on the computer that I do in the room now are place orders or look up study results with the patients.”

As a user of ambient AI, I want to highlight the importance of reducing cognitive load. It feels very liberating to be able to concentrate on the patient and not have to stress about how to record what I am being told. Time previously spent writing notes can now be used for other complex tasks, such as addressing abnormal results.

Is this technology for everyone? No. Is it perfect? No. But it is incredibly good. Quite frankly, this technology is still in its early days and at its  “worst.” However, the learning nature of AI means that it will continue to improve and evolve. We have noticed significant improvements since we first went live, including stylistic changes in how the AI transcribes the note.

The sky’s the limit as to what this technology will do for us as clinicians. It will queue orders as it hears them. Also, it will soon generate summaries of relevant facts about a patient’s health issues. There are many more advancements planned, and I can’t wait to see what’s to come.

I appreciate a technology that enhances my human abilities when I am with my patients in the exam room. Simply put, it feels great to feel like a clinician again. 

The post Allow Your Clinicians to be Clinicians appeared first on HealthTech Magazines.

Healthcare is complicated. Knowing the correct medications, procedures, and care plans requires years of education and experience. The average family member of a patient does not have this knowledge, and most do not claim to have it.

However, what the average family member does know is their loved one who is lying in that hospital bed. They know their “normal” behavior and when the patient is deviating from that; what makes them comfortable, what will cause them distress, what will help with their healing and what will hinder it. Sometimes they know the patient’s past medical history better than the patient does.

Families can provide a wealth of knowledge that, combined with the expertise of medical professionals, can create an equation for better patient outcomes…as long as both sides take the other seriously.

Respectful and frequent communication with a patient’s family needs to be a priority in the healthcare environment. When a family member brings a concern to a care team member, it should be listened to and considered. While the requests or concerns may not always have merit, and the healthcare professional may have clinical knowledge that overrides the request, it is important that the family feels heard and considered. Sometimes what the family brings will truly impact the patient’s outcomes and overall health.

This collaboration can be facilitated using various technology platforms in the healthcare environment. If implemented effectively, they allow for information sharing that can lead to inclusive and effective care plans. The following sections outline some examples of technology that can assist in family-inclusive care.

Family-inclusive care has immense potential to improve patient care and outcomes.

TeleSitter

TeleSitter technology has become more prevalent in healthcare settings in recent years, as the industry has faced staff shortages and a global pandemic. This technology utilizes cameras, two-way video and audio, an alarm system, and centrally located monitor technicians to monitor multiple patients at once.

When patients are placed on TeleSitter via a provider order, a reason is indicated (i.e., altered mental status, attempting to remove medical devices, fall risk, etc.). With this information, the monitor technicians know what to look for on the video feed, and if they see an issue requiring an in-person response they communicate that with the patient’s bedside care team. If the response is needed urgently, the monitor technicians can also set off a loud alarm in the clinical space.

TeleSitter monitor technicians should also be encouraged to communicate with the patient and their family members in the room via the two-way audio/video capabilities. These conversations have several benefits: the patient and family are able to meet the technician who will be keeping an eye on them, the family can convey any concerns they have about the patient, or give the technician tips on things to look out for, and everyone can feel more comfortable that the patient will be safe.

Perhaps the family knows a loud alarm would make the patient’s delirium worse because they suffer from PTSD. They could communicate this to the technician, who can then take all appropriate steps to avoid the need to use the alarm. Or the patient’s spouse knows they always get up at night to use the restroom. The technician can proactively be prepared to speak to the patient over the device and ask them to wait for assistance so they avoid a fall. These anecdotal pieces of information can significantly improve the patient’s experience.

EMR Patient Portals

Patient portals provide an easily accessible window into a patient’s medical record. Patients can see test results, notes, immunization history, problem lists, and other information. Patients can communicate with their providers via secure chats, and in some cases, schedule appointments. These tools have become commonplace in healthcare, with new features continually being developed.

