The event in Nashville, co-hosted by HLTH and CHIME, featured a heavy hitting line-up of health system executives and good discussions about workforce and operations priorities.
As ViVE 2023 packs up and the estimated 7,000 attendees depart Nashville, the biggest take-away from this event isn't any product rollout or partnership announcement. It's the guest list.
Craig Richardville, chief digital and information officer for Intermountain Health, said ViVE gave him an opportunity to rub elbows with a number of his peers, share insight into the challenges and opportunities that new technologies and strategies offer, and hear about what other health systems are doing.
"I might see something really interesting and tell (another healthcare executive) about it, or someone will tell me, 'You should check this company out,'" he said during a chat at the Intermountain Health booth in Music City Center's exhibit hall. "It's the chance to meet up and talk with people."
Richardson, later seen enjoying the Black Crowes concert at the Industry Night Reception at the Wild Horse Saloon, was among dozens of health system executives attending ViVE, the colorful second-year event co-hosted by HLTH and the College of Healthcare Information Management Executives (CHIME). The presence of so many decision-makers in the exhibit hall and in sessions on stages situated around the hall lent significant value to the conversations.
Those conversations were about finding a way to stay ahead in challenging times.
Paul Uhrig, chief legal and digital health officer for New York's Bassett Healthcare Network, said many health systems are just focused on survival at this point. They're also focused on the workforce, where Bassett has a 20% vacancy rate in its provider ranks.
With razor-thin margins, staff shortages and competitors entering the space. Uhrig said health systems are looking for very specific solutions to very specific problems, not the newest technology or tools. And they want skin in the game from vendors.
"We own nothing by ourselves," added Tarun Kapoor, MD, Virtua Health's senior vice president and chief digital transformation officer, describing an innovation and technology landscape that has evolved significantly over the past few years, due to the effects of the pandemic and a struggling economy. The focus these days, he says, is on partnerships, either with the vendors or other organizations looking to improve the industry.
Workforce issues, from staffing and provider shortages to burnout and stress reduction, as well as security, revenue cycle development, and business automation, were on everyone's agenda. Telehealth, remote patient monitoring, digital health tools, AI, and solutions specifically designed to help nurses were also top of mind.
And the people who make the decisions were in the room and ready to talk.
During a panel on digital transformation that featured executives from UPMC, LifeBridge Health, Health First and Mt. San Rafael Hospital, the talk was about developing a strategy to overcome roadblocks common to the industry. William Walders, CIO and senior vice president of IDN operations at Health First, noted he has to work with—and more often around—seven different electronic medical records in his bid to "keep up with Domino's Pizza," one of the most successful consumer-friendly companies in the nation.
"This industry is one of the most antiquated industries out there," added Michael Archuleta, chief information officer at Colorado's Mt. San Rafael Hospital. "We should be leading the pack when it comes to innovation."
Archuleta pointed out that technology is often thought of as a cost center in healthcare, when it should be considered a "true value maker," especially at a time when healthcare organizations are struggling with their bottom lines and need to better define value.
That's what other industries, such as retail, hospitality, and banking, have done.
"I can get a massage, a behavioral health appointment, [or] a girlfriend on my phone—why not a doctor?" Walders mused.
Karen Hanlon, executive vice president and chief operating officer at Highmark Health, said health systems need to improve their digital front door to keep up with the competition. And they need to highlight the fact that health systems know how to do healthcare, whereas other entries in the primary care space are in it for the money.
"The best chance of getting that engagement is when the provider is integrally involved," she said.
The theme of playing catch-up to the likes of Amazon, Domino's, American Airlines, and Hilton was common throughout ViVE, but catering to the consumer wasn't the top concern of healthcare leaders. Most were on hand to find solutions to workforce issues, with the idea that improving the workplace for doctors, nurses, IT staff and others would in turn improve clinical operations and outcomes.
"Workforce is the number one issue we're facing," noted Michael Hasselberg, NP, MS, PhD, chief digital health officer at UR (the University of Rochester) Medicine and director of the UR Health Lab, the health system's digital health incubator. "This has rapidly shifted [to the top of the list] over the past six months, and now we're focused on trying to give clinicians their time back."
For vendors, the innovation and technology marketplace has certainly changed. Health systems don't have the time or money to spend on new ideas or strategies that haven't been proven or take several months to establish. They're looking for technology that has already proven its value, integrates well with existing platforms and quickly shows an ROI.
Shez Partovi, chief information and strategy officer at Phillips, said health systems are laser-focused on solutions that help clinicians, especially nurses. They're also looking for technology that can predict and plan out workflows and identify crisis points in the health system, so that health systems can address issues before they become crises.
"They want to be more proactive" and less reactive, he said.
Intermountain's Richardville agreed. He said health systems need to use data and data analytics to better understand and design workflows. More data, and better tools to analyze that data, gives them better opportunities to manage and improve caregiving.
"We're into any and all things digital, and data is digital," he said.
As a result, health systems are looking for partnerships with vendors, rather than one-off deals for point solutions. They want to work together on problems with solutions that can evolve.
