This CNO has advice for the huge challenges facing nurse leaders as we enter the new year.
As we dive into the new year, CNOs must be prepared to deal with the new and ongoing challenges facing the nursing industry.
Lisa Dolan, Senior Vice President and Chief Nursing Officer at Ardent Health Services, has laid out what she thinks are the five biggest issues that CNOs will face in 2024.
For more information, check out the full article here.
The great termination? More organizations are terminating payer contracts amid heated negotiations, and Medicare Advantage is in the hot seat.
The payer/provider battle is raging, and signaling what may be an emerging trend: More organizations are fighting back against payers by terminating their contracts completely, and Medicare Advantage (MA) has seemingly been the focus.
Thanks to record inflation and operational challenges, hospital and health systems find themselves with their backs against the wall in negotiations, leading CFOs to initiate contract terminations.
But what exactly has led to the turmoil? CFOs say the reasons are vast.
“Bad behavior.”
More organizations are now considering contract terminations due to dissatisfaction with reimbursement rates and overall bad payer behavior.
Healthcare providers have been arguing for years that insurance payers often set reimbursement rates at levels that are lower than the actual cost of providing care. Couple this with skyrocketing inflation costs and labor expenses, and providers can be left with no other choice.
When reimbursement rates are significantly lower than the cost of care and the administrative burdens are so high, healthcare providers may experience unsustainable financial losses. These underpayments along with egregious denials are pushing providers to the limit.
In such cases, CFOs may weigh the option of contract termination as a last resort to protect the financial stability of the organization.
“There is rarely one final straw, but rather, a cumulation of events that negatively impact the fiscal viability of the relationship,” Britt Berrett, managing director and teaching professor at Brigham Young University and former CEO with HCA, Texas Health Resources, and SHARP Healthcare, explained.
“Long before rates become contentious, hospitals are dealing with bad behavior and payer shenanigans,” Berrett said.
For example, he says, payers are rejecting claims based on utilization review criteria. Many healthcare leaders consider these rejections to have little to do with utilization but rather an attempt to refuse payment.
Luckily for providers, organizations are becoming more capable of cost accounting and utilizing analytics to determine the actual cost by patient and payer.
Why Medicare Advantage?
Why has MA been in the hot seat of terminations? While not the only culprit of the turmoil, organizations have been fighting back against MA’s low reimbursement rates for years, and as Berrett said, maybe CFOs are finding no fiscal viability in the relationship with the payer.
One case in point is Scripps Health. Two medical groups within the system canceled their MA contracts for 2024 because of low reimbursement rates, denials, and administrative costs to manage high utilization and out of network care.
“We’re unfortunately on the vanguard of what I think is going to be a very ugly few years between hospitals and commercial insurance companies,” Chris Van Gorder, president and CEO of Scripps, told USA Today.
And Scripps has the resources to better manage these burdens, meaning these burdens are even more exacerbated for smaller systems.
An example of this is Samaritan Health Services. It recently terminated its commercial and MA contracts with UnitedHealthcare.
The five-hospital, nonprofit health system cited slow processing of requests and claims that have made it difficult to provide appropriate care to UnitedHealth's members, according to a news release from Samaritan.
“This, along with other factors, is not in alignment with our mission of building healthier communities together,” the health system said.
Another example is St. Charles Health System, a four-hospital network and healthcare company in Central Oregon, which terminated its MA contracts in 2023.
Steve Gordon, president and CEO of St. Charles, said great thought went into the decision to reevaluate MA participation, and it was done only after years of concerns piled up not just at St. Charles, but at health systems throughout the country.
“The reality of Medicare Advantage in central Oregon is that it just hasn’t lived up to the promise,” he said in a press release. “A program intended to promote seamless and higher quality care has instead become a fragmented patchwork of administrative delays, denials, and frustrations. The sicker you are, the more hurdles you and your care teams face. Our insurance partners need to do better, especially when nurses, physicians and other caregivers are reporting high levels of burnout and job dissatisfaction.”
