HealthLeaders payer editor Laura Beerman sits down with Errol Pierre, senior vice president of state programs at Healthfirst, a nonprofit health plan, and author of The Way Up, a discussion of modern corporate challenges and how they are navigated by professionals of color. Pierre speaks on imposter syndrome and code-switching; the importance of allies, mentors, and champions; and how the Career Assessment Grid can help early-career employees, including professionals of color, define and pursue their goals in the corporate environment.
Washington's MultiCare Health System is using a technology platform positioned above the EHR to match patients with clinical trials run by its Institute for Research & Innovation.
For busy clinicians, determining whether a patient makes a good candidate for a clinical trial is often low on the list of things to do during a healthcare visit. But AI technology is making that process much easier, and opening the door to potential life-changing health outcomes.
The MultiCare Health System, a Washington-based network of 12 hospitals, has been offering a robust slate of clinical trials through its MultiCare Institute for Research & Innovation for almost 40 years, but the process of matching patients to trials isn't easy. Clinicians have to be on top of all the trials underway and each program's inclusion criteria, then they have to comb through a patient's medical records to see if the patient would make a good candidate.
Recently, the health system launched a digital health app for oncology and pediatric practices that does the hard work for clinicians. It sits above the EHR, pulling out patient data to match patients to ongoing clinical studies, then sending alerts to care providers on those matches.
"When a physician introduces a clinical trial opportunity to a patient … we have a lot more success in engaging that patient in a clinical trial, and that increases the chances" of a meaningful outcome, says Annie Reedy, CRA, MBA, MultiCare's chief research and education officer. "When you’re nudging the physicians [with an app that says] this patient may be a good candidate, that's a much better way of working it into their workflows."
Annie Reedy, CRA, MBA, chief research and education officer, MultiCare Health System. Photo courtesy MultiCare Health System.
Clinical trials have long existed in a different orbit than clinical treatment, with few opportunities to bridge the gap unless the provider is personally involved in the clinical trial. Surveys have found that about 90% of doctors would feel comfortable referring a patient to an appropriate clinical trial, but less than 1% are doing it, often because they're just too busy to keep track of all the available trials.
This, in turn, has affected how these trials are conducted. If clinical trials aren't gaining access to the best candidates, only those who've been able to register, the chances of meaningful results diminish. And if a trial doesn't have a diverse and equitable patient base, especially underserved populations, there's a less of a chance of creating a treatment that will help patients who need it the most.
Reedy points out that many therapeutic clinical trials also have strict inclusion and exclusion criteria, making it difficult to find the right candidates. In addition, research tends to be focused on research institutions, rather than health systems with diverse patient populations.
"Access to many of these trials is very, very tough," she says. "That's why you need tools to make that process easier."
MultiCare is partnering with Alabama-based IllumiCare to deploy the company's Trials App, part of the company's Smart Ribbon platform. The technology sits above the health system's Epic EHR, pulling out and analyzing the necessary information and sending alerts to providers.
Reedy says MultiCare's Institute for Research & Innovation is currently involved in about 120 clinical trials, including new trials recently launched to address pediatric migraines and adult diabetes. The health system enters inclusion and exclusion criteria for each of those trials into the platform, which then sifts through the health system's patient base for candidates.
That, she adds, is much more efficient than the old process, in which trial coordinators combed through medical records looking for the right matches. That process was time-consuming and labor-intensive and not always accurate.
"This saves a lot of time and effort," she says, and is much more comprehensive.
Aside from picking the right patients, the process is set up so that the patient's care provider can recommend the clinical trial, which is important. Reedy notes that patients are much more likely to heed their doctor's advice on taking part in a clinical trial, and are much more likely to engage in the trial and stay motivated. This, in turn, improves the effectiveness of the trial.
MultiCare Health is one of the front-runners in adopting IllumiCare's technology, but there are several vendors in the space with different platforms—and plenty of room for expansion. Reedy says the health system is currently set up to screen and recommend only its own clinical trials, and a natural expansion of the platform would take in other clinical trials. That, like any health information exchange program, will take time and involve more sophisticated technology.
