[Editor’s Note: this blog was originally written by Kate Zabriskie]
Statistics and practical experience show it costs time and money to replace an employee, so does it not make sense to new hires off to a good start? For very little money and a modicum of effort, you can set the stage for a new hire’s success.
1. Send new employees a note (handwritten if possible) before they start work. These aren’t messages about policies or parking passes. Rather, you are writing to say “We are glad you are going to be working with us.”
2. Tell new people exactly what to do when they arrive on their first day. Do they park in visitor parking? Should they report to Human Resources first? Eliminating uncertainty will show that you’ve got your act together.
3. Make sure the space a new hire is going to occupy is clean and free of the last person’s personal effects and well stocked with supplies. Nothing says “We don’t care” like dirt and clutter do.
4. Does the new person get a computer, phone, or other electronics? If so, be sure to have those items in place as soon as possible. Without the proper tools, it’s hard to hit the ground running
5. If your organization has coffee mugs, shirts, or other promotional items emblazoned with the company name, gather these together, and present them to the new hire. Most people like a present, and this small gesture is another signal that you are welcoming and excited to have a new team member.
6. Avoid doubt and confusion by providing the new person with a written schedule for the first day. The schedule should include lunch with the immediate supervisor, new colleagues, or other people who will contribute to making the new hire’s first days a success. And while you’re at it, provide the firm’s emergency telephone number.
7. Along those same lines, establish expectations early. Meet with the new person and review what you expect in terms of quantity and quality of work, appearance, hours, and so forth. Much of this could also have been covered by Human Resources or outlines in an employee manual provided by your organization. However, if something is important to you, highlight it verbally. New people have a lot of information to digest, and extra emphasis can’t hurt.
8. During a new hire’s first few weeks, set up 20-minute informational meetings with key employees throughout your company. This should go without saying, but be sure to choose people who believe in your organization, set a good example, and can provide insight about the business.
9. A little background information can help new employees avoid potential landmines. While gossip is obviously not a good idea, insight on the idiosyncrasies of the workplace should be shared if knowing about them will help the new person without hurting anyone else.
10. Pay attention to distribution lists. New people won’t necessarily see the emails or memos they should if someone isn’t looking out for them.
11. If the employee is new to your industry, share trade magazines, websites, and other resources that might be useful.
12. Finally, check in throughout the week, but don’t be a pest.
None of these suggestions is difficult to implement, but they all take planning. The good news is, it’s usually worth it. The faster you can get new employees up to speed, the sooner they will produce the work you hired them to do!
Kate Zabriskie is the president of Business Training Works, Inc., a Maryland-based talent development firm. She and her team help businesses establish customer service strategies and train their people to live up to what’s promised.
[Editor’s Note: this
blog was originally written by Ken Edwards.]
This is a moment in healthcare when we are laying the
foundation for new capabilities, new precision and new operational enhancements
for healthcare organizations. If you embrace it -- and if you lead your team to
focus on maximizing the benefits of it -- you will also be keeping your
organization on the crest of the key major changes taking place in healthcare
That is true of vendors, providers, large healthcare organizations,
payers and every one of us who can benefit from this change -- every one of us
who is responsible for making this transition not just seamless, but
For context, let’s look ahead.
Under ICD-10, every claim filed with a payer will contain significant -- and
significantly more detailed -- information about the true health of the
patient. In aggregate, claims data will paint a richer, more complete picture
of the patient’s story. ICD-10 will create an information-rich, nationally
standardized system that will help us understand the full picture of the patient
when they are receiving care.
Doctors are experts at understanding the patient’s health. Historically,
the gap has been one created by data siloes and by large individual data-sets
that do not contain -- on their own -- the correct or sufficient contextual information.
That is changing -- and the change is coming along with
other major developments in healthcare. As reimbursement becomes more and more
closely tied to outcomes, it is incumbent upon all of us to take a leading role
in supporting the integrity of the additional wealth of healthcare data we are
introducing into the system. Not simply because this is how we will ensure the
continued financial stability of healthcare organizations, but because this
data will play a crucial role in public- and population-health management
efforts. It will be factored into decisions that affect all of us -- not just
those who work in healthcare.
ICD-10 will provide additional and more granular detail
about chronic diseases, comorbid conditions, disease-management best practices
and mental healthcare, just to name a few top-of-mind examples. In aggregate,
this detail will become a rich source of insight for evidence-based medicine,
and also has the potential to accelerate the research process since historical
data (both coding and clinical documentation) will become more comprehensive
and specific. The data will underpin newfound abilities to manage population
health as it will enable informed, accurate segmentation of patients within
existing disease registries or among previously indistinguishable subsets of
Fee-for-service isn’t going away, but as fee-for-value
rises, identifying and addressing gaps in care (along with other aspects of
population health management) will have greater and greater ability to impact
your overall clinical and financial performance.
Fee-for-value requires clinical integration and
comprehensive longitudinal records of care. The quality of those records starts
with the granularity and quality of your documentation (AKA: the same foundation
for coding accurately in ICD-10). Whether you’re striving to meet specific
quality measures for a state incentive program or taking on new risk-bearing
contracts with payers, documentation will play a significant role in how
successful you are under fee-for-value models. Among other things, it will
determine how wisely you expend case manager hours and other care intervention
My advice to you is to embrace the change to ICD-10.
[Editor’s Note: this
blog was originally written by Dr. Anthony Oliva]
The rise of
healthcare consumerism brings with it new ways of evaluating doctors and
healthcare organizations, including patient reviews and physician scorecards.
This post examines what providers can do to manage their online reputations.
I’m a family medicine physician who has been training
residents and medical leaders since President George Bush, Sr. was in office.
In that time, I’ve found very few things that get physicians to spring into
action or worry outside of a “code blue.” We’re trained to stay calm. And we’re
methodical in nature. After all, we are trained in a profession steeped in
knowledge, science and statistical proof. And we are a competitive bunch.
