In 2020, the Department of Justice estimated that fraudulent, wasteful, and abusive (FWA) billing practices account for more than $100 billion of the nation’s healthcare expenditures.¹ Today, the National Healthcare Anti-Fraud Association (NHCAA) conservatively estimates that healthcare FWA costs the nation about $68 billion annually, representing 3% of the nation’s $2.26 trillion in healthcare spending.²  FWA estimates from commercial health plans range as high as $230 billion annually, or 10% of total healthcare spending.³ 

This lost money is far from a concept or abstraction. Every dollar lost to fraudulent, wasteful or abusive billing hurts patients, honest providers, payors and governments. Third-party benefits providers often receive outsized blame for these costs, when in reality, fraud, waste, and abuse is extremely difficult to detect using conventional methods because providers submitting excessive or fraudulent billing claims are constantly changing their methods to avoid detection. 

Fortunately, new advances in artificial intelligence (AI) technology provide our industry a clear path forward to lowering healthcare costs by reducing excessive or overbilling in a way that rewards good providers and returns more dollars to patient care. By helping healthcare payors detect and prevent fraudulent, wasteful and abusive billing practices in greater quantities and before payments are made, it is estimated that up to $1 trillion in fraudulent, wasteful, and abusive costs can be eliminated from U.S. healthcare by 2030. It’s time to stop blaming benefits providers for spiraling costs and start addressing the technology that powers their day-to-day healthcare claims editing, audit and review systems. Here are the key concepts to consider. 

Static Claims Editing Systems Are Exploitable

Most healthcare benefit systems are based on a static, rules-based or use case-based technology that audit a very narrow set of criteria in determining whether a healthcare claim should be paid to the provider. While these systems do a good job of processing and paying billions of claims each year, their antiquated technology allows hundreds of billions of dollars in excessive bills or fraudulent bills to be paid. It’s not because the claims management companies don’t want to stop fraudulent and excessive billing, it’s because their technology can’t see the exploitation that’s occurring. 

Technology Has To See Provider Behaviors, Relationships and Outliers 

When cases are reviewed and adjudicated using traditional rules-based, use case-based and conventional AI methods, dynamic provider behaviors, relationships and outliers are hard to detect. You have to see a provider’s behavior around a claim and all claims and that provider’s relationships with other providers in order to detect fraudulent, wasteful and abusive billing at a significant level before claims are paid out. This means that this sophisticated, interdependent relationship between providers, a current claim form, historical claim forms, and all other providers in a network has to be able to be identified, analyzed and reported on in less than one second when a claim is submitted for payment. 

The Promise of Artificial Intelligence 

AI scares a lot of people, because it is hard to wrap your arms around what it is. Simply stated, one definition of artificial intelligence (AI) is technology that thinks and does what a human can do, but much faster. Even this simple description leaves out the benefit of unsupervised AI being able to identify an infinite number of ‘math problems’ that a human might not even know to look for in a data set. 

Early AI, and much of the conventional AI used in healthcare FWA detection and payment integrity work today, is not much more than a really advanced Excel spreadsheet. Much of the conventional AI operates using structured machine learning. This means that a machine is trained to perform an algorithm or series of algorithms that take an “if-then” approach to analyzing data. 

These structured machine-learning approaches are very helpful, but miss a lot of the dynamic trends, patterns and outliers that can be detected by advanced, unsupervised machine learning. To ‘see’ all of the FWA activity, you have to deploy unsupervised machine learning that identifies trends, patterns and outliers without being “told” specifically to go perform the task. This enables payors to see new fraud trends and patterns forming in near real-time that are indicators of behaviors and relationships that may be signs of excessive payments, over-payments, or even fraud. In short, you can see things and stop things from happening that you did not even know to tell your technology or staff to pursue. 

The Reality Of Integr8 AI^™ Technology In Stopping FWA 

Integr8 AI technology is a new generation of artificial intelligence that is patented for the detection of operational threats. The first application of the technology is to enable healthcare payors – commercial health plans, TPAs, CMS programs, etc. – to take a dynamic, provider-centric approach to processing, auditing and paying healthcare claims. This technology has proven to increase FWA detection by 2X to 10X in initial commercial use, all because it can “see” FWA activity that conventional technology can’t see. And Integr8 AI can see it in a way that does not slow down the claims editing, review and payment process. 

As one payment integrity executive said, “We need to be able to see the FWA activity that we all know is there. Current technology just doesn’t let us see the volume of FWA that next-generation Integr8 AI technology enables. The best part is that this type of technology operates on top of our current claims editing system. We don’t have to make new capital investments to make a big difference fast.”  

The Bottom Line for Benefits Providers

The battle against spiraling healthcare costs has important implications for every stakeholder in the healthcare value chain, but third-party benefits providers stand to benefit the most when fraudulent, wasteful and abusive costs are controlled. Today, almost a third of all insured Americans receive their health coverage through a third-party provider. Removing fraudulent, wasteful, and abusive costs helps benefits providers lower the cost of benefits for customers and their employees, automate and streamline operations, and increase bottom-line profitability. Technology, like Integr8 AI, enables the benefits to be quantified quickly and recognized almost immediately – regardless of what claims editing and adjudication system is being used. 

Now is the time for benefits providers to embrace sophisticated AI solutions for claims management, moving from a relatively static, claims-based model to a dynamic, provider-centric model. It’s time to take control in the fight against adaptable, malicious actors. That fight starts and ends with thinking about the technologies we have in place. 

About Theja Birur 
Theja Birur is the founder of 4L Data Intelligence and inventor of the patented Integr8 AI intelligence platform. She has 20 years of experience in analytics and artificial intelligence with most of that focused on solving payment and quality challenges for healthcare payers and public health agencies. Her career includes work in the government sector with the Ontario Ministry of Health in Canada, with IBM as a management consultant, and in the IBM Innovation Lab focused on analytics. Prior to founding 4L Data Intelligence, Theja worked as a consultant for the California State Compensation Insurance Fund where she was an Associate Director over Big Data and Data Warehouse functions.

