Hospitals will be seeing a payment bump for cases that report homelessness.
CMS recently released the fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) final rule. Along with its yearly payment rate changes, the final rule placed a focus on promoting high-quality care and rewarding hospitals that deliver such care to underserved populations.
Notably, CMS finalized a higher severity level designation for three different social determinants of health (SDOH) codes describing homelessness.
More than 80% of hospitals are collecting data on SDOH—many right through their EHR platform and health information exchanges—yet only half of those hospitals are collecting data regularly. As revenue cycle leaders continue placing a heavier focus on capturing SDOH codes, having CMS continue to increase reimbursement rates will continue to promote their use.
CMS has changed the following codes from the severity designation of "non-complication or comorbidity" to "complication or comorbidity," thus increasing their reimbursement rate:
Z59.00, Homelessness unspecified
Z59.01, Sheltered homelessness
Z59.02, Unsheltered homelessness
According to CMS, after a data analysis of claims data tracking the impact on resource use generated for hospitals, CMS finalized the changes based on the higher average resource costs of cases with those ICD-10-CM diagnosis codes in comparison to similar cases without these codes.
In a news release, CMS stated, “This action is consistent with the Administration’s goal of advancing health equity for all, including members of historically underserved and under-resourced communities … As SDOH diagnosis codes are increasingly added to billed claims, CMS plans to continue to analyze the effects of SDOH on severity of illness, complexity of services, and consumption of resources.”
CMS also finalized changes to The Hospital IQR program, with an increase in operating payment rates of 3.1%. “As part of CMS’ health equity goals, we are rewarding hospitals that deliver high-quality care to underserved populations and, for the first time, also recognizing the higher costs that hospitals incur when treating people experiencing homelessness,” said CMS Administrator Chiquita Brooks-LaSure in the release.
“With these changes, CMS is laying the foundation for a health system that delivers higher quality, more equitable, and safer care for everyone,” Brooks-LaSure said.
Former ONC Chief Donald Rucker questions whether federal regulations around interoperability and information blocking are doing more harm than good.
Editor's Note: Donald Rucker, MD, led the Health and Human Services Department's Office of the National Coordinator for Health Information Technology (ONC) from April of 2017 until January of 2021. He is currently an adjunct professor of emergency medicine at Ohio State University and chief strategy officer for digital health software company 1upHealth.
The 21st Century Cures Act, passed almost unanimously by Congress after the 2016 election, included a key principle granting patients the right to direct digital access to their medical record using the apps of their choice.
Importantly, Congress identified two must-haves to allow patients to get that data. The first mandate requires 'APIs without special effort,' or standard APIs provided by each EHR rather than the proprietary one-off APIs that EHRs had grudgingly been offering. The second mandate gives patients a right to get the data even if the data was no longer available. Withholding information was defined as 'information blocking' and subject to civil penalties.
Donald Rucker, MD, former head of the Health and Human Services Department's Officer of the Coordinator of Health IT (ONC). Photo courtesy 1upHealth.
This modern app-enabling vision of computing in healthcare was defined in rulemaking by the ONC in the 2020 ONC Cures Act Final Rule. (By disclosure, I was the National Coordinator at the ONC during this work.) For APIs, the ONC required RESTful FHIR APIs with OAuth 2 security. This is the same architecture that powers the entire modern Internet economy, from apps on smartphones to websites on computers.
For information blocking, the ONC was required by the Cures Act to define allowable exceptions – i.e. when EHRs would not have to share data – and laid out common-sense exceptions based on privacy, security, and feasibility.
In conjunction with parallel rules from the Centers for Medicare & Medicaid Services (CMS) requiring similar modern APIs from payers, the stage was set for broad-based digital innovation using patient medical records. Access to patient medical records allows for richer and more effective apps. Think of medical apps without your chart in the same way as banking apps without your balance, airline apps without your frequent flyer number, entertainment apps without tailored recommendations, or shopping apps that don’t remember your address and billing information.
Congress anticipated that the tremendous consumer benefits we get from apps everywhere else would flow into healthcare. But now the ONC has released a rule that effectively removes this access.
How did this happen? That we can answer. Why did this happen? ONC and HHS Secretary Xavier Becerra will have to answer that.
