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HIT for HIEs

Posted on October 17, 2017 I Written By

The following is a guest blog by Mike O’Neill, CEO at MedicaSoft. This is the third blog in a three-part sponsored blog post series focused on new HIT for integration. Each month, a different MedicaSoft expert will share insights on new and innovative technology and its applications in healthcare.

Health Information Exchanges (HIEs) have been in the news lately, and for good reason. With major hurricanes devastating Texas, Florida, the British Virgin Islands, and Puerto Rico, accessibility of patient health information rapidly became a major concern. Electronic Health Record adoption has led to most patient data being in electronic form, but it hasn’t necessarily made that data available when and where care is delivered. HIEs can help make that data available; during the recent storms two HIEs were able to spring to action to help clinicians provide care for patients. The ability of the Houston and San Antonio-area HIEs (Greater Houston Healthconnect (GHHC) and Healthcare Access San Antonio (HASA) to exchange information allowed patient records to be accessed remotely – which was absolutely critical during this natural disaster.

If you were on the fence about “the cloud,” this is the perfect case study in its effectiveness. More than ever, HIEs are called upon to assist by making health records available during critical care encounters. HIEs need modern technology to best serve their communities in these instances, going beyond basic connectivity and interoperability to deliver tangible value using the wealth of data they collect –

  1. Organize the data into meaningful health records. HIEs often have access to years of raw data. They may need help organizing it into a clinical data repository, matching patients, and providing a health record that is clinically useful. This is one way we assist HIEs in using the data they’ve collected.
  2. Provide valuable alerts & notifications. These are useful, especially in a crisis, to locate patients, but they can also give patients notice on events they need to follow-up on. This is another layer we build onto HIEs’ data foundation.

Health records that are useful go a long way – beyond individual hospitals, and regions and state lines. To be useful, health records must go where the patients go, wherever that may be.

An emerging approach to meet this need is the Strategic Health Information Exchange Collaborative (SHIEC’s) Patient-Centered Data Home (PCDH) concept among HIEs. PCDH helps providers access real-time health information across regional and state lines, wherever the patient is seeking care. Regardless of where the clinical data originates, it becomes part of the patient’s longitudinal patient record – the PCDH – giving patients control of their data.

About Mike O’Neill
Mike is the CEO at MedicaSoft. He came to MedicaSoft from the U.S. Department of Veterans Affairs (VA) where he was a Senior Advisor and member of the founding team of the VA Center for Innovation. Mike serves as the Chairman of the Board of Directors of the Open Source Electronic Health Record Alliance (OSEHRA). Prior to VA, Mike was involved in the commercialization of new products and technology in startups and large companies. He is a die-hard Virginia Tech Hokie.  

About MedicaSoft
MedicaSoft designs, develops, delivers, and maintains EHR, PHR, and UHR software solutions and HISP services for healthcare providers and patients around the world. For more information, visit www.medicasoft.us or connect with us on Twitter @MedicaSoftLLC, Facebook, or LinkedIn.

Where Patient Communications Fall Short?

Posted on October 12, 2017 I Written By

The following is a guest blog post by Sarah Bennight, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

We are constantly switching devices to engage in our daily lives. In fact, in the last ten minutes I have searched a website on my desktop computer, answered a phone call, and checked several text messages and emails on my cellphone. Our ability to seamlessly jump from one device to the next affects our consumer behavior when interacting with places of business.

Today, we can order coffee and groceries online, web chat with our internet service company, and research store offerings before ever physically walking into a building. Traditionally, healthcare consumers had mainly phone support until the 2014 Meaningful Use 2 rule dictated messaging with a physician and patient portal availability. Recently, online scheduling and urgent care check in has been an attractive offering for consumers of health wanting to take control of their calendars and wait times.

Healthcare is certainly expanding functionality and communication channels to meet consumer demand. But where are we falling short? The answer may be relatively simple: data integration. Much like the clinical side of the healthcare business, integration is a gap we must solve. The key to turning technological convenience into optimal experience is evolving multichannel patient interactions into omnichannel support.

Omnichannel means providing a seamless experience regardless of channel or device. In the healthcare contact center, this means ensuring live agents, scheduling apps, chat bots, messaging apps, and all other interaction points share data across channels. It removes the individual information silos surrounding the patient journey, and connects them into one view from patient awareness to care selection, and again when additional care is needed.

In 2016, Cisco Connect cited four key reasons a business should invest in omnichannel consumer experiences, but I believe this resonates in the healthcare world as well:

  1. A differentiated patient and caregiver experience which is personal and interactive. Each care journey is unique, and their initial experiences should resonate and instill confidence in your brand. We now communicate with several generations who have different levels of comfort with technology and online resources. Offering multiple channels of interaction is crucial to success in the competitive healthcare space. But don’t stop there! Integrated channels connecting the data points along the journey into and beyond the walls of the care facility will create lasting loyalty.
  2. Increased profit and revenue. The journey to finding a doctor or care facility begins long before a patient walks in your door. Most of these journeys begin online, by interviewing friends, and checking online reviews. Once an initial decision is made to visit your organization, you can extend your marketing budget by targeting patients who might actually be interested in your services. When you know what your patients’ needs are, there is a greater focus and a higher chance of conversion.
  3. Maintain and contain operating costs. Integrating with EMRs is not always the easiest task. However, your scheduling and reminder platforms must be able talk to each other not only for the optimal experience, but also for efficient internal process management. For example, if a patient receives a text reminder about an appointment and realizes the timing won’t work, they can request to reschedule via text. Real time communication with the EMR enables agents currently on the phone with other patients to see the original appointment open up and grab the slot. Imagine the streamlining with the patient as well in an integrated platform. Go beyond the ‘request to reschedule’ return text and send a message says “We see that you want to reschedule your appointment. Here are some alternative times available”. Take it one step further with a one-step click to schedule process. With this capability, the patient could immediately book without a follow-up phone call reminder or staff having to hunt them down to book.
  4. Faster time to serve the patient. When systems and people communicate pertinent data, faster issue resolution is possible. Healthcare can be scary, and when you address patient and caregiver needs in a timely manner, trust in your organization will grow. In omnichannel experiences, a patient can search for care in the middle of the night online, and when they don’t find an appointment opening a call could be made. Imagine the value of already knowing that a patient was searching for a sick visit for tomorrow morning with Dr. X. With this data in mind, you are able to immediately offer alternatives and keep that patient in your system before they turn to a more convenient option.

