Category Archives: Mobility

Terry Edwards

Managing the surprisingly troublesome impact of real-time healthcare on clinical decision-making

By Terry Edwards  /  08 Jun 2017

We live in an age of instant gratification. From the texts we send friends and family to the orders we place on Amazon.com, we’ve come to expect immediate results: instant responses, next-day shipping, etc.

The idea of immediacy in healthcare communications is not new. In fact, in 2015, healthcare analyst Gartner outlined a vision for what it dubbed the “real-time health system”—a landscape where healthcare professionals will be constantly aware of what’s happening within their systems and with their patients.

As a person living in the digital age, you’ve probably experienced real-time awareness in other parts of your life: the repetitive dings of received text messages, the intermittent beeps of calendar alerts, the near-constant hum as your smartphone vibrates over and over to let you know your mother, children and cousins have uploaded photos to Facebook, Instagram and Snapchat. In fact, as I’m typing this piece, I’ve heard alerts for two personal text messages that I’ve yet to look at (the temptation is maddening), four work-related emails (that I did have to stop and look at), a notification that someone commented on a thread I replied to on Facebook and more.

While there’s definitely a benefit to each of us knowing what’s happening in our expanded universe in real time—and we can easily draw a direct line to the benefits that doctors, nurses and patients would experience if they could communicate instantaneously while coordinating care—the influx of information is simply overwhelming.

And when alarm fatigue sets in, important messages get missed, the communication cycle breaks down and what was once a valuable resource becomes a liability. Overwhelmed and inundated clinicians cannot optimally use their invaluable expertise to make effective clinical decisions that deliver great health outcomes.

Aggregating, analyzing and managing the distribution of clinical information

Managing the flow of data and alert fatigue is a real challenge that clinicians and the IT teams that support them need to understand. Clinicians need “just the facts, ma’am,” so to speak, and they need to know which set of facts pertain directly to them and the patients for whom they are caring. Receiving more than enough information is not always a good thing, especially when the situation calls for fast thinking and quick decisions.

Investments made in technologies implemented over the past several years have enabled healthcare as an industry to generate very large amounts of digitized clinical information. The challenge is to aggregate this patient data in real time to generate new knowledge about a patient and distribute it in a way that does not inundate the clinician recipients with unnecessary information. Physicians and nurses should receive information they need in order to act in that moment. Everything else is noise.

Implementing communication-driven workflows

Once new knowledge is made available and deemed relevant to a given clinical situation, it’s important to enable workflows that drive this information to the right care team members, who can take action in that moment. Hospital-based communication workflows must encompass all modalities, adhere to strict security mandates and facilitate reliable exchanges among clinicians across boundaries (e.g., acute, pre-acute and post-acute care settings). This kind of clinical integration is the future of healthcare communications.

If clinicians are inundated with unnecessary information, messages and alerts, combined with a communication workflow that creates barriers to a) finding the right care team member to contact, b) finding the contact method that the clinician prefers and c) knowing whether the intended recipient received the message, the workflow is flawed and is inhibiting the decision-making that leads to higher standards of patient care.

Leveraging clinical expertise

The personal judgment of experienced healthcare professionals is irreplaceable in effective, real-time decision-making. Technological advances are no doubt improving healthcare, but human intuition can never be replaced by a new device or software. However, that intuition can be inhibited by technologies if they are not strategically implemented and managed. In this sense, real-time healthcare could, ironically, be eroding quality.

To truly leverage the hundreds of collective years of clinical expertise housed in the minds of your hospital’s medical staff—the expertise that yields great outcomes—you must remove the barriers to effective communication. Collecting patient data in real time is an important part of that. But analyzing and aggregating that data into digestible, valuable pieces of information that can be easily shared and collaborated on is the follow-through that is often overlooked.

The gravitation toward instant gratification isn’t going away. And it’s important to understand that the concept doesn’t apply simply to generating patient data as healthcare events are occurring, but also to the ability to extract the significant portions and begin collaborating with the broader care team to interpret the data and derive a plan to deliver high-value care.

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.

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.

Jennifer DeBruler, MD

3 key learnings from implementing a care team collaboration platform

By Jennifer DeBruler, MD  /  11 Feb 2016

A recent survey of nearly 1,000 healthcare professionals[i] revealed that a majority of respondents require collaboration across the extended-care team to enable population health business models. However, results also revealed strong agreement that the current state of communication has been a barrier to achieving that collaboration. Furthermore, clinicians[ii] are waiting for more information before they take action—resulting in delayed care.

Advocate Medical Group (AMG) recognized these same issues. AMG is a physician-led medical group in the Chicago-land area, with more than 1,300 physicians and specialists at over 200 different practice sites. Our contact center currently serves about 500 physicians and 40 practice sites, and we needed a more efficient way to securely communicate with one another. Our outdated technology didn’t allow messages to be transmitted in a meaningful or a secure manner. There was also an unfulfilled need to facilitate real-time calls among physicians with secure voice and text messages. PerfectServe appeared to be the answer.

We implemented PerfectServe’s Synchrony platform in stages, which allowed us to teach our caregivers the features and customize the communication parameters for each physician. We adopted standardized processes for the entire group to help ensure the right type of information is being recorded and communicated to staff, and is consistent across the entire care team. The processes included creating standardized templates so our associates were sending the most essential information possible.

