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Maine's 'Libraries Health Connect Program' was launched in 10 rural libraries earlier this year, offering healthcare services to residents who may have access issues. The state is one of several using libraries as telehealth sites to improve access for underserved populations.
A telehealth program launched earlier this year in 10 rural Maine libraries is expanding, one of several such programs across the country that aims to improve healthcare access in communities where access can be difficult.
The Maine State Library's "Libraries Health Connect Program" was launched in April, using $50,000 from the 2021 American Rescue Plan Act (ARPA) to equip selected libraries with telemedicine technology and links to healthcare providers for such services as wellness visits, prescription requests, follow-up care, specialist consults, nutritional counseling, behavioral health services, and other non-urgent care.
"Maines libraries are committed to ensuring their communities have access to equitable services," Jamie Ritter, Maine State Librarian, in a press release issued earlier this year. "This means offering programs that you might not associate with your library, like telehealth. We strongly believe that where you live should not dictate the quality of your healthcare. These libraries are leading the way for establishing libraries as another way Mainers can connect with a healthcare provider."
The program is designed to help underserved residents in rural locations access services, and the libraries were chosen for the program based on what officials called "endemic community health issues and a lack of ready access to healthcare."
Libraries chosen for the program are located in Islesboro, Caribou, Houlton, Fryeburg, Steuben, Paris, Jonesport, Pittsfield, Skowhegan, and Dover-Foxcroft.
Officials are now looking to expand the program, either by adding more libraries or expanding the services offered.
"Living in Maine and rural areas you might have to drive a long way to get to see a specialist, and certainly in the wintertime, like the storm we just had, but in the wintertime that can be an extra challenge," Marijke Visser, the Maine State Library's director of library development, said in a recent TV news story.
Maine isn't the only state brining telehealth to libraries. Several see libraries as an ideal location for telehealth, serving as a community meeting place and having the necessary broadband availability to support the technology.
"Access to telehealth is essential for people to get the care they need when traveling to an in-person visit isn't possible,” Ken Zambos, program manager for workforce and economic development in Pima County, Arizona, said in a story posted by the Southwest Telehealth Resource Center (SWTRC). “By providing this service, the library is providing access to equipment that transforms healthcare delivery and positively affects healthcare outcomes."
In many cases, libraries need only dedicate a small, private space within the building for the service, with a booth or table that includes a laptop, audio-visual connections, assorted connected medical devices, and a virtual link to healthcare providers.
"By facilitating telehealth appointments and routine screening for members of under-served communities, libraries can deliver healthcare to those in need," John Chrastka, executive director of EveryLibrary and the EveryLibrary Institute, said in a white-paper released in 2021. "Many libraries have never considered this approach to helping their patrons, but it's possible. Some libraries are already doing it."
A new survey by PYMNTS and Lynx finds that consumers are very interested in accessing and managing their healthcare and insurance services via digital health, but they don't want to use several different portals or apps to get there.
The key to consumer digital health adoption is ease of use, whether it's for clinical care or paying for that care.
That's the take-away from Healthcare In The Digital Age: Consumers See Unified Platforms as Key To Better Health, a survey of more than 2,500 consumers by PYMNTS and financial technology company Lynx. It found that roughly 80% of those surveyed want to use a digital health platform to manage both care and insurance benefits, but half have had problems accessing what they want. With that in mind, about 80% want that access to come on a single digital platform.
"The synergy of one unified platform is clear," the report states. "Better access to information about insurance coverage, medical care, and financial details — when combined with improved information about providers, prescription medications, and pharmacy benefits as well as upgraded channels to share information with providers — can ultimately help consumers manage all tasks related to their care and well-being as well as facilitate coordination among insurers, financial services providers, care providers, and pharmacies."
Consumers have been demanding more digital health options for years, based on the success they've had with these platforms in the travel, hospitality, and retail industries. And while the healthcare industry has acknowledged the need to move toward consumer-directed healthcare, the transition has been slow and often painful.
The pandemic may have helped that process along, as health systems saw the value in shifting services from in-person to online to combat the spread of the virus and help overcrowded hospitals and worn-out providers. But while many healthcare organizations place high value on a digital health strategy, few have managed to bridge the gap to a mature platform.
