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.

What You Should Know:

– Chiefy, a NYC-based cloud platform that helps surgical teams seamlessly embed quality and communication best practices, today announced it has raised $4.2M in seed funding led by LionBird, with participation from Nina Capital and Emerge Ventures.

– The company plans to use the seed funding to accelerate and expand product development and customer acquisition.

Get Surgical Teams Aligned

Globally, over 300 million surgeries are performed each year, and more than $50 billion is wasted due to related errors––80 percent of which stem from miscommunication. According to the Joint Commission 2022 report, communication breakdowns continue to be the leading factor contributing to serious medical errors. Multi-disciplinary surgical teams are hard-pressed to convene safety huddles (or team briefs)–short meetings that proactively enable them to focus on patient safety, team alignment, and communication. Instead, many teams rely on emails, text messages, and phones calls about each surgery. Often, by the time the entire team is in the operating room it is too late to address communication errors without causing delays, waste, and frustration.

Getting all stakeholders in a room at the same time before each procedure is increasingly challenging––and often impossible. With Chiefy, surgical teams can easily perform digital huddles on a cloud-based collaboration platform––built by clinicians for clinicians––that seamlessly complements the clinical workflow. Chiefy represents a low-cost, low-risk opportunity for hospitals and health systems to quickly implement and scale a secure, compliant collaboration platform to engage clinicians and improve care quality.

The platform is HIPAA compliant and does not require EMR integration to demonstrate results and return on investment. Unlike local quality improvement projects that take years to implement and are hard to scale, Chiefy can be implemented in as little as two weeks, with no significant upfront investment, and deliver tangible benefits immediately. 

“When everyone is forced to do more with less, we must find new ways to employ technologies to help clinicians focus on what’s important,” said Chiefy Co-Founder and CEO Maya Ber Lerner. “Chiefy is built to challenge the idea that if hospitals want high quality, they need to be slower, or clinicians need to suffer. We believe that quality, efficiency, and clinician experience can be a win-win-win. This requires building a culture of trust, and our technology serves as an enabler for building this culture.”

What You Should Know:

• 4medica®, a healthcare data quality and matching technology company, today announced that the 4medica Enterprise Master Patient Index (EMPI) platform is now available on Google Cloud Marketplace.
• Built on Google Cloud’s Healthcare API, 4medica’s EMPI offers healthcare organizations access to a highly scalable data management services such as referential matching and identity enrichment.

Impact of Poor Healthcare Data Quality

Far too many healthcare organizations struggle with duplication rates of 20% or more. Inability to accurately match patients to their medical records makes it difficult for clinicians to make evidence-based decisions at the point of care. Inaccurate and incomplete patient records can result in poorer outcomes, medico-legal exposure and operational inefficiencies.

Applying artificial intelligence (AI) and machine learning (ML) to their EMPI data allows healthcare organizations to see patterns, opportunities and gaps that need attention. 4medica’s EMPI platform uses a four-layer process that begins with an analysis of a healthcare organization’s data quality to determine the duplication rate. Data then is run through 4medica’s Big Data MPI, after which ML is applied to automate error detection. Step 3 connects patient data with multiple third-party sources of information for referential matching and data enrichment. A comprehensive review of outstanding duplicate candidates and false positives by the 4medica data science team comprises the final layer.

“Poor data quality undermines the ability of healthcare organizations to improve patient outcomes while controlling costs,” said Riju Khetarpal, director, Healthcare and Life Sciences ISV Partnerships at Google Cloud. “With 4medica’s Master Patient Index now available on Google Cloud Marketplace, customers are able to build high quality data pipelines which improve patient safety and efficiency.”

What You Should Know:

• CareRev, a technology platform reimagining healthcare staffing by connecting hospitals and health systems with local nurses and other healthcare professionals for daily shifts, announced its expansion into Delaware with a partnership with Beebe Healthcare.
• Beebe will utilize CareRev’s technology to identify and hire qualified local Delaware talent to support their full-time hospital staff and ultimately improve patient safety and outcomes. Staffing managers at Beebe Healthcare are now able to post open shifts in real time on CareRev’s platform, to be claimed by pre-qualified healthcare workers, including registered nurses, certified nursing assistants, and techs in the area through CareRev’s mobile app.
• CareRev’s platform is designed to simplify onboarding workflows and produce staffing insights, allowing Beebe Healthcare to identify, activate, and manage a local, flexible workforce all in one place. This partnership will offer Delaware healthcare professionals the flexibility in their careers that they have been searching for, a chance to create their own schedules and work when and where they want. 

