Healthcare delivery organizations and those working with them that are still in business are either well aware of their duties under HIPAA, work with managed service providers that understand the law well, or…are lucky to have made it this far. Even for organizations that have steered clear of both cyberattacks and regulatory fines, vigilance is essential to maintaining a clean bill of (cybersecurity) health.

With HIPAA guidance and enforcement practices shifting increasingly quickly right now, businesses must adapt their cybersecurity strategies to remain alert and in step with regulators’ most current expectations.

The fines they are a-changin’

Historically, HIPAA regulators have most often levied fines in the seven-figure range—but levied them relatively sparingly. As a result, HIPAA enforcement actions have long been viewed as a force of nature akin to lightning strikes: extremely lethal to most businesses, but just as extremely rare. That state of play has made it easy for organizations to adopt a dangerous “It won’t happen to me” attitude, as well as the mindset that fines could happen to anyone with bad enough luck.

HIPAA regulators are now changing their enforcement practices to take that perception of luck out of the equation—and force every organization that touches sensitive patient data to get serious about cybersecurity.

Regulators’ new strategy: assign five-figure fines per violation that most businesses can afford, and ramp up enforcement to make sure all organizations might receive a fine if they aren’t meeting their regulatory obligations. Ironically, this affordable-pricing strategy was pioneered by ransomware attackers in recent years, who have moved away from huge price tags that had their victims defiantly abandoning data, and become clever in sizing ransoms such that a business’s easiest choice is to pay up. With HIPAA regulators now applying clear and constant pressure via fines, organizations are correctly incentivized to maintain compliant cybersecurity practices and avoid writing checks to either law enforcers or lawbreakers.

HIPAA security controls have caught up with the times

When HIPAA was first enacted in 1996, the law’s writers looked to contemporary cybersecurity frameworks (like the versions of ISO and NIST in use at the time) to borrow guidance on effective controls for ensuring the safety of patient health information. Needless to say, a thing or two has changed in the 27 years since, from the sophistication of cyberattack strategies to the introduction of more modernized cybersecurity frameworks. 

The recent bill H.R.7898 has now addressed this discrepancy, allowing organizations to align their HIPAA security policies with modern control sets. Organizations should take full advantage of this development, mapping HIPAA to today’s most effective security standards (such as NIST CSF or ISO 27001) in order to increase the effectiveness of their protections.

New guidelines suggest that HIPAA is no longer DIY for smaller businesses

Back in 2005, the government drafted the Health Industry Cybersecurity Practices (HICP) guidelines to provide healthcare organizations with recommendations and best practices for complying with HIPAA and protecting their patients’ data. Throughout the HICP’s history up until just recently, these guidelines maintained a DIY tone, telling organizations how to accomplish and maintain HIPAA-compliant cybersecurity internally. 

However, a recent substantial overhaul of 405(d) HICP guidelines now directly offers advice on how to select an effective and trustworthy security-minded MSP (or MSSP) partner. At the root of this change: cyber threats and corresponding cybersecurity countermeasures in the HICP guidelines have become so complicated that smaller-scale healthcare delivery organizations and businesses attached to them can no longer be expected to navigate those complexities without expert support. For example, prescriptive cybersecurity controls, including automated threat detection and mitigation, are quickly becoming essential. Getting this right substantially curtails security risk—if in the hands of those (internally or externally) who know how to leverage those tools optimally.

The more things change…

While the sophistication of modern-day cyberattacks and security protections has reached an unprecedented level, the fundamentals remain the same. Safeguarding patients’ HIPAA-protected data requires thorough risk assessments to flag vulnerabilities, effective data encryption and access control, continuous employee training, and incident response planning to meet and overcome challenges as they arrive. Pairing that strong foundation with evolving protections—aligned with an awareness of the latest regulatory behaviors, security controls, and HIPAA guidelines—is the recipe for successful healthcare cybersecurity today.

About Cam Roberson 

Cam Roberson is Vice President at Beachhead Solutions, a San-Jose-based cybersecurity company. Cam previously worked in product management roles at Apple.

What You Should Know:

– A new survey by Artera, a leader in patient communication technology, reveals a stark disconnect between how healthcare providers communicate and what patients actually want.

– The findings, based on responses from over 2,000 patients, paint a picture of frustration and missed opportunities, with simple phone calls and one-dimensional text messages falling short of patient expectations.

Communication Breakdown

– Nearly half (45%) of patients have missed or forgotten a bill due to communication difficulties with their provider’s office.

– 43% report negative health impacts from communication challenges, including issues scheduling appointments or sharing crucial information.

– A staggering 79% of patients want providers to offer text-based conversation on any topic, highlighting a desire for more convenient and accessible communication.

Texting: A Double-Edged Sword

– While 77% find automated text exchanges valuable, simplistic “yes/no” interactions dominate, frustrating 69% of patients who long for deeper conversations.

– Two-thirds report incomplete text experiences, with 31% failing to achieve their goals at least half the time, often resorting to phone calls.

– Technical glitches and unanswered messages further exacerbate the problem, with 62% experiencing error messages, invalid responses, or radio silence from providers “half the time” or more.

Financial and Human Costs

– Providers failing to meet communication expectations face financial consequences, as 59% of patients are willing to switch doctors due to poor communication.

– Artera’s research sheds light on the impact on healthcare workers as well, with a December 2022 report finding outdated communication strategies contributing to staff burnout.

Guillaume de Zwirek, CEO and Founder of Artera, emphasizes the importance of patient-centric communication: “As a $4 trillion market, healthcare should offer unmatched customer experience. If patients can’t communicate seamlessly, they won’t engage, leading to a sicker population and more expensive care long term.”

What You Should Know:

– CoxHealth, a healthcare system in southwest Missouri announced it will implement Epic enterprise EHR across its health system, replacing its long-time Cerner EHR system.

– This strategic move signifies a commitment to delivering the highest standard of care while embracing cutting-edge technology to empower both patients and healthcare professionals.

Unifying Workflows, Streamlining Care

The move to Epic wasn’t taken lightly. Following an extensive selection process involving hundreds of staff and providers, CoxHealth recognized Epic’s potential to:

• Unify disparate workflows: Streamlining processes across various departments, leading to improved efficiency and collaboration.
• Provide seamless patient care: Ensuring smooth information flow across the health system, resulting in better-coordinated and more effective care.
• Bolster patient engagement: Empowering patients through MyChart, Epic’s industry-leading patient portal, with features like appointment scheduling, health information access, and educational resources.

Empowering Patients, Enhancing Outcomes

MyChart’s capabilities extend beyond mere information access. It facilitates seamless communication, simplifies appointment scheduling, and integrates patient records across various healthcare institutions, ensuring holistic care delivery.

