Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

Hospital Patient Identification Still A Major Problem

Posted on April 18, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new survey suggests that problems with duplicate patient records and patient identification are still costing hospitals a tremendous amount of money.

The survey, which was conducted by Black Book Research, collected responses from 1,392 health technology managers using enterprise master patient index technology. Researchers asked them what gaps, challenges and successes they’d seen in patient identification processes from Q3 2017 to Q1 2018.

Survey respondents reported that 33% of denied claims were due to inaccurate patient identification. Ultimately, inaccurate patient identification cost an average hospital $1.5 million last year. It also concluded that the average cost of duplicate records was $1,950 per patient per inpatient stay and more than $800 per ED visit.

In addition, researchers found that hospitals with over 150 beds took an average of more than 5 months to clean up their data. This included process improvements focused on data validity checking, normalization and data cleansing.

Having the right tools in place seemed to help. Hospitals said that before they rolled out enterprise master patient index solutions, an average of 18% of their records were duplicates, and that match rates when sharing data with other organizations averaged 24%.

Meanwhile, hospitals with EMPI support in place since 2016 reported that patient records were identified correctly during 93% of registrations and 85% of externally shared records among non-networked provider.

Not surprisingly, though, this research doesn’t tell the whole story. While using EMPI tools makes sense, the healthcare industry should hardly stop there, according to Gartner Group analyst Wes Rishel.

“We simply need innovators that have the vision to apply proven identity matching to the healthcare industry – as well as the gumption and stubbornness necessary to thrive in a crowded and often slow-moving healthcare IT market,” he wrote.

Wishel argues that to improve patient matching, it’s time to start cross-correlating demographic data from patients with demographic data from third-party sources, such as public records, credit agencies or telephone companies, what makes this data particularly helpful is that it includes not just current and correct attributes for person, but also out-of-date and incorrect attributes like previous addresses, maiden names and typos.

Ultimately, these “referential matching” approaches will significantly outperform existing probabilistic models, Wishel argues.

It’s really shocking that so many healthcare organizations don’t have an EMPI solution in place. This is especially true as cloud EMPI has made EMPI solutions available to organizations of all sizes. EMPI is needed for the financial reasons mentioned above, but also from a patient care and patient safety perspective as well.

#HIMSS18: Pushing Inpatient Care Out

Posted on March 9, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

At present, we need acute care hospitals. Despite the fact that many types of care can now be delivered in outpatient settings, and chronic conditions managed remotely for connected health, there are still some treatments and procedures which can only be done in a big, expensive building.

That being said, some of what I saw at HIMSS18 has convinced me that the drive to push hospital-type services into the community has begun to pick up speed. While nobody seems to have a completely mature solution to decentralizing acute care, I saw some tools that might begin to solve the problem.

Perhaps the most direct example of this trend was offered by a Taiwanese company called Quanta Computer. (The booth was staffed with five company representatives who had flown here all the way from Taiwan, which may suggest that they are not fooling around.)

Quanta was here to pitch QOCA, whose capabilities include offering a “smart hospital at home.”  QOCA Home, an eldercare/assisted living solution including a central, easy to use terminal supporting a wide range of telehealth and connected health services. While the idea is not completely new, the way this blends a smart home approach with connected health intrigued me.

Other vendors took a different approach to some of the same core problems, i.e. managing the patient effectively outside of the hospital. For most exhibitors, this seemed to involve a blend of connected health, care management and patient/provider collaboration.

For example, vendor Virtual Health promises to deliver “whole person health” by tying together providers, healthcare execs, patients and care coordinators. Two points of interest: its solution include a collaborative workflow tool which seems to include patients, something I don’t believe I’ve seen before. Its platform, which is designed to support patients with highly complex medical needs, also addresses social determinants of health, including financial concerns and nutrition.

Now, I’m not here to tell you that any of this is revolutionary. The industry has been kicking around concepts like virtual hospital care, care coordination platforms and the integration of social determinants of health for quite some time, and I’m not suggesting that any of the vendors I saw seem to be all the way there.