If leveraged correctly, these tools can improve communication in the Inpatient setting. A perfect example would be configuring the Electronic Medical Record (EMR) to send provider and nursing notes to the portal. This allows the patient and their family to always be up-to-date on the patient’s status and the care provided without having to track down a staff member for a verbal report. This is particularly helpful when family members cannot physically be at the hospital. It is a streamlined and efficient way to communicate.

Family Participation in Provider Rounds

Multi-disciplinary provider rounds are a standard communication tool amongst healthcare team members, and have been shown to enhance patient care and decrease lengths of stay. Mobile access to the EMR via a smartphone or tablet can easily allow clinicians to reference patient data during these meetings, making the discussions more specific and effective. This rounding method could also easily be expanded to be inclusive of families with the help of some additional technology.

For example, the Case Management team could coordinate with the patient’s family member(s) and establish an audio or video call so the family could participate in the conversation with the care team. If Rounds occur outside of visiting hours when the family cannot be there, they would still be able to ask questions, share information, and be part of the care planning process.

Conclusion

Family-inclusive care has immense potential to improve patient care and outcomes. Family members bring valid and important information to the table, and with some mutual respect, the healthcare team and family members can collaborate to benefit the patient’s ability to heal. Technology can be leveraged to facilitate this inclusion. Health systems should be taking steps to make family-inclusion part of their culture, providing education and tools to the healthcare team to encourage collaboration.

The post Family-Inclusive Care: Using Technology to Facilitate Coordination and Improve Outcomes appeared first on HealthTech Magazines.

Helping Hospitals Get Measurable ROI from Technology

Ascom’s expertise focuses on improving workflows in acute care hospitals and long-term care facilities. The company’s products are used in more than 46% of teaching hospitals in the U.S., and Ascom systems handle more than 800 million alerts every day. The Ascom Healthcare Platform (AHP) encompasses four key areas – nurse call, mobile devices, software and professional services. When customers standardize on the AHP portfolio, they realize the compounded benefits of Ascom’s comprehensive solutions, which are configured to their unique needs; however, being vendor neutral, the AHP also offers the flexibility for customers to integrate Ascom with other vendors’ solutions. Ascom’s solutions enable customers to implement important capabilities, from clinical surveillance with medical device integration (MDI) and clinical decision support, to remote patient monitoring of medical devices, and smart alarming and alerting.

David Gutillo, Director of Field Marketing Innovation in Healthcare at Ascom Americas, believes Ascom and its products are poised to become the enabling platform to which medical devices and systems in a hospital connects, and this will help shift the model to proactive, predictive care.

“We’ve designed our solutions and services to be highly configurable while also supporting standards and best practices to help hospitals meet their goals, whether it be increasing quality of care, reducing nursing turnover, improving patient outcomes or otherwise.”

We bring data to life. Every single second, Ascom systems generate 1.3 million data points, so making sense of all that information is extremely important for clinicians.

Powering Clinical Insights with Ascom Clinicians

The Ascom Healthcare Platform provides the clinical communication and workflow orchestration tools needed to meet a variety of challenges. Our team of veteran clinicians working directly with hospital staff in designing and optimizing workflows, makes a difference in deploying effective solutions that are truly force multipliers. Ascom Americas’ Clinical Application Specialist Kenneth Catoe states that the clinical data analytics team helps hospitals better understand the information their technology is generating by analyzing it and consulting with customers to improve care quality. Because hospitals are dynamic environments this service helps them manage the changes with actionable and goal-oriented insights.

“We bring data to life. Every single second, Ascom systems generate 1.3 million data points, so making sense of all that information is extremely important for clinicians”, Catoe shares. He goes on to add, “When we’re consulting on workflow design, we’re trying to look at the entire picture, from the data our systems are generating and taking other data into account too. Then we combine data analysis with what we’ve seen and learned onsite along with our clinical expertise to provide recommendations for improvements.”

Fellow Ascom Americas clinician Huyen Cam notes that, “This process of identifying areas for continued improvements helps hospitals meet their KPIs, whether it’s being more efficient with nurses working at their top of license to discharging patients faster and increasing throughput.”  