"The expectations have changed," said Roy Schoenberg, MD, MPH, president and co-CEO of telehealth giant Amwell, who sees more interest in health systems for agreements with shared risk and less interest in solutions that address only one small part of the system. "The people we sell to are very different from the people we sold to three years ago."
Schoenberg says investment in innovation and technology is more important now, as health systems understand the value of these platforms and tools in affecting value-based care and predicting future pain points. Where once those decisions were solely handled by CMOs, CMIOs and CIOs, now the COO, CFO, and even the CEO are entering the conversation.
And they aren't interested in small talk.
"If you walk in with a sales pitch, those meetings are very, very short," he said.
Indeed, at an innovation panel held at the Bobby Hotel, near the convention center, Julie Murchinson, a former CEO of Health Evolution who's now a partner with Transformation Capital, noted there are more people at the table to talk about healthcare innovation and technology, and they’re measuring value in different terms.
"Pay attention to the CFO," she said. "They're starting to put dollar signs in front of what we care about."
John Beadle, co-founder and managing partner of Aegis Ventures, cited the structural decline of the healthcare business as a particular challenge, and said health systems have to be involved in new business ventures and partnerships to solidify their standing.
Noting the many new entrants to the healthcare space, from Amazon to Walgreens, Beadle said health systems need to focus on getting back into the driver's set and doing what they do best.
That's what many healthcare executives at ViVE mentioned. With all of the challenges facing the industry and competitors looking to claim their piece of the action, healthcare executives need to remember that they know how to best do healthcare. And their decisions on innovation and technology should create a better environment for clinicians and staff, either by improving workflows or automating repetitive tasks.
Only then will they be able to connect with a patient population waiting for them to catch up to the times.
"We need to see our patients and our community as an IT-enabled participant in healthcare," said Tressa Springmann, senior vice president and chief information and digital officer at LifeBridge Health.
Recent CMS and CDC rulings offer hope that health systems will show more love for innovative treatments like digital therapeutics and virtual platforms.
As healthcare executives and digital health companies converge on Nashville this week for ViVE 2023, the prospects for new tools like digital therapeutics and virtual technology seem to be improving.
On the heels of the Centers for Medicare & Medicaid Services' (CMS) decision to create a unique reimbursement code for digital therapeutic company AppliedVR, the Centers for Disease Control and Prevention (CDC) last week approved the use of video-based directly observed therapy (DOT) for tuberculosis treatment, saying the virtual platform could be used as an equivalent to in-person medication monitoring.
"Missed doses of medication or treatment interruptions can lead to suboptimal drug concentrations, acquired drug resistance, longer treatment times, TB treatment failure, and recurrence of TB disease," the CDC said in its March 24 report. "For these reasons, CDC continues to recommend DOT as the standard of care for all persons prescribed TB treatment; however, based on the evidence summary, this report updates the 2016 CDC U.S. clinical practice guidelines (1) to state that vDOT should be considered equivalent to in-person DOT."
In its ruling, the agency said vDOT, which enables care providers to watch patients taking their prescribed medication by video, usually through the patient's smartphone, has seen higher rates of medication adherence compared to in-person monitoring. In addition, the digital health platform is more convenient for patients and providers, can save time and costs for programs, helps patients who can't easily access in-person healthcare and improves patient satisfaction.
The ruling is specific to TB treatment, which can last several months and relies heavily on a patient's ability to take specific medications at specific times.
Among those supporting vDOT is the New York City Department of Health, whose TB control program included vDOT as far back as 2014. The CDC asked the city, which has one of the highest TB rates in the nation (6.1 per 1,000 people, compared to the national average of 2.5) to participate in a study of the value of vDOT, and used the results in its recent ruling supporting the platform.
“Directly observed therapy has been a backbone of our work for a long time and of course the pandemic put a lot of that under threat in restricting people’s movement and their ability to remain adherent on what can be at a minimum 6 months of treatment, if not longer,” New York City Health Commissioner Ashwin Vasan told STAT News in an interview.
“In over 200 patients studied, it was found to be just as effective as traditional DOT, in addition to being more cost-effective because you obviously reduce transportation costs,” he added. “You reduce delays, you reduce trade-offs and opportunity costs because these are visits that can happen over video that would otherwise cause the person to leave work, or leave school, or to leave wherever they are, and present to a clinic to pick up their medications.”
Both the CMS ruling on AppliedVR and the CDC's move to support vDOT give digital health companies hope that the healthcare industry will embrace these new tools and technologies, especially if Medicare, Medicaid, and other payers also support the treatments.
And that's crucial. Many health systems are operating on razor-thin margins and don't have the time or money to invest in new technologies unless there's a clear ROI.
Among the companies benefiting from the CDC announcement is Scene Health, formerly emocha, which offers vDOT services to a number of public health programs across the US for treatment of a wide range of chronic conditions, including substance abuse, asthma, diabetes, and hypertension.
"In recognizing that video DOT is equivalent to in-person DOT, the CDC has modernized the 'gold standard' for medication adherence," Scene Health CEO Sebastian Seiguer, in Nashville for the ViVE conference, said in an e-mail to HealthLeaders.