Staffing levels continue to plague health systems across all of the clinical and administrative areas, with no real signs of easing in the next several years. Employee retention efforts have never been more critical and leaders are looking to technology to help their staff work smarter. While AI promises to be everything to everyone, the use cases where it is successful are actually quite narrow. However, there has been great progress in automating administrative tasks, particularly in revenue cycle operations, that are producing meaningful productivity improvements and easing the workers’ burden. Collecting every dollar counts and these improvements are making a real difference for revenue cycle teams.

Burnout among providers is at an all-time high causing many to leave the workforce and a healthcare staffing crisis. Despite the promise of technology, to date technology has been more of a contributor to provider burnout than an aid. We must adopt health IT solutions with our providers in mind – implementing technologies that automate and augment repetitive provider tasks, freeing up valuable time for our workforce.

A powerful Master Patient Index (MPI) allows organizations to safely and accurately manage data with fewer resources. Many organizations employ a few to dozens of data stewards to eliminate duplications and resolve record overlays. The number of data stewards required can be reduced drastically through a powerful MPI and referential matching combined with machine learning capabilities.

Health IT is a misnomer. Very little of the health IT industry is focused on improving health; instead it is however focused on collecting codes, rather than innovating workflows that enhance patient care and support providers. The burden that the current state of healthcare IT places on providers directly leads to physician burnout and a reduced capacity to deliver quality patient care.

Imagine if a health system could partner with a tech-enabled virtual care team to offload routine and commoditized tasks. This would open up virtual care capacity for mild urgent and chronic issues, while also freeing up office-based providers to focus on more complex patients. This strategy would also improve clinician burnout by making the primary provider the head of a team that could manage a greater number of people, meaning they could increase their own revenue while ensuring better access for their patients.

Leading hospitals and health systems in North America are using virtual care technology that supports an augmented care environment where a virtual team doesn’t replace, but rather, provides support to the bedside team, enabling health systems to reduce labor costs while liberating their bedside nurses to provide elevated, hands-on patient care. For example, telesitting technology allows health operations staff to raise their patient management abilities from one patient per staff member to up to 16 with virtual monitoring. The solution also enables new Virtual Nursing models which provide health systems with a tool to help address clinician burnout and staffing shortages by efficiently leveraging their most experienced nurses to support bedside care teams and enable more efficient clinical workflows. At Trinity Health, falls declined from as many as 62 in the second quarter of 2020 to as few as 28 in the third quarter of 2021. Not only was patient safety better protected through virtual monitoring, but Trinity Health was also able to reduce its costs by $23M by avoiding non-reimbursed services for those injuries.

Hospitals face the challenge of increasing surgical revenue without adding OR staff or facilities. AI-powered automation in perioperative and inpatient settings, coupled with machine learning and behavioral science, allows systems to more efficiently schedule surgeries and reduce the length of stay. This drives OR growth and relieves overburdened staff of manual tasks.

Burnout threatens clinicians’ effectiveness, which ultimately can harm patients and contribute to costly readmissions. Health IT and intelligent automation that safely reduce the cognitive burden that repetitive and menial tasks place on already overloaded clinicians has never been more needed than it is right now. It also helps ensure certain processes are followed consistently and accurately since growing staff shortages force some hospitals to staff entire units or shifts with temporary or traveling clinicians. Technology can give time back to clinicians so they can focus on their patients – going beyond relieving burnout to reintroducing some of the joy in patient care that has been depleted for so many providers over the last several years.

Whether in a clinical hospital setting or a college campus counseling center, provider burnout is a massive problem touching every corner of care delivery. Fostering wellness in healthcare workers is key to addressing burnout, promoting well-being, and building resiliency among providers. A recent survey by CUPA-HR focusing on employee retention finds that supervisors’ top challenges on campuses are filling empty positions and maintaining staff morale, with almost two-thirds (63%) of supervisors indicating they find filling positions very challenging and over half (54%) facing low staff morale. The integration of medical and behavioral health technology for healthcare providers on college campuses can help relieve many issues, including fatigue and burnout, playing a critical role in fusing healthcare and technology that addresses these critical staffing shortages.

