Predictive analytics have a critical role to play in proactive clinical care

Nov 27, 2017

Healthcare is undergoing a major transition from fee-for-service to value-based care, focused on improving outcomes while safely reducing costs. Along this journey, care teams find themselves equipped with outdated tools that drive a reactive, "let's fix it," care mentality.

However, to reach these new goals, the industry will need to shift the delivery of healthcare to become more proactive and patient-centered. While this concept of proactive care has always been an industry-wide goal, it still has yet to be accomplished, rendering the question "how do we make this happen?"

The answer is combining data from electronic health records (EHR), specifically vital signs, lab results, and nursing data with predictive analytics to help foster a proactive mindset. By leveraging analytics, we can transform the way we provide care.

Imagine for a moment that you knew a patient's condition was deteriorating before he or she coded, or entered an emergency state - this would allow you to intervene sooner and save a life before their condition worsens drastically or irreversibly. Predictive analytics provide care teams with this insight, allowing earlier intervention and enabling a shift from the reactive mentality to proactive patient care.

This shift in care benefits not only healthcare providers, but also patients and their families, because it creates more time to make clinical decisions and improve the care team's workflow. For example, rapid response teams (RRTs) which are made up of seasoned clinicians, who come to the rescue when a patient's health is deteriorating quickly, benefit greatly from predictive analytics due to the nature of their role in the delivery of care. Unfortunately, RRTs show up only when there is a patient that will need to be treated and transferred to a higher level of care due to deterioration in their condition. With the power for care teams to be notified before a patient's deterioration occurs, we may see a shift in how RRTs work becoming more proactive than reactive. This shift in the clinical course of action will enhance the delivery of value-based care and enable hospitals to offer more proactive and personalized care.

Much like the RRT scenario, data has little impact in many response situations, because it's used too late or is inaccessible. This is often the case because health data is siloed - accessing and translating the data into actionable information is an industry-wide obstacle. To overcome these challenges and use data effectively in clinical care situations, health data must be better organized and more easily accessible. Properly organized data allows analytics to be used broadly across the care team and between providers.

The challenges to accessing data and leveraging analytics are not limited to the healthcare industry. Nonetheless, healthcare data comes with its own security and privacy laws which make it difficult to access, share and transmit. In addition, most health data in the EHR is unstructured. Recent studies estimate that of the 1.2 billion clinical documents produced annually in the U.S., 60 percent contain unstructured patient data. This in effect limits the amount of data that is accessible and ready to be used in a clinical setting. Once a higher rate of data access is achieved, the information provided can be used effectively to improve patient care.

Ultimately, the real benefit of leveraging health data through predictive analytics is that it can provide early warning signs of patient deterioration, enable sooner intervention and ultimately save more lives. Continued use of analytics will allow clinicians to work smarter, providing them with the ability to prioritize patients that are in most need of care and shifting the healthcare mindset from reactive to proactive - improving patient safety and saving lives.

Source: Med City News (View full article)

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Stanford and Google team up to streamline EHR documentation

Nov 27, 2017

Steven Lin, MD, medical director of Palo Alto, Calif.-based Stanford Family Medicine, is working with Google Research to launch a pilot study on "digital scribes," according to a Nov. 21 Stanford Medicine blog post.

The collaborators will embark on a nine-month study, during which they will apply machine learning algorithms to detect patterns in audio recordings of patient visits. To collect audio samples, physicians at Stanford Family Medicine will record visits with patients who opt into the research project.

The goal of the study is to identify audio patterns that inform an algorithm's ability to complete progress notes. This "digital scribe" would be able to save physicians time by allowing them to concentrate on patients, while the machine learning algorithm automatically enters information into the EHR.

The researchers will use the pilot study to identify challenges and indicate whether a digital scribe is feasible to create. If successful, they will continue to develop a tool for physician use.

"This is really new and we're in the early stages of this technology," Dr. Lin noted.

Source: Becker's Hospital Review (View full article)

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How Virtualization Improved Patient Care

Nov 27, 2017

Source: Healthcare Informatics

In 2015, Dallas-based Parkland Health and Hospital System opened a new 2.8 million square-foot facility, almost twice the size of the previous facility, which was built in 1954. The new state-of-the-art hospital, built on a 64-acre site and employing 11,000 people, features 862 private patient rooms with annual patient visits exceeding 1 million.