When training a group of physicians on the importance of
clinical documentation last week, I brought up a screen from an online site
that showed “Surgeon Scorecards,” listing specific facilities by location
and specialty where I drilled down to show specific physicians’ names. This had
a “shock and awe” effect, and left my audience with mouths agape. Immediately,
every doctor in the room whipped out their phones and frantically typed their
names in search of reviews, uttering a sigh of relief when they discovered this
potentially damaging online scorecard site published performance stats for
surgeons only. I had their full attention now.
Physician scorecards are a game changer
With online reviews, reputations are at stake, and this transparency of
clinical performance is not coming soon, it’s here now. Physicians and
healthcare providers alike want (and need) to know what can be done to prepare
and get in front of this new, and somewhat scary, development in the world of
healthcare consumerism. Knowing what patients are looking for in their
healthcare experience1 and what they expect from their
providers is key.
The good news is there are methodologies, tools and people
on all sides of them that can help them monitor their reputations when data finds
its way into the public eye. Here are a few suggestions on how to manage online
clinical performance metrics:
- Manage information input from the start: Accurate
documentation of clinical notes at the point-of-care2 is
not only an important part of diagnosing a patient, but also of managing
performance metrics. Record the patient story in detail and avoid gaps in
information that can make the documentation unclear or unfamiliar, which
can cause coding or payment issues, and make you look bad. Carefully input
clinical practices, orders and recommendations ensuring missing details in
clinical documentation are few and far between.
- Do a visual scan: See what online
profiles exist today for you and your organization, and how they look. You
and your team already have a sense of wait times, complications, mortality
rates and patient satisfaction scores. Assess how closely these published
metrics compare to what was expected — and what you can do to fix them.
- Consider the source: Take a
holistic look at your online reviews and feedback3: is it
a few grumpy patients commenting on a general site, is it data from
claims, or scores from patient satisfaction surveys such as Press Ganey,
HCAHPS)? All of these can be helpful or harmful, so look at the
source and quality of these reviews, and plan your attack.
- Remember, medicine is a team sport:
Seeing many patients quickly while practicing the Art of Medicine4 is
a careful balancing act. A short visit can feel fulfilling and provide a
positive experience if it’s combined with eye contact, communication and
focused attention. The many people involved in the process from
door-to-doctor can positively impact the experience.
I recently heard Hal Baker, senior vice president for
Clinical Improvement and CIO, WellSpan Health System say: “Our quality
improvement efforts are really driven around the whole care team. The high
quality of care that is attributed to me, and that my practice is being
measured on, is probably determined more by the other people in my office than
by me.” I couldn’t agree more. We all chose to work in healthcare because
we want to achieve a singular goal: to help people to the best of our abilities.
And helping starts with listening.
Dr. Anthony Oliva is the Vice President and CMO at Nuance
Communications. This post first appeared on What’s Next.
[Editor’s Note: this
blog was originally written by Dr. Anthony Oliva]
With the increased
availability of quality scores and the consumer trend of product ratings and
reviews, it won't be long before patients are relying online reviews to select
their doctors and hospitals.
The site Rotten Tomatoes has become the trusted source and
gold standard for film reviews en masse. The principle is simple: viewers rate
movies, television shows, and discuss movie trailers. It’s like a litmus test
for public opinion, complete with a “Fresh Picks” section, which showcases
newly-rated releases. The site is known for its brutally honest reviews and
it’s not easy to score high; in fact, for a feature to be considered a “Fresh
Tomato,” it has to have a 60% or higher approval rating — everything below that
is considered a “Rotten Tomato.”
So, if we are taking the time to apply that level of
scrutiny to review films on a site like Rotten Tomatoes, how long will it be
before we begin applying that same critical lens and rating system to
physicians or a healthcare system?
The reality is that it’s already happening — just not how
one might expect.
Sharing means caring
A recent survey shows that 70% of young Millennials choose their doctors based
upon recommendations from family and friends, which means that word of mouth is
the primary source of new business for providers among this demographic. However,
this group is also less apt to provide feedback to their physicians when they
are unhappy with their care; instead, they tell their friends — and this can
pose a big problem for healthcare organizations. What happens when Millennials
turn to social media and online forums to share negative feedback to the masses
unbeknownst to the physician who failed to meet their expectations? With
Millennials on the verge of surpassing Baby Boomers as the largest living
generation, providers need to come up with strategies to solicit input from
their younger patients and communicate more effectively with them in new and
Physician reputations at risk
Millennials are estimated to spend $200 billion by 2017 and nearly $10 trillion
over their lifetime, and they are savvy shoppers. As digital natives, most have
grown up with access to online resources, so researching a question or looking
up a product review is second nature. In fact, a recent study found that “more
than twice as many millennials as non-millennials use mobile devices to
research products and read user reviews while shopping,” which means we are
fast approaching a new paradigm in healthcare: one where online patient reviews
of clinicians will increasingly drive business.
Just like Rotten Tomatoes, new sites culling physician
scorecards as well as quality metrics are emerging, and patients will take them
into account as they select their care providers. But in addition to changing
how people shop for healthcare, having this information available for the first
time will also impact physicians’ reputations and the referral system. Physicians
won’t recommend specialists who have low scores as it will call their
credibility into question, and what provider or payer wants to back the
physician at the bottom of online scorecards or with a 20% approval rating? This
change is a surprise to most doctors who, until now, have not worried about
online profiles because it wasn’t personal, historically they’ve always been
associated with hospitals or large groups.
How do you look, Dr. Welby?
This puts good physicians who are poor at clinical documentation1 at
risk. They could be treating very ill patients, but if the severity of that
patient’s condition isn’t reflected in her record, the numbers will be skewed
and they look like bad doctors.
