Easing point-of-care challenges with AI and other innovative solutions
Physicians are confronting a growing tangle of administrative duties, data-driven requirements, and documentation needs, all while striving to maintain high standards of patient care. Ben Scharfe, executive vice president at Altera Digital Health, believes integrating digital tools, like AI, with EHR systems can address these issues without increasing the clinical burden. In the following conversation, Scharfe explains how technology advances are equipping physicians with sophisticated tools and insights that enhance patient care and streamline their workload.
Q: Productivity and efficiency are challenges that healthcare organizations are facing every day. Why?
Scharfe: At the core of the productivity issue is the increasing demand for more detailed patient data at the point of care from stakeholders like government and commercial payers. The goal is to create a corpus of data to share across healthcare entities to reduce costs and improve patient outcomes. However, this well-intentioned push places a heavy load on physicians, who now need to document patient information more meticulously to accommodate risk-scoring models and increasingly granular requirements for diagnostic and procedural codes. And we're only seeing the start of it. The need for more data will grow, especially in areas such as social determinants of health.
These layers of additional complexity require physicians to provide detailed documentation for reimbursement and quality reporting, plus they need to manage and apply real-time data from CMS and insurance companies. Although some of this data aids in patient care, most providers feel it doesn't serve the immediate clinical encounter.
Q:How can technology help alleviate some of these pressures?
Scharfe: Artificial intelligence is a massive disruptor set to transform healthcare by enabling providers to focus more on patient interaction and care delivery. AI has the potential to automate much of the required data specificity. Ambient listening and other AI-driven documentation tools allow providers to engage in and capture more natural dialogue with patients. These technologies are evolving and can create semi-structured notes as a starting point.
However, AI’s real potential lies in its ability to further structure these notes for various stakeholders. It can connect the information—whether typed, dictated, or captured through ambient listening—to specific diagnostic and procedure codes without providers needing to navigate the complexities of particular codes. Beyond documentation, AI can enhance patient care by interfacing with information from payers, the EHR, or analytics platforms, bringing critical insights to providers, thus minimizing their need to manually sift through a patient's entire available history.
Q:How is Altera helping its clients to increase productivity and efficiency?
Scharfe: Currently, we're partnering with companies like Microsoft to integrate AI technology into the EHR system to simplify documentation. This integration will allow for more free-flowing, unstructured documentation and make use of tools like ambient listening without necessitating overly specific documentation. Our goal is to create a highly flexible EHR system while automating many specific documentation requirements.
Additionally, we're making some of the complex requirements of value-based care, such risk scoring data, more accessible within the EHR, reducing the need for providers to toggle between multiple systems to access information. Altera is leveraging AI to perform pre-visit chart reviews that identify gaps in care while also summarizing concerning trends and data.
We also offer a mobile EHR application, which is not a standard EHR offering. This app allows providers the flexibility to use a phone or tablet for dictation or documentation as they move between exam rooms.
Q:What other services or technology can help address these issues?
Scharfe: A compelling yet under-used service is chronic care management, reimbursable by Medicare and Medicaid since 2015, and some private payers. It involves monthly calls to patients with two or more chronic conditions, focusing on care plan adherence—medications, exercise, and diet—and offering crucial support and accountability.
Many provider organizations recognize its value but face implementation challenges due to productivity constraints. This is where Altera is partnering with organizations to offer licensed remote nursing and clinical care teams to handle these patient calls. Our approach integrates seamlessly, ensuring no disruption to existing care delivery, with the provider organization retaining billing control. It ultimately drives better outcomes for patients and providers.
Altera also offers managed services and hosting services to dramatically simplify the care organization’s business model, allowing them to focus on patient care while we handle the technology and infrastructure. As a software and technology company, we're dedicated to helping clients maximize their IT investments. We can augment an organization's IT and EHR staff, addressing the application configuration, provider needs, training, and underlying hardware infrastructure. Our team is skilled in keeping systems responsive and efficient, and we're quick to get things back on track if any issues arise.
Technology's tangible impact on boosting a hospital's bottom line.
Hospitals are feeling financial strain from all directions, from staffing shortages and productivity concerns to value-based care and payer denials. Inflation, lingering issues from COVID-19, and pressures dealing with a hybrid workforce have exacerbated things all the more. Enter technology, the potential game-changer. Kelly Johnson, Managed Services Program Director, Revenue Cycle Center of Excellence, Altera Digital Health, shares how high-performing tech tools, from advanced EHR systems to automation, can and are making a real difference. Below, she dives into the top issues impacting hospital bottom lines and where technology is integral.
