Readers Write: Empowering Value-Based Technologies with Standardization, Agreement, and Leadership

Empowering Value-Based Technologies with Standardization, Agreement, and Leadership
By David Fryefield, MD

Community-based oncology practices, like other healthcare organizations, are struggling to understand value-based care, how to deliver it, and what resources they need to be successful in this increasingly complex and evolving landscape.

When discussing value-based care, talk quickly turns to the need for cutting-edge technologies to track and measure the quality of services provided. In a value-based world, value is defined as the ratio of quality over cost, and the focus is on measuring quality. In our volume-based world, quality was always there, but we did not necessarily measure it, since it wasn’t a requirement in the reimbursement system. Now, however, measuring quality is critical, and that is where technology can play a vital role.

Many organizations are moving forward with technology solutions to help measure quality in this new value-based environment. However, it is important to realize there is much work to do before deploying these technologies, as technology alone is not going to be the catch-all solution.

Several things must happen to enable the technology solution to be an effective tool, and it all starts with standardization of care processes and consensus within the practice. First, quality must be defined; determining what the critical components of quality care are and what will be measured and analyzed. Then there must be agreement within the practice on the components of the care delivery process and how each step will be performed, as this enables the ability to measure whether or not steps and tasks were completed as defined. If the goal is to measure a component of care delivery and every physician does it differently, the end result is immeasurable. So, unlike the fee-for-service world, the value-based environment requires standardization. This is a critical first step, and possibly the hardest, on the road to quality and must occur before technology can effectively be used to measure the various quality components.

Once consensus and standardization have been achieved, technology can be utilized to determine the quality over cost ratio, or the value definition, which can drive both cost and quality improvements. Each step of the care delivery process can be measured and analyzed to identify opportunities for reducing costs while improving or maintaining quality.

For example, a growing concern is the number of oncology patients who visit the ER or are admitted to the hospital. Many of these patient trips to the ER are unnecessary, creating a drain on the healthcare system financially. By being proactive in patient care, this number can be reduced. Technology can track how often it is happening and then predictive analytics can identify risk factors that, if measured ahead of time, can allow clinicians to help patients avoid a trip to the ER or hospital.

End-of-life care is another area where predictive analytics can support better care and help lower costs. Ensuring patients understand treatment options and giving them a voice in their care decisions are important factors in the perceived value of care. If oncology practices have a system in place to measure variables that can predict when a patient could benefit from end-of-life counseling, a better patient experience could be provided.

What is required from a technology standpoint to get where we need to go? First, changes must be made to EHRs. Accurate, comprehensive data needs to be captured in the EHR so it can be easily accessed, shared across the care continuum, extracted, and analyzed. Several technologies come into play here, including EHR and interoperability platforms, as well as data analytics. Once analyzed, the data needs to be presented back to clinicians and others in the practice in a simple format, such as user-friendly dashboards, providing actionable insight for fact-based decisions. Additionally, real-time data will play a crucial role in value-based care. To provide proactive care, information must be timely, ongoing, and constantly monitored – key areas in which technology solutions will be invaluable.

Leadership will also be required to help the organization evolve. Practice leadership is an important part of the equation, guiding the consensus and standardization needed to achieve measurable results to support quality care and lower costs. Technology by itself will not yield much progress on the journey to value-based care. The transition requires the full package ― advanced technologies and leadership ― to drive development of the framework needed to empower the technology solution. The practice workflow and culture that the technology is deployed in is really the critical issue. A practice can have the most advanced technology available, but if a plan has not been developed and agreed upon on how to effectively deploy it, and leadership is not in place to drive the plan, a great deal of the technology solution’s power and potential is lost.

David Fryefield, MD is medical director of operational excellence for The US Oncology Network, and practice president and radiation oncologist with the Willamette Valley Cancer Institute and Research Center.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 3/23/16

Top News

Allscripts forms a join venture with private equity firm GI Partners to acquire behavioral healthcare technology vendor Netsmart Technologies. Allscripts, which will contribute $70 million to the deal, will merge its homecare software business unit with Netsmart. Netsmart CEO Mike Valentine will continue in that role for the combined company.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Here’s the video from last week’s webinar, “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado,” sponsored by Spok.

People

Missy Krasner (Box) joins DigiSight’s Board of Directors. For those keeping score, Krasner helped pass out HISsies at HIStalkapalooza 2014. I still remember Mr. H’s admiration of her dancing skills.

IPC Healthcare founder Adam Singer, MD joins MDVIP’s Board of Directors.

Trade association Health IT Now promotes Robert Horne to executive director. He takes over from Joel White, who will remain involved as a senior advisor.

Announcements and Implementations

Statewide ACO OneCare Vermont selects care management software from Care Navigator, a subsidiary of BluePrint Healthcare IT. Roll out will begin with care coordinators who will initially focus on high-risk patients with complex conditions. OneCare will expand its use of the new software in phases, eventually adding physicians, other clinical staff, patients, and family caregivers.