You can see how omnichannel experiences are going to pave the way for the future of the contact center. Right now, the interactions with patients before and after treatment provide an enormous opportunity to build trust and further engagement with your organization. By integrating the data and allowing cross-channel experiences that build on each other, the contact center will extend into the main hub of engagement in the future. The time to build that integrated infrastructure is now, because in the near future new channels of engagement will be added and expected. Are you ready to deliver an omnichannel experience?

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

Eliminate These Five Flaws to Improve Asset Utilization in Healthcare

Posted on October 4, 2017 I Written By

The following is a guest blog post by Mohan Giridharadas, Founder and CEO, LeanTaaS.

The passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act accelerated the deployment of electronic health records (EHRs) across healthcare. The overwhelming focus was to capture every patient encounter and place it into an integrated system of records. Equipped with this massive database of patient data, health systems believed they could make exponential improvements to patient experiences and outcomes.

The pace of this migration resulted in some shortcuts being taken — the consequences of which are now apparent to discerning CFOs and senior leaders. Among these shortcuts was the use of resources and capacity as the basis of scheduling patients; this concept is used by hundreds of schedulers in every health system. While simple to grasp, the definition is mathematically flawed.

Not being able to offer a new patient an appointment for at least 10 days negatively impacts the patient experience. Likewise, exceeding capacity by scheduling too many appointments results in long wait times for patients, which also negatively impacts their experience. The troubling paradox is that the very asset creating long wait times and long lead times for appointments also happens to perform at ~50 percent utilization virtually every day. The impact of a mathematically flawed foundation results in alternating between overutilization (causing long patient wait times and/or long delays in securing an appointment) and under-utilization (a waste of expensive capital and human assets).

Here are five specific flaws in the mathematical foundation of health system scheduling:

1. A medical appointment is a stochastic — not deterministic — event.

Every health system has some version of this grid — assets across the top, times of the day for each day of the week along the side — on paper, in electronic format or on a whiteboard. The assets could be specific (e.g., the GE MRI machine or virtual MRI #1, #2, etc.). As an appointment gets confirmed, the appropriate range of time on the grid gets filled in to indicate that the slot has been reserved.

Your local racquet club uses this approach to reserve tennis courts for its members. It works beautifully because the length of a court reservation is precisely known (i.e., deterministic) to be exactly one hour in duration. Imagine the chaos if club rules were changed to allow players to hold their reservation even if they arrive late (up to 30 minutes late) and play until they were tired (up to a maximum of two hours). This would make the start and end times for a specific tennis appointment random (i.e., stochastic). Having a reservation would no longer mean you would actually get on the court at your scheduled time. This happens to patients every day across many parts of a health system. The only way to address the fact that a deterministic framework was used to schedule a stochastic event is to “reserve capacity” either in the form of a time buffer (i.e., pretend that each appointment is actually longer than necessary) or as an asset buffer (i.e., hold some assets in reserve).

2. The asset cannot be scheduled in isolation; a staff member has to complete the treatment.

Every appointment needs a nurse, provider or technician to complete the treatment. These staff members are scheduled independently and have highly variable workloads throughout the day. Having an asset that is available without estimating the probability of the appropriate staff member also being available at that exact time will invariably result in delays. Imagine if the tennis court required the club pro be present for the first 10 and last 10 minutes of every tennis appointment. The grid system wouldn’t work in that case either (unless the club was willing to have one tennis pro on the staff for every tennis court).

3. It requires an estimation of probabilities.

Medical appointments have a degree of randomness — no-shows, cancellations and last-minute add-ons are a fact of life, and some appointments run longer or shorter than expected. Every other scheduling system faced with such uncertainty incorporates the mathematics of probability theory. For example, airlines routinely overbook their flights; the exact number of overbooked seats sold depends on the route, the day and the flight. They usually get it right, and the cancellations and no-shows create enough room for the standby passengers. Occasionally, they get it wrong and more passengers hold tickets than the number of seats on the airplane. This results in the familiar process of finding volunteers willing to take a later flight in exchange for some sort of compensation. Nothing in the EHR or scheduling systems used by hospitals allows for this strategic use of probability theory to improve asset utilization.

4. Start time and duration are independent variables.

Continuing with the airplane analogy: As a line of planes work their way toward the runway for departure, the controller really doesn’t care about each flight’s duration. Her job is to get each plane safely off the ground with an appropriate gap between successive takeoffs. If one 8-hour flight were to be cancelled, the controller cannot suddenly decide to squeeze in eight 1-hour flights in its place. Yet, EHRs and scheduling systems have conflated start time and appointment duration into a single variable. Managers, department leaders and schedulers have been taught that if they discover a 4-hour opening in the “appointment grid” for any specific asset, they are free to schedule any of the following combinations:

  • One 4-hour appointment
  • Two 2-hour appointments
  • One 2-hour appointment and two 1-hour appointments in any order
  • One 3-hour appointment and one 1-hour appointment in either order
  • Four 1-hour appointments

These are absolutely not equivalent choices. Each has wildly different resource-loading implications for the staff, and each choice has a different probability profile of starting or ending on time. This explains why the perfectly laid out appointment grid at the start of each day almost never materializes as planned.