The PYMNTS/Lynx study finds that consumers are demanding – and encountering roadblocks with – digital health access for their financial needs as much as their clinical needs. Only about 40%, the survey indicates, are extremely familiar with their health insurance benefits, yet 82% of consumers who do use the platform say it's time-saving and convenient, and a little more than half cite digital health access as the most important feature from an insurer, provider, or health and wellness app.
But consumers want one point of access, not multiple apps or platforms.
"Although consumers know that online access to healthcare information can save them time, increase their control when dealing with providers and help them access their insurance benefits, decentralizing and scattering this information among many portals can add to their frustrations," the survey reported. "Eleven percent of consumers say it is hard to remember login credentials for all their online accounts, and 9% of consumers say they have too many websites, portals or apps to use."
Some 92% of those surveyed who had problems while paying online for healthcare services said they're interested in using a unified digital platform, and 91% of those who had problems using the platform for healthcare services and insurance benefits said the same. More than 70% said a digital health platform would also improve their knowledge and management of services and insurance.
But they're also aware of the drawbacks. More than 40% of those not interested in a unified digital health platform said they're worried about security, with 28% saying it would affect the security of their health records. Some 38%, in fact, said they don’t want all their data in one place.
As for who would manage that platform, those surveyed are mixed on their preferences. About half say they would want their insurance provider to manage that platform, while 31% would prefer that their provider manage the platform and 39% want a healthcare technology company to take that job.
In a lengthy interview with HealthLeaders, ONC Chief Micky Tripathi says simplified data exchange will benefit providers, patients, and even public health.
Federal rules state that certified EHRs must support the standard FHIR application programming interfaces (APIs) by the end of this year. It's one more step toward transforming patient information access in a years-long process dating back to the birth of the EHR, and will touch the day-to-day information sharing of providers, patients, and even public health agencies.
HealthLeaders recently spoke with Micky Tripathi, PhD, MPP, director of the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, about the standardized FHIR API rule and how it will impact health systems and patients in 2023. This interview has been lightly edited for brevity and clarity.
HealthLeaders: What can healthcare IT professionals expect as API standardization is implemented at the end of 2022, as the legislation directs?
Micky Tripathi: They should have available to them the standard FHIR API in their EHR. If they don't already have that available to them, they should be asking their vendor where it is.
That will take time for that to get incorporated into workflows. ONC doesn't have the authority to tell a provider they're required to implement it. As you probably know, providers will often not purchase the latest and greatest software upgrade, so it may be that they lag a little bit. CMS rules do require that providers who participate in payment rules, by the third quarter of 2023, have it in their system as a part of certified electronic health record technology. This policy was finalized in the 2021 Physician Fee Schedule based on the updates to certified health IT finalized in the ONC 21st Century Cures Act final rule.
The other thing I think that they can expect is that they'll have the availability of more apps that are connected to their systems. Some may be apps for patients to be able to access their information. Some may be apps that are for provider-to-provider exchange, or other kinds of use cases. The idea of the standard FHIR API is to make EHRs a little bit more like open platforms that spur a lot of innovation for providers and patients to be able to have better use of data that's in EHR systems.
Right now, because you don't have a standard API across all these EHR systems, an app developer has to build one version for Epic, one version for Cerner, one version for eClinicalWorks, one version for Athenahealth [and so on]. And that undercuts the economics of it. It makes it really hard to scale. The opportunity here is to say that standard FHIR API ought to create more innovation that makes the economics better for truly scalable types of apps in the same way that we've seen in other industries.
We published a blog in August where we were tracking how many vendors were actually certified already. We noted at the time that only 5% of vendors had actually certified their system for the standard FHIR API, but those vendors were large vendors, so they actually covered, like, 60% or 65% of hospitals and 75% of ambulatory providers.
HL: Concerns have been raised about the fact that consumers could use these APIs to share their health data with non-covered entities. Such entities may or may not be adequate data stewards of this highly sensitive personal data. Is there a need for ONC to perform ongoing oversight of these entities to assure patient privacy, or is additional legislation or regulation necessary?
Tripathi: The first thing that patients need to know is that using these apps can provide great benefit to them. But when they use these apps, if it's not an app that's provided to them by their provider, then they are taking the protection of the data into their own hands, meaning they're responsible at that point for what happens. So they're responsible for doing the diligence on the app, or making sure that the app has the privacy and security protections that they want, and that the app is sharing information in ways that they deem appropriate.