• Get Well, a global leader in digital patient engagement, today announced it has expanded its industry-leading digital patient engagement portfolio to include new social determinants of health (SDOH) screening solutions.
• The new solution will be available to more than 200 enterprise healthcare organizations nationwide that are using GetWell Inpatient, an interactive patient care and hospital experience management product, at no additional cost.

Enabling Enterprise Healthcare Organizations to Meet New CMS Requirements

“Today, 80% of health outcomes are driven by non-clinical factors such as physical environment and health behaviors. We need to reimagine the ways we are reaching and engaging patients and do so in a way that is still seamless for overburdened clinicians,” said Michael O’Neil, Get Well CEO. “At Get Well, our mission is to provide high-quality personalized patient care, educate families, and empower clinicians. This starts with better understanding the needs of all patients, particularly underserved patient populations, and enabling our valued partners to leverage these insights in a meaningful way to meet new and evolving regulatory requirements.”

In 2024, CMS and many states will require hospitals to implement SDOH screenings for all patients 18 years and older. The Joint Commission and NCQA have also created requirements or reimbursement incentives to screen and support social needs. In response, Get Well now offers a new suite of features that help automate the screening of SDOH and navigate patients to appropriate resources:

1. Use existing tools to collect SDOH data: Through Get Well’s interactive TVs, client partners can allow patients and caregivers to confidentially complete social needs surveys.
2. Add additional channels for scale: Patients can now also complete SDOH surveys on their phone via text messaging, tablets, or mobile devices, or during tech-enabled staff rounding with GetWell Rounds+.
3. Seamless integration into existing EHR: Directly embedded SDOH screening data into Epic, Oracle Cerner, and other EHRs ensures coordination of data and workflows.
4. Escalate and triage social needs: Care teams can monitor patients in real-time, pinpointing intervention opportunities, and triaging needs to appropriate care teams.
5. Navigation of patients to the social resources they need: GetWell Navigators — virtual, and digitally enabled by the Get Well platform — can guide patients to local resources via texting or phone, reducing the workload for overburdened care teams and closing the loop on community referrals. The “high-tech, high-touch” combination sets the GetWell SDOH solution apart.

What You Should Know:

• Emory Healthcare (EHC) today announced a partnership with NeuroFlow to support and improve the delivery of psychiatric services for both patients and providers at their Brain Health Center and several sites across Georgia.
• NeuroFlow, which offers a cloud-based registry and enterprise platform to help facilitate collaborative care, will support EHC clinical services’ data-driven approach to patient care, with a sharpened focus on improving communication between care teams, including primary care providers, behavioral health specialists and care coordinators.
• The implementation of NeuroFlow in Emory Healthcare’s primary care clinics will begin in May 2023, with plans to expand to additional clinics throughout the year.

Increasing Access to Behavioral Health Services

The strategic partnership will seek to complement and scale Emory’s new collaborative care model (CoCM) within its primary care clinics. The CoCM is part of Emory’s Integrated Behavioral Health (IBH) Program, which was formed by the Department of Psychiatry and Behavioral Sciences to help meet significant access demands for behavioral health services in the EHC network. CoCM is embedding licensed specialists called behavioral health care managers (BHCMs) to work in EHC primary care clinics alongside primary care clinicians to provide psychotherapy onsite and serve as liaisons with psychiatric consultants.

Through NeuroFlow, Emory patients are given 24/7 access to self-directed content that reinforces psychotherapy guided by the program’s BHCMs and provides care teams with frequent measures of patient progress. This engagement between office or telehealth visits supports traditional care and can lead to faster recovery, better overall outcomes and fewer readmissions.

“This collaboration introduces the type of technology needed to assist our healthcare providers and patients in bridging the gap between mental and physical health,” says William McDonald, PhD, chair of Emory’s Department of Psychiatry and Behavioral Sciences. “While our teams already practice collaborative, integrated care, this partnership serves as a driving force to expand and enhance these endeavors throughout the Emory ecosystem, ultimately resulting in improved outcomes and reduced costs.”

What You Should Know:

• Healthcare providers face the difficult challenge of coping with an ever-increasing workload while still providing high-quality patient care and trying to retain their staff. 
• As the CEO of CalmWave, Inc., Ophir Ronen is an expert in both patient outcomes and staff retention who understands the importance of leveraging AI technologies to reduce alarm fatigue and deliver more efficient quiet care. 

Delivering Efficient Care by Reducing Alarm Fatigue

Alarm fatigue is a critical issue that plagues the healthcare industry, particularly in intensive care units (ICUs) and critical care settings. It occurs when healthcare professionals become desensitized to the constant barrage of beeping alarms from medical equipment, which can lead to missed or delayed responses to life-threatening situations. The over-reliance on alarms often results in false alarms, creating a sense of mistrust and a potentially hazardous environment for patients and clinicians. This problem has been exacerbated by the increasing complexity of medical technology and the consequent proliferation of alarms.

 CalmWave, Inc., is an innovative solution that addresses the alarm fatigue problem. By leveraging artificial intelligence and machine learning, CalmWave, Inc., filters out unnecessary alarms and alerts healthcare providers only when it detects critical events, thereby enhancing patient safety and improving clinical outcomes. CalmWave, Inc.’s, technology is highly relevant as it enables clinicians to focus on the most critical patient needs and make more informed decisions, improving the overall quality of care delivered in healthcare settings.

In an interview with HIT Consultant, Mr. Ophir Ronen (CEO CalmWave, Inc.) talks about the importance of AI-driven solutions to alarm fatigue.

How can digital health help healthcare providers balance workloads while still delivering quality care? 

Ophir Ronen, CEO of CalmWave, Inc.: Digital health can revolutionize healthcare by optimizing operations health and streamlining workflows, allowing healthcare providers to balance workloads while maintaining high-quality care. One of the critical aspects of digital health is the ability to leverage and activate the vast amounts of data generated by various systems, such as electronic health records (EHR) and connected devices.

