What You Should Know:

• Today, the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued the “Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” – a temporary rule that extends telemedicine flexibilities adopted during the COVID-19 public health emergency (PHE).
• ·         The temporary rule will take effect on May 11, 2023, and extends the full set of telemedicine flexibilities adopted during the COVID-19 public health emergency for six months – through November 11, 2023. For any practitioner-patient telemedicine relationships that have been or will be established up to November 11, 2023, the full set of telemedicine flexibilities regarding the prescription of controlled medications established during the COVID-19 PHE will be extended for one year – through November 11, 2024.

Background

On March 1, 2023, DEA, in concert with HHS, issued notices of proposed rulemakings (NPRM) to allow for prescribing of certain controlled medications via telemedicine without an in-person medical evaluation of the patient under circumstances that are consistent with public health, safety, and effective controls against diversion. The NPRMs received over 38,000 comments from the public and DEA, in collaboration with SAMHSA, is actively reviewing input in order to develop a permanent rule.

What You Should Know:

• Patientory Inc., the creator of a blockchain-based, HIPAA-compliant, private medical data ecosystem, announced today that it has launched two solutions–Patientory Consumer Decentralized Application-designed to help patients more efficiently and securely store and earn money from their medical data and Neith Enterprise Dashboard in partnership with Prosper Healthtech, a community-backed organization committed to equity in Birmingham offering a supportive network of organizations throughout the city, including UAB Hospital, PackHealth, and Blue Cross Blue Shield.
• Patientory is a consumer-facing mobile dApp putting patients in control of the data they create but previously a challenge to control being confined to patient portals. 

Empowering Patients Financially Via Decentralized Applications

Today, 80% of health data is not readily accessible in order to provide quality care for patients and the remaining 20% is anonymously monetized by data brokers. Available on Android and iOS and equipped with tools to promote healthy lifestyles, the Patientory app aggregates medical information and easily integrates with popular mobile apps and wearables to showcase users’ vitals in a uniform dashboard. 

Working in conjunction with the Patientory dApp, Neith is an enterprise-focused Analytics portal that mines both shared consumer health data and the Patientory blockchain network de-identified health data which represents 190M Americans, compatible with open-source technologies like ChaptGPT.

“Six in ten American adults, per the CDC, have a chronic illness, which means a large percentage of the population is in constant contact with disparate parts of our sprawling health system,” said Patientory Inc. Founder and CEO Chrissa McFarlane. “Even though patients want a better system, the problem is that hospitals and clinicians keep recording patient information in siloed medical data systems. Unfortunately, transmitting vital private data is a frustrating game of ‘telephone’ for these institutions and their patients.” 

Patientory and Neith are both powered by cutting-edge technology and built atop the PTOYMatrix, Patientory’s own private blockchain network which raised over $7M in a token launch and now represents 95% of electronic medical record data in the US. The PTOYMatrix ensures patient healthcare data is cryptographically protected and will remain stored in a secure and decentralized manner with storage access managed by the native cryptocurrency $PTOY. The platform recently joined The Sequoia Project, the organization awarded by the federal government to administer The Trusted Exchange Framework and Common Agreement, also known as TEFCA, which outlines a common set of principles, terms, and conditions to support the development of a Common Agreement to enable nationwide exchange of electronic health information (EHI) across disparate health information networks (HINs). 

Among other features, the Patientory app harmonizes medical records and wearable device health data to understand how a multitude of factors impact patient health in real-time, find trends and curate precise recommendations for users. Its most used feature in Beta, the clinical trial tracker which attracted over 2,000 people to pre-screen allows users to match with clinical trials they are a fit for in proximate geography. A premium feature is the care plan that gamifies helping users make healthy choices on a day to day basis to earn rewards. 

Neith Enterprise Dashboard includes data management tools, healthcare data and electronic medical records from over 10,000 hospitals, predictive analytics through machine learning algorithms, holistic care plan generation, and increased patient data interoperability.

Patientory previously raised an oversubscribed pre-seed and grants for the launch of the dApp from notable investors including, BackStage Capital, Arlan Hamilton, Colorado Permanente Medical Group, RGA Ventures + Moda Health, Expert Dojo, GSK, Novartis, American Heart Association, with prestigious honors and awards being named Startup of the Year, World Economic Forum Tech Pioneer, Prixe Galien Finalists in Digital Health for 2 consecutive years and participants in government sponsored programs including NASA iTech Ignite the Night and MassChallenge/HHS Pandemic(X) Program. 

What You Should Know:

– One year ago, President Joe Biden and First Lady Jill Biden reignited the Cancer Moonshot, setting an ambitious, achievable goal: to reduce the death rate from cancer by at least 50 percent over the next 25 years, and improve the experience of people and families living with and surviving cancer, ultimately ending cancer as we know it today.

– The Cancer Moonshot has spurred tremendous action across the federal government and from the public and private sectors, building a strong foundation for the work ahead.

Understanding the Biden Administration’s Plans To Combat Cancer

The Biden Administration is announcing new actions from inside and outside of government that will drive additional progress, drawing us closer to ending cancer as we know it today.

Last year, the President stood up the first-ever Cancer Cabinet to mobilize the federal government, and called on individuals, health care providers, and leaders across sectors to step up and take action in five key priority areas: (1) close the screening gap, (2) understand and address environmental exposure, (3) decrease the impact of preventable cancers, (4) bring cutting-edge research through the pipeline to patients and communities, and (5) support patients and caregivers.

To date, the Cancer Moonshot has announced over 25 new programs, policies, and resources to address these five priority areas. The First Lady has traveled the country and the world to hear from cancer patients and their loved ones, as well as the researchers, physicians, nurses, and patient navigators who support them – focusing on the importance of early detection and improving the experience of patients, families, and caregivers. And, the White House and Cancer Cabinet have held more than 50 community conversations and events. More than 60 private companies, non-profits, academic institutions, and patient groups have also stepped up with new actions and collaborations.

These new actions will build on the work done in the first year of the reignited Cancer Moonshot. In addition, today, the President is also announcing his intent to appoint six members to the National Cancer Advisory Board, which plays an important role in guiding the Director of the NCI in setting the course for the national cancer research program.

The Cancer Cabinet is taking the following new actions:

1. National Cancer Institute (NCI) is launching a first-of-its-kind, public-private partnership to bring clinical and patient navigation support to families facing childhood cancer. The National Cancer Institute (NCI) is launching the Childhood Cancer – Data Integration for Research, Education, Care, and Clinical Trials (CC-DIRECT) to support children and Adolescents and Young Adults (AYAs) with cancer throughout their cancer journey; provide patient navigation support to families seeking information and optimal care; facilitate research participation; and establish a portable, shareable, standardized cancer health record. This means families facing childhood cancer can reach out for support and get connected to excellent care and the opportunity to participate in research through clinical trials and data sharing initiatives. This new entity represents a groundbreaking collaboration between NCI, the Office of the National Coordinator for Health Information Technology (ONC), Alliance for Clinical Trials in Oncology (ACTO), American Society of Clinical Oncology (ASCO), American Cancer Society (ACS), the MITRE Corporation, Center for Medicare and Medicaid Services (CMS), Children’s Oncology Group (COG), and the American Association for Cancer Research (AACR).

2. Health Resources and Services Administration (HRSA), is awarding $10 million to improve access to lifesaving cancer screenings and early detection including patient navigation support services. HRSA, a part of the U.S. Department of Health and Human Services (HHS), is doubling its investment in new partnerships to bring community health centers together with NCI-Designated Cancer Centers to facilitate access to lifesaving cancer screenings and early detection services for underserved communities. Health centers that receive funding will conduct patient outreach in these communities to promote early detection of cancer, connect patients to screening services, and provide direct navigation assistance with accessing high quality cancer care and treatment, as needed. Today’s awards total more than $10 million for 22 HRSA-funded health centers, expanding on the $5 million awarded to 11 health centers in 2022

3. HHS is launching “CancerX,” a Public-Private Partnership developed as a national accelerator to boost innovation in the fight against cancer. HHS, ONC and Office of the Assistant Secretary for Health (OASH), is launching the “CancerX” National Innovation Accelerator Initiative, a government wide effort to develop tools, such as digital solutions to improve cancer patient care coordination and communication, new software technology to help community organizations meet cancer patients where they are, or new platforms to support patients with their post-treatment care. This new public-private partnership will drive support for and accelerate the development of biotech and health tech startups solutions focused on the continuum of cancer care, including prevention, detection, treatment, and transitions in care. Organizations whose missions are aligned with the Cancer Moonshot goals will work together to surface innovative solutions and coordinate access to research, mentorship, resources, and other collaborative opportunities. This work will help startups scale their business and work toward creating ‘challenge-focused’ solutions for cancer with health equity in mind. This initiative will build on previous models deployed by successful HHS InnovationX program accelerators such as KidneyX and PandemicX.

