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The Truth about AI in Healthcare

Posted on June 18, 2018 I Written By

The following is a guest blog post by Gary Palgon, VP Healthcare and Life Sciences Solutions at Liaison Technologies.

Those who watched the television show, “The Good Doctor,” in its first season got to see how a young autistic surgeon who has savant syndrome faced challenges in his everyday life as he learns to connect with people in his world. His extraordinary medical skill and intuition not only saves patients’ lives but also creates bridges with co-workers.

During each show, there is at least one scene in which the young doctor “visualizes” the inner workings of the patient’s body – evaluating and analyzing the cause of the medical condition.

Although all physicians can describe what happens to cause illness, the speed, detail and clarity of the young surgeon’s ability to gather information, predict reactions to treatments and identify the protocol that will produce the best outcome greatly surpasses his colleagues’ abilities.

Yes, this is a television show, but artificial intelligence promises the same capabilities that will disrupt all of our preconceived notions about healthcare on both the clinical and the operational sides of the industry.

Doctors rely on their medical training as well as their personal experience with hundreds of patients, but AI can allow clinicians to tap into the experience of hundreds of doctors’ experiences with thousands of patients. Even if physicians had personal experience with thousands of patients, the human mind can’t process all of the data effectively.

How can AI improve patient outcomes as well as the bottom line?

We’re already seeing the initial benefits of AI in many areas of the hospital. A report by Accenture identifies the top three uses of AI in healthcare as robot-assisted surgery, virtual nursing assistants and administrative workflow assistance. These three AI applications alone represent a potential estimated annual benefit of $78 billion for the healthcare industry by 2026.

The benefits of AI include improved precision in surgery, decreased length of stay, reduction in unnecessary hospital visits through remote assessment of patient conditions, and time-saving capabilities such as voice-to-text transcription. According to Accenture, these improvements represent a work time savings of 17 percent for physicians and 51 percent for registered nurses – at a critical time when there is no end in sight for the shortages of both nurses and doctors.

In a recent webinar discussing the role of AI in healthcare, John Lynn, founder of HealthcareScene.com, described other ways that AI can improve diagnosis, treatment and patient safety. These areas include dosage error detection, treatment plan design, determination of medication adherence, medical imaging, tailored prescription medicine and automated documentation.

One of the challenges to fully leveraging the insights and capabilities of AI is the volume of information accumulated in electronic medical records that is unstructured data. Translating this information into a format that can be used by clinical providers as well as financial and administrative staff to optimize treatment plans as well as workflows is possible with natural language processing – a branch of AI that enables technology to interpret speech and text and determine which information is critical.

The most often cited fear about a reliance on AI in healthcare is the opportunity to make mistakes. Of course, humans make mistakes as well. We must remember that AI’s ability to tap into a much wider pool of information to make decisions or recommend options will result in a more deeply-informed decision – if the data is good.

The proliferation of legacy systems, continually added applications and multiple EMRs in a health system increases the risk of data that cannot be accessed or cannot be shared in real-time to aid clinicians or an AI-supported program. Ensuring that data is aggregated into a central location, harmonized, transformed into a usable format and cleaned to provide high quality data is necessary to support reliable AI performance.

While AI might be able to handle the data aggregation and harmonization tasks in the future, we are not there yet. This is not, however, a reason to delay the use of AI in hospitals and other organizations across the healthcare spectrum.

Healthcare organizations can partner with companies that specialize in the aggregation of data from disparate sources to make the information available to all users. Increasing access to data throughout the organization is beneficial to health systems – even before they implement AI tools.

Although making data available to all of the organization’s providers, staff and vendors as needed may seem onerous, it is possible to do so without adding to the hospital’s IT staff burden or the capital improvement budget. The complexities of translating structured and unstructured data, multiple formats and a myriad of data sources can be balanced with data security concerns with the use of a team that focuses on these issues each day.

While most AI capabilities in use today are algorithms that reflect current best practices or research that are programmed by healthcare providers or researchers, this will change. In the future, AI will expand beyond algorithms, and the technology will be able to learn and make new connections among a wider set of data points than today’s more narrowly focused algorithms.

Whether or not your organization is implementing AI, considering AI or just watching its development, I encourage everyone to start by evaluating the data that will be used to “run” AI tools. Taking steps now to ensure clean, easy-to-access data will not only benefit clinical and operational tasks now but will also position the organization to more quickly adopt AI.

About Gary Palgon
Gary Palgon is vice president of healthcare and life sciences solutions at Liaison Technologies, a proud sponsor of Healthcare Scene. In this role, Gary leverages more than two decades of product management, sales, and marketing experience to develop and expand Liaison’s data-inspired solutions for the healthcare and life sciences verticals. Gary’s unique blend of expertise bridges the gap between the technical and business aspects of healthcare, data security, and electronic commerce. As a respected thought leader in the healthcare IT industry, Gary has had numerous articles published, is a frequent speaker at conferences, and often serves as a knowledgeable resource for analysts and journalists. Gary holds a Bachelor of Science degree in Computer and Information Sciences from the University of Florida.

Gamification in Healthcare: Just Play or Real Value?

Posted on June 14, 2018 I Written By

The following is a guest blog post by Thomas McFarland, Kerry Harbeck, and Andrea Kamper from Atos.

As early as the 1900s, educators started using rewards to motivate learners. Today, we know that incorporating rewards into learning has limited value; however, gamification spans a much broader strategy than simple reward systems. Coined in 2002, the term gamification takes a variety of complex factors into consideration when studying what makes a person decide to do something; it refers to a multifaceted approach that utilizes psychology, design, strategy, and technology.  The efficacy of gamification relies on experts, often instructional designers, to explore innovative pedagogical solutions.