The emergency department at the new Parkland hospital is over 100,000 square feet, with 250,000 annual ED visits, the most high-volume, single site ED in the country. From a technology standpoint, the new facility required 7.5 million feet of ethernet cable--equivalent of the distance from Dallas to New Jersey--as well as 500 server equipment racks, according to Parkland Health and Hospital System's CIO Matthew Kull.

"When moving into a facility this size, it was not without its own challenges," Kull said during a webinar sponsored by Healthcare Informatics detailing the hospital's digital strategy transformation. The webinar can be accessed here.

As Dallas County has changed, the county's safety net hospital had to change as well. Parkland can trace its history back to 1894, when the first hospital opened, and the hospital moved to a larger, 1.5 million square-foot facility 63 years ago. "In 1954, when we moved into our second iteration of Parkland, Dallas County had 430,000 people. In 2016, when we moved into our latest hospital, Dallas County had 2.6 million people," Kull said. "In 1954, we admitted 14,000 people; in 2016, over 75,000. In 1954, in Parkland 2.0, we delivered 4,000 babies; the year we moved into our third site, Parkland 3.0, we delivered over 12,000."

At the same time, Parkland's patient population provides some unique challenges, as only 8 percent of the patient base has commercial insurance, 44 percent have Medicare/Medicaid and 50 percent are self-pay or charitable or have no ability to pay, Kull said.

"Parkland is a safety net for the most in-need patients. But, with that, driving innovation and efficiency is not something that we do for anything other than a mandatory need to drive that efficiency due to volumes. As it turns out, as technology has progressed, we're finding that it is truly one of the biggest levers for efficiency that we have," he said.

Changing physical logistics and a workforce that increasingly wants to change the way they work also presented challenges, he said. With the transition to electronic health records (EHRs) physicians are spending more time in front of the computer. However, with the patient floors at the new Parkland hospital measuring three football fields long, centralized nursing stations or clinical works areas are not viable, Kull said.

Parkland's leadership team faced a number of critical needs when thinking about the digital strategy for the new hospital--clinicians wanted access to information anytime, anywhere; patients had to remain the top priority; and the security of the enterprise and patient information was paramount.

And, another caveat, as a county hospital, Parkland's senior executive leaders had to plan the new facility to be in operation for the next 50 to 75 years. "Given the pace of change of technology, we had to look at what digital strategy means and how we're going to apply it in a way that continues to give us flexibility and the ability to continually evolve as time goes on in our current facility. In this current evolution, technology is playing the biggest role in the transformation in the way that we treat our patients."

The move to a larger hospital created a need for a new digital strategy and required IT leaders to design an alert management and desktop management environment that would allow users to move freely about large work areas and access data when they needed it, where they needed it, Kull said.

However, planning early proved to be the biggest challenge, as the hospital opened two years ago, but planning for the new hospital started eight years prior. "If we had been planning and picked solutions at that time, we would have a hospital full of people running around with BlackBerry phones," Kull said. "When you're planning a facility of this size and this kind of technical maturity it was difficult to plan early on in an environment where technology was changing. As an example, our mobile solution and our interactive patient experience, these didn't exist."

To meet this challenge, Parkland's IT leaders had to define and design the capabilities and functionalities needed for clinicians, physicians, administrators and the IT team. "We had to define and create a digital platform, a wireless infrastructure that was medical grade, with the ability to capture and transform large amounts of data to an agnostic or non-specific endpoint. This allowed us to come up with an infrastructure that we think we could grow on and pick devices that were just in time and close to our opening."

Working with Palo Alto, California-based technology vendor VMWare, Parkland's leadership team seized the opportunity to employ virtualization and identity management tools enabling the deployment of a single sign-on solution and a tap-to-access roaming desktop profile for each clinician in the facility.

The result, he said, has been that users are spending less time with technology and more time with patients, delivering better care. Clinicians only need to enter their credentials once, and faster logins and easier access to applications equates to more engagement with patients.

