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A Caregiver’s Perspective on Patient Engagement

Posted on August 20, 2018 I Written By

The following is a guest blog post by Michael Archuleta, Founder and CEO of ArcSYS, where he shares his experience as a caregiver for his father trying to navigate the healthcare system.

My dad is 99 years old. Having moved him to Utah 6 months ago into a retirement home, our first step was to get an appointment with a new primary care physician. I brought along a list of his medications and watched the nurse tediously look up and enter each into the EHR. Dad and the doctor got along great on that first visit. She assured us that she could help manage his medications. There was nothing realistically that could be done to really improve quality of life. When you’re 99, you’re stuck.

Around the middle of March Dad noticed blood and clots in his urine. Off to the primary care provider we went. They took a sample of urine, tested it, and there was no sign of an infection. Maybe we should look up a specialist in urology. A referral was given and a few days later the urology practice contacted us to make an appointment. Dad declined.

He didn’t want to see another doctor. Period. But day by day, the blood was always present in the urine. He started to worry and finally relented to going to the urologist. Off to the new doctor. Oh, yes, I brought along the list of medications and watched another nurse go to the process of keying them in.

The next day, I got an email via Updox saying there was a message from Dad’s doctor. Updox?? Really?? That was pretty cool. After being on the front end where our EMR system (Red Planet) uploads everything, this was interesting to see how another EMR system was employing Updox. Sure enough, there was the urologist’s note that had been completed 3 hours after the appointment. But, as I read it, I couldn’t help feel a little disappointed. A boilerplate. Since I had been in the room, I knew what was asked. Some questions were never asked and obviously inferred. Maybe a minor point, but I knew it. Anyway, the recommendation was to get an ultrasound. Off to another provider!

Within one day another message alert came from Updox. On logging into the Updox account, there was the report from radiology. Good news, nothing out of the ordinary.

A week passed and it was back to the urologist for a cystoscopy. I was in the room with Dad while the doctor performed the procedure. “Want to see this tumor?” the doctor asked me. “Sure.” I replied. Through the scope I could see a dark mass on the wall of the bladder. The recommendation was to perform surgery to remove the mass and biopsy it.

Another alert came through within a day via Updox. Still the same boilerplate style with default answers. Oh well, if nothing else it was timely.

On May 21 the procedure was done at an outpatient surgical facility. This time I was lucky: No one had to enter the list of medications. From here, unfortunately, things started to go downhill. Dad was left with a catheter and a bag which became his (our) buddy for 10 days. The unfortunate thing was being confined to his room. He could (would) not walk to the dining room at the retirement facility for his meals. So the meals were brought to him each day in a white clam shell styrofoam container. One piece of good news was delivered via Updox, the biopsy was benign.

Once the catheter was removed, he could be mobile, but was too weak to walk. He languished in his room. I coaxed him to try walking. No result. Others in my family encouraged him with the same non-result. I finally took him back to the primary care doctor. One look at him, and she noticed that the spark of life had been extinguished. She took me aside and asked if she needed to play hard ball with him. “You bet” was my response. In a firm way she told Dad that if he didn’t start walking he was going to be dead in 3 months.

That was the trick. Dad was furious that a doctor would be so “unprofessional” as to say anything like that. As soon as we arrived at the retirement home he pushed his walker half way down the hallway just to prove he could walk just fine, thank you. (Mission accomplished.)

But when you’re 99, the body just doesn’t really get better. There was still blood and clots, but were told that would be expected. A couple of weeks later he calls me to say he was in excruciating pain and can’t pee. By the time I arrive the pain was so bad I need to get a hold of the paramedics. They show up in 5 minutes and whisk him to the ER.

Fortunately, the ER has his list of medications so I’m spared having to go through that process. The doctor on call briefly examined him and turned control over to the nurse. A few hours later we have our “friends” the catheter and bag and head home. At least he was committed to walking to the dining room.

A couple of weeks pass and I received a phone call from the paramedics who inform me that Dad had a fall on his way to breakfast. They are transporting him to the ER. He was diagnosed at the ER with a bladder infection and they are concerned about his cardiac functions. Lab results also indicate e. coli and sepsis. Since they don’t have an on-site cardiologist, he was transferred to another hospital and admitted. And, yes, we have to go through the whole list of medications there because they don’t have access to that information? Go figure.

He hated the hospital. There was no rest. Every hour someone was taking vitals, getting him up, doing this, doing that. He was desperate for sleep and rest. At discharge, the cardiologist gave me explicit verbal instructions to take him off his Furosemide. She also gave orders for home nursing and physical therapy.

Whew. He was back home but again too weak to walk to the dining room. The Updox report came through and the written instructions by the cardiologist tell him to continue all meds including Furosemide. Really? Did she forget what she told me. Did she not take her own notes? The nurse showed up at his apartment, took lots of notes, asked lots of questions and examined him. Hmm. Concerned about the swelling in his feet and ankles. It was bad. We confer and decided the Furosemide needed to be restarted. The nurse reached out to the PCP who concurred.

Over the next 3 weeks the swelling slowly receded. The nurse and physical therapist helped him but the improvement was ever so slow.