Jane McGonigal, author of Reality is Broken: why games make us better and how they can change the world, demonstrated the power of games in solving real world problems.  She demonstrates how games can teach players how to make complex decisions and strategize for addressing issues from poverty to climate change. For instance, the game World Without Oil is a simulation designed to use brainstorming in order to avert the challenges of a worldwide oil shortage. Evoke, a game commissioned by the World Bank Institute, teaches players to find strategies for addressing issues from poverty to climate change. McGonigal makes a strong case for significant advantages held by organizations who can think beyond traditional training. She places a high value on simulation learning that involves strategy and role-based behaviors.

What value does gamification provide in healthcare?  Previous research indicates that gamification strategies enhance learning in a few key areas such as content recall and retention. Simulation of complex, critical processes may be one of the most valuable applications in healthcare. For example, the Education Technology group at the Stanford School of Medicine developed an application to teach physicians how to identify and treat sepsis. The web-based program, Septris, quickly gained popularity and led to a group of surgeons requesting a new application, SICKO, to teach doctors about surgical decisions.  Reception of Septris was immediately positive, and it enjoyed widespread usage. Within one year of launch, the game received more than 32,000 visits, with 16,700 plays and 2,500 completions of the game. Also, while 55% of hits were direct/organic, the other 45% of hits came from referrals. The authors demonstrated both the clinical and financial benefits of gamification for these more complex processes.

A vast set of opportunities exists in healthcare around learning that focuses on clinical & financial outcomes. Revenue cycle is a particularly challenging area for healthcare organizations because of its complex workflow, multiple stakeholders, turnover in job roles and importance of both accuracy and timeliness. Revenue cycle education is an excellent fit for gamification. We at Breakaway Adoption Solutions have created a strategy and role-specific approach called Revenue Cycle $im. It presents the learner with the multi-faceted revenue cycle environment as a computerized board game with animated characters, interactive problem solving, and real-world scenarios. This method allows the learner to quickly absorb the complex and role-specific interactions that have a significant impact on rev cycle success.

Check out some of the screenshots from Revenue Cycle $im below (click on the images to see the larger version) or request a full demo:


 
If you plan to use gamification in your healthcare organization, you should begin by asking if gamification is appropriate for the desired learning objectives. In general, gamification is more effective when the learning method meets the following criteria:

  • The learning includes a complex set of processes
  • The learning involves problem solving
  • The learning content creates a realistic simulation or link to real or analogous processes
  • The subjects require reinforcement over time
  • The learning content or processes have multiple “right” answers or various paths to successful completion
  • The activities or processes have multiple stakeholders that require collaboration and cooperation
  • The learning should use a creative and fun approach

Gamification has tremendous potential to create an interactive, memorable, rich experience for a healthcare learner.

About the Authors
Thomas McFarland is the Research and Development Manager for Breakaway Adoption Solutions, Atos
Kerry Harbeck is the Director of Learning Innovation for Breakaway Adoption Solutions, Atos
Andrea Kamper is the Innovations Operations Manager for Breakaway Adoption Solutions, Atos

About Atos Digital Health Solutions
Atos Digital Health Solutions helps healthcare organizations clarify business objectives while pursuing safer, more effective healthcare that manages costs and engagement across the care continuum. Our leadership team, consultants, and certified project and program managers bring years of practical and operational hospital experience to each engagement. Together, we’ll work closely with you to deliver meaningful outcomes that support your organization’s goals. Our team works shoulder-to-shoulder with your staff, sharing what we know openly. The knowledge transfer throughout the process improves skills and expertise among your team as well as ours. We support a full spectrum of products and services across the healthcare enterprise including Population Health, Value-Based Care, Security and Enterprise Business Strategy Advisory Services, Revenue Cycle Expertise, Adoption and Simulation Programs, ERP and Workforce Management, Go-Live Solutions, EHR Application Expertise, as well as Legacy and Technical Expertise. Atos is a proud sponsor of Healthcare Scene.

New Mexico Hospital Battles Addiction with Health Information Technology Apps

Posted on June 8, 2018 I Written By

The following is a guest blog post by David Dellago, Former Chairman of McKinley County Commission

(This byline focuses on the efforts of David Conejo, CEO, RMCHCS Hospital who spoke on the Health IT Expo Data Integration Panel, May 31 at 2:30 pm.)

McKinley County, New Mexico, is the namesake of the assassinated 25th U.S. President William McKinley. Many locals, particularly those Native Americans of Navajo decent living on reservations, have also been the victim of assassination, but in character in addition to physical attacks.  Three decades ago Gallup, New Mexico, which borders on the Navajo Reservation, was known as “Drunk Town, USA.”

For many years Northwest New Mexico’s Gallup ranked number one nationally in the number of alcohol-related deaths. This reputation also killed many resident’s spirits, contributing to addiction, joblessness, and homelessness, further highlighting the need for behavioral health care in this region. Native American youth have the highest rates of alcoholism of any racial group in the country, according to the National Institutes of Health.

McKinley County Is One of Poorest in U.S.

There are many stories like this. Addiction’s partner is the adjunct poverty of McKinley County, one of the poorest counties in the U.S. In Gallup, there is a large population of Navajo and Na’nizhoozhi Indians. It is the most populous city in the county with 22,670 residents and is situated between Albuquerque and Flagstaff with 61 percent living below the federal poverty line and unemployment at 8.4 percent.

