Tag Archives: ambulatory

1 Myth, 2 Truths, 5 Hot Trends in Health IT

There is a myth out there that healthcare providers are unwilling to adopt new technology. It’s just not true. In the last few months, I have spoken to dozens of healthcare leaders at hospitals both small and large, and I am amazed at their willingness to understand and adopt technology.

Pretty much every hospital CEO, COO, CMIO or CIO I talk to believes two things:

With growing demand, rising costs and constrained supply, healthcare is facing a crisis unless providers figure out how to “do more with less.”

Technology is a key enabler. There is technology out there to help save more lives, deliver better care, reduce costs and achieve a healthier America. If a technology solution solves a real problem and has a clearly articulated return on investment (ROI), healthcare isn’t that different from any other industry, and the healthcare industry is willing to adopt that technology.

Given my conversations, here are the five biggest IT trends I see in healthcare:

1. Consumerization of the electronic health record (EHR). Love it or hate it, the EHR sits at the center of innovation. Since the passage of the HITECH Act in 2009—a $30 billion effort to transform healthcare delivery through the widespread use of EHRs—the “next generation” EHR is becoming a reality driven by three factors:

  • Providers feeling the pressure to find innovative ways to cut costs and bring more efficiency to healthcare delivery
  • The explosion of “machine-generated” healthcare data from mobile apps, wearables and sensors
  • The “operating terminal” shifting from a desktop to a smartphone/tablet, forcing providers to reimagine how patient care data is produced and consumed

The “next generation” EHR will be built around physicians’ workflows and will make it easier for them to produce and consume data. It will, of course, need to have proper controls in place to make sure data can only be accessed by the right people to ensure privacy and safety. I expect more organizations will adopt the “app store” model Kaiser pioneered so that developers can innovate on their open platform.

2. Interoperability— Lack of system interoperability has made it very hard for providers to adopt new technologies such as data mining, machine learning, image recognition, the Internet of Things and mobile. This is changing fast because:

  • HHS’s mandate for interoperability in all EHRs by 2024 means patient data can be shared across systems to enable better care at lower cost.
  • HITECH incentives and the mandate to move 50% of Medicare payments from fee-for-service to value-based alternatives by 2018 imply care coordination. Interoperability will become imperative.
  • Project Argonaut, an industry-wide effort to create a modern API and data/services sharing between the EHR and other systems using HL7 FHIR, has already made impressive progress.
  • More than 60% of the proposed Stage 3 meaningful use rules require interoperability, up from 33% in Stage 2.

3. Mobile— With more than 50% of patients using their smartphone to monitor health and more than 50% of physicians using (or wanting to use) their smartphone to monitor patient health, and with seamless data sharing on its way, the way care is delivered will truly change.

Telemedicine is showing significant gains in delivering primary care. We will continue to see more adoption of mobile-enabled services for ambulatory and specialty care in 2016 and beyond for three reasons:

  • Mobile provides “situational awareness” to all stakeholders so they can know what’s going on with a patient in an instant and can move the right resources quickly with the push of a button.
  • Mobile-enabled services radically reduce communication overhead, especially when you’re dealing with multiple situations at the same time with urgency and communication is key.
  • The services can significantly improve the patient experience and reduce operating costs. Studies have shown that remote monitoring and mobile post-discharge care can significantly reduce readmissions and unnecessary admissions.

The key hurdle here is regulatory compliance. For example, auto-dialing 9-1-1 if a phone detects a heart attack can be dangerous if not properly done. As with the EHR, mobile services have to be designed around physician workflows and must comply with regulations.

4. Big data— Healthcare has been slower than verticals such as retail to adopt big data technologies, mainly because the ROI has not been very clear to date. With more wins on both the clinical and operational sides, that’s clearly changing. Of all the technology capabilities, big data can have the greatest near-term impact on the clinical and operational sides for providers, and it will be one of the biggest trends in 2016 and beyond. Successful companies providing big data solutions will do three things right:

  • Clean up data as needed: There’s lots of data, but it’s not easy to access it, and isn’t not quite primed “or clean” for analysis. There’s only so much you can see, and you spend a lot of time cleansing before you can do any meaningful analysis.
  • Meaningful results: It’s not always hard to build predictive analytic models, but they have to translate to results that enable evidence-based decision-making.
  • Deliver ROI: There are a lot of products out there that produce 1% to 2% gains; that doesn’t necessarily justify the investment.

