AUC and the CVIS 

Leveraging Appropriate Use Criteria for Better Outcomes—and Collateral Benefits

Appropriate Use Criteria (AUC) is intended to help physicians achieve the best outcomes using the most appropriate treatment plan for any situation. Ensuring that physicians comply with established AUC guidelines is crucial to the overall success of a facility. Demonstrated AUC excellence can impact: 

  • Patient outcomes and satisfaction
  • Hospital reputation
  • Reimbursement in the value-based care era

While the goal of all physicians is to provide best-quality, appropriate care for their patients, in the real world this can be challenging to accomplish—and to document—because of the lack of point-of-care access to complete, longitudinal patient information. Providing physicians with access to relevant patient data, and ensuring they have a clear understanding of AUC guidelines, can lead to improved outcomes—and cost savings as well. 


Rachanee Curry, LUMEDX Service Line & Analytics Consultant, explains how LUMEDX solutions help physicians access the patient data they need to comply with Appropriate Use Criteria.

Leveraging Appropriate Use for Cost Savings & More

With the shift to value-based care, service line leaders must seek out every cost-control opportunity. The good news is that there are collateral benefits to AUC compliance: In addition to improved clinical outcomes, collecting and serving up data so physicians can provide appropriate care helps heart and vascular centers improve their financial performance by:

  • Providing the right information, at the right time, to support appropriate clinical decision-making and best-quality care. When you deliver best-quality care, you are avoiding redundant or excessive treatment that can drive up costs; 
  • Delivering clinical workflows wherein quality data can be captured at or as close to the point of care as possible, optimizing efficiency and minimizing redundant manual work. This saves labor costs because clinicians spend more time on direct patient care rather than administrative tasks; 
  • Providing integrated clinical and operational data in near-real time so service line leaders can monitor their programs' performance and take action to improve.

In addition, when you demonstrate that your facility is consistently AUC-compliant, you are better positioned to work with payers on providing best-value care for that patient population. 

LUMEDX HealthView CVIS: Serving Up the Right Data at the Right Time 

HealthView CVIS helps heart hospitals navigate AUC and value-based care standards. The system collects point-of-care data and delivers actionable insights, facilitating better clinical decision-making and helping to improve business operations through increased efficiency and cost savings. 
HealthView CVIS can play a critical role in any hospital's move toward better patient care, greater efficiency, and improved fiscal performance. 


Early Reaction to MACRA Rule Mostly Positive 

Last weekend was a busy one for those trying to parse the new MACRA rule released on Friday. At 2,202 pages, the Medicare Access and CHIP Reauthorization Act rule wasn't exactly beach reading, and it gave the health IT community plenty to talk about on social media and in policy statements.

The dust is still settling, but it appears that early reaction to the rule was mostly positive. Healthcare organizations praised the CMS for being responsive to concerns they had raised during the comment period leading up to the rule's finalization. In fact, about 80 percent of the 2,000+ pages are comments CMS received and its responses.
The American Medical Association was pleased with the permanent elimination of the Sustainable Growth Rate (SGR) formula. "The new law," according to the AMA's press release, "gives many physicians the opportunity to be rewarded for the improvements they make to their practices and for delivering high-quality, high-value care to Medicare patients."
Other features that drew favorable reactions included:

  • The rule's overarching theme that improving the organization and payment models for medical care must stress quality over quantity.
  • Greater reporting flexibility for clinicians, as well as support for innovation in the delivery of care.
  • The formal adoption of a transition year during 2017, which makes major changes to the Quality Payment Program (QPP) reporting requirements, and provides a longer time frame for those transitioning to the QPP.
  • Emphasis on helping clinicians educate themselves about the rule.
  • Easing of the policy defining the Advanced Alternative Payment Model (APM), which will allow additional programs to quality.

But the rule is not without its detractors. "It's disappointing that the flexibility provided for quality reporting in 2017 largely disappears in 2018 and beyond," the Medical Group Management Association said in a policy statement.
Other organizations complained that the nominal risk standard defining the Advanced APM remains too high.