With clinician shortages and an overburdened workforce, healthcare organizations are turning towards digital health strategies to help streamline clinical workflows, boost efficiency, and reduce administrative burdens. Solutions such as remote patient monitoring (RPM) can enable providers to remotely manage patients’ health conditions outside the clinical setting, freeing up vital resources. RPM also allows for improvements in medication adherence, streamlining billing and reimbursement while enabling clinicians to spend more time on patient-facing and revenue-generating opportunities. Although there is no perfect solution for all the growing staffing challenges, digital health technology can help healthcare organizations reduce the burden of routine, manual tasks on clinical staff and deliver greater insights that allow them to focus more on patient care and enhanced outcomes.

In a recent survey, 30% of RNs and LPNs said that making a difference in people’s lives is the most rewarding aspect of the job. Yet, we continue to pile more tedious work on their plates, causing more burnout that results in more clinicians leaving the profession. It’s time to ask nurses to do less. By automating routine and mundane tasks, we can free up nurses to deliver more individualized care, spend time with those patients who need it most, conserve human resources, and reduce costs. Thoughtful automation that lets nurses work at the top of their licenses can have a lasting, material impact on attracting and retaining nursing staff.

With nationwide staffing shortages, budget crunches, patient surges, and the heavy burden upon nurses, physicians, and other healthcare workers during the pandemic era, health systems must make smart, well-informed decisions about staffing, resource use, and system capacity. Like evidence-based clinical decision-making, healthcare operations decision-making needs to be driven by innovative use of hard data and intelligent analytics. Healthcare IT tools, processes, and organizational models like the MDClone ADAMS Center help health systems use their human and physical resources wisely to optimize the care they can deliver to their communities while maximizing the support they give to their professional staff and preventing clinician burnout.

Persistent staffing shortages continue to exacerbate clinician burnout as stress and demands on their time mount. Medical NLP is one technology that holds promise to relieve some of that pressure by improving EHRs for their end-users. By turning the unstructured text in patient documents into succinct, searchable summaries, caregivers can have easier, faster access to the relevant information to patient care and spend less time searching for the ‘needle in the haystack’, reducing their screen time and improving the end-user experience.

Clinician burnout, ‘the great resignation,’ and pandemic-induced capacity issues have turned a glaring spotlight on some fundamental issues plaguing our healthcare system. It’s not a matter of ‘working smarter’ or throwing bodies at the problem, but of empowering our clinicians at the point of care. All too often, technology is a hindrance rather than an enabler. Physicians need immediate access to timely, detailed, and accurate information about a patient to inform therapy options. EHRs alone are not the answer, as they are heavily siloed and built for billing. To make deliberate, informed treatment decisions, clinicians need tools that unify and present relevant clinical data in a way that illuminates trends in real-time.

Most people who go into healthcare or behavioral health services are service-oriented, compassionate people. They’re focused on wanting to use their skills to serve people. Anything getting in the way of that happening creates dissatisfaction. Unfortunately, EMRs can increase burnout by forcing clinicians to spend excessive amounts of time navigating their screens and conducting data entry and administrative work. Telehealth is one of the keys to better work-life balance for providers because the setting gives them more control. It can also mitigate burnout by offering clinicians greater flexibility in how they work, enabling them to work on top of their license, and freeing up time to see more patients, all of which leads to improved job satisfaction.

Angie Franks, CEO of ABOUT Healthcare Inc., which provides access center solutions that enable hospitals and health systems to more effectively manage all aspects of patient transfers and optimize access center operations

The application of technology shouldn’t be limited to one health system or system of care. In fact, its impact can be much more profound when it extends to multiple systems under different ownership. The pandemic is a prime example. With it, we saw an exceptional surge in healthcare demand in a compressed timeframe. Moreover, many of these spikes were tied to geography. Information technology can help health systems load balance capacity across extended regional networks to ensure patient demands for care are met. When the boundaries to care are no longer limited to a specific hospital or health system, healthcare becomes more ubiquitous, and providers can ensure prompt access to care at every stage of the patient journey. And compressing the time to care promotes optimal patient outcomes, which is the ultimate objective.

Prior authorization remains a massive administrative burden for payers and providers, despite ongoing improvement efforts. Patients are frustrated by the care delays that result. Clinicians are experiencing burnout due to the extensive amount of paperwork associated with documenting and conforming to health plan policies. CMS aims to improve prior authorization with a recently proposed rule. It’s a step forward to ease some of the daily administrative workloads. As the conversation continues about reducing health worker burnout, more health plans will start by adopting new technologies to comply with upcoming regulations. Still, many will begin to think bigger and use AI and machine learning in real-time to automate prior authorization decisions – resulting in up to a 60% reduction in administrative work.