While it may seem daunting, this is really about
transparency between physicians and their patients. We are a different society
than we were 20, 30 or 50 years ago, and people want and frankly need to
become more involved in their own care. Quite literally, they have the most
skin in the game. Being able to research and choose physicians based on
important criteria such as the amount of quality discussion time, eye contact
and other bedside manners, as well as health outcomes is the right of every
patient. After all, trust and comfort is at the core of healing and good care. The
key to success in this new world of healthcare centers around accuracy: getting
credit for the care physicians provide to their patients each and every day,
and being appropriately reimbursed for those expected outcomes.
Dr. Anthony Oliva is the National Medical Director at
Nuance Communications. This first appeared on Nuance’s blog, What's Next.
EN-US;mso-bidi-language:AR-SA'>Dr. Anthony Oliva is the National Medical
Director at Nuance Communications. This first appeared on Nuance’s blog, What's Next.
[Editor’s Note: this
blog was originally written by Trace Devanny]
As healthcare consumers increasingly become responsible
for shouldering care costs, they will look to personal recommendations and
online patient reviews to educate themselves on physicians, specialists,
hospitals, and care outcomes. Healthcare providers must understand their
patients' preferences, behaviors, and expectations in order to best meet their
changing needs. So, what do providers need to know in order to ensure patients
have an optimal care experience?
Technology has radically shifted how we approach and solve
problems, and this is something I witnessed continually watching my kids grow
up. Younger generations are hard-wired to research online—they don’t know
any other way—and they rely on this data for everything, whether they’re
looking up NFL stats while drafting their fantasy football teams or buying a
car. Peer reviews play an integral role in their decision-making process.
This is a trend that is starting to impact healthcare.
A few short years ago, quality metrics were really only known to the payer and
the healthcare organization with very little buy-in or impact on
physicians. That is changing. As the industry moves toward a
value-based reimbursement model, metrics are becoming increasingly refined, and
more directly connected to the different specialty groups or individual
physicians who are providing that care. We, as patients, now have access
to information we never had before, and this information can shape our
decisions. Today more than ever, reputations of both healthcare
organizations and their care teams are front and center.
As healthcare consumers increasingly become responsible for
shouldering care costs, they will look to personal recommendations and online
patient reviews to educate themselves on physicians1, specialists,
hospitals, and care outcomes. And, this will drastically change the
business of healthcare. The best cardiologist will quickly look like the
fifth worst specialist by failing to properly document in the EMR. Something
that was not even covered in medical school could be the nail in the coffin for
the business of healthcare or professional reputations. Why? Physicians will
not refer their patients to a specialist with bad outcomes, patients will not
trust that doctor, healthcare organizations will not hire her, and payers will
not reimburse her.
Healthcare is no longer just about the physician, it’s about
the entire operation—from scheduling and parking availability to ease of
prescription refills and surgical recovery times—and it’s about the patient.
As one CIO I recently spoke with noted: “Our quality improvement efforts
are really driven around the whole care team. The quality of care that
I’m delivering, and that my practice is being measured on, is probably
determined more by the other people in my office than by me.”
The business of the patient care experience
This shift in how people shop for healthcare and greater transparency of
information means providers need to understand who their patients are and what
they are looking for when it comes to their care experience. This year,
Millennials surpassed Baby Boomers as the largest living generation, and this
will have a profound impact on healthcare. As part of its ongoing
research on the changing practice of the Art of Medicine2, Nuance
conducted a 3,000 person global survey exploring the evolution of patient
behaviors and preferences3.
We found that more than half of young Millennials search for
health information online before seeing their doctors, which means they are
walking into their appointments as educated healthcare consumers. It also
means they are checking up on their doctors and healthcare facilities, reading
reviews about the courtesy of staff members, the cleanliness of facility, and
rankings for bedside manners.
The findings also reveal that, as digital natives, Millennials
rely heavily on personal recommendations from friends and family when looking
for a physician, and they share their negative feedback with their social
networks. This differs considerably from the behavior of patients 65 and
older, the majority of whom, when unsatisfied with their care, share their
feedback directly with their providers.
This trend indicates a behavioral shift: as more patients
rely on online data to assess their physicians and providers, the healthcare
industry needs create ways to ensure the integrity of this data. Review
sites that simply function as forums for patients to air grievances will not be
seen as credible to physicians or organizations looking to improve their care
experiences. Instead, online healthcare review sites will need to blend
clinical outcomes with patient-reported outcomes. This information can be
used to improve the healthcare experience for patients, but it will only work
if the data has integrity. Forward-thinking healthcare organizations, such as
Swedish Health Services, have made it a priority to consider how their brand
and patient experience relates to publicly reported metrics, and uses their
survey feedback to improve their care experience as well as their online
The digital area is changing the healthcare
marketplace. As patients play an increasing role in determining how,
when, and where they receive care, organizations that don’t stay closely
connected to them won’t be able to survive. And it all comes down to
understanding patient populations; those physicians and providers who do will
remain competitive and best manage their patients’ evolving healthcare needs.
Trace Devanny is the President of Nuance Communications’
Healthcare Division. This first appeared on Nuance’s blog, What's Next.
[Editor’s Note: this
blog was originally written by Jonathon Dreyer of Nuance]
The overall patient
experience is becoming increasingly important, so how can providers ensure they
are meeting their patients' needs? Focusing on accessibility to personal health
information, preserving the art of medicine and improving communication are
three critical ways that can help.
It’s nothing new for businesses – even healthcare
organizations – to evaluate how they are doing in the eyes of customers; but in
healthcare, the “patient experience” has taken on greater meaning. It’s no
longer just the healthcare developer community, user interface (UI) experts or
a single healthcare administrator talking about the importance of the patient’s
overall experience1. Everyone from the chief quality officer and CFO
to front-line caregivers are focused on ways to improve quality and make things
better, faster and easier for patients and their families. The reason is clear:
patient satisfaction is closely connected to quality of care, and better
outcomes improve quality scores, reputations, finances and attract patients and
physicians. The challenge is if I don’t feel like I was treated in a good way, even though my
medical care may have been technically good, my feedback on a provider or their
score will be bad.
