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Health IT

Data breach, cybersecurity, hacking,

In April of this year, Tenant Health, one of the US’s largest hospital care service providers, fell victim to a cybersecurity attack that led to weeks of interruption and cost $100 million in damages. Last May, Scripps Health suffered an attack that halted operations for a month and cost $112.7 million in lost revenue and remediation. The year prior, the University of Vermont Health Network experienced over five weeks of downtime due to a ransomware attack, resulting in more than $63 million in mitigation costs.

What do these three systems have in common? In addition to facing the unfortunate impact of a cybersecurity attack, each organization experienced the detrimental effects of extended downtime. In the past, it was not common for a breach to leave organizations sidelined for more than three days. However, in our current environment, three days have turned into weeks, resulting in major operational disruptions. Critical applications, medical devices, protected health information (PHI), patient safety, and lives are all at risk when extended downtime occurs. The question is, are you and your team prepared? This article explores three questions to consider when preparing for extended downtime.

Question 1: What does extended downtime look like for each department?

The first question to consider is what is the repercussion of extended downtime? When consulting with clients, I review their latest departmental business continuity plans (BCP) and business impact analysis (BIA). The BIA is the exercise that identifies critical applications and the impacts of downtime. It is imperative to bring department leaders together to walk through a timeline of operations without automated processes. Most departmental BCPs are based on a timeframe of up to three days of downtime and need to extend to four to five weeks.

Extended downtime can play out in various ways. If medical devices are down, there could be a need to divert patients to other healthcare facilities for chemo, dialysis, ICU, emergency services, and so forth. Insurance payers no longer accept hard copy claims, and even if they did, coding is automated by your electronic medical record (EMR) system. Healthcare billers are no longer trained on how to code claims manually. Not being able to send electronic claims will impact cash flow. In addition, if the payroll applications are down, there is a significant impact on processes to pay employees. If the Accounts Payable (AP) system is down, there is an impact on paying critical third-party vendors for essential services. Other aspects of an extended downtime include knowing when to involve legal teams and outside agencies such as the FBI and local police. Imagine the chaos that could occur if a well-defined plan for extended downtime is not in place.

Question 2: How do I conduct a Business Impact Analysis?

A BIA is critical to evaluating any downtime period’s effects on your organization and must be updated periodically for change management. The process of establishing a BIA includes identifying critical applications and documenting:

  • Business activity affected
  • Potential operational loss
  • Potential financial loss
  • Minimum time needed to recover operations
  • Other critical application dependencies

These factors will vary based on the type and severity of a disaster. The operational loss could be the inability to conduct business as usual. Financial loss varies widely but can sometimes range from $3000 to $5000 an hour in revenue loss for your organization. An updated, accurate BIA will help you assess which controls need to be implemented to reduce the risk of extended downtimes, such as a Cloud backup or colocation redundancies.

Question 3: Why is education so important?

Unfortunately, there is no silver bullet to ensure cybersecurity. However, education and preparation are essential. While training isn’t a guaranteed safeguard against attack, it is an effective tool to arm your team to know how to respond. I highly recommend tabletop exercises, such as discussing crisis scenarios with various departments and the potential implications for each. What might seem daunting to discuss initially will come into practice should a crisis occur.

Many educational tactics help your team to be better prepared. Along with tabletop exercises, organizations should consistently provide engaging educational events such as webinars, email reminders, video tutorials, and in-person speaker sessions. The National Initiative for Cybersecurity Careers and Studies offers various free tools, as does the Office of the National Coordinator (ONC) for Health Information Technology.

Conclusion

Over the years, technology has evolved in ways that are essential to efficient, effective business operations. However, risk factors remain a reality. Awareness of those factors and ways to combat them requires thinking through the scenarios, educating your staff, and continually updating your BIA and BCPs. Plan today so you can minimize chaos when an incident occurs.

Photo: JuSun, Getty Images

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virtual care technology

Note: This article is part of a series exploring how to unlock the value of remote patient monitoring. The next article in the series explores how medical device companies are using RWE as part of submissions to regulatory bodies. We’ll explore how medical device companies are navigating this segment of the regulatory landscape.

Patient engagement is a critical component of remote patient monitoring. Part of real world evidence (RWE) collection involves patient-reported data. But if medtech companies are to build a collaborative relationship with patients, building trust is critical to get opt-in to share their data. If patients understand why their data is needed and how it will be used, they will be more likely to view this request in a positive light. They’ll see this as a way to help them manage their condition and not as a cynical transactional relationship.