The Indian Health Service (IHS), an operating division within the U.S. Department of Health and Human Services (HHS) is the principal federal health care provider for Indians. Its mission is to raise their health status to the highest possible level. However, there are still issues such as the life expectancy for Indians being approximately 4.5 years less than the general population of the United States, 73.7 years versus 78.1 years.

Data from a 2014 National Emergency Department Inventory survey also showed that only 85% of the 34 IHS respondents had continuous physician coverage. Of these 34 sites surveyed, only four sites utilized telemedicine while a median of just 13 percent of physicians was board certified in emergency medicine. Another behavioral health related disease afflicting the territory is diabetes. In 2016, diabetes was the 6th leading cause of death for New Mexicans and the 7th leading cause in the U.S.

RMCHCS Hospital Fights Addiction with Behavioral Health Apps

Despite the drumbeat of bad news and discouraging statistics, organizations such as Gallup’s Na’ Nihzhoozhi Center Inc.’s (NCI) has 26,000 admissions every year and is the nation’s busiest treatment center with many repeat customers. The detox center was the result of an effort 30 years ago which began when more than 5,000 people marched from Gallup to Santa Fe to demand assistance from state lawmakers and received $400,000.00 for a study to build a detoxification center. The hospital then received two-million-dollar ongoing yearly federal grants out of which NCI was born.

The leader of that effort in the 80s and 90s was David Conejo who returned in 2014 as the CEO of Rehoboth McKinley Christian Health Care Services (RMCHCS) where he leads the fight against addiction with traditional tactics, but also behavioral healthcare innovations which have captured the attention of the healthcare industry.

Turing the Tables on Addiction

When he became CEO of RMCHS a few years ago, he took a financially failing hospital and turned it around with the help of William Kiefer, Ph. D who is the hospital’s chief operating officer. Recognizing the root cause of the region’s health problem was addiction, Conejo revitalized a former rehab building on the hospital’s grounds and with some fundraising he launched the Behavioral Health Treatment Center.

The center is operated by Ophelia Reeder, a long time health care advocate for the Navajo Nation and a board member of the Gallup Indian Medical Center. Bill Camorata, a former addict, is the Behavioral Special Projects Director.  He opened “Bill’s Place”, an outdoors facility where he and hospital volunteers treated the homeless with meals, clothing and medical triage as part of Gallup’s Immediate Action Group which he founded and serves as president.  The center has treated more than 200 addicted residents since the center opened in 2015 and has a staff of 30 who manage resident’s casework, provide behavioral health services and are certified in peer support.

High Information Tech in High Gear

From this traditional form of behavioral health addiction treatment, Conejo has turned to health information technology in his pursuit of behavioral health care remedies while leveraging government insurance changes in Medicare and Medicaid Services (CMS), under the Obama Administration. Rather than traditional acute care services, CMS began to shift its focus on preventive care, identifying a 6:1 cost savings ratio.

Conejo recognized that RMCHCS would benefit by offering preventative care services which fit perfectly with his behavioral care plans while creating a new revenue center through reimbursements by CMS. To achieve this, he recognized the need for the convergence of hospital information across clinical, financial, and operational systems.

He began by integrating data from the hospital’s three clinics—the College Clinic for family and internal medicine, the Red Rock Clinic for general surgery and the Acute Clinic for emergencies and occupational health. He used a cloud suite application from Zoeticx which integrates and streamlines data from the Center for Medicaid and Medicare Services (CMS) including Annual Wellness Visits (AWV), Chronic Care Management and Care Transition between physical and behavioral health services.

Integrating Data and Patients

The cloud application streamlines data from Annual Wellness Visits (AWVs) and integrates it with the hospital’s Electronic Health Record (EHR) systems from Athena Health and MedTech. The app also allows for the management of tracking for patient wellness visits, provides a physical assessments guide through preventative exams and maps out the risk factors for potential diseases for patient follow-up visits.

In addition, the Zoeticx app includes other services that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurer requirements for organizations like Blue Cross/Blue Shield. The app’s time tracker capability automates invoices for faster billing.

RMCHS’ business is growing with full or near-full coverage compliance. And with its Accountable Care Organization (ACO) in startup mode, RMCHS is also receiving a bonus check from Medicare for containing costs, in addition to the new revenues being generated. During the first five months of using the Zoeticx app, the new revenue has matched the financial incentive from its ACO, with the outlook of at least doubling the bonus from the ACO. Furthermore, RMCHS does not increase its current operational cost to achieve this type of outcome.

Joe Wright, the hospital’s director of clinical services, has found the apps provide significant time savings for the nurses and medical assistants when disparate EHR data is integrated and streamlined. He also notes more patients can be seen. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, but if a physician saves 10 minutes per patient, at 18 patients a day, that’s an extra 180 minutes. More minutes, more patients.

In addition, his chronic care patient practice has grown significantly since the recent implementation of Zoeticx’s Chronic Care Management where many patients suffer from diabetes. Patients participating in AWV visits have grown to 250, a 50 percent increase since the apps have been installed. The AWV appointments also mean less patient visits to the hospital. At the hospital’s Behavioral Health Services facility where addiction to alcohol and opioids are the main patient affliction, all 68 beds are full.

Telemedicine Next Step

Conejo’s next big technology push will be a telemedicine program enabling reservation patients to be seen by mobile healthcare physicians connected by satellite to the Internet to extend the hospital’s outreach to patients who can’t visit the hospital for various reasons.  This will enable patients to be treated as if they were at one of the hospital’s clinics with all their data entered into the appropriate systems and ready to be whisked off to the insurance organizations.

Enterprise Resource Planning: Critical Factors for Increasing End-User Adoption

Posted on May 23, 2018 I Written By

The following is a guest blog post by Mark Muddiman, Sallie Parkhurst & Maureen Tellefson from Atos.