"DOT is used for all medications in the inpatient setting, but has seen limited use in outpatient care due to high cost and logistical burden," Seiguer said. "Video technology exponentially reduces these barriers making DOT scalable. At the same time, at Scene Health we’ve worked very hard to preserve the person-to-person, supportive engagement that makes DOT work, regardless of delivery method."
In the AppliedVR case, CMS created a unique Healthcare Common Procedure Coding System (HCPCS) Level II code (E1905) for the company's RelieVRx program, which uses virtual reality-based cognitive behavioral therapy. The CMS ruling classifies the technology platform as durable medical equipment (DME).
"It's finally time to more fully embrace ITx [immersive therapeutics] and move toward its use becoming more towards standard of care rather than a 'one off' niche solution in the treatment of chronic lower back pain, for example," Matthew Stoudt, co-founder and CEO of AppliedVR, said in a press release announcing the CMS action.
"We envision immersive therapeutics as a future alternative to a lifetime of pills or costly surgeries," he added. "Enabling broad coverage for the RelieVRx program will deliver a powerful, yet affordable and scalable digital solution for millions of people."
With ViVE on the doorstep, a new survey finds that healthcare decision-makers are looking for technology that addresses workforce shortages, prepares the health system for a recession and improves data management.
Healthcare executives looking to make technology deals at next week's ViVE conference are looking for solutions that address clinician and staff burnout or help the health system weather a potential recession, a new survey reports.
The survey of some 300 decision-makers in healthcare, conducted by Intelligent Medical Objects, also puts data storage and analysis tools at the top of the shopping list, while AI tools aren't yet worth all the flashy marketing.
According to the survey, 94% say they plan to invest in technology that either addresses workforce issues or prepares the health system for a recession.
“Hospital providers face a lot of uphill battles, from data integration to clinician burnout, and this survey shined a light on how data integration can have a positive impact on patient care and day-to-day operations,” Ann Barnes, the company's CEO, said in a press release accompanying the survey. “It’s helpful to understand the most pressing needs as US provider organizations are making bold changes to improve patient care and are adapting their strategies faster than ever before.”
The survey comes as healthcare CIOs and chief digital health officers converge in Nashville next week for the ViVE 2023 conference, and as they and other decision-makers prepare for the Healthcare Information and Management Systems Society's (HIMSS) annual conference next month in Chicago. Both events are expected to feature discussion on a wide range of critical healthcare issues, including staff and clinician shortages brought on by burnout and stress, the upcoming end of the COVID-19 Public Health Emergency, new technologies and programs like telehealth, remote patient monitoring, Hospital-at-Home, digital therapeutics and AI, and federal efforts to improve privacy and security, enforce prior authorization rules and improve interoperability and data sharing.
Data will likely figure in a lot of conversations, according to the IMO survey.
Almost all of the decision-makers surveyed say their organizations must improve the way it uses data to improve healthcare delivery and operations, and 90% said they've had moments in the past where they lost or leaked revenue due to inefficient practices.
The survey shows similar results from other surveys and reports that list workforce management as the top priority of healthcare organizations, many of which are struggling to retain clinicians and field a good IT department. Many are also worried about the economy, with hospital margins at or perilously close to the red and a recent report indicating more than 60 hospitals are at risk of closure.
According to the survey, 71% cited maintaining or improving clinical care quality as the most important internal risk. Some 65% percent cited problems with clinician burnout, while half cited administrative burnout and 45% cited data issues.
The survey also pointed out a continuing issue for healthcare organizations looking to stay on top of the latest technologies while facing staffing issues. Some 84% of those surveyed said their health system is working with more then 20 vendors. Almost a third said software integration was their biggest problem with vendors, while 29% cited inadequate training provided by vendors and 17% reported long implementation timelines.
And that's a problem. With the economy struggling, many healthcare organizations are taking a hard look at new purchases and technologies, and requiring solid proof of ROI before they consider any new purchases. Health systems aren't going to invest in anything new if they don't see immediate and lasting value, and they certainly won't be interested in products that take a long time to install.
Finally, healthcare leaders are interested in AI technology, and both this and another recent survey pointed out that they're using the technology to address back-end operational and workforce management issues. But at the same time, many of those surveyed said the hype currently outweighs the value.
“For technology to have a positive impact on providers, it has to get out of the way and integrate seamlessly into clinical workflows,” Steven Rube, MD, IMO's chief clinical officer, said in the press release. “This survey validated an assumption that … providers needed assistance to seamlessly integrate relevant clinical data in the care of their patients. The pandemic unleashed a torrent of investment in new healthcare software solutions, and provider organizations have struggled to understand which types of software will present the best ROI."
New programs like Hospital-at-Home and Acute-Care-at-Home are giving health systems an opportunity to reduce inpatient traffic and give patients the care they need in their own homes.
Editor's note: Stephen Parodi, MD, is executive vice president of The Permanente Federation and associate executive director for The Permanente Medical Group. He is also the national infectious disease leader at Kaiser Permanente.