Max Buetow, CoxHealth President and CEO, emphasizes the importance of equipping their team with the best tools: “We have incredible people, and Epic provides them with best-practice tools to achieve remarkable things.” He envisions exciting future possibilities for leveraging Epic’s platform to constantly improve patient safety, quality of care, and operational efficiency.

Epic Enterprise EHR Implementation Timeline

With a projected completion by early 2026, CoxHealth’s Epic EHR implementation marks a significant milestone in its journey to provide exceptional healthcare. This strategic investment positions the health system for continued success in a rapidly evolving healthcare landscape, where technology plays an increasingly crucial role in delivering personalized, efficient, and patient-centric care.

What You Should Know:

– CoachCare, a leading remote patient monitoring (RPM) and virtual health company, has made its fourth acquisition in 12 months, snapping up Nashville-based Verustat for an undisclosed amount.

– This strategic move further strengthens CoachCare’s position in the rapidly growing RPM market, projected to reach $175.2 billion by 2027.

Strengthening Focus on Chronic Conditions

Founded in 2020, Verustat brings valuable expertise in primary care and cardiology, areas plagued by prevalent chronic conditions like hypertension, obesity, and diabetes. CoachCare already excels in supporting patients with these conditions, and Verustat’s addition further solidifies their leadership position.

“We have gotten to know the Verustat team and their approach to remote care aligns well with CoachCare,” said Wes Haydon, President and Co-Founder of CoachCare. “We are pleased to welcome their clients and staff to CoachCare and to continue growing our best-in-class remote care platform.”

Acquisition Impact for CoachCare

The strategic acquisition positions CoachCare to deliver even greater value to both patients and healthcare providers. Patients benefit from a comprehensive remote care solution that addresses their specific needs, while providers gain access to Verustat’s expertise and CoachCare’s extensive resources. This win-win combination paves the way for improved patient outcomes, increased provider revenue, and a more efficient healthcare system overall.

Rules and regulations protecting consumer data often burden businesses, no matter your industry.

Rigorous consumer protections bog down financial institutions, e-commerce companies and educational organizations. These safeguards become even more demanding as consumers and government agencies call for increased transparency and access to personal data. 

Healthcare is no exception. Our industry has undergone several iterations of consumer data protection rules — starting in 1996 with the Health Insurance Portability and Accountability Act (HIPAA). 

In 2009, the Health Information Technology for Economic and Clinical Health Act, HITECH for short, became law, setting standards for electronic health records. 

And, in 2016, the 21^st Century Cures Act — and its rules against information blocking — began requiring organizations to provide patients with easier and broader access to their medical records.

As challenging as it is to keep up, we now recognize compelling reasons, beyond laws and the threat of penalties, for organizations to work toward giving consumers full access to their personal data. 

When it comes to granting broader and easier data access for consumers, the healthcare industry offers a particularly compelling rationale. Here are the top 3 reasons (besides it is the law) to give consumers improved access to records. 

1. Access Can Improve Health Outcomes

Consumers, now more than ever, want control over their healthcare. And research shows giving patients access to their electronic health records can positively impact health outcomes.

For example, one study found electronic health record (EHR) access improved patients’ ability to reduce hemoglobin A1C levels — an important indicator of diabetes control. Having access to one’s long-term data history can be valuable for chronic conditions that can often be challenging to manage. 

Consumers want to manage their care. And to do so, they need access to their complete record to monitor important trends affecting their health as well as to share with other providers in coordinating care. 

2. Access to Historical Health Data Can Save Money

Mergers and acquisitions, a desire for improved workflows and the need for improved interoperability have led many health systems to switch EHR platforms. These technology upgrades have created an abundance of legacy health record data. 

This historical data, captured and stored in an older EHR, often sits ready for read-only access. Therefore, a patient’s full record can be trapped in multiple systems across a hospital or health system setting. 

Storing historical data and maintaining these out-of-production systems can put a financial burden on hospitals and health systems. But consumers may also feel the costs of inaccessible legacy data. 

When providers go live with a new EHR, for example, they must formulate a plan to migrate legacy data and access necessary historical information. Without this kind of plan in place, records of medical tests can be inaccessible and ultimately reordered, costing consumers significant out-of-pocket expenses.

3. Consumer Data Belongs to Consumers 

Healthcare providers are in the business of not harm and, as an industry, we should follow their lead. Only together can we help consumers on their healthcare journeys. 

To ensure their well-being, consumers need access to their records. 

We have a responsibility to produce those records by the law – even in consideration of the financial commitments required to produce them.

Our industry will not benefit from restricting access to consumers’ records.

Develop a Strategy that Works for Your Business

Nearly every organization captures data about its consumers. It’s just the course of doing business in the 21^st century. Outside forces like regulations, internal policies and consumer expectations impact how organizations store that data and how consumers can access it.

Businesses need to develop a clear organizational data lifecycle strategy to meet everyone’s demands. Businesses should ask:

• Do we need one person to oversee our approach to data management? 
• Do we have a data governance team in place, and is it effective? 
• How do we capture and share data, and how long do we need to store it? 

Technology Can Inhibit or Enable Consumer Access to Data

An organization that uses technology to enable consumer access to records has acted on their data lifecycle strategy, consolidated information and ensured their active and retired systems integrate. 

On the other hand, those who have not planned for data storage and access may use systems that inhibit consumers from getting what they need to improve their health. 

Giving consumers their data is possible. There should be nothing stopping us from delivering because building systems that meet consumer demands will prepare us for the future. 

About Tom Liddell
Tom is a Managing Partner for Harmony Healthcare IT, serving as Chief Executive Officer. He has over 30 years of experience in healthcare information technology and was President and Co-Founder of SMI, a healthcare technology firm located in Indiana. SMI was part of an initial public offering that formed Medical Manager Corp (MMC) where Tom served as a Sr. Vice President. MMC merged with WebMD where he held positions of Senior Vice President of Marketing and Business Development, as well as Senior VP of Product Management, in which he was responsible for the development and launch of a fully integrated, award-winning health record and financial system. In 2006, Tom began the position as CEO of Michiana Health Information Network (MHIN) and CIO of a reference laboratory, pathology and blood bank.  In 2007, Tom joined the board of Harmony Healthcare IT and became CEO in 2015. Today, he participates in every facet of the Harmony Healthcare IT business, providing vision and operational guidance.

What You Should Know:

– KAID Health, the AI-powered healthcare solutions pioneer, has secured a significant $9 million in funding led by Activate Venture Partners, Martinson Ventures, Boston Millennia Partners, and Brandon Hull, alongside KAID Health’s Board of Directors.

– With this new funding, KAID Health plans to expand its reach to more providers and their payer partners and develop new service offerings.