Healthcare organizations continue to be bombarded with technology implementations that span every critical path in healthcare, from clinical applications to business processes.  EHR implementations alone increased over 75 percent from 2009 to 2015 (NCHS, 2015).  The change continues at a pace that makes adoption of these systems a difficult journey for IT leadership, administrators, clinicians, and the teams who support them.  Mergers and acquisitions within healthcare are at an all-time high.  Acquiring or being acquired requires system consolidation, new technologies, and decisions about workflow and training.  Sharing the lessons learned from successful implementations will drive improved outcomes and create a better understanding of the factors that contribute to successful adoption.

Surgery Partners, a leading operator of surgical facilities and ancillary services, continues to grow both organically and through acquisitions.  With financial systems at end of life, Surgery Partners worked in partnership with Atos to select a new ERP to help manage their business.  ERP systems play a critical role in the transition to value-based care.  About 69 percent of IT leaders said they will prioritize healthcare supply chain in 2017 as “the most valuable asset for actionable data mining” rather than population health and data analytics tools (Black Book, 2016).  Surgery Partners engaged Atos as a consultant to assist with a thorough system selection that would best meet their needs.  The resulting strategic decision was to implement Infor Lawson to replace all legacy systems for Finance and Supply Chain.

The multitude of challenges that arise during large technology implementations are rarely captured, but can provide significant value when shared.  The leadership team at Surgery Partners was highly engaged and disciplined in how they managed and measured adoption of Infor Lawson.  They utilized a research-based methodology, The Breakaway Methodology, published in a book titled Beyond Implementation: A Prescription for the Adoption of Healthcare Technology.  As their partner, Atos provided expert guidance in navigating the adoption process and measuring the work outcomes according to the methodology.

Surgery Partners understood that their business had to overcome a few unique challenges during their implementation.  With hundreds of users spanning 20 locations in 12 states, their geographic footprint made it challenging to educate their employees on the new Infor Lawson solution.  Traditional classroom training is expensive and time-consuming when users are spread across multiple locations. And, without proper training, many ERP system implementations fail.  Instead, Surgery Partners used a novel approach based on The Breakaway Methodology to educate their employees on Infor Lawson.  Atos developed “simulators” which allowed every user to practice relevant tasks and workflows in a realistic environment that mimicked the actual system without compromising real application data.

Atos and Surgery Partners measured the effectiveness of this novel approach throughout their implementation and continue to measure these factors post-implementation.  Eighty-seven percent of employees assigned to the supply chain learning completed their education and 69% of employees assigned to the accounts payable learning completed their education.  In comparison, less than 60% of employees typically complete traditional e-learning.  More importantly, the employees who completed the supply chain learning achieved an average proficiency score of 94% on challenging, workflow-based assessments in a simulated environment.  Employees who completed the finance learning achieved an average proficiency score of 89%.  In addition, users were asked to rate the quality and effectiveness of every simulation.  Based on 656 responses, 94% believed the simulator courses were valuable to their role.  Eighty-eight percent indicated that the simulations provided the knowledge they needed to perform key tasks in the new system, and 90% would recommend the simulations to colleagues going through similar implementations.

A key component of Surgery Partners strategy for managing change involved engaged leadership.  Executive leadership communicated messages to learners that were jointly developed with Atos.  Varying levels of leadership, from Senior Directors through local leaders, were selected as adoption coaches to assist learners with questions and direct them to the appropriate resources.  This approach that was defined as leading by example, set a tone throughout the organization that the adoption of Infor Lawson was imperative and that leaders were there to ensure success.

Achieving ERP adoption also requires continued investment long after go-live.  Surgery Partners developed standard processes to re-examine workflows and continue to educate users on changes or modifications due to system upgrades.  Adoption of technology often erodes over time due to employee turnover, so they put programs in place to teach new users how to use Lawson Infor and develop the same high levels of proficiency in the system achieved during the initial implementation.

Technology adoption creates significant changes in workflow, resource needs and overall governance.  Surgery Partners knew that simply installing a new ERP wouldn’t be enough; to realize the value they expected from the purchase, they had to ensure that every user across their organization successfully adopted the system.  The results Surgery Partners experienced provide important insight for other organizations going through similar technology implementations.

Recommendations and Best Practices:

  • Align business needs and vendor capabilities using a disciplined vendor selection process. Surgery Partners understood the value of selecting the right system and following a disciplined process for achieving adoption.
  • Executive engagement is a significant predictor of implementation success: prioritize the effort across the entire organization, remove organizational barriers, and develop a communication strategy.
  • Lack of training can cause failure. Provide role-based education that is relevant to user roles and allow users to practice realistic workflows. Simulation learning saves time and results in higher user proficiency.
  • Customize your policy and procedure learning. Implement best practices for specific procedures consistently across all locations, and ensure that the simulator training reflects best practices.
  • Develop a plan to sustain high levels of adoption after go-live. Surgery Partners updates their learning regularly and educates new employees to prevent erosion of adoption over time.

“We were highly committed to adopting Infor Lawson and we appreciated the guidance, leadership, responsiveness, and  expertise of the Atos team.” – Cathy Borst, Senior Vice President, IT.

“The learning has gone very smoothly.  I think this has been extremely valuable.”  – Rick Daniel, Senior Director of Supply Chain and Materials Management at Surgery Partners.

Acknowledgements:
Thank you to the leadership at Surgery Partners for their dedication to this project: Cathy Borst (SVP of IT), Chris Vandercook (Director, Technical Services Hospital Division), Sallie Parkhurst-PM, Carol Mortimer (SME), John Hart (CFO), Kara Baker (VP Finance/Corporate Controller), and Doug Watkins (VP of Supply Chain Management).