Working with mobile and cloud innovations and with many
disruptors in the healthcare industry, I have seen more than a glimpse into the
different ways to make this experience better2. And as a
prosumer of healthcare, and a gadget guy who carries three devices at any given
time, I see a path to helping providers deliver not just a medical procedure,
but also the experience and services that I (or people like me) expect when it
comes to receiving high-quality care.
3 secrets to improving the patient experience
1. Evolve the practice of medicine to recognize that patients want more
information, and that interaction needs to come quickly and digitally. For
most, information about clinical assessments and recommendations is top of
mind, but that’s not all. If you really ask patients what they want, they’ll
say the ability to look up information and access their medical records on
their smartphone, as well as being able to pay their bills on their mobile
devices. It’s about being better connected.
2. Technology can enhance medical care, but not with extra
clicks or drop-down menus that replace eye contact with patients. This is a
timeless expectation, and striking that balance is getting very hard for
physicians (read: “I will not let a computer come between me and my
patient”3). A recent patient survey4 commissioned
by Nuance reinforces that these two can live harmoniously: in fact, 69%
of people have noticed a difference in the amount of technology used by doctors
in the last five years, and 97% are comfortable with it. The problem is with
“how” it is used, and this creates great opportunities to incorporate
technology in ways that both help deliver better care and keep patients
satisfied, for example, showing X-rays on a tablet or YouTube videos to educate
patients in the room.
I know that the health information technology (HIT) field
exists in order to help physicians interact with technology in intuitive ways,
whether that it is a hospital or practice using voice recognition5, mobile
EHR apps6, single sign-on, or something else. However, patients like
me expect HIT to be an enhancer, something that makes the cumbersome
administrative tasks easier, so interacting with technology does not trump the
quality connection between patients and physicians.
3. Engage with patients meaningfully outside of the single
clinical visit. With stats indicating up to 80% of patients saying they
feel engaged7 in managing their own health, most people
are not going to expect a ‘one and done’ experience with their physicians. As
patients assume more responsibility for paying a portion of their care, and
providers assume more risk and accountability for what patients do outside
their office or the hospital, the two will need to be more connected and the
ability to communicate with physicians outside of an office visit will be a big
patient satisfier. Using different members of the healthcare team and new
channels to communicate with patients about their care will round out this
experience to make it more complete and more rewarding.
Patients are increasingly becoming more informed consumers,
that new hip and the multitude of visits and interactions that go with it, all
determine the “patient experience.” Helping doctors deliver on those expectations
in a system that often seems stacked against them is not as easy as it sounds.
It’s time to protect the patient-physician relationship; a foundational element
of quality care.
Jonathon Dreyer is the
director of cloud and mobile solutions marketing at Nuance Communications,
where he is driving a physician-first approach to medicine by bringing
cloud-based speech recognition and clinical language understanding technology
to a worldwide community of healthcare IT developers and provider organizations.
This blog first appeared on What's Next.
[Editor’s Note: this
blog was original written by Jonathon Dreyer]
innovation can be found everywhere — even in the pages of a book. James Bond’s
gadgets and sleek cars have been essential to outsmarting villains and wowing
audiences for decades, but this cool technology might not be as far off as you
I’ll admit it: I’m a James Bond fan. And one of the things I
love most is the obligatory scene in every film where Q does a run-down of all
the gadgets with which Bond will be outfitted — including the upgrades to his
Despite having been penned more than 50 years ago, Ian
Fleming knew that seamless and intuitive technology would forever change the
game. And he was right. As we become increasingly connected, we expect
constant access to whatever information we want, whenever we want it, and our
cars are no exception. In fact, with innovative in-car systems1,
they are becoming increasingly more Bond-like. For instance, when I’m
driving home, I can ask a virtual personal assistant to look up movie times and
buy tickets, and then send a text to let my friends know where and when to
meet. With a simple command, I can check my email, and access my
music library so I can listen to whatever I want2. So why does it
have to stop there? Why can’t this accessibility apply to my personal health
information, as well?
The intersection of health IT and the connected car
In James Bond movies, the Q Branch of MI6 is always coming up with new ways to
connect things, such as James’ watch, with other devices and objects, including
his car. Because I work in healthcare technology, my question for these types
of visions is always the same: how can we make this a reality?
Connected health devices could radically change how we think
about the care continuum, from triaging to daily health management. In Casino
Royale, Bond, who is going into cardiac arrest, stumbles to his car, runs a
diagnostic test that senses he is in distress, and immediately connects him to
an MI6 physician who walks him through his condition and tells him to use a
defibrillator (which is conveniently located in the glove compartment). Needless
to say, the quick response and real-time assistance saves his life, and he goes
on to win the poker game and get the girl (albeit only briefly).
From a personal health standpoint, connecting wearables or
fitness trackers to your car through smart integrations that do not compromise
safety while behind the wheel could yield incredible results. For instance, a
diabetic could wear a watch with a sensor that can detect low blood sugar and
sync with an intelligent agent in the car that routes him to a nearby
restaurant or fruit stand. Or a virtual personal assistant could pull data from
a driver’s smart watch and, noticing she is behind in her daily step count,
suggest a parking lot located further away from the destination, and even check
the weather to make sure her walk is rain-free.
The same level of connectivity could hold true for a
physician traveling between facilities. Being able to receive secure
text-to-speech (TTS) notifications about a patient who has an elevated
potassium levels, and the ability to call or text him simply by giving a verbal
command would help physicians address concerns before they become critical
issues. And, with the help of a virtual personal assistant, that physician
could request a medication order and a follow-up appointment, if needed. All of
these interactions, of course, could be logged into the patient’s electronic
health record using secure speech-to-text and clinical language understanding
and would be immediately available for the next treating clinician, and the
structured data fields properly populated for appropriate reimbursement.