It's also worth noting that Memorial Hermann Health System, the largest hospital system in the Houston region, terminated its agreement with Humana's MA networks at the beginning of the new year. Memorial Hermann has not yet publicly cited why, other than saying the contract negotiations hit an impasse.
OK, but what’s the outcome of termination?
But what is it like on the other side of an MA termination? It hasn’t been so bad for some.
Hamilton Health Care System, a not-for-profit, fully integrated system of care serving the northwest Georgia region, has been out of network with MA for years.
“We are not currently in network with any Medicare Advantage plans. We would end up netting less than traditional Medicare because of denials and administrative hassles,” said Julie Soekoro, EVP and CFO at Hamilton Health Care System.
In addition to a lessened administrative burden, being out of network hasn’t affected Hamilton’s bottom line or patient experience.
“Since we are out of network, the MA plan should be paying us as if the patient were a regular Medicare patient, so it has not affected the patients adversely,” Soekoro said.
All the time and money spent on takebacks, pre-authorizations, and denials add up. Coupled with the aforementioned low reimbursement rates, CFOs can find it doesn’t make business sense to continue with the payer.
MA isn’t the only difficult payer, though; the challenge is universal.
For example, Hamilton Health Care has spent a lot of time going back and forth on a contract with a national payer that wanted to bring them in network, only for Hamilton to walk away from the negotiation table.
“After spending a great deal of time and effort modeling the contract, we learned the payer will require all diagnostic imaging business to go to a freestanding competitor, while building in very attractive looking rates for imaging,” Soekoro said. “This is misleading in that they never intended to allow their subscribers to come to us for imaging.”
“This was discovered incidentally by our contracting director, rather than fully disclosed by the payer,” she added. “Also, certain provider-favorable terms that we built into the language have mysteriously fallen out of the most recent version of the language.”
As stated, Hamilton walked away from that particular negotiation.
Another example comes from Berrett and his time at Texas Health Resources.
While Berrett didn’t specify the type of plan (MA or otherwise), the organization terminated a payer contract because its patients had significantly higher CMI, resulting in losses for their patients.
“The impact [of terminating the contract] was very positive for the hospital. We lost volume but improved margins,” he said. “The payer was able to promote a significantly lower premium for companies because their rates to the providers were so low. When we terminated the agreement, they could no longer sell lower premiums and their market share dwindled. They eventually retreated from the market.”
What does the future hold?
It’s worth noting that the trend of MA terminations is not a common occurrence with the nation's health systems—yet. In fact, several health systems expanded their own 2024 MA subsidiaries.
But that hasn’t stopped the critiques of the program from growing louder.
The Health and Human Services Department’s inspector general reported last year that some MA plans have denied coverage for care that should have been provided under Medicare's rules. On top of this, CMS and the Biden Administration have both proposed rules to address certain aspects of the plan’s requirements.
Even so, the payer/provider relationship is sure to remain heated in the coming year—even beyond MA.
“At the same time that community hospitals are struggling to stay out of the red, the national payers are reporting profits in the billions in their quarterly earnings reports,” Soekoro said.
“It feels to me like the payers became accustomed to taking in premiums during the volume downturns of the COVID years when patients shied away from seeking follow through on regular—and sometimes even urgent—healthcare needs,” she said. “Now the payers seem to be looking for ways to sustain those increased quarterly earnings.”
As for the providers, CFOs could have more leverage in negotiation talks than they think, but it requires willingness and preparation to pull levers that may be uncomfortable yet necessary for financial survival.
Dropping a payer is “absolutely an important strategy,” Berrett says. “Providers are becoming more capable in measuring the impact of the slow or rejected payments, and providers are looking at the actual cost of care by patient. Payers need to be aware that.”
There are two important considerations for providers, Berrett says.
“Are we able to collect our negotiated rates, and are the patients covered by this payer more expensive to treat?”
A study released today by researchers at Mass General Brigham focuses on the safety and quality of care in the Hospital at Home program, which will be discussed in at least one panel session at this week’s CES 2024 show in Las Vegas.
