Here's What It Takes to Build the Nation's Most Trusted & Capable Health Information Network: Best Practices

Through a single connection to the Surescripts network, participants in the Surescripts Network Alliance are able to exchange actionable patient intelligence far more extensively, efficiently and effectively than they could if they had to rely on individual connections to all other organizations. Meanwhile, all Surescripts solutions—and all those who use them—benefit from the industry-leading reliability, security and scalability of the Surescripts network.

Best Practices

• The Trust Fabric - Essential to any two-sided network, the trust fabric creates confidence in participants, the integrity of the system, and how shared data can and cannot be used.
• The Transport Layer​ - The transport layer makes it technologically possible to exchange electronic health information across multiple domains.
• The Usability Layer - The usability layer enables delivery of actionable patient intelligence to the point of care within existing  clinical workflows.
• The Optimization Layer - Touching every transaction Surescripts handles, the optimization layer helps continuously improve network performance in order to deliver actionable patient intelligence as quickly and accurately as possible.

The full Surescripts article can be viewed at this link.  

eHealth Initiative’s (eHI) Guiding Principles for Ethical Use of Social Determinants of Health Data offers guidance on the evolving matter of Social Determinants of Health (SDOH) and its related data use for healthcare purposes. Using SDOH is unchartered territory in both policy and practice. eHI puts forth an ethical framework for SDOH data, specifically five guiding principles in the areas of:

• Care Coordination
• Recognizing Risk Through SDOH Analytics
• Mapping Community Resources and Identifying Gaps
• Service and Impact Assessment
• Customizing Health Services and Interventions

The Guiding Principles for Ethical Use of Social Determinants of Health Data were developed as part of a SDOH collaborative. eHI is an independent, non-profit organization that convenes executives from various healthcare stakeholder groups to discuss, identify, and share best practices, which transform the delivery of healthcare. The work of the SDOH collaborative focused on educating and guiding industry stakeholders and policy makers on the value of leveraging SDOH data for maximum good in healthcare, while addressing SDOH privacy and security concerns.

Organizations and researchers have recognized the impact of Social Determinants of Health (SDOH). Research and programs that evaluate and address the social, economic, and environmental factors that influence health are increasingly important and their relevance is demonstrable.

Examples of Payers Leveraging SDOH

• Gateway Health reported an average reduction of $2443 in second year medical expenditures for individuals who received coordinated referral services to address social needs. https://www.healthleadersmedia.com/finance/health-plan-addresses-social-issues-data
   
• Vermont Blueprint for Health demonstrated 21% reduction of inpatient use of services year over year, resulting in a 22% reduction in PMPM cost. ED use declined by 31%, reducing costs by 36%. Overall costs dropped by 11.6%.
   
• United Healthcare is investing $400mm in affordable housing. one state saw emergency room admissions drop 60 percent. Total cost of care was also 50 percent lower for individuals enrolled in a housing program. https://www.unitedhealthgroup.com/newsroom/2019/2019-03-26-uhc-affordable-housing-path-metro-villas.html
   
• Molina Healthcare opened a homeless members’ resource center to avoid emergency department use for nonmedical needs and launched a clinical setting — WellRx pilot in New Mexico — to screen patients for nonmedical social needs. https://www.healthedge.com/blog-social-determinants-health-what-are-payers-doing

Examples of Providers Leveraging SDOH

• Intermountain is investing $12 million to address issues like housing instability, utility needs and food insecurity
   
• Senior Care Options (Massachusetts) coordinates direct delivery of social support services for patients with chronic conditions and adults with disabilities reported hospital days per thousand were 45% less. 30% reduction in nursing home placements for eligible Medicaid beneficiaries.  https://www.healthaffairs.org/doi/10.1377/hlthaff.2011.0113
   
• The Comprehensive Care Program high risk patient’s hospital use declined by 20% in 2 years. $2mm in cost savings for every 1000 members. https://www.healthaffairs.org/doi/10.1377/hlthaff.2011.0080
   