By aggregating medical data from multiple sources, including vital signs, EHR, and clinician attrition data, digital health solutions can help identify optimal clinical workloads. Artificial intelligence (AI) plays a crucial role in analyzing this data to generate objective measures to enhance staffing and workflow efficiency.

Furthermore, digital health can alleviate the burden of non-clinical tasks on healthcare providers by automating these processes. This automation allows clinicians to focus on patient care, ensuring the highest quality outcomes. By optimizing workloads and streamlining processes, digital health enables healthcare providers to work at the top of their licenses, benefiting patients and healthcare systems.

How can AI improve nurse retention and patient outcomes? 

Ronen: AI has the potential to significantly improve nurse retention and patient outcomes by addressing critical challenges faced by healthcare professionals, such as alarm fatigue and non-value-added work. By optimizing medical alarm systems and reducing non-actionable alarms, AI can create a more manageable work environment for nurses, increasing job satisfaction and reducing turnover.

In Intensive Care Units (ICUs) around the world, an overwhelming number of alarms (85-99%) are non-actionable, contributing to alarm fatigue, stress, and patient disturbance. AI can aggregate alarm data from various sources, such as pulse oximeters and blood pressure cuffs, to identify optimal thresholds that minimize non-actionable alarms. As a result, the clinical work environment improves, leading to higher nurse retention, and patients can rest more effectively, enhancing their recovery.

Moreover, AI can help alleviate the burden of non-value-added tasks that clinicians face daily. Nurses often spend a significant portion of their time on non-clinical work, which can contribute to burnout and attrition. By automating these tasks, AI allows nurses to focus on patient care, leading to better job satisfaction and patient outcomes.

An example of AI in action is the CalmWave Operations Health AI Platform. This platform analyzes the constant flow of data from vital signs monitors to provide objective measures of clinical workload. It identifies clinicians at risk of burnout, enabling healthcare leaders to make informed decisions and implement strategies to improve nurse retention.

Given the concerns about clinician burnout, what role does reducing alarm fatigue with data-driven insights have in combating burnout? 

Ronen: Reducing alarm fatigue through data-driven insights is essential in combating clinician burnout and improving patient care. As a significant contributor to stress and cognitive overload, alarm fatigue can negatively impact healthcare providers’ mental well-being and job satisfaction.

AI-based solutions, such as CalmWave, can identify the sources of non-actionable alarms and provide data-driven recommendations for clinicians to make informed decisions. By offering real-time insights, these AI platforms enable healthcare professionals to adjust alarm settings efficiently, ultimately reducing false alarms and creating a more manageable work environment.

Reducing alarm fatigue benefits not only clinicians but also patients. Quieter environments allow patients to rest more comfortably, contributing to faster healing and better overall outcomes. By addressing alarm fatigue, AI solutions can significantly enhance the quality of care and support healthcare providers in their mission to provide the best possible patient care.

What are some of the barriers to implementing AI-driven solutions aimed at combating alarm fatigue and clinician burnout in healthcare settings? 

Ronen: Implementing AI-driven solutions to combat alarm fatigue and clinician burnout in healthcare settings faces several barriers, including organizational complexity, risk aversion, cost, data privacy, and clinical risk concerns. Hospitals, being highly complex systems with multiple stakeholders and priorities, often need extensive testing and proven effectiveness to adopt new technologies.

Despite these challenges, AI-driven solutions like CalmWave’s Operations Health Platform can offer significant benefits in reducing costs, maintaining data security, and improving patient care. By providing objective measures of clinician workload, the platform helps to enhance nurse retention, reducing the financial burden of nurse attrition in hospitals.

CalmWave’s platform is also SOC2 Type II certified, ensuring that data remains secure and protected. Regarding patient care, the platform reduces non-actionable alarms, alleviating alarm fatigue for healthcare providers and creating a more conducive environment for patients to rest and recover.

Current healthcare systems are overwhelmed, understaffed, and under-resourced, making it difficult for clinicians and leadership to explore new solutions. Some AI implementations require lengthy integration processes and extensive training, adding to this challenge. However, CalmWave’s human-centric design philosophy focuses on minimizing implementation complexity, providing just-in-time training, and enabling clinicians to use the platform to optimize care readily. Overcoming these barriers and embracing AI-driven solutions like CalmWave can significantly enhance healthcare delivery and benefit both patients and providers.

What are other promising implementations of AI that can help alleviate clinician burnout? 

Ronen: Several promising AI implementations under development aim to alleviate clinician burnout. One such development involves integrating patient bedside monitoring equipment, allowing AI-driven platforms like CalmWave to analyze data more effectively and ensure better alarm management.

AI can also actively map individual alarms to specific incidents, generating alarms based on the overall incident rather than each individual alarm. This approach reduces alarm fatigue and cognitive overload, creating a more manageable work environment for healthcare professionals.

In addition to bedside monitoring integration, AI can help reduce paperwork burdens by automating documentation processes, freeing up more time for clinicians to focus on patient care. Increasing efficiency in administrative tasks further lowers the risk of burnout among healthcare providers.

AI can also assist in clinical decision support by analyzing large amounts of patient data and providing healthcare professionals with accurate and timely insights for informed decision-making. This enhancement of care quality reduces the cognitive load on clinicians and contributes to decreased burnout and improved job satisfaction.

What impact does ‘quiet care’ have on the patient? 

Ronen: Quiet care promises to revolutionize care for critically ill patients by providing a truly quiet, peaceful, and restful environment in the ICU, something that has been missing since the beginning of continuous patient monitoring. Clinicians once believed that they and their patients had no choice but to tolerate the noise from monitors, but CalmWave technology is changing that perspective.

Other patient populations, such as those in Neonatal Intensive Care Units and Pediatric Intensive Care Units, have already benefited from noise reduction efforts, recognizing the harm noxious stimuli can cause premature infants, newborns, and children. Studies on Labor & Delivery patients have shown that quieter, peaceful laboring environments lead to more relaxed mothers with lower blood pressure, less labor pain, and calmer babies.