Advocates are touting a first-of-its-kind national study of Hospital at Home outcomes to convince the Centers for Medicare & Medicaid Services to make reimbursements permanent.
The study, led by researchers at Mass General Brigham and funded by the National Institutes of Health, analyzed clinical outcomes for almost 5,900 patients who were treated in CMS-approved Acute Hospital Care at Home (AHCaH) programs across the country. The research, posted today in theAnnals of Internal Medicine, found that those patients saw a lower mortality rate than if they were hospitalized, incurred fewer rehospitalizations, and spent less time in a skilled nursing facility (SNF).
More than 300 health systems and hospitals have launched Hospital at Home programs since CMS created a waiver for the program in 2020, enabling health systems who follow the agency’s guidelines to qualify for Medicare reimbursements. Other health systems have developed their own acute care at home programs, aimed at reducing stress on inpatient services and giving patients an opportunity to recover more quickly and effectively at home.
The study helps advocates who are lobbying CMS to make the AHCaH waiver, which is scheduled to expire at the end of this year, permanent. Many health systems are dependent on the waiver to sustain their programs, and are struggling to expand or develop long-term plans with the threat of losing that reimbursement.
The Mass General Brigham study was led by David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home, one of the first to develop an acute care at home program and study its benefits.
“For hundreds of years, since the inception of hospitals, we’ve told patients to go to a hospital to get acute medical care,” Levine said in a Mass General Brigham press release issued today. “But in the last 40 years, there’s been a global movement to bring care back to the home. We wanted to conduct this national analysis so there would be more data for policymakers and clinicians to make an informed decision about extending or even permanently approving the waiver to extend opportunities for patients to receive care in the comfort of home.”
Levine and his colleagues analyzed Medicare fee-for-service Part A claims filed between July 2022 and and July 2023 for 5,858 patients across the country who had been treated in AHCaH programs. Of that group, roughly 42.5% were being treated for heart failure, 43% for COPD, 22% for cancer, and 16% for dementia. The mortality rate for that group was 0.5%, the escalation rate (returning to the hospital for at least 24 hours) was 6.2%, and within 30 days of discharge, 2.6% used an SNF, 3.2% died, and 15.6% were readmitted.
“Home hospital care appears quite safe and of high quality from decades of research — you live longer, get readmitted less often, and have fewer adverse events.” Levine said in the press release. “If people had the opportunity to give this to their mom, their dad, their brother, their sister, they should.”
Levine also noted that the study found no differences in outcomes for underserved patients, indicating the program could help address some of the barriers that patients face in accessing care.
“There are a number of reasons we think hospital-level care is better at home,” he said. “For one, the discharge process is smoother since we show patients how to take care of themselves right in their homes, where they are also more likely to be upright and move more. In addition, the clinical team has a greater ability to educate and act on the social determinants of health that we see in the home. For example, we can discuss a patient’s diet right in the kitchen or link a patient with resources when we see the cupboards are bare.”
Levine’s colleague, Jared Conley, MD, PhD, MPH, associate director of the Healthcare Transformation Lab at Massachusetts General Hospital, said during a HealthLeaders virtual summit in 2023 that the Hospital at Home program could eventually surpass inpatient care as the highest quality acute care program. The challenge, he said, lies in balancing in-person care with virtual and digital health technology to achieve the best results.
"Think of this as building another brick-and-mortar hospital," he said. "It is very challenging work, but it is so beneficial."
The Hospital at Home concept will be discussed during a panel at this week’s 2024 CES event in Las Vegas. Conley will be taking part in a Thursday panel titled Revolutionizing Health Through Smart Home Innovation, which will be moderated by HealthLeaders Senior Editor Eric Wicklund.
An AI driven tool used by Mercy and called the Chen Chemotherapy model is helping patients steer clear of complications after chemotherapy
With the potential to reduce workloads, streamline services, and aid in patient care quality, AI is rapidly becoming a popular tool in healthcare.