Still, what I saw suggests to me that tech vendors are further along in delivering these options than they have been. If you haven’t looked into new platforms that address these issues, now might be the time. They may not be completely ready for prime time, but they’re well on their way.

Yale New Haven Hospital Partners With Epic On Centralized Operations Center

Posted on February 5, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Info, info, all around, and not a place to manage it all. That’s the dilemma faced by most hospitals as they work to leverage the massive data stores they’re accumulating in their health IT systems.

Yale New Haven Hospital’s solution to the problem is to create a centralized operations center which connects the right people to real-time data analytics. Its Capacity Command Center (nifty alliteration, folks!) was created by YNHH, Epic and the YNHH Clinical Redesign Initiative.

The Command Center project comes five years into YNHH’s long-term High Reliability project, which is designed to prepare the institution for future challenges. These efforts are focused not only on care quality and patient safety but also managing what YNHH says are the highest patient volumes in Connecticut. Its statement also notes that with transfers from other hospitals increasing, the hospital is seeing a growth in patient acuity, which is obviously another challenge it must address.

The Capacity Command Center’s functions are fairly straightforward, though they have to have been a beast to develop.

On the one hand, the Center offers technology which sorts through the flood of operational data generated by and stored in its Epic system, generating dashboards which change in real time and drive process changes. These dashboards present real-time metrics such as bed capacity, delays for procedures and tests and ambulatory utilization, which are made available on Center screens as well as within Epic.

In addition, YNHH has brought representatives from all of the relevant operational areas into a single physical location, including bed management, the Emergency Department, nursing staffing, environmental services and patient transport. Not only is this a good approach overall, it’s particularly helpful when patient admissions levels climb precipitously, the hospital notes.

This model is already having a positive impact on the care process, according to YNHH’s statement. For example, it notes, infection prevention staffers can now identify all patients with Foley catheters and review their charts. With this knowledge in hand, these staffers can discuss whether the patient is ready to have the catheter removed and avoid related urinary tract infections associated with prolonged use.

I don’t know about you, but I was excited to read about this initiative. It sounds like YNHH is doing exactly what it should do to get more out of patient data. For example, I was glad to read that the dashboard offered real-time analytics options rather than one-off projections from old data. Bringing key operational players together in one place makes great sense as well.

Of course, not all hospitals will have the resources to pull something off something like this. YNHH is a 1,541-bed giant which had the cash to take on a command center project. Few community hospitals would have the staff or money to make such a thing happen. Still, it’s good to see somebody at the cutting edge.

Hospitals Excited By Telehealth, Consumers Not So Much

Posted on December 29, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

When telehealth first emerged as a major commercial phenomenon, consumers were the main market targeted by providers, especially direct-to-consumer models like Teladoc and American Well. But if a new research report is right, the dynamics of the telehealth market have changed substantially, with hospitals and health systems investing heavily in telehealth and consumers hanging back.

The study, which was conducted by telehealth solutions provider Avizia, found that while hospitals and health systems are making increasingly large bets on telehealth, including infrastructure, training and process re-engineering, patients aren’t matching their enthusiasm.

Consumers who do access telehealth seem happy by what they find. When Avizia asked them to rate their telehealth experiences on a scale from 1 to 10, with 10 rating it as a “great experience,” nearly two-thirds ranked their experiences between 8 and 10. Also, consumers who were using telehealth said that they like the time savings and convenience it could offer (59%), cost savings due to a lack of travel expenses and lower wait times to see clinicians (55%).

That being said, many consumers haven’t gotten on board yet. In fact, roughly eight out of 10 consumers told Avizia that they weren’t well versed in accessing telehealth, nor did they know whether their insurer would pay for it.