Research also indicates that high noise levels, including alarm noise, in ICUs can negatively affect patients’ sleep quality and duration. Insufficient sleep can increase the risk of developing delirium, an altered mental state, with potential long-term effects. Reducing non-actionable noise in ICUs significantly improves patients’ ability to recover, as they can rest and heal properly. Quiet care allows clinicians to provide the best care to patients without distractions from non-actionable alarms, ultimately optimizing patient recovery and outcomes.

The U.S. healthcare industry has hit an important inflection point. The global pandemic highlighted an increased need to deliver quality patient care. However, outdated, legacy technology is straining many health systems, and in some cases, exaggerating existing problems such as rising operational costs and high rates of attrition.

Health and hospital systems must take a purposeful approach to IT modernization — which includes embracing new technologies — to ensure success. And while each IT strategy should be tailored to the unique needs of individual systems, there are three guiding elements all healthcare institutions should keep top of mind.

1. Take a proactive approach

Much like caregivers encourage their patients to take a proactive approach to their own wellness, healthcare institutions should take a proactive approach to their IT environment. This is especially true for systems that have been impacted by mergers and acquisitions in recent years, as they may be managing the existing burdens of redundant applications and inherited technology.

To address this complexity, healthcare institutions should integrate predictive technologies like AIOps and automation to enable more efficient operations, and ultimately, ensure an uninterrupted patient experience.

For example, if a brewing issue goes unnoticed, it can create a disruption in device ecosystem health, stopping a caregiver’s telehealth appointment or a pharmacist’s ability to scan prescriptions. If it reaches the point when IT support needs to step in, that’s crucial time lost that could be spent with a patient.

Traditional IT monitoring typically falls into two categories, green for “good” and red for “bad”. However, AIOps and automation give us “yellow,” which enables us to put out the brushfire before it becomes a wildfire.

2. Look to your team

Research shows that burnout across healthcare providers has reached an all-time high, resulting in increased turnover and high vacancy rates across hospital staff. While recent studies cite a lack of technology and automation among the top hurdles, the answer isn’t simply to roll out next-gen technologies like A.I. chatbots and assume it will save the day.

The tools healthcare systems adopt must be accessible, intuitive and designed for the unique environments in which they’re deployed. That’s why it’s imperative to first understand all the players that are intimately impacted by technology each day.

One way to tackle this is by bringing healthcare professionals directly into the conversation. For example, when tapping insights from its nursing population, a hospital system may learn the current IT help desk lives in an inaccessible part of the hospital. So, when problems with their IT equipment arise, it requires a large investment of their time – time that could be spent with patients – to resolve the issue. To remedy this, a hospital may consider setting up a designated help desk for caregivers in a centralized location and staffing it with an IT expert that can offer hands-on support.

While these adjustments may seem minor, even if it improves attrition by 1%, that’s massive dollar savings.

3. Establish an end-to-end view

Decades of growth through healthcare mergers and acquisitions have resulted in old, redundant applications that are straining many systems. On top of that, many institutions during the pandemic were forced to quickly adopt new technologies or transfer existing applications onto the cloud without a long-term strategy. This was necessary so they could remain operational amid the healthcare crisis.

But today, many are now left with siloed data across their IT systems, which can result in security vulnerabilities, decreased efficiencies in operations – and even impact revenue growth.

Healthcare institutions must tackle these IT gaps by enabling an end-to-end view of their data. For many, this starts with embracing cloud technology as a way to gain flexibility and interoperability between existing systems, delivering a more secure environment for confidential data and patient information. This also enables institutions to better identify crucial inefficiencies that should be corrected, such as eliminating duplicative vendors or software to streamline costs and workstreams. 

Reap what you sow

Taken together, these baseline changes represent a strong foundation for how hospital systems everywhere — paired with new technologies — can define the future of healthcare in the U.S. 

Ultimately, a comprehensive IT modernization strategy is no easy lift. And it would be a mistake for healthcare institutions to think they can tackle this challenge alone. Rather, identify a trusted partner that understands the ethos and pathos of what drives your health system, and one that can create a modernization roadmap that fits your long-term goals.

Now is the time for the healthcare industry to embrace new technologies and invest in digital transformation. Organizations that shore-up their IT strategies today will reap the benefits of their investments for years to come. And once you have a stable IT infrastructure, you can begin to shift attention elsewhere, identifying new avenues for growth.

About Trent Sanders:

Trent Sanders is the leader for U.S. Healthcare & Life Sciences at Kyndryl, the world’s largest IT infrastructure services provider. Trent and his team help the nation’s leading provider, payer, and life science organizations accelerate IT innovation to drive enhanced experiences and outcomes across the health journey.

What You Should Know:

• ODAIA, developers of MAPTUAL, an AI-powered commercial insights SaaS platform for pharmaceutical companies, announced it raised an oversubscribed $25 Million Series B financing round, led by Threshold Ventures and co-led by Monograph Capital. Wittington Ventures also joined, with participation from existing investors Flint Capital, BDC Capital, StandUp Ventures and Graphite Ventures.
•  Emily Melton, Managing Partner of Threshold Ventures and Charles Conn, co-founder and Partner of Monograph Ventures, will join ODAIA’s board. Megan Kelly, Principal of Threshold Ventures, will also join as a board observer.

Fuelling the Rapid Growth of AI-Powered Solutions Helping Pharma Companies

With its ability to provide near real-time and predictive perspective on the dynamic changes of the pharmaceutical marketplace, ODAIA’s proprietary platform MAPTUAL empowers leading life science brands to more efficiently get therapeutics, drugs and vaccines to the markets that need them with a modern, data-driven solution.