As well as ensuring that accurate, timely data is collected from devices, capturing patient reported outcomes (for example, chronic pain) is also important to build a fuller view of the patient. In a recent webinar on remote patient monitoring and RWE, sponsored by Huma, panelists discussed how they are using patient engagement to trigger earlier interventions, support patients through their care journey and de-escalate the stress and anxiety often associated with managing acute and chronic conditions.

Earlier interventions

One of the exciting opportunities in leveraging RWE and data insights for patients and clinicians is they can lead to earlier interventions for high risk patients. This patient population may include patients with multiple chronic conditions as well as patients recovering from surgery.

AliveCor uses biosensors to convert a smartphone into an EKG to track arrhythmias. This heart condition can be tough to spot in the relatively short window of a physician appointment because they are unpredictable. That spurs the need for data collection over a long period of time when arrhythmias can be detected. The goal of the company is not only to make it easy for patients to collect and share data to avoid a fragmented care experience, but to enable earlier interventions to avoid hospitalizations.

Dr. Archana Dubey, chief clinical officer with AliveCor, shared that by adding remote patient monitoring, the company reduced emergency room visits by 56%. It was also able to cut hospitalization for patients with arrhythmia by 68%.

“That is powerful. That is important … for a primary care physician to better manage and better understand the patients when they’re at home or in the workplace,” Dubey said. “It’s also important for payers because they care about total cost of care reduction.”

In order to provide effective early intervention for the portion of orthopedic surgery patients experiencing complications with recovery, it’s important for that insight to come within one week of surgery. Patient reported data is essential within the week following this surgery, according to Paul Trueman,  global VP for health economics and market access at Smith and Nephew. By receiving patient feedback on pain, mobility, and satisfaction through medical device RWE platforms, surgeons are better positioned to respond in a timely manner and, if possible, deliver better outcomes for the patient.

Trueman noted that the medical device industry’s ability to collect and build big data sets based on patient-reported outcomes as they recover from procedures is where the medtech industry can prove the value and effectiveness of their devices in the long term. 

“That’s where we start to get signals about overarching product performance, rare [adverse] events. We know that’s occurred in orthopedics in the past where we haven’t had that wholesale data collection – we either missed it as an industry or we found it too late. I think as we start to get more and more data or we recruit more patients …. we’ll start to get those signals a lot earlier and correct [problems] earlier as well.” 

As valuable as earlier interventions are, for clinicians to receive and act on data insights for high risk patients, alerts need to be managed in such a way that they don’t create alarm fatigue or otherwise add to the overworked physicians’ caseload.

Supporting patients

Patient engagement with their medical devices is also critical for more subjective measures, especially pain. Abbott’s Neuromodulation division developed the NeuroSphere platform to support virtual care and interactive data collection between patients who have received an implant as part of treatment for movement disorders such as Parkinson’s disease and/or chronic pain. 

What’s compelling about this platform from a medical device company is that physicians are able to adjust the patient’s implant settings remotely, based on patient-reported data. Abbott gets right to the sweet spot of the dynamics that can drive increased patient engagement and lead to better outcomes. If patients share data and express discomfort, that engagement will lead to a physician response, adjusting the settings of their implant, and help them feel and move better. This should empower patients and make them feel they can take an active role in managing their condition and potentially reduce their stress. So even patients in rural areas or where neurologists are in short supply can have the same level of access to physicians who receive their data and respond accordingly. 

Dr. Erika Ross, director of clinical and applied research of the Neuromodulation division at Abbott, noted that it’s incumbent upon the medical device manufacturer to balance the patient’s ownership of their own data with building interfaces so a clinician can use timely insights based on the patient’s data to make a decision in a short amount of time and communicate with patients as clearly as possible . 

“These small movements forward in truly understanding objectively what’s happening in a very subjective disorder, this is going to completely revolutionize an area like the chronic pain practice area,” said Dr. Erika Ross, director of clinical and applied research of the Neuromodulation division at Abbott.

The Covid-19 pandemic has played a role in making individuals more aware of their health and on the alert for symptoms related to the virus. That’s helped make people more engaged in their health generally. 

Alex Gilbert, who works in digital medicine at Huma, said Type 2 diabetes patients he’s working with are sharing data from their devices at a rate of 80%, which is an unusually high level of engagement for patients with this chronic condition. The implications are that when patients can see the benefits of sharing data to track and manage their condition they will be more likely to adopt medtech and companion digital health apps at a higher rate. That, in turn, will lead to more patients opting into sharing their information with both medical device manufacturers and hospitals. 

“It just pays to be very honest and clear about how data is being transferred and transmitted,” Gilbert shared. “We explain that to patients, we help them to understand the process that’s going on. We’ve actually spent a lot of time in terms of engaging them in the right way and getting them involved.”