The ONC’s proposal to effectively block patient digital access ties into a third provision in the Cures Act for the Trusted Exchange Framework and Common Agreement (TEFCA). The ONC was required to designate a coordinating entity, which was The Sequoia Project. The Sequoia Project proposed using a 1990s IHE document exchange-only interchange protocol mediated by a network of brokers known as QHINs (Qualified Health Information Networks).
This is an arcane protocol that has hardly been used over the last 20 years. The IHE protocol supports document-only exchange. As a practical matter, use of the IHE protocol is limited to incumbent EHRs.
The IHE protocol predates core technologies including RESTful APIs, JSON and FHIR, and smartphones. It dates back to an era when the Internet was comprised of page-views and not individually computable data. Document-only exchange is very much like paper faxes. Fax documents provide minimal ability to compute without elaborate parsing software and limited clinical value since ultimately the file has to be read by a human.
TEFCA’s structure is anchored by QHIN brokers who are contracted to exchange documents. By stark comparison, most smartphone apps rely on extremely simple RESTful and similar API styles that are real-time and effectively near-zero cost.
Modern Cures Act apps are anchored by the same privacy and security provisions used to protect banking information and the Internet at large. It is highly unlikely that app developers could find programmers interested in learning the IHE protocol, let alone build a successful business model encumbered by brokers. TEFCA’s policies also provide many opportunities for EHRs to delay or deny data access with manual permissioning.
The ONC's proposed HTI 1 rule would allow EHR vendors to stop providing modern APIs to anyone who has ever needed to use TEFCA for any reason. The subtle regulatory language creates a near-total limitation for modern apps that may want to avail themselves of multiple data acquisition strategies. Since almost all medical records sit in legacy EHRs, this rule proposes that anyone who has ever needed a QHIN or TEFCA for any reason can be totally blocked from modern API use and access. The specific way the ONC proposes to do this is to allow the EHRs to 'information block' modern software by providing an 'information blocking exception' to the EHRs. In some cases, these EHRs are also QHIN brokers.
The ONC’s proposal effectively overturns the Congressional requirement for 'APIs without special effort.' It would allow global information blocking by the largest holders of medical data – data for which patients, employers, and taxpayers spend $4 trillion a year.
Why do TEFCA participants need an 'information blocking' license? It's because 'information blocking' is defined in the Cures Act as blocking the ability of patients to 'access, exchange, and use' their records. TEFCA precisely fits the Congressional definition of information blocking with access requiring payments to QHINs, exchange in a non-computable-document-only format, and use requiring antiquated software approaches.
The Sequoia Project has stated they will at some point use modern data formats (FHIR) though they miss the point that modern computing is not just about data formats but also low-friction APIs. Ironically, realizing TEFCA provides largely non-computable data, The Sequoia Project is now proposing meetings to see if computing could be done on their documents.
Ultimately this is all about competition. Legacy EHRs and their consolidated delivery system providers have been battling patient digital access and potential new competitors since the start of the Cures Act. The arguments against giving patients digital control of their health have largely been paternalistic, with EHR vendors (ironically some of whom plan to sell patients information via their owned QHINs) stating they are 'protecting privacy.' The ONC is now proposing a regulatory permission to information block.
If TEFCA works as claimed, there should be no reason for anyone to be concerned about information blocking. The Sequoia Project also states they will 'modernize' TEFCA, though they haven't provided technical details or said why they didn’t start with modern protocols to begin with.
The ONC should not be denying the American public modern digital access to their medical records by granting incumbent EHRs and delivery systems carte blanche to deny access. Obscure regulations tucked deep in a 500-plus-page proposed omnibus rule which require ancient approaches to computing under the guise of 'interoperability' and a 'digital on-ramp' consisting of a network of toll-taking brokers seems far from what Congress wanted for us in 2016 and what will advance healthcare in 2023.
We need a consumer economy in healthcare, where we can get the same prompt service we have when using our phones to shop, rideshare, or get dinner. We need a modern digital world so that devices and monitors on our smartphones help us to get and stay healthy. Let’s not stop the digital revolution before we start.