Unlocking the Power of Whole Chart Analysis

KAID Health’s flagship platform, Whole Chart Analysis, leverages cutting-edge natural language processing (NLP) to unlock the true potential of electronic medical records (EMRs). Unlike traditional NLP solutions that focus on specific data points, KAID Health goes beyond, analyzing every available piece of information within a patient’s chart, including notes, conditions, medications, and lab results. This comprehensive approach enables:

• Improved coding accuracy and capture: KAID Health demonstrably boosts coding accuracy, ensuring providers receive proper financial compensation while improving data-driven decision-making.
• Streamlined quality reporting: Effortlessly fulfilling complex quality reporting requirements, freeing up valuable time for clinicians.
• Enhanced care management: KAID Health identifies key patient needs, facilitating proactive care interventions and optimizing clinical outcomes.

Real-World Impact, Proven Results

KAID Health’s impact extends beyond theoretical promises. To date, the platform has already:

• Revolutionized Medicare Advantage coding for large provider groups nationwide.
• Simplified chart review for prior authorization and clinical trial enrollment.
• Outperformed physicians in identifying surgical risks at a major medical center.

“KAID Health continues to deploy technology that makes clinicians more efficient, translates that efficiency into more cost-effective care, and grows revenues,” explained Kevin Agatstein, CEO of KAID Health. “By combining best-in-class, scalable, flexible, secure technology with deep clinical workflow and market expertise, we can partner with each customer to meet their informatics needs while alleviating chronic staff shortages.”

What You Should Know:

– PCA Rx and Cost Plus Drugs, are joining forces to tackle the longstanding issue of opaque and inflated drug pricing in the US healthcare system.

– This landmark collaboration paves the way for greater transparency, accessibility, and affordability for employers and individuals nationwide.

Prioritizing Drug Pricing Transparency

By prioritizing transparency, this partnership empowers employers and members to make informed choices and fosters a more engaged healthcare community. It signifies a major leap forward in transforming the industry’s approach to drug pricing and paves the way for a more accessible and affordable healthcare system for all.

PCA Rx, known for its transparent PBM model, and Cost Plus Drugs, the brainchild of Mark Cuban focused on cost-plus pricing, share a mission to empower patients and employers with clear information about medication costs. This partnership combines their expertise to offer an unprecedented level of clarity in drug pricing, addressing a major pain point in the healthcare sector.

This collaboration actively seeks solutions to prescription affordability challenges. Kelly Cromer, PharmD, VP Operations & Clinical at PCA Rx, emphasizes, “PCA Rx and Cost Plus Drugs are committed to lowering drug prices and enhancing transparency, empowering individuals and employers to make informed healthcare decisions.”

To obtain test results today, there’s no need to visit the hospital. Simply open a mobile app and download the report to your smartphone. Doctors remotely manage patient data without being tied to a specific medical facility. They also handle large volumes of data effortlessly within their hospitals. This became possible thanks to electronic health records, telemedicine, and cloud solutions. However, along with advancements, challenges in digital healthcare are increasing. Let’s discuss how to tackle them and explore the IT solutions essential for modern healthcare institutions.

Challenges in Medical Data Management

The healthcare sector contains an abundance of confidential information related to patients, medical procedures, treatments, and population health. This includes personal data, medical histories, laboratory results, insurance numbers, and more. When it comes to managing medical information, we go even further. Technologies, laws, standards, and people contributing to data solutions are integral to this process. Continuous development in this field ensures a fusion of business, science, and IT, allowing effective configuration while considering the nuances of handling personal data.

Confidentiality

Laws and regulations govern the confidentiality of medical data. State documents define rules for collecting, storing, processing, and transmitting medical information. In Europe, this is GDPR (General Data Protection Regulation), in America, it’s HIPAA (Health Insurance Portability and Accountability Act). Software developers and applications collaborating with medical institutions are also obliged to adhere to these laws.

Storage of Information in Various Systems

While serving diverse medical institution needs, Electronic Health Records (EHR) and Electronic Medical Records (EMR) parallel existence complicates information access and exchange between doctors, patients, and different medical centers. Electronic Health Records encompass a broader context of patient medical information storage, incorporating treatment records, diagnoses, lab results, allergy data, vaccinations, and more. In contrast, Electronic Medical Records capture information about specific visits to a doctor or medical facility, circulating within one institution. Unlike EMRs, requests for access to EHR records can be made by other medical centers.

To seamlessly obtain information from various systems, healthcare data exchange standards are essential. Healthtech providers can adopt HL7 (Health Level Seven) or FHIR (Fast Healthcare Interoperability Resources). The main difference lies in FHIR’s use of RESTful web services and open web technologies like XML, JSON, and RDF, while HL7 supports only XML. 

HL7 has various versions, with CDA being the most widespread. CDA supports document exchange among all structures involved in patient care. It allows the reuse of medical data for healthcare reports, tracking treatment quality, and ensuring clinical research safety. CDA can be utilized in numerous medical applications.

Terminology Differences

Philips conducted a survey among healthcare professionals on obstacles to the industry’s digitization. One major issue identified was the use of different terms to describe identical concepts (illnesses, procedures, devices, services, etc.). Challenges arise due to synonyms in professional jargon and variations in local translation choices (national counterparts vs. borrowed terms). For instance, “physiotherapist” or “physical therapist”.

Addressing this issue involves adopting international classification standards like SNOMED CT and ICD-11. IT companies collaborating with healthcare providers can implement these standards as follows:

• Integrate SNOMED CT and ICD-11 support into electronic records (EHRs or EMRs) and other systems. This enables medical institutions to code terms according to standards.

• Develop applications for term coding based on unified standards. Virtual “assistants” can offer automatic recommendations and select the necessary terms.

There is no doubt that the healthcare sector will evolve alongside technology. Consulting with IT providers can offer solutions for managing medical data smoothly and, most importantly, securely.

Technologies Facilitating Work with Medical Data

Cloud Storage for Information Preservation

“Clouds” provide an excellent way to store medical data without the need to invest in new equipment and software. Various optimal storage options are available depending on the client’s needs and budget.

MS Azure (Microsoft Azure)

Pros:

• Broad PaaS functionality (Platform as a Service): A ready-made infrastructure for developing, integrating, and managing various types of software.
• Pay only for the resources you use.

Cons:

• Delays in technical support.
• Requires qualified management due to a large number of services and cloud features.

Amazon Web Services (AWS)

Considered a Leader in Cloud Platform Services for Healthcare.

Indeed, the research company KLAS has published a report explaining why healthcare systems consistently choose AWS over its counterparts. According to respondents, this cloud platform is more tailored to the healthcare industry.

AWS solutions require software compatible with HIPAA standards. There are guidelines on configuring cloud storage according to these standards.

Pros:

• Scalable for different needs.
• User-friendly with guides, video instructions, and courses available on the site.

