Category Archives: Healthcare Technology

Terry Edwards

Healthcare is Ripe for Tools to Enable Value-Based Collaborative Care

By Terry Edwards  /  29 Dec 2016

Game-changing value-based reimbursement models are radically altering the healthcare landscape. CMS’s new program, Medicare Access & CHIP Reauthorization Act of  2015 (MACRA), along with the expanding Bundled Payment for Care Improvement Initiative (BPCI) are dominating headlines, calling into question physician and organizational readiness and the ability to address complexities that impact the revenue cycle.

These new payment models will require clinicians to collaborate around their patients in ways that they have not done so in the past. Increased collaboration is necessary to effectively coordinate a patient’s care among care team members who cross ambulatory, acute and post-acute care settings and organizations. To quote one esteemed health system nursing executive, “If you can’t communicate and exchange information with all of the people involved in an ACO or other new risk-sharing model, you can’t deliver quality care.”

However, many obstacles exist – brought about by healthcare’s fragmented cottage-industry structure – which critically hinder efficient care team collaboration. Inefficiencies are inherent in this siloed work culture, which if left unaddressed can lead to compromises in patient safety and employee relationships. The inevitable lack of communication, coordination and access to critical information points to our most prevalent problems with patient care.

Collaborating under one payment model, one price

This concept is best illustrated by Michael Porter and Robert Kaplan in an article from the July-August 2016 Harvard Business Review in which they offered a simple analogy between buying a car and paying for healthcare services. According to the authors, consumers do not buy the motor, the brakes, the seats, the wheels and other individual parts from different suppliers. Instead, “They buy the complete product from a single entity.”

Like the automotive industry, our healthcare system comprises different suppliers – different healthcare professionals employed by different organizations who provide components of care in a single episode of care. However, unlike the automotive industry, patients rarely, if ever, pay for all of these services from a single entity. Bundled payment aims to change this paradigm.

However, numerous navigational barriers exist in provider-to-provider communication, primarily because each organization possesses different workflows optimized around their own needs for how they receive communications. This ranges from identifying and coordinating the right specialist for a consult, to arranging physical therapy and tests.

To echo Porter and Kaplan, it just makes good sense to collaborate under one model and one price where all suppliers unite to assemble a car—or administer care—in the most efficient manner for the consumer/patient, which is where value-based payments come into play.

Rethinking strategies and tools for bundled payments

Under the new bundled payment model for as many as 48 clinical conditions, CMS will disperse one lump sum to the health system or hospital covering a patient’s entire episode of care. This means that organizations must rethink the most effective strategies and supporting tools to coordinate care activities among a network of acute and post-acute provider participants in a community—and pay them.

Without a doubt, efficient care team collaboration and patient-centered coordination are the nexus of transformative change. To accelerate this level of collaboration, innovative communication technologies are necessary to support this new era of incentivized care. But these communication technologies must be purposefully designed and extend beyond the EHR (and the hospital).

Transforming care with communication technology

The level of collaboration required means that providers need communication technology that transcends geographic and organizational barriers. It must enable and expedite contact among care team members who work in and across multiple coordinating facilities and locations.

In addition, this communication technology must be able to identify and provide immediate connection to the “right” care team member for a given clinical situation. This type of logic requires that—for every single communication by every care team member—the contextual variables of each interaction must be analyzed in real time to ensure communications are routed to the correct individual based upon the recipient’s workflow.

Bottom line: MACRA, BPCI and other market forces are imposing high demands on the care team in making clinical communication and collaboration even more critical for success under value-based care. Leaders in medical practice can take heart in the creation of a permanent impetus that meets the needs of the patient to achieve stronger correlation of the best health outcomes, while rewarding their care services. Assessing communication technology and business processes is a logical place to start.

 

Don Dally

How to increase the impact of smart mobile devices

By Don Dally  /  15 Dec 2016

Post originally published on HIT Think from Health Data Management.

For the usage of smart mobile devices to make a real impact on clinical care, hospitals and health systems must extend their concept of enterprise mobile communications to a holistic strategy—one that evolves around the end user, workflow, data, applications and other factors.