Empowering Customers with Solutions That Make a Difference

Ascom solutions are making a difference for customers. For example, RiverSpring Living, a senior living facility in New York, is using the complete AHP, beginning with implementing the Ascom nurse call system. Staff use an Ascom Myco smartphone to receive alerts from Ascom’s Unite software, so as soon as a resident presses the nurse call button, staff can respond immediately. During the first year of operation, RiverSpring Living processed more than 90,000 alerts and answered 95 percent of calls in less than two minutes. This ROI is making a difference in both resident and nurse satisfaction. 

In another example, Ascom’s Unite software solution helped a Southern California Hospital experience a 32% reduction in alarm notification messages sent to caregivers through basic filtering rules. By using a 10-second alarm filtering delay, the hospital saw a 38% reduction in alarm notification. This improvement resulted in smoother, more efficient workflows and made alarms more actionable and relevant.

A Complete Provider for Clinical Workflow Solutions

Ascom offers a full range of services through its network of more than 150 partners and 2,000 technicians to help hospitals realize the benefits of Ascom solutions. Technical services include plans for hardware repair, software upgrades and technical support as well as remote monitoring of a customer’s IT infrastructure connected to the AHP.

Delivering Continuous Innovation and Sustainability

A five-point strategic plan guides Ascom Americas and its regional leadership team, consisting of Kelly Feist, Managing Director; Corrado Grieci, Vice President of Sales; Tom McKearney, SVP Business Development and Marketing; Michael Augusti, Head of Market Innovation; Nancy Duffy, Finance Head; Robert Wittwer, SVP Professional Services and Chris LaFratta, SVP, Customer Success. For the near term, Ascom is delivering against four strategic pillars to accelerate growth and performance. Continuous innovation underpins this focus to further embed Ascom as a critical infrastructure at the center of delivery of care in the acute care environment. Over the longer term, many of Ascom’s solutions will continue evolving to become a cloud-native platform while enhancing MDI, alarm management, clinical collaboration, and augmented intelligence capabilities. Smart Nurse Call will evolve with enhanced software and hardware capabilities, and better designs will streamline installing and configuring them. With the Ascom Healthcare Platform, the future for clinical workflow technologies that help hospitals solve some of their biggest challenges looks bright and laden with opportunity.

The post Ascom Americas Powers Clinical Efficiencies & Quality of Care appeared first on HealthTech Magazines.

Health care providers continue to experience financial pressures due to various internal and external factors, like declining reimbursement rates, rising inflation, declining workforce availability and complex regulatory requirements. Marshfield Clinic Health System has not been immune to these factors and has been focused on a Financial Improvement Plan throughout 2023. As part of this Financial Improvement Plan, the health system embarked on a comprehensive revenue cycle optimization effort that looked at traditional and innovative solutions to create meaningful financial impact.

Areas of Focus

The health system has undergone a multi-year Electronic Medical Record (EMR) installation over the last couple years. This resulted in a 2023 focus for revenue cycle optimization on (a) a one-time cash acceleration by reducing the Discharge Not Final Billed (DNFB) and billed Accounts Receivable (A/R) backlogs; and (b) a sustainable net revenue improvement through comprehensive revenue integrity and reduction of administrative write-offs.

To achieve these objectives, the revenue cycle optimization efforts were divided across four pillars of work: DNFB Reduction, A/R and Denial Management, Revenue Assurance and Pricing and Denial Prevention. Each pillar identified and implemented initiatives across people, processes and technology.

The remainder of this article will focus on the technology initiatives, especially ones considered innovative solutions that go beyond the traditional EMR optimization.

Solutions

Limited availability of revenue cycle resources and rising labor costs have been key driving factors to look for innovative solutions to create meaningful impact across the revenue cycle. To create this impact, organizations need to rely on various avenues like data science and machine learning (ML), intelligent automation and data analytics, versus relying on just one solution like Robotic Process Automation (RPA).