Hospitals are on precarious footing. After nearly three years of a pandemic that pushed capacity and resources to their limits, rising inflation, and healthcare workforce burnout, many hospitals are finding it difficult to deliver the lifesaving care their communities need. In fact, many hospitals again faced bed shortages during the recent “tridemic” – a collision of RSV (respiratory syncytial virus), influenza, and COVID-19.
In the face of these monumental challenges, health systems must seek innovative solutions to ensure that patients have affordable access to physician-led, hospital-level care, even if it means rethinking how and where it is delivered.
Stephen Parodi, MD, executive vice president of The Permanente Federation and associate executive director for The Permanente Medical Group. Photo courtesy Kaiser Permanente.
One movement that gained traction during the COVID-19 pandemic is the delivery of hospital-level care directly into a patient’s home. Thanks to waivers put in place by the federal government at the outset of the pandemic, 114 health systems across 37 states implemented an advanced care at home program, including Kaiser Permanente.
The ability to provide hospital-level care in the homes of patients is essential when brick-and-mortar hospitals are inundated with patients, as they were during the COVID-19 pandemic. And it is reasonable to anticipate that we will continue to see more high acuity illness related to deferred and delayed care.
What’s more, health systems see advanced care at home as a sustainable delivery model for the future. The aging baby boomer population has expressed clear preferences for receiving care in their homes. This demand comes at a time when the cost of building a new hospital can range from $60 million to more than $1 billion. Not only does in-home hospital care deliver care where patients want to receive it, it also has the potential to make care more cost-effective if it is sufficiently scaled.
However, building a program that brings hospital-level care directly into the home is not for the faint of heart. It requires vision, fortitude, and significant investment. In the more than three years we’ve spent planning, developing, and implementing an acute-care-at-home program, we’ve learned multiple lessons that we believe can help other health care organizations develop their own care-at-home programs:
Put the patient at the center of the program’s design. Our first step was to conduct focus groups with patients and find out what they might look for in this type of program, and what would make them feel safe and supported. One of the concerns was usability. That’s why the technology in patients’ homes is simple: the touchpad has one call button to contact a physician and care team. Each morning, care teams and patients discuss the day’s schedule so a patient knows each of the appointments and visits during the day, and the care team even knows when a patient will wake up with their morning coffee.
Align key quality, operations, and marketing functions. Understand that building an advanced care-at-home program takes a village. You need your quality, compliance, operations, marketing, and communications all aligned in understanding the goals of the program. This starts at the top with buy-in from leadership. By sharing stories about why this is the care of the future and what physicians and clinicians would want for their own families, leaders can rally teams from across the healthcare delivery system to collaborate to build this new model of care.
Pressure-test the program before launch. We practiced admissions into a home with our multidisciplinary team. We would simulate problems that could arise in the supply chain, lab, pharmacy, and other functions so that when we were ready to go live with our first patient, we were confident that we would have a very stable, secure program supported by technology with multiple redundancies.
Show healthcare workers how the program can improve their work life. We’ve learned that our program helps retain and improve job satisfaction for healthcare workers, from nurses to hospitalists. A hospitalist is a clinician whose primary professional focus is the general medical care of hospitalized patients. Hospitalists providing care in this program have said the program gives them joy and meaning because in addition to healing, they are able to communicate with satisfied patients and family members who feel they have more control in the comfort of their home, vs. in a hospital. That experience has been a big selling point for our program at a time when health care worker burnout is rampant nationally.
Understand that change management takes time. When we initially scoped the program, we thought we could get 20 to 25 patients in the program in relatively short order. We have learned that it takes time for the physician and the team to gain confidence that a new program will provide high-quality care consistent with the traditional hospital. We have conducted case conferences, town halls, video production, and testimonials, and are transparent with the data with our physician teams. All these elements are essential to have physicians, care teams, administrators, and ultimately patients and families embrace this new care concept.
To commit fully to advanced care at home models, systems programs and regulators will need to develop specific quality measures to ensure that patients receive care safely.
Recent passage of the $1.7 trillion omnibus bill that extends the Centers for Medicare and Medicaid Services (CMS) hospital-at-home waivers through the end of 2024 provides assurance over the next two years that there is an opportunity to develop a regulatory framework that healthcare organizations will need to initiate, grow, and mature hospital-level care-at-home programs.
These programs' growth will enable us to collect more data on their quality, safety, and efficiency. Just as important, we will learn more about how to build and scale such programs more efficiently and effectively.
The waivers extension also offers the opportunity to create more benchmarks for the performance of these programs. That will enable us to compare more of these innovative programs to brick-and-mortar facilities and identify new measures for the programs that will be unique as we move more care into the home.
In addition, extending the waivers opens the door to expand services beyond the hospital. For example, the waivers support the provision of lower-acuity emergency care for patients outside a hospital setting and for more complex needs care in the home.
The investments that are likely to follow the waivers extension will enable healthcare systems to deliver safer, more convenient, and patient-centered care and improve the long-term outlook for patients and the health systems that serve them.
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The Rhode Island School of Design's Center for Complexity has developed a new tool that helps non-English patients accurately describe their pain for emergency care providers.
