Tag: Health iT
“At its core, technology would seem to be the antithesis of humanity,” said Dr. Chris Derienzo, chief quality officer at Asheville, North Carolina-based Mission Health System. “It doesn’t feel, it doesn’t think and it can’t see the humanity of the person in front of it,” he explained.”
Ask physicians how the feel about electronic health records, or read Atul Gawande’s recent New Yorker feature, “Why Doctors Hate Their Computers,” and it’s apparent that most healthcare professionals’ relationship with technology is ambivalent at best.
“It’s tempting to say there’s no way we can build or leverage technology in order to restore some humanity to the practice of medicine,” said Derienzo. “But I think that’s fundamentally a wrong assumption.”
At HIMSS19 in Orlando, in one of the new TED Talk-style SPARK Sessions, titled “Humanity and Technology in Medicine: Antithetic or Symbiotic?” Derienzo will explain why.
The reason technology seems to pull us away from people, rather than bring us together, mostly boils down to “how we’ve designed it and what we’ve designed,” Derienzo said. But rethinking both of those, IT could be repositioned in a way where it enhances, rather than detracts, from the clinician and patient experience.
With funny personal anecdotes and real-life case studies, he’ll show how technology, properly deployed, can restore joy to healthcare – helping burnt-out physicians better engage person to person, enabling them to practice at the top of their license and use their skills to solve complex challenges
“If we focus on the right types of technology, and we build it right, then we can actually use it to empower people to do more of the things that only people can do in healthcare,” said Derienzo.
How technology is designed, and what it’s used for, plays a big role in how well it is liked by its end-users. Consider tech that’s intentionally created connect people, such as telemedicine. “We see much more positive reaction to it.”
EHRs, on the other hand, were not designed with joy in mind. They were developed under certain conditions, with necessary check-the-box functionalities related to regulatory compliance and billing capture.
And they were “based on a world where we took what we did on paper then did the same thing on computers,” said Derienzo. They effectively ignored a lot of the human factor elements for how to design a way to document and record care electronically.”
But EHRs are only one challenge, he said. “Our monitors are another. How we use algorithms is another very important one.”
Derienzo predicts that “our electronic documentation will evolve drastically over the next few years as we move away from this built environment and toward a world where human factors matter a whole lot more.”
In the meantime, he sees one technology doing a lot to return humanity to healthcare. One that may seem ironic, to say the least, given the trepidations many have about its potential to disrupt and displace: artificial intelligence.
“AI stands positioned to be one of the core technological advances that allows us to return humanity to healthcare,” he said.
For example, he explained, “we’ve built a machine learning model at Mission Health and we’ve now gotten it fully up and running. Its purpose is to help risk-stratify patient who are case managers need to focus on. To serve them, not only by a ranked-ordered list but a concept as to why our model thinks they may be at a high risk of being readmitted.”
That’s a fairly AI application, “but its purpose is to pull out things that people don’t have to be doing so now my care manager team can spend less time wondering who to focus on and more time actually focusing on people,” said Derienzo.
Ditto with radiology, he said: “I don’t think that reading a thousand normal chest X-rays brings radiologist a ton of joy. But doing the really complex work – is it this, is it that? – is what they enjoy. How do we bring the expertise and brains of these terrific musculoskeletal and neuroradiologists tp the things we actually need them to be doing? That is how something like AI can actually empower humans.
The practice of medicine is an ancient art, and one that’s long depended on the power of human interaction, he explained.
“At one point that was all we had – other than leeches and bloodletting, all we had was the ability to interact with our patients one on one and be human with them,” said Derienzo.
“We’ve vastly improved our ability to care since then, but in some ways we’ve lost an appreciate for that aspect of a clinician patient relationship,” he explained. “My fervent hope is that once we get this right, we’ll actually be returning, somewhat, to a place where it’s that person to person relationship that’s the most valuable part of our day.”
- Providers are increasingly turning to payment technologies to collect patient bills and improve the customer experience, a new Billing Tree survey finds.
- Respondents ranked “collecting once the patient has left the facility” as the No. 1 payment challenge in 2018, followed by “patient’s inability to pay” and “lack of payment channels.” Rounding out the top six were “disputes over amount billed,” “knowing the correct amount to bill/due after insurance” and “compliance challenges.” The least important challenge was “posting to the database.”
