Emerging Technologies in Healthcare - IT Today · 2018. 3. 13. · Emerging Technologies in...

EmergingTechnologiesin Healthcare

Suzanne Moss Richins

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v

Contents

Preface........................................................................... ix

About.the.Author........................................................... xi

1 Telehealth,.Telemedicine,.and.eHealth.....................1Telehealth............................................................................. 2Telemedicine........................................................................ 8eHealth................................................................................19Conclusion...........................................................................20

2 The.Role.of.mHealth.for.Self-Care.and Remote Care.....................................................21Elder.Care............................................................................24Self-Monitoring................................................................... 28Wearable.Devices................................................................35Patient.Engagement.............................................................40Gamification....................................................................... 46New.Accountability.............................................................47Training.............................................................................. 48Robotics...............................................................................49Changing.Payor.Practices....................................................50Conclusion...........................................................................51

3 Legislation.and.Trends.in Emerging.Technologies.... 53Clinical.Trials.......................................................................55Mobile.Medical.Applications..............................................55Unique.Device.Identification.System.................................57FDA.Rules.for.Drug.and.Device.Advertising.....................58



vi ◾ Contents

Regulating.Fitness.Apps......................................................59Too.Much.Reliance.on.Technology....................................59Ensuring.the.Safety.of.Data................................................59Privacy.and.Surveillance.....................................................60Licensure.............................................................................62Conclusion...........................................................................62

4 Intervention.and.Diagnostic.Technology................65Wearables............................................................................663D.and.4D.Printing.............................................................67Prosthetics...........................................................................72Big.Company.Interest.........................................................73Decision.Support.................................................................78Conclusion...........................................................................78

5 Social.Media.Use.in.Health.....................................81Invasion.of.Privacy..............................................................85

6 Healthcare.Reform.and.Risk.Management.in Technology.........................................................87Chief.Information.Security.Officer.................................... 88Medical.Identity.Fraud........................................................89Reimbursement.Fraud.........................................................91Do.No.Harm.......................................................................92Telemedicine.Regulation.and.Usage..................................92

7 Healthcare.Analytics.Use.in.Population.Health.....95Revenue.Cycle.Management...............................................97Data.for.Improvement........................................................ 98Population.Health.............................................................. 99Dictation.Translated.to.Text.and.Coding.........................101Research............................................................................101

8 The.Future............................................................103Using.the.Body.to.Cure.Itself.and Realigning.the Body.for.Health..........................................................103Natural.Healing.................................................................106Google.Glass.....................................................................107Video.Glasses....................................................................109



Contents ◾ vii

Concierge.Care..................................................................109Genomics.......................................................................... 110Immunotherapies.............................................................. 115Stem.Cells.......................................................................... 115Minimally.Invasive.Procedures......................................... 116Employee.Safety................................................................ 116Technology.Adoption........................................................ 117Microclinics....................................................................... 117Radio.Frequency.Identification......................................... 117Conclusion......................................................................... 118

References...................................................................121

Index........................................................................... 153



ix

Preface

Most.people.associate.innovation.with.healthcare..During.the.last.century,.scientists.discovered.miracle.drugs,.genome.sequencing,.minimally.invasive.surgery,.transplants,.stem.cells,.the.ability.to.grow.new.tissue.and.organs,.and.more.recently,.both.3D.and.4D.printing.of.tissue.and.organs..The.enactment.of.the.Patient.Protection.and.Affordable.Care.Act.(Obamacare).has.triggered.the.need.for.more.innovation.due.to.the.focus.on.the.health.of.the.population.with.global.payments.to.accountable.care.organizations.

Urgent.care.clinics.and.retail.clinics.have.moved.patient.care.away.from.the.emergency.room.to.less.costly.and.more.convenient.delivery.of.care..Telemedicine.makes.it.even.more.convenient.since.the.patient.can.access.care.anytime,.from.anywhere,.24.hours.a.day..It.also.creates.more.access.to..limited.specialists.without.the.need.for.travel.

The.implementation.of.electronic.medical.records.(EMRs).provides.two.advantages..First,.the.EMR.ensures.that.the.patient’s.history.is.readily.available.to.each.and.every.care..provider,.which.creates.a.more.coordinated.effort.in.patient.care.and.decreases.the.possibility.of.competing.therapies.and.drug–drug.interactions,.along.with.avoiding.the.duplica-tion.of.tests..Second,.the.collection.of.patient.data.through.the.EMR.also.provides.a.rich.database.for.studying.disease.and therapeutics.