The public and private sector is stepping up with the following new actions:

Promoting Cancer Prevention

4. National Minority Quality Forum (NMQF) is launching local community-based activities to increase cancer screenings in at-risk communities. NMQF, a nonprofit, nonpartisan organization that integrates data and expertise in support of initiatives to eliminate health disparities, is releasing a new online hub, which includes several interactive features designed to increase awareness about cancer disparities, innovation in early detection and treatment, and patient- and clinician-oriented resources to close gaps in cancer care delivery. In addition, to help spur action on the ground, the Cancer Stage Shifting Initiative, which was created to move from late stage to early- stage diagnosis and treatment of cancer, improving cancer care and reducing cancer deaths for all, will work together with private and public partners and local advocates to increase awareness of cancer risk and treatment, improve clinical trial diversity, and support efforts to understand the impact of the water crisis on cancer risk in Flint, Michigan.

5. Supergoop! is committing to donate SPF sunscreen to schools and communities across the country to encourage children to start protecting their skin at a young age. Since sun exposure is cumulative throughout a person’s lifetime, Supergoop! is committing to providing the country’s youth the education and resources to keep them protected. Supergoop! is growing the “Ounce by Ounce Program”, designed to give SPF sunscreen to schools for free. So far, Supergoop! has donated more than 6,800 SPF sunscreen pumps to over 1,900 classrooms and youth organizations and is dedicated to expanding this cancer prevention program.

Supporting Patients and Caregivers through their Cancer Fight

6. American Cancer Society and the Richard M. Schulze Family Foundation launch $10 Million challenge grant to benefit five American Cancer Society Hope Lodges. The American Cancer Society and the Richard M. Schulze Family Foundation (RMSFF) announced the launch of a $10 million challenge grant to benefit five American Cancer Society Hope Lodges – in Omaha, NE; Charleston, SC; Lexington, KY; Lubbock, TX; and Kansas City, MO. Funds raised through the RMSFF challenge grant will be used to establish $2 million endowments at each of the five Hope Lodges to support ongoing maintenance of their physical facilities and operations and support physical improvements to those building.

7. Colorectal Cancer Alliance is launching BlueHQ, the first-of-its-kind comprehensive support hub for patients, survivors, and caregivers to navigate colorectal cancer. BlueHQ is a free support service designed to help patients learn, connect, and take action to improve outcomes. The support hub includes features to suggest helpful information and resources that align with the patient’s profile; connects patients to allies with similar experiences, as well as a patient and family support navigator; and safely and securely stores appointments and notes or journal entries, which can be shared with caregivers and healthcare providers.

8. New coalition launches to address the obstacles rural patient communities face accessing care. A broad national advocacy campaign is set to be launched, bringing together a diverse coalition of public-private partners to raise awareness and spur action to address the persistent, underlying issues that have caused rural America to fall behind in healthcare, technology, and infrastructure. The coalition includes Stupid Cancer, the American Cancer Society Cancer Action Network, Prevent Cancer Foundation, Cervivor, National Coalition for Cancer Survivorship, Cancer and Careers, Triage Cancer, Tigerlily Foundation and Fight Colorectal Cancer Patient Advocate Foundation. Underpinning these efforts will be a storytelling campaign led by OffScrip Health, a leading digital health media platform focused on patient engagement, health equity, and access to care, and FINN Partners, a global integrated marketing and communications agency that will tackle critical issues impacting rural communities’ health, such as access to care, broadband infrastructure, consumer goods, clean water, telehealth, and more. The series will also spotlight the new technologies, partnerships, and practices that can make a difference in addressing this crisis of care.

Bringing Cancer Screening to More Communities

9. Prevent Cancer Foundation to launch “Early Detection = Better Outcomes” campaign to improve knowledge and completion of recommended cancer screenings. The Prevent Cancer Foundation is launching a new signature campaign, “Early Detection = Better Outcomes,” to educate Americans on what recommended cancer screenings and cancer-related vaccinations they need and to encourage them to schedule appointments. Better Outcomes shares evidence-based resources, including screening options by age and information on vaccinations to prevent cancer, tools to find free and low-cost cancer screenings, and information on how family history can impact cancer risk. The campaign will address two additional barriers that Americans face — fear of screening examinations and lack of access — and introduce a new, interactive tool to deliver a personalized screening plan that can be shared with a health provider.

10. Siemens Healthineers is committing to address cancer screening disparities in underserved regions. Siemens Healthineers is working to increase breast screening capabilities and capacity by providing a mobile mammography screening truck, as well as dedicated technologists to perform scans and artificial intelligence- (AI-) technology to help read 3D examinations in Pennsylvania and North Carolina. To date 680 free mammography screenings have been administered, in partnership with Penn Medicine and the Office of Children and Families Philadelphia in Southwest Philadelphia and WakeMed Health & Hospitals at Raleigh Medical Park. Expanding on the success of this program, Siemens Healthineers will be purchasing an additional mobile screening truck with the goal to partner on 10-12 additional mobile screening events this year, reaching at least 2,000 women in underserved areas, including urban and rural sites around the country.

Driving Research Advances through Data Sharing and Clinical Trial Expansion

11. CancerLinQ® and Owkin pursue a new research collaboration to improve the care of patients with metastatic non-small cell lung cancer. CancerLinQ®, a health technology platform from the American Society of Clinical Oncology, and Owkin, a French-American AI biotech company, launch an initiative to improve outcomes for people facing metastatic non-small cell lung cancer (NSCLC). They will use data from CancerLinQ Discovery®, a real-world oncology database of de-identified electronic health record (EHR) data from more than 6 million patients with cancer and blood diseases in the United States to identify possible predictive factors of why some patients with NSCLC), the most common form of lung cancer, respond poorly to immunotherapy treatment. The goal is to use the data routinely collected at the point of care to learn how to better tailor treatments for patients with advanced NSCLC.

12. Hyundai Hope On Wheels awards nearly $15 million to accelerate pediatric cancer research and treatments. Hyundai Hope On Wheels, a non-profit organization supported by Hyundai and its U.S. dealers, donated $15 million in research grants to over sixty hospitals and research institutions across the country in 2022. With this contribution, Hyundai Hope On Wheels will surpass $200 million in lifetime funding for research and innovative treatments in pursuit of a cure for pediatric cancer. As Hyundai Hope On Wheels celebrates its 25th anniversary this year, they are more committed than ever to inspire hope around the nation.

13. Susan G. Komen commits resources to improve outcomes and expands services for the breast cancer community. Susan G. Komen awarded $21.7 million to fund 48 new research projects at 26 distinguished academic medical institutions in the United States that are focused on improving patient outcomes – particularly for people with the most aggressive breast cancers, or who have experienced a recurrence or metastasis. With this investment, Komen is now supporting more than 152 active research projects, representing more than $115 million in funding. Additionally, Komen has expanded access and affordability for breast cancer screening and diagnosis by growing its screening and diagnostics program to 12 cities and providing no-cost breast cancer screening mammograms and diagnostic tests to individuals who meet income qualifications.

Nate Maslak, the co-founder/CEO of Ribbon Health

Price Transparency: In 2022, we saw CMS’s Transparency in Coverage rule go into effect, requiring non-hospital entities like health plans and providers to publish publicly available rates for care. In 2023, we’ll see this price transparency data become more mainstream as it finally makes its way into the hands of patients, empowering them to find the best care for them, reevaluate their care choices, and shop around for the best possible care options. Healthcare enterprises will invest in technology and infrastructure to manage this data and interpret it to be more accessible for their users.