About the Authors
Mark Muddiman is an Engagement Manager for Breakaway Adoption Solutions, Atos
Sallie Parkhurst is a Project Manager for Digital Health Solutions Consulting, Atos
Maureen Tellefson is an Engagement Manager for Digital Health Solutions Consulting, Atos

About Atos Digital Health Solutions
Atos Digital Health Solutions helps healthcare organizations clarify business objectives while pursuing safer, more effective healthcare that manages costs and engagement across the care continuum. Our leadership team, consultants, and certified project and program managers bring years of practical and operational hospital experience to each engagement. Together, we’ll work closely with you to deliver meaningful outcomes that support your organization’s goals. Our team works shoulder-to-shoulder with your staff, sharing what we know openly. The knowledge transfer throughout the process improves skills and expertise among your team as well as ours. We support a full spectrum of products and services across the healthcare enterprise including Population Health, Value-Based Care, Security and Enterprise Business Strategy Advisory Services, Revenue Cycle Expertise, Adoption and Simulation Programs, ERP and Workforce Management, Go-Live Solutions, EHR Application Expertise, as well as Legacy and Technical Expertise. Atos is a proud sponsor of Healthcare Scene.

5 Ways Allscripts Will Help Fight Opioid Abuse In 2018

Posted on May 22, 2018 I Written By

The following is a guest blog post by Paul Black, CEO of Allscripts, a proud sponsor of Health IT Expo.

Prescription opioid misuse and overdoses are on the rise. The Centers for Disease Control and Prevention (CDC) reports that more than 40 Americans die every day from prescription opioid overdose. It also estimates that the economic impact in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement.

The opioid crisis has taken a devastating toll on our communities, families and loved ones. It is a complex problem that will require a lot of hard work from stakeholders across the healthcare continuum.

We all have a part to play. At Allscripts, we feel it is our responsibility to continuously improve our solutions to help providers address public health concerns. Our mission is to design technology that enables smarter care, delivered with greater precision, for better outcomes.

Here are five ways Allscripts plans to help clinicians combat the opioid crisis in 2018:

1) Establish a baseline. Does your patient population have a problem with opioids?

Before healthcare organizations can start addressing opioid abuse, they need to understand how the crisis is affecting their patient population. We are all familiar with the national statistics, but how does the crisis manifest in each community? What are the specific prescribing practices or overdose patterns that need the most attention?

Now that healthcare is on a fully digital platform, we can gain insights from the data. Organizations can more precisely manage the needs of each patient population. We are working with clients to uncover some of these patterns. For example, one client is using Sunrise™ Clinical Performance Manager (CPM) reports to more closely examine opioid prescribing patterns in emergency rooms.

2) Secure the prescribing process. Is your prescribing process safe and secure?

Electronic prescribing of controlled substances (EPCS) can help reduce fraud. Unfortunately, even though the technology is widely available, it is not widely adopted. Areas where clinicians regularly use EPCS have seen significantly less prescription fraud and abuse.

EPCS functionality is already in place across our EHRs. While more than 90% of all pharmacies are EPCS-enabled, only 14% of controlled substances are prescribed electronically. We’re making EPCS adoption one of our top priorities at Allscripts, and we continue to discuss the benefits with policymakers.

3) Provide clinical decision support. Are you current with evidence-based best practices?

We are actively pursuing partnerships with health plans, pharmaceutical companies and third-party content providers to collaborate on evidence-based prescribing guidelines. These guidelines may suggest quantity limits, recommendations for fast-acting versus extended-release medications, protocols for additional and alternative therapies, and expanded educational material and content.

We’ll use the clinical decision support technologies we already have in place to present these assessment tools and guidelines at the time needed within clinical workflows. Our goal is to provide the information to providers at the right time, so that they can engage in productive conversations with patients, make informed decisions and create optimal treatment plans.

4) Simplify access to Prescription Drug Monitoring Programs (PDMPs). Are you avoiding prescribing because it’s too hard to check PDMPs?

PDMPs are state-level databases that collect, monitor and analyze e-prescribing data from pharmacies and prescribers. The CDC Guidelines recommend clinicians should review the patient’s history of controlled substance prescriptions by checking PDMPs.

PDMPs, however, are not a unified source of information, which can make it challenging for providers to check them at the point of care. The College of Healthcare Information Management Executives (CHIME) has called for better EHR-PDMP integration, combined with data-driven reports to identify physician prescribing patterns.

In 2018, we’re working on integrating the PDMP into the clinician’s workflow for every patient. The EHR will take PDMP data and provide real-time alert scores that can make it easier to discern problems at the point of care.

5) Predict risk. Can big data help you predict risk for addiction?

Allscripts has a team of data scientists dedicated to transforming data into information and actionable insights. These analysts combine vast amounts of information from within the EHR, our Clinical Data Warehouse – data that represents millions of patients – and public health mechanisms (such as PDMPs).

We use this “data lake” to develop algorithms to identify at-risk patients and reveal prescription patterns that most often lead to abuse, overdose and death. Our research on this is nascent, and early insights are compelling.

The opioid epidemic cannot be solved overnight, nor is it something any of us can address alone. But we are enthusiastic about the teamwork and efforts of our entire industry to address this complex, multi-faceted epidemic.

Hear Paul Black discuss the future of health IT beyond the EHR at this year’s HIT Expo.