The.wars.in.Afghanistan.and.Iraq.focused.attention.on.the.need.for.better.prosthetics.and.the.use.of.robotics.to.restore.



x ◾ Preface

function.to.these.injured.veterans..These.innovations,.focused.on.the.veterans,.also.help.trauma.victims.and.those.born.with.congenital.anomalies.since.the.intent.is.to.create.optimal.function..and.independence.for.the.patient.

Advancement.in.healthcare.delivery.systems.creates.an.ecosystem.beginning.with.diagnosis,.treatment,.and.ensuring.optimal.health.status..New.discoveries.include.prescription.drug.classification.in.new.categories.such.as.kinase.drugs.that.inhibit.the.growth.of.enzymes.in.cancer..Personalized.medicine.utilizes.designer.drugs.specific.to.the.DNA.of.the.patient.and.the.disease..Designer.drugs.use.the.DNA.of.the.disease.(like.cancer).or.the.DNA.of.an.infection.and.match.it.with.the.DNA.of.the.patient.to.target.the.specific.cells.in.need.of.treatment..intervention.

Scientists.have.discovered.new.ways.to.activate.the.patient’s.natural.defense.and.immunity.system.by.stimulating.the.thymus..gland..With.the.advent.of.Obamacare’s.focus.on.popula-tion.health,.individuals.need.to.take.charge.of.their.own.health..New.apps.for.smartphones,.such.as.the.iPhone.HealthKit.allow.individuals.to.monitor.their.own.vital.signs,.progress,.and.goal.tracking..A.way.to.foster.the.natural.alignment.of.the.body.through.exercise.can.eliminate.stress.on.joints.that.creates osteoarthritis.

New.apps.and.sensors.that.transmit.data.allow.seniors.to.age.in.place.and.remain.independent,.creating.a..better.quality..of.life,.which.is.less.of.an.expense.than.institutionalizing.the.elderly..Technological.advancements.can.also.remind.seniors.to.take.their.medication.and.stimulate.activity.



xi

AbouttheAuthor

Suzanne.Moss.Richins,.DHA,.is known.as.an.early.adopter.of technology.and.innovation..As a senior.leader.in.healthcare,.she was.one.of.the.first.to.look.at.using.analytics.to.structure.staffing.schedules—based.on.patient.arrival.acuity.to.the.emergency.department.for.her.master’s.thesis..The.methodology.was.adopted.throughout.Intermountain.Healthcare.(Salt.

Lake.City,.Utah).and.various.other.well-known.healthcare.systems..While.serving.on.the.American.Hospital.Association.board.and.the.Joint.Commission.Advisory.Committee,.Dr..Richins.conducted.her.dissertation.on.patient.satisfaction.prior.to.the.adoption.of.these.standards.by.both.of.these.respected.organizations..Her latest.work.is.in.using.analytics.to.predict.patient..outcomes.and.improve.quality..She.also.teaches.DBA,.DHA,.and.DNP.students.for.various.universities.

Dr..Richins.earned.her.nursing.degree.from.Weber.State.University.(Ogden,.Utah),.her.professional.arts.degree.from.St..Joseph’s.College.(North.Wyndam,.Maine),.her.MBA.from.Utah.State.University.(Logan),.and.her.doctorate.in.healthcare.administration.at.the.Medical.University.of.South.Carolina.(Charleston)..She.earned.her.degrees.while.advancing.from.



xii ◾ About the Author

staff.nurse.to.manager.of.the.operating.rooms,.director.of.emergency.and.urgent.care.clinics,.director.of.medical/surgical.services,.administrator.of.freestanding.surgical.centers,.and.chief.operating.officer.

Due.to.her.varied.education.and.experience,.Dr..Richins.currently.provides.consultation.and.advice.to.clients.about.software.for.electronic.medical.records,.revenue.cycle.man-agement,.and.predictive.and.retrospective.analytics..She.is.the.senior.vice.president.for.healthcare.at.Global.Targeting,.Inc.



95

Chapter 7

HealthcareAnalyticsUseinPopulationHealth

In.the.business.world,.leaders.use.the.terms.big data.and.business intelligence..Healthcare.analytics.or.healthcare.infor-matics.are.actually.terms.for.the.same.thing..Data.collection.and.aggregation.provide.an.opportunity.to.look.for.patterns.and.based.on.these.patterns.to.make.decisions.to.improve.quality.and.decrease.costs..The.driver.of.this.change.comes.from.the.payment.shift.from.volume.to.value.inherent.in.the.Patient.Protection.and.Affordable.Care.Act.(PPACA)..It.aug-ments.the.Health.Information.Technology.for.Economic.and.Clinical.Health.(HITECH).Act,.which.requires.the.implementa-tion.of.electronic.medical.records.(EMRs).