– A recent study by researchers at Intermountain Healthcare in Salt Lake City finds that following up a cardiac event, such as a heart attack, with a statin prescription and cholesterol-measuring blood test, prevents 94% of patients from having or dying from a second cardiovascular event during the next three years. 

– Having one cardiac event, like a heart attack or stroke, puts a person at high risk of having a second one. One in five people who have a heart attack will be re-admitted to the hospital for a second one within five years, and there are about 335,000 recurrent heart attacks in the U.S. every year, according to the American Heart Association.

Patient Safety-Oriented Cardiovascular Health Research

Headquartered in Utah with locations in eight states and additional operations across the western U.S., Intermountain Healthcare is a nonprofit system of 33 hospitals, 385 clinics, medical groups with some 3,900 employed physicians and advanced care providers, a health plans division called SelectHealth with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs.

The question for heart researchers is what can clinicians do to mitigate the risk of having cardiac events, especially soon after the first one.

“We already know that these patients are at a very high risk of having continued heart problems, and dying from heart disease,” said Kirk U. Knowlton, MD, principal investigator of the study, and director of cardiovascular research of the Intermountain Healthcare Heart and Vascular Program. “We wanted to see if interventions like a statin and checking in on their cholesterol levels make a difference. These results are astounding.”

Study results were presented at the American Heart Association’s Scientific Sessions 2022 in Chicago.

In the retrospective study, Intermountain researchers examined 68,411 patients who had a heart attack, stroke, or were diagnosed with peripheral artery disease between January 1, 1995 and December 31, 2016, and who survived that event. Researchers then analyzed whether or not those patients had a subsequent low-density lipoprotein-cholesterol (LDL-C) blood test, which measures for “bad” cholesterol, and/or statin prescription, and how they fared for up to three years or until death.

Researchers found that patients who did not have a follow-up LDL-C blood test or statin prescription were at a 60% risk of a second major cardiac event or death. In comparison, those who had a follow-up LDL-C blood test and statin prescription only had a six percent chance of a second cardiac event or death.

They say these findings reinforce the importance of follow-up care with patients who already have heart disease and are at a high risk of having a second cardiac event. “It’s important to the healthcare system that we make sure we offer patients every opportunity to be treated for their cholesterol levels and to make sure they’re maintaining medically directed therapy,” said Dr. Knowlton. “By following up with their physician, checking their cholesterol numbers, and continuing to take appropriate cholesterol-lowering medication, we can help our patients can extend their lives for years, even decades, to come.”

Trend #1:  Consolidation of IT Procurement

In recent years, changes to the health systems in countries such as the US and UK, for example, are making standalone hospitals a thing of the past.  Today, many hospitals are already part of healthcare networks combined with primary care clinics, allied care providers, insurers, and other agencies working together to coordinate and deliver a range of care services within their communities.  This is evident in the US with the insurgence of both IDNs and ACOs, in France with the development of GHTs, and in the UK with the growth of ICSs (Integrated Care Systems).  The mandate of these healthcare networks is clear – to improve patient experiences and population health outcomes while simultaneously reducing costs.  And a crucial factor influencing this mandate is increasing levels of digital transformation.   

As health organizations and care networks regularly depend on the use of digital tools, a larger portion of IT software continues to be sold as either part of regional tenders or as a piece of an enterprise strategy.  This has created the emerging role of C-suite health executives as portfolio managers focused on increasing growth, enhancing productivity, and reducing care costs within the organizations they lead.  And when it comes to IT procurement processes, decision-making influence has now shifted from departmental users to C-suite health executives or central stakeholders (i.e., CIOs, CEOs, government, etc.) creating tension between these groups when it comes to streamlining purchasing options and the reduction of IT vendor contracts.

Speaking directly to CIOs, many have emphasized to us the myriad of organizational benefits to IT vendor consolidation such as reduced costs, greater purchasing power, improved IT vendor management, increased vendor quality, and efficient processes.  However, they have also highlighted several key challenges such as the time, resources, and project management efforts required to make IT vendor consolidation changes within an enterprise. Some departments or physician practices acquired within a network do not want to change to a different vendor, so getting their agreement to roll under one centralized contract can be a difficult process.  

Many health IT buyers have also shared their perspectives with us on the changes to their roles over the years that coincide with the growth of the digital economy.  For example, CIOs today are no longer just overseers of IT operations and services.  They are now acting as key business strategists, working alongside other C-level peers and the board of directors to create business models necessary to thrive and survive in this new era.  They manage IT investment processes and frame questions around the potential effectiveness of these opportunities and alternatives.  