Telemedicine

Indiana Governor Mike Pence signs House Bill 1263 into law, enabling physicians, PAs, and APNs to offer telemedicine services to patients without a prior in-person visit.

Government and Politics

Just in time to celebrate the Affordable Care Act’s sixth anniversary, GAO releases a report that covering actions that are needed to enhance data security and privacy controls at Healthcare.gov. Turns out the federal exchange was the victim of 300 cyberattacks over the course of 18 months, none of which “successfully compromised sensitive data.” The 55-page report specifically points out weaknesses in the site’s ability to protect data flowing through the Federal Data Services Hub, a portal used to exchange information between the marketplace and CMS partners. Red flags include insufficiently restricted administrator privileges for data hub systems, inconsistent application of security patches, and insecure configuration of an administrative network.

ONC will hold its annual meeting May 31-June 2 in Washington, DC.

Other

HealthcareSource adds 1,000 courses to its Elearning library for healthcare professionals. New courses and updates include the fields of regulatory compliance, leadership, ICD-10/RCM, and desktop skills.

Sponsor Updates

Blog Posts

• High Performance Telemedicine for Your Practice (AdvancedMD)
• The Value and Challenge of Patient Generated Health Data (Culbert Healthcare Solutions)

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Readers Write: Balancing HIPAA Compliance with Efficiency Across EHRs and Paper Records

Balancing HIPAA Compliance with Efficiency Across EHRs and Paper Records
By Stuart Pologe

While EHR systems continue to improve efficiency, paper documents are still a vital part of the healthcare information workflow. For many healthcare organizations, it’s a challenge to manage digital and paper materials while balancing the need for efficiency and compliance with HIPAA.

We were confronted with similar challenges at Night Nurse, a nationwide nurse triage company serving private practices, hospitals, universities, self-insured companies, and more. Our operational infrastructure had been a paper-only system since the company’s inception in 1999. As the business grew and demands increased, we realized the significant need for a hybrid paper-digital system. Built in-house, our IT system today merges 20,000 paper documents per month with disparate EHR and data sources while maintaining regulatory compliance.

If your organization has comparable needs and challenges, consider building a similar system. When executed properly, aim for your digital/paper management platform and strategy to:

• Expedite response times to improve patient outcomes.
• Improve information workflow.
• Maximize productivity.
• Reduce labor costs.

Since healthcare organizations are held to the highest standards of data security, your system will also need to ensure compliance with HIPAA and other regulatory directives. These requirements often create speed bumps, so you’ll find that balancing efficiency and compliance are the biggest challenges. Here are recommendations to equally accomplish both needs.

Optimize Your Workflow

Just a few extra minutes can mean the difference between a positive and negative patient outcome. To ensure that data entry and device speeds never stand in the way of patient outcomes, begin by examining your intake system for wasted steps.

How long does it take from the moment a patient arrives in your facility/on your phone until care is provided? Discover how many times information must be entered and transferred and eliminate steps, as possible. Also think about policies and devices that can more quickly register patients into the pipeline.

For intake/output of paper documents, high-speed printers, faxes and scanners shave valuable minutes that patients appreciate. With our call volume at greater than 90 to 100 requests per hour in rapid succession, the Brother MFC-8950DWT laser all-in-one has been key to our dispatch operation moving smoothly.

Ensure Secure Document Transmission

For many healthcare organizations, the most seamless HIPAA-compliant way to transmit information is still by fax technology. Although there are HIPAA-compliant ways to manage electronic transmission, it can become challenging and inefficient when you’re dealing with dozens of unique information sources and systems that involve paper and digital.

Many fax devices are built with advanced security features to address the increasing demand for secure document management. Secure fax documents through:

• Secure function lock – For restricting or granting access and privileges on a per-user or per-group basis.
• Active directory – For network user authentication and access to corporate email features.
• NFC card readers – For user-based walk-up authorization to release confidential fax/print jobs.

Move Information Seamlessly Between Paper/Digital Formats

Most healthcare organizations can handle paper documents and digital files smoothly; however, it’s the integration of the two mediums that often bring productivity to a screeching halt. At Night Nurse, we recognized this challenge early in the process. We solved it with a combination of procedures and technology solutions that help us ensure patient care to emergent situations in less than five minutes, made possible through rapid paper-to-digital transmission.

Printers and scanners provide a highly connected on-ramp/off-ramp between digital healthcare systems and physical paper documents. For some organizations, scanner connectivity with EHRs, cloud assets, and mobile apps assist in executing efficient and accurate data integration. And don’t overlook the value of seemingly simple conveniences, such as a fax machine’s ability to index and time-stamp paper documents for rapid, visual identification of critical information.