Data Science and ML

As most readers know, revenue cycle within any health system is driven by data. With over 73,000 diagnosis codes, 10,000 procedure codes, 80 locations, 400 health plans and other key variables, there are billions of reasons why an individual encounter becomes a revenue cycle issue. At the health system, we rely on the use of practical data science and ML to organize work quickly for our revenue cycle teams that has exceeded the capabilities of rules-based systems designed in the past.

For the DNFB reduction initiative, we targeted high-value encounters buried inside of complicated system logic or worklists, identified programmatic fixes that may be available and worked with Information Services and other teams to resolve and optimized our resources and team structures based on the patterns identified through data science.

For the billed A/R and denials management initiative, we used data science and ML to drive enhanced collections performance across the entire account population by connecting similar work across revenue cycle functions. We have embarked on a comprehensive A/R prioritization effort that goes well beyond the high-dollar and aged worklists that have been traditionally used to drive work in the back end of the revenue cycle.

At Marshfield Clinic Health System, we rely on the use of practical data science and ML to organize work quickly for our revenue cycle teams that has exceeded the capabilities of rules-based systems designed in the past.

Automation

Intelligent automation is being used across several revenue cycle functions. Forexample, we are  implementing automated administrative intake in partnership with a leading intelligent automation company. We have automated appointment reminder outreach, collection of demographic information, consent forms, insurance forms and insurance cards. Another area being evaluated for RPA is the resolution of credit balances. Health System teams are engaged in developing Process Definition Documents (PDDs) that will be used to design automation for these processes.

Data Analytics

The health system relies on robust data analytics for decision-making in partnership with our internal Analytics Center of Excellence (ACE). Working with ACE, we developed a comprehensive set of dashboards to monitor revenue and usage reporting, pre-claim edits, claims, billed A/R and denial and write-offs. These dashboards allow our leadership teams to track the health of our revenue cycle metrics, use underlying data to root cause issues and collaborate across revenue cycle, operational and clinical areas.

AI Governance

As the health system continues to expand the use of AI across the system, in the summer of 2023, we established an AI governance program that ensures responsible and ethical adoption of AI technologies within the health system enterprise. The goal of this program is to mitigate risks and harms that can be caused by AI systems. The governance council comprises a diverse group of individuals charged with the responsibility of reviewing all requests to develop or acquire AI technology. It also provides oversight of the ongoing responsible use of AI technology.

Workforce Impact

As we implement AI and automation solutions, the need to accommodate the impact of these solutions on our workforce is ever-increasing. With the adoption of these solutions, there is a constant need to address our workforce levels, reallocate and re-educate our staff constantly and allocate resources to implement these solutions. At the health system, we are exploring avenues to address these needs, like flexing our vendor resources based on automation levels and maintaining a cross-functional pool of resources for problem-solving and technology implementation.

Path Forward

As we continue our revenue cycle optimization journey in 2024, we expect to double down on our use of intelligent automation and responsible AI throughout the revenue cycle. While the journey continues along the various initiatives listed in this article, we will continue to look at other areas to automate to improve our patient experience.

The post Marshfield Clinic Health System’s Technology-Driven Revenue Cycle Optimization appeared first on HealthTech Magazines.

By Neal Chawla, MD, CMIO, WakeMed Health & Hospitals

Clinical governance of IT systems can be challenging, but it is a framework for success that continues to gain ground across the health care industry. Now more than ever, IT plays a critical role in every aspect of the health care continuum – from clinical care and patient outcomes to daily operations, infrastructure and financial performance. While many organizations have governance in place, the approach is not one size fits all.

Clinical IT governance is an iterative process. To remain effective, strategic and to truly leverage technology to achieve goals, it is key for IT governance to change and evolve alongside the organization. Think of IT governance as an extension of an organization’s mission and identity. So as a company grows, innovates and builds a strong culture, so should this framework. Proper IT governance ensures that IT initiatives, processes and investments align with an organization’s strategic plan and benefit leadership, clinical staff and most importantly, patients.