Closer to home, Reedy would like to expand MultiCare's platform so that it could not only link patients to clinical trials, but other care management education and resources, especially for patients who opt out of clinical trials.
The University of Virginia Health System is using a federal grant to expand stroke treatment and telehealth training, as well as access to its iTREAT telestroke platform, to six rural Virginia counties.
The University of Virginia Health System is spearheading a new digital health program aimed at improving emergency treatment of strokes in rural areas.
UVA Health is using a $1.5 million grant from the US Health Resources and Services Administration (HRSA) to launch a three-year telemedicine program to educate and train rural healthcare providers on pre-hospital emergency care and post-discharge follow-up care for stroke patients. The program will also link ambulances in those counties to the health system's iTREAT telestroke platform, which connects EMS crews treating a suspected stroke victim in real-time with specialists.
"This will help us render excellent care not only for sudden strokes but also for the prevention and follow-up treatment of stroke,” Nina Solenski, MD, a stroke neurologist at UVA Health’s Comprehensive Stroke Center and the program’s director, said in a press release. “This is urgently needed. Buckingham County, for example, has nearly twice the rate of stroke deaths in non-Hispanic Black individuals compared to the national average. Reversing these types of disparities in our own surrounding communities is our goal and it’s a team effort with all different types of healthcare providers.”
The program's training element will focus on three areas. Paramedics and other EMS providers will be given instruction on community paramedicine strategies, which will enable them to treat more 911 calls at the scene and reduce unnecessary ED transports. Through a Project ECHO telemedicine platform, they'll be educated on the latest methods for identifying and treating patients suspected of suffering a stroke from specialists. And they'll also be taught how to use telemedicine for stroke treatment and care management.
“This is an important goal of the program," George Lindbeck, MD, an emergency medicine physician at UVA Health and the program’s co-director, said in the press release, noting the education resources will also be made available to students at the Charlottesville-Albemarle technical Education Center and nursing students at UVA Wise. "We want to encourage the development of these trainees and get them excited about joining a team of technology-savvy healthcare professionals dedicated to ensuring healthy lives for all.”
One of the longer-running and most documented telemedicine services, telestroke has been proven to boost clinical outcomes and save lives in both urban and rural regions. The service centers on a secure and reliable audio-visual telemedicine platform that gives emergency responders an on-demand link to a stroke specialist who can identify and diagnose stroke symptoms and prescribe clot-busting drugs. The sooner that a stroke id diagnosed and those drugs are administered, the better chance the patient has of avoiding brain damage and death.
The platform is widely used in telemedicine programs that link smaller, rural hospitals and healthcare sites to a larger hospital with stroke speciialists, with the goal of improving clinical outcomes in rural and remote areas where it takes much longer to reach a specialist and administer medication. Some cities and health systems have also used vehicles fitted with telemedicine technology and deployed solely for stroke vicitims, though the price tag for those vehicles is high. As the technology improves, a more likely approach will be to include telemedicine in ambulances and EMS vehicles.
More than 95% of certified healthcare IT developers met last year's deadline to upgrade interoperability standards as mandated in the Cures Act Final Rule, according to the agency.
More than 95% of certified healthcare IT organizations met last year's deadline to upgrade application programming interfaces (APIs) to new federal standards, according to the Health and Human Services Department's Office of the National Coordinator of Health IT.
In a blog issued this week, Rob Anthony, director of the Certification & Testing Division in the Office of Technology, said the upgrade to new certification standards mandated in the Cures Act Final Rule "will have long-lasting impact for patients, clinicians, and certified health IT developers." Specifically, those changes:
Advance interoperability for patient and providers through the use of FHIR-based APIs;
Ensure that electronic prescribing is reliable and complete; and
Give all stakeholders a common and visible view into Real World Testing plans, through which certified healthcare It developers test their technology in real-world settings.
"These new criteria make it easier for patients to access their own health IT record from mobile devices, allow electronic health information to flow more freely between health IT systems, and provide enhanced privacy and security for health IT," Anthony said in the blog.
According to the agency, 646 product listings from 411 developers met the deadline to update to 2015 Cures standards by the end of 2022.