The agency will meet in September with interested parties to discuss a long-debated proposed registration for providers wishing to prescribe controlled substances via telemedicine without first conducting an in-person exam.
The US Drug Enforcement Administration may finally be open to giving healthcare providers more freedom to prescribe controlled substances via telemedicine.
The DEA has scheduled two public listening sessions, to take place on September 12 and 13, to discuss creating a special registration for providers who want to prescribe controlled substances without first conducting an in-person evaluation.
The notice marks a change in tone for the agency, which has long resisted creating that registration process even though it was mandated by Congress in 2008 through the Ryan Haight Online Pharmacy Consumer Protection Act. Telehealth advocates have long argued that providers should be able to prescribe certain medications without first needing an in-person exam as a way of expanding access to and treatment for mental health and substance abuse issues. Several members of Congress and the American Hospital Association have also chimed in, urging the DEA to take action.
Relaxed rules for prescribing controlled substances via telemedicine were included in waivers put in place during the COVID-19 Public Health Emergency, but the PHE ended in May. The DEA proposed a new set of rules set to take place after the PHE, then backtracked and extended the waiver for six months after those new rules drew strong criticism.
"Among the 38,369 comments submitted in response to the [proposed new rules] a significant majority expressed concern, with respect to at least some controlled substances, that the proposed regulations placed limitations on the supply of controlled substances that could be prescribed via telemedicine prior to an in-person medical evaluation," the DEA said in its meeting notice. "In addition, several hundred comments specifically raised the possibility of a separate Special Registration for those practitioners who seek to prescribe controlled substances without conducting an in-person medical evaluation of patients at all."
"DEA is open to considering—for some controlled substances—implementation of a separate Special Registration for telemedicine prescribing for patients without requiring the patient to ever have had an in-person medical evaluation at all," the agency continued. "DEA also observes that making permanent some telemedicine flexibilities on a routine and large-scale basis would potentially create a new framework for medicine that fundamentally expands access to controlled substances in a way that warrants a new framework for accountability based, in part, on increased data collection and visibility into prescription practices in order to ensure patient safety and prevent diversion in near-real-time."
With that in mind, the agency is asking those attending the upcoming meetings to consider the following questions:
If telemedicine prescribing of schedule III-V medications were permitted in the absence of an in-person medical evaluation, what framework, including safeguards and data, with respect to telemedicine prescribing of schedule III-V medications do you recommend to help the agency ensure patient safety and prevent diversion of controlled substances?
Should telemedicine prescribing of schedule II medications never be permitted in the absence of an in-person medical evaluation? Are there any circumstances in which telemedicine prescribing of schedule II medications should be permitted in the absence of an in-person medical evaluation? If it were permitted, what safeguards with respect to telemedicine prescribing of schedule II medications specifically would you recommend to help the agency ensure patient safety and prevent diversion of controlled substances?
If practitioners are required to collect, maintain, and/or report telemedicine prescription data to DEA, what pieces of data should be included or excluded? What data is already reported to federal and state authorities, insurance companies, and other third parties?
If pharmacies are required to collect, maintain, and/or report telemedicine prescription data to DEA, what pieces of data should be included or excluded? What data is already reported to federal and state authorities, insurance companies, and other third parties?
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The head of innovation and product discusses why healthcare shouldn't mimic either Amazon or the banking industry, but it should harmonize with the music industry's transformation.
The path to healthcare transformation isn't an easy one, and there are many examples of how to do things wrong. A health system has to invest in leadership that knows how to plan innovation strategy and develop the technologies and services that show true value and improvement.
HealthLeaders recently sat down (virtually) with Brian Mullen, head of innovation and product at The Clinic by Cleveland Clinic, to get his take on how healthcare should be evolving and where healthcare providers should look for inspiration.
Q: How do you define innovation within healthcare?
Mullen: Innovation in healthcare is simply about moving the field forward to improve quality of life outcomes.
If you’re involved in digital transformation at a healthcare organization, one of the first assumptions you need to abandon is the view that healthcare isn’t innovative. Healthcare is by far the most innovative industry in the world today. Considering the different stakes involved in healthcare and other technology delineates this point quite clearly: The challenges in healthcare aren’t often simply a matter of incremental improvement but more likely involve earth-shattering paradigm change like curing cancer, replacing a heart, or developing and deploying a vaccine to millions of people in a matter of mere months.