A.2014.survey.of.the.most.wired.health.systems.shows.that.data.in.isolation.means.nothing..In.fact,.36%.of.hospitals.share.their.information.with.community.health.record.exchanges.ensuring.a.more.complete.picture.of.a.patient’s.medical.history...Another.71%.of.the.most.wired.providers.actively.managed.care.transitions.from.acute.to.long-term.care.or.home.care.compared.to.57%.of.the.total.respondents..Health.systems.(43%).also.find.that.clinical.and.claims.data.together.create.a.way.to.stratify.the.population.and.prioritize.needs.in.



96 ◾ Emerging Technologies in Healthcare

order.to.create.a.more.healthy.population..In.addition,.69%.retrospectively.analyze.the.data.for.quality.improvement.and.cost.reduction.(Millard.and.McCann.2014).

As.technology.continues.to.improve.and.all.types.of.care.include.computer.documentation.that.interface.through.mobile.medical.applications,.patients.can.review,.revise,.and.provide.input.into.their.electronic.record.for.both.indi-vidual.use.and.for.improving.the.health.of.the.population..The.improved,.real-time.communication.through.the.use.of.patient.portals.and.real-time.documentation.from..medical.sensors.allows.for.improved.research.results.increasing.the.accuracy.of.focused.data.capture..Real-world.evidence.creates.new.opportunities.for.evidence-based.treatment.regimens..Increased.data.sharing.also.provides.a.database.for.retro-spective.and.predictive.analytics.

A.good.example.of.using.these.tools.in.clinical.trial.research.involves.the.use.of.a.calculator.to.determine.cardiac.risk.in.patients.with.rheumatoid.arthritis..Thirteen.centers.in.10.nations.use.this.tool.to.predict.the.development.of.cardiac.problems.over.a.10-year.period..No.single.center.had.enough.data.to.create.a.meaningful.database.for.the.study..The.ability.to.aggregate.the.data.from.all.13.centers.created.the.opportu-nity.for.a.credible.and.significant.study.(Goth.2014c).

Drug.manufacturers.create.narrow.studies.to.determine.the.efficacy.of.their.drugs.during.the.premarket.phase..In.the..postmarket.phase,.they.want.to.look.at.other.factors.that.might.be.changed.when.using.the.drug..For.this.reason,.Merck.has.initiated.a.trial.using.20,000.patient.sites.in.several.countries.to.test.the.impact.of.a.diabetes.drug..Merck.wants.to.study.what.happens.in.the.everyday.life.of.a.patient.taking.its.drug,.Januvia..This.study.will.include.multifaced.data.contained.in.electronic.medical.records,.combined.with.patient.generated.questionnaires..The.study.will.evaluate.incidents.of.hypo-glycemia,.blood.sugar.control,.and.quality.of.life.to.obtain.a.more.complete.picture.of.use.and.reactions.to.the.medication.(Meek 2014).



Healthcare Analytics Use in Population Health ◾ 97

RevenueCycleManagement

The.confluence.of.regulation.for.EMRs.and.payment.reform.creates..the.need.for.good.data.to.be.used.for.both.clinical.applications.and.for.improving.the.business.of.healthcare..Revenue.cycle.management.is.one.area.for.improvement,.which..means.automating.coding.and.billing,.and.avoiding.claims.rejections..This.means.starting.the.cycle.when.patient.schedul-ing.occurs..At.every.step.of.the.patient.encounter,.employees.need.to.check.and.double.check.the.accuracy.of.the.data.input..Automation.of.claims.ensures.quicker.payments,.but.only.if.the.claims.are.clean,.accurate,.and.free.from.other.errors..According.to.The.Electronic.Payments.Association.(NACHA.2014),.more.than.8.million.healthcare.claims.were.automated.using.the.national.clearinghouse.in.January.2014,.which.was.the.first.month.that.required.health.plan.compliance.with.the.newly.adopted.healthcare.electronic.fund.transfer.standard.transaction..The.sum.of.these.transactions.was.approximately.$45.billion.in.payments.from.health.plans.to providers.