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Source: Healthcare Informatics (View full article)

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SCL Health Gives Time Back To Doctors With Simplified IT Experience

Nov 22, 2017

As a $2.5 billion nonprofit healthcare network with 11 hospitals, 210 physician clinics, and home and hospice services throughout Colorado, Kansas and Montana, SCL Health supports more than 20,000 associates, physicians, clinical staff, students, contractors and consultants. This means that at any given moment, there are thousands of people who depend on the SCL Health IT network to access patient records, care for patients using an electronic medical record, and schedule and coordinate appointments. Since 2005, SCL Health has been in a strategic partnership with Citrix to facilitate and streamline its IT processes by simplifying how associates access data and systems so they can ultimately focus more time on patients.

Source: Health IT Outcomes (View full article)

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Top five technology investment areas for healthcare organizations

Nov 22, 2017

Nearly 70% of healthcare companies who transition to the digital economy are expected to see their growth significantly impacted over the next two years, according to a new survey. The digital economy harnesses the power of digital platforms and devices, analytics, the Internet of Things (IoT) and other technologies to reduce costs and create more value for patients across the continuum of care.

"Digital Transformation in Healthcare: A Positive Prognosis," from SAP/Oxford Economics, was designed to track the progress of digital transformations of healthcare companies, including their abilities to better anticipate real-time demand and supply for services, streamline prevention and treatment, and give patients greater control over their own health. Nearly 400 healthcare executives were surveyed; 21% of respondents call the U.S. or Canada home. The balance of participants hailed from Latin America, Europe, the Middle East and Asia.

"Digital innovation will fuel the next wave of breakthroughs in healthcare and accelerate the broader shift toward data-driven care for healthcare organizations. Unlocking actionable data insights in real time is critical for the future success of value-based care," says Thomas Laur, global president, SAP Health.

While lacking substantial impact from digitization efforts so far, respondents expect significant impact over the next two years in the areas of customer satisfaction (61%) and innovation (59%), according to the survey. Digitization provides a path to redesign business models, remove organizational and data silos, automate processes and reduce repetitive tasks.

"The findings support the fact that healthcare organizations are planning to invest most heavily in big data and analytics (76%) and cloud technologies (65%) in the next two years.

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Laur draws five conclusions from the survey results regarding where healthcare organizations are investing in technology most heavily:

1. Technology that improves efficiency. With increased cost pressures, healthcare organizations are striving to standardize and streamline administrative processes for greater efficiencies and improved operations.
2. Technology that supports decision making and personalized medicine. With aging demographics and the rise of chronic diseases, organizations are increasing investments in big data and analytics that can support simpler decision-making while providing data-driven insights for personalized clinical treatments and optimized patient outcomes.
3. Technology that empowers patients. Digital empowered and connected patients have greater expectations for readily accessible and valuable healthcare insights. "The early prioritization to patient experience and digital engagement practices reflects the movement toward helping patients better navigate the healthcare system, empowering them to take active roles in monitoring and managing their health, and in the facilitation of open and immediate communication with the healthcare provider network--all with digital services," Laur says.
4. Technology that protects against cyber threats and data breaches. The shift to a connected digital healthcare network elevates the need for improved security and privacy, and this is reflected in increased investments in security.
5. Technology that improves remote health monitoring. The emergence of advanced medical devices, sensors and wearables provide patients and healthcare providers an opportunity to reap the potential benefits of extended monitoring, greater disease prevention, and improved fact-based care decisions. Healthcare organizations are continuing their investments in mobile and IoT to support these emerging opportunities.

Source: Modern Medicine (View full article)

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Health System Preparedness for Quality Payment Program

Nov 22, 2017

A new report based on a survey of 120 health systems and integrated delivery networks indicates that most healthcare organizations are relying on electronic health records (EHRs) and population health management (PHM) solutions for quality performance management. However, survey respondents also report low satisfaction with these solutions, and most respondents said their vendors do not offer specific tools for quality reporting programs.

This lack of preparedness indicates that healthcare organizations are at risk of falling short of their goals for maximizing payment incentives, the report authors state.