Brian Mullen, head of innovation and product at The Clinic by Cleveland Clinic. Photo courtesy The Clinic by Cleveland Clinic.
An app, which is the sort of innovation we’re seeing in many other industries, doesn’t cure anything, nor does it change a terminal illness to a chronic condition yet. Digitalizing and automating existing processes and interaction is impactful but not the only way to innovate.
Q: You've said that the future of healthcare will look more like the music industry rather than banking. What do you mean by that?
Mullen: We’ve heard people for years say that 'Healthcare needs to be like the financial industry.' But do you really love your bank? Why in God’s name do we want healthcare to look like banking?
Frankly, the analogy has gotten us incremental change. We may have an app now that can remind us of an appointment or allow us to pay an outstanding bill, but that doesn’t move the needle on an individual or population’s health. Chronic care programs essentially just remind people to do things, which is helpful but limited. Healthcare has focused so much on automating transactions the same way that banks do, but it hasn’t transformed into true impact to patients like we see in other areas of healthcare innovation like biotech, medtech, etc.
The reason I think the future of healthcare may and should look more like the music industry is because of the advances we’ve seen in music in both alignment that serves the interest of all key stakeholders and personalized services for the consumer.
For instance, years ago you had to buy a whole CD for $15 to get the one song you wanted. Napster and others created ways for customers to get the music they wanted when they wanted it, but free music didn’t work for the labels or the artists. Apple found a way to offer songs for $1 that made customers happy and worked for the labels and artist. It was a solution that benefited everyone.
The next generation of the music industry aims to deliver more personalized experiences. Both Apple and Spotify, as well as other services like Pandora or Deezer, are leveraging historical data and predictive algorithms to anticipate the sort of music you might like and recommend it.
In healthcare, finding solutions that provide value to all parties—patient, provider, and payer—are positioned to deliver better patient outcomes, higher customer satisfaction, and more efficient business models for everyone involved. Once the alignment happens across parties, will we be able to offer customized personalized services to patients that will support and enable them to improve their care.
Q: What are the biggest challenges or barriers you see to healthcare innovation?
Mullen: Better regulatory structures are critical, especially when it comes to patient access. Other than healthcare, I can’t think of any other major industry where you can’t access services across state lines.
The good news is healthcare has already shown its ability to adapt and change radically. During the COVID-19 pandemic, for instance, the number of telehealth appointments in the nation grew close to 800%, according to the National Institutes of Health, and telemedicine is now a permanent part of our healthcare landscape.
That’s important. I live in Boston, where within 10-15 miles I have top-class medical specialists of every sort easily available to me. But for most of the world it's not like that, and I expect the growth of telehealth to be a key enabler in breaking down access to care.
Overcoming this lack of access is core to our mission at The Clinic. Our mission is to increase access to the world's best clinicians anywhere in the world. It shouldn’t just be limited to those lucky enough to live in a few select geographic locations like Boston and Cleveland.
Q: How should traditional healthcare organizations react to the emergence of new, direct-to-consumer participants in the healthcare space like Amazon, Google, Walgreens, and others?
Mullen: The call for healthcare delivery to 'be more like Amazon' is getting louder. But as someone who is deeply entrenched in digital health, I can tell you the 'Amazonification' of healthcare might not be what we want.
Amazon is a master of distribution. It delivers but doesn’t exercise much control on the quality and services provided through its marketplace. In healthcare, the platform to use for care delivery is only as good as the care itself. A great digital platform with sub-par providers is still a sub-par solution. Digital transformation to increase access isn't enough.
Trust is critical in healthcare. Patients need to trust they are getting the best advice and aren't being upsold. We work every day at The Clinic to make sure we are increasing access to the world’s best, but we're also delivering quality and building trust with our customers. If the patient has trust in the quality, then they can have the confidence and peace of mind they are seeking when getting a second opinion.
Healthcare institutions are increasingly realizing that preserving brand quality plays an essential role in successful digital transformation. Healthcare’s future relies on change that will come from collaborations with tech companies and key players in the healthcare system. Just like what transformed the music industry: When tech companies like Napster made changes without the rest of the industry following suit, it failed, but when Apple aligned their tech with the broader music industry there was a paradigm change where the customer won.