Among the many societal barriers to clinical outcomes is communication. If you don’t speak the same language as your healthcare provider, important things will be lost in translation.
That's especially true in crisis situations such as the Emergency Department, where studies have found that non-English speaking patients have higher morbidity and mortality rates. To tackle that problem, the University of Rhode Island School of Design's Center for Complexity (CfC) is developing technology aimed at translating pain.
Researchers at the center have partnered with Seattle-based "human experience design" company WongDoody to develop Say Your Pain: The Universal Pain Translator, a digital health tool that enables users to describe pain symptoms to care providers. The platform pairs dozens of common pain symptoms, such as throbbing, cramping, burning, and piercing, with animations, enabling care providers to gain a better understanding of a patient's condition and plan care accordingly.
“Humans are complex social organisms whose health is shaped more by the environments they live in and the people they care for than the clinical services they receive," Justin Cook, founding director of the CfC, said in a press release. "The frontier of improving human health is connecting the dots between our biology, our environment and our social lives. This is a complex challenge that demands a creative solution.”
To develop the platform, researchers worked with animators who are experiences in semiotics, or the study of signs and symbols and their use in interpretation, along with more than 30 clinicians. They've designed the tool to be used on most connected devices and, initially, in three core languages: Spanish, Mandarin, and Ukrainian (due to the fact that many Ukrainian refugees are now seeking care from American and Canadian providers).
Cook sees this project as a means of addressing one of the biggest social drivers of health (SDOH) and a key aspect of improving health outcomes for underserved populations.
“Our aim, starting with pain, is to dive directly into the cultural, social and environmental factors that are at the core of human health and develop solutions that make good health and wellbeing available to everyone," he said. "This is critical work in our efforts to achieve health equity.”
It also addresses a considerable challenge in emergency healthcare: Understanding a patient's condition and being able to design a quick and effective care plan.
“Justin and the team at the CfC are committed to bringing humanity back to healthcare," added Grace Francis, WongDoody's global chief creative and design officer, in the press release. "From their deep research and understanding, we were able to spot a design opportunity that can help patients advocate for themselves in medical situations. We hope it will help doctors diagnose faster and more accurately when there’s a language barrier. This has the potential to save lives and could make ER visits less traumatic for patients who don’t speak English."
With the nation's maternal mortality rate rising, hospitals are turning to text messages to make a connection with at-risk mothers.
With recent news that the maternal death rate rose significantly in 2021, healthcare leaders are looking for innovative and effective ways to connect with at-risk mothers-to-be and collaborate on better care management and outcomes.
In Dallas, the spotlight is on the Preterm Birth Prevention Program launched in 2018 by Parkland Hospital and the Parkland Center for Clinical Innovation (PCCI). The program, which affects some 13,000 mothers-to-be a year, uses data on social drivers of health (SDOH) to identify at-risk women and develop targeted interventions aimed at improving care.
"Healthcare itself only accounts for 15% to 20% of health outcomes," says Yolande Pengetnze, MD, a pediatrics specialist and PCCI's vice president of clinical leadership. "True health … comes outside of the health system. That's where we need to be."
The program is one of many being deployed by health systems and payers across the country to tackle the high maternal mortality rate, especially among underserved populations. Many of these efforts are looking outside the typical boundaries of clinical treatment to community and cultural factors that affect healthcare, including employment, housing, transportation, education, daycare, welfare, cultural biases, and other factors that affect healthcare access.
Parkland's program tracks socioeconomic and demographic factors and clinical data to identify pregnant women at risk of preterm delivery. The data also helps providers at Parkland design personalized care plans that meet both the care team's needs and the patient's preferences.
"An informed patient is the best patient in healthcare," says Pengetnze, who notes that prior to using this technology, "we'd wait for them to come to the doctor."
Yolande Pengetnze, MD, vice president of clinical leadership, Parkland Center for Clinical Innovation. Photo courtesy PCCI.
The program is run through a health plan, which uses its database to screen for social drivers of health (SDOH) and make that first connection to patients through their care managers and text messaging. From that point, the patient is directed to a wide range of care management resources, and are even connected to a social worker if needed. In addition, a care team at Parkland is brought in to manage clinical interventions.
"We're trying to create some sort of continuum of care for these patients and be proactive," Pengetnze says. "We want to be able to identify these problems before they come to the doctor."
The program uses personalized text messages like the following:
Remember to take your prenatal vitamins every day! Prenatal vitamins help you and baby get all of the vitamins and minerals you need for healthy growth.
Doctor's visits are a great time to ask all your questions about pregnancy! Bring a list of anything you want to know.
In the third month, baby will be the size of a peach!
Ask your doctor about the signs of labor at your next doctor's visit. It is helpful to know the signs of labor to know when to start preparing.
Stay Safe! Make sure to wear your seatbelt under your belly and over your hips, NOT over your belly. Also try not to drive more than 5 to 6 hours a day.
Pengetnze says the messages are sent two to three times a week, sometimes more often for women deemed at high risk.