What I have experienced was a medical world of silos. Each health care provider focused on just what they do. The urologist was pleased with surgery and how well it turned out. But he didn’t have to deal with 3 months of bags, styrofoam meals, ER visits, depression and hospitalizations. None of the doctors conferred with each other about the best treatment. The number of times I filled out past medical histories was finger-numbing. The written documentation didn’t accurately match what took place or what was verbally instructed. The cardiologist was adamant about the meds which would be best for his heart. Within each silo the people were very kind, compassionate, caring and professional. But, the EHR systems just seemed to get in the way of real care. Yes, INDIVIDUALLY, everything was working, but PEOPLE and their SYSTEMS were not interacting to solve the problem.

On the up-side, not one out-of-pocket penny was spent by way of the Medicare Advantage plan. Insurance and billing performed flawlessly. A little over $65,000 was billed and $12,000 was paid.

Clearly, providing health care is not easy. Maybe things should have been done differently. This was a relatively simple issue, but there was no clear direction. Will any healthcare administrator ever be aware of this situation? Probably not. Will any insurance company ever study this case? Doubtful. In hindsight, it would have been just as easy for me to pass out copies of medications and histories and have people tape them to the wall. A few phone calls between providers would certainly have come up with a better solution. But here we are down the road and Dad is not a happy camper.

Is anybody listening?

Top 5 Ways to Create a Stellar Patient Experience

Posted on August 13, 2018 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

Patient experience has always been something healthcare delivery organizations should strive to improve. However, in the past couple of years, patient experience has received a necessary focus as health consumers are presented with more choice, transparency, and data to navigate their healthcare journey. But with so many choices available, what can health providers do to drive loyalty?

I recently had to schedule a visit for my annual mammogram, a much dreaded experience for most women. I’m lucky to have many imaging options around me, making it easy to get in on a day that was convenient for me. However, the choice was very simple after the exemplary experience I received last year. One facility in particular made me into a loyal patient, and they did so in five key ways.

1. Convenience of access: Consumer-centric businesses like Amazon and Starbucks have made it so seamless and easy to get what you need from them when you need it, that it makes waiting in healthcare more painful than it used to be. Now, we expect to handle business transactions on our own terms and to receive immediate results. Even Amazon Prime’s two-day shipping wasn’t enough for us, and now we have Amazon Now. When it was time to schedule with the facility, it was simple to connect and get care when convenient for me. They offer online scheduling, which enabled me to browse open appointments and choose an option that fit my busy schedule. They have a phone number as well if you prefer to schedule that way, but I prefer doing most business transaction from my phone.

2. Patient-first in clinic experience: Everything at the facility was set up to make something no woman really wants to do, an enjoyable experience. I was greeted with a warm smile when I walked in and promptly taken back to the changing rooms. Their rooms are finely decorated with warm lighting and comfortable dressing rooms. I never sat idle for more than 10 minutes. They have even taken the extra step to provide lockers for your personal belongings with the names of famous amazing women so you can remember where your belongings are. I chose to be Eleanor Roosevelt one year, and Jane Austin this year.

3. Putting data in the patients’ hands: Both times I have been in for a screening, I receive my secure results within 24 to 48 hours and they send the results to both my OB/Gyn and my primary care provider. Armed with information contained in my profile, I can choose to have a more in depth conversation with my care providers regarding the risks and results, or I can keep them and compare year after year. Knowledge and education are the first two steps in patients having the ability to manage their health.

4. Proactive engagement in care: Patients can be very forgetful (especially when managing the care of four additional family members). If there is something I need to do in order to take better care of myself, it’s better to be proactive and ping me instead of assuming I’ve got it covered. This facility let me know several months in advance that it was time to reschedule. I knew the exact date I was eligible per my insurance, so it made it easy to take the best step to keep on top of my health.

5. Ease of doing business: No one wants to spend hours filling out paper forms. When looking for a repeat appointment for this year, I saw that there was a clinic closer to my office. I arrived a few minutes early to fill out the insurance forms since I scheduled online and there was no place for me to put the card information. When I walked in and gave my name at sign in, they had everything: my address, insurance, birthdate, records from the last visit at a different facility. This is imperative for healthcare organizations to prioritize as mergers and acquisitions mean multiple EHRs, billing systems, and contact centers. The experience and ease of doing business with your team before and after care will affect patient loyalty. Make it easier to do the small things, and watch your patient satisfaction increase.

The facility has gone to great lengths to ensure their patient experience is above par and their efforts have definitely paid off. And they will have my loyalty for it as long as they serve my area. Their mission states:

“Our promise is to provide an exceptional experience, exceptionally accurate results, and Peace of Mind to everyone we serve. Our purpose is to be the National Leader in Mammography and imaging services, helping patients achieve and maintain optimal health.”

What is your promise to your patients? Is your number one to provide an exceptional experience? Are you meeting the above five areas of the patient experience beyond the clinical face to face interaction? What are some additional ways you ensure the best experiences for everyone in your care?

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

Regulatory Heat: Is Your BAA House in Order?

Posted on August 9, 2018 I Written By

The following is a guest blog post by Greg Waldstreicher, Founder and CEO of PHIflow.

Actions by the Office for Civil Rights (OCR) have clearly demonstrated stricter enforcement of HIPAA rules in recent years, specifically upping the ante on compliance with business associate agreements (BAAs). Much of this activity can be attributed to a grim outlook on security risks: globally, 70% of healthcare organizations have suffered a data breach, and a recent Ponemon Institute report found that the vast majority have experienced multiple security incidents involving protected health information (PHI).