Q: What are the leading financial challenges that healthcare organizations face today?
Kelly Johnson: Hospitals and health systems have a lot going on post-COVID-19. A primary concern is the disparity between escalating costs and payer contract constraints that put a 5% cap on price increases. Hospitals are dealing with rising drug and supply costs that far surpass this threshold.
This economic pressure is evident, especially when observing community hospitals that struggle with the same issues despite having additional funds and grants from donors and community plans. A telling example is hospitals closing specific departments, like maternity units, due to competition and unsustainable overhead for minimal monthly cases.
Where we land is that hospitals require more advanced IT resources to navigate these cost issues, including detailed insight into overhead, revenue per procedure, and other crucial financial metrics. The rise of the self-pay patient demographic highlights this urgency, with the burden of high-deductible plans causing an uptick in bad debt. Modern systems that determine self-pay segmentation and employ algorithms to predict a patient's propensity to pay are essential. Further, hospitals are starting to see real value in robotic process automation (RPA) and bot technologies for things like analyzing claims to ensure key charges are properly documented.
Q: How can healthcare IT help address the challenges presented by value-based care?
Johnson: Denials are one of the biggest hurdles under value-based care—an issue accelerated by providers’ loss of COVID monies. Healthcare has not fully addressed the core pieces that drive value-based pricing. For example, providers get stuck identifying what to track and the appropriate order to track it so that it gets reimbursed appropriately. Additionally, healthcare organizations generate a lot of pharmacy waste, but many are not up to speed on reporting it correctly so that it gets on the claim and into the 837 form.
Advanced EHR technology can help. For example, with our Sunrise™ EHR, we ensure from a regulatory perspective that we are operationalizing key features like pharmacy waste so providers can properly document it. We are also helping prevent these problems upstream—around 85% of denials are initiated during registration and preauthorization. We look for denial patterns and then build rules during registration and preauthorization. For example, if a specific payer denies X-rays without a preauthorization, we create a rule requiring an authorization field to be populated before service. We also have an EHR feedback loop that identifies frequent flyers in the ED, automatically notifying their primary care physician through the patient portal for follow-up to improve care and reduce inappropriate readmissions.
Q: How can health IT technology help reduce the amount of duplicate medical records?
Johnson: Managing duplicate medical records is another costly headache in healthcare, requiring robust processes and tech solutions. Good visibility through dashboards and reports is vital to spot potential duplicates immediately and rectify inconsistencies. It's about the financial data and consolidating medical documents into the appropriate medical record, timely and efficiently. Most importantly, your EHR should be versatile and capable of handling various medical record merges, whether at the enterprise or facility level or within a single visit. The EHR should also provide a reliable audit trail, as auditors often inspect merged records to trace the lineage between the old and new data. The goal is to ensure the utmost accuracy and integrity of patient information, and the right technology can make all the difference.
Q: What kind of technology or services can help organizations become more efficient and address their staffing shortages?
Johnson: These are hot topics right now. Revenue cycle staffing shortages mirror those happening across healthcare. To help, hospitals are using productivity technology—often tied to an EHR tool—to monitor employee efficiency. They are particularly interested in employees working from home, as more tasks, such as pre-registration and preauthorization, are being done remotely.
Productivity software has advanced significantly, providing insights into whether an employee is more or less productive when working from home. It can track the number of accounts an employee works daily, how often they interact with an account, and even specific actions they take. These tools include dashboards, detailed reports, and work queues, clearly showing individual and team productivity.
Additionally, RPA and bots are becoming essential tools, handling repetitive tasks while freeing up staff to focus on more complex issues. Bots excel in areas like processing coordination of benefits denials or checking insurance eligibility. In the future, the ideal scenario will be a balanced combination where technology supports and enhances human expertise.
In an era marked by rapid progress in healthcare technology, Altera Digital Health is forging a unique path, reshaping how healthcare IT solutions are envisioned and implemented.
Marcus Perez, president of Altera, formerly the Allscripts Hospitals and Large Physician Practices business segment, discusses the 2022 acquisition by the Constellation Software (CSI)/Harris Healthcare family. He emphasizes Altera’s dedication to continually improving clinical products, including EHR platforms, while bolstering client relationships and setting a new direction grounded in core values that guide every decision and action.