Cons:

• Amazon EC2 limitations depend on the region.
• Requires extensive learning before use.
• Often lacks experts for technical support.
• Budget estimation is challenging due to the multitude of services.

Google Cloud Platform

The storage operates by HIPAA standards. It includes Google Drive, Cloud IoT Core, Cloud SQL, and Cloud Storage.

Pros:

• Allows scheduling server maintenance time.
• Easy integration with other Google Cloud services.
• Automatic SSL certificate updates enhance data security.

Cons:

• Different pricing models with unnotified changes.

Blockchain for Enhanced Confidentiality

Based on blockchain, electronic medical cards have been developed. Researchers from the Massachusetts Institute of Technology created the MedRec system using this technology. Developers found that blockchain can improve the confidentiality of medical records and reduce administrative costs for patients. Users also noted that they are now more confident in the security of their data.

Blockchain also allows providing different levels of access to data. We have tested this capability with blockchain as well. Our experts created an online platform with three key participants: the hospital (pediatrician), parents, and the primary school. For the security of medical information, it is displayed differently to users. The platform operates with the following mechanism:

• Parents sign an agreement with the hospital where the child undergoes examinations.
• The pediatrician accesses medical records and updates the child’s health information.
• Parents apply for the child’s enrollment in an elementary school, and if accepted, the school requests the pediatrician’s report on the student’s health.
• The doctor creates the report, and parents must consent to its verification by a specific elementary school or multiple educational institutions.

Artificial Intelligence as a “Smart” Assistant for Doctors

Medical chatbots have proven their necessity during the COVID-19 outbreak. Only on the Microsoft platform, more than a thousand chatbots were created during the pandemic. According to Persistence Market Research, the market for such AI-based products is expected to grow by an average of 21% by 2030.

Artificial intelligence algorithms noticeably simplify data management. A study by MIT Technology Review Insights found that with AI, doctors spend less time on administrative tasks and, instead, focus more on patients.

However, it is crucial to consider the compliance of chatbots with security standards. Currently, ChatGPT does not meet HIPAA standards. In contrast, SmartBot360 was specifically developed as a medical tool with adherence to these requirements.

Problems and Solutions for Data Protection

According to Check Point Research, health organizations worldwide experienced a 38% increase in cyberattacks last year compared to 2021.

Medical records remain a desirable target for cybercriminals as they can be used for fraud or ransom demands. Outdated technical equipment and the actions of employees can assist fraudsters in gaining access to these records.

Non-compliance with Cybersecurity by Medical Professionals

No modern technologies will protect against hacker attacks if your password is everywhere “1234” or your date of birth. One study found that access to medical records is often “cracked” primarily due to the negligence of employees in following basic cybersecurity rules.

IT solution providers, in collaboration with healthcare institutions, can ensure the necessary level of data protection. How to achieve this:

• Conduct cybersecurity training for medical professionals. This can include training sessions, webinars, and online courses by developers, or cybersecurity experts. Specifically for Ukrainian healthcare institutions, the Ministry of Health, together with the USAID project “Support for Health Reform,” has developed guidelines on how to maintain data confidentiality.

• Regularly communicate with healthcare providers even after the completion of the project and product release. This will allow for the identification of potential security gaps promptly, preventing their occurrence, and protecting systems from attacks. Instructions for medical professionals from cybersecurity experts, and monthly/quarterly reports sent to technology developers for analysis, will also be useful.

Vulnerabilities in Medical Equipment and Devices

The global statistics for 2023 are alarming: the frequency of attacks on IoT devices in healthcare institutions has increased by 123%. One of the reasons is outdated devices and infrastructure. They do not support system updates and, as a result, lack an adequate level of protection.

What IT professionals recommend for the protection of electronic data:

1. Regularly update software. Developers continually work on improving the security of their products and release new versions to eliminate vulnerabilities. If updates are no longer supported on your devices, use complex passwords for accounts (minimum 12 characters, uppercase and lowercase letters, numbers, and special characters), download antivirus software, and update programs that can be updated. However, the best solution is to install new equipment.
2. Set up automatic data backup creation. This will prevent information loss in the event of cyberattacks or malfunctions. You can choose where copies will be stored: on external drives, local servers, or cloud storage.
3. Separate IoT devices into separate networks to reduce the cybersecurity threat in case one device is compromised. For example, you can divide them into different physical networks using VLANs or use different SSIDs (unique Wi-Fi network names) for devices.
4. Use the TLS (Transport Layer Security) protocol for data transmission between different servers, messengers, applications, etc.
5. Additionally, use firewalls, virtual private networks (VPNs), antivirus software, and other security tools.

Technologies have changed medicine for the better and continue to do so—for both patients and healthcare providers. However, new opportunities come with risks that need to be overcome, or better yet, avoided. Therefore, the main recommendation is to explore innovations in healthcare and choose what can provide your institution with efficient and secure patient data management. Today, there is a technical solution for every such need.

About Natalie Tkachenko, Healthcare Software Solutions Consultant at NIX

Natalie is a HIPAA-certified expert with high-grade knowledge in the healthcare and pharmaceutical industries. She helps medical companies of all sizes, from startups to enterprises, get the most valuable tech solutions for fundamental digital reinforcement in patient care, automation of operational processes, and overall business progress.

What You Should Know:

– The American Health Information Management Association (AHIMA) has appointed Dr. Kevin Klauer as its new Chief Executive Officer (CEO), effective January 8, 2024.

– Dr. Klauer will succeed Amy Mosser, MBA, who served as interim CEO since June. Mosser, a critical member of AHIMA’s executive team since 2019, will transition to the role of President of HCPro, LLC, a for-profit, wholly-owned subsidiary of AHIMA.

Dr. Klauer Bio/Background

Dr. Klauer’s extensive background in healthcare delivery and association leadership uniquely positions him to guide AHIMA into a future focused on growth and innovation. Formerly the system chief medical officer at HCA Florida Ocala and West Marion Hospitals, Dr. Klauer brings a wealth of healthcare experience from senior executive positions at the American Osteopathic Association (AOA), TeamHealth, the American College of Emergency Physicians, and Emergency Medicine Physicians, Ltd.

Dr. Klauer, a highly regarded clinician, executive, educator, and thought leader, holds a Doctor of Osteopathic Medicine (DO) degree, is board-certified in emergency medicine, and earned an executive juris doctorate from Purdue Global Law School. Known for his national contributions, Dr. Klauer has served on numerous committees and boards dedicated to improving patient care and enhancing the quality of life for healthcare professionals.

Drive AHIMA Growth and Innovation

As the visionary leader, Dr. Klauer will play a pivotal role in positioning AHIMA to achieve its growth goals, providing strategic leadership, and ensuring professionals working with health data are well-prepared for the rapidly changing healthcare landscape. Dr. Klauer’s responsibilities extend to collaborating on national programs and influencing health policy, reinforcing AHIMA’s role as a key player in shaping the future of the health information industry.