Tough challenges lie ahead for IT departments tasked with refining their enterprise mobile device strategy to grow with future needs.

Here are 10 “tried and true” recommendations to support greater levels of mobility, care team adoption and efficiency, and patient care.

1. Request the certified communications/smart device list from your electronic health record vendor. Most EHR vendors can provide this as a starting point to build or refine your enterprise mobile device strategy. The list ideally ranks the computing power of the device and its ability to access clinical data within the EHR.

2. Understand the market for shared mobile smart devices in the acute care setting. This market is in its infancy, with less than 10 percent of U.S. health systems having deployed shared mobile smart devices in their patient care settings. Be aware that many devices designed for healthcare are first-version releases and will rapidly evolve pending real-world clinical experience.

Two challenges commonly experienced by early adopters include learning to operationally deploy and manage devices exclusive of evidenced-based best practices and proven tools; and discovering that your expensive device investment is unexpectedly outdated and financially unfeasible due to the rapid technology evolution.

3. Compare iOS-based devices to Android-based devices. Key differences exist between the iOS and Android device landscapes. Apple’s iOS devices are consumer devices, whereas some Android devices are built purposely to support healthcare and other rugged environments. Notable differences are also found between consumer-grade and enterprise-grade devices.

4. Review devices that include VoIP phone capabilities. Ascom, Motorola and Spectralink are three such manufacturers.

5. Explore adding VoIP capabilities to a smart device lacking native VoIP support. Some ruggedized device manufacturers do not include native VoIP phone capability, including the Caterpillar CAT s50c and Honeywell Dolphin CT50H. VoIP phone capabilities can be added to devices by using an app offering “softphone” capabilities.

6. Consider the product lifecycle of a smart device. Purchasing a device in the first half of its lifecycle enables an organization to maximize its usefulness and longevity. For instance, if a device is in its fourth year of a five-year product lifecycle, the device most likely has a processor architecture that is four years old. In its second year of use, that processor architecture will be more than six years old. This may result in care team users decrying the devices are slow to use—especially as more apps are added through the years. Before making a significant investment in an older processor, research the timing of the next release.

7. Examine the performance of the device roaming across wireless access points. Most healthcare organizations have a high volume of wireless access points situated across multiple facilities. As a result, a device’s usability and performance in managing patient handoffs between access points is influenced significantly. To prevent problems, providers can question the device manufacturer for details on the work completed to ensure frequent access point transfers do not disrupt care operations. For example, find out how often device access points are checked for changes, as infrequent device polls increase the probability of certain access points being no longer in range. Likewise, count the number of access points in a 15-second walk in the facility.

8. Understand the difference between Android apps in the Google Play Store and Android devices. Several device manufacturers have modified their operating systems such that some functionality has been removed. Both the Motorola MC40 and the Ascom Myco, for example, offer custom versions of Android that no longer support the Google Play Store or Google Cloud Messaging capabilities. Thereby, apps leveraging push notifications can fail to work unless the app developer adds those capabilities. Question those differences, including the device’s Android consumer version.

9. Determine if your Android device choice supports Android for Work. Android for Work is a new enterprise program enabling consistent IT management and secure app distribution through an ecosystem of MDM vendors. It provides IT with a unified way to secure enterprise apps, manage disparate devices, and separate work and personal data at the OS level. Android for Work is the industry standard for app vendors providing capabilities to leverage a facility’s MDM and requires the Android device to be version 5.x or greater. For those device versions 4.x or less, the app installation and subsequent future upgrades must be completed manually.

Manufacturers that develop Android devices built purposely for commercial settings have a device lifecycle that better aligns with health enterprise expectations as opposed to consumer expectations. Consequently, while most consumer Android devices in use are version 6.x, the healthcare purpose-built devices are typically 4.x.

10. Make a well-researched device choice. Providers do not have to choose a single smart mobile device for enterprise-wide adoption among all care team members. In making your device selection decision, consider the care team member’s role and respective needs such as workflow. For example, deploying a device featuring VoIP phone capabilities for nurses—and other direct care personnel—may make more sense for accommodating workflow, as does selecting a less expensive device without VoIP capability for clinical support service staff.