Although it seems far-fetched, what is truly remarkable is
that independently, these technologies already exist in different form factors —
it is up to us to break down the silos, challenge the status quo, find
inspiration in the everyday and come up with new use cases. The ability to
have immediate access to health data and advice would not only help consumers
make more informed health decisions, it has the potential to unlock better
population health outcomes. We have entered the age of the connected car, and
this may be the very thing that shifts us into high gear and helps drive us
toward a healthier future.
This blog first appeared on What's Next.
[Editor’s Note: this article was originally written by
Eric Venn-Watson MD, MBA, senior vice president - Clinical Transformation,
This is the third in a
three-part series looking at how digital health is transforming healthcare.
The Goldman Sachs report1 I mentioned in the
first part of this series mentions that remote patient monitoring (RPM)2
enables healthcare providers to better manage high risk patients, potentially
decreasing healthcare spending through better chronic disease management. Further,
the report notes that most chronic disease spending can be attributed to heart
disease, asthma and diabetes-disease states that represent the most fertile
ground for digital health.
This is one of the most promising – and limitless –
opportunities in healthcare today. Current RPM devices3 allow us to
monitor CHF patients from home, providing a real-time assessment of their heart
health and decreasing their risk of readmission. In the case of an asthmatic
patient, RPM devices can monitor a patient’s respiratory health and provide
notifications when factors such as the local air quality puts them at risk for
an exacerbation. For diabetic patients, RPM can provide continuous blood
glucose levels and help provide a level of glucose control that was previously
unachievable. The future of RPM involves combining these tools and the
patient’s entire health history with streaming analytics and clinical decision
support tools that can detect when a patient’s physiologic parameters are
trending outside of the normal range, and send a notification to the patient
and potentially the care team when appropriate. As a result, we are able to
predict and track diseases before they become acute – and potentially even
prevent them from ever happening. In essence, we will be able to shift the
management paradigm from reactive care to proactive care, which is mission
critical in an environment where caregivers are scarce.
Ultimately, clinicians want to provide the best care
possible and make a positive impact on our patients’ quality of life. The
digital healthcare revolution is helping us achieve that goal, improving the
way we practice and provide medical care, streamlining our clinical workflow,
and helping us to make the vast number of patient data sources relevant and actionable.
The old ways of doing business are no longer acceptable. The new financial and
regulatory models won’t allow for it – and ultimately, the patients won’t stand
The digital healthcare revolution has arrived.
[Editor’s Note: this article was originally written by
Eric Venn-Watson MD, MBA, senior vice president - Clinical Transformation, AirStrip]
This is the second in a three-part series looking at how digital health is
Last time, I talked about how the digital healthcare
revolution has arrived1 and its potential applications,
including telehealth. Another way this digital transformation is changing
healthcare is how it affects behavioral modification and adaptation.
Over the past few years, I have noticed a significant
culture change in my patients. They are more knowledgeable about their health
in general, more informed about management options and more likely to want to
work toward an improved level of health. They also tend to be more open about sharing
their health profiles and results with family members and friends and more
inclined to gradually change their behavior if they can get real-time feedback
illustrating the impact of their efforts. Digital health technology provides
this feedback and can be as simple as providing daily step counts or charting
caloric intake vs. calories burned, or more complex by combining live
physiologic monitoring with complete past medical histories to create a real-time
True success, however, can be achieved when patient
behaviors are modified using customized health programs based on individual
profiles. Digital health applications2 are rapidly
evolving as a method for affecting behavior through customized, real-time
interventions that can be adapted for each individual based on prior outcomes,
previous responses to intervention, current physiologic and psychologic
parameters, environmental and social context, as well as a range of other
variables that influence the state of an individual’s health. These tools allow
us to change our focus from differences between individuals to differences
within a single person over time.
As more and more data sources become available and
integrated into the feedback loop in a manner that provides value, we will see
a continued increase in people intimately engaged and driving their own
We’ll be wrapping up this blog series with a look at remote
patient monitoring, so be sure to check back.
This is the first in a
three-part series looking at how digital health is transforming healthcare.
[Editor’s Note: this article was originally written by Eric Venn-Watson MD, MBA, senior vice president - Clinical Transformation, AirStrip]
Digital healthcare holds the promise of saving a staggering
$305 billion, according to a recently published report from Goldman Sachs1.
The report predicts the technology revolution will come from increasing access
to diagnostic, treatment and preventative care, coupled with dramatic cost
reductions. In particular, they see significant opportunities for
digitally-enabled telehealth, behavioral modification and remote patient
monitoring, while much of the savings will be generated by the elimination of
redundant and wasteful spending in the area of chronic disease
They are right, and here’s why. Digital technology has
already transformed a multitude of industries including banking, travel and
retail by aligning provider and consumer. Almost every aspect of our lives is
being touched by digital technology; we are more ‘connected’ than ever before.
Concurrently, a number of factors are driving a similar transformation in
healthcare: increased consumer demand for better, more convenient and more cost
effective care, changes in reimbursement and the shift to value-based care, and
of course, the availability of tools such as smartphones, tablets, wearable
sensors and portable diagnostic equipment. Thanks to a digital health ecosystem
that brings it all together, the relevant data becomes available through
streaming analytics, clinical decision support tools and immediate
communication back to patient and provider via mobile devices, when
The Goldman Sachs report points to the following three
specific opportunities: telehealth, behavioral modification and remote patient
monitoring. Today we dive further into this first topic: telehealth.
Telehealth applications are being driven both by consumers
and providers, and are rapidly changing the way healthcare is practiced. I am
seeing this with my own patients, who have busy schedules and a desire for
convenience. They are asking for easy and efficient alternative methods such as
secure texting and videoconferencing to connect with me outside of the
traditional office visit and receive medical guidance. This model of care has
gained significant traction, as evidenced by Teladoc’s 11 million consumers and
its recent, very successful IPO.