De-escalating patient concerns

As the case of Abbott demonstrates, medical device manufacturers are taking on a larger role in patient engagement. It’s part of a slow but widening trend. That interaction is not only illustrated by changing a patient’s device settings in response to them sharing data. It is also reflected by medtech companies using patient data and feedback to de-escalate patient concerns.

Patients using Smith and Nephew’s devices receive an explanation from the company when they’re concerned about the pace of their recovery from surgery or concerns over developments like swelling and stiffness and how long those symptoms will last and give them a sense of the parameters of their recovery. 

“We’re not directly intervening,” Trueman explained. “But where we have signs and symptoms of an escalation of an infection, for example, we’re trying to give the patient enough insight and knowledge and education to actually know when to pick up the phone to [call] their provider.” 

To optimize patient engagement, it’s crucial for there to be synchronicity between medical device companies, patients, clinicians and payers. When medical device companies build an interface for their devices that supports data sharing between patients and clinicians, this can make it easier for patients to share meaningful data with clinicians and, passively, medtech companies. It can also help patients better understand their condition and motivate them to be more candid about the data they share with their clinicians and even medtech companies. By sharing more personal information in a timely manner, it could improve communication between clinicians and patients and avoid needless trips to the emergency room and reduce complications that lead to hospitalization.

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From left: Ayush Jain of Revolution’s Rise of the Rest Seed Fund; Ayse McCracken of Ignite Healthcare and INNOVATE Health Ventures; Max Rosett of Research Bridge Partners; and Dr. Hubert Zajicek of Health Wildcatters

When it comes to investment, including healthcare and biotech, companies in the Bay area, Boston and New York tend to get the lion’s share of venture capital. But in recent years there’s been greater attention to investment in companies beyond those regions. The Covid-19 pandemic also played a significant role, as people were forced to limit travel and use Zoom to connect. In a panel discussion at INVEST Digital Health, healthcare and life science investors discussed investment strategies and why they are placing their funding bets in states like Texas, Indiana, Utah and Arkansas.

The panel, Investing between the coasts, moderated by Dr. Hubert Zajicek, CEO, partner and co-founder of Health Wildcatters, offered a window into how investors are finding companies that match their investment theses, even in states that are not thought of as startup hubs. The panel was sponsored by Lyda Hill Philanthropies.

“We were the most active investor in Arkansas last year,” said Ayush Jain, a senior associate with Revolution’s Rise of the Rest Seed Fund. The fund, which was started by Steve Case of AOL fame, has made investments in more than 200 companies in 40 states since 2017.

The video platform Zoom has made an indelible impact towards democratizing investment across the country, according to Ayse McCracken, a founder and board chair with Ignite Healthcare in Houston and president of eNNOVATE Health Ventures. Ignite focuses on women-led digital health and medical device startups, while eNNOVATE invests in a broad array of startups across the continent of Africa.

McCracken said it was one of the unintended consequences of the pandemic.

“[Zoom] has allowed us to connect with entrepreneurs all across the country and all across the world and match them with mentors across the U.S. All of a sudden, we were working with an expanded ecosystem coast to coast, and we were working with startups coming from all across the country. We have eight of the 22 companies [in our latest cohort] that are coming from the Texas market — San Antonio, Austin, Dallas and Houston, which is great. We’d love to see Texas continue to grow. Denver has been another location where we’re seeing a number of entrepreneurs come from, also Minneapolis.”

Max Rosett, a principal with Research Bridge Partners, conceded that Zoom has been useful for connecting with and keeping in touch with portfolio companies in areas that would have otherwise been costly to travel to from his offices in Salt Lake City.

“This is going to sound incredibly trite and yet it’s incredibly real. Now that it’s okay to have board meetings over Zoom, life is much easier,” Rosett said.

Research Bridge Partners, which focuses on life science companies, is trying to chip away at what it refers to on its website as the “geographic misalignment” of venture capital in the Bay area and Boston. It also calls attention to trends among larger venture capital firms of creating lab-to-market systems to advance ideas towards financial liquidity that make it tougher for midcontinent principal investigators to access, because these firms favor  institutional brand and geographical proximity to their offices.

Although everyone is pleased that the worst of the pandemic appears to be over, Zajicek said that in the past two years the accelerator has received a record number of applications from all over the world, which has spurred the development of a hybrid program combining in-person and Zoom-based interactions with startups in its cohorts. It has added an international flavor to its startup portfolio. Add to that the accelerator’s advantageous base in Dallas, in close proximity to an airport with the most direct flights in the country.

“It has flattened the world in non-trivial ways,” Zajicek said.