And this method has worked. According to officials at Parkland, the interventions have helped to reduce the preterm delivery rate by 20%, boosted prenatal visits to the doctor by some 8%, and reduced costs by 6%. A survey of those taking part in the program, meanwhile, found that almost three-quarters said they felt better prepared to take care of themselves and their new family members.
Those percentages are particularly important to the Medicaid population, which sees a higher rate of preterm deliveries and complications due to access issues. Surveys have shown that socioeconomic factors contribute to stress and depression, which in turn affect preterm health.
The challenge lies in reaching those underserved populations and identifying who needs help. Pengetnze says HIPAA (Health Insurance Portability and Accountability Act) guidelines can hinder how providers use data and connect with patients, while providers often can't locate or access the socioeconomic data they need because patients are reluctant to provide that information. And since text messages aren't secure communications, the program needs consent from the patient before sending them.
"Some women don't even want it known that they are pregnant," she points out. "With SDOH, some data elements are sorely missing in the system. The EHR is a good platform, but we need technology that can collect that type of data and standardize it."
Noting the success with at-risk pregnant women, Pengetnze says the platform can be used to target other populations and health concerns.
"The [text messaging] platform is good because it's simple, and that's what we need to reach out to these populations," she says. "We need to make it simple for them [to connect], and then we'll do the complex part. Any additional step in that process increases the risk of losing that patient along the way."
A new survey from The Health Management Academy finds that healthcare leaders are bullish on AI technology, especially if it can make back office operations easier and help with burgeoning workforce management issues.
A new survey on the use of AI in healthcare finds that roughly half of the health systems surveyed are using the technology for back-office operations and workforce issues—especially nursing--and there's a lot of interest in conversational applications.
The survey of 40 leading healthcare executives, conducted by The Health Management Academy, sees growing support for AI "to fill gaps and improve productivity," according to a press release accompanying the report. And that growth is coming fast: Almost 85% of those now using AI for workforce issues expect a moderate to significant increase in one to three years.
Healthcare organizations are embracing AI at a fast pace, with executives seeing the technology as a means of improving the quality and accuracy of business tasks, reducing manual labor and improving clinical and staff workflows. Some have argued that the industry may be embracing automation too quickly, at risk of fraying the "human element" of healthcare.
Much of the early adoption of AI is driven by the workforce crisis in healthcare, a combination of a shortage of skilled workers and rising labor costs during a sour economy. With health systems struggling to stay in the black, executives are turning to technology.
According to the HMA survey, 47.5% of executives are now using AI for workforce issues, and the rest are "currently evaluating or considering AI solutions for the workforce." Most health systems start with AI in the back office (78% say they're using or evaluating AI for revenue cycle management tasks, while human resources and supply chain management are also popular), where they see "quick financial wins through cost savings." Then they'll move on the clinical operations, then clinical care.
One area of growth is in nursing. According to the survey, only 15% of executives are now using the technology to support their nurses, but 82.5% say they're evaluating AI for that department. And 65% are exploring AI applications for other clinical staff, including call center, administrative, and financial staff.
"Historically, nursing and other clinical staff have been overlooked for technology investments," the report noted. "However, as competition for labor escalates, health systems are seeking new ways to attract and retain talent and ensure staff work efficiently and effectively at the top of their license. Executives recognize that technology plays a big role and are ready to make the investments."
As for what's on the horizon, healthcare executives are intrigued by conversational AI. Just 27.5% are using that technology now, most often in chatbots, while the other 72.5% is evaluating how they might put AI to use.
"Conversational AI incorporates advanced automation, artificial intelligence, and natural language processing to make machines capable of understanding and responding to human language," the report says. "When asked whether their health system uses conversational AI, most executives answer, 'yes, we have chatbots.' While chatbots have gained traction, it is important to acknowledge they are only one of many use cases for conversational AI."
Finally, healthcare executives say they'll be focusing on using AI technology that integrates with other technology and shows ROI. According to the survey, executives list the five most important factors of AI products as interoperability with the EHR, privacy and security, ability to augment EHR capabilities, anticipated return on investment, and expected value (hard and soft) across three or more years.
The Delaware-based health system is jumping into the direct-to-consumer telehealth space with a new service that emphasizes personalized virtual care.
ChristianaCare is launching a direct-to-consumer telehealth program for residents in Delaware, Pennsylvania, Maryland, and New Jersey.
Executives at the Delaware-based health system say Virtual Primary Care challenges the popular DTC telehealth strategy by matching patients with a care team, rather than assigning care requests to the next available provider.
"We offer a personalized approach in which patients have the attention of their care team who are all focused on their specific needs and health goals," Sarah Schenck, MD, FACP, the health system's medical director for virtualist medicine, said in a press release. "Each care team knows their patients and is actively working to help them reach their personal health goals. And when patients need specialized care or services, our providers have access to ChristianaCare’s network and the ability to refer to the trusted services and specialists a patient might need outside of primary care.”