“I am honored to work with the Board of Directors to lead AHIMA into its next chapter, a future of growth, innovation, and unwavering commitment to excellence in health information,” said AHIMA CEO Dr. Klauer. “Together, we will drive meaningful change for the profession, patients, clinicians, and the entire healthcare industry. Better health is contingent upon trusted health information. AHIMA and the professional community we serve will lead the industry into the digital health era.”

As the healthcare sector embraces technology to tackle slow, time-consuming workflows, one task targeted for an innovation makeover is surgical supply data collection.

The capturing of every reportable item used in surgery is vital from a patient safety and business perspective.

In this article, we look at the evolution of surgical supply documentation tools – and in particular, assess the current transition from traditional 1D linear barcodes to 2D. 

We investigate whether the barcode upgrade will improve surgical supply chain management, and also compare it to the emerging technology of image recognition and AI.

Product data documentation during surgery

New digital tools are increasingly being used for supply chain management, in particular, to track medical devices, implants and consumables as they move through the supply chain. Asset tracking technology can be an effective way to monitor the movement of supplies, however, there is one particular healthcare setting that is known to challenge current data collection methods, and that is the point of care. 

There is pressure on healthcare providers to capture full, timely and accurate consumption data to achieve regulatory compliance. The FDA UDI regulations require all healthcare supply chain stakeholders to digitally track medical devices and implants throughout their lifecycle. Manufacturers now place encoded barcode labels on product packaging as the means of capturing item data and communicating with hospital technology to identify, track and document these items as they move through the supply chain. 

Existing data collection processes in OR procedure rooms are known to be inefficient, but this is an area that healthcare providers need to get right. Accurate surgical documentation is not just a clinical issue that enhances patient care, it is also a vital driver for efficient healthcare administration, supporting:

• A ‘right size’ inventory’, with timely restocks and significant cost-savings 
• Accurate charge capture and optimized medical billing and case revenue.
• Enhanced patient safety and prompt recall management
• Vital OR and procedural room data to support healthcare management and planning.

It’s very common to find a barcode scanning system for product usage documentation at the point of care, but there are many reported issues relating to reliability.

So, why is barcode scanning such a challenge in the surgery setting?

Barcode limitations in the surgical setting

Perioperative nurses report several issues with using 1D barcode scanning at the point of care:

1. Readability issues – failed scans due to faulty scanners, corrupted labels, system issues, etc.
2. Multiple barcode labels placed on all sides of the packaging confuse and require nurses to methodically scan each barcode looking for the data they require. 
3. Missing information – when nurses can’t find all the information they need, such as the expiry date or batch number, they end up manually inputting this data into the hospital system, which is time-consuming and prone to errors. 
4. Item missing from the system. The barcode may scan fine but if there’s no data match with the Item Master then the product cannot be identified, and the automated process breaks down.

The benefits of 2D barcodes in healthcare

2D barcodes are widely used in digital IoT applications. They are easy to identify and store all pertinent information in one place – so no need to scan multiple labels to populate all the required fields in the hospital system. 

2D codes can be scanned at any angle, and any mobile device with a barcode scanning app can be used. 

This ‘next generation’ of 2D barcodes is being heralded as the solution for simpler, more effective supply chain scanning by organizations such as GS1, which are a 2D data carrier and state, 

“… these high-capacity barcodes can also have a product’s batch or lot number, serial number, expiry date and more. With access to that data, business partners up and down the supply chain can boost transparency, improve inventory management, enable traceability and sustainability initiatives, reduce waste, and simplify recall and return processes.”

With all the fanfare over the introduction of 2D barcodes, could this upgraded technology solve the existing point-of-care data collection issues, or is barcode scanning simply the wrong technology for this setting?

The move from 1D barcodes to 2D barcodes in healthcare 

2D barcodes offer a great solution for many areas of healthcare. In terms of supply chain management, the ultimate goal is end-to-end tracking, and a crucial stage is documenting consumption. 

The point of care, however, has specific challenges: 

1. The items used in surgery are not always stock items.
2. ‘Bill-only’ and consignment items that aren’t pre-enrolled on the system may be used.
3. Documentation during surgery is more likely to result in full, timely and accurate patient records, however, the priority for patient care, and the limitations of current systems, make this difficult to achieve.

When the routine recording of surgical utilization fails, organizations resort to post-surgery documentation and internal audit checks.  

The limitations of 2D barcodes at the point of care

We’ve identified the factors that make the surgery setting so problematic for product documentation, so let’s now look at how the roll-out of 2D documentation has worked in practice.

To be successfully recorded in the electronic medical record (EMR), an item needs to go through the following stages: 

Collection: Product data needs to be captured – this is commonly either manually keyed into the system, or collected by hardware, such as barcode scanners. 

Identification: Hospitals rely on their Item Master as the source of truth. Maintaining this catalog is a tough task due to the sheer volume of SKUs stored, and constant updates to item data. A further issue is the number of non-stock items used in surgery, which may not be listed at all. Where Item Master pairing isn’t achieved, a system error will be generated and the process falls. 

Documentation: Successful documentation requires the first two stages to have worked effectively – item capture and identification. Then, for efficient documentation to take place, the hospital system needs to be integrated and compatible with the data capture software. 

Although there are certainly benefits to the greater storage capacity of 2D barcodes, the complexity of managing inventory at the point of care is exposing the limitations of this system. Continuing reliance on the Item Master is the biggest negative of 2D barcodes

The barcode obsession

Every type of technology has its natural environment, the places where it thrives.

Yet barcodes have struggled in the surgery setting, so is investing in yet more 2D the answer?

Even when it was clear that a new approach was needed, the industry stuck to their barcode fixation and created a different version of the same thing. 

This inability to move on to next-generation technology reminds me of that famous Henry Ford quote, “If I had asked people what they wanted, they would have said faster horses.”

Maybe surgical data capture needs a rethink.

If you analyze the challenges experienced by healthcare providers, could other technologies improve surgical documentation? 

We think so!

In fact, we feel the time is right for healthcare providers to:

• End their obsession with barcodes – and embrace breakthrough technology for the environments where barcode systems are not the best solution.
• Ditch the reliance that barcode systems have on the Item Master – by using independent identification sources.

The next generation of point-of-care data capture isn’t 2D barcodes, it’s image recognition and AI technology.

A better alternative to 2D barcodes

Breakthrough technology is providing a brand-new approach to surgical data collection, making it quick and easy for nurses to capture every product used in surgery. 

Collection: Computer-vision technology ‘reads’ product packaging (the whole box or label, not just the barcode). Hand-written Implant Sheets can also be ‘read’ and digitized using computer vision sensors. 