"As part of a new dynamic for the Certification Program finalized in the Cures Act Final Rule, our requirements for standardized APIs included a provision to update certified API technology previously certified to § 170.315(g)(8) to FHIR-based APIs in 170.315(g)(10) as well as provide that updated certified API technology to customers by December 31, 2022," Anthony continued. "These provisions are intended to ensure that providers participating in certain [Centers for Medicare & Medicaid Services] payment programs, such as the Merit-based Incentive Payment System, are able to successfully deploy and use FHIR-based APIs by September 30, 2023."
Anthony said the ONC will now turn to monitoring adoption and conformance through its Lantern platform, and will provide updates throughout 2023.
While some waivers have been extended for two years, other freedoms—including an important Ryan Haight Act provision—will end soon, forcing some providers to take action now.
With the Biden Administration announcing the end of the COVID-19 public health emergency (PHE) on May 11, healthcare organizations are assessing how their digital health and telehealth programs will be affected. While Congress put in place a temporary reprieve in its budget bill, certain freedoms and waivers will end soon.
"This is going to be a trying time" for health systems, says Jacob Harper, a partner in the Morgan Lewis law firm who focuses on the healthcare industry. "It's kind of a double-edged sword. Without knowing [what will happen with the extended waivers], it's really hard to evaluate what the future looks like when you don't know the long-term outcomes."
When the PHE was created in January of 2020 to help the nation deal with the growing pandemic, a number of waivers and exemptions were put in place by federal and state regulators to help healthcare organizations expand and be reimbursed for digital health and telehealth services. The idea behind this was to allow providers to use virtual and connected health tools and platforms to reduce the spread of the virus and make sure consumers were able to access needed healthcare services.
As a result, telehealth use soared during the height of the pandemic, as providers launched new services and programs and consumers enjoyed the benefits of virtual on-demand healthcare. While in-person care is mounting a comeback, health systems are now adjusting to hybrid workflows that allow for in-person and virtual care.
But many programs are buoyed by those PHE waivers, especially those launched by the Centers for Medicare & Medicaid Services (CMS). A growing concern among healthcare executives is that many of these new programs won't be able to stand up on their own without the waivers or new regulations that improve telehealth use and coverage. Those programs may have to be shut down, cutting off patients from important healthcare services.
With the recent Congressional passage of the Consolidated Appropriations Act of 2023, several of those CMS waivers have been extended until the end of 2024. The wavers include that::
Healthcare providers can bill Medicare for telehealth services regardless of the location of both the patient and provider (including the home)
Audio-only telehealth services, such as phone calls, are reimbursable
Federally qualified health centers (FQHCs) and rural health clinics (RHCs) can be reimbursed through Medicare for telehealth services as a distant site provider
Hospice care providers can use telehealth to recertify their eligibility
The list of healthcare providers allowed to bill Medicare for telehealth services is expanded to include physical and occupational therapists and speech language pathologists and audiologists
Members of high-deductible health plans (HDHPs) and health savings accounts (HSAs) can use "first dollar coverage" for telehealth visits without first having to meet a deductible
CMS' acute hospital care at home program remains in place
Harper says this is a reprieve in one sense, but it mainly kicks the can down the road.
"I don't think you can relax," he says, noting those waivers will still end in two years unless CMS or Congress takes further action. "You can't really take your foot off the gas pedal."
Other waivers and freedoms, meanwhile, will end on May 11. Chief among them is a waiver of the Ryan Haight Act's in-person exam requirement. Passed into law in 2008, the Ryan Haight Online Pharmacy Consumer Protection Act severely restricts the prescription of controlled substances, and requires an in-person exam by a qualified provider before those drugs can be prescribed via telemedicine. Enforcement is handled by the US Drug Enforcement Agency (DEA).
Writing in their Health Care Law Today blog, Thomas Ferrante and Rachel Goodman, partners with the Foley & Lardner Law Firm and members of the firm's Telemedicine & Digital Health Industry Team, say the waiver of the in-person exam during the PHE ensured that "millions of both established and new patients were able to receive medically necessary prescriptions via telemedicine."
"There have been efforts to amend the Ryan Haight Act and encourage the DEA to activate the telemedicine special registration rule before the PHE expires, including pending federal legislation," they wrote. "However, to date, the Ryan Haight Act has not been changed and the DEA has not activated the telemedicine special registration rule."