That's a source of a lot of confusion for individuals in the country, and that's a real problem for us as a country. HIPAA has been called something like the most misunderstood, most important law in the country because people think that HIPAA protects medical record data wherever it lives. And it doesn't. It only protects medical record data when it's in the hands of certain entities, like a hospital, a doctor, or a health insurer. So that's the first thing: Patients absolutely need to know that they are the ones who are responsible, once they've downloaded the information and brought it into apps that they control that weren't provided to them by their provider. It's something that HIPAA didn't really contemplate back in 1996.
Right now, the protections that exist for entities that live outside of HIPAA, and data that flows outside of HIPAA, is FTC Section Five, a consumer protection kind of provision that affords some protection, but not nearly as much as a patient probably thinks it affords. Basically, FTC Section Five says that an organization needs to abide by its published privacy policies. You can have an app that lives outside of HIPAA, and has a privacy policy that literally says we're going to take your data and sell it to whoever we want, whenever we want. And of course, you just click through. That technically wouldn't be a violation because they told you, right? It was in the fine print, but they told you.
The data that that lives outside of the healthcare delivery system itself has a ton of what we would consider medical record information. It's just not in a medical record. Think about the information that is part of what we call the data exhaust, the data that I just leave behind when I'm using my phone. So I get a backache. And I start to search 'backaches.' And then I use Google Maps to go to my doctor. And then I use Google Maps to go to CVS or Walgreens. And then I get the prescription, then I look up the drug on Google, and then I, and then I have fitful sleep for two weeks and every night in the middle of night, I'm picking up my phone and looking at my phone. All of that information is information that one could put together and create what people call an inferred medical record, that I would argue is probably at least as good for that particular encounter as the medical record that my doctor actually has. Because it's a day-to-day track of how I'm doing.
The conversation about privacy is really a much bigger conversation. It's not just HIPAA. It's not just medical records. It's about privacy in general, and just the recognition that we have information that's out there that people can use to infer things about our healthcare that we may not appreciate.
HL: Another issue that comes up with this patient-directed data is provenance. Patients might want to carry their digital X-rays to their next provider. But today, the system seems more suited to asking the next provider to request the X-rays from the previous provider. And that's where lots of complication ensues -- how difficult it is to do that? And we're starting to get into the info blocking issue. Does this new API standardization in any way address the issue of provenance?
Tripathi: It does.
You just described two different patterns for exchange of information. One would be provider-provider, whereas we think of the B2B, and the other would be B2C2B. I get my records from one provider, and then I myself am the broker, or the custodian, of that data, and then I provide it to the next provider.
What we want is to support both, because we think both are really valid, and that provides resiliency and assuredness in the system. In an ideal world, it would actually be automated, so that the provider's scheduling system would see that you are coming in tomorrow, and I should blast out queries to find all the records on you that I can find, so that those are available to the provider when they're doing a review of your chart before you come in the next day. That's how a number of nationwide networks work today. They do look at the schedule one to three days in advance, and they go off and query the information. But we also want to enable, through these FHIR APIs, the ability for you to do just as you said, that you want to be in control of it for whatever reason. So it supports both. TEFCA [the Trusted Exchange Framework and Common Agreement], which we haven't talked about, would support that provider-provider exchange, and the FHIR API kind of capability would support that kind of focused exchange.
HL: Patients also want something that can be auditable. Do the API regulations themselves provide for that?
Tripathi: I totally agree with that. That's one of the ways in which that backbone infrastructure, TEFCA, provides that kind of high-volume, high-reliability capability in the back end that's traceable and auditable. It's a part of the technology and the technical specification. And it's also a requirement from a HIPAA perspective, if you're a provider organization, you're required to keep track of the disclosures that are made of that patient's information to you or to other parties. Now, again, a non-HIPAA entity, they don't have those requirements. So that's the thing to be cautious of.
HL: Will the new APIs help in any way with compliance with the information blocking regulations? Or are they two separate issues?
Tripathi: They are separate issues, but they are related.
The way in which they are separate issues is that information blocking is agnostic to technology, completely. Information blocking is focused on the data that says that there is a corpus of data called electronic health information, which is the electronic portion of the HIPAA-designated record set. And that information is what is required to be made available to patients or other authorized parties, by any actor under information blocking, which is providers, technology developers like EHR vendors, and health information networks. So that's agnostic to FHIR, to CCDAs, it's even agnostic to EHRs.