As a result of this multifaceted role shift, C-level health IT decision-makers also place value on the need to work with IT vendors that offer future-proof technology, access to third-party partnerships, and innovation to continuously support the changing needs of their organizations.  In conversations with healthcare IT decision-makers, many have confirmed their need to constantly keep the theme of potential IT vendor mergers and acquisitions at the back of their mind when making any purchasing decisions.  

Trend #2:  Reducing Data Siloes while Improving Interoperability and Analytics  

With the growth of diverse healthcare ecosystems, this evolution continues to be a significant contributor to functional data siloes affecting care delivery services.  Added pressures of value-based care and cost-effective population health management are forcing healthcare organizational structures to rethink how they utilize data to support and assess their care delivery paradigm.

Speaking to CIOs, they have made it clear that incomplete patient information at the point of care is a constant problem.  Much of patient health data management is still largely siloed, even with information available through EHRs.  Data siloes can easily form in any department where data is stored creating the potential for providers to miss out on critical patient information.  And most IT decision-makers agree that full EHR interoperability and data standardization remain the holy grail that fuels their drive for employing different strategies within their organizations to access a patient’s complete medical history.  This is a major challenge with almost every healthcare system in existence today simultaneously utilizing EHRs from multiple vendors. 

While health systems are prioritizing their efforts to improve interoperability between EHRs and siloed patient data, healthcare IT vendors are also following the trend.  And many organizations are adopting new international standards like FHIR that lay out how healthcare information can be exchanged.  

Healthcare IT decision-makers we spoke to have also mentioned how a patchwork of health information exchanges is attempting to fill data gaps with some EHR vendors such as Epic, athenahealth, and eClinicalWorks, for instance, creating private exchange networks to allow more data sharing between different health organizations with similar platforms.  Our conversations with IT buyers also highlight that having appropriate tools to do in-depth data analysis that produces actionable insights is what creates value over and above simply collecting and storing data from different systems.  And while EHRs store the bulk of the patient information, these solutions fall short of providing built-in user-friendly analytics tools for measuring things like patient health outcomes or tracking KPIs; thereby reducing timely and efficient reporting capabilities.  This shortfall has led to organizations adopting external DIY business intelligence software (i.e., Tableau, PowerBI, etc.) to fill the data analysis gap.   The use of external BI software requires additional manual data handling processes which in turn consume greater staffing resources.  

While the notion of universal interoperability is a daunting proposition for many healthcare IT buyers to address with current disparate vendor solutions on the market, most agree that once achieved, both health systems and patients stand to gain.  And that a key element of this journey is recognizing that any interoperability and data analysis solution needs to be built around EHRs with IT purchasing decisions focused on key drivers such as improving patient care, enhancing clinical staff workflow efficiencies, and reducing data fragmentation. 

Trend #3: Ensuring Cloud Success with New Approaches to IT

To achieve digital transformation within healthcare organizations today, investment in cloud migration is a priority.  Moving databases, applications, IT resources, and workloads from legacy infrastructure to a cloud environment bring new opportunities for assembling siloed data, increasing interoperability, and improving patient outcomes.

In recent years, healthcare IT leaders have told us about the many benefits of cloud migration within their organizations, such as easier access to data across care settings, reduced capital expenditure costs for maintenance of in-house infrastructure equipment, and improved data and systems backup cover in case of emergency or natural disaster.  They also have mentioned how cloud computing enables greater flexibility and scalability for organizations needing more storage capacity or changes in the deployment of applications based on demand spikes or workload.  The scalability that comes with cloud migration also offers the opportunity to employ advanced technologies such as AI/ML to run analytics on big data which provides greater insights into patient needs or advances clinical research into effective treatments. 

An increasingly common trend within medium to large-scale healthcare settings is to have full EHR or aspects of these systems connected to the cloud, followed by other software such as HR, payroll, and various enterprise applications related to workflow efficiencies, training, or learning.  And while there is growing appetite amongst C-suite executive decision-makers to develop widespread cloud-adoption plans, the journey is often cumbersome and slow-moving at best.  Only around 15% of health systems we have spoken to, for example, have completed the migration of their EHR to the cloud. The complexity and bureaucracy of health systems or regional procurement contribute to long adoption cycles, with some deals taking up to five years for implementation.  