5. Setting appointments is more complicated than first-come, first-served.

Schedulers typically make appointments on a first-come, first-served basis. If a patient were scheduling an infusion treatment or MRI far in advance, the patient would likely hear “the calendar is pretty open on that day — what time would you like?” What seems like a patient-friendly gesture is actually mathematically incorrect. The appointment options for each future day should be a carefully orchestrated set of slots of varying durations that will result in the flattest load profile possible. In fact, blindly honoring patient appointment requests just “kicks the can down the road”; the scheduler has merely swapped the inconvenience of appointment time negotiation for excessive patient delays on the day of treatment. Instead, the scheduler should steer the patient to one of the recommended appointment slots based on the duration for that patient’s specific treatment.

In the mid-1980s, Sun Microsystems famously proclaimed that the “network is the computer.” The internet and cloud computing were not yet a thing, so most people could not grasp the concept of computers needing to be interconnected and that the computation would take place in the network and not on the workstation. In healthcare scheduling, “the duration is the resource” — the number of slots of a specific duration must be counted and allocated judiciously at various points throughout the day. Providers should carefully forecast the volume and the duration mix of patients they expect to serve for every asset on every day of the week. With that knowledge the provider will know, for example, that on Mondays, we need 10 1-hour treatments, 15 2-hour treatments and so on. Schedulers could then strategically decide to space appointments throughout the day (or cluster them in the morning or afternoon) by offering up two 1-hour slots at 7:10 a.m., one 1-hour slot at 7:40 a.m., etc. The allocation pattern matches the availability of the staff and the underlying asset to deliver the most level-loaded schedule for each day. In this construct, the duration is the resource being offered up to patients one at a time with the staff and asset availability as mathematical constraints to the equation (along with dozens of other operational constraints).

Health systems need to re-evaluate the mathematical foundation used to guide their day-to-day operations — and upon which the quality of the patient experience relies. All the macro forces in healthcare (more patients, older patients, higher incidence of chronic illnesses, lower reimbursements, push toward value-based care, tighter operating and capital budgets) indicate an urgent need to be able to do more with existing assets without upsetting patient flow. A strong mathematical foundation will enable a level of operational excellence to help health systems increase their effective capacity for treating more patients while simultaneously improving the overall flow and reducing the wait time.

About Mohan Giridharadas
Mohan Giridharadas is an accomplished expert in lean methodologies. During his 18-year career at McKinsey & Company (where he was a senior partner/director for six years), he co-created the lean service operations practice and ran the North American lean manufacturing and service operations practices and the Asia-Pacific operations practice. He has helped numerous Fortune 500 companies drive operational efficiency with lean practices. As founder and CEO of LeanTaaS, a Silicon Valley-based innovator of cloud-based solutions to healthcare’s biggest challenges, Mohan works closely with dozens of leading healthcare institutions including Stanford Health Care, UCHealth, NewYork-Presbyterian, Cleveland Clinic, MD Anderson and more. Mohan holds a B.Tech from IIT Bombay, MS in Computer Science from Georgia Institute of Technology and an MBA from Stanford GSB. He is on the faculty of Continuing Education at Stanford University and UC Berkeley Haas School of Business and has been named by Becker’s Hospital Review as one of the top entrepreneurs innovating in healthcare. For more information on LeanTaaS, please visit http://www.leantaas.com and follow the company on Twitter @LeanTaaS, Facebook at https://www.facebook.com/LeanTaaS and LinkedIn at https://www.linkedin.com/company/leantaas.

Top Five Challenges of Healthcare Cloud Deployments and How to Solve Them

Posted on October 2, 2017 I Written By

The following is a guest blog post by Chad Kissinger, Founder of OnRamp.

According to the HIMSS 2016 Survey, 84 percent of providers are currently using a cloud service, showing security and compliance issues are not preventing organizations from deploying cloud environments. Despite growing adoption rates, breaches and security incidents continue to rise. Cloud deployments and ongoing environment management errors are to blame. 

Cloud services offer clear benefits—performance, cost savings, and scalability to name a few—so it’s no wonder healthcare organizations, like yours, are eager to take advantage of all that the cloud has to offer. Unfortunately, vulnerabilities are often introduced to your network when you adopt new technology. Let’s discuss how to identify and overcome common challenges in secure, compliant cloud deployments so you can opportunistically adopt cloud-based solutions while remaining on the right side of the law.

1. Ambiguous Delegation of Responsibilities
When technology is new to an organization, the responsibility of finding and managing that solution is often unclear. You must determine who owns your data. Is it your IT Department? Or perhaps your Security Department? It’s difficult to coordinate different people across departments, and even more difficult to communicate effectively between your organization and your provider. The delegation of responsibilities between you and your business associate will vary based on your service model—i.e. software as a service, infrastructure as a service, etc.

To prevent these issues, audit operational and business processes to determine the people, roles, and responsibilities for your team internally. Repeat the process for those services you will outsource to your cloud provider. Your business associate agreement should note the details of each party’s responsibilities, avoiding ambiguity and gaps in security or compliance. Look for provider credentials verified by third-party entities that demonstrate security levels at the data center level, such as HITRUST CSF and SSAE 16 SOC 2 Type 2 and SOC3.

2.    Lack of Policies, Standards, and Security Practices
If your organization doesn’t have a solid foundation of policies, standards, and security practices, you will likely experience one or more of the security-related issues outlined below. It’s necessary to not only create policies, but also ensure your organization is able to enforce them consistently.

  • Shadow IT. According to a recent HyTrust Cloud Survey of 51 organizations, 40% of cloud services are commissioned without IT input.
  • Cloud Portability and Mobility. Mitigating risks among many endpoints, from wearables to smart beds, becomes more difficult as you add more end points.
  • Privileged User Access. Divide your user access by work role and limit access to mitigate malicious insider attacks.
  • Ongoing Staff Education and Training. Your team needs to be properly trained in best practices and understand the role that they play in cybersecurity.