In.addition,.good.data.provides.information.about.what.the.patient.owes.upfront..This.knowledge.means.that.collect-ing.the.patient’s.portion.of.the.bill.can.begin.more.quickly..Historically,.providers.waited.until.after.the.insurer.paid.their.portion.of.the.claim..The.contract.information.that.includes.the.patient’s.portion.of.the.bill.is.readily.available.upon.admission..At.that.time,.patients.can.provide.a.check.or.charge.card..The.payment.of.the.patient’s.portion.of.the.bill.upfront.reduced.accounts.receivable.days.and.the.potential.for.bad.debt..If.the.patient.cannot.meet.the.obligation,.a.payment.plan.or.charity.option.can.also.begin.at.that.time,.which.reduces.stress.on.the.patient.and.family.and.improves.the.revenue.cycle.

Many.payors.also.include.patient.satisfaction.as.part.of.the.contract..The.creation.of.a.stress-free.and.seamless.experi-ence.for.patients.increases.satisfaction..Most.patients.want.to.know.upfront.what.they.will.owe..A.patient-friendly.pro-cess.can.begin.during.scheduling.and.registration.and.can.




prevent.surprises.and.a.negative.experience.later..Typically,.the..revenue.cycle.steps.begin.with.the.first.patient.encounter.and.may.also.be.the.last.interaction..Therefore,.a.good.process.free.from.surprises.results.in.a.positive.experience..Good.data.shared.between.physician.offices.and.hospital.departments.creates.a.collaborative.partnership.that.reduces.denials.and.increases.reimbursement.

DataforImprovement

Data.comes.from.charting.patient.complaints,.diagnoses,.test.results,.and.treatment.plans..From.this.information,.acuity.and.outcome.assessment.identifies.criteria.for.change..One.focus.of.improvement.revolves.around.the.need.to.streamline.work.processes..Nurses.at.Florida.Hospital.Celebration.Health.agreed.to.wear.a.GPS-like.device.that.tracks.their.movements..The.nurses.were.promised.that.the.tracking.would.only.be.used.for.improvement.purposes..For.3.years,.the.data.was.used.to.create.efficient.changes.in.care.that.satisfied.both.the.nurses.and.their.patients..One.analysis.showed.that.just.as.many.nurses.were.needed.for.the.patients.at.night.as.are.needed.during.the.day.(Pecci.2014a).

The.best.decisions.based.on.data.require.a.full.set.of.data.from.the.disparate.information.systems.used.in.the.organiza-tions..Disparate.data.requires.normalization,.standardization,.and.for.unstructured.data,.it.requires.structuring..Only.about.20%.of.the.data.in.the.EMR.is.structured.

The.data.stored.in.the.EMR.can.be.used.to.predict.events.and.outcomes..After.analyzing.patterns,.valid.predictions.about.when.a.patient.needs.intervention.can.result..These.predictions.offer.the.opportunity.to.prevent.an.untoward.event..Prevention.saves.money..For.instance,.the.United.States.spends $55.million.annually.on.missed.predictions;.spends.$210.billion.on.unnecessary.care;.and.spends.$130 million.on.inefficient.care.(Optum.2014)..Analytics.identifies.who.




receives.the.most.care.from.organizations.and.what.care.is.the.most.costly..This.identification.makes.it.possible.to.use.predictive.analytics.on.these.areas.to.both.improve.the.quality..and.reduce.the.cost.of.the.care..Nationally,.the.three.most.costly.care.conditions.include.diabetes,.chronic.obstruc-tive.pulmonary.disease.(COPD),.and.congestive.heart.failure.(CHF)..Identification.of.these.three.populations.and.the.use.of.evidence-based.medicine.can.ensure.the.financial.viability.of.the.organization,.especially.with.the.new.focus.on.paying.for.population.health.instead.of.treatments.

In.many.cases,.analysis.of.test.results.occurs.through.com-puter.algorithms.before.they.are.even.sent.to.the.physicians..Groups.of.lab.values.are.analyzed.together.along.with.imaging.results,.which.create.more.accurate.diagnoses..These.algo-rithms.successfully.interpret.electrocardiograms.and.are.often.as.accurate.as.human.experts;.yet,.the.combination.of.artificial.intelligence.and.human.validation.creates.even.more.accuracy.and.decreases.errors.of.omission..Imaging.software.can.direct.attention.to.suspicious.areas..In.addition,.the.results.from.the.tests.can.create.alerts.for.intervention.before.the.patient.seeks.emergency.care.(Topol.2014a).