Providers, for their part, have ambitious plans for telehealth use. According to the study, the top one was the ability to reach or expand access to patients (72% of respondents). However, they face several obstacles, the study notes, including problems with getting reimbursed by health plans (41%), program expenses (40%) and resistance from clinicians (22%).

The Avizia results suggest that hospitals are still wrestling with many of the problems they’ve faced over the past few years in implementing telemedicine.

For example, a study by KPMG released in mid-2016 noted that about 25% of the 120 providers it studied had implemented telehealth and telemedicine programs which have achieved financial stability and improved efficiency. Thirty-five percent of KPMG respondents said that they didn’t have a virtual care program in place, though 40% had said they had just implemented a program.

Another study, released earlier this year by Reach Health, notes that 50% of hospitals and health systems are beginning to shift department-based telehealth programs to enterprise-based programs, which suggests that they no longer see virtual care as an experimental technology. They still aren’t rolling out these larger programs yet.

Still, the fact that hospitals are continuing to push ahead with telemedicine, and even make meaningful investments, makes it clear that they’re not going to be put off by current telemedicine obstacles. When the reimbursement tide floods the gates, I’m betting that hospital telemedicine programs will go from “not unusual” to “omnipresent.”

Catholic Healthcare West Drops Church Affiliation

Posted on January 23, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In a move I wouldn’t be surprised to see imitated, big religious hospital chain Catholic Healthcare West has broken its official ties with the Roman Catholic Church, though it will continue to include both Catholic and non-Catholic facilities in its flock.   The chain, which is changing its name to Dignity Health, currently includes 15 non-Catholic hospitals and 25 Catholic hospitals.

The system’s leaders have concluded that they couldn’t meet their ambitious growth targets if forced to adhere to faith-based care guidelines in all of its facilities.

According to CEO and president Lloyd Dean, who spoke to USA Today, he’s had to step away from potential deals several times when partners questioned their role in a Catholic system. This way, it should be much easier for CHW to work with other systems and acquire medical practices, observers say.

I expect to see other faith-based chains consider similar moves over the next year or two. As we’ve noted in this forum before, having to adhere to religiously-based rules can be a bit of a hassle for secular organizations, especially those that hope to compete in tight markets.  Mergers between the two sides can become a Tylenol headache very quickly.

Consider the struggles the University of Louisville (KY) went through in an effort to merge with Catholic-owned St. Mary’s Healthcare, forcing it propose build a “hospital in a hospital” to provide forbidden services. It makes my eyes water just to think about it. With health reform afoot, mergers a fact of life and new partnership models emerging every day, CHW may have done the only thing it could do.

A Snapshot: Is Free Care in Minnesota What It Appears?

Posted on January 16, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

With any luck, we’ve finally left the worst of the financial crash behind, and with it the financial challenge posed by large numbers of medically indigent patients.  A recent report from Minnesota’s hospital trade group underscores how bad things were for patients. It also suggests that the hospitals may not quite be as charitable as they claim.

According to the report, the level of free or discounted care provided by the state’s hospitals shot up 27 percent in 2010, driven largely by falling state coverage and rising unemployment.  The Minnesota Hospital Association said that state hospitals provided $226 million in charity care last year, along with $498.5 million expenses generated by Medicaid patients receiving discounted care that wasn’t reimbursed.

OK, let’s break this down. We’ve got, very broadly, $750 million in direct charity care expenses among 135 hospitals.  While I don’t know exactly what they grossed in 2010, we can be pretty sure it exceeds that figure by at least three or four orders of magnitude.

Sure, several million in charity care per hospital is enough to erode the slim margin most hospitals cope with year to year.  On the other hand, we know it’s not a simple matter of money in, expenses paid for charity care.  The accounting gets more complicated than seven-way chess, and let’s admit it, some of the numbers are a bit dicey at best.

Now, I’m not suggesting any individual hospital is gaming the system worse than others. But I am suggesting that if this is the best they can come up with, they’d better get cracking. Neither the IRS or Congress has much patience for charity care numbers that don’t add up, and municipalities (at least in Illinois) are getting into the “yank the tax exemption” act too.