Proper security and compliance also involves the processes that safeguard your data and the documentation that proves your efforts. Such processes include auditing operational and business processes, managing people, roles and identities, ensuring proper protection of data and information, assessing the security provisions for cloud applications, and data decommissioning.

Communicate your security and compliance policies to your cloud provider to ensure their end of the operations falls in line with your overall plan.

3. Protecting Data and Meeting HIPAA Controls
The HIPAA Privacy Rule, the HIPAA Security Rule, and HITECH all aim to secure your electronic protected health information (ePHI) and establish the national standards. Your concern is maintaining the confidentiality, availability, and integrity of sensitive data. In practice, this includes:

  • Technology
  • Safeguards (Physical & Administrative)
  • Process
  • People
  • Business Associates & Support
  • Auditable Compliance

Network solution experts recognize HIPAA compliant data must be secure, but also needs to be readily available to users and retain integrity across platforms. Using experienced cloud solution providers will bridge the gap between HIPAA requirements, patient administration, and the benefit of technology to treat healthcare clients and facilitate care.

Seek the right technology and implement controls that are both “required and addressed” within HIPAA’s regulations. When it comes to security, you can never be too prepared. Here are some of the measures you’ll want to implement:

  • Data encryption in transit and at rest
  • Firewalls
  • Multi-factor Authentication
  • Cloud Encryption Key Management
  • Audit logs showing access to ePHI
  • Vulnerability scanning, intrusion detection/prevention
  • Hardware and OS patching
  • Security Audits
  • Contingency Planning—regular data backup and disaster recovery plan

The number one mistake organizations make in protected data in a cloud deployment is insufficient encryption, followed by key management. Encryption must be FIPS 140-2 compliant.

4.    Ensuring Data Availability, Reliability, and Integrity
The key to service reliability and uptime is in your data backups and disaster recovery (DR) efforts. Data backup is not the same as disaster recovery—this is a common misconception. Data backup is part of business continuity planning, but requires much more. There’s a gap between how organizations perceive their track records and the reality of their DR capabilities. The “CloudEndure Survey of 2016” notes that 90% of respondents claim they meet their availability, but only 38% meet their goals consistently, and 22% of the organizations surveyed don’t measure service availability at all. Keep in mind that downtime can result from your cloud provider—and this is out of your control. For instance, the AWS outage earlier this year caused a ruckus after many cloud-based programs stopped functioning.

5.    Ability to Convey Auditable Compliance (Transparency)
Investors, customers, and regulators cannot easily discern that your cloud environment is compliant because it’s not as visible as other solutions, like on-premise hosting. You will have to work closely with your cloud provider to identify how to document your technology, policies, and procedures in order to document your efforts and prove auditable compliance.

Putting It All Together
The cloud provides significant advantages, but transitioning into the cloud requires a thorough roadmap with checkpoints for security and compliance along the way. Remember that technology is just the first step in a secure cloud deployment—proper security and compliance also involves the processes that protect your sensitive data and the documentation that proves your compliance efforts. You’ll want to identify resources from IT, security and operations to participate in your cloud deployment process, and choose a cloud provider that’s certified and knowledgeable in the nuances of healthcare cloud deployments.

For more information download the white paper “HOW TO DEPLOY A SECURE, COMPLIANT CLOUD FOR HEALTHCARE.”

About OnRamp

OnRamp is a HITRUST-certified data center services company that specializes in high security and compliant hybrid hosting and is a proud sponsor of Healthcare Scene. Our solutions help organizations meet compliance standards including, HIPAA, PCI, SOX, FISMA and FERPA. As an SSAE 16 SOC 2 Type 2 and SOC 3, PCI-DSS certified, and HIPAA compliant company, OnRamp operates multiple enterprise-class data centers to deploy cloud computing, colocation, and managed services. Visit www.onr.com or call 888.667.2660 to learn more.

Translating Social Determinants of Health Into Clinical Action

Posted on September 25, 2017 I Written By

The following is a guest blog post by Anton Berisha, MD, Senior Director, Clinical Analytics and Innovation, Health Care, LexisNexis Risk Solutions.
The medical community recognizes the importance of social determinants of health (SDOH) – social, economic and environmental conditions in which people are born, grow, live, work and age that impact their health – as significant and direct risk factors for a large number of health care outcomes.

The negative outcomes include stress, mental health and behavioral disorders, alcoholism and substance abuse, to name a few. Negative SDOH worsen a slew of major chronic conditions, from hypertension and Coronary Artery Disease to obesity; they also lead to lower patient engagement and medication adherence while increasing low-intensity ER visits and hospital admissions and readmissions.

In fact, a study shows that medical care determines only 20% of overall health outcomes while social, economic and environmental factors determine about 50% of overall health. The National Quality Forum, Centers for Disease Control and Prevention and World Health Organization have all acknowledged the importance of addressing SDOH in health care.

Not all SDOH are “created equal”

When it comes to SDOH, there is a misconception that all data regarding a person’s lifestyle, environment, situation and behaviors relate to their health. Although there is a myriad of basic demographic data, survey data and other Electronic Health Records (EHR) data available to providers today, much of it has a limited potential for identifying additional health costs and risks.

The key to addressing SDOH is to use current, comprehensive and longitudinal data that can be consistently linked to specific patient populations and provided in a standardized format. One example is attributes derived from public records data such as proximity to relatives, education, income, bankruptcy, addresses and criminal convictions.

Moreover, each SDOH attribute has to be clinically validated against actual healthcare outcomes. Clinically validating attributes is critical to successful predictive analytics because some attributes do not correlate strongly to health outcomes.