Another.use.for.data.comes.from.a.cooperative.agree-ment.between.Washington.state.emergency.physicians,.the.Washington.State.Hospital.Association,.and.payors.who.created.a.statewide.database,.which.captures.the.name,.data,.and.reason.for.a.patient’s.visit.to.an.emergency.room.(ER)..This.way,.physi-cians.know.the.recent.history.of.any.patient.who.has.visited.an.ER..It.decreases.costs.to.the.state.Medicaid.budget.and.increases.the.quality.of.the.care.that.the.patient.receives.by.identifying.abuse.or.a.need.for.more.intensive.treatment.(Weise.2014).

PopulationHealth

A.good.starting.point.in.understanding.patient.population.involves.the.aggregation.and.analysis.of.data.that.identifies.the.




economics.and.demographics.of.the.population.served,.along.with.their.preference.for.the.sites.they.use.to.obtain.care,.and.finally.the.types.of.care.they.seek..Next,.the.most.costly.and.most.common.care.is.analyzed.in.order.to.initiate.treatment.and.prevention.plans..Analysis.of.these.treatment.and.preven-tion.plans.must.occur.continuously.in.order.to.understand.what.works.and.what.does.not.work.

Wearable.and.implantable.devices.ensure.that.the.at-risk.segments.of.the.population.with.expensive.chronic.con-ditions.are.monitored.and.that.early.intervention.occurs,.which.maintains.these.patients’.optimal.level.of.health..status..An.example.of.an.implantable.device.is.the.conges-tive.heart.failure.device,.which.monitors.pulmonary.artery.pressure.and.heart.rate..Patients.with.class.III.heart.failure.often.experience.multiple.hospital.admissions.in.a.year..The.monitor.alerts.providers.of.the.need.to.adjust.therapy,.improve.function,.and.reduce.the.need.for.hospitalization.(Slabodkin.2014a).

The.more.information.a.provider.possesses.about.the.patients.they.serve,.the.more.they.can.make.a.difference.in.the.health.of.the.population..As.the.paradigm.shifts.from.episodic.care.to.coordinated.longitudinal.care.(population.health),.systems.need.to.be.developed.that.ensures..providers.receive.test.results.and.act.upon.the.data..When.a.patient.is.hospitalized,.they.routinely.receive.care.from.a.hospi-talist.who.orders.tests..These.patients.may.be.discharged.before.all.of.the.results.are.received..Historically,.the.primary.care.physician.had.no.knowledge.about.these.pending.test.results..Brigham.and.Women’s.Hospital.in.conjunction.with.Partners.in.Health.designed.an.automated.system.that.sends.these.pending.test.results.to.the.primary.care.physician..The.outcome.of.their.research.was.a.76%.increase.in.response.to.the.results.versus.a.38%.response.in.a.control.group.(Dalal.et.al..2014).




DictationTranslatedtoTextandCoding

One.of.the.requirements.for.population.health.involves.main-taining.accurate.records..Legislation.has.required.the.adop-tion.of.Electronic.Health.Records.(EHRs).and.standardized.coding.for.billing.using.ICD-10.codes..At.the.same.time.that.reimbursement.continues.to.decline,.clinicians.are.turning.to.technology.to.increase.their.productivity..One.new.develop-ment.involves.the.use.of.computerized.medical.dictionaries.that.translate.words.or.phrases.into.the.required.computer.language.known.as.SNOMED CT..The.guidelines.for.certify-ing.EHR.products.now.requires.the.use.of.SNOMED.codes.(Conn 2014a).

Research

Registry.trials.allow.for.large-scale.research.that.saves.money.and.creates.an.opportunity.to.easily.enroll.patients.and.to.collect.data.in.a.low-cost.way..These.clinical.registries.provide.a.standardized.methodology.for.collecting.demographic.and.quality.data..Registry.trials.can.aggregate.the.results.of.trials.more.quickly.than.the.traditional.randomized.trials.that.were.so.costly..The.retrospective.outcome.of.data.currently.requires.an.extra.step.in.data.entry..The.next.phase.will.include.exporting.data.automatically.from.the.EMR.

Discussion.Questions

. 1..Describe.the.use.of.big.data.to.improve.processes,.decrease.costs,.and.increase.the.quality.of.care.

. 2..The.focus.on.revenue.cycle.management.has.developed.due.to.the.changes.in.payment.contained.in.the.Patient.Protection.and.Affordable.Care.Act..Describe.how.organi-zation.leaders.are.addressing.revenue.cycle.management.




Assignment

Describe.the.use.of.big.data.by.providers,.payors,.and.the.government..Describe.how.their.usage.differs..Identify.areas.where.they.can.collaborate.and.areas.where.they.should.remain.separate..Analyze.whether.or.not.the.use.of.big.data.has.improved.the.health.of.the.population.




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