BAAs play an important role in security as the framework by which an organization ensures that any vendor creating, receiving, maintaining or transmitting PHI complies with HIPAA. In recent years, these contracts have come under increased scrutiny amid high-level audits launched by OCR. Mismanagement of BAAs have thus far resulted in penalties ranging from $31,000 for simply not having a BAA in place to upwards of $5.5 million for more serious offenses.

While the stakes are high, healthcare organizations often lack effective oversight strategies for these important patient protection tools. In fact, it’s not uncommon for even the most basic information to elude the executive suite such as:

  • the number of BAAs that exist across an enterprise
  • where BAAs are located
  • the terms of each BAA

In an industry that has witnessed a significant uptick in security incidents and breaches in recent years, this current state of affairs is less than optimal. In truth, the reach of recent audit activity is still an unknown as the healthcare industry awaits full disclosure and recommendations from OCR. One of the latest OCR settlements —$3.5 million levied against Fresenuis Medical Care North America—resulted from multiple incidents that occurred in 2012, underscoring the lengthy timeframe associated with finalizing investigations and legal processes.

All told, current trends point to the need for better oversight and management of BAAs. While penalty activity subsided some in recent months as OCR went through internal transitions, industry legal experts expect that investigative momentum will continue to increase in proportion to heightened security risks across the healthcare landscape.

Unfortunately, healthcare organizations face notable roadblocks to getting their BAA house in order. Amid competing priorities, many simply lack the resources for tracking these agreements. Health systems are increasingly multi-faceted, and current trends associated with mergers, acquisitions and consolidations only exacerbate the challenge. The reality is that some large organizations have as many as 10,000 BAAs across the enterprise. Because these agreements are typically spread across multiple departments and facilities and have a multitude of different owners, managing them in a strategic way via manual processes is nearly impossible.

In tandem with the internal resource challenge, the language contained in BAAs has become significantly more complicated due to not only a fluid and evolving regulatory environment, but also the vital role they play in an overall security strategy. While a simple, cookie-cutter approach to these agreements was fitting a decade ago, BAAs are now intensely negotiated between covered entities and business associates and between business associates and sub-business associates, often involving HIPAA attorneys and resulting in requirements that go beyond HIPAA and HITECH. Subsequently, the terms of each BAA across an organization may vary, making efficient and effective management extremely difficult.

The good news is that there is a relatively simple solution—automated management of BAAs. The right technological framework can lay the foundation for timely access to all contracts across an enterprise, improving compliance and ensuring readiness for audits or breach response. Once consolidated, artificial intelligence can then be applied to BAAs to draw actionable insights in near real-time, informing key personnel of the key terms across all agreements.

The healthcare industry at large has drawn heavily on the promise of automation and data analytics in recent years to power more efficient and effective processes. Management of BAAs is no different and is an area ripe for improvement. Today’s healthcare executives need to consider the high stakes associated with ineffective management of BAAs and take action to shore up strategies amid greater security risks and a challenging regulatory environment.

About Greg Waldstreicher
Greg Waldstreicher is the founder and CEO of PHIflow, and the cofounder and former CEO of DoseSpot, where he worked at the forefront of the electronic prescribing (e-Prescribing) market for nine years. Under Greg’s leadership, DoseSpot licensed its SaaS e-Prescribing solutions to 175 healthcare software companies across the medical, dental, hospice and digital health markets. Greg received a B.S. from the University of Maryland College Park in Accounting and an M.S. from Northeastern University in Technological Entrepreneurship.

5 Practical Use Cases Anchoring Blockchain in Healthcare

Posted on August 1, 2018 I Written By


The following is a guest blog post by David Houlding MSc CISSP CIPP, Principal Healthcare Industry Lead at Microsoft Health working specifically on the Azure Team.

The hardest thing about blockchain is not the technology. To be clear, there are many technical challenges that must be addressed to be successful with blockchain, and these are not trivial. However, even harder is building the network of healthcare organizations and trust to a point where they are willing to participate, connect, and transact.

Existing B2B Healthcare Networks

It is faster to apply blockchain to an existing B2B network of healthcare organizations than to build a new network around a new use case from scratch. This is why blockchain is first taking hold in healthcare in existing B2B networks where healthcare organizations already transact around a use case, albeit with a conventional “hub-and-spoke”, centralized architecture with a trusted intermediary. In some cases, these existing B2B networks are looser, with healthcare organizations collaborating ad-hoc as needed, even via antiquated technologies such as faxes, rather than fully automated and integrated systems.

Cost Reduction Value Prop

These business value propositions are driving blockchain forward in healthcare:

  1. Improving patient outcomes
  2. Reducing healthcare costs
  3. Improving patient experience, and engagement
  4. Improving healthcare worker experience

Amongst these, those that have a strong cost reduction value proposition have the most interest from healthcare organizations—most want to see a strong near-term ROI justification for participation.

Leading Use Cases for Blockchain in Healthcare

In this article I highlight 5 practical use cases—plus one emerging use case—where blockchain is taking hold. Here are the ways that blockchain is adding value in these networks:

  • Decentralization, avoiding the need for a central hub (and associated costs, delays, and single point of failure).
  • Improving trust through a shared immutable ledger.
  • Mitigating fraud through transparency of transactions.
  • Improving performance and efficiency.
  • Paving the way for new levels of automation and collaboration around smart contracts and DAOs (Decentralized Autonomous Organization).