We can get a lot of mileage out of educating our colleagues about clinical IT governance. When creating an IT governance process, it is important to consider what type of framework may work best for your organization – *at this point in time.*

Tighter Governance

Governance can be very buttoned-up and disciplined. A highly structured governance framework can exist with multiple levels, from the front lines to executive leadership, with issues passing through the lines until approved at the right levels. This can give an organization a clear, defined channel and chain of command. It leaves no room for doubt as to where a decision will be made and who will be at the table and have a voice and vote.

When a controversial issue needs to be decided upon, tight governance can give you definitive answers.  As an organization becomes more strategic and needs to prioritize projects to match their resources, tight governance can set scope and priorities.

On the other hand, tight governance can be overly bureaucratic. An issue may go through three layers or more before being approved, which adds both hurdles and hoops – and time.  It can also take significant resources, time and discipline to maintain a tight governance.  With tighter governance, the ‘process’ should not be the goal, but rather the outcomes.

Depending on who makes up each group and what issues they decide on, there may be a risk of having people with a voice and vote who may not have the right expertise. There is also a concern that the frequency of meetings related to governance could result in too much informational discussion and less action in the long run.  In a health care setting, this system may leave clinicians with the feeling that the politics of governance will trump good decision-making and, as a result, disengage providers if they view their participation as not worth the time away from clinical duties.

Looser Governance

A looser governance structure can allow a system to be nimble. A more flexible IT governance can turn discussions into action at a faster pace. More decisions can be made with less formality and more ‘work’ can get done.

This can be a wise approach for less complex projects, when following a strict set of formalities can seem like a waste of time and resources. In addition, ad hoc groups made up of people with the right expertise can be brought into discussions to get the right people in the room for a decision at the right time. It takes less administrative effort to coordinate looser governance while still ensuring that the processes are sound.

However, doing more work isn’t always better, especially when the work being done isn’t part of a strategic plan or roadmap.  Looser governance can sometimes make it more difficult for an organization to create and follow a disciplined strategy – especially if there is a disagreement on an issue. In these situations, it takes strong leadership to get the right folks to the right decision. Without it, an organization may become paralyzed and swirl on a decision too long.

What is the right governance fit for an organization?

There is no right answer. It depends.

Through different times in an organization’s maturity, the sweet spot between tighter and looser governance is a shifting target – being able to balance is important. There are times when an organization needs to move quickly, when looser governance and less bureaucracy may be needed.  There are also times when organizations need to be very strategic and disciplined, where tighter governance can be more advantageous.

An organization can find that balance and over time define criteria to identify what issues need a strict framework versus a more flexible approach. For example, small changes that help clinicians’ efficiency to help them better get through the day probably fare better with looser governance.  Contrastingly, controversial topics may do better with tighter governance if your committees have the right people. For larger projects that will take more resources and need to engage and align more people, tighter governance may also be most appropriate. Especially in cases when it is more important to do things ‘right’ rather than ‘fast.’

There may be times when IT clinical governance swings tighter or looser depending on an organization’s current goals. It is important to understand the balance, make ongoing evaluation part of the process and, in most circumstances, avoid the extremes.

The post Clinical IT Governance – How to Find the Right Fit and Framework appeared first on HealthTech Magazines.

Blockchain is a means of storing and exchanging data with vendors, partners, and patients that is strongly secure, verifiably accurate, and significantly more efficient than existing manual processes. It will become an integrated layer inside of dozens of current IT systems and will enable the creation of new services that cannot be fully automated today. Using cryptographic techniques, a blockchain creates a mathematically secure system of exchange and storage which cannot be falsified, deleted, or spoofed.

Businesses of all types currently use systems of manual checks and balances to create a level of trust and security that is sufficient for important business transactions. In healthcare, these include patient records, clinician certifications, insurance claims, pharmaceutical records, research data, employee records, and many more. But when manual steps are involved, those systems are slow and expensive to operate. Blockchain applications promise to deliver higher levels of trust and security at faster speeds, lower costs, and without manual human interventions.

Understanding the detailed inner workings of a blockchain system can be very involved and may require a background in computer programming, mathematics, and cryptography. However, healthcare leaders need not to dig that deep to come to an appreciation of why the technology has suddenly become such a hot topic and to identify a few internal problems for which the technology might be a solution.