"Thus, when the PHE expires on May 11, without further action on the part of the DEA, the in-person requirement is set to revert, without any special registration rule or other process established to ensure continuity of care," Ferrante and Goodman conclude. "Therefore, continued prescribing of controlled substances for patients never seen in-person, and only through virtual means during the PHE, will be prohibited and these patients would either need to be seen in-person or have their care transitioned to a local provider."
Because the pandemic coincided with—and helped propel—a surge in substance abuse and mental health issues, the last few years have seen a marked increase in telemental health and opioid and substance abuse programs using telehealth and digital health. The key to the success of those programs is the ability to prescribe medications via telehealth.
"I don't know how many of [those programs] are going to survive," Harper says.
Among those calling for action is the American Telemedicine Association (ATA).
"The ATA and [its lobbying group] ATA Action implore our government leaders to provide a sense of certainty to a huge cohort of individuals requiring access to important medications for substance use disorders and other necessary drugs via telehealth after May 11," Kyle Zebley, the organization's senior vice president of public policy and executive director of ATA Action, said in a press release. "Without a plan in place, these vulnerable populations will be left out in the cold, and we are quite sure this is not the intent of our government leaders."
“The ATA and ATA Action have been urging the [DEA] to release its rules for special registration for telemedicine, which will hopefully be a new pathway to continue providing this care post-pandemic," Zebley continued. "However, we are extremely concerned as those rules have been required since the original Ryan Haight Act was passed in 2008 and reiterated in statute by Congress in 2018, but we have yet to see them published. There is now an extreme sense of urgency with the public health emergency ending in only a few months.”
Other changes that will take place with the end of the PHE, according to Ferrante and Goodman, include:
Medicare payment parity. During the PHE, CMS increased reimbursement for telehealth services outside the hospital setting, such as in a patient's home, essentially allowing providers to receive the same payment for a telehealth service as they would for an in-person service. That will end with the PHE, thus reducing telehealth reimbursements outside the healthcare setting. This may prompt some providers to curb their telehealth services or focus more on in-person services.
Telehealth and remote patient monitoring (RPM) co-payment waivers. The US Department of Health and Human Services' Office of the Inspector General (OIG) issued a policy statement during the PHE that they would not enforce sanctions under the Anti-Kickback Statute for cutting or waiving deductibles and co-payments (cost-sharing) for telehealth or RPM services for Medicare patients.
"The guidance documents expressly tie this waiver to the duration of the PHE," Ferrante and Goodman wrote in their blog. "Thus, unless the OIG issues additional guidance or an extension, after May 11, healthcare providers offering telehealth or RPM services to Medicare beneficiaries may no longer reduce or wave any cost-sharing obligations that patients may owe for such services. Digital health companies without payment and collection mechanisms for these payments will need to act swiftly to operationalize new process to ensure these amounts are charged and collected."
RPM program expansion. During the PHE, CMS allowed RPM programs to expand beyond established patients and include (and bill for) new patients. That ends on May 11, and providers will have to conduct new patient evaluation and management services before adding anyone to their RPM programs. This could slow the growth of RPM adoption.
Virtual direct supervision. CMS also changed direct supervision guidelines during the PHE to allow a "supervising professional" to use audio-visual telemedicine to remotely supervise a procedure. CMS did not extend this policy beyond this year in its 2023 Physician Fee Schedule, so virtual direct supervision will no longer be allowed after 2023.
HIPAA enforcement. According to Ferrante and Goodman, the HHS Office for Civil Rights (OCR) relaxed its enforcement of the Health Insurance Portability and Accountability (HIPAA) rules during the PHE, enabling providers to use telehealth in good faith even if they didn't meet HIPAA standards (for example, the use of certain technologies for virtual visits). After May 11, the OCR has said it will resume enforcing those guidelines.
A five-year pilot project launched by California's Medicaid program that addressed social determinants of health in high-risk, high-utilization patients reduced costs by almost $400 per member per year and cut down on ED visits and hospitalizations.