Lessons Learned from the 2017 AHIMA Information Governance Survey – HIM Scene

Posted on May 16, 2018 I Written By

The following is a guest blog post by Stephanie Crabb, Co-Founder and Principal at Immersive as part of the HIM Scene series of blog posts.

The American Health Information Management Association (AHIMA) 2017 Information Governance (IG) survey follows previous surveys administered in 2014 and 2015 to identify trends and offer insights associated with the healthcare industry’s understanding and adoption of IG. The good news from the 2017 survey is that awareness of IG, at least among the 1500+ survey respondents, is high with 84.6 percent reporting that they are familiar with IG. The bad news from the survey is that 51.6 percent of those same respondents report that lack of awareness or misunderstanding of IG is a barrier (the most significant barrier reported) to IG adoption in their organizations.

Who participated?

While the 2017 survey garnered more participation from outside the health information management professional community than previous efforts, it is important to note that the majority of respondents identified themselves as health information managers (HIM-ers). AHIMA’s work to raise IG awareness and educate the healthcare industry since 2012 has been significant and is to be commended. The body of knowledge created and published and the work completed is extraordinary; it has certainly paid off with its own constituents. Perhaps the survey demonstrates that there is still work to be done with additional stakeholders or that we need to do more to demonstrate the knowledge and capabilities that HIM-ers possess to support IG efforts.

IG Adoption, Drivers and Benefits

Based on what we see, read and experience, in every sector of the industry information and the data from which it is created are at the center of nearly every strategic and tactical activity. So why the disconnect, or the slow pace of formal IG adoption? Why did only 14.8 percent of respondents report an “initiated” IG program as illustrated below? Further, why did percent of respondents report that IG is not considered a priority in their organizations?

A closer look at what respondents had to say about the barriers to IG adoption is useful. The survey offered respondents a list of commonly-cited barriers to IG adoption across all industries and asked them to select their top three, resulting in the following:

For many, the term “governance” implies bureaucracy, expense, complexity, misplaced power and control, among other negative connotations. This may offer some context for these survey results and explain, in part, the top responses.

IG is a complex discipline, no doubt. However, everyone can identify IG or IG-like work that is getting done in their organization every day; it is just not formalized, organized or recognized as such. Sadly, much of that work is buried or siloed, in part, because it is not connected to a strategic imperative where it might gain greater visibility and appreciation as an IG effort.

The data around low IG adoption are even more confusing when we look at what respondents had to say about what they think does or should drive IG efforts. The survey demonstrates that there is no shortage of compelling and meaningful drivers to spur action. While the survey did not provide respondents with the same response choice options for “drivers” and “benefits” there was a connection and association reflected in the responses to these two questions.


These responses reflect an impressive number of business units, departments and individuals–workforce and patients—that can truly be served by and through IG.

What’s Changed from 2014 to 2017?

In 2014, 43% of respondents reported that a formal IG program had been initiated compared to 14.8% of respondents in 2017. What contributes to this dramatic change? Does it reflect organization abandonment of previously initiated IG efforts? Does it reflect that respondents are more educated today so what they labeled as IG in 2014 was not really IG? This area may warrant further exploration in future survey efforts.

In 2014, respondents cited “strong agreement” with regulatory compliance (80 percent), improvement in patient care and safety (73 percent) and the need to manage and contain costs (61 percent) as the top three drivers for IG, followed by analytics and business intelligence (53 percent). Interestingly, trust and confidence in data was the lowest rated driver. In 2017, data quality and trust ranked second. Analytics and business intelligence tops the list of drivers, patient safety falls to the middle and regulatory compliance is at the very bottom of the list.

The most promising insight from the 2017 survey is that data governance (DG) is a growing priority and reality in healthcare. Thirty percent of respondents reported a “formal structure” for DG in their organization. There is still a bit of confusion between IG and DG as disciplines. DG is one of the competencies in AHIMA’s IG Adoption Model and often referenced as a sub-domain of IG in other reference models. Simply stated, data are the building blocks of information, so DG is requisite to IG. One takeaway from the survey is that healthcare organizations are progressing along a path that positions DG as a precursor to IG, rather than a component of IG.

Conclusion

While the drivers for IG seem to have shifted over the time that AHIMA has spent surveying the industry, there is a universality to the vision and expectation that healthcare wants and needs to put its data and information to work to accomplish its ambitious and complex mission. Much of AHIMA’s and its IG partners’ work to document the experiences of IG pioneers is available at IGIQ.org.

Have ideas about how we can better study the topic of IG and deliver meaningful insights to you? Please share your comments.

About Stephanie Crabb
Stephanie is Co-Founder and Principal at Immersive, a healthcare data lifecycle management company where she leads program and solution development, knowledge management and customer success. Stephanie brings 25 years of experience in the healthcare industry where she has served in program/solution development, client service and business development roles for leading firms including The Advisory Board Company, WebMD, CTG Health Solutions and CynergisTek. She has led a number of program and product launches with an emphasis on competitive differentiation, rapid adoption, client satisfaction, and strategic portfolio management.

Prior to her work at these firms Stephanie worked for a large Maternal and Child Health Bureau grantee working on the national Bright Futures and Healthy Start initiatives to develop and document best practices in the care continuum for pediatrics and infant mortality, and to inform federal and state health policy initiatives in these areas.

Stephanie holds her A.B. and A.M. from the University of Chicago. Stephanie serves as the Scholarship Chair of CNFLHIMSS, on AHIMA’s Data Analytics Practice Council and recently completed a two-year term on the Advisory Board of the Association for Executives in Healthcare Information Security (AEHIS) of CHIME.