Q: The Clinic by Cleveland Clinic was launched via an intriguing partnership between the Cleveland Clinic and Amwell. How has this partnership helped the health system?
Mullen: What’s been fantastic about our partnership is how fully it’s helped both patients and providers. The Cleveland Clinic has a vast team of world-class providers in almost every specialty you can imagine. The Amwell platform enables us to deliver a connected digital care experience to the patient and providers
Patients love it because they now have a chance to get a second opinion consult by one of the world’s best specialists or subspecialists from the comfort of their home without traveling, which wasn’t possible just a few years ago. Providers like it, and consistently give us high scores, because they feel empowered and engaged, and they know they are having an impact on people who don’t have access to the highest quality of care.
Q: What new technologies or strategies are you hoping to use in the future? What's on the horizon for healthcare innovation?
Mullen: I am particularly excited about the use of AI and data analysis. I think we’ll soon see solutions that will support doctors in offering patients highly personalized and accurate diagnoses, treatments, and medications. I also think AI has a huge opportunity to improve safety in healthcare by helping to detect things like negative drug interactions at an individual level.
A challenge for healthcare—and an opportunity—that comes with assimilating and analyzing the huge amount of data we have available today is streamlining the presentation of it in personalized ways to provide better dashboards, portals, and medical device interfaces that offer patients fast, understandable updates on their condition. In addition, how do we ensure that historical bias isn’t further amplified in the AI tools that we build?
Q: What has surprised you about healthcare innovation to date, good or bad?
Mullen: There is so much good. I’m fascinated by it. Today we have things many of us couldn’t imagine as kids: artificial hearts and kidneys. Face transplants. More medications to help turn potentially fatal ailments into chronic diseases, the number of cancers we can now cure, and a whole set of more proactive and personalized ways to treat chronic disease.
Most strikingly in recent history has been the almost overnight ramp-up of telehealth to serve populations everywhere during the pandemic. We’re no longer tethered geographically to the medical experts within just a few miles of where we live.
The downside, perhaps, is that with the proliferation of modern information we’ve had so many innovators, and we now have thousands of apps out there for each different condition. I’d like to see us get to a place where a patient who has, say, diabetes and heart problems will have a single app to manage both and have information presented to them in a way that’s easy to understand, helpful, and motivating. We’ve made a lot of improvements in providing a better patient experience, but I think we have a lot of room for improvement, too.
Q: How do you see The Clinic by Cleveland Clinic evolving?
Mullen: I am tremendously excited to see faster development of both our national regulatory structure and our national insurance payer models, which I know will facilitate the simpler, faster, more affordable, and more widespread use of telehealth.
The tools we have today in telehealth can provide expert access at the right time to people in need to provide both peace of mind and the best care available, but we’ve only begun to make that promise available nationally and internationally. I think we have some very exciting years ahead that will make both patients and providers much more satisfied with our healthcare system.
The two organizations, members of the Coalition for Health AI, have forged a five-year partnership built around the new Duke Health AI Innovation Lab and Center of Excellence.
Duke Health and Microsoft are aiming to get ahead of the AI wave with the launch of an AI Innovation Lab and Center of Excellence.
The two organizations announced a five-year partnership this week "aimed at responsibly and ethically harnessing the potential of generative artificial intelligence (AI) and cloud technology to redefine the healthcare landscape."
The news comes as healthcare organizations across the globe are experimenting with AI and as federal and state governments, tech firms, and health systems grapple with how to oversee the technology. Just last month, the White House and the heads of several major tech companies—including Microsoft—announced a non-binding commitment to responsibly govern how AI is developed and used.
The Duke-Microsoft collaboration aims to give the healthcare industry a place to forge those standards.
"The partnership is a milestone in the evolution of digital healthcare," Jeffrey Ferranti, MD, senior vice president and chief digital officer of Duke Health, said in a press release. "Our unrivaled expertise in data science, patient care, and technology innovation synergizes perfectly with Microsoft's healthcare solutions and AI technology. Together, we are poised to propel Duke into the forefront of digitally focused health systems, while simultaneously studying the reliability and safety of generative AI in healthcare."