The data doesn't have to be in an EHR. It's really just about the data. It defines, there is this data and you as an actor are required to make that available if it's available to you electronically. The way in which it's related, and there's an overlap, is that FHIR APIs give a provider or technology developer or health information network another way of making that information available in an easy manner.
HL: It's been some months now since the implementation of information blocking. What is the data telling you from what people are reporting on the information blocking portal?
Tripathi: There's over 500 complaints now. I think it's running at probably something like one every day or two every three days. As you can see on the portal, where we, every month, summarize the data and break it out by category of the complaint, the complainant, and then category of who the complaint is against. The majority of the complaints are coming from patients, or their authorized representatives, I think over 80%, and those complaints are mostly against providers.
500, on one hand, seems like a lot. On the other hand, if we compare it to HIPAA complaints, which are in the tens of thousands per year, it's kind of a drop in the bucket. But we're just getting started here. So those proportions could change just because of small sample and all of that. But we're encouraged, actually, that a large number of the complaints are from patients.
I don't want there to be any information blocking. But to the extent that if you think about these regulations are somewhat arcane, and certainly providers are aware of them, but even a lot of small providers don't sort of fully understand the scope of it right now. And we're doing a lot to try to educate and provide outreach. Vendors understand that because they're actors, and they could get penalized if they don't comply with it. But it was surprising to me that it was bubbling all the way down to patients. So the patients actually knew there is this thing called information blocking, and they actually have recourse. They can actually come to the ONC web site.
HL: How do you process those reports? Do you reach out to the providers who have been named? Do you reach out to vendors who have been named? What does ONC do with that other than collect that information?
Tripathi: The law was fairly specific about the way this has to work, and it's pretty complicated. ONC is responsible for the policy, which is to say, to define what is information blocking, and to define what would be allowable exceptions to sharing of information. That's what we put into effect on April 5, 2021. We said, here's the policy, here's the regulation. You are from this point forward required to comply with this regulation.
But what the law specified was that the Office of Inspector General in HHS is responsible for investigation and enforcement. ONC is not a law enforcement organization. It isn't as if we have investigators who can go out to the field and determine whether someone is complying with that. OIG is responsible for enforcement. They haven't yet published their final rule on how they're going to do enforcement. So right now, in theory, you know, OIG isn't doing enforcement, because they don't have the final rule out.
Now someone can complain directly to OIG if they want, but we were the ones who were stated in the law to set up a portal and allow complaints to come into that portal. What happens with ONC is, we get a complaint, we'll do a high-level screen of it to determine certain things. Is this information blocking, at least on the face of it? Or could it be information blocking without investigation? Payers, by law, were not named, so ONC doesn't have the authority to say, this applies to payers. So we're not going to pass that forward to OIG.
To anyone who submits a complaint, we say that within 48 hours, we'll let you know what's happened to it. And so that means there are two things. One is we'll say if this does not appear to be information blocking, if you'd like to resubmit, please resubmit. But this does not appear to be information blocking. Or we say we have passed your complaint to OIG. And that's all we can do at that point.
HL: What's on your priority list for 2023?
Tripathi: TEFCA is a big one – nationwide network interoperability. To date, our nonprofit partner, the Sequoia Project, has gotten 12 letters of intent from different organizations who are stating that they intend to become [TEFCA] networks. We're anticipating that in early 2023, we'll be able to announce the first set of potential candidate Qualified Health Information Networks who have made it through the first big step, which is that their eligibility has been approved, meaning their application has been accepted and approved, and they are signing the common agreement.
HL: And when this goes live, that will mean a much greater velocity to the sharing of health records?
Tripathi: Yes, it should mean greater velocity. It should also mean a broader aperture to the type of information that can be shared. Now, that won't happen overnight. But we're working very hard to have public health be a part of these networks. For example, right now, you've got nationwide networks like Carequality and Commonwell that do great work, but public health agencies aren't connected, for a whole variety of reasons.
But now with ONC, and the CDC, and other parts of the US government involved, you're helping to provide that overall governance framework, and we're now working with public health agencies to say how can we get them directly connected to these networks, so they can get the information directly from providers in you know, in low-cost ways, that's a better deal for taxpayers. So we're not paying for all these complicated interfaces in every jurisdiction. And it also means higher performance and a better public health system overall.