Health Wildcatters recently moved its offices to Pegasus Park, a 13-floor building that offers lots of space for healthcare and life science startups to work and connect with investors and collaboration partners.

Jain agreed that Zoom can offer a useful complement to in-person meetings and has made it easier to foster relationships with startups. He emphasized the importance of regional startup incubator and accelerator spaces, which frequently host demo days and other events to bring investors and startups together. They can also prove useful for investors from out of town seeking to plug into the regional startup ecosystem.

“If there’s a city that you gravitate towards, whether it’s because of a particular industry strength, or a personal connection, those are factors to leverage when you build relationships in those cities and find deal flow there,” Jain said. “That’s something we lean on a lot. We’re not lead investors. So we rely on finding opportunities to invest in startups, mostly through local regional investors, accelerators, incubators, places like Pegasus Park, where there’s a ton of companies. There’s some institutions in other cities like this. I think finding those and really honing in on them and building relationships is important.”

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Rural areas are particularly vulnerable, and delivering healthcare services while ensuring a positive patient experience presents a unique set of challenges.

Couple those challenges with the increasingly complex compliance and regulatory environment, whether it’s the Omnibus Burden Reduction rule or complying with HIPAA changes amid increasing cyber threats, navigating the rural healthcare landscape can be tricky.

Increasingly, rural hospitals are closing their doors, and rural medical centers are having trouble attracting the talent they need to maintain operations.

An analysis from the Federal Reserve Bank of Richmond revealed that hospitals nationwide have 105,000 fewer workers than in February 2020, a roughly 2% decline. Rural providers acutely feel the pinch.

Maintaining, let alone enhancing the patient experience, is near impossible for resource-constrained rural healthcare providers. Often, providers struggle with streamlining their operations and don’t act quickly or decisively.

If there is a silver lining to the Covid-19 pandemic, it has been a catalyst for change that many rural and community practices and hospitals wanted to make but did not for various reasons.

Insurance regulations

As insurance becomes increasingly complex, many health organizations have needed additional staff to keep up with the requisite paperwork. The costly proposition is not one most hospitals can afford amid the shifting landscape.

Finding the talent and expertise needed to navigate complex regulations is a multi-pronged dilemma, especially in many rural areas suffering from population declines. But not doing so can prove more costly in the long run.

Organizations must simplify their process to meet the regulatory requirements and evolve as regulations change. That is especially true for patients with two insurance plans — a commercial plan and Medicaid as the secondary.

A system that can handle the complexities of rural health settings and alert the billing department when payments are made and when to act serves as a pressure valve to an overburdened department.

The right technology partner can help streamline the management of insurance regulations, including Medicare and Medicaid. While not without cost implications, technology partners can securely house necessary documentation, maintain records and process payments to help alleviate the regulatory burden on already stretched teams.

The cybersecurity threat

Every year seems to be worse than the year before regarding cybersecurity. Hackers and bad actors have increasingly set their sights on healthcare recently.

The reasons are varied, but providers are likely to pay ransoms to restore IT services, considering that it is a matter of life and death and that private health data is a profitable commodity on the dark web. The median ransom is $75,000, making cybersecurity one of the most critical investments hospitals can make.

Rural providers’ lean IT teams and limited budgets hinder the investments they can make. Every investment is critical, and health IT platforms must include built-in security solutions.

Amid the Covid-19 pandemic, the Office for Civil Rights released multiple waivers to help ease the burdens of complying with HIPAA. However, as the world emerges and moves on from the pandemic, HIPAA will again be a top compliance priority.

Technology is a partner

Whether minimizing the time staff members need to review electronic health records (EHR) to help offset staff shortages, streamlining the billing process and giving unprecedented insights into patient records, the right technology can provide critical support to healthcare teams.

Ultimately, navigating the complex compliance and regulatory environment requires new solutions to long-standing issues. Against new and long-standing challenges, rural providers must adapt to position their organizations for future success and stability.

Solutions that empower health care providers to transform their operations digitally will play a key role here. Providers must make strategic investments that reap long-term returns, particularly in cybersecurity, analytics and cloud-based platforms.

For example, data-driven analytics will empower rural providers to understand better how different social determinants of health (SDOH) impact their population. This insight will help organizations apply for grants that benefit and elevate community-centric programs.

Additional investments in broadband access at the federal level will help close the digital divide. Doing so will allow more patients to access health services via telehealth and patient portals.

The pandemic brought a new focus on health inequities, as long-disadvantaged communities encountered worse outcomes from Covid-19.

We’re faced with unprecedented headwinds. Many rural and community practices and hospitals have scaled back their services to maintain some level of operations.

Technology can help organizations navigate these headwinds and position themselves for future success. The time to act is now — before a new regulation mandates it.