BJ Schaknowski, CEO of symplr

In the coming year, the greater economy’s financial concerns are reflected in the healthcare industry. Budgets will remain stretched as decision-makers navigate rising inflation, diminishing reimbursements, and increased supply chain issues all while addressing staffing and burnout concerns. Increasingly, stakeholders will need to prioritize system interoperability and cost-optimizing solutions that leverage data-driven insights. Organizations should expect financial pressures to drive decision-making in the new year.

Russ Thomas, CEO of Availity

In 2023, mounting economic pressures mean revenue cycle leaders will further expand the use of AI and RPA technology to automate and streamline workflows, going beyond authorization and claim status processes commonly seen today. Claim corrections, posting functions, appeal processes, and patient engagement are just a few areas where AI can identify actions to automate with RPA technology. In addition to focusing on operational efficiencies, healthcare revenue cycle professionals will need to develop new skill sets to monitor and manage these technologies to identify and prioritize activities. While efficiency is always a priority for revenue cycle leaders, it’s becoming increasingly critical in today’s market.

Siva Namasivayam, co-founder and CEO of Cohere Health

The adoption of electronic prior authorization is long overdue, as our current processes are not sustainable. Between federal legislation and CMS’ proposed rules impacting the prior authorization process, health plans will need to adopt technologies that not only comply with the new federal regulations but also enable more strategic, proactive care management. As one of the first data signals of planned healthcare encounters, prior authorization is invaluable as a tool to hasten patient access to high-value care. Intelligent prior authorization solutions will provide the transparency and automation needed to align patients, physicians, and health plans on individualized care plans that rely on evidence-based guidelines to reduce variations in care and improve outcomes.

Lynn Carroll, COO of HSBlox

We will see increased development of programs that align global reimbursement with patient-specific episodic models.  Alternative Payment Models for global reimbursement will incorporate patient-specific sub-capitation components, such as specialty carve-outs, episodes of care, and bundled payments.

Patty Hayward, VP of Strategy for Healthcare & Life Sciences at Talkdesk

Healthcare is in an inequitable situation where payers are experiencing double-digit growth and high profits while many providers are reporting record operating losses. The loss of government health emergency funding will only make this worse. This is not sustainable, and I predict it will lead to consolidation in the provider space. One of the bigger impacts will be providers embracing automation and other technology tools that can reduce operating expenses. Automation also can help providers overcome the severe shortage of healthcare workers, particularly in key non-clinical roles like contact center staff.

Kimberly Hartsfield, Executive Vice President, Growth Enablement at VisiQuate

As healthcare organizations are still struggling with data visibility across their revenue cycle operations, the internal debate of build v buy continues.  Many leaders experience “sticker shock” with vendor proposals while failing to consider the actual cost of internal development, lack of resources and ongoing maintenance/support.  There is a time and place to embrace vendor technology.  The data management issues surrounding revenue cycle management operations are not a tomorrow problem.  Finding vendor partners with deep expertise and quantified success saves both time and money while eliminating administrative waste in healthcare operations. In 2023, speed to value is the name of the game.

Michael Stearns, MD, Specialized Consulting Director – Medical Informatics, Health Language

Risk adjustment comes under the microscope: Medicare Advantage Organizations (MAOs) will see increased regulatory pressure in 2023 due to the cost of the program exceeding traditional Medicare and concerns over adequate documentation of reported conditions. Recent MAO audit reports published by the Office of the Inspector General of HHS suggest an increased focus on the adequacy of supporting documentation for reported diagnoses. MAOs will need to carefully review medical records to ensure there is documentation of evaluation and management of all reported conditions and increasingly turn to clinically tuned technology, such as natural language processing, to streamline the process with accuracy to ensure compliance.

Ryan Younger, VP of Marketing, Virtua Health

Finances will continue to be top-of-mind for health systems in 2023, particularly if we enter a defined economic downturn because consumers will tighten their belts across the board; healthcare is no exception. As consumers look for areas to cut unnecessary spending, they will seek out less services proactively. Health systems that collaborate effectively with physicians to offer a full spectrum of services will have a leg up because they provide more options and lower-cost settings. 

What You Should Know:

– Bill & Melinda Gates Foundation awarded VisualDx a new grant to develop diagnostic tools for surveillance, detection, and triage of Neglected Tropical Diseases (NTDs) and other rare infectious diseases in India and Nigeria.  

– This project comes on the heels of similar public health collaborations with HHS and the state of Vermont. It also marks the second Gates Foundation grant VisualDx has received, following a successful 2020 project in Botswana to provide an offline version of its clinical decision support tool for users in remote areas.

Initiative Details

As part of the initiative, VisualDx will support national public health efforts in India and Nigeria by developing country-specific logic for its decision-support platform to enhance surveillance, detection, and triage of Neglected Tropical Diseases (NTDs) and other rare infectious diseases. The company’s application combines AI/ML image analysis with structured clinical data, information, and questions to educate providers about the presentation and management of NTDs and other similar diseases, and can be tailored to meet the experience level of various users, from community health workers to physicians. It also offers robust tracking and reporting capabilities to study cases, differentials, and outcomes across each country. 

The healthcare industry is in the middle of navigating two major trends: technology is moving into healthcare, and healthcare is moving into the home. As providers, payers, vendors, and industry newcomers scramble to figure out “who’s on first,” we all sense the possibility of this quantum leap moment for healthcare. 

Many of our collective conversations right now are focused on a critical imperative for these emerging care models: improving health equity across racial, gender, age, economic, educational, and geographic lines. This goal has rightly become front and center for many care-at-home programs across the country. 

With new care-at-home programs announced every week, it’s vital that these initiatives implement the right technology and support to address and improve inequities. Here are four ways care-at-home programs can make or break the pursuit of improved equity in access, adherence, and outcomes.

1. Build digital product interfaces designed for patients and accessible across languages and health literacy levels. 

As we move care into the home, patients must be able to access and navigate the digital products that care-at-home programs rely on. Whether the application lives on the patient’s own device, a provided device, or lacks a true interface, whatever the patient is interacting with must be broadly accessible.  

Any gaps in accessibility, as minor as they might appear, could impact the patient’s ability to adhere to their care plan. In the U.S., 21.6% of people speak a language other than English at home—that’s one in every five adults[2]. Low health literacy often correlates to groups who face barriers to accessing care[1]. Often, these patients also need care the most or have chronic or comorbid conditions that could benefit from ongoing monitoring.

Key program touchpoints that can support equity across language and literacy:

– Product Setup Instructions: Simple, well-defined, and accessible product setup instructions can differentiate between a successful experience and a complete failure. It must be approached as more than just “how-to” material and must be tested with patient populations while in development; it contributes to the overall experience and is part of the patient’s care. 

– Task Descriptions: When outlining tasks, follow general best practices, such as striving for short descriptions, plain language, and bullet points. However, go beyond to include clear graphics and/or animation that show how to take a measurement or use a device. Well-designed graphics will enable comprehension for patients with low reading comprehension. Make sure you use a health literacy assessment to evaluate all patient interfaces.

– Telehealth Interactions: In addition to ensuring interfaces can be configured for accessibility, it’s imperative that translation within telehealth calls can be easily accessible and readily available. Multi-party calls should allow for on-demand translators, family members, or other providers to join via video or audio.

 2. Provide human support for the initial activation.

Activation at the beginning of a care-at-home experience is a critical moment for equitable patient experiences. The degree of support that patients need will depend on several variables, including the technology components, the logistics process, and the patient’s acuity level. For some care models, you may need to provide over-the-threshold support for setup. For others, it may be sufficient to provide written and video instructions for setup, or to complete setup before the patient leaves the clinic or healthcare facility.  

Regardless of the activation process, adding a layer of human support can help ensure no patient is left behind. Have someone reach out to the patient confirming receipt of the first health data transmission and answer any questions that may have arisen since the patient last spoke with a member of their care team. Then, provide patients with multiple options to access support: phone, email, and chat within the digital health application.