Want to know more? Healthcare Dive has a great breakdown of the rule changes you need to know. And for even more information on the new rule, click here. 
What's your take on the final MACRA rule? Share your thoughts in our comment section below.

Clinician mobile device use increasing as healthcare organizations struggle to protect data 

The number of clinicians who use smartphones and other mobile devices on the job is rising rapidly, and so is the number of facilities that have created mobile device management strategies to cope. "Organizations with a documented mobility strategy have nearly doubled, and in-house use of pagers has increased slightly during the past two years," according to Health Data Management.

Almost 90 percent of physicians surveyed reported using smartphones, while about half of nurses and other staff members use them. In response, more than 60 percent of hospitals surveyed have a documented mobile device strategy. (The survey, by mobile messaging service vendor Spok, included responses from about 550 hospitals.)
The leading mobile devices used in hospitals are:

  • Smartphones (78 percent)
  • In-house pagers (71 percent)
  • Wi-Fi phones (69 percent)
  • Wide-area pagers (57 percent)
  • Tablets (52 percent)

Security and privacy, of course, are huge concerns for those setting mobile device policy, leading some organizations to forbid clinicians to use personal devices for work-related communication. About 80 percent of surveyed hospitals with such policies cited fear of data breaches as the reason behind their rules. 

Click here to download the survey.
What's the mobile device policy at your organization? Share your thoughts with the LUMEDX community by commenting below. 

Healthcare Cybersecurity Failings Draw the Ire of Accountability Office 

GAO Recommends Corrective Action by Department of Health and Human Services

More than 113 million electronic health records were breached in 2015, a year that saw a total of 56 cybersecurity attacks in healthcare alone. That's a 13-fold increase from 2006 to 2015.
The Government Accountability Office isn't going to let those cybersecurity failures go unremarked upon. The GAO last week came down hard on the Department of Health and Human Services, pointing out a number of weaknesses in efforts by HHS to help health plans and other providers protect data.
"HHS has established an oversight program for compliance with privacy and security regulations, but its actions did not always fully verify that the regulations were implemented," wrote the GAO in a report released Sept. 26. The report also called out HHS for giving technical assistance "that was not pertinent to identified problems" in cybersecurity, and for failing to follow up on cases it investigated. 
In short, the GAO found, loss or misuse of health information is not being adequately addressed by HHS. To help healthcare organizations comply with HIPAA and prevent further data breaches, the Office said, HHS should take the following corrective actions:

  • Update its guidance for protecting electronic health information to address key security elements.
  • Improve technical assistance it provides to covered entities.
  • Follow up on corrective actions.
  • Establish metrics for gauging the effectiveness of its audit program. 

HHS generally concurred with the recommendations and stated it would take actions to implement them.

UPDATE: On Oct. 4, HHS announced that it had awarded funding to help protect the health sector against cyber threats. Learn who received the funding, and how it is intended to help healthcare organizations.

Medical Errors Are Made at an Alarming Rate 

How Integrated Systems Can Help 

Medical errors are dangerous, deadly, and all too common. Research published in The Journal of Health Care Finance found that these mistakes cost the United States $19.5 billion in 2008 alone. A 2016 study estimated that medical errors cause 251,000 deaths a year in the U.S., where they are the third-leading cause of death (after heart disease and cancer). 

To Err is Human, the groundbreaking report by the Institute of Medicine, found that nearly half of all deaths attributed to medical errors were preventable. What's even more disturbing is the limited improvement that has occurred since the publication of that 1999 report. "The overall numbers haven't changed, and that's discouraging and alarming," Kenneth Sands of Beth Israel Deaconess Medical Center told the Washington Post.


Mickey Norris, National Vice President of Sales for LUMEDX, discusses how a CVIS can help reduce medical errors.