For example, while knowing how close an individual’s nearest relative or associate lives to the patient does correlate to health outcomes; knowing how many of those relatives or associates have registered automobiles does not. Even when attributes are clinically validated, different attributes correlate to different outcomes with different accuracy strengths.

Translating SDOH into actionable intelligence

After SDOH have been correlated to healthcare outcomes, providers have two implementation options. One is to use relevant individual SDOH attributes per outcome in clinical and analytic models to better assess and predict risk for patients. Another is to use SDOH as part of risk scores estimating specific healthcare risks; for e.g., to estimate an individual’s total health care risk over the next 12 months based on cost; a 30-day readmission risk; or a patient engagement score.

Risk estimation can be done either in combination with other types of legacy healthcare data, such as claims, prescription and EHR data or with SDOH alone, in the absence of medical claims.

Recently, a client of LexisNexis® Health Care did an independent study to evaluate the impact and usefulness of Socioeconomic Health Score (SEHS) in risk assessment for several key chronic conditions, when no other data are available. Findings proved that the top decile of SEHS captures significantly more members with given conditions than the bottom decile. The study concluded that the difference was important and very helpful in estimating risks in a newly acquired population without legacy healthcare data.

Integrating SDOH into clinical workflows and care recommendations

Validated SDOH can be presented in a form of risk drivers or reason codes directing the clinician toward the most important factors influencing a given negative outcome for each patient: income, education, housing or criminal records.

The risk drivers and reason codes can then be integrated into workflows within the clinician’s IT systems, such as the EHR or care and case management, in the form of an easy-to-understand presentation. It could be a data alert that is customizable to patients, treatments and conditions, helping the provider make score-based decisions with greater accuracy and confidence. At this point, the SDOH information becomes actionable because it has the following characteristics:

  • It is based on hard facts on every individual.
  • It is based on correlation and statistical significance testing of large pools of patients with similar behavior.
  • It provides clear and understandable reason codes driving the negative outcomes.
  • It can be tied to intervention strategies (outlined below) that have demonstrated positive results.

Clinicians empowered with actionable SDOH information can modify their interventions and follow-up strategies accordingly. Based on resources at hand, patients living in negative SDOH could be either properly managed by clinicians themselves or other medical staff, social workers and newly created roles such as health coaches. Sub-populations at risk could benefit from access to community resources to get help with housing (permanent supportive housing for homeless), transportation, education, childcare and employment assistance.

Moreover, SDOH are particularly effective in helping providers develop a population health management strategy fueled by prioritized tactics for preventive care. Tactics can range from promotion of healthy food to free screening services. For patients with chronic diseases (who can typically be managed appropriately when they adhere to therapy and healthy lifestyle choices), SDOH-informed interventions can help keep them under control and potentially reduce severity. For patients recently released from the hospital, aftercare counseling could prevent complications and readmissions.

To sum it up

Socioeconomic data is a vital force for healthcare risk prediction as it provides a view into the otherwise hidden risks that cannot be identified through traditional data sources. When SDOH are clinically validated and correlated to healthcare outcomes, they help providers better understand an individual’s risk level and address it through appropriate intervention strategies.

Create Happier Healthcare Staff in 3 Easy Steps

Posted on September 14, 2017 I Written By

The following is a guest blog post by Chelsea Kimbrough from Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms
Chelsea Kimbrough
Creating excellent patient experiences is the focus of nearly every healthcare organization. To do this, providers are increasingly turning to new patient engagement tools and technologies. It’s important to note, however, that patient experience woes cannot be mended with technology alone. The healthcare professionals facilitating communications and care will always play an integral role in patients’ overall satisfaction and loyalty.

Unfortunately, those providing in-person care are often distracted from important patient-facing responsibilities by front office tasks. Thankfully, many modern engagement tools are able to create more seamless operational workflows for healthcare professionals in tandem with enhanced patient experiences. But with the market growing increasingly competitive, it’s important to pick the tools and technologies that best serves both populations.

Outlined below are three steps healthcare organizations can take to create a more enjoyable workplace for their staff and what key capabilities are necessary to ensure the greatest ROI.

  1. Lessen the number of phone calls
    If the phone isn’t demanding attention, healthcare professionals are better able to focus their talent and effort on the patients and people in more immediate need of their expertise. This ability drives better health outcomes, operational efficiencies, and patient experiences.

    Telephone answering solutions and technology help achieve these results. However, it’s important whoever is answering your phones is prepared to handle any question, task, language, or call volume. Unfortunately, many internally-run call answering solutions are unable to swiftly manage fluctuating call volumes. By partnering with a third-party telephone answering service, healthcare organizations can ensure every call is met with exceptional care.

    When searching for a call center solution, healthcare organization should seek:

    • Flexible call answering solutions
    • Multilingual live agent support
    • Control over call flow & scripting
    • Proven experience & expertise
  1. Automate appointment reminders
    Patients crave convenient experiences – and so do healthcare professionals. Automating informational messages to patients, such as appointment reminders, population health notifications, and relevant event announcements, removes part of this communication responsibility from staff, directly enabling them to focus on in-person care.

    It’s important, however, that this particular service is able to integrate with the health systems’ EHR or EMR. This ability enables the health system to target a patient’s contact method of choice when sending automated messages, seamlessly enhancing their experience. And by communicating every interaction with the health system, staff members are kept informed and prepared to meet patients’ needs should they choose to reach out.

    When searching for a messaging solution, healthcare organization should seek:

    • Email, voice, and text messaging capabilities
    • Patient-specific customization
    • Easy message deployment
    • EHR/EMR connectivity
  1. Optimize patient scheduling
    Patients of all ages can benefit from a smoother appointment scheduling processes – and for many patients, online scheduling is the answer. By eliminating the need for a timely phone call, online scheduling better fits into the digitally-driven lives of today’s patients.  And when implemented properly, online scheduling can directly benefit both telephone answering and automated messaging, too.