A senior doctor using a smartphone

Mobile charge capture: A simple change to your business practices with significant outcomes

By Michelle McCleerey, PhD, MA, MEd, MBA, RN  /  19 Jul 2016

While there are conflicting perspectives on the physician shortage, there is resolute agreement that the demand for primary and specialty care is growing due to the expanding older population. Concurrently, the challenges for physician practices, which are needed to provide that care, are also increasing. Older patients require 2–3 times the amount of specialty and primary care to treat and manage chronic conditions and age-related illnesses. Unfortunately, in today’s ever-changing healthcare environment, many practices are struggling to survive.

As has never been experienced previously, practices are facing daunting obstacles to care delivery due to rising operating costs, regulatory burdens and barriers to receiving pay/reimbursement. The cost to operate a practice has increased at twice the rate as the consumer index due to increasing rent, malpractice insurance, liability coverage, health insurance and personnel expenses. Mounting regulatory requirements have not only served to increase overhead, but have also consumed valuable patient care time with oppressive documentation and administrative requirements for HIPAA, Meaningful Use, prior authorization and quality mandates.

Now in the wake of the time-consuming and costly protracted transition to ICD-10 and EHR implementation, physicians are struggling to get paid. In part, this is due to the ACA which has introduced reimbursement cuts and increased penalties. Last year, the Centers for Medicare & Medicaid Services (CMS) began to apply the value-based payment modifier to adjust reimbursement amounts to reflect the quality and cost of care provided. Those practices not meeting performance standards will receive less reimbursement. In addition, this year, the penalty for non-participation in the Physician Quality Reporting System (PQRS) increased to a 2% reduction in the CMS market basket update. Further, the increased number of patients with insurance provided through state exchanges or the Federal marketplace has exacerbated the payment problem. These patients typically have very high deductibles, along with a 90-day window to pay premiums, posing more obstacles to the collection of co-pays and out-of-pocket expenses. Notoriously, it should be noted that the CMS also takes longer to reimburse physicians as compared to private payers. Moreover, the ICD-10 transition has resulted in increased claims denials, resulting in labor-intensive, time-consuming efforts to overturn the same.

Confronted with these challenges, paradoxically, many physicians have had to reduce the number of patients they see, further eroding financial return. However, for those struggling practices, indiscriminate cost slashing is not the answer as physicians must finely balance improved operational efficiency with the achievement of the aims of quality patient care. This is where innovative technology can play a key role. Smart investment needs to target technology that is able to:

  • Reduce operational expenses
  • Ease regulatory compliance and the documentation demand
  • Facilitate physician workflow
  • Increase patient care time
  • Generate more revenue

One such technology that meets the above criteria is mobile charge capture functionality within a secure messaging application. This would enable physicians to quickly and easily capture charges at the point of care and automatically and securely communicate this information to billing staff or a billing application.

To ensure there is no increased burden to physicians, this process must only take a couple “clicks” or a matter of seconds. For example, the application must have immediate accessible “favorite” codes composed of those services and diagnoses used most frequently and denoted by the terms most familiar to that particular practice, rather than formal codes and code definitions. Additionally, when needing to find a rarely used code not contained within favorites, the application should provide decision-support enabling the easy selection of the right ICD-10 code to be associated with the CPT code. Also, there should be code bundles available so multiple code combinations can be assigned to a patient in a single click.

This prompt and speedy process replaces the manual paper-and-pencil method in which physicians retrospectively attempt to make a note of the procedures performed —sometimes days or even weeks after the encounter. Consequently, quite often, not all services that were provided are recalled. These “notes” were then provided to the practice billing team who then must interpret the right procedure and identify the correct codes for billing purposes. Often because of the lack of detail within the notes, the specific details of the procedure are lost, reducing the amount of reimbursement received on top of the lost charges due to poor memory.

These issues could be virtually eliminated with smart mobile charge capture functionality. Additionally, this functionality enables the ability to easily add and document PQRS codes while facilitating patient rounding, with a customized patient list and direct access to previous charges, and with the ability to rapidly “clone” them for the day’s visit. This information would also be visible across the entire group of physicians, if desired.