• High risk patients receiving care coordination at Mercy experience a 17% reduction in annual hospital readmission rates. Overall cost savings of $37.70 PMPM. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2010.1298
   
• Care Management Plus patients with diabetes saw 21% lower hospitalization from designated intervention and control clinics within Intermountain Health Care system. Use reductions with diabetes patients save $70,000 per clinic
   
• Sharp HealthCare Care Transitions Intervention Program empowers chronically ill adults discharged from the hospital to take an active role in their healthcare, reducing 30 day readmits from 12.6% to 2.3% in one year https://innovation.cms.gov/initiatives/CCTP/Round-4.html
   
• Kaiser Permanente’s “Total Health” framework addresses social determinants in neighborhoods and schools for health-promoting policy, system, and environmental changes. Kaiser Permanente is screening patients for unmet social needs to refer them to relevant resources in their communities. Data shows that 78% of those screened have one or more unmet social needs. https://catalyst.nejm.org/health-care-that-targets-unmet-social-needs/
   
• Montefiore Health System investing in housing, reducing emergency room visits and unnecessary hospitalizations for an annual 300% return on investment. https://www.healthcarefinancenews.com/news/what-montefiores-300-roi-social-determinants-investments-means-future-other-hospitals

General SDOH Resources from the eHealth Resource Center

• Roundtable Presentation: Putting Social Determinants of Health Into Action (AHIP)
   
• Roundtable Presentation: Social Determinants of Health- A Kaiser Permanente Perspective
   
• Presentation: States' Capacity for Using Social Determinants of Health Data for Population Health Management
   
• Toward Addressing Social Determinants of Health: A Health Care System Strategy
   
• Considerations for Success in Addressing Social Determinants of Health at the Individual Level
   
• Adoption and Use of Social-Behavioral Determinants of Health
   
• Creating a Conduit for Better Health: Technology Connects Medical and Social Services
   
• Effects of Social Needs Screening and In-Person Service Navigation on Child Health
   
• Webinar: Social Determinants: Alternative Drivers of Healthcare
   
• The top six myths about Social Determinants of Health
   
• America's Health Rankings: Annual Report 2018

How Startups And Providers Can Drive Transformation In Health Care: Best Practices

All technology improvements are iterative. Even the ones that seem like breakthroughs have taken a long time to come to fruition. For startups and providers that want to capitalize on opportunities in the industry and help to drive it forward, here are three things you must do:

Best Practices

• Understand the landscape - Founders and CTOs should always design their systems in such a way that the data is portable or can be made portable with relative ease. It’s much harder to retrofit tech systems to match new standards than it is to design and build them from scratch in a way that ensures that they’re portable and adaptive to standardization.
• Align with the right partners - Especially given the interoperability issues within the industry, startups will generally be more successful if they align themselves with established players (think Google, GE and IBM Watson Health) to help them navigate a technically and politically divided industry landscape.
• Keep your promises - Health care providers and startups can’t forget their most important asset in pursuit of big data breakthroughs -- the trust of their patients. Moreover, now that the value of patient data has been clearly established, it is a target. No data is ever completely secure, and the more that health care data is aggregated into larger and larger pools, the greater the risk that bad actors will gain access to it, either through hacking or nefarious business practices. As such, providers should anonymize patient data whenever possible, obfuscating all but what is absolutely required to develop requisite insights.

The full Forbes article can be viewed at this link.  

How To Successfully Implement An EHR System: Best Practices

In today’s information age, as our lives are getting increasingly digitized, health data is valuable. Health data is required for maintaining our health records, for helping physicians and health care professionals review patient information and collaborate on providing health care services and for driving health-related decision making, whether for an individual patient or for broader analysis such as determining the efficacy of health procedures or medication or monitoring emergency medical situations.

Hospitals and health care facilities should consider EHR implementation as more of a process engineering project than a technology project — one that adapts their organization and health care staff to modernized health care processes that make use of a technology system. This focus on medical processes allows you to use the EHR system as a tool to make work more efficient, rather than letting the technology dictate the work of your staff. Use the following best practices and tips to make your EHR implementation more successful.