Research by the Health Management Academy (The Academy) and Teladoc Health finds that many leading health systems place high value on a digital health strategy, but they haven't reached a point where that strategy is sustainable.
Many healthcare organizations have launched virtual care programs as a result of the pandemic, but how many have programs that are sustainable? A new report offers four recommendations for bridging that gap.
According to a survey of healthcare executives from 38 health systems across the country conducted by the Health Management Academy (The Academy) and Teladoc Health, there's a large gap between where health systems want to be with virtual care and where they are now. The executives rated overall performance of their programs at only 2.9 on a scale of 1 to 5, with the lowest marks focused on care model design, workforce readiness, clinician satisfaction, consistency of experience, and patient satisfaction.
"The problem is that technology alone won’t solve integrated virtual care," the report, prepared by Victoria Stelfox and Anne Herleth of The Academy, states. "Health systems need the wrap-around functions that support virtual care technologies. But because health systems haven’t migrated toward organized, system-wide virtual care programs, they haven’t yet mastered the critical workforce and organizational inputs required to succeed."
Health system executives see a mature virtual care program as being integrated, consumer-focused, and scalable, but are having problems reaching that point. Many jumped on the bandwagon over the past few years to deal with the COVID crisis, helped in part by federal and state waivers aimed at boosting access to and coverage of telehealth and digital health during the public health emergency. But they did so without a long-range strategy, or a plan to continue after the PHE ends.
To reach that level, the report lists four imperatives:
Develop a realistic and actionable digital health strategy. According to the report, many organizations say they have a strategy, but when pressed, they can't define or articulate it. In many cases they've used digital health to enable a strategy but haven't made that strategy a priority.
"Health systems leaders are quick to recognize that a clear digital strategy is needed to push forward on integrated care delivery (among many other strategic imperatives)," the report states. "But to do it, LHS [leading health systems] need to decide who they want to be as an organization—and for virtual care delivery, what markets they want to play in. These may not be quick or easy decisions, but it’s a critical step in moving from disjointed decisions to a scaled, system-wide investment plan."
Look beyond vendor contracts and focus on partnerships. A consumer-focused digital strategy is one of the top priorities for many health systems, and more than three-quarters of those surveyed are joining forces with outside organizations to reach their digital health goals. But many are contracting with vendors or other organizations in purely business terms.
"What is needed is skin in the game on both sides," the report notes. "For both health systems and industry organizations, a good partner is not based on metrics like pricing or contract terms. [Healthcare leaders] describe productive partnerships with terms like flexibility, ongoing communication, culture and values alignment, willingness to hear feedback, and long-term delivery on promises. Industry partners echoed similar sentiments, adding the value of long-term partnerships and aligned incentives."
Make sure everyone is on the same page and supportive. The biggest mistake that health systems make in launching a digital health program is forgetting to include (or ignoring) key participants, such as nurses, or failing to secure support from everyone involved.
"Our data shows that it’s uncommon for operational leaders to be involved in virtual health strategy, despite often being held responsible for the performance of the tools," the report notes. "The result is that projects end up floundering and leaders wonder why the implementation hasn’t been successful. CMIOs and population health leaders observe that they are often brought into implementation conversations during the later stages of virtual health investments, negating the chance for them to provide early and actionable feedback."
"Virtual health implementations today can avoid mistakes of the past by involving key stakeholders early and selectively choosing solutions that make clinicians’ lives easier—not more complicated," the report concludes.
Proceed cautiously with scaling. Many digital health programs start small, addressing a specific pain point or population to prove that they work, and then branch upwards and outwards. But scaling a program or strategy, while critical to long-term growth and sustainability, is challenging. Only about half of those health systems surveyed have achieved mid-stage virtual health maturity.
"To beat this catch-22 and scale well, LHS must conduct an honest assessment of their virtual health maturity by looking at key indicator performance such as governance, data and technology management, financial sustainability, and clinical integration—each of which represents a critical component to scale," the report says. "Organizational self-assessment across these maturity indicators can help health systems determine their readiness for scaling virtual health solutions. However, most LHS still have a long way to go before they will be ready to scale. They will need to focus on solidifying and planning for the governance, sustainable financing and more of their virtual health programs before attempting to scale across the organization."
A bill before Congress would, if passed, continue COVID-era Medicare telehealth waivers until the end of 2024, while also extending the CMS Acute Hospital Care at Home program for two years.