Healthcare organizations are very risk-averse by nature and can be expected to approach these blockchain tools with caution.

Since blockchain is used to protect and exchange digital data of value between parties that are not part of the same trust circle, we should look for healthcare situations that contain these same features. Currently, hundreds of healthcare organizations, consulting firms, and systems integrators are searching for these matches between capabilities and needs. These groups have identified a small set of key areas that seem to be well-formed for a blockchain solution.

The first is in tracking pharmaceuticals and medical devices as they move through long, multi-party supply chains. Blockchain can provide a record of the provenance of these products from the initial manufacturer all the way to the final consumer. Such a record can play a valuable role in curtailing counterfeit products and theft. Today, it is possible for counterfeit or stolen drugs and medical devices to be sold into weak points in the supply chain. This is of tremendous concern to manufacturers and consumers alike, even when these products are a perfect chemical formulary or a fully functional device. A blockchain system would require that each lot or device be traceable back to its origins. With a blockchain, the validation of the product can be carried out in minutes and is 100% reliable and unforgeable.

A second application is in processing insurance claims that fall across multiple service providers. This blockchain would include all of the injury claims, conditions, expenses, and current actions on a claim. Parties privy to the contents of this chain can all see what has happened and how it is being handled, to include visibility by the patient who is usually kept in the dark on the status of their claims. The current opaqueness of the process is a problem for everyone involved in the transaction and blockchains can provide complete transparency that is strictly limited to authorized parties. Insurance companies are primarily concerned with ensuring that a claim is being handled within the terms of the contract and is not an instance of fraud. Accomplishing this with traditional systems is very labor and time intensive. Blockchain solutions should be able to reduce the processing costs for these claims, while also speeding up settlements. It is a win-win for all parties involved.

Finally, the most beneficial and most difficult application is in handling a patient’s personal health information (PHI) that currently resides in multiple disparate and barely interoperable Electronic Health Record (EHR) systems.  Every patient has noticed that when they visit a doctor, every office posts their results to a different EHR. Even within large, supposedly integrated, healthcare networks there are multiple EHRs in use because those systems grew through multiple acquisitions, each of which had its own legacy EHR. In this situation, literally no single organization has the ability to access all of the medical data about a specific patient. The patient can’t do it, the physician practice can’t do it, the hospital can’t do it, no one can do it. Blockchain idealists envision a future in which a healthcare blockchain exists separate from the medical providers. In this picture, the patient subscribes to a blockchain enabled service and personally holds the keys to the data on that chain. Then every time they visit a medical provider, the patient provides a public key to the provider which allows them to access past medical data and to post a new record on the chain. In this scenario, the patient has ownership, access, and control of all of their own medical data, which they do not have with today’s systems. The medical providers are also able to access a complete set of medical records through a single portal, something that is nearly impossible today. This is a beautiful picture, and it may be a reality someday. But the path from where we are today to something like this is long and complicated. There are many smaller steps to be taken with the existing EHR systems before we arrive anywhere near this ideal state.

These are just three of the most often cited applications of this technology in healthcare. There are literally hundreds of smaller concepts being developed for this industry and which will begin to appear in the next year. Healthcare organizations are very risk-averse by nature and can be expected to approach these blockchain tools with caution. Most will be looking for tools that can be implemented and tested without posing a threat to their core business. Ideally, these could be added as a new service that will differentiate them from competitors but without risking any downside to their traditional services.

Healthcare leaders who are interested in exploring the power of blockchain applications might consider following some very basic steps. First, identify internal problems that do not have solutions with the current IT systems. Second, select a blockchain pioneer to learn the technology and build relationships with external providers. Third, engage in the global discussion about the technology. Fourth, watch for viable products or services that align with your unsolved problems. And finally, begin by addressing a problem that will not threaten core operations. Blockchain applications are transforming the internal IT processes in the financial services industry right now and will spread to other areas as applications are proven for each industry’s unique form of data, regulations, relationships, and business operations.