Identification: Item identification is automated via a globally populated cloud database. All relevant details are automatically extracted, including SKU, batch number and expiry date.

Documentation: Seamless interoperability ensures 100% item and charge capture in all core systems, such as the ERP, EHR and MMIS.

The triple technology of AI, machine learning and image recognition technology transform surgical data capture into a simple 3-second task.

Image recognition trumps 2D barcodes

The point of use is a challenging environment to capture full and accurate usage data.

Image-to-data technology outperforms 2D barcode systems when it comes to documenting surgical utilization. 

It’s time to let nurses focus on patients, not products.

About Shlomo Matityaho

Shlomo Matityaho is IDENTI’s founder and CEO. He is a veteran entrepreneur in the Israeli health-tech sector, with 30 years of experience in using technology to improve operational and business processes.

What You Should Know:

– The 15th annual Gartner Healthcare Supply Chain Top 25 ranking is out, offering a snapshot of the leading U.S. health systems excelling in this crucial area.

– This year, Cleveland Clinic reigns supreme, showcasing leadership in digital initiatives and environmental, social, and governance (ESG) commitment.

Cleveland Clinic Takes the Top Spot

Cleveland Clinic clinches the top spot in the 2023 ranking, demonstrating leadership in both digital initiatives and environmental, social, and governance (ESG) commitment. This underscores the increasing importance of sustainability and technology adoption in shaping successful healthcare supply chains.

Top Trends Shaping the Future

– Building Digital Supply Chains: Leading health systems are leveraging automation, system upgrades, and advanced analytics to tackle backorders, improve demand planning, and drive overall efficiency. Gartner research indicates data analytics and digitalization are top priorities for supply chain leaders, shifting the focus towards strategic value creation.

– Attracting and Retaining Talent: Talent acquisition and retention pose a major challenge, particularly for frontline workers. Leading organizations are adopting automation solutions and elevating the Chief Supply Chain Officer (CSCO) role to address this issue. Research shows CSCOs have higher retention rates, highlighting the importance of strong leadership in talent management.

– Developing Antifragile Supply Chains: Healthcare supply chains are moving beyond risk and resilience towards antifragility. This involves understanding vulnerabilities, anticipating uncertainties, and proactively implementing initiatives to become stronger in the face of challenges. Antifragility extends beyond traditional risk assessments, encompassing cybersecurity and financial partner viability.

The Healthcare Supply Chain Top 25 for 2023

About the Healthcare Supply Chain Top 25 Methodology
The Healthcare Supply Chain Top 25 ranking is derived from two main analyses: quantitative measures and opinion components. Quantitative measures provide a view into how companies have performed in the past and establish proxy connections between financial health, quality of patient care, ESG and supply chain excellence. The opinion components offer a qualitative assessment of value chain leadership and demonstrated supply chain performance — crucial characteristics of our Top 25. The qualitative and quantitative components are combined into a total composite score.

What You Should Know:

– TREND Health Partners, a rapidly growing provider of AI-driven solutions, has acquired Advent Health Partners, an AI-driven platform identifies and standardizes clinical attributes from itemized bills and medical records, expediting critical information presentation and ensuring timely and appropriate reimbursement.

– This strategic combination brings together two industry powerhouses, creating a comprehensive platform for payers and providers seeking to optimize revenue and streamline operations.

Synergy through Expertise and Technology

Founded in 2010, Advent boasts CAVO®, a proprietary AI-powered platform specializing in medical record review for revenue cycle and payment integrity processes. This expertise aligns perfectly with TREND’s existing TRENDConnect platform, enabling seamless integration of clinical and non-clinical data and analytics. This holistic approach promises even greater value for clients, addressing a wider range of challenges in areas like denials management, utilization management, and DRG reviews.

Enhanced Value for Payers and Providers

The combined entity will serve over 50 health plans and nearly 1,000 hospitals, offering substantial benefits to both sides of the healthcare equation:

– Payers: Improved reimbursement accuracy, reduced administrative costs, and enhanced transparency in provider billing practices.

– Providers: Streamlined claim submission and processing, faster turnaround times, and clearer understanding of payer expectations.

AI-Powered Payment Accuracy

The TREND-Advent merger signifies a significant step forward in the evolution of healthcare payment accuracy. By leveraging AI and collaborative approaches, this combined entity is poised to transform the industry, ensuring fairer reimbursement, smoother operations, and ultimately, better care for patients.

“Rarely do you come across two companies with such complementary capabilities and aligned visions as what we found with TREND and Advent. CAVO® will help us extend our existing platform, TRENDConnect, to solve an even broader set of challenges for our payer and provider clients. We are very excited to welcome the Advent team into our organization,” said Sarah Armstrong, CEO of TREND.

What You Should Know:

– Physicians are cautiously optimistic about artificial intelligence (AI) in healthcare, according to a new survey by the American Medical Association (AMA). While 41% are equally excited and concerned about its potential, nearly two-thirds see its advantages if specific concerns are addressed.

– The survey of 1,081 physicians, conducted in August 2023, reveals a complex picture of how doctors view this transformative technology, highlighting both its potential benefits and lingering concerns.

Physicians Sentiment Towards AI in Healthcare

The survey reveals a nuanced picture of physician sentiment towards AI. While doctors recognize its potential to improve care and efficiency, concerns about trust, transparency, and patient-doctor relationships remain. By addressing these concerns and prioritizing responsible development, AI can become a valuable partner in shaping a better future for healthcare.

Key findings of the survey include:

– Doctors Crave Relief from Administrative Burdens: The survey reveals a clear desire for AI tools that alleviate the administrative burden plaguing modern medicine. Doctors are most enthusiastic about AI’s potential to ease documentation (54%) and prior authorization hurdles (48%), freeing them to focus on patient care.

Enhancing Care, but Protecting the Patient-Doctor Bond: Physicians recognize AI’s potential to improve diagnostic accuracy (72%), workflow efficiency (69%), and clinical outcomes (61%). However, concerns about AI’s impact on the patient-physician relationship (39%) and patient privacy (41%) remain high, highlighting the need for careful development and deployment.

Trust and Transparency: Keys to Unlocking AI’s Potential: The survey underscores the importance of trust and transparency for successful AI adoption. Doctors overwhelmingly demanded data privacy assurances (87%) and freedom from liability for AI model errors (87%). They also seek clear information about the design, development, and deployment of these tools (80%).

AI in Action: Early Steps on a Long Road: Despite concerns, 38% of physicians already use AI tools for tasks like generating discharge instructions (14%), documenting codes and notes (13%), translation services (11%), and even assisting with diagnosis (11%). These early applications offer a glimpse of AI’s potential, but also highlight the need for further development and refinement.