The implementation process taught us three key lessons:

  • Physician engagement upfront is key: We brought the appropriate operations and physician leaders in to the design sessions, and have solicited physician feedback after they go live with the platform. We also have weekly conversations with the practices to ensure everything is running smoothly, and physicians make it a point to call us at the contact center if there are any issues. Having these regular touchpoints have helped create a smooth transition and implementation.
  • Develop customized training materials for your system’s providers: In addition to using the training materials that PerfectServe provided, we realized we needed to customize parts of the implementation to standardize the platform for our specific practices and system. We didn’t want physicians to opt out of certain rules and workflows as that would interfere with the system. Customization was vital.
  • Set a timeline for gradual implementation: Implementing a platform across your entire network at the same time can lead to confusion, frustration and chaos. It’s helpful to set a timeline of gradual implementation dates before the project begins. Doing so affords hospitals within the system an opportunity to make sure all the settings are right and that the doctors have programmed their PerfectServe platform based on their preferences. If there are any major adjustments to make, they can be made before onboarding the next hospital.

Through adopting a staged approach, we have experienced a successful PerfectServe implementation to date. We have also noticed many improvements within our system since we began using the platform in January 2015. Physician contact management has improved throughout our network; we now have more than 4,000 physicians using the platform across 12 different Advocate hospitals. Furthermore, 96 percent of our AMG physicians who have downloaded the smartphone app are actively using it. Our practice communication management has also improved through PerfectServe’s algorithms, which direct calls to on-call physicians and can decipher covering physicians.

Through our real-time tracking and reporting we were able to see that with time comes comfort. In December 2015 alone, our physicians had more than 4,600 interactions on the platform compared to only 481 in January 2015, when we first implemented PerfectServe. Our physicians are using PerfectServe more and more to communicate with each other. Our tracking also shows that the majority of our calls are answered within 10 minutes. Additionally, 50 percent of the messages are retrieved in 5 minutes or less, which helps deliver communication and patient care more efficiently.

PerfectServe’s technology has helped AMG grow and succeed, thanks to its focus on collaboration, secure communication and improved patient care.

Check out this video about how clinicians at Advocate Health Care use PerfectServe to communicate easily.

[i] “Healthcare professionals” includes hospitalists, primary care physicians in large offices, specialists in both hospital and office settings, nurses in hospitals, case managers, hospital administrators and office managers.

[ii] “Clinicians” includes all physician categories surveyed, nurses and case managers, and excludes hospital administrators and office managers.

 

Terry Edwards

2016 Trends: What’s in store for providers?

By Terry Edwards  /  21 Jan 2016

As I mentioned in my post last week, despite healthcare’s slow-moving reputation, many of the players are moving quickly to re-steer the ship and transition to value-based population health management. Yes, population health an overused phrase with too many definitions, but it’s also the biggest change in healthcare since the invention of penicillin, and will form the backdrop for many of the trends that will change the way healthcare organizations operate and deliver care in 2016:

  1. Roles between payers, providers, vendors will blur. Consolidation in healthcare isn’t new, and I see this trend continuing into 2016. After all, consolidation is still the best strategy for organizations to get scale to reduce costs, freeing up more resources to increase innovation in everything from new modes of care delivery to payment models. As organizations grow, we can expect that the role of each player will shift so that the lines between payers, providers and even vendors, will blur to the point where they’re nearly unrecognizable. In 2016, more IDNs will create their own payer branches, and we’ll also see more large health systems develop their own proprietary technology, either on their own or in partnership with both startups and established technology vendors to help deliver their own population health strategy.
  1. The continuing shift to patient-centered care will bring patients and their families into the care team. It can be difficult for patients with multiple chronic conditions to navigate the complexities of follow-up appointments, medication regiments and other therapies. Their providers, who are often strapped for time and resources, can find it hard to coordinate patient care effectively. We’re going to see increased demand for remote care managers, who are responsible for hundreds of patients with chronic conditions. The remote care manager will be an increasingly important member of the broader patient care team and be able to remotely monitor all of their patients using sensors and analytics to identify each patient’s condition, enabling the coordinator to proactively reach out to patients and intervene before a situation becomes an emergency. Families and friends, too, will have a bigger role to play in a patient’s care. Providers will start using tools like text notifications and social media to loop in a patient’s support network so that they can reiterate important information, facilitate follow-up visits and help patients stick to their medication regiment.
  1. Providers will need to create new methods to provide patients and clinicians relevant information from ALL points of care. No longer do patients need to schedule an in-person visit with their primary care physician for a simple prescription. Retail clinics at CVS and Walmart – as well as virtual visits via telehealth – make it possible for patients to get care quickly. While the increase in access points to care is a positive development, it can lead to disjointed and fragmented care. In 2016, providers will continue to struggle with how to manage all fragmented patient visits (after all, that’s what the acquisition of PCPs was supposed to resolve.) One option to corral all of these independent visits will be a new kind of patient portal—or rather, a wellness application—that gives patients and clinicians information from all points of care, whether it’s a hospital, PCP, specialist, retail clinic or other emerging care delivery method. This new kind of wellness application will tether multiple existing portals and make it possible to aggregate information from all providers, regardless of their healthcare system affiliation, which may help prevent medical mistakes and duplicate testing in addition to providing much needed increased convenience.

The next few years are going to be an exciting time to work in healthcare. What trends and changes do you see on the horizon? What did I miss? Let me know here, or via Twitter @PerfectServeCEO