When considering cloud success, health IT leaders agree that a well-thought-out strategy and plan for migrating applications is a necessity.  And along with that plan, IT leaders also need to examine their departmental structures and reorganize their technology teams to ensure that they align with the overall cloud strategy.  Re-organizing workers will empower staff to make use of the enhanced capabilities that cloud computing will provide.

According to several IT buyers we have spoken to, cloud capabilities of software solutions play a significant role in their purchasing decisions along with the protection of patient’s health data from security breaches.  They will only consider cloud providers who ensure sensitive data is stored securely while adhering to industry regulations. 

Trend #4:  Improving Patient Safety

Patient safety challenges are constantly evolving and within health systems, these challenges are exacerbated by other issues such as staff shortages, workforce burnout, and misinformation about treatments.

Quality improvement issues are paramount for hospitals and health systems to achieve their patient safety goals and health information technology can provide the tools to standardize workflows, improve insights, and aid clinicians and health staff to reduce barriers to equitable care.  

Clinical Decision Support (CDS) solutions are an important add-on to EHRs, providing the potential to limit patient care errors and improve adherence to medicines.  CDS provides medication reconciliation with the potential to cross-check prescriptions, reduce adverse drug reactions, and assist with ensuring compliance with practice guidelines.  

Health IT buyers have told us they recognize that health information technology is a significant tool for ensuring care quality and safety.  However, when choosing which technology to invest in, buyers agree that health organizations need to be selective as some solutions have limited evidence in improving patient safety outcomes.  When choosing potential solutions to purchase, key factors that tend to be considered most often amongst buyers are the quality and frequency of alerts, clinical flags, or reminders, the tracking and reporting abilities of consultations and diagnostic testing, and most importantly, the availability of complete patient data.  

Trend #5: Decreasing Clinician Burnout 

Clinical workforce burnout is a significant issue within the health industry affecting healthcare professionals.  Burnout is a result of long-term exposure to occupational stressors and can depend on several factors including workload pressures, inefficiencies, or moral distress.  

Healthcare professionals are susceptible to burnout from IT solutions such as EHRs and CDS.  EHR usability issues can potentially result in an increase in task loads, which consequently limits the amount of available working or cognitive memory for medication decision-making and patient communication.  This limitation contributes to clinician burnout.

CDS software can also increase clinician frustrations and lead to burnout.  CDS is a significant module of some EHRs, and while the software is designed to reduce medication errors or support decision-making, it can also cause other issues such as delays in treatment.  CDS impacts clinicians in several ways, including changing their workflow and volume of tasks, causing alert/alarm fatigue, contributing to loss of autonomy, and the build-up of anxiety due to medical/legal ramifications of potential clinical decision errors.  

For a significant number of health IT buyers, reducing clinician burnout is a major reason why an EHR solution would be reassessed or possibly replaced with a new system.  And when considering purchasing new software, buyers are prioritizing features that improve efficiency and would support the displacement of existing solutions.  Examples of such features include integrations with software applications providing voice dictation or speech-to-text capabilities, improved drug safety, and better integration with billing and practice management.   

And there you have it – five significant trends driving IT purchasing decisions of health buyers.  Which trends excite you the most?

About Rohinee Lal

Rohinee joined Signify Research’s Custom Research & Consultancy team in early 2022. She brings over 24 years of experience collecting, analyzing, & presenting market intelligence across various industries including pharmaceuticals, medical devices & digital health. She has a master’s in medical Anthropology from the University of British Columbia (Canada).

The world we live in is becoming increasingly integrated, and as it does, the amount of data also increases. It is estimated that 2.5 quintillion bytes – that’s 2,500,00,00,000 million, for perspective – are created, captured, and shared every day, and experts predict that number will grow exponentially in the coming years. Estimates show that the healthcare industry generates about 30% of the world’s data volume. That number is expected to reach a compound annual growth rate of 36% within the next few years. This is no surprise; electronic health data can improve the speed and quality of care by giving providers easy access to a patient’s medical history, medications, test results, diagnoses, and treatment plans. 

Unfortunately, the compounding growth presents vast opportunities for those with malicious intentions to wreak havoc through cyberattacks on healthcare systems. The surge in cyberattacks in recent years has strained IT departments and highlighted vulnerabilities in electronic health record (EHR) systems that store sensitive protected health information (PHI). Ransomware, malware, and other malicious attacks have disrupted service operations, damaged system integrity, and shut down means of communication across health systems – all of which put patient safety at risk. 