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We’ve all heard in the news, and are certainly disheartened, about the opioid crisis. According to the Centers for Disease Control and Prevention (CDC), on average, 115 Americans die daily from an opiate overdose.

There are many solutions being discussed, rightly so, such as cutting back on prescriptions to patients and providing alternate pain management plans; as well as increasing the number of addiction programs. There is certainly a role on the clinical side to addressing the crisis. But we should also consider how using technology – specifically the power of data and analytics – can help. What if we armed medical professionals on the front lines with up-to-date information about their patients’ histories with narcotics and amount of prescriptions they have received most recently?

This can be accomplished through a universal patient identifier (UPI) – a concept that is not new. Unfortunately, it hasn’t been very “universal,” despite the many reasons it should be. One reason, in particular, makes a strong case.

Beyond the opioid crisis, drug overdoses in general are the leading cause of death among Americans under 50, according to the CDC. Prescription drugs are often the culprit as they are being prescribed to individuals from multiple providers without any way for medical professionals to cross-reference the patient’s past and current drug prescriptions.

Those who are leading the charge successfully

The concept has been embraced at the local levels. According to a University of Michigan study released this year, the prescription drug monitoring programs in Kentucky, New Mexico, Tennessee and New York have significantly reduced opioid prescriptions and the dosages of those prescriptions.

But while this has proved successful at the local level, patients very often move to a different state or city or need a specialization not offered by their current medical group, requiring them to start all over with a new doctor. However, using UPI technology, patient data—and supporting patient demographic data—can be used for the common good to improve patient safety, increase quality of care and reduce mistaken identity risks.

The creation of a UPI will allow the healthcare industry to facilitate accurate information exchange to stop problems before they start. For example, the National Council for Prescription Drug Programs (NCPDP) has already started using this vendor-neutral technology to establish a cost-effective solution for national patient safety. This technology can link patient data at scale efficiently and accurately to improve patient safety and care coordination.

There are many more clinical, administrative benefits

The benefits of a UPI extend across the entire healthcare system as well, as it improves the quality of patient identities, which can have duplicate, overlapping and incomplete records. Additionally, a UPI can help eliminate incorrect medical treatments; deliver current and accurate patient data; and prevent identity fraud, HIPAA breaches and incidental disclosures of protected health information (PHI).

As consolidation within healthcare continues, data management suffers and the interoperability issues become more evident; thus managing records becomes even more of a challenge. While organizations complete the conversion to electronic health records and increase information sharing through Health Information Exchanges (HIEs) and Integrated Delivery Networks, accuracy emerges as a primary concern, as overlapping and incomplete records become commonplace.

There is no doubt a UPI will lead to more informed clinical decision-making

A UPI prevents duplicate, overlapping and incomplete records from impacting continuity of care, delaying treatment, increasing the risk of medical errors, delaying billing and opening the door to fraud, all of which costs healthcare organizations millions of dollars each year. It is estimated that the average hospital has around 800,000 records, of which 8 to 12 percent are duplicates. With duplicates costing up to $50 per record pair to reconcile, this could add up costing the industry billions. UPIs could eliminate this issue.

It doesn’t stop there. UPIs benefit patients directly too. Consumer demand – and they are consumers – for access to their own health information could be satisfied, as they begin to compile health histories through apps from different health organizations, UPIs can help ensure the right person is connected with the right information. Gone would be the daunting task of assembling one’s healthcare history by relying on memory or spending an inordinate amount of time requesting records from individual providers through fax or mail and piecing together a history. Patients are demanding more ease, options and control over their care experience and providers need to start to view their patients as “customers” who can shop elsewhere, in order to improve satisfaction and maintain loyalty. This is a key step in embracing the consumerism environment that healthcare providers face today.

There is no doubt a UPI will lead to more informed clinical decision-making, allow open communication among providers, enable more integrated and coordinated care, enhance quality of care, and result in more prudent use of valuable healthcare resources. Ultimately, this approach would improve customers’ health and save lives – which we can all agree is benefit No. 1.

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