“We are reimagining healthcare by making it radically convenient and accessible, and by creating a unique and personal experience,” added Sharon Anderson, RN, MS, FACHE, the health system's chief virtual health officer and president of ChristianaCare’s Center for Virtual Health, which is overseeing the new program. “The Virtual Primary Care practice goes beyond simply offering video visits to patients. We’ve transformed care so it no longer revolves around waiting for an appointment — it’s immediate, coordinated, continuous. Patients can now access virtual primary care 24/7 as well as a host of other health services — all through their computer, tablet, or smartphone.”
The health if offering subscriptions on a monthly, quarterly and yearly basis, starting at $35 per month, with access to primary care services and text-messaging. Emergency room visits, labs, imaging and specialist referrals are not included in the subscription price.
With this program ChristianaCare is taking on the growing DTC telehealth market and an increasingly competitive primary care marketplace that includes healthcare organizations, telehealth companies, health plans and retail companies like Amazon, Walmart, CVS Health and Walgreens.
While many of these programs are designed to put consumers in front of the first available provider, some health systems are pushing back against that strategy by focusing on personalized care, or care teams that follow the patient's healthcare journey.
"When individuals sign up, they’ll choose their care team of experts including a primary care provider, nurse, and a patient digital ambassador (PDA)," the health system says in the press release. "The patient digital ambassador serves as a personal health guide to assist individuals with registration and technology set-up for their virtual visits. As a care team member, the PDA is available as a personal health guide, while the primary care provider supports patients with their clinical care needs."
Digital health tools that allow providers to electronically prescribe controlled medications can improve care management and curb drug misuse if they're used correctly.
Digital health technology has been hailed as an important tool for healthcare providers in prescribing medications, but those tools can be used for harm as well as good. That's why federal regulators are very strict in regulating digital prescribing, or e-prescribing.
The Centers for Medicare & Medicaid Services (CMS) established new rules at the beginning of 2023 for Electronic Prescribing for Controlled Substances (EPCS), focusing on Schedule II, III, IV, and V controlled substances (including prescription opioids) covered under Medicare Part D. This mandate requires providers to use secure prescribing practices aimed at preventing drug diversion, including multi-factor authentication and comprehensive reporting that tracks prescription events as they occur.
The mandate can be tricky to understand, but it also gives providers an avenue to e-prescribing that can improve care management and outcomes. HealthLeaders recently sat down, virtually, with Dan Fabbri, senior vice president and chief data scientist at Imprivata and an assistant professor at Vanderbilt University, to explain the new mandate.
Q. Under current regulations, what must healthcare providers do to virtually (electronically) prescribe medications?
Fabbri: The federal Electronic Prescribing for Controlled Substances (EPCS) mandate that went into effect at the beginning of 2023 includes two main requirements for healthcare organizations: Multi-Factor Authentication (MFA) and comprehensive reporting to track prescription events. MFA verifies the physician's identity and ensures they have authorization to prescribe a particular medication, while the reporting requirement creates an extensive record of medication prescriptions in order to detect any anomalous activity, such as drug diversion. These requirements apply to all Schedule II, III, IV, and V controlled substances covered under Medicare Part D. To meet the DEA requirements for EPCS, healthcare organizations must have a detailed, highly collaborative cross-functional project plan that outlines the five key phases: assessment, preparation, testing, enrollment, and transition.
Q. How do these regulations reduce the chance of misuse or drug diversion?
Fabbri: Implementing MFA and comprehensive reporting required by the federal EPCS mandate has the potential to prevent and mitigate drug diversion by asking healthcare organizations to create a record of what medications are being prescribed, why they are being prescribed, when they are being administered, and who is prescribing and administering them. MFA confirms a physician's identity and their right to prescribe a particular medication, while the reporting allows auditors to search for abnormal activity such as drug diversion.
While these requirements are much-needed steps in the right direction, they are only as strong as the degree to which they’re implemented. Healthcare organizations must now navigate technology tools to meet compliance requirements while also being careful to not slow down workflows and compromise patient care.
By using the proper tools to ensure only valid physicians are prescribing via MFA and create a digital audit trail of prescription activity to give greater visibility into drug diversion events, healthcare organizations can reduce medication errors, improve patient outcomes, and reduce the number of patient visits, while combating the opioid abuse epidemic. Overall, EPCS enhances accountability and creates room for improvement in prescribing, allowing providers to make better-informed decisions and reducing the chance of addiction.
Q. How do they affect telehealth and digital health programs?
Fabbri: There are Drug Enforcement Administration (DEA) compliant tools that allow for quicker and safer prescribing of controlled substances, even when the provider is not at the hospital. This technology enables patients to get medication as soon as they need it without inconveniencing clinicians.
EPCS has also been a critical component of continuing patient care through telehealth during the COVID-19 pandemic, as practitioners were able to serve patients through approved real-time video platforms while limiting the potential of community spread, due to an exception to the Controlled Substances Act. Proposals have recently been announced to close this telemedicine exemption and require in-person prescribing visits with potentially greater clinician and patient burden.