The potential damage caused by a successful attack on an EHR could be catastrophic, not only in terms of financial loss but the loss of patient data, disrupted communication and care delivery, and reputational damage. With so much at stake from these malicious cyberattacks, healthcare organizations must take proactive steps to protect their systems from hackers and other threats. Thus, there is an urgent need for healthcare IT professionals to develop robust security protocols and find solutions to safeguard against such threats and ensure care teams can communicate in the event of an attack to reduce risks to patients.

Maintaining Care Team Communication During a Cyberattack

The effectiveness of EHRs as a means of communication for healthcare professionals has been called into question due to their original purpose being primarily systems of record and revenue cycle management tools. This has led to an increased emphasis on finding new ways of securely sharing information that does not rely solely on the use of EHRs and, in fact, augment the ability to utilize the data within. With hackers continually improving their methods, the industry must step up its focus to protect patient information. As cyberattacks against on EHRs specifically grow in frequency and magnitude, organizations need to develop robust strategies for safeguarding data, including exploring alternate means of communication and collaboration outside the scope of EHRs as part of overall security plans in the event of a cyberattack or another emergency. 

With the explosive growth of data in the healthcare industry, effort must be placed on bolstering security measures. Unfortunately, cybercriminals have done a masterful job of recognizing and taking advantage of vulnerabilities, leveraging them for ransom, or selling sensitive information on the dark web. Healthcare organizations rely heavily on EHRs to acquire and store patient data. Still, the structural limitations of an EHR make it incredibly challenging to continue providing that care should the EHR be compromised.

Transformative Solutions

A growing number of healthcare organizations have turned to advanced clinical communication and collaboration (CC&C) platforms to address the structural limitations of EHRs and ensure they can continue to deliver high-quality care in an emergency. These workflow solutions not only integrate with hospital systems like EHRs; but also work outside of them and will remain operational in the event of an outage. Additionally, cloud-based CC&C platforms offer data encryption and are HIPAA-compliant to protect patient data. Furthermore, they can auto-delete messages after a set period and even remotely wipe devices, an invaluable feature considering the rise in malicious attacks on healthcare organizations using sophisticated techniques. 

Along with encryption, these systems provide additional functionality such as scheduling, patient engagement, alarm management, and event notification, all without sacrificing user experience. When implemented alongside advanced security strategies, CC&C solutions help organizations keep patients and their data safe, streamline critical workflows, and protect patient information from malicious actors, enabling cross-functional teams to focus on improving patient outcomes and allowing healthcare organizations to offset the threat of cybercrime with more robust patient data security and optimal care delivery in an emergency. With cyberattacks becoming increasingly sophisticated and difficult to combat, CC&C platforms have become essential for strengthening security measures, protecting critical data, and ensuring the safe operation of critical systems in the healthcare industry. 

It has never been more critical to have the right platform in place – and now is the time for healthcare organizations to take steps toward bolstering their defenses against cyberattacks.

About Andrew Brooks, M.D.Andrew A. Brooks, M.D., is a fellowship-trained, board-certified orthopedic surgeon. He currently serves as the chief medical officer at TigerConnect, a company he co-founded in 2010 to revolutionize healthcare workflow and productivity. He has authored numerous peer-reviewed articles and book chapters in his field of interest. In addition to his work at TigerConnect, Dr. Brooks is also a managing partner for 111 West Capital; his primary focus is early-stage healthcare software businesses. Dr. Brooks is board certified by the American Board of Orthopedic Surgery and is a Fellow of the American Academy of Orthopedic Surgeons.

Doctors and other healthcare professionals are entrusted with the responsibility of safeguarding the health and well-being of their patients, ensuring they receive the highest quality of care. While healthcare professionals are expected to provide a certain standard of care, any deviation from that standard that results in harm or injury to a patient may leave them exposed to a medical malpractice claim.

The consequences of medical malpractice can be severe, and in some cases, can result in permanent injury, disability, or even death. Patients harmed by medical malpractice may suffer from physical and emotional pain, financial loss, and other damages that severely impact their quality of life. This article will examine some of the causes of medical malpractice and outline steps to prevent its occurrence.

Causes of Medical Malpractice
There are many scenarios that can lead to a medical malpractice claim. Among the most common causes of malpractice are:

– Diagnostic errors: Misdiagnosis occurs when a medical professional fails to correctly identify a patient’s medical condition, resulting in the wrong treatment being administered or no treatment being provided at all. 