3. Deliver connectivity. 

More than one in six people in poverty had no Internet access in 2019.[4] Pursuing equity within care-at-home programs requires removing in-home high-speed internet as an eligibility requirement. To do this, we have to ensure data transmission and communication without relying on in-home broadband access. Offer cellular-enabled connectivity hubs, and, if the patient needs one, a smart device. 

Troubleshooting connectivity is another key opportunity for human support. If a device loses connection or something happens in the patient’s environment, responsibility shouldn’t fall to the patient, their family, or a clinician to get everything back online. Dedicated technology support can make care-at-home experiences better for providers and patients alike, especially if that support can extend into patients’ homes (e.g., the Geek Squad).

4. Don’t wait for patients to reach out.

A proactive approach to patient engagement is important for an equitable program because it removes the onus from patients to ask questions or ask for help. 

Throughout a care-at-home experience, there are several patient engagement opportunities that should not be missed: at the point of activation, in response to biometric data trends, in response to non-compliance or non-adherence, and at regular junctures during a patient journey or care plan (e.g., every patient receives a call on day five just to check in).

The best medium for patient engagement will depend on the program type and patient population. Some patients may prefer text-based messages, while others need or want to hear someone’s voice on the phone. Scaling multi-modal patient engagement can be challenging (and even be unsustainable) for teams whose work is not dedicated to the care-at-home model. But virtual Command Centers can provide that dedicated support and enable programs to scale sustainably. 

A Holistic Approach

To make a meaningful difference in health equity in our communities, we have to take a holistic approach and move beyond a “check the box” mentality. In addition to the opportunities mentioned here, program leaders must look at patient eligibility and exclusion criteria with an inclusive lens, and test to ensure the technology and algorithms involved in remote patient monitoring are not exacerbating inequities. And finally, healthcare is delivered by people, so hiring and training plans must reflect the communities and populations a program aims to serve. Cultural appropriateness is key. Cultivating skills within the design and care delivery teams that improve cultural competence and humility, as well as cross-cultural communication, will enable the delivery of equitable care and support improved patient outcomes.

Care at home has the potential to offer more accessible longitudinal healthcare interactions that can improve outcomes and lower costs. However, making this happen in an equitable way requires a thoughtful and intentional approach to people, processes, and technology that are powering care at home. 

About Chemu Langat

Chemu Langat is the Chief Operating Officer for Best Buy Health, leading the Operations and Quality & Regulatory functions. In this role, she is responsible for the Caring Centers, expanding the reach of our supply chain and operational ecosystem, driving a culture of quality and ensuring compliance of our offerings and medical devices. She also leads the health equity work for Best Buy Health.

Prior to joining Best Buy, Chemu was the Regional Head for Africa under Medtronic Labs, developing and scaling community-based, technology-enabled solutions for chronic disease management across. Chemu previously worked as a Principal Biomedical Engineer for Medtronic, as well as a Systems Safety and Reliability Engineer at NASA’s Johnson Space Center.

References

[1] Levy H, Janke A. Health Literacy and Access to Care. J Health Commun. 2016;21 Suppl 1(Suppl):43-50. doi: 10.1080/10810730.2015.1131776. PMID: 27043757; PMCID: PMC4924568.

[2] United States Census Bureau: https://data.census.gov/cedsci/table?tid=ACSDP5Y2019.DP02&hidePreview=true

[3] United States Census Bureau: https://www.census.gov/quickfacts/CA[4] Office of the Assistant Secretary for Planning & Evaluation ● U.S. Department of Health & Human Services: https://aspe.hhs.gov/sites/default/files/private/pdf/263601/internet-access-among-low-income-2019.pdf

For years, the healthcare industry has been inundated with stories about the importance of sharing data among payers, providers, and other key stakeholders – and for a good reason; widespread interoperability of healthcare data has the potential to transform much of the industry for the better.

What’s often not mentioned is how expensive, time-intensive, and potentially legally hazardous data-sharing is. Combining disparate data sets is a technically challenging undertaking that requires substantial integration work that generally involves numerous highly compensated health IT workers.

Even when data is “de-identified” as part of a singular data set, unsavory characters may “re-identify” patients by combining the data with information from other data sets, creating potential legal liability for exposing patients’ protected health information.

One significant reason we build data ecosystems is to overcome these limitations. By aggregating and standardizing data from a wide array of sources – claims, electronic health records, demographics, and more – healthcare data ecosystems deliver the ability to accelerate innovation in medical research, drug development, and public health.

The broader context of healthcare data ecosystems

According to BCG Consulting, a business ecosystem is a dynamic group of largely independent partners working together to deliver integrated products or services. Business ecosystems offer three key advantages:

– They deliver quick access to a broad range of external capabilities that often are too expensive and time-consuming to build internally.

– They are easy to scale due to their modular setup, which simplifies adding partners to expand the network.

– They are flexible and resilient and can quickly adapt to changing consumer needs or technological innovations, making them valuable in unpredictable environments.

Data ecosystems are essentially the same as business ecosystems, dedicated to sharing data. Data-sharing is common in some industries but less so in healthcare. Think Uber’s ride-sharing data ecosystem, which connects customers seeking to book an on-demand ride with thousands of drivers as partners, or Airbnb’s data ecosystem, which enables hosts with extra rooms or space to connect with guests seeking a place to stay.

One notable example of a data ecosystem in healthcare is Blue Health Intelligence, which has collected a database of 234 million unique patients’ medical and pharmaceutical claims from Blue Cross and Blue Shield health plans. Healthcare organizations contract with the company to use its data to help inform strategic decisions, such as evaluating market expansion opportunities, analyzing provider performance, and training predictive models.

Requirements for healthcare data ecosystems

 As healthcare data ecosystems evolve, they will likely be defined by the needs of different patient populations, according to McKinsey. On one end of the spectrum are healthy patients without severe medical conditions, who often set personal wellness goals. On the other end are patients experiencing multiple complex chronic diseases, particularly the Medicare and Medicaid dually eligible population.

Regardless of which groups of patients an ecosystem seeks to serve, there are several common elements and requirements for establishing thriving healthcare data ecosystems. These include:

The correct data custodian and partners

In a data ecosystem, the custodian or “orchestrator” hosts the data platform, defines governance, and attracts partners. The custodian must protect partners’ data, contribute technical resources, and act as a neutral partner to all participating organizations.

The primary value of any data ecosystem comes from the collective sum of different data sets, so attracting the right partners is essential. It starts with understanding each prospective partner’s goals and incentives and developing a compelling vision of how the ecosystem will help them achieve their business objectives.

Potential partners are more likely to show interest if we can convince them there are net benefits to joining, a competitive risk associated with not participating, and limited investment is required.

Data harmonization: Custodians must meet partners where they are in their data journeys, whether the data comes in the form of a CSV file or FHIR. Healthcare data is notorious for having quality issues and is often unstructured and fragmented, leading to numerous problems with standardization. Custodians must create a standard data schema to remove silos by allowing participants to operate off the same data sets with increased coordination.

Diverse data sources

Innovation often involves discovering new correlative or causative effects between events or conditions previously unrealized. Healthcare data ecosystems need a broad, diverse range of data for analysts to study. In healthcare, this requires going beyond the traditional claims and patient records to incorporate other sources of information, such as surveys, games, retail, or social media.

The promise of healthcare interoperability and data-sharing is real, but it is important to acknowledge there are also drawbacks – costs, technical challenges, and potential legal liability. Health data ecosystems help stakeholders realize the benefits of sharing data while minimizing the downsides.

About Brett Furst

A senior executive with three decades of experience managing technology solutions within the manufacturing, CPG and healthcare industries, Brett Furst serves as President of HHS Technology Group, LLC a software and solutions company serving the needs of commercial enterprises and government agencies.rior to joining HTG, Brett founded Foresight Ventures which focused on providing strategic guidance and leadership to emerging health IT companies. During which time, Brett was a co-Founder of Payformance Solutions and where he served as its Chief Strategy Officer. Payformance is a platform for analyzing and facilitating value-based arrangements between payers and providers.

What You Should Know:

– Epstein Becker Green (EBG) recently released its 2022 updates to the Telemental Health Laws survey. 

– The 2022 updates report a significant evolution of the telemental health and telehealth industries, including increased regulatory flexibilities that promote increased use of telehealth.