- The top two factors affecting choice of payment processing services were HIPAA compliance and the price of payment processing. Half of the respondents were collection firms, one-fifth were long-term care facilities and the rest were multi- and single-site businesses.
Efforts to boost hospital finances are fueling activity in revenue cycle management as more providers look for ways to work with patients on payment plans. According to a Connance survey, 70% of providers claim it takes more than a month to collect from patients. A 2017 Advisory Board analysis found the average 350-bed hospital lost up to $22 million in revenue due to revenue cycle issues.
The major EHR vendors, as well as other third-party players, are investing in RCM solutions as demand for services increases. In an earnings call earlier this year, Cerner officials highlighted RCM as a good growth opportunity, along with population health. Allscripts CEO Paul Black has also touted strong sales of RCM products.
The trend is also spurring consolidation as vendors vie for market share. In February, Chicago-based R1 RCM snapped up Intermedix’s healthcare division, which includes physician and emergency services RCM, practice management and analytics. The acquisition increased R1’s capability to integrate revenue cycles across care settings, the company said at the time, citing Intermedix’s more than 15,000 providers nationwide.
Survey respondents showed a willingness to accept a wide range of payment types. More than nine in 10 accepted health savings accounts and flexible spending accounts, 82% accepted paper checks or money orders and about 73% accepted credit/debit payments and electronic checks.
The survey also shows growing use of automation, with nearly two-thirds reporting acceptance of web portal payments. In addition, 27% offered payment by an interactive voice response system and the same percentage offered payment by text.
Asked what payment technology they would most likely add in the next 12 months, more than half (54.5%) said web payments. Not surprising given the growth in text payments, more than a quarter planned to deploy text notifications for payments and billing notifications.
“Technology service providers continue to play a critical role in helping organizations of all kinds that are striving to collect payments in a timely and efficient manner to maximize revenues, control operational costs, while also mitigating compliance risk,” Billing Tree says. “Beyond simply processing transactions, industry-leading payment processors partner strategically with their clients to provide education and guidance on best practices to maintain regulatory compliance.”
- Profitability in the U.S. healthcare industry could be elusive for some players in the coming year, but the overall outlook is stable, according to a new Fitch Ratings report.
- Issuer fundamentals, including leverage and coverage ratios, will be neutral for 2019, while creation of cash flow should trend positive. Healthcare pricing and profit margins will continue to face pressures, but Fitch expects liquidity to be manageable.
- The credit rating agencies predicts this year’s two-to-one ratio of downgrades to upgrades will carry over into next year.
The report points to four trends that could impact healthcare in 2019: regulatory efforts to rein in rising pharmaceutical prices, debate around access to care and affordability, lawsuits claiming industry culpability in the opioid crisis and effect of large vertical mergers of providers, payers and pharmacy benefit managers.
“Most disruptive threats to healthcare business models boil down to an attack on pricing power, including outside industry competitive upstarts, government price setting and consumer and employer efforts to force lower pricing,” Megan Neuburger, managing director of Fitch Ratings, said in a statement. “Of all of these, the government policy aspect poses the greatest threat since it is the farthest reaching. That said, we think that radical changes to the current system are unlikely.”
The forecast comes as CVS and Aetna finalized their $78 billion megamerger this week, creating a retail pharmacy and health insurance combo with annual revenue of more than $245 billion — second only to Walmart.
The report echoes previous reports citing continued pressures on hospitals as they face smaller volumes, rising costs and lower federal reimbursements. A Fitch report on the financial soundness of nonprofit hospitals and health systems in the third quarter of 2018 showed a mixed bag, with 11 security ratings upgrades and 11 downgrades.
Third quarter earnings reflected the strain. Quorum Health saw net operating revenue fall 7.7% year over year to $460.5 million and had $9.3 million in losses due to lower volumes. Community Health Systems also reported a drop in operating revenues for the quarter — down 5.9% to $3.5 billion.
By contrast, insurance giant UnitedHealth Group tallied 12% increases in both revenues and earnings from operations in Q3 compared with the prior year, finishing the period with $56.6 billion in revenues and $4.6 billion in operations-related earnings. The company benefited from enrollee growth in Medicare Advantage plans, Medicare supplemental plans, risk-based commercial plans, individual plans and international customers, as well as growth in its Optum division.
