Tag: Health iT

Dive Brief:

• Healthcare is becoming more democratized, with providers and patients possessing more data, an accelerating pace of data exchange and better tools to interpret results, according to Stanford Medicine’s just-released 2018 Health Trends Report.
• Driving the movement are advances in AI and machine learning, partnerships between tech companies and healthcare organizations and efforts to ensure data privacy and security.
• Still, obstacles remain — among them, accessibility, data quality, physician burnout and ethical guidelines for sharing patient data for research and other uses.

Dive Insight:

Big Data is changing healthcare, giving doctors new tools to diagnose and treat patients and creating new opportunities for patients to participate in their own health. The report notes the Apple Heart Study, a Stanford and Apple collaboration, is recruiting 400,000 people to study how accurately Apple Watch detects atrial fibrillation. An initiative called Second Opinion, powered by Grand Rounds, lets patients obtain a second opinion from a Stanford physician from the comfort of their home.

Key benefits of AI in healthcare include prediction, personalization, access, reduced costs and better outcomes, according to the report.

“By one estimate, AI could help reduce health care costs by $150 billion by 2026 in the U.S. alone,” the report says. “From a business perspective, intelligent computing creates an opportunity for industry players to optimize savings and profitability while still taking advantage of growth.”

True democratization is still a ways off, however. Among the biggest hurdles are interoperability and lack of standards for EHR data preparation. “The biggest problem is that our data are not prepared in a way that allows us to even make sense of it,” Amy Abernethy, chief medical officer, chief scientific officer & SVP oncology at Flatiron Health, told Stanford Medicine.

Security, privacy and safety also are key as more patient data is stored in EHRs and health systems remain targets of cyberattacks. As more intelligent computing systems come into play in healthcare, the lines also blur around who owns data, adding to confidentiality concerns, according to the report.

That said, the traditional doctor-patient relationship will continue to underpin progress in healthcare and partnerships be built with patient trust in mind. “Patient safety remain at the forefront of industry priorities, for good reason: if protections erode, trust in these medical advances will dissolve, greatly limiting the benefits,” the report states.

Dive Brief:

• A report by the Healthcare Information and Management Systems Society (HIMSS) and sponsored by wearables pioneer Fitbit suggests health coaches — professionals who facilitate patient treatment and education for physicians — could help improve the use of patient-generated data from wearables.
• HIMSS surveyed 101 healthcare IT and hospital administrators for the report, which found that half of hospitals and health systems planned to connect patients with a health coach or were already using health coaching. Mid- to large-sized organizations were three times as likely to do so than small healthcare systems.
• Survey participants said the top three barriers to using wearables to generate patient health data were costs, issues integrating data into the patient record and data overload on providers.

Dive Insight:

In contrast to widespread skepticism that greeted the devices when they first came to market a decade ago, health systems are no longer questioning the value of patient-generated health data, the report said.

Fitbit recently launched Fitbit Care, a connected health platform that combines coaching and virtual care to help people manage chronic conditions. The product combines Fitbit’s wearables technology with the Fitbit Plus app and Twine Health’s disease management platform with the aim of increasing patient engagement and care coordination. Fitbit acquired Twine in February.

The HIMSS/Fitbit survey found that 79% of respondents agreed they would like to have more data about patients between encounters such as office visits, and 72% said they need patient-generated data to make good decisions on chronic disease management.

Of those respondents already incorporating data from wearable devices in their workflow, 90% see it as strategy that can positively affect management of chronic conditions such as type 2 diabetes, obesity, hypertension and smoking addiction.

The top three reasons to incorporate wearables data, according to the survey, are more timely interventions, immediate feedback and improved patient accountability. Timely interventions improve patient motivation and behavior change.

“We are learning to trust the data. Furthermore, we’re learning how to make actual wearables and activity monitors more effective tools in both preventing disease and managing chronic disease,” senior manager of the Personal Connected Health Alliance at HIMSS John Sharpe said.

The report suggested that health coaches along with advances in interoperability can accelerate the integration of patient-generated health data from wearables.

“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.”

Dive Brief:

• 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.

Dive Insight:

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.”

Dive Brief:

• 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.

Dive Insight:

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.

Dive Brief:

• 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.

Dive Insight:

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.