Q. How can healthcare providers use technology (cyber solutions) to make this process safer and easier?
Fabbri: By using digital identity solutions, healthcare organizations can comply with DEA standards quickly and efficiently while improving visibility into who has been prescribed what, when, and why. By implementing technologies and applications that integrate with their current electronic medical record (EMR) systems, healthcare organizations can achieve EPCS compliance without creating additional burdens on healthcare professionals or IT teams. Digital identity tools can help providers prescribe medication faster and safer without limiting the effectiveness, efficiency, and performance of nursing and physician staff.
For example, healthcare organizations often use multi-factor authentication (MFA). With the latest digital identity technology, doctors can efficiently and securely prescribe needed medications when they are away from the hospital while still complying with EPCS rules. New digital identity tools provide users with a variety of ways to enforce MFA, custom-built for the fast-paced provider workflow. There are several DEA-compliant options providers can choose from - hands-free authentication, push token notifications, fingerprint or facial biometrics, or conventional hardware and software tokens. These options make the authentication process less tedious and time-consuming than typing in a password each time, allowing patients to get their medication without unnecessary delays.
Additionally, AI-powered drug diversion platforms enable healthcare organizations to flag suspicious behavior, such as an unusual number of pills being pulled from a cabinet. This technology also detects less nefarious behavior that raises the risk of drug diversion, like leaving a cabinet open to avoid slowdowns in care. By utilizing MFA and single sign-on solutions in tandem with AI monitoring, healthcare organizations can have better visibility over all prescribing activity in the organizations, also reducing drug diversion.
These solutions empower healthcare organizations to prevent fraudulent actors from obtaining and abusing opioids, while making the EPCS process safer and more manageable for staff. Overall, leveraging these innovative cybersecurity tools can help healthcare organizations ensure compliance with EPCS regulations, and expand their capabilities for detecting, preventing, and remediating drug diversion - all improving patient care.
Q. What are the challenges or barriers that providers have to overcome to use this technology?
Fabbri: While the benefits of EPCS compliance are clear, the complexity of the DEA requirements and certification process can make it a daunting task. The implementation of EPCS also requires a significant number of tactical steps involving various departments such as IT, clinical leadership, pharmacy, application/EHR teams, and compliance/credentialing. Successfully navigating DEA compliance while providing streamlined workflows for clinicians can be difficult, requiring careful planning and coordination between different departments within a healthcare organization.
One of the main challenges for on-the-floor providers to meet EPCS compliance is ensuring that the requirements don’t slow down workflows and negatively impact patient care. To avoid this impact, it will be crucial for healthcare organizations to strategically choose technology that meets compliance mandates while simultaneously improving workflows and patient care.
Q. Can these technologies/processes improve medication adherence and clinical outcomes?
Fabbri: Aided by technology, electronic prescribing ensures that prescriptions are accurately and efficiently transmitted to pharmacies without the potential for mistakes that can occur with handwritten paper-based systems, such as medication errors due to illegibility, incomplete or incorrect information, and fraud due to stolen prescription pads.
By automating the prescription process and integrating AI tools, providers can reduce the potential for human error, and electronic systems can be cross-referenced with clinical decision support tools to alert providers of potential drug interactions or contradictions.
The use of AI and analytics-based cybersecurity tools help healthcare organizations detect suspicious trends and outliers that may impact patient care and improve clinical outcomes by providing valuable insights into prescribing patterns. For example, these technologies can analyze PHI, including EHRs and prescription histories, to identify patients who have been prescribed opioids for an extended period or at high doses, or who have a history of substance abuse. By identifying these patients, healthcare providers can take proactive measures to prevent overprescribing, which in turn reduces healthcare costs, and mitigates legal and reputational risks.
Q. Is there a need or a desire among telehealth advocates to improve the regulations or change them to make the process easier?
Fabbri: Despite a boom in telemedicine, patchwork laws and insurance coverage in the US has hindered telehealth access for years. A repeal of policy that protects telemedicine will limit advancements in providing care through mobile devices and impact patient outcomes.
Q. How should this process evolve? What's on the horizon for electronic prescribing of medications?
Fabbri: The EPCS process is likely to evolve in a direction that requires electronic prescribing of all controlled substances, regardless of payer status. At the federal level, EPCS is only required for controlled substances under Medicare Part D. However, many states already have mandates that require electronic prescribing for all controlled substances, and the trend is likely to trickle up all the way to the federal government. In fact, a new EPCS bill is making its way through Congress that would expand the kind of controlled substances subject to EPCS regulations.
To ensure that EPCS continues to meet the needs of the healthcare industry, healthcare organizations will need to collaborate with regulators and technology vendors to focus on improving the technology and tools used for electronic prescribing, as well as addressing issues related to privacy, security, and interoperability. Overall, the nationwide move towards EPCS is a positive step for improving medication adherence and clinical outcomes—including tackling the country’s opioid crisis— and as the healthcare industry continues to evolve, it will likely become an increasingly important tool for healthcare organizations.
HealthLeaders Innovation and Technology Editor Eric Wicklund talks with Danielle Louder, a program director at the Northeast Telehealth Resource Center and member of the Maine Connectivity Authority, about healthcare access in a rural state like Maine and how telehealth and digital health are closing gaps in care.