The technology has now entered the cancer care unit. The Mercy healthcare system is using AI to help cancer patients - by texting them.
Often, chemotherapy patients find themselves struggling with side effects such as general pain, fever, diarrhea, fatigue, and vomiting; these are red flags that frequently lead to hospitalizations. According to a study by the National Institutes of Health, “of 18,486 patients who received chemotherapy for metastatic cancer, 92% were hospitalized at least once for any reason, including 51% hospitalized for a likely toxicity.”
Care units need a way to track these symptoms before they lead to patient hospitalization. Enter the Chen Chemotherapy model.
Named after lead data scientist Jiajing Chen, who lost their own battle with cancer in 2023, the model notifies doctors before these symptoms become severe, keeping patients out of the hospital.
The program works by creating a risk score for non-leukemia chemotherapy patients over 18 years old. As the program learns, it’s able to predict how likely it is that a patient who is experiencing symptoms will be hospitalized within 30 days after their chemotherapy treatment.
Once patients are opted into the smart texting platform, they will receive a text each day for seven days, minus weekends and holidays, to monitor their symptoms. When a patient selects a symptom, they rate it and, based on their answers, the information may be sent to their provider.
Prior to this model, providers were oblivious as to which patients were experiencing problems until patients called or showed up at the emergency room.
This tool allows providers to be more involved in the process of chemotherapy recovery.
“The Chen Chemotherapy Model and smart texting allows us to proactively manage these patients and identify when they are having problems earlier in the journey,” Jay Carlson, DO, medical director of Mercy oncology service line, said in a press release. “This means they may be able to be treated in the office, recover faster and feel better overall.”
The success of AI in cancer care has led to the development of several other tools by different creators. Last year a neurobiology and human genetics professor at the University of Utah, along with a 20 person team, created an AI algorithm to help identify more than 200 ‘micro-symptoms’ for cancer patients, such as behavior, speech, and vocal patterns. These range from abnormal neurological phenotypes and eye movements to sadness in the vocal tone. A clinical trial of the tool is scheduled to start in January 2024 at the Moffitt Cancer Center. Identifying these small changes can help assess how patients are handling the treatment and can even predict changes in future symptoms.
Healthcare providers have also been using AI to improve breast cancer screenings. According to The Lancet Oncology, a recent survey of 80,000 women in Sweden found that, when put up against two experienced radiologists, AI-enabled breast cancer screenings outperformed their standard readings.
Cancer is the second leading cause of death in the U.S., compelling the need for new innovations and screening technology. In recent years the U.S. Food and Drug Administration has approved more than 500 AI and machine learning-enabled medical devices, ranging from imaging software to remote cardiac monitoring devices.
Burnout is everywhere, and it has become a matter of patient safety.
It’s no secret that nurses and healthcare professionals across the industry are burnt out.
Nurses are feeling overworked and undervalued, and since the COVID-19 pandemic and the massive nursing shortage, it has only gotten worse.
Nurse and nurse practitioner burnout is known to have a direct impact on the patient’s experience, and now it’s leading to more emergency department visits.
A recent study from the Columbia School of Nursing found two pieces of key information: A sizeable proportion of primary care nurse practitioners are burnt out, and primary care practices with higher rates of nurse practitioner burnout are seeing higher rates of older patients with chronic conditions receiving acute care.
The problem
Out of the nurse practitioners included in the study, 26.3%, or more than 1 in 4, reported burnout, which is comparable to the levels of burnout amongst other clinicians, such as physicians and registered nurses. According to the authors of the study, Lusine Poghosyan, PhD, MPH, RN, and her colleagues, these numbers should cause concern, and they indicate the need for more attention and research on burnout among nurse practitioners, since most of the research currently available was conducted on physicians or registered nurses.
The effects of burnout on patient care go beyond nurse practitioners. The authors cite previous research that states that hospitals with high nurse burnout rates have extended lengths of stay and greater odds of patient mortality. This new study clearly supports the idea that burnout is affecting patient safety, and that addressing burnout must be a priority for health systems.