There is another important and exciting aspect of
telehealth: clinician-to-clinician communication. Telehealth tools enable me to
reach out to fellow physicians and specialists rapidly to share and view
secured, real-time patient information. This collaboration expedites my
workflow and enables me to make quicker, data-driven management decisions. I
have no doubt that these models of care will continue to expand and become, as
the Goldman Sachs report states, a ‘viable component in daily healthcare
[Editor’s Note: the following blog was written by Karen
The Joint Commission has issued new standards around
protocols, documentation and education that are designed to reduce unnecessary
medical imaging and improve quality and safety. But is it enough?
The Joint Commission standards1 for
diagnostic imaging, which recently went into effect, are designed to help
prevent duplicate and unnecessary medical imaging of patients, and reduce
potentially harmful exposure to radiation when patients need CT scans, MRI or a
combination of these and other diagnostic tests. Beginning July 1, 2015, these
standards require protocols, documentation and data collection, staff education
and other criteria that raise the bar for quality and safety at ambulatory
imaging sites, critical access hospitals and accredited hospitals. What do
these standards really mean to the patient?
The new imaging standards focus primarily on the radiation
dose index2. There are a number of uncertainties tied to the
long-term impact of imaging on patients, but researchers agree it impacts
patients differently depending upon sensitivities to radiation, age, body parts
being tested, absorption rates and other factors and these are still being
studied. In the meantime, to prevent undue risk, The Joint Commission has put a
stake in the ground with these specific standards to help improve patient
safety. The Joint Commission joins other accredited healthcare
organizations, such as the American College of Radiology (ACR) and other
clinical associations that are releasing new quality-focused
recommendations, enhanced education tools and technologies3 to
make it easier for healthcare teams to keep you safe from unintended risks
while you receive diagnostic imaging that could shed light on serious health
As a patient and someone who has worked in healthcare
technology for more than 20 years, I believe the combination of diagnostic
imaging, evidence-based medicine and expert medical oversight that exists today
will help organizations big and small better manage radiation exposure and
protect patients today and in the future. These efforts provide great
improvements in reducing unnecessary testing and putting safeguards in place to
generate important results, while mitigating the long-term risks to patients
when they need different exams.
The Joint Commission’s imaging standards were initially
intended for release last year, but they were postponed due to lack of detail
and clarity. In conjunction with imaging guidelines provided by the
American College of Radiology’s4 “Body Imaging Commission” and
other clinical associations, they help providers focus on the right testing to
do at the right time to improve quality of care when radiologists face a flurry
of different kinds of patient cases every day.
The Joint Commission’s report explains that knowledge of a
patient’s previous imaging exams helps prevent duplicate imaging examinations
and further radiation exposure, and they recommend considering a patient’s age
and recent imaging studies when deciding the most appropriate exam. The same
precedent exists for surgery today so it makes sense that something similar
would apply to diagnostic imaging. The fundamental part of medicine is based on
“do no harm.”
Obstacles to accurate and reliable imaging
While The Joint Commission’s standards will ultimately benefit hospitals, there
are a few challenges they face in complying with these new regulations based on
healthcare delivery today. Compliance becomes difficult when a patient is seen
by multiple healthcare providers – especially in different geographic regions –
and when the patient’s journey spans different facilities, specialists and time
zones as they strive to get well.
Today, many hospitals keep a record of a patient’s medical
images in their facility, and they typically provide a CD of relevant images to
the patient to take with them when being treated somewhere else. However, too
often the CD will end up damaged or unreadable to the next physician, and even
if it works, the CD will not contain a complete story of the patient’s health
including their medical imaging history. Incomplete or missing information
creates doubt and risks that are not welcome in healthcare. The patient is
looking for certainty in their diagnosis, the radiologist is looking for
certainty in recommending next steps and the referring physician wants to
ensure that he or she is providing the right treatment for the best outcome.
Without accurate and reliable imaging information, everyone may not have the
answers and assurances they need. The result? Repeat medical imaging.
Repeat exams are particularly problematic for patients who
are most at risk because of the cumulative effectives of overexposure to
radiation, such as the elderly and children. Concerns over unnecessary use of
medical imaging and unnecessary costs of these tests have been around for
years, but despite concerns, recent statistics show it is still a common
practice. A study published in the Journal of Emergency Medicine in March
2015 shows 97% of ED physicians order unnecessary imaging because of
worries that they will miss something and be sued5. Half of these
physicians identify that improved education on advanced diagnostic testing
would help cut down on this practice of over-ordering tests.
This all goes back to certainty. With regulations changing,
clinical guidelines evolving, patient volumes growing and information access
ranging from hard to get to hit or miss, the implications are clear. When
physicians are unfamiliar with the appropriate diagnostic tests or the clinical
best practice for a specific symptom, or they can’t see the complete patient
story such as prior radiation dosing for the patient, they try to do what’s
best and that often leads to repeat medical imaging.
Karen Holzberger is
the vice president and general manager for Diagnostics at Nuance
Communications. This post originally appeared on Nuance’s blog, What's Next.
Physicians don't always realize the correlation between their clinical documentation and the level of credit they get for providing quality patient care.
[Editor’s Note: the following blog was written by Jennifer Woodworth]
No one chooses to work in the healthcare industry because it’s easy. We do it because we want to help others. The mounting frustrations doctors face as the result of an increasingly burdensome healthcare system are not only understandable, they are justifiable. These men and women did not go to medical school to sit through hours of meetings about code sets. Their primary responsibility is to treat patients. And for those of us who work with them, it is our role to be the trusted partner of our doctors and clinical care teams — to ensure they share the right information where and when it’s needed. I’ve spent close to a decade working with physicians on clinical documentation to make sure it reflects their intent and they get credit for the level of care they are providing.