At the heart of Harris’s commitment to healthcare tech is a straightforward philosophy: acquire and forever hold. This focused methodology sets the stage for Altera’s long-term growth and success. Perez unpacks the nuances of this strategy and how the company's perspective aligns with the evolving needs of the healthcare industry.
Q: Tell me about Altera's core values and their impact on your customers.
Perez: We have ten core values that inform every decision we make. “Respect for the individual” stands at the forefront. We champion diversity and ensure that every voice is heard during decision-making processes. We also prioritize “understanding reality and making difficult decisions” so that we make decisions based on concrete insights, not just hope. My recent visits with 77 Altera clients reinforced this value. When clients say they are struggling with your products or services, that's your reality. And it may mean making some difficult decisions, such as investing more in resolving problems closer to home rather than doing aspirational spending.
Furthermore, our belief that "bad news doesn't get better with time" fosters transparency and trust and leads to quicker resolutions. We also emphasize “solutions, not problems” and encourage this mindset, especially in client interactions. In addition, our three pillars for building an enduring business promote operational excellence, investing in people, and focusing on growth, a byproduct of the first two.
Q:Can you give me a real-world example of applying a core value to improve a client's experience?
Perez: One core value is genuinely understanding our clients’ businesses. Emphasizing client success, we strive to view the world through their eyes, which hasn’t always been the case. Previously, there was more of a quarterly results focus with some of our acquired assets, including our EHR solutions. Harris and Altera champion a more holistic view. With this in mind, we are shoring up core products and transitioning our client success program to an executive tier, addressing immediate concerns and aligning with our clients’ future vision. Additionally, we are putting more resources into collaborating with individual clients to optimize solutions, making sure they perform at a high level.
The value of “understanding reality and making difficult decisions” recently manifested in feedback regarding our ambulatory EHR. The prior company introduced it as a modified acute-care product that wasn’t as streamlined as our inpatient EHR. This resulted in physicians spending more time on documentation. Currently, our investments are centered on reducing that burden, enabling clinicians to spend less time with technology and more time seeing patients.
Q:What’s Altera’s new vision for healthcare?
Perez: The healthcare industry often uses catchphrases like “transformational change” and “revolutionizing healthcare.” But at Altera, our approach is more granular regarding summiting healthcare technology and moving the needle for clinicians and patients. The future of healthcare is undeniably dynamic, as demonstrated by the rapidly evolving telehealth and care-at-home models. Yet, what clinicians and patients deserve now is an optimized experience. The idea of instant transformational change is unrealistic. Real progress in healthcare technology happens gradually, one move at a time.
Consider the ultimate goal of the EHR: it should provide accurate and timely information to clinicians to assist in their decisions. We anticipate a future where an AI-supported health platform streamlines this information flow, ensuring outstanding experiences for all involved. Our distinction lies in our strategy. We want to bring this next-level healthcare experience within reach through deliberate steps. That's how you reach the summit of healthcare technology.
Q:How does Altera's future look, being part of the CSI/Harris lineage?
Perez: Being part of the CSI/Harris family gives Altera a significant advantage. With CSI’s $58 billion market cap and impressive 37.4% compounded annual growth rate, we’re in a solid position to help our clients along their journeys and deliver products that drive stakeholder value. This lineage provides us with substantial financial backing and operational expertise. We buy distressed assets and are driven by endurance rather than quick fixes because we adopt a “forever” view. By dedicating time, attention, and resources, we bring our companies to their peak potential.
Scharfe: At the core of the productivity issue is the increasing demand for more detailed patient data at the point of care from stakeholders like government and commercial payers. The goal is to create a corpus of data to share across healthcare entities to reduce costs and improve patient outcomes. However, this well-intentioned push places a heavy load on physicians, who now need to document patient information more meticulously to accommodate risk-scoring models and increasingly granular requirements for diagnostic and procedural codes. And we're only seeing the start of it. The need for more data will grow, especially in areas such as social determinants of health.
Marcus Perez, president of Altera, formerly the Allscripts Hospitals and Large Physician Practices business segment, discusses the 2022 acquisition by the Constellation Software (CSI)/Harris Healthcare family. He emphasizes Altera’s dedication to continually improving clinical products, including EHR platforms, while bolstering client relationships and setting a new direction grounded in core values that guide every decision and action.