The study also offers an alternative explanation to blaming exhausted clinicians for lack of care quality. The authors suggest that there are broader failures within health systems that have policies and working conditions which lead to burnout.
So, what’s the solution?
In the study, the authors state that poor work environments for nurse practitioners are those where there is a “lack of autonomy, inadequate support for care delivery, and poor relationships with practice administrators.” These issues carry over into all of nursing, where there are continuous calls for better working conditions and more support from health systems.
CNOs have a responsibility to their nurses to deliver better working conditions and help them maintain a better work-life balance. According to Lisa Dolan, Senior VP and CNO at Ardent Health Services, there are many things that can be done to help solve this issue.
“One of the initial things is just to be open and talk about burnout,” she says, “and recognize that it’s a real situation.”
Dolan suggests implementing wellbeing check-ins and debriefings after serious incidents, and potentially offering support programs for new mothers or those caring for aging parents. She also emphasizes the importance of celebrating wins as they come, and using patient feedback as a method of uplifting nurses’ spirits.
“If we have great outcomes,” Dolan says, “let’s celebrate every opportunity we [can].”
Maribeth McLaughlin, Chief Nurse Executive and Vice President at UPMC, chats with nursing editor G Hatfield about workforce challenges, team-based models, travel nurses, and the different strategies CNOs can use to improve recruitment and retention.
The annual consumer technology event, expected to attract more than 100,000 attendees to Las Vegas next week, will showcase the latest in innovative technology, as well as digital health trends affecting the healthcare industry
Healthcare executives gearing up for the 2024 International CES event next week in Las Vegas are focusing on one big question: How can I use consumer technology and digital health tools to improve the healthcare experience for my patients?
That’s always been the question for healthcare decision-makers intrigued by the massive consumer technology show, which takes over nearly every hall in the Las Vegas Convention Center and Venetian and is expected to draw 130,000 attendees this year. But while healthcare has long been overshadowed by cars, games, entertainment systems, and the odd robot and smart birdfeeder, digital health is now an integral part of the show, with its own space and session track.
The challenge lies in identifying the trends and technologies that hold value for healthcare executives, not just the latest and most innovative gadgets for consumers that a hospital or doctor might like to use. Health systems have long sought to integrate clinical uses with consumer technology to spur adoption and continued engagement, with often mixed results.
That’s especially true in this economy, which leave little room for innovation.
“CES is an opportunity for these digital health innovations to shine brightly in a dark moment in medicine as we face more hospital closures, high rates of clinician burnout, and increasing demand from consumers for a better experience,” Arielle Trzcinski, a principal analyst with Forrester, said in an e-mail to HealthLeaders.
Among the hot topics are, of course, AI, digital health apps, wearables, remote patient monitoring (RPM) tools and platforms, and smart technology in the home setting, a highlight of two concurrent events at CES, the CONNECTIONS Summit hosted by Parks Associates and AARP’s AgeTech Summit. The latter will feature the Samsung Health House, a smart home designed by Samsung in collaboration with AARP to show how seniors can age in place in the future.
“As medical deserts emerge for consumers, there is a growing opportunity for health systems and health insurers to tap into remote monitoring and wearables to empower consumers and keep them connected to much needed care,” Trzcinski added.
For healthcare execs focused on digital health, CES is bringing back its Digital Health Summit, a series of panels taking place Tuesday and Wednesday.in Room 250 of the Las Vegas Conference Center’s North Hall:
Other events of interest for healthcare executives include keynotes by the CEOs of Siemens, Walmart, Intel, Elevance Health, Qualcomm, and Best Buy, along with the CES Innovation Policy Summit, which includes a session titled Can Policy Affect Health Innovation? , a panel on AI governance around the world, and a special series of interviews, called “Conversations with a Commissioner,” that includes FDA Commissioner Robert Califf, FTC Commissioner Rebecca Slaughter, and FCC Commissioners Brendan Carr and Anna Gomez.