Over the years, the doctors have taught me some valuable lessons. When it comes to implementing a successful clinical documentation improvement (CDI) program, start with these three fundamentals:
Skip the catering: meet your doctors where they are
Everyone is busy, especially doctors, and initially, we tried to engage with them by holding early morning meetings where we provided breakfast and information about our CDI program. We quickly discovered that we were left with not much more than a tray of cold eggs and pancakes. So we made adjustments and began meeting doctors where they were — in their departments, on grand rounds and within the agenda of a medical staff meeting. This significantly improved physician engagement and helped us better collaborate on capturing the patient’s care in a way that was accurate and complete not just to other doctors. CDI programs are not one-size-fits all, and keeping this in mind as you reach out to your physician teams is very important.
Become a translator for health IT language
Because specialty groups each have their own medical vocabularies, different registries and workflows, they will also face unique challenges and concerns. Swedish Health Services is a multi-hospital health system that includes a heart and neural hospital. When we implemented our CDI program, we realized that we needed to tailor our approach by physician specialty — what was an important quality driver in one clinical area is not necessarily the same in another. Swedish is a “5-star institution,” and we need to uphold that reputation. So, in order to do this, we first had to figure out what each specialty group’s quality scoring was based upon, and then sit down and work with our physicians to show them the impact their documentation was actually having on their scores.
Seeing clinical data is believing
Doctors have analytical minds, after all, that’s how they decide how and when to modify treatment plans — by looking at results and analyzing the data. This holds true for clinical documentation, too. They don’t always realize that how they document is just as important as how they are providing care; in fact, it’s the proof they are doing the right thing for patients. When we reviewed our clinical data, we found that our ICU patients were typically on ventilators longer than the average, which was negatively impacting our quality scores. Sitting down with our ICU physician team, we conducted a retrospective review and discovered that the majority of these patients had pre-existing respiratory conditions that necessitated an extended time on a mechanical ventilator. It wasn’t that they weren’t receiving good treatment, it was, in fact, our doctors doing the right thing for these patients — keeping them on the ventilator longer because they needed it — that was negatively skewing our numbers. It was a simple error of omission: our doctors didn’t realize that by not fully documenting their patients’ pre-existing conditions in the clinical record, they were hurting their reputation as great doctors, and ours as an excellent hospital.
While not always easy, changing a culture to support a value-based care model makes sense: hospitals and healthcare organizations get paid, or not, based on how they care for their patients. Our physicians trust us to help them accurately represent the good care they are providing, and, in turn, we use CDI data to identify areas where together we can optimize quality to do what’s best for the patient.
The accurate clinical data that results from an effective CDI program not only helps our doctors earn credit for the good work they do, but also improves patient care and reimbursement for our organization. Accurate clinical data also enables us to get a clear picture of who our patient population is so we can adequately prepare for their future health needs. And, at the end of the day, that is what healthcare and the continuum of care is all about.
Jennifer Woodworth is the Director, Clinical Documentation Integrity Program (CDIP) at Swedish Health Services in Seattle, Washington. This blog originally appeared on Nuance Communications’ blog, What’s Next.
[Editor’s Note: the following blog was written by Paul Vosters, Discovery Health Partners president and COO]
Organizational and technology structures can keep health plans from recognizing, understanding and resolving their payment integrity challenges. However, another factor may be at the root cause of some of those challenges: eligibility.
Eligibility issues impact a multitude of payment integrity areas including Coordination of Benefits and Medicare Secondary Payer validation and, to a lesser extent, Workers’ Compensation, Other-Party Liability and Subrogation. In fact, our research indicates that approximately 30% of payment integrity costs are driven by eligibility errors. In addition to the financial cost of payment integrity errors, eligibility issues can also have a direct effect on member satisfaction. Claims that are declined due to inaccurate or out-of-date eligibility data can lead to member abrasion and lost market share as well.
At their core, these issues all stem from the fact that health plans lack a single, definitive resource for making eligibility status determinations prior to paying a claim. This creates tremendous downstream issues as health plans make business decisions and pay claims based on flawed data.
The complex structure of health plans means that member eligibility is updated at multiple points in the claims payment process and is managed by multiple departments across the organization. As a result, it’s often inconsistent, outdated or inaccurate, and leads to improper claims payments. Until plans are able to establish a single source of the truth for eligibility, these inaccuracies can cost plans millions of dollars. Let’s examine a few of these challenges more closely:
Multiple data sources
The sheer number of data sources feeding the master eligibility file has a significant impact on accuracy. Information comes from the members, providers, CMS, data-match vendors and other data sources. These feeds are all subject to their own timelines, standards and information challenges. In addition, these external feeds to eligibility status have a high rate of change, creating a complex hierarchy of overlapping status updates. Plans are challenged to manage these work processes and make a clear determination of primacy and eligibility that can support all of the transactions that rely on this data.
The eligibility challenge isn’t just technical, it is also frequently organizational. Eligibility is commonly managed by line of business, meaning that status updates made by one group are not necessarily shared across the organization. For example, changes in a member’s eligibility status might not be effectively communicated between the commercial and government lines of business as the member moves from commercial to Medicare Advantage coverage. With no clear owner of the member eligibility status, managing the data across departments adds an additional level of complexity.
In addition to being spread out across different departments, responsibility for managing eligibility status is shared by several administrative systems. Plans often make the mistake of addressing eligibility in a single point solution, rather than taking an enterprise view of member eligibility management. Claims and enrollment systems often fail to address eligibility on a consistent transactional basis, and frequently capture crucial updates in notes or text format. Eligibility data is rarely shared between systems, and because there is no single data master, the priority of status changes is unclear.
Looking to the future…
Health plans have the opportunity to dramatically improve their payment integrity performance and member retention by managing member eligibility as a business asset. The ideal solution will provide a complete and integrated picture of eligibility status across membership types and lines of business, while providing validated data for downstream applications. Doing so will require a shift in culture, as well as new technologies. Nonetheless, there are strategies that let you achieve progress in a staged progression, which we will explore in future posts. Managing eligibility data as a strategic asset is worth the effort, as it will result in millions of dollars in recoveries and cost avoidance.