With several top 20 global pharmaceutical companies as customers and having grown year- over-year annual recurring revenue (ARR) in 2022 by over 750%, ODAIA is transforming pharmaceutical marketing and commercialization with its lead product, MAPTUAL. MAPTUAL is a SaaS platform that leverages AI to streamline and automate the prospecting, qualifying and engagement of healthcare providers (HCP), a process that has largely been manual, labor intensive and time consuming.

“ODAIA’s ability to constantly ingest and update a broad mix of life sciences data and turn it into comprehensive insights in near-real-time turns pharmaceutical sales from reactive to proactive,” said Emily Melton, Managing Partner at Threshold Ventures. “We’re thrilled to lead their Series B financing. ODAIA helps get life changing drugs into the hands of those who need them faster and more efficiently.”

MAPTUAL is engineered to take the guess-work out of Pharma’s current workflow by unifying commercial teams through digestible and actionable predictive insights. Its two products, MAPTUAL Field and MAPTUAL Sphere, are built on an easy to navigate platform that provides a near-real-time and predictive perspective on a brand and its market;

● MAPTUAL Field provides sales reps with a granular view of health care providers, allowing pharma sales reps to use robust segments, prescription data – both historical and predicted – to improve their pre-call planning and spend more time seeing customers rather than analyzing data.

● MAPTUAL Sphere enables sales managers to effectively coach their team by discussing territory brand and market dynamics and HCP channel preferences. Marketers are also able to understand the contribution of different channels, by HCP segment, on prescription trends to make better marketing strategy and execution decisions.

Using MAPTUAL Field and MAPTUAL Sphere together allows for tailored insights to be delivered to the right teams, while ensuring consistency in analytics and data sources, and ultimately leading to better and timely patient care. Through its impressive predictive technology, ODAIA is unlocking smarter ways for leading life science companies to engage customers and lead to better patient care.

The pandemic has accelerated the adoption of digital health technologies across the healthcare industry. Digital transformation is now the top priority for many healthcare leaders as they seek to build resilient systems. At its core, this means implementing emerging digital technologies to modify essential operations, processes, and services to ease staff workload and withstand future challenges.

The primary drivers of digital transformation are consumerism, cost, and experience/expectations, each largely stemming from the pandemic. According to the Deloitte Center for Health Solutions, health systems are considering emerging digital technologies as the conduit to transform their relationship with consumers and increase staff efficiency and satisfaction. In fact, 92% relayed that increased consumer satisfaction and engagement are the top outcomes facilities aim to achieve from digital transformation, followed by improved care quality at 56%. Additional top outcome goals include enhancing the patient experience, IT/cybersecurity, clinical care delivery, and staff satisfaction.

As these goals and digital investments progress, the once golden standard of optimizing healthcare performance has shifted from the Triple Aim (enhancing the patient experience, improving population health, and lowering costs) to the Quadruple Aim, which factors the clinician’s well-being into the equation. Over the last few years, the pandemic has repeatedly demonstrated the effects of clinician burnout and how it impacts the patient experience, health outcomes, and financial costs. As healthcare organizations seek improvements to the patient experience, care quality, and costs, they must also consider the clinician’s well-being. Digital transformation holds the key to fully re-engineering healthcare processes for the better, which will benefit the patients, clinicians, and healthcare organizations overall.

Delivering Value and Operational Efficiency

Digital transformation isn’t about removing the human component but focuses on using technology at each step to optimize the experience for all parties. In healthcare, the transformation means adopting different tools to enable patients to take a more active role in their care journey while also reducing provider involvement in non-clinical tasks to increase their time with patients.

Advanced technology leverages capabilities that keep patients and healthcare professionals better connected, helping to address the Quadruple Aim. In most industries, the customer (or patient) is a significant part of the equation. This can be better mirrored and developed within the healthcare industry through interactive patient care systems leveraging open APIs. This allows added functionality via electronic health records (EHR) and integrations with existing systems such as nurse call, environmental controls, and meal ordering to drive patient satisfaction and operational efficiency. For example, the patient can change the room’s temperature, lower the lights, order a meal, and place a service request without needing facetime with a nurse. These systems give the patient a sense of independence and control in an unfamiliar space and allow staff to remain focused on care, improving healthcare experience and efficiency through digital enhancements. 

Digital Transformation provides new ways to deliver value and can do so in a variety of ways by integrating systems at scale. The benefits of these integrations range from supplying the patient the ability to self-schedule appointments on the front end to staff using advanced analytics and Robotic Process Automation (RPA) to settle claims on the back end. The options are endless with an open API.

The ability to integrate data from different providers and systems into one easy-access platform, also known as interoperability, holds great promise for patient care and staff satisfaction. By leveraging a secure and advanced digital platform, patients can become more involved with their care. Patients can review their health records, check prescriptions, schedule appointments, request additional information from doctors, view lab results, and share health data with their providers. These tools also pair with personal devices, allowing individuals to navigate their health journey easily and safely from the comfort of their own phone, tablet, or even the television anytime, anywhere. 

At the point of care, integrations between the latest television technology and existing HIT applications are cost-effective and open the door to an enhanced patient experience with customized educational materials, easy communication methods, and improved collaboration tools. Integrations on the patient’s in-room television incorporate patients into their care, lowering costs and elevating satisfaction on all levels of the facility. When patients gain easy access to their health data, they’re empowered to make more informed decisions about the kind of care they would like to receive during and after hospital admission. Patients who are actively engaged in their own healthcare journeys see more improvement than passive participants. 

Outcome-Driven Acceleration

Empowering patients and families to be informed partners in their care improves outcomes while creating opportunities for staff to receive real-time patient feedback and make immediate adjustments to improve the patient experience. Digital transformation is accelerating healthcare using a focus on people — this means the patient experience, quality outcomes, and staff satisfaction come first. 

Transparency and open communication between patients, providers, and loved ones are at the heart of the people-focused approach and drives better results. This patient-centric focus must be at the center of every innovation and be based on listening to the consumer with empathy and putting the other person first (patient, family, and clinician). 