Photo: marekuliasz, Getty Images

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According to the Office of the National Coordinator for Health Information Technology, 32% of individuals who went to the doctor in 2018 reported a gap in information exchange. This gap included anything from needing to redo a test because their prior data was unavailable, provide medical history because their chart could not be found, bring results to an appointment, or waiting longer than expected for lab results. This lack of data stewardship causes a loss of patient data, which forgoes interoperability that the health IT industry has been working toward for 20+ years. Below we will discuss the move to interoperability, key takeaways from the April 2022 ONC annual meeting, and the importance of archiving data.

Right data, right time, right format

Interoperability is about having the right data at the right time in the right format. Interoperability is also a critical component for systems to communicate. Inability to access patient health records is not just an inconvenience; in some cases, it could be the difference between life and death, which is why managing data and ensuring its access and usability between systems is important. Data must be easily accessible and usable for patients and physicians without exerting any undue effort. Having data that is accessible is imperative for providing high-quality, effective and efficient healthcare. Patients should be able to seamlessly transfer their data between health organizations. Continuity of care relies on the interoperability of systems, which makes the entire healthcare process more effective for everyone involved.

Key takeaways from the 2022 ONC annual meeting

The ONC meeting in April placed importance on interoperability for the future of healthcare. Incorporating acceleration of real-world health evidence into research demonstrates the necessity and timeliness of the ONC’s guidance. The meeting dove into several relevant discussions relating to interoperability and the 21st Century Cures Act, and access of patient records across critical ancillary systems. A summary of the themes discussed at the ONC Meeting are highlighted below.

  •     Interconnected EHR highway

Interoperable systems serve as the foundation for health information exchange highways. Many organizations are adopting Fast Healthcare Interoperability Resources (FHIR), especially due to the 21ST Century Cures Act. FHIR was developed to meet the growing amount of health data and the need to exchange that information quickly between computer systems. Under the 21st Century Cures Act, any practice that prohibits patients from accessing their data or limits them from transferring their data wherever they want it to go is a violation. For this reason, interoperability is paramount for adherence with the Cures Act and to meet the needs of patients in modern times. FHIR is the standard health systems should be implementing to provide efficient, holistic patient care.

  •     Effective healthcare begins with easy access and transfer of patient data

The 21st Century Cures Act also addresses information blocking to remedy the impact of data silos across an organization’s ancillary systems. The implementation of numerous systems within an organization may hinder the accessibility of data if each system is not interoperable.  As organizations evolve and implement new systems, the need to preserve legacy data in a meaningful and accessible way has become top priority. When legacy data is archived and made accessible through standard methods such as HL7 FHIR, it creates an ecosystem that allows the patient and care team members to make quicker and better clinical decisions that are data driven. Making legacy data easily available also ensures compliance with data blocking regulations.

Interoperability coming to fruition

Interoperability has been talked about for decades. Health organizations are implementing FHIR standards across their existing systems and are archiving legacy data. These steps will make healthcare more effective and efficient while meeting the regulations put in place by the 21st Century Cures Act.

Data stewardship is critical given the vast amount of patient data available. The future of healthcare is unfolding with interoperability and FHIR at the forefront. Access to data can lead patients and healthcare teams to make better, more informed and effective decisions about clinical care.

Photo: karsty, Getty Images

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More than one in eight federally qualified health centers (FQHCs) are “fiercely committed” to remaining independent of hospital affiliation, according to a recent report conducted by Porter Research on behalf of NextGen Healthcare. FQHCs differ from other primary care centers and hospitals because they receive federal funds to increase access to care for marginalized communities. They serve nearly 29 million patients annually.

However, a slew of obstacles are challenging FQHCs’ financial stability — including workforce shortages, the expansion of Medicaid, evolving payment models and increasing regulatory requirements. Given these challenges, it is vital that FQHCs face work together more closely, the report argued. 

For the report, Porter Research garnered data from more than 50 executives at mid- to large-size FQHCs across the country to understand more about their organizations’ unique needs. 

Part of FQHCs’ funding and reimbursement is tied to clinical quality and financial metrics, which are measured on an annual basis by the Health Resources and Services Administration’ Uniform Data System. This system provides insights into the overall quality of care delivered at FQHCs versus the total cost to deliver that care. This process places a critical importance on the health centers’ ability to accurately report on the care they are providing, said Srinivas Velamoor, NextGen’s chief growth and strategy officer.

FQHCs’ data needs are further complicated by their unique positioning as last-mile delivery entities for integrated healthcare in marginalized communities. Velamoor said this means they need broader visibility into individual medical and behavioral health data, as well as data on patients’ social determinants of health, including housing status, financial circumstances, social isolation and access to food and transportation.