“Physicians are optimistic about the advantages that properly designed AI-enabled tools can have for patient care, and nearly two-thirds of physicians see an advantage to AI if key requirements are met,” said AMA President Jesse M. Ehrenfeld, M.D., M.P.H. who is board certified in both anesthesiology and clinical informatics. “The AMA survey illustrates that physicians’ greatest hope for AI rests in reducing the crushing administrative burdens that plague modern medicine, which drain health care resources and pull physicians away from patient care.”

Data is a crucial pillar of healthcare. But more than just the data itself, the flow of data between all stakeholders is what enables everything from care coordination to quality measurement, payment efficiencies, risk management, and other key goals. Yet, the healthcare industry has historically struggled with data exchange due to the lack of aligned interests caused by a third-party payer system and the predominance of proprietary technology.  Additionally, data privacy, which all would argue is necessary, has created a significant cultural opposition to data democratization. As a result, our current system creates an unnatural boundary between health and care that is more focused on treating illnesses than supporting broad scale health and wellness. 

Though interoperability and the benefits it brings have long been intangible, there is a bright light at the end of the tunnel, and we are starting to move toward it as an industry. That light is burning bright due to the development and support of the FHIR standard, which is opening up how data and technology can be used to shift healthcare into a more aligned and connected system that will ultimately support keeping people healthy while keeping risk and costs down. 

The advent of FHIR

While today’s medical records have mostly evolved from paper to servers, they are still more static than free flowing, and their value is locked up in the systems that they are stored in. The good news, though, is that it is widely recognized that making health data more available will move the industry in the right direction.  And as has been the case with progress during the tech revolution of the past 30 years, standards have set the foundation for improved operations and innovations previously unattainable. The FHIR data standard is in the class of tech enablement tools and because it was designed specifically for healthcare it is an accelerator that will enable the collection, aggregation, and analysis of information on individuals and populations to give providers, health plans, pharma organizations, and other stakeholders more ways to support patients at a lower cost, with better quality and lower risk.

Healthcare’s data revolution is now officially underway thanks to regulations like the CMS Interoperability and Patient Access Rule and related rulings involving FHIR. In late 2022, the 21^st Century CURES Act mandated medical records be accessible to patients via FHIR, and by the beginning of 2023 all providers were required to use FHIR. Though FHIR adoption has been slowed due to political, technical, and cultural obstacles – there has been progress as more and more organizations make the shift and start uncovering what FHIR is capable of.

With the FHIR infrastructure in place and regulations guiding the way, the stage is set for innovation to come. Similar disruption has occurred in other spaces, enabling processes to be faster and more efficient. For example, digital payment apps, like Venmo and Cash App, are driving the fintech revolution and providing an alternative to traditional banking with instant transactions and secure payments. Now is healthcare’s time to undergo the same transformation, and FHIR is making it possible.

FHIR today, FHIR tomorrow

Now that organizations are starting to use FHIR, they are quickly seeing the benefits that this standard can bring in the short term – and even catching glimpses of what it will enable in the coming years. With FHIR, some health plans are using the combination of claims and clinical data to find gaps in care and improved care planning options.  The comprehensive nature of the combined data set truly allows for a new and deeper level of actionable insight, and as a result, better business performance. 

FHIR is poised to unlock next-level capabilities and business models. Think of any modern consumer experience – it’s digital, intuitive, and makes it easy to save your information (possibly even pulling from other sources to better tailor the experience). It is exciting to think that this could be healthcare’s future.  A world where providers, payers, and everyone involved are working to deliver better care for all. FHIR-enabled data would make it possible to create detailed profiles on each patient to paint a comprehensive picture of overall health. These profiles could contain medical data plus lifestyle and behavioral data pulled from health monitoring devices, social media, exercise and health apps, public records, and so on – helping to inform more holistic approaches to support health outcomes while reducing risk and costs. 

Modernized, consumer-friendly healthcare experiences would also encourage individuals to participate more in their own journeys, which is a critical element of effective preventative care. For example, plans could use FHIR to access real-time data from wearables/remote monitoring devices and offer members discounts for healthy habits when staying in target range on key health metrics. Just like the devices that car insurance companies use to discount drivers for safe practices, FHIR could help healthcare organizations design new programs that give patients real-time, measurable ways to get involved in their own health outcomes.

Fanning the flames

Many other industries have embraced open-source technology in the name of improving efficiencies and consumer convenience, but healthcare has long been on the sidelines. Now, skyrocketing costs and increasing demands for a better system are shifting the tides whereby healthcare will transition from closed, inefficient systems to open, cloud-based infrastructure.

Large volumes of high-quality data can kick off a self-feeding cycle; the more the data gets used, the more in demand it becomes. That is why it’s crucial for more healthcare organizations to start using FHIR and generate more momentum for this much-needed data revolution. Universal FHIR adoption, along with APIs and open technology, will optimize data exchange across diverse platforms to enable capabilities that healthcare has never seen. Leveraging modern cloud tools allows for reliable, cost-effective infrastructure management for all stakeholders. FHIR, combined with lower barriers to innovation, entrepreneurship, and collaboration around creating richer data sets, will enable a new healthcare model empowering all to achieve their maximum health and wellness potential. 

About Joe Gagnon

Joe Gagnon is currently CEO of 1upHealth a cloud-based data interoperability platform that unlocks healthcare data to improve outcomes. He is also an avid blogger, co-host of the Chasing Tomorrow podcast, and a serious endurance athlete.

Hospitals, health systems and group practices nationwide are finding value and effectiveness by partnering with an outsourced care guidance resource to extend clinical staff and strengthen care management support. The addition of a structured and highly scalable care guidance program that goes beyond mere navigation efforts provides a unique solution as a service proposition to comprehensively address many of the operational and financial challenges that directly affect the entire provider ecosystem. 

An Extension of the Clinical Team Beyond Mere Patient Navigation

Modern care guidance is an evolution of patient navigation that combines a systematized assessment to support disease-specific clinical conditions with a tech-enabled, human-led solution. Care guidance serves as an extension of a hospital’s clinical team to support a range of service lines and support activities. 

When properly designed and implemented, care guidance supports a myriad of clinical and non-clinical functions, including facilitating pre-and-post-discharge and continuation of care. While care coordination usually includes a limited set of commonly performed tasks like scheduling follow-up appointments, helping patients understand what the next step in their clinical journey should be, care guidance goes deeper into social determinants and the life factors that can impact a patient’s ability to stay on track. 

An effective care guidance program depends on specially selected care guides who work to establish a peer-to-patient connection with patients and their families. This human-led approach builds trust, enhances a patient’s ability to communicate and helps to uncover issues that pose barriers to care. The support of care guides then works to resolve these issues and assist patients in the ongoing process of their care. However, while the human touch is vital, care guides are unlikely to meet efficiency goals without a technology platform that goes beyond logging into structured workflows and barrier resolution pathways.