    Because scheduling an appointment should be a pain-free process, healthcare organizations should simplify it by sending an automated reminder with a unique, secure link to digitally schedule an appointment from their phone, laptop, or other internet connected device. By choosing a tool that automatically communicates this information with the health system’s EHR, patients can call about their appointment and receive consistently accurate information no matter what healthcare employee answers the phone. What’s more, this particular patient engagement tool lessens the appointment scheduling burdening from staff, enabling them to provide better in-person care.

    When searching for an appointment scheduling solution, healthcare organization should seek:

    • Intuitive, user-friendly tools
    • Accurate appointment availability
    • Easy message deployment
    • EHR/EMR connectivity

When the right communication tools and technologies are implemented, entire healthcare organizations thrive. With the above three strategies and the technologies associated with them in place, healthcare professionals can better focus on patients with the reassurance their phones are answered by trained professionals, important messages are promptly delivered, and schedules are being filled.

Healthcare organizations that implement communication tools and technologies that benefit both patients and staff are better positioned to have happier, more satisfied team members. And with a happier staff tending to patients’ healthcare needs, organizations can better safeguard patient loyalty for years to come.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services. Connect with Stericycle Communication Solutions on social media: @StericycleComms

Better Tech is Here for Healthcare

Posted on September 13, 2017 I Written By

The following is a guest blog by Brandt Welker, CTO at MedicaSoft. This is the second blog in a three-part sponsored blog post series focused on new HIT for integration. Each month, a different MedicaSoft expert will share insights on new and innovative technology and its applications in healthcare.

What are some of the common complaints doctors and nurses have about their EHRs?

“I have to click too much.” “Information is buried.” “It doesn’t follow my workflow.” “It’s slow.”

“I feel like a data entry clerk.” “*insert your favorite gripe here*” There is no shortage of commentary on the issues irking clinicians when it comes to technology. What there is a shortage of are ideas to fix it.

Better technology is out there serving other industries … and it can be applied in healthcare. Technology should ease administrative loads and put clinicians back in front of patients! I’ve talked about some of this previously and how we keep clinicians involved in our design process. When it came to building an entirely new EHR, the driving force behind our team researching and adopting new technologies was to imagine a clean slate.

Most of our team came from backgrounds with the Department of Veterans’ Affairs (VA’s) world of VistA. We learned a lot about legacy systems over the years – both beloved and maligned – and asked ourselves what a system would look like if it was unencumbered by the past. How would that system look? What could that system be? What technology choices should we make to simplify things? How could it play nicely with other systems and encourage true interoperability? How could it support users’ clinical workflow?

From the beginning, we decided that the most important thing was to get the platform right. Build the platform and build it right and things will work together. Build it to play nicely with other technology and interoperate. Make it fast. Make it easy. Make it open. Make it affordable. All of these needs were a part of our system “wish list.”

So, how’d we do it? We researched technology working in other fields and also elected to use HL7® FHIR® to its fullest extent. By now, you’ve probably heard a lot about the HL7® FHIR® standard. Many companies are using HL7® FHIR® to build APIs that are doing amazing things across the industry. We decided to use the HL7® FHIR® document data model as the basis of our platform – it simplifies implementation without sacrificing information integrity. We coupled it with a very powerful database and search engine – Couchbase & Elasticsearch. These are two high-performance tools used across industries. When you need a whole lot of data to move fast, you use Couchbase and Elasticsearch.

Couchbase is our NoSQL database. Couchbase is open-source and optimized for interactive applications. It provides low-latency data management (read: lots of data very quickly) for large-scale applications (like an EHR!). It lets us store records as documents and it’s really good at data replication. You might recognize Couchbase  — many other industry giants such as ebay, LinkedIn, and Verizon use it. It is an open-source database optimized for interactive applications. We selected Elasticsearch as our search engine. Some of your favorite sites and services use Elasticsearch – Netflix, Facebook, LinkedIn, and Wal-Mart, to name a few.

On top of Couchbase and Elasticsearch are FHIR APIs. These interactions are managed by type. We also use a Parser/Assembler Service that lets us combine, rearrange, and augment documents. Data is placed in the proper JSON format to be sent through the FHIR API into Couchbase. Our Community Health Record sits on top of this and everything described here is a part of our open platform – the one we built from scratch and architected to be interoperable and easy. Pretty neat, huh?

Once you have the platform, you can build all kinds of things to sit on top of it. The sky is the limit! In our case, we have a Personal Health Record and an Electronic Health Record, but we built it this way so you can use a wide range of technologies with the platform – things like Alerts or Analytics or Population Health or Third Party Applications, even custom built items that folks may have developed in-house will work with the platform. Essentially, using the platform means we can integrate with whatever you already have in place. Maybe you have an EHR with some issues, but you don’t have the time or budget allotted for another huge EHR implementation. No problem – we can help you view your data with a modern interface – without having to buy a whole other EHR. Revolutionary!

There are several other technology choices we made along the way, too – Node.js, NGINX, Angular.js are a few more. Angular.js allows us to be speedy in our development process. We can develop and build features quickly and get changes in front of clinicians for their feedback, which results in less time between product builds and releases. It means folks don’t have to wait months and months for changes they want. Angular is also web-based, which means user interfaces are modern and just like the interfaces everybody uses in their day-to-day lives. Angular.js was created by Google and there are many large companies you’ll recognize who use it to develop – PayPal, Netflix, LEGO, YouTube, to name a few.

I believe healthcare is lagging in adopting new technologies and there are a lot of excuses around why user interfaces in healthcare are generally horrible – they range from the software being written before Web 2.0 to users accepting that it is how it is and finding a way to work around their technology. The latter is probably the saddest thing I see happening in hospitals and clinics. Tech is there to make work easier, not more complicated.