To ensure that FQHCs’s data needs are met, Velamoor recommends the following actions: simplifying and expanding interoperability and public data exchange programs, increasing access to patient data directories, and accelerating partnerships with non-FQHC community organizations. He also recommended that FQHCs collaborate with one another. 

“FQHCs deliver some of the most complex healthcare services under one organization in all of ambulatory care,” Velamoor said. “While some larger organizations have resources to address the needs of their populations, they don’t necessarily have the perspective that working collaboratively affords. For those that lack resources, pooling capabilities can help accelerate their ability to scale and evolve capabilities and address individual shortages.”

Further, the patient populations that FQHCs serve share a similar socioeconomic profile, one that is less advantaged than the patient populations served by private health systems. Collaboration between FQHCs allows them to learn from each other to meet the evolving needs of their communities, according to Velamoor.

“Collaboration also provides a safety net entity for vulnerable populations in key ZIP codes that can more effectively ensure appropriate coverage across the health continuum,” he said. “This requires collaboration with not just other FQHCs but non-FQHC community organizations that can provide visibility into patient and community needs.”

The report found that 72 percent of participants are willing to work with like-minded organizations, including other FQHCs, to pool data and glean more insights.

NextGen piloted an example of this type of collaboration last year when it launched the NextGen Community Health Collaborative. The initiative seeks to provide FQHCs with data benchmarking, comparative analytics and reporting services, as well as a forum for members to share best practices for improving community health.

Photo: metamorworks, Getty Images

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A new health IT partnership aims to improve clinical data quality and thereby increase the volume of data available for care quality measurement.

The partnership will combine Chicago-based Apervita and Farmington, Connecticut-based Diameter Health’s expertise to provide payers, providers and other healthcare stakeholders with access to clean clinical data for value-based care delivery, said Rick Howard, Apervita’s chief product officer, in an email.

“The healthcare industry has no shortage of data, but the way it’s leveraged continues to be a challenge for both quality measurement and for supporting value-based contracts,” he said.

Apervita provides stakeholders with the infrastructure necessary to develop value-based care models.

Per the new partnership, the company’s quality measurement and value optimization solutions will leverage Diameter Health’s Fusion engine to clean healthcare data in multiple formats, including clinical, claims, behavioral health and laboratory data, Howard explained.

The clean data can be used to glean performance insights that are needed to develop value-based contracts between providers and payers.

Diameter Health’s technology ingests raw — that is, poorly formed, unstructured or incorrectly coded — health information from EHRs, labs and aggregators, and automatically normalizes, re-organizes, deduplicates and summarizes the data, said a Diameter Health spokesperson in an email. The technology identifies data quality errors early in the ingestion process, which makes data sharing more efficient.

“We are thrilled to be a critical and foundational component to Apervita’s platform by delivering clean, normalized, and enriched multi-source clinical data to their customers, empowering providers, payers and other healthcare stakeholders to improve quality and deliver value,” said Eric Rosow, CEO of Diameter Health, in a news release.

Healthcare data is proliferating as the industry becomes more digitized. Telehealth and remote patient monitoring services, in particular, grew exponentially amid the Covid-19 pandemic. And the data generated by these services also grew.

In addition, wearable health technology, like glucose monitors and the Apple Watch, are becoming more widely used to track patient diagnostics and encourage patient engagement, Howard said. This provides even more data for the healthcare industry to contend with.

“As the volume of healthcare data continues to grow, so will the need to have technology that normalizes the data so that it can be used to support quality measurement, value-based contracts and analytics,” he said.

Photo: Dmitrii_Guzhanin, Getty Images

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The Covid-19 pandemic has affected every sector of our society and requires coordinating a broad coalition of assets to contain it. The response includes multiple federal and state government agencies, thousands of hospitals, and a broad swath of commercial manufacturing capabilities and supply chains. We saw this coordination and collaboration early on with personal protective equipment and ventilators, and we see it again as we ramp up vaccine distribution.

To coordinate an effective response, it is critical to integrate disparate data types from multiple domains and sources, something that has been a long-standing challenge in health care. Obstacles include government agency budget structures that don’t incentivize data sharing and legacy databases that create barriers to data integration. The commercial sector also brings the challenges of competition and proprietary systems. Even seemingly simple questions, such as how many ICU beds are available in a community, are maddeningly difficult to answer in near real time. While well-branded and user-friendly websites provide impressive updates on case counts, emergency operation centers have found it challenging to integrate that data with bed availability, hospitalization projections, work force data, supply chain data, mitigation interventions, social determinants of health, and other key data elements that allow for effective planning and response.