An innovative program designed to improve access to healthcare services for California's most at-risk Medicaid patients reduced per-patient costs by almost $400 per year during the five-year length of the program, according to a new study.
The Whole Person Care program, which ran from 2016 to 2021, enrolled 247,887 Medi-Cal members, according to a review by the UCLA Center for Health Policy Research. Run through 25 pilot projects covering 26 counties, the $3.6 billion program connected participants not only with primary care and mental health care providers, but more than 500 social service organizations, housing support groups and other resources aimed at addressing social determinants of health.
As a result, the program saw 45 fewer hospitalizations and 130 fewer Emergency Department visits per 1,000 beneficiaries (compared to a control group), and a reduction in Medi-Cal payments of $383 per person per year.
“The Whole Person Care program aimed to promote access to care for the most vulnerable Medi-Cal beneficiaries, and evidence suggests that the program was successful in developing needed infrastructure and delivering services needed to support effective care,” Nadereh Pourat, associate director of the UCLA center, head of its Health Economics and Evaluation Research Program, and lead author of the report, said in a press release. “Patients received more care and had improved outcomes.”
The program is one of many that healthcare organizations across the country are launching to address health inequity by identifying non-clinical barriers to healthcare access, called social determinants of health. Advocates say that by addressing those barriers, providers can improve access and clinical outcomes while promoting long-term health and wellness.
In the Medi-Cal program, the California Department of Health Care Services (DHCS) used a Section 1115 Medicaid waiver called 'Medi-Cal 2020' and targeted high-risk enrollees with complex health concerns who often used emergency care services, including those with substance abuse issues, recently released prison inmates, people dealing with severe mental health issues, and homeless residents and those in danger of becoming homeless.
According to the UCLA report, the program accomplished three primary objectives. It:
"Invested in promoting meaningful and diverse partner engagement and buy-in through consistent communication, consensus on strategic priorities, and/or financial incentives;
Acquired and implemented innovative data sharing platforms needed to support cross-sector care coordination and facilitate data sharing with partners; and
Were successful in developing appropriate infrastructure (e.g., staffing, standardized protocols) and processes (e.g., needs assessment, care plan, referrals) to support effective care coordination."
And while the program reduced ER visits and hospitalizations, it also saw an increase in the use of certain outpatient services, such as substance abuse treatment and specialty care, while also seeing a decrease in primary and mental health care services.
“The results show that such programs help complex patients in different ways, depending on their needs,” Pourat said in the press release. “Most importantly, our findings highlight the overall success of the Whole Person Care program and its potential for improving the lives of high-risk patients.”
School districts across the country are partnering with local health systems and telehealth companies to give students access to primary and chronic care services, along with much-needed behavioral and mental health services.
Healthcare has become a vital resource in schools, alongside the familiar staples of reading, writing, and arithmetic. But schools are moving beyond delivering care through a school nurse or staff member with rudimentary medical training. They're using telehealth and digital health tools to give students and staff on-demand access to healthcare providers, offering everything from primary care to chronic care management and behavioral health services.
Providing telehealth to a school or school district can be complex, often because of the costs involved. Schools don't have a lot of money to spend on healthcare, so they rely on grants, federal and state appropriations, or partnerships with local health systems or telehealth companies.
The benefits are numerous. Access to telehealth in the school can reduce both staff and student absenteeism, improve morale and even boost test scores, while also improving clinical outcomes. In many rural and underserved communities, a school's telehealth program may be the only care provider-for students whose families can't afford or travel to any other healthcare services.
In South Dakota, Avel eCare, a telehealth company spun off from Avera Health, is providing virtual care services to students living with Type 1 diabetes in roughly 100 schools in several states. The program was launched as a demonstration project by Avera Health, the Juvenile Diabetes Research Foundation, and the Helmsley Charitable Trust.
Sheila Freed, RN, BSN, NCSN, Avel eCare's school health director and a nurse with some 20 years of experience, says many rural schools don't have a nurse on hand, don't have the money to hire one and wouldn't be able to find one even if they had the funding.
"There's a huge gap there that someone has to fill," she says. "Some nurses are driving from school to school, maybe 60 to 100 miles a day, and they're spending more time behind a windshield than with a student."