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Making Healthcare Data Useful

Posted on May 14, 2018 I Written By

The following is a guest blog by Monica Stout from MedicaSoft

At HIMSS18, we spoke about making health data useful to patients with the Delaware Health Information Network (DHIN). Useful data for patients is one piece of the complete healthcare puzzle. Providers also need useful data to provide more precise care to patients and to reach patient populations who would benefit directly from the insights they gain. Payers want access to clinical data, beyond just claims data, to aggregate data historically. This helps payers define which patients should be included in care coordination programs or who should receive additional disease management assistance or outreach.

When you’re a provider, hospital, health system, health information exchange, or insurance provider and have the data available, where do you start? It’s important to start at the source of the data to organize it in a way that makes insights and actions possible. Having the data is only half of the solution for patients, clinicians or payers. It’s what you do with the data that matters and how you organize it to be usable. Just because you may have years of data available doesn’t mean you can do anything with it.

Historically, healthcare has seen many barriers to marrying clinical and claims data. Things like system incompatibility, poor data quality, or siloed data can all impact organizations’ ability to access, organize, and analyze data stores. One way to increase the usability of your data is to start with the right technology platform. But what does that actually mean?

The right platform starts with a data model that is flexible enough to support a wide variety of use models. It makes data available via open, standards-based APIs. It organizes raw data into longitudinal records. It includes services, such as patient matching and terminology mapping, that make it easy to use the data in real-world applications. The right platform transforms raw data into information that that aids providers and payers improve outcomes and manage risk and gives patients a more complete view of their overall health and wellness.

Do you struggle with making your data insightful and actionable? What are you doing to transform your data? Share your insights, experiences, challenges, and thoughts in the comments or with us on Twitter @MedicaSoftLLC.

About Monica Stout
Monica is a HIT teleworker in Grand Rapids, Michigan by way of Washington, D.C., who has consulted at several government agencies, including the National Aeronautics Space Administration (NASA) and the U.S. Department of Veterans Affairs (VA). She’s currently the Marketing Director at MedicaSoft. Monica can be found on Twitter @MI_turnaround or @MedicaSoftLLC.

About MedicaSoft
MedicaSoft  designs, develops, delivers, and maintains EHR, PHR, and UHR software solutions and HISP services for healthcare providers and patients around the world. MedicaSoft is a proud sponsor of Healthcare Scene. For more information, visit www.medicasoft.us or connect with us on Twitter @MedicaSoftLLC, Facebook, or LinkedIn.

Improving Data Outcomes: Just What The Doctor Ordered

Posted on May 8, 2018 I Written By

The following is a guest blog post by Dave Corbin, CEO of HULFT.

Health care has a data problem. Vast quantities are generated but inefficiencies around sharing, retrieval, and integration have acute repercussions in an environment of squeezed budgets and growing patient demands.

The sensitive nature of much of the data being processed is a core issue. Confidential patient information has traditionally encouraged a ‘closed door’ approach to data management and an unease over hyper-accessibility to this information.

Compounding the challenge is the sheer scale and scope of the typical health care environment and myriad of departmental layers. The mix of new and legacy IT systems used for everything from billing records to patient tracking often means deep silos and poor data connections, the accumulative effect of which undermines decision-making. As delays become commonplace, this ongoing battle to coordinate disparate information manifests itself in many different ways in a busy hospital.

Optimizing bed occupancies – a data issue?

One example involves managing bed occupancy, a complex task which needs multiple players to be in the loop when it comes to the latest on a patient’s admission or discharge status. Anecdotal evidence points to a process often informed manually via feedback with competing information. Nurses at the end of their shift may report that a patient is about to be discharged, unaware that a doctor has since requested more tests to be carried out for that patient. As everyone is left waiting for the results from the laboratory, the planned changeover of beds is delayed with many knock-on effects, increasing congestion and costs and frustrating staff and patients in equal measure.

How data is managed becomes a critical factor in tackling the variations that creep into critical processes and resource utilization. In the example above, harnessing predictive modelling and data mining to forecast the number of patient discharges so that the number of beds available for the coming weeks can be estimated more accurately will no doubt become an increasingly mainstream option for the sector.

Predictive analytics is great and all, but first….

Before any of this can happen, health care organizations need a solid foundation of accessible and visible data which is centralized, intuitive, and easy to manage.

Providing a holistic approach to data transfer and integration, data logistics can help deliver security, compliance, and seamless connectivity speeding up the processing of large volumes of sensitive material such as electronic health records – the kind of data that simply cannot be lost. These can ensure the reliable and secure exchange of intelligence with outside health care vendors and partners.

For data outcomes, we’re calling for a new breed of data logistics that’s intuitive and easy to use. Monitoring interfaces which enable anyone with permission to access the network to see what integrations and transfers are running in real time with no requirement for programming or coding are the kind of intervention which opens the data management to a far wider section of an organization.

Collecting data across a network of multiple transfer and integration activities and putting it in a place where people can use, manage and manipulate becomes central to breaking down the barriers that have long compromised efficiencies in the health care sector.

HULFT works with health care organizations of all sizes to establish a strong back-end data infrastructure that make front-end advances possible. Learn how one medical technology pioneer used HULFT to drive operational efficiencies and improve quality assurance in this case study.

Dave Corbin is CEO of HULFT, a comprehensive data logistics platform that allows IT to find, secure, transform and move information at scale. HULFT is a proud sponsor of Health IT Expo, a practical innovation conference organized by Healthcare Scene.  Find out more at hulftinc.com

Workers’ Comp ROI – Disclosures For Workers’ Compensation Purposes – HIM Scene

Posted on April 10, 2018 I Written By

The following is a HIM Scene guest blog post by Don Hardwick, Vice President, Client Relations and Account Management at MRO.