Always be Prepared

Reliability and 100-percent uptime are critical in providing a timely continuum of care. Fast-paced, regulation-laden healthcare environments leave no room for error, so you must have fail-safe procedures in place. This is one area where a digital/paper system shines. If one system experiences challenges, we’re able to move to the other without losing a beat.

Design your workflow procedures with capability to switch from hybrid to just paper or digital on a moment’s notice. To entirely avoid workflow interruptions, the magic word is redundancy. Follow these guidelines for glitch-free operations:

• Maintain always-on, business-class Internet connectivity. This is especially critical when utilizing cloud-based or SaaS systems. Our data center has numerous redundancies, including connectivity from four different Internet service providers, including full 4G ISP. Our primary business-class connectivity is provided by RCN, with the other services available at a moment’s notice. Operations are unaffected if one ISP goes down.
• Make sure your business is equipped with enough phone/fax lines for high-volume seasons and unexpected interruptions. Even in the digital world, phone-based communications still serve as a critical tie between healthcare providers and patients – particularly in emergent situations. Night Nurse maintains service from multiple telephone providers with service-level agreements. This supports more than 80 analog and VoIP phone lines with 4G switchover capabilities.
• Deliver consistent electric power. Interruptions in power – even for a few minutes – degrades patient care and introduces risks. Be prepared with alternate power sources to maintain service at all times. Our entire facility is also backed up by a dedicated natural gas generator. Also, every computer in our data center is individually equipped for short-term power interruptions with a battery backup system.
• Include staffing redundancies in your plan. Always have on-call healthcare providers ready to handle patients during unexpected peaks.
• Be ready with back-up technology solutions. Night Nurse has been very fortunate, with few breakdowns in more than 15 years. However, anything can break at any time, so alternate hardware systems must be powered-up and ready to go on a moment’s notice. For example, in addition to our reliable fax server, our Brother multifunction machines automatically activate and serve as standalone fax machines. If these two layers fail, an IntelliFax 4750e laser fax machine kicks in.

Also be prepared with these additional layers of redundancy:

• Run an alternate server at all times. This could be onsite or co-located elsewhere, but be ready for immediate switchover in case of failure.
• Stock extra supplies, such as high-capacity toner/ink, paper, office supplies, and other often-overlooked necessities.
• And always keep electronic archives of all documents in case paper is destroyed or vice versa.

Night Nurse’s reputation for rapid patient care is a tribute to our IT infrastructure. Through improved workflow, we’ve experienced significant gains in patient response times, expanded nationwide, and markedly increased profitability. Your organization can experience similar results; and earn the trust of patients, employees, and partners by implementing strategies and technologies to seamlessly meet the challenge of balancing paper records, digital document solutions, and regulatory requirements.

Stuart Pologe is COO of Night Nurse in Wayland, MA.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 3/22/16

Top News

PracticeUnite, a Newark, NJ–based developer of mobile communication and collaboration software for physician practices, merges with Minneapolis-based Uniphy Health, which offers similar products that connect ambulatory and acute care teams. In tandem with the merger, the combined company, which will operate as Uniphy Health, has added Casey Cowell (Durandal), Mike Martone (ADP), and orthopedist John Lockwood, MD to its Board of Directors. PracticeUnite executive team members have retained their roles.

Webinars

None scheduled in the coming weeks. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Telemedicine

Teladoc celebrates 3,000 visits in a single day, a number it equates to “all ambulatory care patient visits in a typical day at a major US medical center, or the total number of patients seen in one day by the country’s five largest hospital emergency departments combined.”

McDowell Technical Community College in Marion, NC receives a $25,000 grant from the Kate B. Reynolds Foundation to purchase a mobile telemedicine unit, which it has installed in a refurbished closet now dubbed the “telehealth room.”

Grand Rapids, MI-based RespondWell celebrates a $2 million capital raise with an eye to raising an additional $8 million. The startup, which develops virtual care software for at-home physical therapy sessions, will use the funds to add staff and further develop its technologies. The company, led by former Xbox and Wii game developer Ted Spooner, signed a deal with the new Philips Aging Well Services unit earlier this year to provide virtual care to seniors recovering from surgery.

Announcements and Implementations

Springfield Clinic (IL) joins the Midwest Healthcare Quality Alliance. Founded in 2014 by Memorial Health System and Southern Illinois University HealthCare, the alliance works on improving quality, safety and community outcomes across Central Illinois. The clinic will also become a member of MHQA’s Quality Alliance Patient Safety Organization, a federally certified organization working to improve patient safety through advanced data analysis.

Spokane, WA-based Next IT Healthcare will host its virtual health assistant and coaching technology on ClearData’s HIPAA-compliant cloud.

Government and Politics

Providers, check your spam folders: OCR begins the second phase of HIPAA audits. The agency notes this latest round will primarily be desk audits, and that the information gathered will help OCR “develop tools and guidance to assist the industry in compliance self-evaluation and in preventing breaches.” Audit results will help the office develop its permanent audit program.