1. Health Information Exchange

Currently, the healthcare industry experiences major inefficiencies due to diverse, uncoordinated and unconnected data sources and systems. Effective care collaboration is vital to improve healthcare outcomes. With digitized health data, the exchange of healthcare information across healthcare organizations is required.

Grapevine World is one of the leaders in the application of blockchain technology. They make use of the IHE methodology for interoperability, and multiple blockchains for tracking data provenance and providing a crypto token as means of exchange within their ecosystem.

2. Provider Directory

Healthcare organizations, including payers, must maintain directories of healthcare providers, or doctors. Today this is done redundantly across multiple organizations. Further, if these directories get out of sync, it can lead to issues such as claims bouncing. Through blockchains, provider directories can be maintained by various healthcare organizations in a shared, decentralized ledger. This reduces redundancies and inconsistencies, and thereby improves operational efficiencies (including around claims adjudication).

Optum is one of the leaders in applying blockchain technology to the directory use case.

3. Provider Credentialing

Doctors, nurses, and other healthcare workers must have credentials to provide healthcare. These credentials must be validated by every healthcare organization they practice at, and periodically thereafter, usually every two years. This creates a huge amount of redundant effort and cost, and often delays a doctor’s ability to practice at a new facility. Blockchain provides a way for healthcare organizations in a consortium to update doctors’ credentials. That includes the validations of those credentials, helping to eliminate redundant effort. Doctors will be able to practice at new facilities with minimal delay.

ProCredEx and Hashed Health are leaders in the application of blockchain technology to the provider credentialing use case.

4. Drug Supply Chain

Medications must be tracked from manufacturers (such as the big pharmaceuticals), through distributors, to dispensaries (such as pharmacies). This enables the pharmacist, patient, or family caregiver to verify the authenticity, provenance, and safety of the product. It helps reduce drug counterfeiting and enables improved operational efficiencies, with associated cost reductions. Blockchain is particularly well suited to applications that require tracking of items across organizations. Regulations such as DSCSA also require tracking of drugs through the supply chain. And compliance with these regulations provides an additional incentive, or forcing function for the adoption of blockchain.

Adents and the C4SCS (Center for Supply Chain Studies) are leaders in the application of blockchain technology to the drug supply chain use case.

5. Medical Device Track and Trace

This is another example of a supply chain use case; except medical devices are being tracked, rather than drugs. Devices can range from implantables to MRI machines. The idea is to track these across the supply chain and throughout their life cycles, or even multiple life cycles as they are resold and reused. Such tracking enables fast response to recalls, thereby improving patient safety and operational efficiency. It enables one to monitor the maintenance of these devices over their lifetime—which can also help improve quality, and patient  outcomes.

Spiritus Partners is a leader in the application of blockchain technology to the medical device track and trace use case in healthcare.

Emerging: Anti-Fraud

Anti-fraud is another use case that is starting to take hold in healthcare. It is interesting both as a stand-alone use case (of particular interest to healthcare payers), and as a more general business value enabled by blockchain. Fraud prevention is attractive across most other use cases for blockchain in healthcare. For example, blockchain can help mitigate counterfeiting fraud in the drug supply chain use case. Blockchain has major potential to block fraud through:

  • Immutability (transactions cannot be altered)
  • Improving detection through transparency
  • Advancing artificial intelligence used for anti-fraud

For more on this use case and fundamental value of blockchain see Blockchain as a Tool for Anti-Fraud.

What other use cases do you see blockchain being applied to in healthcare? Welcome any comments, questions, or feedback you may have below. Blockchain in healthcare is fast evolving. I post updates extensively for blockchain in healthcare. Reach out to me on LinkedIn or Twitter.

About David Houlding
David Houlding is the Worldwide Healthcare Industry Leader on the Microsoft Azure Industry Experiences Team. David has more than 24 years of experience in healthcare spanning provider, payer, pharmaceutical, and life sciences segments worldwide, and has deep experience and expertise in blockchain, privacy, security, compliance, and AI / ML, and cloud computing. David also currently serves as Chair of the HIMSS Blockchain in Healthcare Task Force, a group of 50+ leaders from across healthcare worldwide, collaborating to advance blockchain in healthcare.

EMR Integration Paying Dividends For All Types of Healthcare Practitioners

Posted on July 17, 2018 I Written By

The following is a guest blog post from the team at Fullscript, a proud sponsor of Healthcare Scene. Follow and engage with them on Twitter: @FullscriptHQ

It would not be a stretch to say that EMRs have been both a blessing and curse for healthcare practitioners. There is no doubt that EMRs have improved the safety of care and the mountain of data that has been collected is now powering the renaissance of Artificial Intelligence in healthcare. However, EMRs have also increased the workload on clinicians which in turn has negatively impacted the overall patient experience and has contributed to burnout. It would not be a stretch to say that EMRs have been both a blessing and curse for healthcare practitioners. There is no doubt that EMRs have improved the safety of care and the mountain of data that has been collected is now powering the renaissance of Artificial Intelligence in healthcare. However, EMRs have also increased the workload on clinicians which in turn has negatively impacted the overall patient experience and has contributed to burnout.