For example, innovative technologies that address patient pain points have been frequently leveraged to reduce new barriers. During the height of the pandemic, as necessary infection controls resulted in separation between families and admitted patients, tools such as video chat integrated with the television system in patient rooms were able to return comfort as patients could communicate virtually with their loved ones. This technology continues to be utilized and returns trust between patients and providers, reduces family separation, eases anxiety, and empowers patients and providers to communicate more effectively.

These digital transformations make care delivery more accessible and approachable for all patients. Data-driven solutions that are patient-focused present an engagement roadmap to enhance the experience while preparing the patient and family for smooth transitions throughout the care journey. This shift toward patient-focused cross-continuum care creates opportunities to accelerate mobile-optimized digital care journeys that engage and activate patients before, during, and after care. Digital technology bolsters more efficient care coordination, giving patients the right care and support at the right times in the right settings. With digital transformation, indirect communication and redundancy are eliminated, response times are reduced, and the overall care journey is more efficient. 

The Future of Healthcare

All industries, including healthcare, will continue to transform and advance using digital innovations. There are significant benefits to it in healthcare including reducing the amount of data that is siloed and providing more accessible health information to increase efficiency. 

As consumerism, costs, experiences, and expectations continue to drive digital transformation, healthcare facilities should select an end-to-end partner with a secure patient engagement system that fully integrates with the existing HIT and helps healthcare teams seamlessly collaborate with patients and families across the care continuum. A trusted service provider will be equipped in delivering value to customers and patients alike in a quickly evolving ecosystem. 

Digital transformation is designed to increase staff efficiency and benefit operations while improving patient outcomes and experience. With new ways of delivering value, digital transformation will allow patients, families, and providers to become more connected and ensure better health outcomes.

About Dave Bennett 

Dave Bennett is the CEO of pCare. His visionary approach to patient engagement, digital and mobile technologies, and IT integration ensure continuous innovation of the #1-KLAS ranked pCare platform and a company culture dedicated to delighting customers. Prior to joining pCare, Dave served in a variety of executive roles at ViiMed, GetWellNetwork and StayWell. Dave holds a CISM certificate from ISACA and is an active member of the Healthcare Information and Management Systems Society (HIMSS), The American Health Information Management Association (AHIMA), Information Systems Audit and Control Association (ISACA), and the American College of Healthcare Executives (ACHE).

What You Should Know:

• As electronic medical record (EMR) adoption grows worldwide, healthcare organizations considering this digital transformation all have the same question: what benefits can we really expect to receive from implementing an EMR?
• KLAS interviewed leaders at 36 non-US healthcare organizations—12 of which are HIMSS Level 6 or 7—to learn about their journey to realizing benefits from an EMR implementation. Their latest report summarizes their insights, including what clinical and operational benefits they have seen, when those benefits were realized, and what recommendations they have for peer organizations.

Industry Insights into the Expected Benefits From Adoption of the EMR

The key benefits mentioned in the report are as follows:

1. Improved Patient Care: Improved patient care is the main overarching clinical goal of an EMR implementation for most organizations. Almost all surveyed said they achieved this, at least in part. Care improvement is realised through a variety of avenues. It was also identified that slower adoption of the EMR can delay full realization of care improvements..
2. Consolidated Medical Record and Reduced Medication Errors: It was identified that adoption of electronic medical records allowed most organizations to bring together patient records into single source of truth, thereby creating greater visibility into patient history/care journey and higher patient and clinician satisfaction. Furthermore, order sets, alerts, CDS, and barcoded medication administration help catch issues of high doses, allergies, and other errors
3. Use of Clinical Decision Support (CDS): More digitally mature organizations often achieve this benefit, including a related drop in medication errors. About half of respondents have not achieved this as expected, citing the longer-than-expected process to develop databases and set up needed rules and triggers.
4. Reduced Sepsis/other HAIs: Multiple organizations report ability to identify sepsis faster because of EMR alerts and triggers. Organizations also see improved visibility into and measurability of HAI rates, which can be difficult to compare to pre-implementation rates. Often varies by vendor depending on strength of sepsis tools.
5. Increased Time With Patients: Organizations have mixed opinions of EMR’s effect on patient/clinician care time. Outcome is highly dependent on the individual organization, depending on how efficiency gains are used (i.e., more time with patients versus increasing patient load). For some, electronic charting takes similar time as paper charting, especially in early stages, leading to nonexistent or lower- than-expected gains in clinician time with patients.

The report also included insights into how healthcare organizations can also expect significant financial and operational benefits from their EMR. Increased staff efficiency was identified to be the biggest overarching operational outcome that interviewed organizations expect. 61%–80% achieved this outcome to some degree, particularly when staff members were up to speed with the EMR.

These organizations describe templated clinician documentation, less duplicate documentation, faster intradepartmental communication about orders and results, and automated alerts and notices (which prevent clinicians from having to chase reports). However, just over 60% of surveyed organizations have not achieved the level of efficiency gains they expected. Some say gains were bigger for clinicians than IT personnel; naturally, implementing an EMR increased the IT load, specifically infrastructure management and IT support. Other organizations say EMR documentation still takes a good deal of time, and the number of clicks detracts from expected efficiency gains. Notably, most organizations can only estimate effect on efficiency, which is difficult to concretely measure.

The report concludes by asking the question, “What Can Organizations Do to Achieve More

Benefits from an EMR Implementation?” The advice KLAS gives is two-fold:

1. Have a strong plan and vision in place before beginning the implementation

46% of interviewed organizations feel their success was driven mostly by their organization, and 43% say it was achieved in even partnership with their EMR vendor. Across both of these groups, organizations agree they needed to come to the table with a clear understanding of their own needs, unique workflows, and goals and objectives to guide the implementation.

2. Work closely with your vendor partner

Organizations that feel benefits were equally driven by the organization and the vendor were more likely to report clinical and financial/operational benefits, compared to those whose success was primarily organization-driven. One organization described the necessary partnership as one where the healthcare organization can bring ideas to the vendor, and the vendor provides guidance and suggestions on what to do and how to do it. It’s important to select a vendor partner who will work with the organization to understand their specific needs and workflows and implement the EMR accordingly. Some vendors can be more proactive about this type of partnership than others.