- Breaches of protected health information can seriously harm an organization’s brand and finances, but little is known about how breaches occur and the steps organizations take to prevent a recurrence, according to a research letter in JAMA Internal Medicine.
- The researchers analyzed 1,138 breach cases that occurred between Oct. 21, 2009, and Dec. 31, 2017. The cases, reported to the HHS Office for Civil Rights, affected the PHI of 164 million Americans.
- Based on detailed event descriptions, 77.6% of the cases were correctly classified, while 22.4% were listed as “unknown” or placed in an incorrect category by the reporting entity.
Healthcare organizations are required to notify OCR of breaches affecting 500 or more people, and to classify those breaches as one of six types: hacking, improper disposal, loss, theft, unauthorized access or disclosure and unknown.
“Healthcare entities must understand the causes of PHI breaches if they aim to effectively manage the trade-off between wider access or higher efficiency and more security,” writes John Jiang of Michigan State University’s Broad College of Business and Ge Bai of Johns Hopkins’ Carey Business School.
The No. 1 cause of data breaches was theft by outsiders or unknown parties, making up about one-third (32.5%) of the 1,138 cases. Rounding out the top three causes were employee mailing mistakes (10.5%) and theft by former or current employees (9%). More than half (53%) of all PHI breaches originated inside the organization.
The researchers also looked at the location of the breaches. Mobile devices factored in 46.1% of cases, paper records in 28.7% and network servers in 29.3%.
Corrective actions included encrypting devices and restricting use when they stored PHI data, strengthening network firewalls and monitoring access, among other tactics. Organizations also tightened mail and email security with mandatory verification of recipient, copy protocol and encrypting content, according to the letter.
“Today, the reality of breaches means you need to be assuming a breach is in your environment at all stages,” Vincent Weafer, chief operating officer and CTO of TriagingX, told Healthcare Dive in an interview last year. He recommends using skilled cyberthreat hunters to identify vulnerabilities and prevent breaches before they occur.
Anthem found out the hard way just how costly health data breaches can be. Last month, the health insurer agreed to pay OCR $16 million to settle HIPAA violations resulting from the breach of 79 million members’ electronic PHI during a series of targeted cyberattacks in 2015. The settlement, the largest-ever HIPAA fine, follows a separate $115 million settlement in August to cover four years of credit monitoring, claims, costs and fees associated with the affected individuals.
ClearData, IBM, PureStorage and others are positioning themselves for an environment where providers rely on a mix of public and private secure clouds for their data.
Recent announcements from three major healthcare cloud vendors offer an interesting perspective on where the technology is trending.
ClearDATA, which focuses on security in the healthcare cloud, scooped up $26 million this week in a new round of financing to help it innovate its products and fuel growth. The funding comes from a diverse group of strategic investors, including Humana and Health Care Service Corporation, and points to a confidence in and reliance on secure health data – even as the cloud environment grows in complexity – that would have been hard to imagine in healthcare even a few years ago.
That same day, Pure Storage, the flash storage vendor, launched its new Cloud Data Services, a suite of new tools to run on Amazon Web Services, that enable healthcare customers and others to leverage a single architecture to unifies application deployments, on-premises and on the cloud, for their analytics, AI and machine learning needs.
Meanwhile, a new report in ZDNet points to further evolution in the market as the types of cloud hosting available to healthcare continues to shift and expand. Specifically, it examines IBM, which looks to be positioning itself to help the many organizations who depend on multiple clouds – some 90 percent of them, according to one report. Adding to the complexity, thost clouds often run in a complex mix of environments: public, private, firewalled, etc.
WHY IT MATTERS
As cloud options have multiplied so too have the uses healthcare systems have had to adapt the technology for. So-called hybrid clouds incorporate a mix of public and private clouds, both on- and off-site.
Multi-cloud use is getting to be the norm and now large players are getting involved. Consider IBM, with a long history of helping manage complex IT systems, is positioning itself not just as a cloud provider but as a way to “clean up the mess” of the modern hybrid cloud world, according to ZDNet.