And finally, CES gives healthcare executives an opportunity to see where innovation is going in the consumer tech space, even if it is a bit far-fetched for hospitals and health systems at this time. They can look at unique ideas such as smart toilets, toothbrushes and home appliances, footwear and apps that track gait and balance, digital health tools for veterinarians, wearables, health and wellness apps, new sensors that track biometric data, and AR and VR tools.
According to this CNO, here’s what nursing leaders are facing in the new year.
2024 is gearing up to be another hectic year for healthcare. With the never-ending stream of new AI technologies on the rise, and the upcoming presidential election, there are sure to be some curveballs thrown at the entire industry, including nursing.
While the impacts of these changes cannot always be predicted, there are many trends that can be.
To get a glimpse at what to expect in nursing this year, we sat down with Lisa Dolan, CNO at Ardent Health Services, to discuss what she thinks are the top five biggest challenges facing CNOs, and the impacts of new technologies and virtual nursing.
This transcript has been edited for clarity.
What do you predict will be the top 5 biggest challenges in nursing in 2024?
Well, of course, at the top of the list is just the supply of nurses. The demand is far outpacing the supply. So that'll be a key piece.
Second to that is stabilization of support roles. As nursing becomes more and more taxed, it's especially important that we have a support team around the nurse. We're finding it more and more difficult to be competitive in our staffing of support roles. That's a that's a key worry and concern as well.
I think another key piece is innovation. There's so much great innovation going on, but how we incorporate that so that it's helpful to the nurse and not adding additional burden to the nurse is especially important.
Frontline nursing leaders and being able to retain the nursing leader. That's a very difficult position, in fact, I always say it's one of the toughest positions in the hospital. Being able to retain and support those frontline leaders will be key.
And then last but not least is really just burnout in general of the clinical staff. The roles are so difficult at times, and so [having] a healthy work environment for people to feel comfortable and not experience the rate of burnout that they have over the past several years [will be critical].
What can CNOs do to help mitigate those challenges?
Well, probably one of the biggest things is just to create efforts that reenergize their communities and their markets around nursing and healthcare careers in general. I think COVID-19 initially painted healthcare workers in a positive light, and on the heels of COVID-19 we had a lot of people think, “Gosh, I really don't know that I'd want to do that for a living.” So, really trying to help reenergize the public about healthcare careers and how fulfilling they can be is a key piece and a key role for the CNOs going forward in their communities.
Additionally, I think really creative partnerships with academic settings to help produce more healthcare workers. We've got healthcare settings that need support and staff, but then the academic settings also need help and are short staffed. If we can be creative in our partnership efforts with those academic settings to help augment their staffing and clinical instructors, and allow them to take additional students, [that] would all be very helpful as well.
What do you foresee being the next technological trend in nursing next year? How can that technology aid CNOs and their teams?
There's several that I wanted to make sure that I mentioned. I think virtual care and virtual care platforms are key for our future. Virtual care in nursing can assist with data collection. We can help admit patients, discharge patients, do patient education, family education. There are many things that a virtual nurse can assist a bedside nurse to complete and do, and actually feel like they have more time to spend with the patient. So that's a key piece.
Additionally, I think virtual provider support, and what I mean by that is bringing specialist to the bedside, and that might be a specialist in nursing, to offer support to maybe a newer nurse, or it could be a certain specialist physician to see a patient. Where those resources might be scarce, it can help bring that provider or that specialist to the bedside much quicker. So that whole virtual platform is going to be a huge benefit to nursing and bedside care in general.
One of the other pieces that's pretty significant are wearable technologies to monitor vital signs and monitor the patient's status. So that is just going to open [everything] up. One, it allows more continuous monitoring of vital signs. It frees [up] the staff so they don't actually have to do the task of taking vital signs, but can spend time with their patients doing other things.
Then we have just that continuous and reliable monitoring that can then feed into systems, which takes me to AI and the future of taking that information and that data and helping to support the clinician to make decisions. [AI] can even add alerts and pick up things quicker to aid the team at the bedside.