Best Practices

• Assess your needs - Take a process engineering approach and focus on understanding the medical processes at the hospital and how these need to be changed and adapted to use an electronic system. Form a joint team with the EHR system implementation vendor and key hospital staff members and shadow the medical processes at the facility to understand and document them and visualize how they will adapt to the electronic system.
• Choose a flexible platform - The EHR system should provide flexible APIs and bidirectional data integration for supporting interoperability. 
• Check your contract - Your contract should have provisions to give you flexible access to the data along with ownership so you can do reporting and analysis as required and integrate the EHR with other products and devices for future growth and advancement.
• Make sure support is available - Ensure you have enhanced support for the first three to six months of operation. You should expect to find gaps and areas for improvement when you first put the system live. You should have the flexibility to make updates and adjustments accordingly until your system stabilizes for long-term use.

The full Forbes article can be viewed at this link.  

BEST PRACTICES AND GUIDELINES FOR JAIL-BASED MEDICATION-ASSISTED TREATMENT

Medication-assisted treatment (MAT)—utilizing the FDA-approved medications methadone, buprenorphine, or naltrexone—is considered a central component of the contemporary standard of care for the treatment of individuals with opioid use disorders.

Best Practices

• Determine enrollment - Individuals should be clinically assessed for substance abuse disorders and recommended treatments.
• Determine the correct treatment - Shared decision making and regular testing should be used to inform treatment.  
• Consider pregnant women - Pregnant women require specialized treatment.
• Partnerships and support services - Couple MAT with other services and collaborative relationships.
• Have the right program components - Assemble the right team, safeguards, protocols, and structure for success.
• Client screening - Client screening is important for addressing treatment continuation, withdrawal, and relapse.  
• Facilitate health care coverage - Engage Medicaid and postrelease financial assistance.

The full resource can be downloaded below.  

Caring for the mental health of the medical workforce: Best Practices

This report marks the first stage of the project and provides a summary of findings from a large-scale survey of both doctors and medical students. The survey, which was open to BMA members and non-members across the UK from 10 to 31 October 2018, received over 4,300 responses including around 1,400 medical students. The survey provides a quantitative overview of experiences and attitudes to mental health and offers a starting point for the next stage of our project which is a more in-depth qualitative study.

Best Practices

• Building a supportive culture - Valuing the workforce, preventing the cause of ill-health, raising mental health awareness, using innovation, and offering support are all means to improve in this area.
• Enhancing access to support - Improving awareness of services, meeting service user needs, and providing spaces to rest can improve this area.  
• Encouraging self-care and peer support - Valuing and maintaining one's mental health, and offering support to colleagues can improve this area.  

The full article can be downloaded below.  

How to fight an outrageous medical bill, best practices explained

I’ve come across some astounding charges investigating how emergency rooms bill patients. A woman in California fell off her bike and now faces a $20,243 bill. A patient in New Jersey never got past the ER waiting room and ended up with a $5,751 bill. A dad in Connecticut got a bill for $629 for the Band-Aid put on his 1-year-old daughter’s finger.

Most patients can’t afford these kinds of bills. But they often don’t know that it’s possible to negotiate them down.

I recently interviewed a dozen patients who successfully got their bills reduced, some who were unsuccessful, and even one whose bill went up after he attempted to get it lowered (more on that later).

I learned that people can indeed shrink their bills, but only if they’re willing to put in significant time and, in some cases, money. Here’s what patients say worked — and didn’t.