Insights and Trends from Telemental Health’s Survey

The Telemental Health Laws survey is authored by Amy Lerman and Audrey Davis, with support from Jenna Horowitz, Erin Sutton, Christopher Taylor, and Bailey Wendzel. EBG Law Clerk Jack Ferdman and the following 2022 EBG Summer Associates provided research and drafting support: Nija Chappel, Madeline Dwivedi, Annie Lucatuorto, Diego Perea, Ada Peters, and Kyla Portnoy.

The survey’s focus on behavioral health professions highlights an ongoing mental health crisis and an industry in dire need of qualified mental health services and resources. In 2022, reports of a 25 percent increase in the global prevalence of anxiety and depression pushed the Biden administration to prioritize access to mental health services, including the $1.5 trillion Consolidated Appropriations Act of 2022, which extended Medicare coverage related to telemedicine practices. As a result, mental health care services multiplied as state and local legislatures expanded policies to support the provision and coverage of these services.

As within many areas of health care, however, expansion and innovation contributed to a higher risk of fraud and resulted in an increase in enforcement activity. Telemental health providers were not immune to this activity in 2022, and providers should prioritize regulatory compliance as the industry looks ahead to 2023.

“As legislators began to address regulations heavily impacted by COVID-19, the United States also faced the demand for more accessible mental health services,” explained Amy Lerman, a Member of the Firm in EBG’s Health Care and Life Sciences practice. “The heightened importance of telemental health services calls for more flexibility and expanded access. That call was answered in 2022, and now the industry must ensure that services maintain quality and compliance for real change to occur.”

Below are more key insights from the industry progress:

1. Telemental Health Becomes More Accessible Across States

 While physicians continue to use telemedicine and telehealth services in their practices, 2022 brought continued regulatory updates in many states that promote flexibility and access to telehealth technology for use by other mental and behavioral health professionals, such as psychologists, social workers, and counselors. These are some measures of increased accessibility in 2022:

– Broader Coverage Under State Medicaid Programs: While all state Medicaid programs provide coverage and reimbursement for some telehealth services, a key development was certain state Medicaid programs making permanent the temporary COVID-19 flexibilities in coverage and reimbursement, to promote coverage of telehealth services. For example, some states’ Medicaid programs now provide coverage for certain services supplied through audio-only modalities. 

– Interstate Practice: States have continued to evolve with respect to how professionals can fulfill professional licensure requirements. In certain states, specific types of providers may provide services to patients in the states as long as they hold a license in good standing in their home state. Greater state participation in various professional compacts also has helped facilitate cross-state practice activities.

– Remote Prescribing: States continue to clarify and refine requirements under which physicians and certain other professionals can prescribe remotely, specifically by eliminating the requirement that the provider conduct a prior in-person examination and allowing instead for the necessary examination to occur via telehealth.

2. “Telefraud” Met with Continued Enforcement

As telemental health services have seen unprecedented demand, states and federal lawmakers are addressing the increased risk of fraudulent schemes. In 2022, the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) continued to build on previous activity. Notable actions and reporting include the following:

Look to these best practices to enhance your organization’s vendor risk management program

Vendor partnerships are critically important in today’s business world, especially as the pandemic accelerated many organizations’ digital transformation and the shift to remote operations, cloud adoption, and virtual services, such as those through telehealth, medical apps, and other healthcare technology and communication platforms continues to expand. This increased reliance on third parties also comes with a price: added exposure to cyber risks and vulnerabilities. 

While the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) is exercising its enforcement discretion to not impose penalties for noncompliance with  HIPAA and the HITECH Act as it relates to “good faith” implementations of remote technologies used to provide telehealth. That is not to say that such regulations are not important to customer data and the organization’s reputation, as well as future enforcement by OCR and HHS.    

One thing’s for certain: Healthcare data breaches continue to rise in 2022. Healthcare providers so far this year, have reported 96 breaches affecting 31.6 million individuals within the past 12 months compared to 39 breaches affecting 10.3 million in the 12 months prior. Some notable breaches this year have involved third parties.

Recently North Broward Hospital District (Broward Health) notified OCR of a breach affecting 1.3 million individuals. According to the January 2022 notification, an intruder gained access to the Broward Health system through a third party. Data about patients and staff, including names, birthdates, financial information, social security, treatment and diagnosis records, and other sensitive information was exposed. 

More recently, Shields Healthcare Group, an MRI, PET/CT, and ambulatory surgical services provider disclosed in May 2022, that patient data had been compromised including that of their 50 partner facilities (and potentially their partners), resulting in 2 million individuals exposed.  

Mitigating ‘Nth party risk’

Increased exposure via vendors is called “Nth party risk,” or the idea that a breach to your organization can come through a vendor’s vendor or even a vendor’s vendor’s vendor. Breaches involving third parties cost up to $700,000 more on average.  Yet experts warn that nearly three-quarters of organizations still aren’t demanding their vendors implement proper information security practices. 

Enhancing your  vendor risk management

Organizations should take a holistic approach to champion information security across their business and vendor network. 

To start, designate a team (that includes members of executive management and IT professionals from within) to develop a program to both manage business associates and vendor relationships to mitigate the associated risks, as well as evaluate the organization’s environmental, social, and governance (ESG) impact – and consider engaging an experienced and knowledgeable risk advisory firm to assist with these efforts and help identify any gaps. 

Consumers are becoming more socially conscious, and ESG-related regulations are on the rise. Those organizations that do not comply may fall behind. ESG is not only about climate change and labor standards.  It is also about company practices, community relations and customer satisfaction, as well as executive and board composition. Cybersecurity plays an important role within the social pillar of ESG frameworks and how the organization operates and manages the data it has been entrusted with.  This includes managing those cyber risks brought on by engaging with vendors. For these reasons and more, it is critical that an organization implements an appropriate vendor management program that includes cybersecurity.

Below are six practices that can enhance your vendor management program and help you mitigate third-party cyber risk.

1. Establish risk appetite and tolerance across the entire organization. 

Each organization has its own approach when it comes to risk.  However, every organization needs to determine its risk appetite and risk tolerance to serve as a guide for the vendor management program. Specifically, leadership needs to decide which types of risks and the amount of risk the organization is willing to accept in conducting business.

– Risk appetite is the overall risk or loss exposure the organization is willing to accept or bear in pursuit of its business objectives.

– Risk tolerance is the specific level of risk that an organization can accept or bear with regard to an individual project.

It’s possible that your organization has a low-risk appetite overall but a higher risk tolerance when it comes to a specific area – or vice versa.

2. Assess business associates and vendor risk. 

Each business associate or vendor opens your organization to potential risk — and that risk increases as their access increases — so, do your due diligence. Determine how critical the vendor is to the success of your business and what potential risks they could pose to not only your operations but to your reputation.  During your due diligence, the organization should also review the vendor’s environmental and social impact, as that may in turn affect the organization.

Request a system and organization controls (SOC) report from the vendor. For evaluating cybersecurity-related controls, you should specifically ask for a SOC 2 report that may include an assessment of compliance with HIPAA. The report will include an independent auditor’s opinion on whether cybersecurity controls in place are designed, implemented as of a period in time (Type 1), and operating effectively for a period of time, such as a 6- or 12-month period (Type 2). It’s important that all vendors who manage your client’s data have controls in place to mitigate risks from relevant threats and vulnerabilities to the business. 

A qualified risk advisory consultant can perform a comprehensive risk assessment to help you identify vendor-related vulnerabilities, rank each vendor’s risk based on factors such as access to critical data and operational activities, and assist with developing corrective actions to remediate identified control issues or gaps.

3. Establish a universal risk rating methodology. 

A business associate or vendor risk rating system will help you allocate resources to focus on higher-risk organizations. Following the same methodology for the organization’s various risk assessments, including IT, cybersecurity, and enterprise risk assessments, would add uniformity and standardization across the organization and help leadership bring together all risks and identify any areas of risk that are greater than the organization’s risk tolerance. 

For example, if you choose three levels (e.g., high-moderate-low), utilize them throughout all risk assessments. Also, consider using an existing and recognized framework to help you identify and manage risks. Depending on the type of risk assessment, a different framework may suffice.

As part of this exercise, you will establish a consistent risk rating system and implement an appropriate risk management methodology across the organization.