Congress is expected to pass an omnibus spending bill this week that would extend pandemic-era Medicare telehealth waivers until the end of 2024. The bill would also keep in place the Centers for Medicare & Medicaid Services' (CMS) innovative Hospital at Home program, and continue several other programs aimed at boosting connected health access and coverage.
Among several organizations praising the news is the American Telemedicine Association, which had long warned that the elimination of these waivers and programs would seriously hinder telehealth and digital health adoption.
“The ATA and ATA Action never wavered from our appeal to Congress, to provide stability around the life-saving telehealth flexibilities that have become a relied upon and valued option for healthcare providers and patients," Kyle Zebley, senior vice president of public policy for the ATA and executive director of ATA Action, said in a press release. "Today, our Congressional telehealth champions on both sides of the aisle came through for the American people and for ATA and ATA Action members, by meeting our plea for more certainty around telehealth access for the next two years, while we continue to work with policymakers to make telehealth access a permanent part of our healthcare delivery for the future.”
"The inclusion of a two-year extension of Medicare telehealth and commercial market telehealth flexibilities will make a huge difference to so many Americans," The Alliance for Connected Care said in a separate press release. "The Alliance for Connected Care has been calling for predictability for patients and clinicians while continuing to work toward permanent telehealth authorization. This gives us both."
Generally, the bill, if passed, would:
Remove geographic requirements and expand the list of originating sites for telehealth services;
Expand the list of providers eligible to furnish telehealth services;
Expand telehealth services for federally qualified health centers (FQHCs) and rural health clinics (RHCs);
Delay in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology;
Permit audio-only telehealth services, such as phone calls;
Allow the use of telehealth to conduct face-to-face encounters prior to recertification of eligibility for hospice care during the emergency period; and
Mandate a study on telehealth and Medicare program integrity.
The inclusion of audio-only telehealth services is a nice surprise for telehealth advocates. Federal and state regulators have long mandated that telehealth services be audio-visual, and have severely restricted any use of the telephone or an audio-only telemedicine platform for care delivery. But during the pandemic the telephone became a popular tool in regions where access to either telemedicine equipment or reliable broadband is limited. CMS has indicated it will return to those restrictions after the PHE ends, saying the platform isn't reliable enough for care delivery.
The bill would also extend for two years the waiver for the CMS Acute Hospital Care at Home program, an innovative service launched by CMS that allows health systems to shift more care for acute patients from the hospital setting to the home, through a platform that includes remote patient monitoring, telehealth services and in-person care. More than 200 health systems have signed up to take part in the program, and many had said they would be forced to curtail, drastically change, or even cancel the program once CMS support for the program ends.
“We greatly appreciate Congress including extensions the High Deductible Health Plan (HDHP) and Health Savings Account (HSA) telehealth tax provision, giving American workers continued access to needed telehealth coverage without first having to meet annual deductibles, including telemental health services," Zebley said in the ATA press release. "Further, the extension to the Acute Hospital Care at Home Program ensures continued access to this patient-centered care delivery model that is proving to effectively lower cost of care while improving patient health outcomes and satisfaction."
Not all the news was good, however. While the omnibus bill includes several measures aimed at addressing the nation's substance abuse epidemic, it does not include an extension for a waiver that currently allows healthcare providers to prescribe controlled substances via telehealth for substance abuse treatment.
Federal law bans are severely restricts prescriptions of controlled substances through telemedicine. Federal regulation is channeled primarily through the Ryan Haight Act, passed in 2008, which prohibits physicians from prescribing controlled substances electronically until they have conducted an in-person examination, or if they meet the federal definition of practicing telemedicine, which requires that the patient be treated by, and physically located in, a hospital or clinic which has a valid DEA registration; and the telemedicine practitioner is treating the patient in the usual course of professional practice.
The nation’s ongoing opioid abuse crisis is creating a groundswell of support for changes in federal law to make telemedicine and telehealth a more prominent feature in treatment. Congress has been considering bills that would, if passed, create a special registration through the US Drug Enforcement Agency to enable healthcare providers to prescribe controlled substances through telemedicine.
The bill does direct the DEA to implement that special registration process, but the DEA has been asked to start that process for several years and has yet to do so.
While the omnibus bill, if passed as expected, would extend all of these freedoms for another two years, the ATA and others are lobbying to make many of the provisions permanent, rather than just pushing the finish line farther down the road.