Medical errors can obviously result from many factors. Some relate to process or people issues, such as the inability to read another physician's handwritten notes, verbal communication breakdowns between medical professionals, or delays in adding notes to a case after treatment occurs.

But many errors stem from the lack of having accurate, up-to-date, or complete information about a patient readily available to clinicians at the point of care. In most cases this is a technology problem, yet technology can also be the solution.

Technology Can Help Reduce Medical Errors

The best technology solutions take an analog process and make it more efficient and accurate through a digital solution. The same is true in healthcare. The effectiveness of patient treatment hinges on getting the right information in front of the right caregivers at the right time. And historically that has been a challenge because the data physicians need is often located in multiple systems. These systems don't always communicate with each other.

For example, a physician may check a pharmacy log to determine which medications have been administered to a patient. But the patient may have been given additional medications in the cath lab, which weren't documented in the same log. This lack of complete information could result in drug interactions or overdoses, or in simply repeating tests. Similarly, the results of tests conducted outside a hospital may not be immediately available to a physician in a hospital. 

Integrating critical patient data from multiple systems automatically, and making it accessible to physicians and clinicians where and when they need it, helps reduce medical errors and improve care overall. Indeed, by minimizing the "number of hands" and number of times information is entered into a system, data quality improves, as there are fewer chances of error. 

Integrating data also reduces costs, because integration minimizes duplicative manual work. Clinicians can spend less time entering redundant data into silo'd systems and more time working with patients. Complete, accessible, high-quality data and improved operational efficiency in CV care are critical to the financial success of a facility.

LUMEDX HealthView CVIS: Increase Efficiencies, Reduce Errors

LUMEDX HealthView CVIS has the ability to interface digitally with almost every point-of-care device in use, and is completely vendor-neutral. Our suite of clinical interfaces allows device and clinical system data-ECG, hemodynamic systems, PACS, cardiac ultrasounds and more-to be captured automatically so that physicians and clinicians always have the most up-to-date information at their fingertips. And our structured reporting applications and registry modules support improved workflow efficiency and clinical quality, while minimizing redundant data entry and the potential for human error. 

HealthView CVIS also complements established workflows. It collects more than 30,000 discrete data points-from point-of-care devices to physician reporting. The robust analysis and reporting engine provides meaningful insights in the areas of treatment options, clinical evaluation and training, and service-line optimization. It's an important addition to any heart hospital's electronic records system, turning it into a robust and dynamic dataset where new information is added in near real-time. Fresh, relevant data that enables better medical care is a critical step in reducing medical errors. 


Heart Attack Patients Get Faster Care When Medical Teams Use Smartphone Social Network System 

18-month study tracked 114 STEMI patients

New research shows that patients in need of a hospital transfer were treated 27 minutes faster when their medical teams used a smartphone app-based social network system (SNS) to set up the transfer, compared to medical teams who didn’t use the smartphone technology.

The research, published in the Journal of the American College of Cardiology, monitored the time that patients with ST-elevated myocardial infarction (STEMI) suffered from ischemia (reduction in blood supply) while they waited to have a procedure opening their blocked arteries. On nights and weekends, the treatment time reduction was even greater than during the regular work week.

One of the study’s senior researchers, Jin Joo Park, M.D., pointed out that there is a higher risk of death for patients who get to a hospital during off hours—a worldwide trend.

“Transferred STEMI patients rarely achieve timely reperfusion due to delays in the transfer process, especially when transferred during off-hours,” Park told Dicardiology.com. “The use of a smartphone SNS (Social Network System) can help to achieve timely reperfusion for transferred STEMI patients with rapid, seamless communication among healthcare providers.”

Over a period of 18 months, the study enrolled 114 STEMI patients who were transferred to Seoul National University Bundang Hospital. The transfers for 50 of the patients were completed using the SNS app, while the remaining patient transfers used a non-smartphone-based STEMI hotline. The transit times for both groups of patients were similar.

Click here to read the research letter.