[Editor’s Note: The following blog was written by Dr. Anthony Oliva]
Being able to "speak doctor" ensures that physicians are accurately capturing the level they provide to patients, and enables healthcare organizations to correctly identify their patient populations and predict their future healthcare needs.
I’ve worked as a CMO at hospital systems for much of my career, and one thing that I’ve learned is the importance of knowing how to speak doctor. This means listening for clues one physician shares with another about a patient that are critical to their immediate assessment and delivery of patient care. Physicians can communicate a lot of information very quickly, in very few words, and because other clinicians are trained to understand and to act quickly, the system worked… most of the time. Until recently. Now short written notes or verbal handoffs are a thing of the past and what is being conveyed about patients’ conditions may not be clear or may be buried in charts with note bloat, which is a real problem for money, patients, and predicting risks. Here are the three big problems you need to fix to get ready for population health:
Problem #1: Say what you mean
The way doctors speak is different than the coding language needed for billing and hospital payments. The impact is real, unrealized revenue for a hospital or health system when care is provided, but not documented by a physician in the EMR. The last place I worked realized $9 million of traditional revenue by fixing physician documentation up front, and Swedish Medical Center secured more than $18 million in appropriate reimbursement. Better translation of what doctors say up front through a Clinical Documentation Improvement (CDI) program brings predictable financial improvements.
Problem #2: It’s in the patient story details
When a doctor’s clinical documentation leaves clues everywhere in the chart pointing to a risky condition, but sparse clinical documentation leaves out specific details, good care may not look like it. That carries big risks for physicians and healthcare organizations that need to look good on scorecards and quality outcomes. When clinical speak indicates a potential condition, complication or cause for treatment, but it isn’t translated into co-morbidities or diagnosis codes in a record, a patient receiving healthcare may look much healthier than he or she really is. I can’t tell you how many times I’ve seen a chart when a patient spent three days in the ICU being treated for sepsis, which is a very serious and expensive situation, but the chart classified the patient through codes as having something close to a bladder infection because the diagnosis was not properly identified. In today’s competitive healthcare environment, a doctor cannot afford to look bad to payers or patients.
Problem #3: Know your patient population
Your crystal ball better predict the future correctly. When it comes to population health and accountable care, the rules are changing. If your charts don’t accurately reflect how sick your patients are or the conditions you treat in your community, there will be no path to population health management because you won’t really know your populations.
Healthcare is changing and everyone is assuming more risk ‒ physicians, provider organizations and even patients ‒ and in order to stack your team with the right types of providers, who are resourced to deliver the right services that your patients want and need, you have to know what those needs are and what they will be in the future. Accurate clinical documentation that starts with physicians today is a prerequisite for predictive modeling. No one wants to prepare for one patient population and then look back later wondering why mortality is so high or the level of care and resource drain is so much greater than anticipated. That is a problem we are solving for today.
And it starts with physicians. Hearing and understanding them, and then helping them translate what they do into the appropriate documentation is key. What a physician sees when he looks at a chart may seem completely obvious, but we live in a world where unless the words are documented in that chart, the care being provided won’t count. It’s time to retrain doctors to explain what they do in a language everyone will better understand, and reap the clinical and financial benefits. We can do this with the basic building block of a clinically-focused CDI program to help with the translation.
Dr. Anthony Oliva, DO, MMM, FACPE, is the National Medical Director at Nuance Communications. This blog first appeared on What’s Next.
There is a culture of certainty in healthcare that is driving unnecessary testing and increasing costs. But some organizations are using the latest technology innovations in radiology to help improve patient care and protect their bottom line.
[Editor’s Note: the following blog was written by Karen Holzberger]
A few years ago, there was a witty car commercial advertising an alert feature that took the guesswork out of filling your tires by gently beeping to signal the appropriate pressure had been reached. It featured a series of vignettes where the car horn would beep, cautioning the owner to reconsider just as he was about to overdo something (for instance, betting all of his money on one roll of the dice). The concept of getting a reminder at the point of a decision is a compelling one, particularly if it can save you time or aggravation and guide you to do the right thing. In healthcare, any technology that can provide that level of support will have a profound impact on patient care.
Albeit humorous, that car commercial wasn’t far off the mark with healthcare challenges. Unnecessary medical imaging exposes patients to additional radiation doses and results in approximately $12 billion wasted each year, but it has also had another unintended downstream effect. It has fueled a culture of medical certainty, where tests are ordered in hopes of shedding light on some of the grey areas of diagnostic imaging, including incidental findings. The reality is that incidental findings are almost always a given, but not always a problem. So how do you know what to test further and what to monitor? And while one radiologist may choose the former option with a patient who has an incidental node finding, another might decide to go with the latter option, so who is right?
Beep! It’s important
This is a jarring situation when so starkly presented, which is why the American College of Radiology (ACR) has released clinical guidelines on incidental findings. By offering clinical decision support on findings covering eleven organs, the ACR is helping radiologists protect their patients through established best practices for diagnostic testing.
While this is a great step forward for the industry, some hospitals are taking it one step further. Massachusetts General Hospital (MGH) is using its radiology reporting platform to provide real-time quality guidance at the point-of-care to drive better patient care. Now, when a radiologist is reading a report and notes an incidental finding, the system will automatically ping her with evidence-based recommendations for that finding. For instance, if the node is a certain size, it should be tested further. These clinical guidance best practices are updated constantly, which means that radiologists have access to the most up-to-date information when treating their patients and can make the most informed decisions based on industry best practices.
Patients deserve and need to have the best and most thorough care; however, this shouldn’t put them at risk for unneeded radiation exposure. It is neither safe, nor financially sustainable. Health IT innovations like these – that can ping clinicians in real-time with the latest in quality guidance – will be the tipping point in the shift to value-based care. They will forever change the standard of patient care and the landscape of the healthcare industry, and that is exactly what we need.
Karen Holzberger is the Vice President and General Manager
for Diagnostics at Nuance Communications. This blog originally appeared on What’s Next.