So, lots of technologies. There’s also the whole notion of smart rooms, and creating smart room technology that allows you to monitor patient movement within the patient room. You can look for things like patients who are at risk of falling that might be sitting out of bed, or is a patient turning as often as they should, and then driving alerts to the team to help with an intervention if needed.
One really exciting piece is the smart room that can hear and listen, so the opportunity might be there for transcription, or [doing] documentation just by talking through the room and having that assist with my documentation. Or, if I'm in a potential safety situation, then I could say keywords or call for assistance and be able to get help if I needed it in the room.
What do you think the impact of remote patient monitoring and virtual nursing will be?
I think what we're going to see is significant impact to certain outcomes. I would anticipate that virtual care is going to be able to help us manage our length of stay for patients. It'll eliminate some delays, possibly, in a specialist coming to the bedside. I think we'll be able to pick up on patient deterioration much quicker if we've got continuous vital sign monitoring.
I think that the assistance it provides will help retain nurses, because it's going to free their time from doing tasks, [and] maybe they can use that time to spend with patient at the bedside, with emotional support, actually caring and [doing] compassionate activities with a patient, which is going to be very fulfilling for the nurse. That's typically why nurses go into this career. It frees them up from doing being so task focused and allows them to really take care of activities that are much more fulfilling and provide the patient with support.
How can CNOs help their staff avoid burnout and maintain a healthy work-life balance?
Gosh, there's a lot that can be done. I think one of the initial things is just to be open and talk about burnout and recognize that it's a real situation. We can do things like having well-being check ins, [or] debriefings after a serious patient event, [and] we can do things creatively to help our staff adjust with key life events. You know, maybe offer support programs that are geared toward new moms or people who are taking care of aging parents.
I think the thing that we forget so often is just to recognize people and celebrate wins. If we have great outcomes, let's celebrate every opportunity we have, and then make sure that we harvest especially patient feedback to recognize our nurses anytime we can.
Are there any other trends you’re seeing that you think will continue into the new year?
I think we're going to see continued emphasis on quality and safety measures. That whole focus of pay for performance and meeting all of those key metrics is going to continue to be really important.
I think we're going to see a transition. I know that at Ardent, we will see a transition from a focus on patient experience in the hospital to almost a consumer experience across the care continuum. So, what is the experience for our patients when they interact with the system? That might be making appointments, it may be their experience when they access their information through their epic chart. Those are all key things.
I think the other piece that we'll see a lot of is different pilots on care delivery models. Because we know we don't have enough nurses to support historic approaches, we'll see people do different team approaches to care. The ability for people to work as a collaborative group and come together and care for a patient, I think it's going to be key into the future over the next year.
New research from the Regenstrief Institute gives health system executives specific recommendations on how to use their EHRs to help clinicians identify and prescribe drugs to their patients.
New research out of the Regenstrief Institute gives health system executives specific recommendations on how to use EHRs to reduce dangerous drug-drug interactions.
“Drug-drug interactions are very common, more common than a lot of people outside the healthcare system expect,” Michael Weiner, MD, MPH, a researcher with the US Department of Veterans Affairs, Regenstrief Institute, and Indiana University School of Medicine and senior author of the study, said in a press release. “In the US, these interactions lead to hundreds of thousands of hospitalizations in any given year at an enormous cost. Most of these drug interactions are preventable.”
With the advent of EHRs and digital health technology, health systems are looking to reduce those interactions by pinpointing when they can occur and giving clinicians on-demand access to information to prevent them. But that technology depends on understanding how clinicians prescribe drugs and how they look for dangerous interactions.
“This study was needed because we previously didn’t have a great understanding of how clinicians actually make decisions in assessing these interactions,” Weiner said. “No one had really taken apart the thinking process step-by-step to understand it from the beginning to the end. There's a patient, there's a drug and another drug. There is now a potential interaction. There's been a decision about how to resolve it following an assessment and then a resolution process. Understanding all this is very important if we are hoping to design improvements to the medical system that enhance patient safety.”