Providing the technology for a virtual visit isn't that complicated. A small room is needed for privacy, and many programs use a PC or laptop to establish an audio-visual connection with a care provider. The Avel eCare program uses a telemedicine device developed by Tyto Care to capture vital signs and other biometrics during the virtual visit.
Freed says the Avel eCare program operates as a hub-and-spoke telemedicine network, with the care provider at one location offering services to a number of schools. The program will train someone at each school on how to use the technology.
"We set up the whole program so that teachers can relax," she says.
That idea extends beyond teachers. With a telehealth program in place, Freed says, providers can not only boost care management for students, but be a resource for school staff and even the student's family, helping everyone within the child's orbit to improve their understanding of diabetes and how to help someone living with the chronic condition.
"Type 1 diabetes doesn't end when the school day is over," she says.
And while the program was set up to focus on students living with diabetes, Freed says they'll treat a variety of health issues. One of the long-term goals of the demonstration project, she says, is to prove the feasibility of a telehealth program for addressing almost any health issue in rural and remote schools where access to care is limited.
Avera Health, the sprawling, 300+ site health system based in South Dakota, is supporting the project through its research branch. As of late last year, the program included schools in the Dakotas, Minnesota, Montana, Nebraska, and even Maine, where Avel eCare providers had to learn about the brown-tail moth rash and tick-borne illnesses to treat students, with other states showing interest as well.
"Health systems should pay more attention to these programs," Freed says. "It's a wonderful match for value-based care. Sometimes there's a bit of a disconnect between school system and local health systems, and these programs can bridge that gap."
While some school districts are partnering with health systems for school-based telehealth programs, others turn to telehealth companies like Hazel Health, a San Francisco-based organization launched in 2015 and now working with thousands of schools across the country.
In Los Angeles, city and state organizations are using telehealth to address the dire need for access to behavioral health services in schools. According to the California Master Plan for Kids' Public Health, more than 284,000 school-aged children are dealing with major depression, and two-thirds aren't receiving treatment.
The Los Angeles County Office of Education, partnering with the LA Care Health Plan, Health Net, and the Los Angeles County Department of Mental Health to make free telemental health services available to more than 1.3 million students in kindergarten through grade 12. With $24 million in funding from the health plans and the Department of Health Care Services' Student Behavioral Health Incentive Program, for the next two years, the partnership has contracted with Hazel Health, which expanded its platform to include telemental health services in 2021.
"We continue to see the devastating impact the pandemic has had on our children's mental well-being. This crisis has called us to collective action," Los Angeles County Superintendent of Schools Debra Duardo said in a Los Angeles Daily News story earlier this week. "As a mental health professional, I am keenly aware that partnerships and collaboration across sectors are necessary to meet our children's needs. We must remove barriers to access and continue our efforts to destigmatize help-seeking around mental health. We must also recognize that physical and mental health is crucial to teaching and learning."
Much of the need for behavioral and mental health services has been driven by the pandemic, which disrupted school-based programs and cut off students from familiar healthcare resources. The Centers for Disease Control and Prevention says more than a third of high school students reported mental health issues in 2022, and according to a School Pulse Panel survey used by the US Department of Education's National Center for Education Studies, more than two-thirds of the nation's schools have increased access to mental health services to address that problem.
“I think people should always ask for help,” SaRiya Parker, an 8th-grade student at Benjamin O. Davis Middle School in Compton, told the Los Angeles Daily News. “If you’re suffering in silence it’s like that drowning feeling when you get in the water and can’t get out. Coming to a school psychologist for help is a good way to get out of the water.”
The New Jersey health system is using the latest in smart technology, for both the patient and the care team, in its new Helena Theurer Pavilion.
Hackensack University Medical Center recently opened the Helena Theurer Pavilion, a nine-story surgical and intensive care tower that showcases the latest in healthcare innovation for both care providers and patients.
Mark Sparta, FACHE, president of Hackensack UMC and the northern region of the Hackensack Meridian Health network, says the 10-year project offers a good look not only at the hospital of the future but the hospital room of the future. Working with New York-based digital health company pCare, healthcare executives created a patient-friendly environment that focuses on collaborative health and on-demand access to resources and family.