Through the partnership, Duke Health will use Microsoft's Azure cloud platform to develop AI-based programs to support healthcare services, both administrative and clinical.
“Microsoft is excited to collaborate with Duke Health to operationalize responsible AI principles, helping to ensure that AI is deployed safely, effectively, and in an unbiased and transparent manner,” David Rhew, MD, Microsoft's global chief medical officer and vice president of healthcare, said in the press release. “Together we will apply the latest Microsoft technologies to expedite and scale Duke Health’s nationally recognized model of AI governance. By sharing best practices and lessons learned, we hope other organizations will benefit from our experience.”
Microsoft is also looking to get a handle on telehealth applications. Last month, the company announced a partnership with Teladoc to use AI to help streamline administrative challenges and documentation in virtual care.
HealthLeaders editor Melanie Blackman is joined by Kasey Paulus, MBA, RN, CENP, senior vice president and chief nursing executive for WellSpan Health. During the conversation, Kasey details her career journey from bedside nurse to executive leader and ways that WellSpan is innovating and challenging the status quo of nursing, and also shares advice for nurses and future leaders.
The Maryland-based health system's vice president and chief innovation officer says healthcare must create platforms that connect patients to the resources they want and need.
To William Sheahan, the future of healthcare lies in connected care.
That's not exactly a new idea, says the vice president and chief innovation officer of MedStar Health, a 10-hospital, 300-plus-site health system centered in the Baltimore-Washington D.C. area, and executive director of the MedStar Institute for Innovation. But it is rooted in change management and focused on the redesign of traditional healthcare practices.
And that's a lot to swallow for an industry that hasn't quite caught on to consumer-based care.
"We have a lot to learn from other industries," he says. "I think we need to do a lot more to … improve the patient experience."
William Sheahan, vice president and chief innovation officer at MedStar Health and executive director of the MedStar Institute for Innovation. Photo courtesy MedStar Health.
For connected care to work, Sheahan says, healthcare organizations need to understand where and why those connections are necessary. Healthcare is moving away from the idea of having the patient go to the care provider and toward "the distribution of expertise using technology," whereby the provider connects with the patient, either in person or through virtual channels.
"We need to meet patients where they are," he says.
Sheahan, whose career includes time spent as a paramedic, educator, and chief officer of an emergency services organization, joined MedStar Health in 2013 as executive director of the MedStar Health Simulation Training & Education Lab (SiTEL), then took over the MedStar Telehealth Innovation Center in 2017, just in time to guide that group's exponential growth during the pandemic.
He's part of a wave of innovation and transformation leaders at healthcare organizations across the country who are taking lessons learned from the COVID-19 crisis to advocate for systemic change in a struggling industry.
"We have to look at each service line … [and] deconstruct and reconstruct it with digital care" as one of the core components, he says.
That's because consumers are demanding more convenient access to care, he says, through channels that allow them to see information (including their health data) and care providers when and where they want. If a health system or hospital is reluctant to offer those services, he says, those consumers will shop around for other care providers.
And that marketplace is growing. Retail giants like Amazon and Walmart, health plans, telehealth companies with their own cadre of doctors, and others are staking a claim in the healthcare sandbox, offering convenience and lower costs.
Sheahan says MedStar Health, like all other health systems, is faced with a "transformation imperative" that goes beyond consumerism. Operating margins are razor-thin, healthcare costs are too high, and the workforce is struggling with stress and burnout and shrinking. Health systems from the top down need to be aligned to address those issues with new ideas and technologies, including drawing ideas that have worked in banking, retail, travel, and hospitality.
"Why can't we have an experience like a Marriott or a Hilton?" he asks.
That's where efforts like the MedStar Institute for Innovation come into play. Sheahan says the center helps create a culture of innovation within the health system, creating an environment for unique ideas to improve both business workflows and clinical outcomes; which are both integral to establishing a new healthcare paradigm. Novel ideas and technologies that improve business processes and reduce stress and workflow issues for staff will, in turn, improve the patient experience and boost clinical outcomes.