“The hard work continues, as we persist in pressing telehealth permanency and creating a lasting roadblock to the ‘telehealth cliff,’" Zebley said. "Additionally, we will continue to work with Congress and the Biden administration to make sure that a predictable and preventable public health crisis never occurs by giving needed certainty to the huge number of Americans relying on the clinically appropriate care achieved through the Ryan Haight in-person waiver.”
Closing gaps in care requires knowing just when a technology-powered nudge will help, rather than cause more stress.
At Ardent Health Services, physician burnout is a constant concern, and an issue that technology can address. The challenge for the Nashville-based healthcare organization, formerly known as the Behavioral Healthcare Corporation, is to find the right technology and not make things worse.
To thread that delicate needle, they're using a technology, developed in part by physicians, that identifies gaps in care and cost considerations.
Ardent deployed the IllumiCare Smart Ribbon in June and has found immediate benefits in a metric that often puts "lots of pressure" on its hospitalists, says chief medical officer FJ Campbell.
"The classic metric is discharges before 11 a.m.," Campbell says. "If you're moving your med/surg patients out by 11 a.m., then you're able to transfer your patients from your ICU to your med/surg units. We deployed IllumiCare, and discharges by 11 a.m. went up over 175%."
But reaching this level of improvement involves much more than just plopping the latest technology in front of hospitalists, Campbell says.
FJ Campbell, chief medical officer of Ardent Health Services. Photo courtesy Ardent Health Services.
Ever since he attended medical school, Campbell has been intrigued by the inefficiencies evident in the hospital setting.
"When you're a surgery resident, and you're in the hospital 100 to 110 hours a week, you take inefficiency personally," he says.
After passing his boards, Campbell pursued an MBA and entered hospital administration, initially as director of medical operations at Virtua Health. A stint at Centennial Medical Center, a flagship hospital of HCA, reinforced a notion to bring clinicians into operational decisions, one that ultimately informed his interest in tools such as Smart Ribbon.
"People who understand workflow make better products," he says. "And good workflows lead to good clinical outcomes, which lead to good financial outcomes."
Since then, Campbell says he has sought out technology defined in part by clinicians themselves, since they're the ones who ultimately have to live with that technology.
After HCA, Campbell became an equity partner and chief medical officer at an urgent care company called CareSpot. He also served as vice president of clinical services at Community Health Systems before moving to Ardent.
At Ardent Health Services, Campbell is responsible for all clinical service lines and initiatives, including hitting the health system's CMS metrics and Leapfrog scores. Nursing and case management services also report to him.
"The case management activity has been concentrating on moving patients through the continuum of care," he says. "The nursing activity has been around how do we leverage technology to overcome the staffing challenges that we have?"
Campbell also helps identify opportunities to start delivering care more effectively outside of the hospitals' four walls. That focus on workflow was intensified by the pandemic.
"We had to be conscious and cognizant of workflow," he says. "Like, how are we going to separate respiratory illness from non-respiratory illness? How are we going to turn a med/surg unit into a step-down unit? How are we going to make negative pressure rooms widely distributed now?"
Pandemic time highlighted the number of clinicians who didn't have a clear enough understanding of operations and their challenges, Campbell says.
"You had many operators with no clinical background, who had to understand clinical medicine a lot more to really appreciate how they could problem solve," he says. "COVID created a nexus and a need for it between operators and clinicians. We're going to have to be doing more to leverage technology to achieve our clinical and operational outcomes."
Clinicians want to be well-informed, but any hints or nudges from technology must be delivered in a manner that is not disruptive to their workflow, Campbell says.
"It really starts getting back to [technology] made by end-users for end-users," he says. Best practice advisories from EHR vendors such as Epic must be accurate, and IllumiCare, by populating the Epic App Orchard with its own apps, adds more important ways to inform clinicians without being intrusive.
"If you're going to give them something that is going to take their attention away from the next lab to track down or the next X-ray value to assess, your clinical decision support content had better be spot on, easy to access, easy to understand, and therefore easy to execute on," Campbell says. "Otherwise, forget it; you will be blown off in a New York minute."
Executives should focus even more on workflow as the successful path to technology adoption, he says.
"I'm going to bring you a tool that's going to make it easier for you to execute on your job," he says. "You're either going to see that very quickly, or if you won't, you're going to help position me to make modifications with the other clinical partners that we have."