There was a great quote from Dale Sanders, Executive Vice President of Product Development at Health Catalyst in MedCity News last week:

“Every C-level in healthcare has to be a bit of a technologist right now,” he said. “They need to understand this world. If you’re not aware of technology, it puts you … at a strategic disadvantage.”

I can’t emphasize how true this statement is. If you’re not paying attention to where technology is going, you’re not paying attention to where healthcare is going and you’re going to get left behind.

About Brandt Welker
Brandt is a HIT architecture and software expert. He calls Reading, Pennsylvania home. He has architected software systems and managed large IT and innovations programs at the U.S. Department of Veterans Affairs (VA) and the National Aeronautics and Space Administration (NASA). He’s also trained astronauts at the Neutral Buoyancy Lab. He’s currently the Chief Technology Officer at MedicaSoft. Brandt can be found on LinkedIn.

About MedicaSoft
MedicaSoft designs, develops, delivers, and maintains EHR, PHR, and UHR software solutions and HISP services for healthcare providers and patients around the world. For more information, visit www.medicasoft.us or connect with us on Twitter @MedicaSoftLLC, Facebook, or LinkedIn.

Why Do We Settle in Healthcare?

Posted on August 22, 2017 I Written By

The following is a guest blog post by Monica Stout, Marketing Director at MedicaSoft. This is the introductory blog in a three-part sponsored blog post series focused on new Health IT for integration. Each month, a different MedicaSoft expert will share insights on new and innovative technology and its applications in healthcare.

Imagine your typical Friday night. You’ve worked hard all week and now you’re ready to watch Netflix. You’ve picked the perfect movie. You’re ready to watch. You hit a button and your movie is right there, available and on demand. But what if it didn’t work? You’d be annoyed. You’d hop on social media to complain or see if Netflix is down. Someone somewhere would hear you.

On Black Friday or Cyber Monday, you might visit Walmart.com to search for some holiday deals. These are the busiest shopping days of the year. What if the website didn’t work? Or, what if you had to enter your shipping and billing data every single time you viewed an item? You’d be outraged. You might hop on social media to complain or see if others are experiencing the same problem. Someone somewhere would hear you.

Now imagine it’s the middle of winter and you’ve caught the latest bug du jour. You call your doctor for an appointment. When you arrive, you’re handed a clipboard and asked to fill out the same repetitive paper form with your health information that you fill out every time you visit. You’re certain they have this information already, but you’re required to fill it out yet again. You might wait 30, 40, or 60 minutes past your appointment time before you’re called back to a room.

Once you’ve made it to an exam room, a nurse comes in to take your vitals. The nurse will ask questions about what medications you are on. Nine times out of ten, the medications the nurse repeats back to you are outdated or entirely incorrect. You wonder where that data came from and are sure you’ve told this particular office the same thing the last four times you’ve gone there, so why is it wrong? Again, you wait in the exam room for the doctor. Your doctor comes in and spends more time looking at a laptop screen and clicking than making eye contact with you. Do you hop on social media and complain? Probably not. Does anybody hear you? No, because you’ve accepted that this is just how it is. In fact, you were grateful to receive a same-day appointment instead of waiting at home in misery.

The technology exists today to make things work and work fast. Other industries have intuitive UIs that people use every single day – we use them so much we don’t think about them. So, why do we settle for what doesn’t work in healthcare? Why do we accept a system that isn’t operating in ways that are beneficial or efficient to us as patients or to our doctors or nurses? Shouldn’t health information technology and the systems that support our health, well-being, and in certain situations, life or death, work more efficiently than our television subscription services or retail websites? Technology can do better in healthcare.

The technology on the back-end of Wal-Mart’s servers was robust enough to handle Black Friday and deploy with over 200 million users online THREE YEARS AGO. Amazing, right? But it’s that way because people won’t accept something that doesn’t work. If Wal-Mart’s website wasn’t available come Cyber Monday, consumers would vote with their dollars and move on to another retailer’s website that did work. That retailer would get all the business. Yet in healthcare, we keep revisiting a system that’s broken – where our health records are disjointed, incomplete, exist in duplicate (or many, many more), and just don’t work well together across practices, hospitals, or health systems. We don’t have a one centralized record with our health information serving as our source of truth. Sharing data across our providers is broken.

I realize that healthcare is more complicated than simply voting with our dollars and moving on, but why is that? The Wharton School Economics Professor Eric K. Clemons wrote a great piece on why healthcare is complicated. The technology is there to help advance healthcare to be what humans need it to be, so when will we stop accepting less? When will we demand more?

There is technology that’s easy to use and access, makes your information available, and centralizes your health information into one record. In our subsequent guest blogs, our experts will talk in more detail about these best of breed technologies and how they can be applied to healthcare to capture, exchange, and share data.

About Monica Stout
Monica is a HIT teleworker in Grand Rapids, Michigan by way of Washington, D.C., who has consulted at several government agencies, including the National Aeronautics Space Administration (NASA) and the U.S. Department of Veterans Affairs (VA). She’s currently the Marketing Director at MedicaSoft. Monica can be found on Twitter @MI_turnaround or LinkedIn.

About MedicaSoft
MedicaSoft  designs, develops, delivers, and maintains EHR, PHR, and UHR software solutions and HISP services for healthcare providers and patients around the world. For more information, visit www.medicasoft.us or connect with us on Twitter @MedicaSoftLLC, Facebook, or LinkedIn.

Assembling The Right Stuff: The Keys to Gathering and Supporting A Successful EHR Go-Live Support Team

Posted on August 16, 2017 I Written By

The following is a guest blog post by Jaime Jaimes, Instructional Writer at Conduent, Breakaway Learning Solutions). Check out all of the blog posts in the Breakaway Thinking series.