As healthcare organizations experience the profound financial impact of nurse shortages, care guidance is providing an innovative and efficient solution. It provides truly effective supplementary support services, functioning as a lower-cost extension of clinical teams and freeing up labor, time and resources so that nurses can focus on high-value clinical tasks.

A successful care guidance program delivers a strong return on investment (ROI) by improving efficiencies, reducing time and resource allocation, and helping overutilized clinical care teams focus on truly clinical items, all while improving patient satisfaction and retention Care guidance is of especially high value in alleviating non-clinical tasks and of its ability to help identify and solve barriers embedded in the social determinants of health that have an outsized impact on the patient care continuum. When a guidance program is properly deployed, it functions to promptly identify and resolve non-clinical issues patients experience before they become clinically problematic and costly. 

Value of a Technology-Enabled Care Guidance Resources 

A technology-enabled care guidance resource offers the most effective patient activation solution. It seamlessly integrates with a health system’s care management team to reduce clinical resource use, improve patient experience, advance health equity and enhance value-based care and reimbursement.

The right mix and integration of human and tech elements support personalized and meaningful peer-to-patient relationships and personalized communication, providing patients and their families with the connected support they need to stay on track and engage in the management of their condition throughout their care continuum. 

Integrating care guidance with information technology can significantly enhance the efficiency and effectiveness of healthcare services. By leveraging these technologies, care guidance programs become more agile, patient-centered and efficient. They facilitate quicker responses to patient needs, streamline administrative tasks and ultimately improve the overall patient experience within the healthcare system.

Collaborative Function of Care Guidance

Collaboration between provider teams supports a triad of care coordination and management. Hospitals and their clinical staff receive the extended support they need from a dedicated care guidance service.

• Reach and manage more patients, maintain their continuity of care.
• Remove non-clinical tasks from the workloads of nurses and clinical staff.
• Perform follow-ups and monitoring, conducting follow-up tasks and ensuring that potential issues and barriers are proactively identified and resolved.
• Schedule appointments, screenings, preventive care and annual wellness visits.
• Find financial resources, such as assistance programs, to alleviate medical costs.
• Arrange transportation and other logistics that enable a patient’s ability to receive care.
• Ensure compliance, adherence and medication management. 
• Reduce unnecessary service utilization and avoidable readmissions.

Addressing Social Determinants of Health and Resolving Barriers to Care

As healthcare organizations prioritize to deliver equitable, patient-centric care they must consider the full spectrum of a patient’s condition, including non-clinical factors and socioeconomic characteristics that influence their ability to access, receive and adhere to care.

Care guidance takes into account the role of social determinants of health (SDoH), with personalized services provided by skilled and trained care guides that recognize these non-clinical factors that influence an individual’s ability to access care and adhere to treatment. It’s this “human touch” that supports patients who are at-risk based upon SDoH characteristics.  These patients frequently require amplified levels of activation and monitoring that cannot be addressed within the typical hospital’s resource capacity and clinical scope limitations. 

SDoH are categorized by socioeconomic, education, cultural and environmental domains. Sub-standard conditions among these domains are shown to perpetuate patient health disparities, contribute to their unmet resources, services and transportation needs and widen health inequities, especially affecting those with chronic health conditions.

When non-clinical factors, which account for 80% of patient issues, are not promptly addressed and effectively resolved, they can lead to:

• Health deteriorations
• Excessive rates of clinical service utilization
• Extended hospitalizations and readmissions
• Higher total cost of care

Care guidance programs have proven to be effective in supporting disadvantaged and underserved patient populations who are at-risk for these complex health challenges. 

Data Captures Provide Strategic Insights

Optimally, care guides are equipped with scalable, technology platforms that provide structured workflows and use evidence-based disease and condition-specific protocols to proactively identify and resolve practical and non-clinical barriers experienced during the care journey. A patient activation platform that augments a hospital’s care management workflow and automates protocols helps uncover both non-clinical and clinical issues and barriers. With this technological support, care guides ensure that non-clinical issues get promptly resolved and clinical issues are immediately escalated to proper clinical care teams. 

An effective care guidance platform captures SDoH data and disparity-related barrier resolution, exceeding the capabilities of typical electronic health record (EHR) systems which are not specifically designed to facilitate the kind of resolution workflows that are needed to address health equity and SDoH issues. A specialized platform facilitates operational improvement by seamlessly exchanging relevant insights for each patient population. 

How Information Technology is Utilized in Care Guidance:

• Resource Allocation: Data analytics help healthcare organizations allocate resources effectively based on patient needs, optimizing the patient navigation process.

• Machine Learning and AI: AI algorithms analyze patient data to offer personalized recommendations for treatments, lifestyle changes and support services.

• Interoperability: IT systems communicate across different platforms ensuring the smooth flow of patient information between healthcare providers and navigators, improving coordination of care.

• Data Analytics: By analyzing patient data, IT systems predict potential health issues, allowing providers to intervene early and prevent complications.

• Measuring Outcomes: Collect data to measure the effectiveness of their services, including patient satisfaction, adherence to treatment plans and health outcomes.

• Continuous Improvement: Based on collected data, patient navigation programs can be improved to better serve patients’ needs.

Data analytics within the platform provide insight into non-clinical issues, identify probable SDoH risks and facilitate personalized communication. AI and machine learning anticipate patient needs based upon condition-specific protocols that enable care guides to deliver an unprecedented level of vital, just-in-time communication. Led by this intelligence, care guides provide patients with the information they need to engage in the process of their care and empower each consumer to receive a better understanding of their treatment plan and options. 

Why More Health Systems Are Considering Care Guidance Programs 

Care guidance is now becoming a “must-have” addition to the service line portfolio of health systems, hospitals and provider organizations. It is at the nexus of managed care priorities where care guidance represents an innovative approach to connected care, advancing heath equity and delivering high-quality care.

A well-designed, scalable care guidance program offers a cost-effective, connected care solution, aligning with the “Triple Aim” goals of improving care, enhancing population health and reducing costs. Patients receive personalized, equitable care, clinical staff can focus on their core tasks and hospital administrators can improve financial and operational performance. This is where care guidance presents the most value and opportunity.

About Craig Parker, JD, CPA

Craig Parker, JD, CPA, CEO, Guideway Care, a company that partners with healthcare organizations to deliver on the promise of health equity through its unique combination of highly trained Care Guides and its patient activation platform. Craig Parker has a history of building innovative healthcare companies with business models that improve care delivery and provide better experiences for all involved. Before taking the helm at Guideway Care, Craig served as a senior leader in healthcare companies working in the patient experience and provider efficiency spaces. In his role as CEO, Craig serves as the company’s chief evangelist, spreading the message that Guideway Care’s services improve life for patients and providers alike.