"It was important for us, through that building, to be iconic in design," Sparta says. "But at the same time, what went on inside the building was really most important."
The building features 24 operating rooms, 72 post-anesthesia care unit beds, 50 ICU beds, and 175 medical-surgical beds. The operating rooms are equipped with the latest in robotic technology, as well as intraoperative MRI capabilities, large monitors, video-streaming capabilities, and dedicated CT imaging on the ICU floor.
Sparta said health system leaders worked with doctors and nurses to design ICU rooms to their specifications, right down to the placement of equipment and lighting. In addition, they worked with a patient experience committee, comprised of former patients and family members, to get the patient rooms right.
"Sometimes providers and patients and families look at different things from different angles of the prism," he says.
Mark Sparta, FACHE, president of Hackensack University Medical Center. Photo courtesy Hackensack UMC.
When the pandemic hit, and Hackensack UMC found itself in the bullseye, the project slowed down a bit. But Sparta says hospital executives learned a lot during the crisis, including how to isolate patients and create rooms with negative pressure to prevent the spread of the virus. Because only the framework of the new tower had been built so far, he says, they were able to make subtle changes in room design.
"Some of them may seem relatively trivial and almost like no-brainers," he says. "But until you have a pandemic they’re not as evident."
Sparta says it was important that Hackensack UMC also took advantage of the latest in smart room technology—for both patients and providers. That started with the lighting. The hospital used the latest in LED lighting, which he says was "so far advanced" when compared to legacy lighting systems used in the past.
Of the 24 operating rooms included in the new tower, six were designated specifically for da Vinci robotic surgeries, with six multi-port robotic surgical systems and one single-port system, and four robots specifically designed for joint replacement surgeries.
"That level of technology is really important, because when you can minimize tissue disturbance during surgery, recovery is much quicker, [and there is] much less pain," he says. "It's also much more precise [and there is] much less risk for infection."
"In addition to that, we have the ability to video-stream, within the ORs, the entire procedure," Sparta says. "That gives us the opportunity to have pathologists … come in virtually and explore the surgical field with the surgeon, which is really, really important from a diagnostic standpoint, as well as [for] other consultative specialties. We're able to leverage that technology … to teach folks not just from Hackensack University Medical Center and Academic Medical Center, but also from all around the world. Surgeons can stream in. That was very important to us."
The Patient Room of the Future
Turning to patient rooms, Sparta says each room is more spacious, with enough room for the patient and his/her family. Each room is also equipped for virtual visits not just with the care team, but family members, with a camera mounted on the TV and a special code that patients can give out to family members.
That's a lesson learned from the pandemic.
"So many patients—too many—had to say goodbye to their family members over an iPhone that was being held by one of their nurses through Facetime," Sparts says. "It was horrible for the family, horrible for the patients, horrible for the staff."
"Family support and family visitation is really critical to the recovery process," he adds. "We wanted to tackle that not just when a patient is in isolation, but …every day each and every patient [should have] the opportunity to visit with their family members whether they are 5 minutes away, around the corner and can't get away from their desk on their lunch time to come visit, or … whether they're 3,000 miles away on the other coast."
"It's a technology of convenience, but really a necessary technology to promote the healing process," he adds.
Another change is the messaging process. Sparta points out that typical hospital rooms have dry-erase boards on which the care team leaves important reminders and other messages. Each patient room in Hackensack UMC's new tower includes a tablet in its own compartment on the wall just outside the door, integrated with the EHR, which care team members consult before entering the room.
That dry-erase board is also incorporated into the 65-inch flat-screen TV in each room, Sparta says. Each TV has a split-screen capability, so that patients can access their information through the TV. They also have a tablet mounted to the overbed table that they can use to order food and control the TV, shades, temperature, and lighting and access additional resources.
"When we think of healthcare, we think about clinical technology," Sparta says. "What has surprised me is how much technology is available outside of healthcare that we were able to incorporate into the patient experience. It's fascinating."