To help practitioners, HealthIT vendors need to ensure their products can be:

  • Tightly integrated with EMRs so that data can be shared easily
  • Seamlessly incorporated into existing workflows
  • Tuned to fit the specific needs of the practice

Fullscript, an online e-prescribing platform helps integrative medical practitioners dispense supplements without the need for physical inventory. This saves valuable office space and improves the overall safety of practices. The company offers over 20,000 professional-grade supplements. Key to the company’s success has been the integration of their platform with existing EMRs coupled with their user-friendly workflow features.

Dr. J. E. Williams, a highly respected integrative medicine clinician who treats and revitalizes patients across a spectrum of illness, implemented Fullscript in order to provide his patients with a streamlined experience and to improve the performance of his practice.

Prior to Fullscript, Dr. Williams, used a non-integrated e-prescribing system. That system was difficult to use and his patients frequently complained at how confusing it was. The result was that patients were not filling their scripts and were not following the prescribed regimen. After switching to Fullscript, Dr. Williams could seamlessly e-prescribe what his patients need, directly from within his EMR. In addition, the easy-to-use nature of the system has made it less confusing for patients. The net result is that Dr. Williams has experienced 100% patient compliance by using Fullscript through his EMR.

“I can write a recommendation when a patient is in front of me, or immediately afterwards. ​Patients want to see their recommendation in their inbox right away, and that’s what Fullscript provides. My patients love it.” – Dr. J.E. Williams

Dr Williams is on a mission to bridge complementary as well as alternative therapies with evidence-based clinical science. Although some would see this as controversial, Dr. Williams firmly believes that there is growing evidence of improved patient outcomes when melding ancient wisdom with modern science. The ultimate goal is to use the most efficient therapies with the least side effects for patients.

The success of Dr Williams demonstrates the power of tight integration with EMRs for all types of clinicians. Gone are the days when clinicians had to tolerate clunky stand-alone systems. Today, they can and should expect their HealthIT partners to provide systems that seamlessly integrate with their existing applications.

Fullscript embraces this vision and has worked with over a thousand practitioners just like Dr Williams to provide the ability to e-prescribe nutraceuticals in as little as 4 weeks.

To learn more about Fullscript’s EMR integration or to read more about Dr. Williams, click here.

Alleviating “Pregnancy Brain” With Appointment Reminders

Posted on July 12, 2018 I Written By

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

Brittany Quemby - Stericycle

Picture this: I’m standing on the tradeshow floor watching as people try to grab as much swag as possible. I’m speaking to someone who really isn’t listening to my spiel because they are only in it for the free pen. Then, I get someone who is fairly interested in our appointment reminder service. Thinking I’ve hooked, lined and sunk them, I am met with a familiar objection: “We don’t need an appointment reminder service for our OBGYN clinic because women, especially pregnant women, don’t forget when their appointments are.”

Thinking back, I wish I knew then what I know now and could have countered that argument with some cold hard facts.

You may have heard about little bouts of forgetfulness during pregnancy. According to most experts, pregnancy does not change a woman’s brain, but some women don’t feel as sharp as usual when they’re pregnant. Although the science is still out on whether “pregnancy brain” is truly myth or reality, being seven months pregnant, I can testify that I am definitely not at the top of my game.

I have to check that I’ve locked the door three times. I forget simple words. I have a hard time remembering anything if I don’t write it down. Of course, I remember that I am due at the doctor once a month (I’m not an animal) and enter the date and time of future appointments into my phone. But between work meetings, presentations, ultrasounds, and other appointments, I inevitably forget when I’m supposed to go in and begin to question myself. Did I write down the date correctly? Did I already miss my appointment?

Every month, this confusion and second guessing always leads me to call my doctor’s office before my appointment to check the appropriate date and time.

What I do know is that this seconding guessing and additional effort could be completely eliminated if my clinic were to provide more patient-focused engagement before my appointments with the help of simple appointment reminders. With so many other things to worry about, I have come to appreciate these gentle reminders from places like my hair stylist, masseuse, and even prenatal class instructor, all of who send me a quick note including the following:

  • Appointment date
  • Appointment time
  • Location
  • Preparation instructions and,
  • Any additional “need to knows.”

Although it may seem like pregnant women would never forget an appointment that has to do with something as pivotal as bringing a child into this world, I can firmly say it happens. And something as simple as an appointment reminder goes a long way to ease a patient’s mind and elevate their overall patient experience. Now if only I could remember the name of the OBGYN clinic from that tradeshow I was at…..

Click here, to learn more about how Stericycle Communication Solutions is helping to create the optimal patient experience through our customized automated messaging solutions.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality answering services, online scheduling solutions, and messaging solutions. 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

How e-Prescribing Features Improve Your Practice Life

Posted on July 9, 2018 I Written By

The following is a guest blog post by Dr. Tom Giannulli, CMIO at Kareo.

e-Prescribing, the process of electronically fulfilling a medication prescription directly from your practice, is far from new. In fact, this service has been around long enough that the majority of patients have come to expect the convenience that accompanies it.

Most private practices are using some type of medical software that aids in the e-Prescribing process. Some may have incorporated said software because they felt obligated, but others have realized that an integrated software solution can do more than help meet the requirements for the meaningful use electronic health record (EHR) initiative.