4. Create boundaries with vendors. 

Set your business up for success by creating boundaries — or a minimum set of requirements for cybersecurity — with your vendors. The most basic may be requiring vendors to have their own information security program, but it’s also a good idea to clarify the boundaries between your vendor and their vendors or clients.

A recent example of the importance of vendor boundaries is the Volkswagen Group of America breach announced in June 2021 that disclosed that one of their vendors had exposed the data of more than 3.3 million of their customers. One of the primary lessons learned so far from the ongoing investigation is that providing vendors with unlimited access to your network can have devastating consequences. 

While sometimes this situation is difficult to avoid, there are ways to protect your customers by setting boundaries for your vendors to help mitigate the risk that your vendors will compromise your organization’s ability to maintain a secure environment: 

– Segregate your vendors from the network 

– Have a redundant system working in parallel 

– Use an unrelated third party to actively monitor for anomalies

– Define vendor responsibilities for responding and recovering from incidents prior to engaging with them

Privacy, security and breach notification requirements for healthcare organizations require a business associate agreement with vendors who are sharing protected health information (PHI). 

5. Develop an enterprise-wide vendor management program. 

The vendor management program should also include other criteria such as:

– A formal vendor selection process 

– Contract requirements: data breach notification requirements, termination clauses, confidentiality, minimum information security requirements and cybersecurity requirements, defined roles and responsibilities, monitoring/right to audit

– Due diligence: financial review, business continuity planning/disaster recovery planning, incident response procedures, HIPAA compliance review, information security program, SOC review, OFAC review, site visit, performance and privacy program review according to their risk rating

– Ongoing risk-based monitoring

– Vendor termination procedures and follow-up

6. Stay up-to-date. 

Vendor management isn’t a task to check off a list. It’s critical to review and update your program annually. Pay special attention to material changes such as managerial changes within your organization or new technology that’s been onboarded that may require further action confirm alignment with the organization’s risk and governance policies.

When not managed properly, vendor risk can lead to financial loss, reputation damage, lost business, and regulatory penalties. However, cyber risks and other third-party-related risks can be mitigated by developing, implementing, and maintaining a strong and sound vendor risk management program. 

About Daniel Rosenberg

Daniel Rosenberg is a manager in Kaufman Rossin’s Risk Advisory Services practice, where he performs cybersecurity and compliance services.

About Nathalie Feria

Nathalie Feria is a manager in Kaufman Rossin’s Risk Advisory Services practice, where she works with clients on information security and investigative engagements related to money laundering, due diligence, and internal corporate compliance.

What You Should Know:

– The U.S Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), awarded nearly $1.5 billion to support states, tribal lands, and territories’ efforts to address the opioid crisis and support individuals in recovery.

– The grants are part of SAMHSA’s State Opioid Response and Tribal Opioid Response grant programs. The grant programs provide funding to states and territories to increase access to treatment for substance use disorder, remove barriers to public-health interventions like naloxone, and expand access to recovery support services such as 24/7 Opioid Treatment Programs.  

 Address the Overdose Epidemic and Support Recovery

The funding will also allow states to increase investments in overdose education, peer support specialists in emergency departments, and allow states to invest in other strategies that will help save lives in hard-hit communities.  The full funding includes:

– Investing over $104 Million to Expand Substance Use Treatment and Prevention in Rural Communities to Beat the Overdose Epidemic. 

– Investing $20.5 Million to Increase Access to Recovery Supports. 

– Releasing New Guidance to Support and Facilitate Greater Access to FDA-approved naloxone products. 

– Announcing Additional Funding for Law Enforcement Officials on the Front Lines of the Overdose Epidemic. 

– Releasing New Guidance for Employers to Create Recovery-Ready Workplaces. 

– Deploying Financial Sanctions to Disrupt Global Drug Trafficking Operations. 

What You Should Know:

– Eko, a digital health company applying machine learning in the fight against heart and lung disease, today announced that it was awarded a $2.7M Small Business Innovation Research (SBIR) Direct Phase II grant by the National Institutes of Health’s (NIH) Department of Health and Human Services (HHS).

– The grant will fund the development of a machine learning algorithm that detects and stratifies pulmonary hypertension (PH) using phonocardiogram (PCG) and electrocardiogram (ECG) data provided by Eko’s smart stethoscopes.

Improving Clinical Decision-Making Through New Machine Learning Algorithm

Pulmonary hypertension is a severe condition that occurs when the pressure in the vessels that carry blood from the heart to the lungs is higher than normal, causing undo stress on the heart. PH affects up to 1% of the global population and is a marker of poor health outcomes.¹ PH can cause premature disability, heart failure, and death. Unfortunately, delays of over two years frequently occur between the onset of symptoms and diagnosis of severe kinds of PH.  The gold standards for diagnosing PH are echocardiography and right heart catheterization, which are costly, invasive, and require a heart specialist. ECG-based AI models have been clinically proven to improve the diagnosis of PH but are challenging to deploy.³ To address this challenge, Eko formed a research partnership with Lifespan Health System’s Cardiovascular Institute to collect real-world PCG and ECG data using the Eko DUO ECG + Digital Stethoscope. This data will help develop an algorithm that can detect PH and stratify its severity. This easy-to-deploy early identification tool aims to diagnose PH earlier and more accurately, leading to beneficial interventions that can save patients’ lives

“The major goal of this study is to determine whether an Eko algorithm based on phonocardiography coupled with electrocardiography can identify the presence and severity of pulmonary hypertension when compared to the current gold standard,” said Dr. Gaurav Choudhary, Principal Investigator and Ruth and Paul Levinger Professor of Cardiology and Director of Cardiovascular Research at the Alpert Medical School of Brown University and Lifespan Cardiovascular Institute. “This machine learning algorithm has the potential to be a low cost, easily implementable, and sustainable medical technology that assists healthcare professionals in identifying more patients with pulmonary hypertension.”

This award marks Eko’s fourth SBIR grant from the NIH, bringing their total funding to date from the NIH for cardiopulmonary machine learning development to $6M. A previous $2.7M grant, awarded to the company in July of 2020, funded the collaborative work with Northwestern Medicine Bluhm Cardiovascular Institute to validate algorithms that help healthcare professionals (HCPs) identify pathologic heart murmurs and valvular heart disease (VHD) during routine office visits. That grant for VHD directly contributed to the FDA clearance and commercialization of Eko Murmur Analysis Software (EMAS) – the first and only machine learning algorithm to assist HCPs in identifying structural heart murmurs using a smart stethoscope.

Eko is advancing how healthcare professionals detect and monitor heart and lung disease with its innovative suite of digital tools, patient and provider software, and AI-powered analysis. Its FDA-cleared platform is used by hundreds of thousands of healthcare professionals worldwide, allowing them to detect earlier and with higher accuracy, diagnose with more confidence, manage treatment effectively, and ultimately give their patients the best care possible.

What You Should Know:

– As COVID-19 accelerated demand for more advanced digital health and patient engagement technologies, hospital and health system IT departments shouldered these expectations – rolling out new capabilities in record time, while still balancing daily operational support responsibilities. Now, IT staff burnout has escalated into major career jumps, with many hospital IT departments struggling to fill talent gaps from high turnover.

– Utilizing flexible staffing programs, to address resource gaps and IT catch-up projects, stands as a top-of-mind focus for hospital and health system CIOs, according to Stoltenberg Consulting’s 10th annual Health IT Industry Outlook Survey.

Key Trends from the Health IT Industry Outlook Report in 2022

In light of COVID-19 and the immense burden the healthcare industry had to shoulder, the new Stoltenberg Consulting’s 10^th annual Health IT Industry Outlook Survey provides some interesting insights into the key trends to look out for in 2022. They are listed and explained as follows:

1. The great resignation ripples into HIT operational burden: For a third-consecutive year, IT talent strain looms as a significant concern for health IT leaders. Almost two thirds (65%) of healthcare CIOs pinpointed “retaining and budgeting for qualified IT resources amid the great resignation” as their largest operational burden related to IT this year. This figure hit an all-time high in 2022, rising 10% from last year’s top-spot amount of 55%. “Demand management while juggling multiple IT initiatives” (11%) earned the next highest ranking in IT operational burdens felt by CIOs. Additional IT concerns — “aligning IT with maximizing value-based care reimbursements,” “provider burnout related to EHR burden and inefficiency,” and “IT service failures (i.e. system downtimes or cybersecurity hits)” — all stood below 10%, with the latter two earning half the votes as the previous year.