What You Should Know:

Today at HIMSS23, Amazon announced a new suite of Alexa Smart Properties (ASP) for Healthcare capabilities designed to improve the patient and medical staff experience at hospitals.

– With these new capabilities, healthcare and solution providers have even more ways to enable device fleet management and build Alexa capabilities at scale for patient care.

The new Alexa features include:

• Upcoming availability of WebRTC support: will help patients and medical staff conduct audio and video calls between Echo devices and non-Echo devices like tablets and laptops
• Private Branch Exchange (PBX) Support: Allows healthcare providers to link ASP-supported devices with their hospitals’ phone systems for routing Alexa calls and supporting caller ID when patients and medical staff conduct inbound and outbound calls.
• WPA2 Enterprise Wi-Fi: The upcoming ability for providers to onboard ASP-supported devices to WPA2 Enterprise Wi-Fi networks so that healthcare providers can safely and securely connect these devices to Wi-Fi more seamlessly.

Amazon also announced the upcoming availability of the Echo Show 15, an entirely new type of Echo Show that hangs naturally on the wall and features a large screen for ideal accessibility and digital signage. Its plastic and glass case materials can also be sanitized more effectively for hospital settings.

What You Should Know:

• Rimidi, a leading clinical management platform designed to optimize clinical workflows, enhance patient experiences and achieve quality objectives, today announced the company is now integrated with MEDITECH Greenfield.
• MEDITECH customers will  now able to utilize Rimidi’s cloud-based software platform within their existing workflow, further enhancing efforts to support efficient models of care for chronic disease management through Fast Healthcare Interoperability Resources (FHIR) application programming interface (APIs).
• The healthcare industry initially adopted FHIR as the protocol of choice for API-based data exchange to enable a seamless transfer of patient health information from multiple data sources. As the industry continues to strive toward a value-based care model, the overall healthcare API market is expected to increase to $309.86 million by 2032, allowing for more enhanced collaboration to enable better patient care. 

Rimidi/MEDITECH Greenfield Integration Benefits

Rimidi’s integration with MEDITECH allows clinicians to use Rimidi within their existing MEDITECH workflow. Specifically, the integration: 

What You Should Know:

– Xandar Kardian, a Toronto-based leader in developing radar signal processing technology for vital sign monitoring, has formally announced an integrated partnership with Caregility, an enterprise telehealth leader dedicated to connecting care for patients and clinicians everywhere.

– For the first time ever, Xandar Kardian will embed its radar technology and data into a partner’s existing product line, joining Caregility’s Best in KLAS Caregility Cloud™ virtual care ecosystem to create a solution wholly focused on optimizing acute patient care. 

– Xandar Kardian’s partnership with Caregility, which will begin rolling out across facilities this spring, will increase capacity for staff to virtually observe and manage higher-acuity patients in a traditional med-surg environment while leveraging a workflow and connectivity they are already familiar with.

What You Should Know:

– Today, Global Healthcare Exchange (GHX) announced that it has signed a definitive agreement to acquire Pittsburgh, Penn.-based Prodigo Solutions, Inc. (Prodigo), a supply chain and data enablement technology company.

– Prodigo was founded in 2008 by UPMC, the world-renowned Pittsburgh-based healthcare provider and insurer. Prodigo’s offerings help to broaden the healthcare supply chain’s span of control, expanding the potential for savings across multiple categories of spend (including non-traditional categories such as purchased services, minor equipment, and labor) and across a quickly expanding continuum of care (including acute, nonacute, clinics, offices, and direct-to-patient care). 

– Prodigo shapes demand by directing spending toward contractually compliant and cost-optimized product options during the procurement process.

What You Should Know:

• For years, documentation has been a pain point that has led to clinician frustration and burnout, but numerous strategies have emerged to ease that burden and enhance patient care. COVID-19 has exacerbated burnout, leading organizations to renew their focus on improving documentation.
• A new report by KLAS examines physician-facing documentation technology and services, along with how vendors compare in overall scores, and the key performance metrics of value and outcome.

Key insights on Clinical Documentation Strategies in 2023

Over the last three years, healthcare organizations have seen increased employee attrition, heightened levels of physician burnout and dissatisfaction, and increased costs that have squeezed already tight profit margins. As a result, outcomes and value are top of mind for provider organizations as they consider their documentation strategies, even taking precedence over technology consolidation, which is a focus for organizations in many other areas. The outcomes that are most frequently commented on include improved dictation accuracy, increased capture of billable issues, correctly identified and coded encounters, reduced time spent preparing and reviewing documentation, and improved documentation closure times to decrease outstanding A/R days.

The most crucial findings from the report are as follows:

1. Ambient Speech Recognition: Technology Rapidly Growing and Showing Initial Promise: While there are a few vendors that either employ or are working on ambient speech technology, this is still a newer market that is not yet fully measured by KLAS.
2. Front-End Speech Recognition: Becoming the Go-Forward Platform for Documentation: Provider organizations report that the overall market is moving toward speech recognition as the go-to documentation platform. Respondents feel that speech recognition has improved over the last couple  of years in its accuracy and ability to detect accents, at least to the point that it is on par with the accuracy seen in transcription.
3. CAPD: Organizations See Benefits, but Physician Buy-In Remains Low: Almost all respondents mention the benefits of CAPD; the real-time nature of CAPD enables more efficient code capture and therefore improved revenue and reduced documentation time. Still, adoption among physicians is proving to be a challenge for a few reasons. Some provider organizations using CAPD solutions cite inaccurate or erroneously fired recommendations.
4. CDI: Technology Drives Results, but Development Has Been Slow: There is currently wide adoption of CDI in the inpatient space, and there is significant growth of CDI in outpatient care. Even so, provider organizations feel that development of CDI software overall has stagnated. An exception to that may be Iodine Software, who respondents see as a highly innovative company.
5. Transcription Services: Adoption Decreasing, but Still a Valuable Part of Provider Workflow: Respondents feel that transcription will continue to play a limited but important role in documentation. Transcriptionists and scribes have been especially useful as an aid for physicians who are hesitant to adopt speech recognition technology and as a backfill for organizations with large documentation backlogs. The transcription market has recently seen a lot of change, as AQuity Solutions has spun off from MModal after being acquired by 3M, and as DeliverHealth has acquired Nuance’s transcription services arm. As a result of these changes, respondents feel that their relationships with their firms have suffered slightly. Client satisfaction with executive involvement, proactive service, and communication have all recently declined somewhat.
6. Virtual Scribes: Still Having Highly Positive Impact, though Replacements Cause Inconsistencies: 94% of respondents feel that their virtual scribe has a positive or highly positive impact on their documentation time, and most mention that their documentation is completed by the end of the day. Provider organizations are most likely to recommend using a virtual scribe as a bridge to help achieve same-day closures when physicians are having difficulty closing their notes in a timely manner. 