They recognize that it may also help to improve their practice.

As the clinical leader for an electronic health record (EHR) vendor serving independent practices, I can attest that Kareo’s cloud-based software is designed with the intent to improve the unique needs of the private practice. The changes in regulations and requirements might mean you should change the way you practice, but it doesn’t have to reduce the personal connection between patients and their providers.

Improve Upon Value-Based Care

Value-based care is driven by data and has required practices to become more efficient and effective in order to reduce overall healthcare costs.

Without the automated support that accompanies e-prescribing, compiling the number of required reports could become overwhelming and significantly reduce your efficiency. Our software can make compiling this data with accurate reports both simple and manageable, which saves you valuable time. It makes tracking the quality metrics related to drug compliance much easier, but it’s also tracking quality by:

  • Helping to reduce your liability with legible prescriptions
  • Improving upon prescription accuracy
  • Reducing medication errors
  • Improving upon patient compliance
  • Monitoring fraud and abuse from duplicate prescriptions

Having an automated perspective on drug interactions and prescription history at your fingertips allows you to focus on measures that improve preventative care. This global perspective on each patient’s individual treatment can potentially reduce abuse and readmissions.

Leverage a “Heads Up” Philosophy

You won’t hear many, if any, physicians state that they chose medicine for the abundance of paperwork.

The time EHR can save on administrative tasks provides the physician with more time to do what they enjoy—care for their patients. Patients often choose a practice because they want that personal connection with their physician. Someone who knows their story, and is aware of their health history. Most patients don’t enjoy waiting while the physician is writing notes, asking them to repeat their medical history, or trying to find the correct button on the computer. This won’t help to increase patient satisfaction, and gain patient loyalty. With the information right in front of you, you have more time to devote to quality communication, which gains your patient’s trust.

There are several secondary key benefits to practicing “Heads Up” Medicine with e-prescribing that help improve the patient experience by devoting your attention to your patient, not your computer. You’re still getting the essential information with an easy method of information collection by pointing and clicking.

  • Reviewing key points and a simple question and answer interview can help you build your narrative.
  • Your EHR is accessible on a mobile device, such an IPad, and not just on a website
  • You don’t have to spend the extra time typing the narrative in each time and starting from scratch.

Save Significant Time

Time is valuable to you, and your patients. The time saved with automated support does more than make your patients happy by getting them in and out of their visit quicker, it also shows that you respect their time.

Less time waiting and more time with their providers often results in better patient satisfaction. Word of mouth is often the most effective form of marketing and satisfied patients refer new patients to help you continue to grow your business.

Our software takes care of the bulk of your work with chart, bill and fill to reduce administrative tasks and improve your workflow. It helps you write the note, ensures that you get the billing codes correct and fills the prescription and orders lab work. This allows you to improve your workflow by:

  • Getting the billing done quickly and accurately to expedite payment
  • Allowing you to see more patients in the same amount of time
  • Helping you gain a better balance between your work and personal life to reduce the risk of burnout
  • Making sure your patients don’t leave because of extended wait times

Maintain a Personal Connection

Engaging more with your clients can foster patient satisfaction and loyalty to your practice. Your patients want compassionate care provided and human interaction, and you can leverage this “heads up” philosophy with the simple solutions offered in EHR software to manage the bulk of your administrative work.

Seek out technology and service solutions to improve your practice, increase patient satisfaction and provide you with more time to focus on priorities to aid in the growth of your practice, rather than being burdened with administrative tasks. Because you chose to work in private practice for the patients, not the paperwork.

About Tom Giannulli, MD, MS
Tom Giannulli, MD, MS, is the chief medical information officer at Kareo, a proud sponsor of Healthcare Scene. He is a respected innovator in the medical technology arena with more than 15 years of deep experience in mobile technology and medical software development. 

How Hospitals Can Drive Revenue in Value-Based Care Using 7 Key Cycles of Their Data

Posted on July 5, 2018 I Written By

The following is a guest blog post by Richard A. Royer, Chief Executive Officer of Primaris.

Back in the day – the late 1960s, when social norms and the face of America was rapidly changing – a familiar public service announcement began preceding the nightly news cast. “It’s 10 p.m. Do you know where your children are?”

Today, as the healthcare landscape changes rapidly with a seismic shift from the fee-for-service payment model to value-based care models, there’s a similar but new clarion call for quality healthcare: “It’s 2018. Do you know where your data is?”

Compliance with the increasingly complex alphabet soup of quality reporting and reimbursement rules – indeed, the fuel for the engine driving value-based car – is strongly dependent on data. The promising benefits of the age of digital health, from electronic health records (EHRs) to wearable technology and other bells and whistles, will occur only as the result of accurate, reliable, actionable data. Providers and healthcare systems that master the data and then use it to improve quality of care for better population health and at less cost will benefit from financial incentives. Those who do not connect their data to quality improvement will suffer the consequences.

As for the alphabet soup? For starters, we’re as familiar now with these acronyms as we are with our own birth dates: MACRA (the Medicare Access and CHIP Reauthorization Act of 2015), which created the QPP (Quality Payment Program), which birthed MIPS (Merit-based Incentive Payment System).