2. Flexibility helps balance competing IT initiatives: As CIOs face pressure to cut costs while contending with resource and competing project strain, they seek new staffing support solutions. When asked to identify the top area of IT where they wished they had more support, over half of healthcare CIOs (54%) said, “flexible IT staffing support to ramp up or down with real-time project demands. Clinician end-user education and knowledge transfer (30%) came in at No. 2 for additional support requests, while telehealth end-user onboarding and technical support (9%) and the IT help desk (7%) ranked lower in the IT support wish list.

3. Ensuring ROI from current IT investments: Amid supply chain issues, high talent turnover and a turbulent market, healthcare leaders are increasingly vying to identify cost savings and make do with current purchases. For a second-consecutive year, “getting the most out of existing IT purchases” ranked as the highest CIO priority for IT-related financial goals at 64% in 2022. Although no other IT financial priority came close, “reducing claims denials and speeding up insurance and/or patient payments” (13%) and “facilitating value-based care reimbursement maximization” (9%) trailed in next. “Improving the speed, accuracy and value of financial reporting” (7%) and “driving down vendor support costs” (7%) tied as the lowest IT-related financial focuses.

4. IT spending and mission critical events align: While EHR new version upgrades earned the highest IT spend focus, they also ranked as hospital and health system CIOs’ most recent or near future mission critical event (25%). Virtual care program deployments (20%), from pandemic-era care shifts, came in second, while M&A system consolidation activity (18%) reemerged across the industry in third place. Whether upgrading internal EHR instances or linking hosted, community-shared EHRs with surrounding healthcare organizations, many hospitals are doing multi- version upgrades. These jumps aim to get them back on pace with their EHR vendors for functionality, security and interoperability advancement. Additional, less common mission critical IT events were cybersecurity responses (14%); “other” (12%), which included revenue cycle system replacements and infrastructure changes; and system, server or software patching (11%).

5. End-user frustrations causing EHR burnout: For a second year in a row, healthcare CIOs expressed that end users are most frustrated with inefficient system workflow (43%). In second place, IT ticket resolution ineffectiveness grew 10% in votes from last year, impacting over a quarter (27%) of hospital and health system end users in 2022. End-user frustrations with poor support analyst communication (18%) rose more than double last year’s amount, while IT issue and/or help desk call wait times earned 12% of end-user concerns. As noted by trends in poor ticket handling, end-user customer service feels the ripple effect of IT teams being stretched thin. With staffing strain and resource costs mounting, IT support performance metrics may slack.

6. Continued emphasis on operational catch ups: Pivoting back to operational projects put on hold during COVID-19, CIOs are refocusing on their IT systems’ health and coordination within their evolving organizational footprint. For a second year in a row, EHR new version upgrades and/or system alignment (43%) took the top spot of where healthcare organizations are investing the most IT dollars. Aligning with industry hot topic concerns, cybersecurity (23%) took the No. 2 ranking for IT budget prioritization. Additional areas of IT spend included “other” — comprised of votes for infrastructure modernization and revenue cycle optimization — and maximizing data analytics programs, which tied at 11%. AI initiatives (7%) and telehealth support (5%) landed at lowest prioritization, likely indicating that the pandemic’s initial telehealth platform boom has plateaued.

7. Cybersecurity concerns: Lastly, as seen in media and conference headlines, cybersecurity took the leading spot for hot topics, with just cause. According to the U.S. Department of Health and Human Services (HHS), within 2022 alone, there are over 298 major healthcare data breaches under investigation by the Office for Civil Rights2. Aligning with this data, within the Health IT Industry Outlook Survey, over a third of U.S. hospital and health system CIOs said that beyond continued COVID-19 recovery, cybersecurity (42%) is the biggest health IT industry focus for the year.

Patient engagement, which earned the top spot in last year’s survey, followed in second place with 29% of votes, while interoperability (21%) ranked third. Trailing behind in industry focus, AI earned 6% of votes, while greater marketplace competition earned last place with 2%.

In its 10th year, the survey demonstrates the evolution of health IT industry trends and the CIO leadership role — with COVID-19 serving asa trigger for change. In prior years, the elusiveness of value-based care dominated industry focus. Now, value-based care alignment has expanded into consumer-driven digital health advancements. Traditional patient care evolved into digitally enabled methods, with telehealth, virtual care and hospital at home programs serving as more convenient revenue-generating care that expands patient reach.

With the emphasis on virtual care, remote work enablement, digital infrastructure alignment and cybersecurity, the health system IT department bears higher than ever burden. Many CIOs noted that IT demands are greater than they’ve seen in many years. Now, CIOs serve as the force unifying the advancing technology footprint needed to sustain competitive health system growth. In doing so, the healthcare CIO holds a much more prominent seat at the decision-making table.

The U.S. has reached a grim milestone with an estimated 107,622 drug overdose deaths in the United States during 2021. With a post-pandemic spotlight on mental health and substance use disorder challenges, Congress and the Biden administration are working on multiple plans to address these issues. 

Earlier this year, the Biden Administration sent its first national drug control strategy to Congress, which focused on two pillars, one of which centered on addressing untreated addiction. This strategy is just the tip of the iceberg. As part of President Biden’s Mental Health Strategy, which was announced during his first State of the Union, the Department of Health and Human Services (HHS) awarded nearly $105 million to 54 states and territories as they prepared for the transition from the National Suicide Prevention Line to the 988 line this past July. A bipartisan group in Congress proposed the 988 Implementation Act, with the goal to increase access to behavioral health services, especially those in crisis through the three-digit number, akin to 911. Further, President Biden referenced the opioid epidemic and how imperative it is we beat it as a nation. 

While we’re certainly headed in the right direction, enacting policy that promotes care coordination and supports behavioral health crisis management will be the next step in combatting substance use disorder in the United States. To meaningfully improve mental health care and outcomes, the federal government must take steps to integrate mental health information into our clinician’s workflows. 

Currently, our country’s healthcare system operates in silos, separating physical care from mental care, even though they are interconnected. Now that the 988 line has launched, lack of care coordination is evident and will only further our country’s siloed system. Care coordination and integration is at the core of solving this issue, but we need our governments at the state and federal level to help facilitate this necessary change. 

First, it’s important that the federal government make financial investments that aid in this integration. While physical health providers were eligible for federal financial incentives from the Health Information Technology for Economic and Clinical Health Act enacted as part of the American Recovery and Reinvestment Act of 2009 (P.L. 111-5), mental health providers were left out of the equation. To create meaningful change, the federal government must back this integration through financial means for both mental and physical health providers. 

In addition to providing financial investment, our government must also consider how to balance policies that encourage care coordination and the unique privacy concerns related to mental health data. Currently, patient data – regardless of its relation to physical or mental health – can simply get stuck in our doctor’s offices. Providers often cannot share a patient’s medical history or even a list of current medications with other providers in a patient’s care team due to patient privacy concerns. This can become a significant issue when a patient has multiple providers for their behavioral and physical health conditions. 

While patient privacy is of the utmost importance, it also can hinder care coordination, further separating the healthcare system into silos. In many instances, state privacy laws are more stringent than federal laws, meaning care coordination becomes even more limited depending on the state where care is delivered. Through policy, our state and federal governments must consider how to protect this data while allowing the exchange of information that could save lives, especially in crisis situations. This could be accomplished by urging state governments and partnering with them to adopt more unified guidelines for effective physician communications across the U.S.  

While the recent focus by Congress and the Biden administration to address the nation’s substance use and mental health crisis is encouraging, there’s more work to be done. We must first enable an infrastructure for crisis management that supports our country’s growing behavioral health needs. By first offering financial investments and incentives and enacting policy that pushes care coordination and integration forward, our clinicians can focus on what matters most – caring for their patients.