5. Internet of Things— While hospitals have been a bit slow in adopting IoT, three key trends will shape faster adoption:

  • Innovation in hardware components (smaller, faster CPUs at lower cost) will create cheaper, more advanced medical devices, such as a WiFi-enabled blood pressure monitor connected to the EHR for smoother patient care coordination.
  • General-purpose sensors are maturing and becoming more reliable for enterprise use.
  • Devices are becoming smart, but making them all work together is painful. It’s good to have bed sensors that talk to the nursing station, and they will become part of a top level “platform” within the hospital. More sensors also mean more data, and providers will create a “back-end platform” to collect, process and route it to the right place at the right time to can create “holistic” value propositions.

With increased regulatory and financial support, we’re on our way to making healthcare what it should be: smarter, cheaper and more effective. Providers want to do whatever it takes to cut costs and improve patient access and experience, so there are no real barriers.

Innovate and prosper!

5 Tips to Reduce Outpatient Lawsuits

If a patient or her attorney believes a physician is responsible for a bad outcome at an outpatient medical facility, the facility itself will be sued, not just the physician. Therefore, it is up to the facility to have established procedures and protocols in place to deter the risk of lawsuits. Here are five tips for outpatient medical facilities that may help reduce the risk of lawsuits.

#1. Good patient communication

Communication is the No. 1 issue in any medical setting – outpatient care is no exception. Within outpatient services, patients don’t typically have the same depth of relationship with the doctors as they do with their own primary physician. This often makes them more inclined to pursue legal action in the case of a bad outcome or adverse event. If facility physicians and staff take even a few minutes of extra time to answer all questions and address all concerns, patients and their families will walk away feeling as though they had all the information – even if a bad outcome occurred.

#2. Confirmation of informed consent

The patient is at the outpatient facility because of a medical problem – usually determined by his primary physician – who then referred him to the outpatient facility. It is the facility’s job to confirm that informed consent has occurred between the patient and physician, so policies must be in place to ensure this happens with each and every patient encounter. Patients must be informed of the details of the procedure, the risks and benefits and any alternative treatment options. A procedure should not be performed until informed consent has been confirmed. When patients or their families feel they were provided all available information, they are much less likely to pursue a lawsuit in the case of an adverse outcome.

#3. Proper documentation

Documentation can make or break a case when attorneys become involved. Be sure everything is documented, including all test results as well as the date, time and subject of all conversations with both the referring physician and patient. In the event of an adverse outcome where the court becomes involved, the ability to show all conversations is essential. For example, it can be invaluable to show that the referring physician was spoken to on a specific date and that the patient was given specific recommendations.

#4. Thorough and safe medical records

The outpatient setting leaves many opportunities for accidental breaches simply because so many patients are cycled through the facility on any given day. Printed medical records must be kept safe and strictly out of the public view – and that includes being locked away each night. It’s essential that facilities have protocols in place that diligently track the security of medical records at every step.

#5. Prompt diagnosis

Patients often don’t realize how long it may take for medical tests to return. Some lab tests can take days or weeks. Outpatient medical facilities must have an efficient procedure in place for obtaining results and delivering them to patients and the ordering physician in a timely manner. Let’s say a patient had an MRI because of an unidentified growth in breast tissue. If the MRI indicates suspicion for cancer, how does the facility ensure that test results aren’t getting lost in the shuffle? The cancer could spread and lead to a bad outcome. A system of checks and balances must be in place that helps the ordering physician see the results, and act quickly based on the findings. In an outpatient facility, all staff must be informed as to which test results need to be called in to the referring physician immediately.

Bottom Line – All of these reasons come back to the No. 1 issue: communication. For a busy outpatient facility, it can feel as though there simply isn’t enough time to talk to patients, but, from a risk management perspective, the importance cannot be stressed enough. It’s important to take the time to communicate every step of a patient’s care with her – to listen and answer her questions. Not only does this help to build trust, it can also minimize the risk of a lawsuit. Excellent communication between the provider and patient almost always creates a “win-win” situation.