For just a moment, put yourself in the shoes of a provider who needs to work with a new EHR. You’ve known that the EHR go-live event was impending, and now it’s here. You took the training, slipped a little job aid booklet in your pocket, and think you’ve got everything under control. But once you’re on the floor, you hit a sudden roadblock. Rifling through your packet in hopes of finding an answer could waste valuable time. What you really need is a friendly face to calmly talk you through that first hurdle and get you back on track.

This scenario is the reason that some physicians are identifying at-the-elbow support as a vital part of successful EHR implementation. A confident support team can create a calm and stable environment for your staff as they learn the ins and outs of their new system. But structuring your support strategy is easier said than done. Fortunately, I was able to sit down and discuss some key go-live support elements with two of Breakaway’s client services managers: Adam Koch and Meredith Wheelock.  Between them, they’ve overseen countless go-live events for hospitals and ambulatory locations alike, and they have three key pointers for any team planning a new EHR implementation or update.

Start assembling your support team early

Creating a support team is a daunting prospect. In our experience, at least a 1:3 support-to-learner ratio is the ideal level of staff training needed for a go live, a number backed up by online research journal Perspectives in Health Management. Beginning your search for the right people early on gives you the time to vet potential team members, and ensure they have the necessary certifications and experience specific to your go live. While you can get a team together in a month, we recommend starting the process two months or more before the event so that you can identify the right people and make sure they are prepared.

This may seem like a lot of time to invest, but having this at-the-elbow support can actually save you time at go live. A support team member can resolve questions and frustrating issues quickly, which in turn allows your staff to return to their other duties. Plus, the fact that the question was resolved in-the-moment, and in the environment in which your staff will likely face the issue again, increases the probability of knowledge retention and improves their confidence in using the system.

Get everyone on the same page

Even though you’re assembling a team of experts familiar with your EHR, you still need to make sure they’re all following the same workflows. This ensures your support team won’t teach different workflows to different departments or locations. Learning your best practices also means there won’t be a conflict between pre-go-live training and at-the-elbow assistance. After all, your staff expects help when they approach a support team member. If they get advice that contradicts their training, they will walk away feeling even more confused and frustrated, hindering their adoption progress. As this EHR Intelligence article notes, “Critical to the project’s success is supporting physician EHR users the right way at the right time.” Taking the time to teach your support team best practices is the easiest way to make sure you’re supporting your team the right way.

Establish lines of communication

A go-live event is a big endeavor, and even the best support team will encounter a quirk in the system they haven’t seen before. It’s at these times where having a defined path to escalate problems and share the solutions you generate will keep your EHR’s implementation on track. For those first few weeks, a daily touchpoint meeting with your support teams and site super-users can prove invaluable, as it allows everyone to identify pain points, troubleshoot issues, and come away with one clearly identified solution. Having this coordinated effort and standard way of communicating is critical for organizations large and small, and helps guarantee that even when a larger problem arises, your team doesn’t grind to a halt as you try to figure out the solution.

Your at-the-elbow support team is just one part of the successful go-live puzzle, but it’s a piece that can mean the difference between a frustrated staff and one that’s confident that this new EHR is just another part of their day.

Conduent is a sponsor of the Breakaway Thinking series of blog posts. Breakaway Learning Solutions is a leader in EHR and Health IT training. Download their Free Whitepaper “Leadership Insights: Gaining Value from Technology Investments.”

Patients Want Customizations – Just Not Too Much!

Posted on August 10, 2017 I Written By

The following is a guest blog post by Cristina Dafonte, Marketing Associate of Stericycle Communication Solutions as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter:@StericycleComms
cristina-dafonteEverything around us is customizable: your laptop background, the layout of applications on your phone, any product dashboard you have access to. Customization sells, and consumers crave it. Consumers love to think that something is unique or special for just them, even if they know in their hearts that isn’t the case.

Patient engagement, especially appointment reminders, shouldn’t be the exception to the rule. We’ve far surpassed the days of the robo-dialer letting you know your doctor’s office was calling. Today, patients look for custom communications.

There are two ends of the spectrum that I have seen with customization of appointment reminders. The first is no customization at all.

Example: My dentist sends an email that is “Please click to confirm your appointment. We look forward to seeing you!” And includes a large CONFIRM button.

This message leaves me wondering a few things: when is my appointment? Which dentist am I seeing? What if I need to reschedule? What kind of appointment did I schedule? The message wasn’t personalized to my appointment or to me.

The second end of the spectrum is too much customization. I didn’t know it was possible to personalize a message too much until I received the following text message from my eye doctor:

(1/2) Hi Cristina, your contacts are ready for pick up. Please stop by the office at your earliest convenience to get them. Our office hours are 7-3pm on the first Monday of every month, 8-4pm every

(2/2) other Tuesday, and 8-6pm on the second Thursday of every month, and 7-12pm on Friday. Thank you for choosing [my eye doctor].

The first time I received that text message, I read it at least 3 times, trying to figure out what the office hours were for the day I needed to go get my contacts! That, my friends, is a reminder with too much customization.

Fortunately, the team at Stericycle Communication Solutions has figured out just the right amount of customization. Our patient communications are built on 4 pillars:

  1. Arrive: what needs to be done when the patient arrives
  2. Bring: what they need to bring for the appointment
  3. Prep: if there is any pre-appointment prep work that needs to be completed
  4. Do: any specific instructions for the patient’s arrival.

These best practices ensure that the patient feels the communication is specifically for them and that they have enough information to confidently and comfortably arrive at the office – without feeling bombarded with facts or instructions.

Want to learn more about Stericycle Communication Solutions’ patient engagement customizations? Download our FREE overview “Customizing Your Patient Engagement.”

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media: @StericycleComms