About Vatsala Kapur

Vatsala Kapur, senior director of government affairs at Bamboo Health, has over two decades of experience in health policy and public health. Bamboo Health, formerly Appriss Health and PatientPing, is a healthcare technology solutions company focused on fostering care collaboration and providing information and actionable insights across the entire continuum of care.

What You Should Know:

– Bicycle Health, today announced that its high-quality, evidence-based virtual opioid use disorder (OUD) treatment is now part of Evernorth’s behavioral health network

– Furthermore, it will be made available to all Evernorth clients, as well as Cigna health plan customers who receive health coverage through their employer or marketplace exchange plans in 24 states. Evernorth is the health services business of Cigna Corporation.

Increasing Access to Care Using Virtual Care Models

Bicycle Health’s virtual care model dramatically increases access to OUD treatment – which is largely inaccessible in an in-person setting. An estimated 40 percent of counties in the United States do not have a single MAT provider for OUD, and 56 percent of counties with the greatest need have “inadequate capacity” to treat patients in an office setting, according to a 2020 report from the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS).

Through Bicycle Health, customers will have access to behavioral health clinicians who can help develop a personalized care plan, including a prescription to Buprenorphine/Naloxone (Suboxone), if appropriate. To access Bicycle Health’s care, customers first have an enrollment call to ensure the program is a fit for the individual’s specific needs. After that call, an appointment is scheduled with a provider.  

“We’re grateful and inspired by the visionary approach Evernorth has brought to this collaboration. Opioid addiction is highly stigmatized in the US, which directly contributes to 90 percent of people with the disorder not pursuing treatment,” said Ankit Gupta, CEO and founder of Bicycle Health. “By joining Evernorth’s behavioral health network, health plans and employers are now able to cover this kind of care more easily than ever before. It is only through that kind of vision and leadership that we will turn the tide in addressing the opioid crisis.” 

Today’s news continues a year of massive growth for Bicycle Health – including its Series B announcement and expansion in 7 new states. Bicycle Health has now served over 17,000 patients across 24 states as the company continues to increase access to more affordable, flexible, and effective care for people across the United States struggling with OUD.

Maintaining patient data integrity is more complicated than ever; cybersecurity threats loom, patients are taking more ownership of their care (self-registration, for example) and health system merger activity is on the rise. It can make the quest for the ever-elusive 1% maximum duplicate rate seem, at times, unattainable.

But a secure, accurate, and duplicate-free MPI/EMPI can be achieved. It just requires a multi-pronged approach to protect data throughout its journey into a health system and at every touch along the way.

Duplicate problems

AHIMA points out that hospitals face an average duplicate record rate between 5% and 10%. However, this figure likely underestimates the true scope of the problem, given one recent study that put the duplicate rate at 18%. Coupled with duplicate rates that suggest as many as 20% of all records are incomplete (up to 40% of demographic data was missing from commercial laboratory test feeds for COVID-19), the problem balloons from what on the surface appears to be relatively innocuous into something much more severe.

In its white paper “A Realistic Approach to Achieving a 1% Duplicate Record Error Rate,” AHIMA notes that duplicate patient records lead to misidentification errors and administrative inefficiencies. In addition, missing data within the record can reduce contact tracing, vaccination, and public health reporting.

The financial toll is equally severe; misidentification costs the average healthcare facility $17.4 million per year in denied claims and lost revenue. Further, while progress is being made on both fronts, the lack of patient identification standards and a unique patient identifier exacerbates the overall problem.

Cybersecurity risks

Along with increased opportunities for duplicate and overlaid records, healthcare organizations face growing cybersecurity threats from all sides. The FBI’s 2021 Internet Crime Report revealed that the healthcare sector dealt with the most ransomware attacks in 2021 of any critical infrastructure sector, with the Internet Crime Complaint Center (IC3) receiving 148 complaints of healthcare ransomware attacks.

HIMSS, in its 2021 Healthcare Cybersecurity Survey, found that phishing (45%) and ransomware (17%) are the most significant security threats and financial information is the primary target. Among survey respondents, 67% indicated that their healthcare organizations experienced significant security incidents in the past 12 months, with 32% stating the security level was high and 12% considering it critical.

The threat is severe enough to have prompted the introduction in the Senate of the bipartisan Healthcare Cybersecurity Act, which would establish a partnership between HHS and the Cybersecurity and Infrastructure Security Agency (CISA) with the goal of improving cybersecurity in the healthcare and public health sector. The Act mandates a study by CISA on the risk facing the healthcare industry that also explores strategies for securing medical devices and EHRs, and how data breaches impact patient care. It also calls for the agency to work with information-sharing organizations and analysis centers to create healthcare-specific resources and promote threat-sharing information and educate healthcare asset owners and operators on managing cybersecurity risks.

End-to-end protection

The first step of every patient encounter is choosing the right patient record. While that’s obvious, it doesn’t always happen in the given moment. However, getting it right at the outset is a critical moment for eliminating medical errors, unnecessary costs, and safety issues associated with an MPI tainted by duplicate records.

Clean patient records at registration prevent downstream contamination into other departments – from clinical to imaging to billing, and enhance revenue cycle efficiencies to reduce AR and decrease denials. Positive patient identification also enables digital transformation across the healthcare system, leading to improved interoperability, patient engagement and even improved patient access.

Because of these drivers, health systems are increasingly aware of and using technology to address patient data integrity issues where they can control them. For example, according to Johns Hopkins Hospital, more than 90% of patient record errors begin at registration. These errors lead to duplicate record creation. In addition, health systems protect against front-end contamination of the MPI/EMPI.

In an end-to-end protection model, mismatched records are prevented and mismatches are caught upfront. However, most EHR patient lookup requires specific processes and data to be entered the field by field, in just the right way. If even one detail is off, a search will yield invalid results and can lead to the creation of a new, duplicate patient record. Current dynamic patient lookup solutions return instant patient results as they are typed into the system search bar, just like a web browser. Everyone involved in the patient matching process can narrow and refine results as they type to achieve positive patient identification.

Such a solution is critical when uncontrolled factors, like a health system merger, AHIMA notes. In these instances, duplicate rates can rise to 20% or more. Conducting data and record clean-ups before merging records or health systems can eliminate patient misidentification. Patient lookup technology can help rectify duplicates, getting about the effort of patient engagement much more quickly.

AHIMA notes that technology that conducts ongoing monitoring can identify and eliminate duplicate records and ensure errant records are eradicated before they can contaminate downstream systems, particularly important during mergers, especially if patient registration and identification issues are addressed early on or from the onset.

Combined management and clean-up ensure accurate patient identification anywhere along the patient journey and at any point in the care continuum. These dual approaches also can protect patient medical records from unauthorized user access, breach, or attack, thus securing all patient information and minimizing the ongoing costs of maintaining quality patient data.

How It Works

Resolve patient misidentification issues by leveraging biometrics to collect images and patient information, creating the patient record within the MPI. Then, that data can be analyzed, cleaned, and returned with a copy of the patients’ photos and corresponding medical record numbers.

Such an approach to MPI/EMPI protection operates in multiple environments. For example, the patient’s photo is taken and attached to their unique medical record during on-site registration. During remote registrations or remote visits, the patient is sent a text message with links to take and submit a selfie-and photo of their driver’s license. The system uses this information to search for any record matches before assigning biometric credentials to new patients.

When integrated into the EHR, healthcare organizations can prevent duplicate record creation during patient registration, ensure remote patient data capture and authentication, and clean patient data across the care continuum. The result is improved patient safety, reduced misidentification-related medical errors, fewer write-offs and denied claims, and reduced cybersecurity threat risks.

In the end, end-to-end EMPI/MPI management and patient identification require a multifaceted approach to tackle one of healthcare’s most prevailing problems and reduce the volume of duplicate medical records while securing patient information and minimizing the efforts required to maintain quality patient data.

About Lora Hefton

As Executive Vice President, Lora oversees all aspects of Harris Data Integrity Solutions, including its vision, strategy, controls, procedures, development, distribution, support, as well as ensuring it has the people to deliver quality services and solutions to healthcare entities while maintaining growth. She joined Just Associates in 2010 and, prior to its acquisition by Harris Computer, served as Chief Operating Officer working closely with its founders to expand the solutions and services offered by the business.