Research and Innovation

The only thing consistent about wearables are their inaccuracies at measuring energy consumption, or so say researchers in a new JAMA study. Researchers compared calorie consumption data from 12 wearables with data from standardized measurements.  All, including Jawbone and Fitbit, underestimated total energy expenditure, which reaffirmed the research team’s initial notion that there has thus far been no evidence proving a wearable’s ability to accurately measure such expenditure.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 3/21/16

Top News

Apple announces CareKit at a town hall ahead of its 40th anniversary on April 1. The new HealthKit- and ResearchKit-friendly open-source framework will help software developers design apps that make it easier for people to manage their own medical conditions. Launching next month, CareKit apps will feature care plan and action item tracking, symptom and measurement tracking, an insight dashboard, and secure sharing capabilities. Early adopters include several health systems and pregnancy app developer Glow, which will incorporate CareKit features into its Glow Nurture app. Apple also announced a new ResearchKit feature designed by 23andMe that lets researchers incorporate genetic data into their studies.

Webinars

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Chronic illness management startup Signallamp Health plans to add 69 jobs at its Scranton, PA headquarters over the next three years. The fledgling company, which employs nurses to follow-up with patients on behalf of providers, received a $100,000 grant earlier this month from Ben Franklin Technology Partners of Northeastern Pennsylvania to build out its technology infrastructure. It also anticipates receiving nearly $130,000 in government grants for employee training. Signallamp has signed on 25 physician practices since launching late last year.

On-demand urgent care company Mend wins the 2016 ReleaseIt competition at SXSW Interactive. The Dallas-based startup (and Practice Fusion customer) was founded a year ago by emergency physician Jonathan Clarke, MD a US Navy veteran who served wartime tours of duty as a physician in Iraq and Afghanistan, and now serves as a flight surgeon and chief of flight medicine in the US Air Force Reserve.

Physician group alliance Stratum Med signs a three-year, $25 million group-purchasing agreement with Medline. The deal will afford 50 Stratum Med practices in the Midwest negotiated pricing on medical supplies.

Announcements and Implementations

PatientClick releases a PC Portal app for IPhones and IPads. Compatible with the company’s EHR, the new app features appointment scheduling, secure messaging, and clinical note review.

Pulse8 adds EHR integration and coding technology to its line of risk adjustment and quality analytics tools for providers and payers.

People

Sharon Arnold (AHRQ) joins the Patient-Centered Outcomes Research Institute’s Board of Governors. Arnold will take over acting AHRQ leadership when Richard Kronick steps down later this month.

Massachusetts Governor Charlie Barker presents Athenahealth CEO Jonathan Bush with the Ellen M. Zane Award for Visionary Leadership at the 2016 Working Wonders for Tufts Medical Center benefit event. Tufts Medical Center and Floating Hospital for Children (MA) President Michael Wagner (above, right) was on hand to add to the kudos.

Telemedicine

The President’s Council of Advisors on Science and Technology advocate for the advancement of telemedicine in a new 80-page report on “Independence, Technology, and Connection in Older Age.” The authors stress the importance of expanded broadband access and alternative payment models, and point to the progress CMS has made in expanding telemedicine access via the Next Generation ACO and Bundled Payment for Care model programs. The report also highlights the licensure and reimbursement issues physicians face when looking into telemedicine models of care.

Government and Politics

AHIMA launches a petition urging HHS to lift a ban on federal work to develop a national patient identifier. The petition needs 100,000 signatures by April 19 to elicit a response from the White House. Congress has had a ban on developing such an identifier since 1998.

Other

A Google audit of the Web’s top 100 non-Google sites (which account for 25 percent of the world’s Web traffic) reveals that nearly 80 percent don’t use HTTPS, an extra layer of security that companies are increasingly adding to the standard HTTP protocol. Nearly 70 percent of that group uses outdated encryption or nothing at all. Names that readers will likely recognize include apple.com, microsoft.com. NIH.gov, and amazonaws.com.

Kudos to The Atlantic for recognizing “y’all” – one of the English language’s most underappreciated words – over other attempts at second-person plurals. “’Y’all,’ that strange regional and ethnic conjunction, offers a simplicity to speech that can’t be found elsewhere,” the author writes. “It is a magnificently elegant linguistic creation. It sounds elegant, warm, and inviting. It offers both economy and an end to second-person ambiguity. Teach it in schools across the country. Mouth it to babies. Put it on end-of-grade tests.”

Sponsor Updates

Blog Posts

• Key Takeaways from HIMSS16 (Medicity)
• Your Peers Think You Should Go to the VUE – Here’s Why (Versus Technology)
• Insights from HIMSS16: Four key takeaways (PerfectServe)

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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