The survey, conducted by Atlanta-based Porter Research and sponsored by Chicago-based SA Ignite, a consulting and software services firm, surveyed 120 medical, quality and operations executives and directors from large health systems and integrated delivery networks (IDNs), and found that the majority (64 percent) of healthcare providers intend to maximize payment incentives associated with the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP). The survey also found that almost all the respondents (97 percent) rely on their EHR or PHM solution as their primary tool to manage performance in the QPP.

However, the survey responses also indicated low satisfaction scores (39 percent average) for the EHR and PHM tools that health systems are using, which indicates that these ambitious goals may be at risk, the report authors state.

Three factors surfaced in the study that threaten the providers' ability to maximize QPP incentives using these tools, including lack of system preparedness, poor customer satisfaction rates and limited focus on program complexities, according to the report.

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Source: Healthcare Informatics (View full article)

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Why the Entire C-Suite Needs to Use the Same Metrics for Cyber Risk

Nov 21, 2017

When it comes to cybersecurity, the chains of communication that exist within an organization, if they exist at all, are often a mess. Multiple conversations about cyber risks are happening across a multitude of divisions in isolation. At the same time, members of the C-suite are measuring their potential impact using different metrics -- financial, regulatory, technical, operational -- leading to conflicting assessments. CEOs must address these disconnects by creating a culture that promotes open communication and transparency about vulnerabilities and collaboration to address the exposures.

Organizations of all sizes across all sectors are experiencing an exponential increase in their exposure to cyber risk. The number of endpoints that need protecting is exploding as consumers demand more digital interactions and smart devices. (Gartner estimates there will be more than 20 billion connected devices by 2020.) Adversaries have evolved from individual bad actors to highly capable organized crime groups and nation states. The regulatory landscape is increasingly shifting and, at times, conflicting at local, national, and international levels. High-profile cyberattacks -- ranging from the one suffered by Sony Pictures in 2014 to the global ransomware attacks that occurred last May and June -- highlight the huge financial and reputational stakes.

CEOs committed to staying on top of this ever-evolving threat must break down the silos that exist in the organization in order to assess the full dimensions of the risks across the enterprise and address these exposures holistically. The consequences of not doing so could cost them the trust of their shareholders and customers and even their jobs -- as the recent Equifax hack demonstrated.

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Source: Harvard Business Review (View full article)

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Data Quality, Liquidity Key to Physician Practice Transition to Value-Based Care

Nov 21, 2017

Because Steven Waldren, M.D., heads up the Alliance for eHealth Innovation at the American Academy of Family Physicians, he has a great perspective on the data needs of practices in relation to the shift to value-based care. He shared some pain points during a Nov. 20 webinar put on by the eHealth Initiative.

Issues with data liquidity and quality will make the transition to value-based care difficult, Waldren said, "but the horse is out of the barn, and we will move toward value-based payment no matter what."

He said that from a practice perspective, the shift does not involve tweaking a few workflows or checking a few new boxes in the EHR. "For many practices it is a fundamental transformation," Waldren said. He walked attendees through some of the capabilities required of practices and the associated data needs.

Risk-stratified, active care management: Providers need to classify attributed individuals into groups based on identifying them as high-, medium- and low-risk, and establish strategies for working with each group. "You have to think about these groups very differently," he said, because you do not have enough resources to be highly interactive with every patient, and it would be counter-productive to be more proactive with very healthy patients.

Waldren said that in order for practices to be effective at care management, their data must be timely and accurate. Clinicians have to stop putting data into EHR just as a note or for billing purposes and think of it more as an asset to run analytics and inform them on how to take care of a patient. The data also must be robust and predictive, he said. Providers need help determining who is moving toward being high-risk so they can intervene early.

Waldren noted that care coordination across practices and settings requires distributing data across the medical neighborhood, and clear roles and responsibilities for a care team. What is happening to your patient in other care settings is important, he said.

"Interoperability is critical," he said. "We need to have utilization information sent around and a shared care plan so everyone is on the same page. We need to think about more robust communication between teams. To have more of a team-based approach, more constant communication is going to be important. We need task management and tracking across multiple organizations and EHR vendors, and that is a daunting issue."