By automating and expediting the charge capture process, there is a direct impact on the practice’s financial homeostasis:

  • The elimination of lost charges and improved coding specificity directly translates into higher revenue.
  • The coding decision support and the inability to mismatch CPT and ICD-10 codes mean reduced potential for costly and time-consuming audits and claims denials.
  • The easy documentation of PQRS avoids the 2% CMS penalty and facilitates compliance.
  • The immediate transmission of charges to billing staff speeds the time to billing, reducing the amount of time to payment received.
  • The number of FTEs required to support the coding and billing process can be dramatically reduced markedly decreasing operational expenses.

Most importantly, such technology can allow physicians to spend more time doing what they want to do and what we need them to do—caring for and treating patients.

real-time-healthcare

3 “must haves” for simplifying complex clinical communications

By Julie Mills, RNC  /  30 Jun 2016

Part 3 of a 3-part series in conjunction with our nurse leadership webinar series.

Imagine a world where you launch the EMR, review a patient’s chart, and want to discuss it with the covering cardiologist that day. You click a link for the cardiologist within the EMR and it references that provider’s group workflow processes, reviews their schedules and monitors their momentary status to direct you to the correct provider. Then you type your message. The patient’s information is pulled from the EMR and is securely routed to the recipient based on their contact preference in that moment. It can happen – but this is not the norm in most healthcare facilities today.

Practicing medicine today is complex – clinicians need to consider an ever-changing landscape, federal and state regulations, not to mention the many different innovations designed to help streamline everything from care delivery to reimbursement. Adding to the complexity are the many different providers treating patients, working across various care settings with large care teams.

Given the vastness of these care networks, it can be daunting – albeit necessary – to coordinate care. One way to help connect clinicians in all care settings and improve care team collaboration is through a comprehensive communication solution.

It’s important to first understand why clinical communication is complex and why many of the technologies implemented today aren’t solving the issues clinicians are facing. Factors such as the patient’s reason for contact, the physician’s location, team coverage, degree of urgency and unassigned ER calls all impact the communication process.

Looking across varied care settings, people, processes and preferences also differ. Between inpatient and outpatient facilities, medical group practices and post-acute care, there are many variations in care team communication strategies and approaches that make it prone to gaps and breakdowns. In fact, one of the most frustrating parts of a nurse’s job is the daily battle to determine the correct covering provider.

In this complex environment with so many participants, the continuum of patient care demands that communication solutions span much further than the four walls of a hospital or practice. And as healthcare delivery models change, it’s imperative that care coordination, and the communication that drives it, be streamlined and efficient across all of these settings. When looking for a platform to simplify clinical communication, healthcare organizations should keep the following three “must have” capabilities in mind:

  • Span the entire care continuum: A comprehensive solution must address the needs of all care team members across all types of settings – from a single hospital to a multi-site system, as well as outpatient practices and care settings. They all have different demands and communication requirements. For example, larger practices and hospitals need advanced directory capabilities to bring the opportunity to coordinate care based on facility, group or ACOs, with the appropriate workflow processes built in. In addition, the solution should have the ability to generate real-time patient updates – such as when the patient presents to the emergency department, is discharged home, or when important results are available. This is essential to timely coordination of care. Finally, it’s imperative that the communication solution connect to the organization’s other HIT systems to maintain integration for alarms and alerts, such as if stroke team is activated. It’s critical that covering providers respond quickly and that a back-up process is in place.
  • Provide a standardized, yet flexible way to communicate: Clinicians should have flexible, yet standardized communication options that allow their messages to be routed appropriately and securely, and account for today’s technology. Gone are the days of referencing binders, faxed schedules or notes taped to the wall or desk. Once the communication process is initiated, the process should seamlessly connect you with the correct covering provider for the clinical situation at hand – whether through call, text or via a mobile app.
  • Address process complexities with intelligent routing: Schedules, workgroup rules, team mobilization requirements and escalation paths should all be configured so that you are connected to the right care team member with real-time accuracy. A solution with dynamic intelligent routing is able to deliver messages at the right time, to the right person in any given clinical situation. Clinicians should be able to customize based on their device and delivery preferences, and make changes based on their activity (e.g., what to do with a call while in the OR).