In addition to the public health challenges, new care delivery models have underscored the need to better integrate data to deliver care for chronic diseases. The pandemic has accelerated the adoption and use of telehealth. But again, tools, sensors, apps, and devices are often deployed on disparate data platforms that make it cumbersome for patients and providers to integrate data in a meaningful fashion.

The pandemic illustrates the need for better data integration to improve management of this crises as it continues to impede the everyday care of patients.

Lessons learned from defense and intelligence communities
The health industry lags behind other commercial sectors in its adoption of data management and open-source innovations. The health community can learn a great deal about data management from defense and intelligence agencies, which must integrate vast amounts of data from disparate systems to create a common operating picture to support life and death decisions for warfighters.

The 9/11 attacks demonstrated that data gaps can be deadly. The 9/11 Commission Report revealed that information that could have prevented this tragedy was scattered across several different intelligence agencies’ databases. Following the Commission’s critique, the intelligence agencies adopted low schema data “lakes” that could accommodate multiple “streams and rivers” of disparate data and allow for easier integration. Think of these data systems as giant spreadsheets, with each cell containing an entry item. With automated meta-tagging, each cell of information can be correlated with any other item of data to reveal patterns that would otherwise have gone undetected. These data platforms also enabled the accumulation of massive data stores that optimize advanced analytics and artificial intelligence. Intelligence agencies also benefited from security protections at the individual cell level that enhanced data security, an important feature to consider as health information increasingly comes under cyberattack.

The intelligence community also embraced open source tools and open architectures for these data systems. Open source allows the rapid development of new tools at lower cost. Open architectures avoid costly and stagnating vendor lock, and it enables the adoption of new best-in-class tools and capabilities as they are often developed by small niche firms and start-ups

While novel 15 years ago, many of these innovations have been avidly adopted in the commercial sector. However, the same cannot be said for the health domain. That said, there are notable exceptions that are bright spots on the health care landscape.

Advana: Uniting disparate systems and users on a common platform
Advana, a Department of Defense (DoD) data platform, pulls together more than 200 business systems across the DoD and makes data discoverable, understandable, accessible, and usable for advanced analytics for more than 17,000 users across the Army, Navy, and Air Force who need to make decisions about mission readiness, contracts, supply chain logistics and more. The platform has helped the DoD coordinate its Covid-19 response by enabling the easy integration of a wide range of data, including case, bed, supply chain, readiness, and financial data, to inform critical health care decisions. The open architecture platform supports multiple projection models and analytic tools, which allows the DoD to validate findings in a way that would not have been feasible with a single approach.

Advana faced many of the data integration obstacles familiar to health care IT leaders: non-standard interfaces, duplicate data and systems, legacy technologies, and a history of different units pulling their own data for decision making. To integrate disparate data from spreadsheets, application programming interface (APIs), database dumps, and data warehouses from across the enterprise, Advana streams data feeds, automatically categorizing, tagging, and transforming them into a common data model to improve enterprise level analytics.

Preparing for the next health crisis
The value of big data in health care is clear but unless we can integrate and correlate disparate types of data, we can’t realize the benefits. The data challenges of the Covid-19 response illustrate this issue. The seams between government agencies, health systems, and departments within the same organization create chronic barriers to data sharing. Few organizations manage more data than the defense and intelligence agencies, and as with health care, their decisions often have life and death consequences. For critical decisions, they have developed effective strategies to create a common operating picture through robust data integration. As we continue to respond to this pandemic and prepare for the next crisis, the health care community should learn from these mission critical organizations.

Editor’s Note – The author is a Department of Defense consultant.

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The journey toward achieving interoperability in healthcare needs to now move beyond data exchange, and instead, focus on data management.

This is the opinion of a panel of experts who gathered at the all-virtual Health Datapalooza and National Health Policy Conference Thursday to discuss one of healthcare’s most hotly debated concepts: interoperability.

The healthcare industry has come a long way with regard to interoperability, especially with the new rules proposed by the Department of Health and Human Services, set to take effect April 5. These rules aim to provide patients with unprecedented access to their data.

But the healthcare problems of today require solutions that support data management, and not just data exchange, said Claudia Williams, CEO of California-based Manifest MedEX, at the Health Datapalooza conference.

The industry has focused on enabling the basic exchange of health records between providers and made great progress, but the connective tissue that enables data management — including matching and cleaning data — is lacking, she said. And it’s the smaller providers that are being left behind.

“In California, a slim share of the health delivery systems, mostly the big health systems, have hundreds of people doing this work, and safety net providers and small Medicaid plans and others really are stuck with just being able to pile up CCDAs [consolidated clinical document architecture] or maybe not even process CCDAs at all,” she said.