Another key to value-based care is patient engagement. Providers need to empower patients to take an active role in their care. Most practices have turned to a patient portal as their No. 1 modality for this. But Waldren pointed out that with open application programming interfaces, it is possible that the patient will be able to pull data from their provider portals rather than having to be tethered to them. Then the patient's personal health record could amalgamate all their data in one place. That approach has challenges of its own, including semantic ones. The PHR system would have to stitch that data together, not just in a longitudinal way, but pulling together the medication lists from across four EHRs.

Waldren mentioned that remote patient monitoring, secure messaging, and patient-generated health data are important but all raise questions around how the data gets integrated into the patient record.

Source: Healthcare Informatics (View full article)

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Actionable Analytics For Improved Financial Outcomes in Healthcare

Nov 21, 2017

Hospital leaders face substantial challenges when it comes to aggregating and comparing vast datasets to identify and correct problems. The sheer magnitude of data is prompting these healthcare organizations to recognize this deficit in their existing systems. As they learn about the value and benefits of actionable analytics to address and solve problems in virtually every aspect of operations, they are adopting new technology that is now available. A key benefit is that these new platforms overlay current transactional systems to deliver a cleaner, smarter and cost-effective solution.

The consolidation of data required to perform actionable analytics, allows astute hospital leaders to efficiently retrieve, compare, reconcile and analyze all data through multiple platforms. Because there is no large upfront investment and no need to discard existing systems, this puts organization management in control of aggregating data, and detecting/resolving issues that impact revenue integrity, as well as clinical and operational performance.

Radiology Case Study For Actionable Analytics
Let's say a patient presented a script for a CT scan of the abdomen without contrast. The patient underwent the first test, but upon review the radiologist decided a CT with contrast was needed and updated the order. The problem was that the initial registration and authorization were for CT without contrast, and the new test and fee were completed without the proper authorization.

As a result, the bill contained several errors related to insurance authorization and an unexpectedly higher bill, leading to lower than expected revenue in the department, re-work and delays in the receivable, a late bill and the potential for an insurance denial.

With actionable analytics, the story would see significantly better results: Sophisticated actionable analytics systems would have allowed the hospital to use any data from any transactional system to set up sophisticated alarms, and the issue would have been detected immediately.

Source: Health IT Outcomes (View full article)

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eClinicalWorks sued for nearly $1 billion for inaccurate medical records

Nov 20, 2017

EHR vendor eClinicalWorks has been hit with a class-action lawsuit that alleges patients couldn't trust their medical record's accuracy due to flaws in the company's software.

The suit comes just six months after the company was hit with a $155 million settlement to resolve a False Claims Act suit that claimed it gave customers kickbacks to publically promote its products.

The company did not immediately respond to a request for comment.

Kristina Tot -- in charge of the Stjepan Tot estate -- filed the complaint in the U.S. District Court in the Southern District of New York on Thursday. Tot is asking for $999 million in monetary damages for breach of fiduciary duty and gross negligence.

Stjepan Tot died of cancer, and the suit claims that "he was unable to determine reliably when his first symptoms of cancer appeared [as] his medical records failed to accurately display his medical history on progress notes."

Further, the lawsuit claims that millions of patients have compromised patient records, as eClinicalWorks' software didn't meet meaningful use and certification requirements laid out by the Office of the National Coordinator.

These patients "can no longer rely on the accuracy and veracity" of their medical records as it stands in eClinicalWorks EHRs. According to the suit, more than 850,000 healthcare providers use eClinicalWorks software.

In the complaint, Tot lists a wide range of the company's shortcomings including failure to reliably record diagnostic imaging orders; failed audit log requirements; failed data portability requirements; and failure to satisfy required certification criteria, among others.

eClinicalWorks settled with the Department of Justice in May for knowingly falsifying meaningful use certification, which allowed for fraudulent incentive payments to providers. It was the first case of its kind. But some have suggested eClinicalWorks was not the only vendor to shirk certification criteria.

As a result, DOJ demanded eClinicalWorks transfer its data to rival EHRs for free and hire an independent watchdog for the company.

The lawsuit was first filed by whistleblower Brendan Delaney, who was a software technician at the New York City Division of Health Care Access and Improvement at that time.

Source: Healthcare IT News (View full article)

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