The goal is simple: Remove the variability, the hand offs and the touch points that introduce risk and opportunities for communication breakdowns. Initiate the communication in the manner you wish, and let the process connect you to the correct covering provider for your clinical situation at any moment in time.

While efficient clinical communication is a challenge, the right solution can lead to tremendous benefits for every care team member, as well as the organization. The solution must be comprehensive, providing standardization and the ability to streamline the communications process. By implementing technology that addresses these three areas, healthcare organizations will not only be able to improve clinical communication, but will ultimately improve the experience for patients, and the extended care team.


Interested in learning more? Read part 1 and part 2 of this series on nurse leadership in care team collaboration.

Terry Hayes

Building an effective care team collaboration strategy: 4 focal points

By Terry Hayes, MSN, CPNP, CNOR  /  23 Jun 2016

Part 2 of a 3-part series in conjunction with our nurse leadership webinar series.

The need to unify physicians, nurses and other care team members through effective communication at the point of care is growing in significance. According to a 2015 Gartner report, 80 percent of providers report deploying fragmented communication technologies, which results in degraded care team communication and collaboration.

Collaboration is both a process and an outcome. It affects the patient experience, outcomes and care occurring across a variety of settings in an increasingly complex and mobile environment.

To resolve the fragmented and non-secure communication encountered in healthcare, true care team collaboration is dependent on consolidating disparate technologies into a single solution capable of directly addressing the communication obstacles degrading patient care today.

To some, this may sound like an unachievable goal, but with a strategic plan focused in areas that facilitate workflow processes and communication leading to improved patient care, it is attainable.

You may wonder, where do I even begin? Many organizations, in response to specific challenges, have deployed single-point technologies that provide only incremental gains. True communication and collaboration requires a comprehensive strategy, and to begin you must carefully evaluate your entire communication landscape. You’ll need to assess your current technologies, HIPAA compliance plan, near miss or sentinel event occurrences, nursing time to reach providers and consult notifications procedures – all of which will highlight your communication strengths and weaknesses.

Developing a comprehensive care team collaboration strategy spans four major areas of consideration. Failure to address any one of these areas may leave you with an incomplete solution. Each organization is unique, certainly, but departments and organizations must work together to create an environment ripe for collaboration.

  • Clinical – Mobile technologies are becoming more prevalent in healthcare settings, thus the need to leverage these technologies to facilitate secure communication amongst the care team is becoming increasingly important. A clinical communications solution should enable communication-driven workflows to facilitate timely care team communication. The solution should facilitate direct conversations among nurses and physicians via the preferred mode of contact – be it a mobile phone, pager, email or office land line. By triaging incoming calls and applying personalized algorithms for call placement, care team members reach the correct physician without searching through call schedules.
  • Operational – Once your plan is in place, bringing it to life warrants consideration and considerable forethought. A well-defined adoption strategy will be key to a successful implementation. Clinical champions help drive decisions and engage end users. Leadership engagement is often the most essential driver of adoption of any initiative, plan or policy. You should also consider and plan around timelines, specific tasks and resource requirements.
  • Technical – To achieve success, understanding and addressing technical infrastructure is a must. The strength of your Wi-Fi and cellular networks should be evaluated. Does your organization have a device strategy or do you have a BYOD policy? Do you desire integration with clinical systems and is the solution you are considering interoperable?
  • Financial – In any financial consideration, ultimate ROI and total cost of ownership are needed to justify approaches. When you close communication gaps across the extended care team to facilitate patient care collaboration, you can potentially improve referral revenue, decrease readmissions and avoid penalty costs. The ability to do mobile charge capture at the bedside, and to quickly and fully document exam and procedure details at the point of care will result in revenue recognition and improved cash flow for physicians.

There is no short list of considerations when it comes to building an effective care team collaboration strategy. However, if you focus on these four areas, gain support of leadership and identify a solution that hits these marks, you will be well on your way to effectively addressing your communication and collaboration needs.


Interested in learning more? Read part 1  and part 3 of this series on nurse leadership in care team collaboration.