Bottom line, you better keep your nose clean and those charity care numbers better be above board. If you’re not already, it’s time to avoid accounting tricks and play it straight.

ACO Proves Major Political Turning Point For Boston Hospital Chain

Posted on January 2, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Transforming a hospital system into a fully-functioning ACO is a huge project, and one which requires a big commitment.  It’s hardly surprising that going through the process would change how its leaders think about their business.  But the following is the first case I’ve heard of in which a hospital system made a major break with its peers over its ACO status.

Apparently,  for-profit Steward Health Care System has just resigned from the Massachusetts Hospital Association, bringing its 10 hospitals (and 11 percent of the MHA’s revenues) with it.  Steward, which was created by the acquisition of six-hospital Caritas Christi Health Care Chain a year ago by VCs, has since picked up four hospitals and done a host of doctor deals.

Not surprisingly, Steward seems to have bruised some competitors’ feelings along the path to ACO-hood, which probably has something to do with its MHA departure, but Steward isn’t copping to that of course.

At this point in its evolution, Steward’s leaders say, the MHA’s positions on politics don’t represent its needs anymore. Particularly when it comes to health reform, Steward’s leaders feel it now has a different take than other members of the MHA, which has to advocate for shared positions across almost 100 hospitals with varied approaches.

As for me, I’m not sure what those differences are; in fact, I’d think that a “real” ACO would be an inspiration for, and partner to, other hospitals on the path to health reform.  In fact, this raises some questions as to how the growing ACO trend will affect hospital relationships this year:

* Are IDNs that work hard at building a true ACO going to upset their peers so much that it will create a drag on their business overall?

* Most healthcare business models have some detractors and some fans, but is this one of the few that can actually divide the industry?

*  Are ACOs a direction every IDN can take, or are there resource constraints (such as the size of a local market or number of unaffiliated doctors) that will prevent some from building one? Will the coming rush create ACO “haves” and “have nots”?

What do you think, folks?  Have you seen anything happening in your markets that might answer these questions?

Hospital Uses Disney Magic To Improve Patient Satisfaction

Posted on December 26, 2011 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Ideally, patients come away from their hospital stay not only healthier, but happier too. So how about taking a page from the Happiest Place On Earth?  Yes, I mean Disney Land.

Dissatisfied with its patient satisfaction scores, one Florida hospital has struck a partnership with Walt Disney Co. to pick up some of that Mouse Magic.  Since then, the hospital’s scores have shot up — and patient volumes, too.

Back in 2009, satisfaction was at rock bottom at 200-bed Florida Hospital for Children. To change its luck, the 200-bed hospital decided to make sure of a pioneering program run by Disney, laying out about $200,000 in consulting fees to bring the entertainment company in.

Not only did Disney help the hospital improve its presentation, it also got tips on improving staff morale and treating patients as customers. (The “staff morale” thing is a bit amusing, since, as all former Florida residents know, Disney’s own employee policies have earned it the title “the Rat.” But I digress.)

These days, when little patients and their parents enter the Walt Disney Pavilion, they’re greeted by a “park ranger” who offers directions, a Disney-theme play area and a ukelele-playing greeter in character costume, according to USA Today.

Behind scenes, some staffers have been tagged as Disney-style “cast members,” and work areas have been renamed “back stage” and “front stage” areas.

While some of this may sound a little silly, it’s generated big results.  Florida Hospital’s patient satisfaction scores have climbed to the 80th percentile of all children’s hospitals nationally. Even better, patient volumes are up by nearly half, administrators told the paper. You can’t beat that with a stick.

Though I’m sure kids are more focused on the fun, park-like attractions, my hunch would be that the back-office changes were as important to Florida Hospital’s transformation as the cosmetic fixes. After all, when it comes right down to it, the parents who pay for care are more worried about things like working with staffers who are upbeat and happy with their jobs.  Still, it’s an intriguing approach overall.