The colorful acronyms are deeply rooted in data. As a result, understanding the data life cycle of quality reporting for MACRA and MIPS, along with myriad registries, core measures, and others, is crucial for both compliance and optimal reimbursement. There is a lot at stake. For example, the Hospital Readmissions Reduction Program (HRRP) is an example of a program that has changed how hospitals manage their patients. For the 2017 fiscal year, around half of the hospitals in the United States were dinged with readmission penalties. Those penalties resulted in hospitals losing an estimated $528 million for fiscal year 2017.

The key to achieving new financial incentives (with red-ink consequences increasingly in play) is data that is reliable, accurate and actionable. Now, more than ever, it is crucial to understand the data life cycle and how it affects healthcare organizations. The list below varies slightly in order and emphasis compared with other data life cycle charts.

  • Find the data.
  • Capture the data.
  • Normalize the data.
  • Aggregate the data.
  • Report the data.
  • Understand the data.
  • Act upon the data.


One additional stage, which is a combination of several, is secure, manage, and maintain the data.

  • Find the data. Where is it located? Paper charts? Electronic health records (EHRs)? Claims Systems? Revenue Cycle Systems? And how many different EHRs are used by providers – from radiology to labs to primary care or specialists’ offices to others providing care? This step is even more crucial now as providers locate the sources of data required for quality and other reporting.
  • Capture the data. Some data will be available electronically, some can be acquired electronically, but some will require manual abstraction. If a provider, health system or Accountable Care Organization (ACO) outsources that important work, it is imperative that the abstraction partner understand how to get into each EHR or paper-recording system.
     
    And there is structured and unstructured data. A structured item in the EHR like a check box or treatment/diagnosis code can be captured electronically, but a qualitative clinician note must be abstracted manually. A patient presenting with frequent headaches will have details noted on a chart that might be digitally extracted, but the clinician’s note, “Patient was tense due to job situation,” requires manual retrieval.
  • Normalize the data. Normalization ensures the data can be more than a number or a note but meaningful data that can form the basis for action. One simple example of normalizing data is reconciling formats of the data. For example, a reconciling a form that lists patients’ last names first with a chart that lists the patients’ first name first. Are we abstracting data for “Doe, John O.” or “John O. Doe?” Different EHR and other systems will have different ways of recording that information.
     
    Normalization ensures that information is used in the same way. The accuracy and reliability that results from normalization is of paramount importance. Normalization makes the information unambiguous.
  • Aggregate the data. This step is crucial for value-based care because it consolidates the data from individual patients to groups or pools of patients. For example, if there is a pool of 100,000 lives, we can list ages, diagnosis, tests, clinical protocols and outcomes for each patient. Aggregating the data is necessary before healthcare providers can analyze the overall impact and performance of the whole pool.
     
    If a healthcare organization has quality and cost responsibilities for a pool of patients, they must be able to closely identify the patients that will affect the patient pool’s risks. Aggregation and analyzing provides that opportunity.
  • Report the data. Reporting of healthcare data to registries and the Centers for Medicare and Medicaid Services (CMS) is not new, but it is a growing need. Required reporting will become even more integral to health care quality improvement as private payers follow the CMS lead towards value-base care.
  • Understand the data. What was effective? What is the clinical point of view versus a dollars/cost point of view? How are these two points of view reconciled to get the “right” results?
     
    When Drug B is half the price but equally as effective as Drug A, that is an example of evidence-based medicine, which was the result of the data life cycle. When healthcare organizations and providers have data they can understand, a root cause analysis is an ideal way to achieve sometimes conflicting goals of quality and cost– and move forward – on solving deficiencies or other problems flagged by the data.
  • Use the data. There are other crucial facets of the data life cycle that must be dealt with, including data maintenance and management and purging or destroying data in a way that is compliant with HIPAA. But the most important function of data is using it to improve clinical processes and outcomes, the patient experience, and the financial bottom line.
     
    Data that is accurate and reliable is not all that useful until it is actionable. How is the data being used to manage quality of care and cost of care? The final stage in the data life cycle is certainly the most important. The technology and human capital needed to accomplish the other aspects of the life cycle are extensive, and expensive. But data gathering is a lost cause and, really, an exercise in futility unless the flurry of data and reporting activity leads to action. In the age of value-based healthcare, data is the key that will allow providers to be financially successful in the future as payments become more heavily based on value, and patients seek providers that meet their growing expectations.

About Primaris
Richard A. Royer, Chief Executive Officer of Primaris, a healthcare consulting and services firm that works with hospitals, physicians and nursing homes to drive better health outcomes, improve patient experiences and reduce costs.

5 Steps to Ensure Revenue Integrity After Implementing a New EHR

Posted on June 18, 2018 I Written By

The following is a guest blog post by Lisa Eramo, a regular contributor to Kareo’s Go Practice Blog.

In the rush to implement EHRs for Meaningful Use incentives, many practices lost sight of what matters most for continued success—revenue integrity, says Joette Derricks, healthcare compliance and revenue integrity consultant in Baltimore, MD. Revenue integrity—the idea that practices must take proactive steps to capture and retain revenue—isn’t a novel concept. However, it’s becoming increasingly important for physician practices operating in a regulatory-driven environment, she adds.

Revenue integrity is also an important part of ensuring smooth cashflow during and after the transition to a new EHR, says Derricks. This is a time when revenue opportunities are easily overlooked as practices adjust to new navigation, templates, and more, she adds.