Researchers at the University of Illinois and OSF HealthCar are working on a digital health app that would enable providers to better combat false rumors and malicious reports that hinder public health efforts.
Researchers at the University of Illinois are working on a digital health app that would alert providers to healthcare misinformation circulating on social media.
Kevin Leicht, PhD, a sociology professor at UI, and Mary Stapel, MD, community care lead physician for OSF HealthCare Saint Francis Medical Center and assistant program director for the combined Internal Medicine-Pediatrics Residency at the University of Illinois College of Medicine Peoria (UICOMP), are using a $100,000 grant to develop the resource, which would give users real-time alerts about rumors and malicious reports that impact public health efforts.
"What our project actually does is take not only the pre-existing fact-checked data and query it all in one place, it brings it forward in a user-friendly fashion," Leicht said in a press release from OSF Healthcare. "But then it's also trying to come up with a way of adding to this data in a way that's faster than having a human fact checker just scan the web all the time, looking for what the new piece of misinformation is."
Leicht, the science team lead at the Chicago-based Discovery Partners Institute (DPI), and Stapel are using a grant from OSF Healthcare's Jump ARCHES (Applied Research for Community Health through Engineering and Simulation) program, and building on past work, supported by the National Science Foundation, to identify the spread of misinformation about COVID-19 and other debunked medical research.
"If we can even get ahead of that – know what information is circulating and start feeding out more accurate information ahead of time through our community partners; that really could be a game changer when we're thinking about things like pandemics and infectious disease," Stapel said in the press release.
Stapel said the app would help healthcare workers, especially those in community health, to better inform patients and gain their trust at a time when public healthcare workers are struggling against false information that affects their credibility.
"Having humans curate that a little bit … you have content experts that look at that and say, 'Is this dangerous or is it not? Is this trending, is it not?' And then figuring out a way to deliver that to the final customer in a way that requires as little inner interface by them as we can possibly get away with," she added.
HealthLeaders Innovation and Technology Editor Eric Wicklund chats with Joerg, Schwarz, senior director of healthcare interoperability strategy and solutions at Infor, about how healthcare organizations should be selecting and using data platforms.
A start-up from the Mayo Clinic orbit is partnering with Pfizer to develop an AI-enhanced ECG that can detect cardiac amyloidosis, a progressive disease that's difficult to diagnose early.
A startup launched out of the Mayo Clinic Platform is partnering with Pfizer to develop AI software that can detect cardiac amyloidosis in an electrocardiogram.
Anumana, which was launched in 2021 and is part of the nference software company's portfolio, intends to develop the AI-ECG tool as a software-as-a-medical-device (SaMD) and market the algorithm in the US, Europe, and Japan.
This isn't the first time Anumana has created software addressing cardiac issues. The company has developed AI-ECG algorithms in the past through the Mayo Clinic for detection of low ejection fraction, pulmonary hypertension, and hyperkalemia, all of which have received Breakthrough Device designation from the US Food and Drug Administration (FDA).
The latest software takes aim at cardiac amyloidosis, an often undiagnosed and progressive disease characterized by the stiffening of the walls of the heart, interfering with the function of the left ventricle. Symptoms include shortness of breath, knee pain, bilateral carpal tunnel syndrome, kidney disease, and gastrointestinal issues.
Because the symptoms are so diverse, the condition is hard to diagnose. Earlier detection would give clinicians time to develop more effective treatment plans that would improve clinical outcomes over time.
“The challenge in diagnosing cardiac amyloidosis can prevent patients from getting treatment while the disease continues to progress,” David McMullin, Anumana's chief business officer, said in a press release. “We believe this collaboration [with Pfizer] will demonstrate the power of Anumana’s AI-ECG algorithms to help clinicians intervene earlier, giving them greater ability to improve patient outcomes and prolong lives.”
The project is the latest of many that aim to use AI to spot infinitesimal trends in data that might not be picked up by manual data review until much later.
“AI-ECG solutions alert clinicians to humanly imperceptible patterns in ECG signals, providing an early warning for serious occult or impending disease,” added Paul Friedman, MD, chair of the Mayo Clinic's Department of Cardiovascular Medicine and chair of Anumana’s Mayo Clinic Board of Advisors. “This stands to improve the lives of people with cardiac amyloidosis by improving the speed of triage and care of this group.”