"There is a lot of opportunity for automation and efficiency," he says, noting the integration of AI and analytics tools at the back end and the slow-and-gradual development of generative AI.
To address workflow shortages, particularly in the nursing ranks, Sheahan says MedStar Health needs to rethink how technology is used in the hospital setting. Concepts like interactive TV sets in patient rooms, virtual nursing (also known as telesitting), and wireless sensors that drive the "hospital room of the future" not only improve patient engagement and satisfaction but help nurses and other staff improve their outcomes and outlook.
That's not to say every innovation finds a place in the healthcare setting. Health systems like MedStar Health don’t have endless amounts of money to spend on bright new ideas.
"Investments have to be well rationalized," Sheahan says. The "burden of technology on the workforce" means that new tools must prove their value before being embraced.
Sheahan says MedStar Health can be a national leader in connected care, and points to an ongoing collaboration with Intermountain Health and Stanford Medicine as evidence. The three health systems, supported by the Agency for Healthcare Research and Quality (AHRQ), have formed the Connected CARE (Care Access, Research, Equity) & Safety Consortium to dig deeper into how healthcare organizations can use technology to connect patient and providers.
"There's a focus on building technology with our partners that will really drive this transformation," he says.
And that, he says, is how healthcare can and should evolve.
An ONC data brief finds that most hospitals are collecting data on social determinants of health, and many are using technology to gather that information, but a lot fewer are collecting that data regularly.
More than 80% of hospitals recently surveyed by the American Hospital Association are collecting data on social determinants of health (SDOH), many through their EHR platform and health information exchanges. Yet only half of those hospitals are collecting data regularly.
Social determinants (or drivers) of health are non-clinical factors that can affect one's health and wellness, including family and housing issues, employment, transportation, food insecurity, and cultural and societal pressures.
"If left unaddressed, the social needs experienced by an individual may lead to poor health outcomes and more time spent in hospitals and interacting with the healthcare system," ONC staffers Wei Chang, Chelsea Richwine, and Samantha Meklir wrote in a recent blog post accompanying the ONC data brief. "Hospitals, therefore, are uniquely situated to help address social needs and mitigate social risk factors by screening for social needs, assisting with transitions of care, and making connections to social service organizations."
According to the AHA survey, administered in 2022, some 83% of hospitals are doing just that, with nearly 75% using a structured screening tool to collect that information, 36% using free-text notes, almost 30% using diagnosis codes, and 20% using non-electronic methods.
Some 60% of hospitals collecting SDOH data are getting some of that information from external sources, the survey found. Those sources include HIEs (46%), other healthcare organizations (28%), social service or community-based referral platforms (22%), and community/social service organizations (18%).
As for how they're using the data, 72% of hospitals collecting SDOH are using the information to inform discharge planning, while 67% cited clinical decision-making, and 65% cited referrals to social service groups. In addition, 48% of the hospitals are using the data for population health analytics, 46% to inform community needs assessments or other equity issues, and 42% for quality management purposes.
These tools and tactics are crucial to improving access to care and clinical outcomes among underserved populations, yet the survey finds that healthcare providers serving those populations aren't necessarily addressing SDOH.
According to the survey, 54% of hospitals collecting SDOH data are doing so on a regular basis, yet lower-resourced providers, such as small, critical access, rural, and independent hospitals, were "significantly less likely" to regularly collect data.
In their blog, Chang, Richwine, and Meklir note that the Centers for Medicare & Medicaid Services (CMS) recently added two SDOH data elements to the Inpatient Quality Reporting (IQP) program. That's one step in the right direction toward compelling providers to collect and use that data.
"While much attention has been devoted to screening—a critical first step to understanding patients’ health-related social needs—additional focus is needed on effective usage of data collected through screening since not all patients who screen positive for social needs are successfully connected to the resources they need," they wrote. "This may be attributable to a number of challenges providers face in using social needs data, including a lack of standardized referral processes and sustainable financial resources, which speaks to a need for building partnerships with community-based partners and increasing their capacity to respond at the community level, and tracking changes in health outcomes following the identification of social needs."
"Looking ahead, more work is needed to capture social needs data in an actionable way so that this information can be used to support shared decision making and address social needs, with the ultimate goal of improving individual and population health," they concluded.
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