 

 

To Avoid Readmissions, Hospitals Trying Post-Discharge Clinics

Posted on December 12, 2011 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In recent years, hospitals have been under increasing pressure to keep their readmission rates low. The next bump in the road comes in October 2012, when Medicare will begin cutting back on reimbursement for facilities whose readmit rates are too high.

Hospitals are already hard at work at preventing readmissions due to preventable medical errors, which may not be reimbursed at all by Medicare at all. But it seems like they’re still far behind in the care coordination department.

In fact, research suggests that they’re facing an uphill battle, in part because patients often don’t get the kind of follow-up care they need.

In theory, fragile patients  should move smoothly from inpatient care to their PCP, ideally a medical home equipped to coordinate whatever follow-up care needs they have. Few primary care practices are up to speed yet, however.  In fact, some aren’t even sure when their patients are discharged.

How bad is the problem? According to one study quoted in The Hospitalist, only 42 percent of hospitalized Medicare patients had any contact with a primary care physician within 14 days of being discharged.

One solution to this problem might be a “post-discharge” or transitional care clinic offering primary care on or near a hospital’s campus, the article notes. This makes sense. After all, it’s more likely a patient will follow through and get follow-up care if it’s convenient to do so.

The idea behind these clinics isn’t to replace the patient’s existing PCP; instead, the clinic’s hospitalists, advance-practice nurses or PCPs are there to make sure patients absorbed their post-discharge instructions and are compliant with the meds prescribed during their stay.

Some hospitals have invested significant resources in building out transitional clinics, including Beth Israel Deaconess Medical Center, Seattle-based Harborview Medical Center and Tallahassee (Fla.) Memorial Hospital, which partnered with a local health plan to kick off the effort.

That being said, the idea is a new one and few other hospitals have taken the plunge as of yet. It will be interesting to see whether this approach actually works, and particularly, whether one model of transitional care stands out.

P.S.  I’d particularly like to know whether hospitals can accomplish some of these objectives by monitoring patients remotely after they’re discharged. After attending last week’s mHealth show, I’m betting remote monitoring would be cheaper than setting up a new clinic. Can’t wait to see whether hospitals try that route!

 

 

 

Idea That Might Work: “Hospital at Home” Model Delivers Hospital-Level Care

Posted on November 27, 2011 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Far too often, ideas developed by academics end up sitting in a dusty file or published by an insider journal that hospitals CEOs seldom see. In the following case, however, it seems academia and the hospital biz are seeing eye to eye on a new approach to acute care which could offer substantial savings.

A growing number of hospitals have begun to embrace the “Hospital at Home” model, an approach originally developed by the Johns Hopkins School of Medicine which offers hospital care to people in their own homes. HAH is focused on the elderly, not surprisingly given the high cost of caring for them, but I bet it’d offer advantages in caring for chronically-ill patients of just about any age.

While this approach isn’t as whiz-bang neat as, say, bringing an emergency department to a patient’s home — something already done in France — it’s a solid concept.

This model fits hand in glove with maturing technologies which monitor patients from afar while leaving in their home (tracking metrics like blood sugar, patient weight or cardiac functioning and shunting the data to doctors via the Internet).

According to a recent Forbes article, one of the biggest proponents of this approach is Presbyterian Healthcare Services, a New Mexico-based system which manages the largest program in the country. PHS has estimated that treatment averages one-third shorter than equivalent cases treated in an inpatient setting. And the system calculates that it’s saved $2,000 to $3,000 per case, as well. Neat stuff.

Folks, frankly I’m mystified that this approach hasn’t become more standard…or would be, I suppose, if the hospital industry I know and love didn’t have this habit of ignoring trends until they explode in someone’s face.

In any event, if any of you are implementing or even considering HAH, I’d love to hear from you. And if you think that this model can’t work, I’d love hearing from you even more. Let me have it!