Best Practices

• Challenge what’s in your bill and how it was coded​ - Find any documentation about how your medical visit was coded and what services were provided. Once you get an itemized bill, you can analyze it for mistakes. You might see a charge for something that never happened, duplicate fees, or things being billed at exceptionally high prices. In the emergency bills I’ve read, I’ve seen a decent number of success stories from patients who challenge the coding of their facility fee — the charge for walking into an emergency room and seeking care. Emergency rooms typically charge higher facility fees to cases they deem especially complex, using a 1 to 5 scale.
• Ask for a prompt-pay discount​ - Patients I’ve spoken with said they often found hospitals pretty willing to offer a discount to those who are ready to pay their bill right then and there.  From the hospital’s vantage point, this often makes sense: It can be easier to take a smaller payment rather than chasing down a bill you might never pay.
•  Call. Then call again. And again. And again.​ - This is something I heard from nearly every patient I interviewed: Negotiating a medical bill almost always involves time on the phone. This is all about getting to the person who has the power to change your bill.
• Consider hiring a professional​ - If you're a patient facing especially big bills, consider working with a professional patient advocate who knows the ins and outs of medical coding.
• Go public​ - When all else fails, shining a spotlight on your bill can often do wonders. Find out who covers the health care industry for your local paper and send an email. It’s important that you have your billing documents and are willing to share those with the reporter. If you’re not having luck with a reporter, social media can be helpful. Tweeting or posting on Facebook (and tagging the involved parties) is a pretty low-effort way to get some attention to your case.
• Be aware that sometimes negotiating won’t work — and can even backfire​ - At the end of the day, it’s really up to the hospital whether to say yes or no. And in some cases, attempts to lower a medical bill can backfire.

The full Vox article can be viewed at this link.  

Implementation best practices: Clinical communication in the spotlight

Communication between caregivers and others throughout a healthcare organization, be it a health system or hospital or group practice, is critical. Any hiccups in communications can directly impact patient care or even cause medical errors.

Healthcare communications technology has come a long way since the days of pagers and landline telephones. Today smartphones are everywhere, mobile apps and portals are connecting caregivers and caregivers not to mention caregivers and patients, and doctors and nurses are communicating via other healthcare information systems.

Here, three experts in healthcare communications technology offer comprehensive best practice advice and knowledgeable tips for healthcare CIOs implementing communications technology, which is also useful for those organizations with communications technology already up and running.

Best Practices

• Assess mobile maturity - Successful implementation of a healthcare communications technology starts with assessing the organization's mobile maturity status before making a clinical communications investment.
• Have a current assessment - A good place to start is by assessing the current state of communication technology throughout a facility; this could be imperative to discover what needs must be addressed.
• Establish ROI goals - Establish ROI goals prior to implementation.  Engaging patients and attracting healthcare consumers depends on the CIO developing meaningful metrics that are organizational mission-specific and are key for all health system executives to show evidence that the secure communication platform they employ is effectively encouraging healthcare delivery improvements and cost savings.
• Evaluating the product - The combination of a comprehensive needs-assessment, inclusion of the relevant clinical leadership and end users, and a thorough evaluation of the solutions will help ensure that the implementation you choose will be successful and well-received by clinical users.

The full Healthcare IT News article can be viewed at this link.  

Implementation best practices: Getting healthcare analytics right

Data and analytics have become increasingly critical to the operation of any successful healthcare organization. And with the advent of healthcare imperatives such as value-based care and population health management, analytics technology has become more important than ever.

Here, four experts in healthcare analytics technology offer their advice and suggestions for healthcare CIOs implementing analytics in their provider organization. These are a variety of best practices for analytics implementation in healthcare.

Best Practices

• Look to stakeholders and required data - Implementing an analytics system first requires outcomes defined by multiple stakeholders that second drives alignment on what data elements are required, said Bradley Hunter, a research director at KLAS Research.
• A shared vision, and AI - In the past decade, new incentives and value-based programs that reward payers and providers for proactively managing the health of members have increased their collaboration and created an even greater need for data and analytics to get the right care to the right patient at the right time.  Start with applications of data and analytics that can show an immediate impact by freeing up time and cost.
• Analysis and collaboration - Conduct a stakeholder analysis of existing conditions so one can best understand how the change management will affect each of the stakeholders.  Furthermore, technology vendors and CIOs should work hand in glove with a clinical sponsor for all new initiatives.

The full Healthcare IT News article can be viewed at this link.