Revenue integrity is all about compliance, says Derricks. “It’s about taking a holistic approach to operational efficiency, regulatory compliance, and maximizing reimbursement,” she adds. “It’s about doing things the right way.”

Maximizing reimbursement isn’t about ‘gaming’ the system to upcode. Rather, it’s about implementing processes and procedures to ensure that practices are paid for all of the services they perform without leaving money on the table or generating revenue that payers will later recoup, she explains.

Derricks provides five simple steps practices can take to ensure revenue integrity following an EHR implementation:

1. Review EHR templates. Do templates include the most specific CPT and ICD-10-CM codes? And do physicians understand the importance of avoiding unspecified codes, when possible?

2. Examine the interface between the EHR and practice management system. Do the codes that physicians assign in the EHR feed correctly into the practice management system? For example, when a physician performs an E/M service in addition to a procedure, does the EHR map both codes to the practice management system for billing purposes? Does the practice management system correctly bundle and unbundle services, when appropriate?

3. Run your numbers frequently. Ideally, practices will perform a monthly data analysis to help gauge performance and identify potential missed revenue opportunities, says Derricks. For example, she suggests running a report of the practice’s top 20 billing codes in a particular month. Then, compare those codes with the top 20 codes the practice billed that same month in the previous year. What has changed, and why? And have these changes benefited or hurt the practice? For example, practices may see new codes in that list because they added chronic care or transitional care management, both of which provide additional revenue. Or practices may discover a system glitch that incorrectly bundled services that are separately payable, thus causing a revenue loss.

“Everybody can play the ‘I’m too busy’ game, but this is too important to fall into that trap,” says Derricks. “I applaud the office manager or practice administrator who recognizes the value of constantly being on the lookout for system-wide improvements and analyzing their own numbers.”

Some practice management systems provide robust billing analytics that can help practices identify the root cause of billing errors and omissions. Working with a consultant is another option, says Derricks. Consultants provide unbiased input regarding inefficiencies and vulnerabilities and can provide a ‘fresh set of eyes’ necessary to effect change. They also often have access to benchmarking tools and other resources that can help practices identify revenue gaps and delays, she adds.

For example, Derricks suggests performing an assessment for revenue gaps and roadblocks to reduce the workflow process errors that delay revenue. Download the assessment.

4. Provide physician training. Physicians need thorough training on how to use the EHR properly so as to avoid data omissions, says Derricks. They also need annual training on new CPT and ICD-10-CM codes as well as new documentation requirements, she adds.

5. Create an environment that promotes compliance. This requires a top-down approach from physicians and practice managers, says Derricks. “Everyone should have their eyes open and feel comfortable being able to address concerns,” she says. “It should be an open-door policy in terms of looking at processes versus putting your head down.”

About Lisa Eramo
Lisa Eramo is a regular contributor to Kareo’s Go Practice Blog, as well as other healthcare publications, websites and blogs, including the AHIMA Journal. Her focus areas are medical coding, clinical documentation improvement and healthcare quality/efficiency.  Kareo is a proud sponsor of Healthcare Scene.

Creating Provider Loyalty – And Why Communication Matters

Posted on June 14, 2018 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

A few months ago, I was on the hunt for the perfect healthcare provider – and my list of expectations was high. Thankfully, my extensive search paid off. I am happy to report I found an amazing physician who I fully plan on remaining loyal to for years to come! The main reason for this loyalty boils down to one common characteristic: communication. Across every step of my patient journey, I was engaged in a clear, convenient way.

Scheduling my appointment was easy. Like many patients, I enjoy the convenience of online scheduling. But as a first time patient, I opted to pick up the phone to make my appointment. The person who answered my call was friendly, focused, and efficient. I was not asked to repeat information and ended the call more quickly than I anticipated – and with more confidence that I’d made the right choice.

Before my appointment, I received a number of reminders. The first was sent via email a few days before my appointment. When I failed (read: forgot) to reply to it, I received another friendly reminder via text message. This time, I promptly confirmed my appointment. A few days before the appointment, I was invited to pre-check in online. I did this from the comfort of my home computer in just a few minutes. As a digital-minded patient, I was stoked that this was an available perk of my new doctor’s office.

When I arrived, I was thanked for already checking in. Unlike other locations where I needed to fill out additional paperwork upon arrival, I didn’t need to do this often repetitive task. This pleasant surprise allowed me to simply wait to be called back.

During my appointment, the doctor looked me in the eye, asked me genuine questions, and clearly explained anything I wanted to know more about. This level of dedicated attention made me feel genuinely cared for. What’s more, she ensured I understood what to expect after my appointment.

After my appointment, I received the communications I was advised to expect in a timely and unobtrusive manner. What’s more, I was invited to provide candid, anonymous feedback about my appointment. The survey was quick and unobtrusive, and left me feeling as if my opinion was valid and valued.

Each point of my patient journey was met with timely, convenient, and reliable engagement. As a patient, I felt confident and at ease. And as someone who works closely with healthcare communication services and solutions – both human and technology based – I was impressed. Few healthcare organizations provide patient experiences that meet patients’ traditional and digital expectations and reliably deliver on the expectations they set. Those that do, however, are sure to acquire patients like me who will stay loyal for the foreseeable future.

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