The study, recently published in BMJ Open, identified 19 information cues used by clinicians to manage drug-drug interactions, including information on the potential severity of a drug reaction, side-effects, a patient’s expected duration of exposure to an interaction, patient-specific conditions, a patient’s need for those drugs, and the characteristics of safer medications. Using that list, Weiner and his colleagues developed recommendations for designing alerts through the EHR.
They are:
Provide information on the expected range of timing of potential drug-drug interaction effects (days, weeks, months, or years).
Give clinicians a platform to review multiple electronic drug-drug interaction reference sources directly from the alert, side-by-side.
Leverage data analytics to populate drug-drug interaction alerts with "smart" displays of alternative drugs that align with three criteria used by clinicians.
Provide recommendations on the alert along with associated patient characteristics (for example, “monitor, if patient indicates willingness and capability of measuring blood pressure daily”).
Alissa Russ-Jara, PhD, a researcher at the Purdue University College of Pharmacy and US Department of Veterans Affairs, Regenstrief Institute affiliated scientist, and the study’s lead author, said the research highlighted the fact that no two clinicians use the same protocols in assessing drug-drug interactions.
After interviewing all of the clinicians involved in the study, she said in the press release, “many … expressed surprise at how much nuance went into their own decision. Their decisions often occur so rapidly, yet involve so much expertise. Ours was the first study to really unpack that for their decisions around drug-drug interactions.”
“We expect our findings can improve the design and usability of drug-drug interaction alerts for clinicians, and so they can more effectively aid patient safety,” she added. “Our study focused on clinical decision-making, regardless of whether the clinician was warned by an alert or not, so our findings have implications for clinicians, informatics leaders, and patients, and for any EHR system.”
The use of EHRs has grown substantially over the last decade, but patients still face problems getting to their health data
EHRs may be commonplace in healthcare, but that doesn’t mean everyone can access them, according to a new report from the Health and Human Services Department’s Office of the National Coordinator for Health IT.
Now that patients have had a taste for easy access to their health records, they’re demanding more. During the pandemic, patients wanted access to their records following a telehealth visit and to obtain COVID 19 test results. More patients also wanted to message their providers following the pandemic, at a rate of 53% in 2018, and climbing up to 64% in 2022.
Healthcare apps have made access to records even easier, and by 2022 more than half of patients were using apps to access their EHR data. They were also looking at their records more frequently than web-based portal users. In 2020 the ONC’s Cures Final Rule Act required certified health IT developers to create broader patient access through apps with standards-based application programming interfaces (APIs).
According to the ONC, healthcare organizations are seeing three barriers to patients being able to access their data:
Not All Apps Are Created Equal
Currently, a majority of patients are not using emerging third-party apps that have adopted APIs; Instead, they’re using apps provided by their healthcare provider or an online patient portal. APIs make information more widely available across smartphone apps, and they do so in a more secure method than other apps and web-based portals. By encouraging patients to use these API based apps, healthcare providers can ensure their patients are easily accessing their data in the most secure manner.
But What Does It Mean?
Another problem with EHR technology is that they don’t offer detailed explanations of diagnoses or test results. Patients may have access to their health records, but that doesn’t mean they understand them, especially complicated diagnoses. Research shows that patients like having timely access to their test results on their patient portal, rather than waiting for a call from their doctor. Going forward, health IT developers will need to monitor this and evolve the technology to add more context for patients.
Disparities and Barriers
Lastly, certain populations still face barriers to accessing their medical records. There are “disparities in patient access by race and ethnicity, education, income, and other socio-demographic factors,” according to a study by the Health and Human Service Department’s Office of the National Coordinator for Health IT. Other barriers include internet access, health literacy, and language. Although the ONC provides resources for patients to access and manage their health records through different methods, this issue persists.
The healthcare industry’s rocky relationship with EHRs will continue as long as patients have problems accessing their information. Providers need to step up and take action to ensure all patients have access to, understand, and can manage their health records