Even under the best of circumstances—excellent staff, streamlined workflows, the latest technology— Release of Information (ROI) is a precarious process. Specific rules apply to different categories of requests. One area of complexity and confusion is the disclosure of Protected Health Information (PHI) for workers’ compensation purposes. While the ROI process for workers’ comp requests is similar to the process for “regular” requests, the type of information allowable for disclosure is different unless the request is accompanied by a patient authorization.

According to HHS guidelines, “The HIPAA Privacy Rule does not apply to entities that are either workers’ compensation insurers, workers’ compensation administrative agencies, or employers, except to the extent they may otherwise be covered entities.” However, the rule recognizes the legitimate need of these entities involved in workers’ compensation cases to access PHI according to state or other laws. Due to variability among such laws, the Privacy Rule permits disclosures of PHI for workers’ compensation purposes in different ways.

Disclosures without individual/client authorization. In most cases, an employer or insurance carrier is permitted to request and receive information pertaining to the injury—on behalf of the company or on behalf of the client—without an authorization. So employers, insurance companies or their attorneys can obtain information on behalf of the insurance company or on behalf of the client. Typically an attorney would get an authorization from the client. However, the employer, the payer or an attorney representing the payer can generally request those records without individual authorization.

Disclosures with individual authorization. The Privacy Rule permits covered entities to disclose PHI to workers’ compensation insurers and others involved in workers’ compensation systems if the individual (patient/client) has provided an authorization for the Release of Information to the entity. The authorization must meet specific Privacy Rule requirements.

When considering a workers’ comp claim, we can only disclose PHI pertaining to the event that initiated that particular claim. For example, suppose a patient had five admissions in 2017, and was injured January 2018. The employer may want to determine if the patient had preexisting injuries or conditions where the most recent injury occurred. If the January 2018 injury was secondary to a problem that already existed with this patient, the requester generally cannot obtain prior information without a HIPAA valid authorization.

The main point is that rules and regulations pertaining to workers’ compensation claims differ depending on the type of request for information and the type of requester.

About Don Hardwick
As Vice President of Client Relations and Account Management, Hardwick oversees all client relations initiatives including implementation and account management. Prior to joining MRO, he was CEO and President of Record Enterprises Inc., a Health Information Management (HIM) company that provided hospitals with an outsourcing program for patient release of information, medical coding and medical/confidential record storage. Previously, he was CEO and president of MedRecs Law Inc., a record acquisition company. Additionally, he was a manager in the healthcare consulting division of Ernst & Young and worked as the Director of HIM at Saint Margaret Hospital in Montgomery, AL and Southampton Memorial Hospital in Franklin, VA. Hardwick is a past President of the Virginia Health Information Management Association (VHIMA) and the recipient of East Carolina’s Allied Health Sciences Distinguished Alumni Award. He holds a B.S. in Health Information Management.

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Coding Accuracy: Study Reveals Differences Between Domestic and Offshore Coding – HIM Scene

Posted on March 23, 2018 I Written By

The following is a guest blog post by Bill Wagner, CHPS, Chief Operating Officer, KIWI-TEK.

In January 2015 the ICD-10-preparation frenzy was at its peak. Healthcare provider organizations were scrambling to find coding support during the implementation and transition phases of the quickly approaching ICD-10 implementation deadline. KIWI-TEK was one of those outsourced coding companies being asked to supply experienced, qualified coders.

KIWI-TEK was valiantly trying to keep up with the burgeoning client requests for coding support. And although they had been actively recruiting for months, their coding bench was empty. For the first time in company history, KIWI-TEK decided to augment their team with additional coding resources by contracting with several offshore coding services.

By April 2016, the crunch for additional coding support was all but over. However, the appeal of lower coding costs via offshore coding support drives many healthcare executives to contract with international outsourced coding support. Interest in offshore coding remains even to this day as evidenced by Partners Healthcare recent decision to outsource medical record coding to India.

But what about coding accuracy? This question remains and HIM Directors deserve a data-driven answer.

The Study

Until now, the only information available for providers to compare outsourced domestic coding quality with offshore coding performance was anecdotal. Specific quality data had not been produced or shared. Amidst rampant questions and red flags, KIWI-TEK partnered with six hospitals and health systems to answer the coding industry’s toughest question: “Who delivers higher coding accuracy, domestic or offshore outsourced coding services?” (Be sure to check out the full study results for a more detailed answer to this question).

Each of the six participants had experience with both domestic and offshore coders for at least one year. The same onboarding, auditing, and training procedures were applied equally to all.

Code Accuracy Lower with Offshore

Across all six organizations, code accuracy was lower for the outsourced offshore coding service versus the domestic coding companies by an average of 6.5 percentage points.

Poor coding quality also increased payer denials with additional management time required to onboard, train and audit the outsourced offshore coders.

And What About the Cost?

The final results showed that, despite what seems to be a much lower hourly rate for offshore coders, the total cost is much higher when all factors are taken into consideration. These factors include:

Auditing – Offshore coders required an average of 6 more hours per coder per month of auditing due to poor accuracy results.

Denied claims – Offshore coders averaged 10 more denied claims on Inpatient and Same Day Surgery encounters per week than domestic coders. Reworking of denied claims on these patient types takes 40 minutes for each claim.

The Final Answer

Yes, there is a difference. Offshore coding is less accurate, and in the long-term, may also be more expensive.

To read detailed findings of the study, download the KIWI-TEK White Paper entitled “Is Offshore Coding Really Saving You Money”.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.  KIWI-TEK is a proud sponsor of Healthcare Scene.