What You Should Know:

• Arcadia, a healthcare data analytics company raises $125M from Vista Credit Partners and a strategic investor and financing partner focused on the enterprise software, data and technology market.
• Arcadia helps providers and health plans deliver actionable insights to advance care and research, drive strategic growth, and ensure financial success.
• The investment will accelerate Arcadia’s platform innovation and go-to-market strategy to meet the growing demand from leading healthcare organizations to aggregate and analyze data from across disparate systems for business efficiencies and improved patient care.

The greatest innovation in healthcare in the last twenty years is something that connects us all… data. At any given moment, healthcare facilities, hospitals and more rely on data to operate more efficiently, drive forward patient care and further develop medical research. Even in the last two years, data has been paramount to the development of mRNA technology that has helped us combat the COVID-19 crisis and even led to a new treatment for type-two diabetes. 

The recent medical breakthroughs speak to the power of data and the vast potential it has to help improve lives. Unfortunately, as data becomes more valuable, the threats become direr. As the attackers evolve, organizations need to take a holistic approach if they want to defeat the threats.

 Let’s explore what these threats are and what healthcare institutions can do to protect the essential data of their customers and patients.

The health risks of patient data in healthcare

Ransomware is among the leading risks in data exploitation — and sensitive patient data is a honey pot for cybercriminals looking to take advantage of glaring vulnerabilities. Because healthcare organizations keep up with such a high volume of data (i.e., medical records, patient forms, health insurance claims, provider and patient communication records, etc.), they can become prime targets for hackers. 

Cyber attacks on healthcare organizations happen so often that 45 million people were directly affected in 2021. In the summer of 2022, one of the largest healthcare cyber incidents to date struck more than 2 million patients across 50 facilities in an attack on Shields Health Care Group. 

The right systems must be put in place in order to protect hospitals and other key healthcare infrastructures from these types of attacks. Successful attacks can leave healthcare organizations reeling for weeks or even months, with many juggling the ransom demands from malware gangs with the bureaucracy and communications needed to reconcile fragile patient data. This can put enormous strain on existing systems and draw the issue to its breaking point.

Additionally, natural disasters are more frequent, destructive, and striking new locations. Large storms like Hurricane Sandy and Katrina caused hospitals to evacuate patients, taking them and their sensitive data to different facilities. Many data systems were down for weeks during these disasters, making patient identification, health logs and more incredibly difficult to track. Today, when healthcare is almost impossible without the patients’ data, one disaster has the potential to wipe out a hospital’s data center and its ability to provide care, especially when that hospital has nothing in place to effectively restore lost patient data once it happens.

Finally, one of the greatest threats to patient data comes from the inside. Patient data has been stolen or sold by those who had insider access, making the threat of these kinds of exploitations both an internal and external affair. In all cases, whether it’s from a ransomware attack, flood, or insider, losing data harms patients, slows research, and causes the public to lose faith.

Healthcare data deserves a routine check-up

It is paramount that your data be protected and available on demand, no matter the scenario. Adopting the mindset of anticipating the unexpected is key to a successful anti-ransomware strategy. When that time comes, you must recover data quickly to limit downtime and service disruption. Creating an integrated protection plan and staying vigilant is important — ransomware actors are constantly updating their methods of attack so when it comes to protecting your data, you cannot “set it and forget it.”

Begin updating your own plan by identifying the areas that your teams have access to and which areas are experiencing rapid data growth. Once you have done that, back up all your data to a secure, offsite location. This will ensure that in the event your primary environment becomes compromised by a disaster, like an unexpected flood to your data center, you’ll have duplicate information on standby. Finally, try to assess which types of data support your mission-critical applications, so you can set up additional high-availability infrastructure. 

What’s the purpose of protecting all data ahead of determining which parts are mission-critical? First, it must be understood that the relationship between data, infrastructure, and applications can be complex. Disaster can strike amidst your attempts to untangle the web of data in your infrastructure. Second, new data is constantly being processed and uploaded to new locations. By default, you should protect it because it is better to be safe than sorry. Third, data prioritization always changes, so you don’t want to sell yourself short leaving key data points unprotected.

Protecting your data can feel overwhelming, so your goal should be to deploy modern systems that ensure automated backups are constantly occurring. The cloud is a dependable platform that can help you meet global recovery needs in the event of a disaster — it doesn’t depend on any on-premises hardware or appliances to provide the support your organization may need in the time of an attack.

About Stephen Manley

Stephen Manley is the Chief Technology Officer at Druva, a SaaS platform for data resiliency, and the only vendor to ensure data protection across the most common data risks backed by a $10 million guarantee. Stephen delivers solutions to help customers extract the full potential of their data. In leading development of data management capabilities for startups and serving as CTO of the Data Protection Group at Dell EMC, Stephen found his passion in partnering with customers to solve data protection challenges for today’s enterprise and evolve modern data storage. He also spent time at NetApp as a senior technical director of data protection.