"We took a lot of feedback from some of those patients and families that we invited in very early on," he adds. "[They asked] questions that we didn't necessarily ask ourselves. Could you do this? Could you integrate this? What if we did this? What if we did that? It's really, really important to be a great listener, and to be able to invite people in, even if you think you know about what the public expects and our community is interested in. It's really eye-opening when you bring them in and give them a forum to provide that type of feedback."
At the same time, Sparta says it's important to think of technology as a part of the healthcare ecosystem but not the only part, or even the most important part. He notes Hackensack UMC conducts all sorts of drills with its providers and staff in the event of a cybersecurity attack or loss of power.
"It's really important to start from the ground up and understand there's a manual process for doing things when and if the technology is not available to us," he says. "With that in mind, the question is how does all this technology, how does the hospital room of the future, bring back the human side to healthcare?"
Sparta says the biggest lesson he's learned from the process is to involve as many stakeholders as possible, from doctors and nurses to patients and families. They have opinions and ideas that go far beyond what technology can do, and those views will determine whether a certain tool, design, or care plan works or becomes ineffective and wasteful. Too many health systems adopt the latest technology without stopping to think about who will use it.
"You'll never take the humans out of healthcare, because this is a people business," he says.
HealthLeaders editor Melanie Blackman is joined by Carol Lovin, executive vice president, chief of staff, and chief integration officer for Advocate Health, the combined health system of Advocate Aurora Health and Atrium Health. During the conversation, Carol shares her career journey from nurse to executive leader, the power of teamwork, and the integration work being done this next year to bring the two health systems together.
The Healthcare Transformation Consortium and Wildflower Health are partnering on a value-based care program that will give health systems and OB-GYN offices access to digital health resources to improve care management for expectant and new mothers and their babies.
A consortium of New Jersey-based health systems is expanding its digital health platform to improve maternity care management and outcomes.
The Healthcare Transformation Consortium (HTC), which includes the Atlantic Health System, CentraState Healthcare System, Holy Name Medical Center, Hunterdon Healthcare, Valley Health System, Virtua, and Saint Peter's Healthcare System, is partnering with San Francisco-based digital health company Wildflower Health on the statewide program. The health systems, each of which have self-funded employee health plans, will adopt a maternity bundle developed by Wildflower Health that includes digital health tools and resources.
The partnership will also include OB-GYN practices across the state, including those affiliated with Lifeline Medical Associates and Axia Women's Health.
“This new partnership will allow the HTC to bring all stakeholders together to work for the benefit of expectant mothers, new moms and their babies,” Kevin Lenahan, Atlantic Health's executive vice president and chief business and strategy officer, said in a press release. “Additionally, our physicians, nurses and team members are the most important asset to any healthcare system. Working with Wildflower allows us the opportunity to improve both member and physician experience, while helping reduce the cost of care and improve the quality of care for our employee health plan.”
The program addresses a key pain point in American healthcare. The nation's maternal mortality rate in 2020 was 24 deaths per 100,000 live births, more than three times higher than most developed nations, and that rate was even higher for underserved populations such as women of color. New Jersey ranks 47th in the nation with 46.5 deaths per 100,000 live births, and First Lady Tammy Murphy has launched an effort, called Nurture NJ, to cut that rate in half within five years.
The HTC-Wildflower Health partnership aims to bring digital health resources to bear, addressing key social determinants of health that contribute to these deaths, and create a value-based care program that rewards providers for outcomes.
The bundle includes prenatal and postnatal services and encompasses both the mother and baby. Among the services provided are access to health associates and coaches from Wildflower Health, educational content, virtual visits and remote patient monitoring tools.
"With this bundle, providers can evaluate and design value-based models alongside payers; install both digital health and point-of-care decision support tools; adapt current workflows to value-based requirements and continuously process data, both for leveraging key clinical metrics in real-time, as well as managing financial payments, reconciliations and outcomes measurement," the two groups said in the press release.
“As the demands on OB-GYNs continue to mount, it’s critical that we work together to find innovative ways to offer more support,” Gaurov Dayal, MD, chief executive officer at Axia Women’s Health, said in the press release. “The model being introduced in New Jersey fully equips clinicians to work more efficiently while providing personalized support for every patient, even between office visits. It makes it possible for providers to do their best work and be rewarded for high-quality outcomes.”