 

Spotlight on Analytics, Part 6 

Q & A with Gus Gilbertson, LUMEDX Products Manager

 

The Role of Mobile & The Cloud

Q: What is the role of mobile and the cloud in the healthcare analytics industry?

A: Cloud-based technologies hold the promise of delivering better technology solutions at reduced cost. Mobile will increasingly be the platform of choice for quick updates of the most relevant information for a specific situation. Mobile platforms provide an efficient and effective way to consume healthcare analytics.

Q: What challenges and benefits do you predict will arise as mobile and cloud-based access becomes more prevalent?

A: Security protocols will have to meet standards and may limit access to specific patient data. Analytics not at the patient level will become easy to access. Increasingly, caregivers will know how their organizations are doing at meeting care quality goals efficiently. Eventually, patients may get there too.

Q: What use will healthcare organizations have for patient-generated data?

A: Over time, biometric data collection devices will become connected, cheap enough, and prevalent enough that we will all know our health metrics much better than we do today. As standards arise, healthcare organizations will have to engage with patients to better understand what stories biometrics have to tell, and patients will want to share with their providers to gain better insights into their own health. If providers are not able to deliver insights from biometric data, someone else will.

Enhancing the EHR 

Why Department-Level Systems Remain Critical to Quality 

The need for Electronic Health Records (EHRs) has become widely accepted, and methods to accelerate hospital adoption are proving to be successful, albeit resource-and cost-intensive. While EHRs are highly useful tools for collecting certain kinds of information and making that information available widely across services, cardiovascular care is complex; the data generated by this care is equally complex; and therefore cardiovascular service lines require systems that can match this complexity.


 

Chris Winquist, LUMEDX President and COO, explains how the CVIS augments the EHR to provide CV services with the deep data needed for clinical and business excellence.

Publicly Reported Measures & the Need for Deep Data

Even with the rapid pace of innovations in treatments and technologies, cardiovascular disease is the leading cause of death in the United States.(1) Unsurprisingly, today a large percentage of publicly reported quality measures are CV measures. Further, new value-based payment models are making up-to-date tracking and managing of performance ever more critical. Demonstrating quality of care delivered has never been more central to cardiac and vascular departments. 

How can a hospital best report, monitor internally and improve quality performance in key measures like Mortality, Complications, and Appropriate Use? With discrete, queryable data. This data must be:

  • Acquired at the point of care so workflow is efficient and data is of high quality 
  • Made accessible to providers across the care continuum so they can make fully informed treatment decisions
  • Reported to the registries
Getting Actionable Information

It's not enough to report to the registries once a quarter and then hope for the best. A high-performing facility must monitor and drill-down into its own data to investigate any problems and take action-as quickly as possible. For this, service lines need systems that can capture information as queryable data elements. And these systems need to integrate with all the devices and clinical systems at work in the service line (ECGs, Stress, Holters, cardiac ultrasounds, hemodynamic systems--to name just a few). 

A dedicated departmental system-one that integrates with clinical-modality systems and the EHR, and offers automated registry data collection and submission to the full suite of cardiac and vascular registries-is the only way for complex environments like cardiac and vascular services to get the data they need to measure and improve performance (clinical, operational) in a substantive way.   

LUMEDX HealthView CVIS Enhances the EHR and Supports Operational Efficiency

With more than 30,000 discrete, queryable data points, HealthView CVIS offers the depth cardiac and vascular departments need for optimal clinical and business excellence. We've developed a powerful data engine that brings insight to every aspect of CV suite operations by drilling into details and reporting on both trending and outlier situations. 

The HealthView CVIS also accepts and transmits relevant data from and to the EHR, so that the enterprise and the service line can operate at the highest levels of efficiency, facilitating best-quality care, improved performance and cost savings.

(1) Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28-e292.