ClearDATA has recently been broadening its business model to focus multi-cloud solutions, it notes in its new funding release, working to better integrate healthcare organizations with the mix of cloud options while at the same time ensuring security and compliance.
Pure Storage, for its part, touts a single storage architecture that unifies application deployments, enabling health systems to run multiple clouds while avoiding some of the infrastructure problems that arise between industrial enterprise systems and more user-friendly clouds.
THE LARGER TREND
Successful healthcare organizations scale and deliver improved outcomes by leveraging advances in data sharing and interoperability, as ClearDATA claims. But it’s reality that health systems rely on multiple different clouds, and that variety necessarily muddies the waters for a streamlined experience across all of them.
While cloud-based solutions are more user-friendly, more secure and more in-demand by consumers, they don’t always provide the enterprise-level assurances and security that providers need. Pure Storage notes that “organizations are too often forced to choose between on-premises or cloud,” while in reality a better option is a hybrid approach with both onsite and cloud applications where necessary.
Not surprisingly, there is no single solution to hosting apps, accessing data and sharing services. Different clouds exist for different use cases. Most healthcare systems probably depend on a few different cloud solutions, so finding a way to integrate the data to make it more valuable while protecting its security are big musts.
IBM is positioning itself as a solution to that headache, while ClearDATA and Pure Storage are both working in the hybrid cloud space as well to help healthcare providers make their data more valuable, accessible, and safe.
ON THE RECORD
“Today, there exists a cloud divide – the cloud is not purpose-built for enterprise applications, and enterprise infrastructure isn’t as user-friendly as the cloud,” said Pure Storage CEO Charles Giancarlo, in a statement. “Customers should be able to make infrastructure choices based on what’s best for their environment, not constrained by what the technology can do or where it lives.”
Meanwhile, Humana CIO Brian LeClaire explained that the insurer, in partnering with ClearData to advance its integrated care delivery model, is more and more using the “computing and analytic power and scalability of the public cloud to accelerate our ability to deliver better outcomes and experiences to our members and providers.”
The number of reported data breaches in 2018 is at a consistent pace with this same time period in 2017, according to new research from Risk Based Security, but there’s a catch: mega-breaches and hacking persist as top cybersecurity concerns across all industries.
WHY IT MATTERS
So far there have been 3,676 publicly disclosed data breaches across all industries exposing approximately 3.6 billion records.
Seven of the breaches through the third quarter of this year exposed 100 million or more records, with the 10 largest accounting for 84.5 percent of the records exposed, the report said.
Hacking continues to be the leading cause of data breaches, accounting for 57.1 percent and fraud was the cause of the most records being exposed, accounting for 35.7 percent.
THE BIGGER TREND
“Despite the decrease from 2017, the overall trend continues to be more breaches and more ‘mega breaches’ impacting tens of millions, if not hundreds of millions, of records at once,” said Inga Goddijn, executive vice president for Risk Based Security.
Threats continue. For example, a new Symantec report found that the notorious, highly targeted SamSam ransomware virus is primarily hitting the U.S. – especially the healthcare sector, where hackers may believe organizations are more likely to pay. SamSam breaks into networks and encrypts multiple computers across an organization. The clean-up costs can run in the double digit millions, according to Symantec.
While healthcare organizations are better at understanding and investing in cybersecurity needs, hackers are keeping pace — and then some, according to a panel of CISOs at the HIMSS Healthcare Security Forum in Boston late last month. When asked to rank the cybersecurity posture of the healthcare sector, four healthcare infosec leaders found that while the industry has improved, there’s still a long way to go.
Anahi Santiago, chief information security offier of Christiana Care Health System, said larger organizations are much more secure — but small to mid-size hospitals are struggling.
In the next five years, healthcare will be the biggest target, information security experts say, and hackers will be able to quantify how they can monetize the data. As the use of healthcare data matures, the hackers will keep pace. In the end, healthcare will only be successful when infosec leaders have a seat at the table when it comes to strategy,
ON THE RECORD
“The number of reported breaches shows some improvement compared to 2017 and the number of records exposed has dropped dramatically,” said Inga Goddijn, executive vice president for Risk Based Security. “However, an improvement from 2017 is only part of the story, since 2018 is on track to have the second most reported breaches and the third most records exposed since 2005.