There needs to be policies and strategies enacted at the state and federal levels to create an infrastructure that has more to do with the management of data than with health record exchange, Williams said.

While policy actions are necessary, there also needs to be more alignment between the needs of the providers on the ground and the health IT technology and capabilities available today, said Dr. Farzad Mostashari, CEO of Bethesda, Maryland-based Aledade, during the panel discussion.

Through Aledade, which operates accountable care organizations in partnership with more than 800 primary care practices, Mostashari has experienced that disconnect firsthand.

“What EHRs do today have nothing to do with what I need,” he said. “Well, not nothing, but they really don’t fill the thermometer of what I need to do for population health.”

It is costing Aledade millions to map, match and translate EHR data, he added.

Looking ahead, care quality measurement needs to be automated within the EHR and providers should get free access to information that is already mapped in accordance with data standards, Mostashari said.

The technical tools needed to push interoperability forward already exist, but the regulatory landscape needs to catch up, said Donald Trigg, president of North Kansas City, Missouri-based Cerner, during the session.

The government is now both the biggest healthcare regulator in the country and the biggest payer. This means it is in a unique position to use health IT certification and provider reimbursement to help create the interoperability architecture that is necessary for the coming decade, Trigg said.

“I’m still an optimist,” he said. “And I think that Covid and this administration will be an accelerant for the next wave of meaningful data exchange.”

Trigg’s advice for the new administration’s HHS is to tackle the inter-agency complexity that exists at the federal level.

Coordination between agencies like the HHS, Federal Trade Commission and Food and Drug Administration is necessary. This means, it will be important to create clarity around the inter-agency landscape and data management so that the healthcare industry can innovate and do more, Trigg said.

Photo: LeoWolfert, Getty Images

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The Covid-19 pandemic spurred the use of technology, but with growing use comes new challenges.

Southfield, Michigan-based Beaumont Health experienced this firsthand at the end of January, when an unknown user took advantage of an Epic scheduling tool vulnerability. But the incident served as a teachable moment, with the system quickly working to safeguard its vaccine scheduling process, said Beaumont Health Chief Information Officer Hans Keil in a phone interview.

The user publicly shared a link to the scheduling module for the clinic providing Covid-19 vaccines. This allowed 2,700 people to register for an unauthorized vaccine appointment, all of which had to be canceled.

Keil believes that the high level of demand for Covid-19 vaccine is what ultimately led to this incident.

“We had challenges with demand,” he said. “We had to triple our server capacity to be able to support the public and their high interest in getting vaccinated.”

When the vaccine rollout began, Beaumont was leveraging technology already available via its Epic EHR system. It had previously used this technology to schedule influenza vaccinations and conduct serology testing last April.

But the Epic system did not have the ability to send out randomized invitations for vaccinations, Keil said. It was important for the health system to be able to randomize that process to ensure it was administering the vaccine equitably. So, Beaumont set up that capability themselves and improved its server capacity to field the high level of demand. But that still left a gap in the process within the Epic EHR.

The vaccination scheduling process was running smoothly until the unknown user found a way to exploit that gap, short-circuit the registration and go straight to the scheduling tool, Keil said.

It was a sudden spike in traffic that alerted the health system’s IT team to the breach. The health system shut down its Covid-19 vaccination registration and scheduling services, for close to 24 hours.

Now that nearly two weeks have passed since the incident was discovered and addressed, Beaumont is focused on preventing this from happening again.

In the short term, the health system is monitoring its IT traffic and making sure every pathway coming through is legitimate, said Keil.

In addition, Epic now offers the capability to randomize vaccination invitations within their EHR. Going forward, the health system will use that capability as well as other enhancements that Epic has made to make sure it is “one individual, one ticket, one opportunity to schedule,” said Keil.

Keil does not envision any further IT issues arising in scheduling upcoming Covid-19 vaccinations. But high demand remains a concern.

“We just need to make sure that we maintain the integrity of this process and we be as fair as possible,” he said. “These tools, these platforms were never meant for this kind of demand. Epic didn’t think about that way, we didn’t think about it that way. But it’s different now.”

In some ways, the pandemic has sharpened the focus of the health system’s IT team.

Beyond the rollout, Keil and his team are thinking about how to help get the system’s surgery volumes up to help with financial recovery. This will include creating end-to-end experiences around surgery services and increasing the level of digital engagement among patients.

“You can get spread thin on lots of priorities,” Keil said. “This [public health crisis] makes it a lot more crystal clear as to what’s most important…to make a difference for the experience of patients and the financial health of the system.”

Photo: bsd555, Getty Images

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