Improving the Business Performance of Your Heart Hospital 

An effective CVIS strategy can improve the business performance of your hospital

The primary goal of any healthcare provider is to improve the lives of patients through effective treatment. However, because they are also businesses, hospitals have concerns that entail much more than this. To be viable in the long term, hospitals must manage their margins to fund their mission.
There are three main pillars of business concern for any hospital:

  • Clinical—health outcomes are measured with the goal of healthier patients leaving the facility.
  • Financial—the dollars must add up to keep the enterprise solvent.
  • Operational—staffing and facilities are measured against cost and need.

Ultimate success for a hospital demands strength in all three areas. It's incumbent upon clinicians and service line managers to work together to seek out efficiencies in each of them.


 

Praveen Lobo, VP Strategic Products

 
New Operational Realities

Payers' shift away from a fee-for-service model toward a value-based payment model demands that clinicians and administrators expand the above-mentioned pillars to include cost, patient outcomes, and patient satisfaction.

These changes aren’t easy. Providers have long been paid based on quantitative measures: the number of procedures performed. New operational realities demand new ways of measuring the qualitative value of those procedures. Reimbursement is linked to these metrics, and hospitals must find ways to leverage their investments in data technology in order to maximize their financial opportunities.


Granular Data Brings Actionable Insights

Data is critical to the shift to VBP. For example, if we know that extubation within six hours improves patient outcomes, it makes sense to monitor that metric internally on an ongoing basis. When outliers crop up, data points gathered from across the treatment spectrum can allow us to understand why. Perhaps a different treatment was needed at the outset, or some other patient health factor influenced that measure.

Over time, granular data can allow us to understand which type of treatment is best for patient outcomes in that circumstance.

It is discrete, granular data that can help providers fine-tune their processes in order to improve patient outcomes—and of course patient satisfaction. This same kind of close analysis can be applied to reducing costs. But for all three new, expanded pillars, efficient data collection, management, and analysis are needed. 

LUMEDX HealthView CVIS collects more than 30,000 discrete data points—from point-of-care devices to physician reporting. The robust analysis and reporting engine provides meaningful insights in the areas of treatment options, clinical evaluation and training, and service line optimization. HealthView CVIS is an important addition to any heart hospital's electronic records system.  

Spotlight on Analytics, Part 5 

Q & A with Gus Gilbertson, Product Manager for LUMEDX

Predictive Analytics

Q: How much of the healthcare industry has adopted predictive analytics?

A: By definition, negotiations between providers and payers are a game of who can better predict patient outcomes. Win-win scenarios can certainly be devised, but a lack of predictive ability puts an organization at risk for poor contract structuring.

Clinical outcomes are increasingly a game of predicting outcomes and identifying the levers that affect those outcomes so providers are able to improve on future outcomes. Operational predictions are also important, as misunderstanding patient care needs can lead to expensive outlier care patterns or care variations that break capacity management efforts and budgets.

Q: How do you see predictive analytics having an impact on healthcare organizations, and specifically on heart hospitals?

A: Outcome prediction and risk profiling will increasingly guide care pathway selection and tailor care patterns to targeted patient profiles. Predicting and applying the care pathway that leads to the best health outcome at the lowest cost is the foundation of healthcare in the value-based purchasing era.

The dynamics of heart health are increasingly being researched and documented, leading to continued technical evolution and improved outcomes. Being able to predict which technology will lead to the best patient outcomes per dollar spent--whether it be a TVR, and VAD, or an aspirin—is a crucial skill for providers.

Q: What is the role of predictive analytics in affecting areas like heart failure readmissions?

A: Estimates continue to suggest that as much as 20 percent or more of care is wasted. Access to predictive models for identifying patients at risk for readmissions--and providing better targeted treatment up front--are the keys to reducing readmission. Those who best understand their care pathways and patient risk profiles will be the ones who can provide the best value in heart failure care. They will be the ones who can best explain the risk factors inherent in their readmission outcomes to stakeholders from patients to community groups and regulators.

Stay tuned for Part 6 of this series!

 

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