– Surgical errors: There are many types of surgical errors, such as damage to internal organs, incorrect incisions, operating on the wrong area, or leaving foreign objects behind after surgery.

– A failure to treat patients: A failure to provide adequate treatment to patients can encompass a range of issues, such as neglecting to administer necessary medical tests or failing to address a medical condition in a timely or appropriate manner.

– Birth injuries: These can result from various causes, such as the misuse of delivery tools, failure to perform a timely cesarean section, or inadequate prenatal care.

Medication errors: This may occur when a medical professional prescribes or administers the wrong medication or dosage.

If you have undergone a failed tubal ligation procedure you may be entitled to compensation for your injuries. You can speak with a specialist attorney such as those at The Tinker Law Firm PLLC to see if you have a claim.

Preventing Medical Malpractice 

The prevention of medical malpractice is critical to ensure patient safety and reduce the risk of injury or harm. The following steps can help in achieving this goal.

Effective Communication 

Medical professionals should communicate clearly with patients about their medical conditions, treatment options, and the potential risks and benefits. Patients should also be encouraged to ask questions and express their concerns about their treatment. 

Electronic Health Records 

Another vital way to prevent medical malpractice is through technology. EHRs can help to reduce the risk of medical errors by providing medical professionals with accurate and up-to-date information about a patient’s medical history, allergies, and medication use. EHRs can also help to ensure that medical professionals are following the correct guidelines and protocols for patient care.

Staying Current

Medical professionals can prevent medical malpractice by staying up to date with the latest research, information, and guidelines in their field. By participating in ongoing education and training programs they can ensure they are providing the most effective and safe treatments to their patients.

The steps outlined above can help to prevent medical errors and ensure that patients receive the appropriate care and treatment.

What You Should Know:

– The pediatric mental health crisis is named the number one patient safety concern, according to ECRI’s 2023 list of most pressing patient safety concerns.

– The nation’s largest nonprofit patient safety organization notes that, while rates of depression and anxiety in children have increased since 2017, the COVID-19 pandemic has elevated the situation to crisis levels.   

Here are the top 10 patient safety concerns for 2023:

1. The pediatric mental health crisis

ECRI’s experts identify several recommendations to address the crisis, including performing universal mental health screenings during every office and hospital visit, making personal connections between pediatric mental health providers and patients/families (i.e., warm handoffs), and providing additional support to address social determinants of health.

2. Physical and verbal violence against healthcare staff

Healthcare organizations should prioritize protecting their workforce against workplace violence, from other staff as well as from patients and visitors

3. Clinician needs in times of uncertainty surrounding maternal-fetal medicine

Healthcare organizations must develop strategies to support clinicians in addressing changes in how maternal-fetal medicine is delivered by methodically identifying areas of uncertainty, creating clear communication channels, and implementing solutions to support effective and safe clinical decision-making.

4. Impact on clinicians expected to work outside their scope of practice and competencies

Maintaining comprehensive patient and worker safety and competency assessment is essential to ensure healthcare workers are equipped to deliver safe, effective care and reduce patient and provider harm.

5. Delayed identification and treatment of sepsis

Sepsis is a medical emergency where seconds count. The following are recommendations to ensure early identification of sepsis and timely intervention.

6. Consequences of poor care coordination for patients with complex medical conditions

As the number of a patient’s chronic medical conditions increases, so does care complexity. Optimizing multidisciplinary care team communication across the continuum is the crux of effective care coordination for patients with complex needs.

7. Risks of not looking beyond the “five rights” to achieve medication safety

Safe medication practices are a culmination of the interdisciplinary efforts of practitioners working within reliable systems and using advanced technologies. Although the rights work as a general guideline, they are no substitute for actionable procedures.

8. Medication errors resulting from inaccurate patient medication lists

An effective medication reconciliation process within and among care settings that emphasizes standardization of practice for doctors, nurses, pharmacists, pharmacy technicians, and medical assistants is vital for patient safety.

9. Accidental administration of neuromuscular blocking agents

When used in error, NMBs can cause significant patient harm and even death. Organizations should ensure policies are in place to mitigate risks associated with such medication errors.

10. Preventable harm due to omitted care or treatment

Missed care opportunities are errors of omission that can result in adverse consequences for patients. Organizations should focus on improving factors such as work environment, staffing levels, and communication to reduce instances of missed care.

It’s a tired, old saw: Healthcare organizations are woefully behind when it comes to technology, automation and digital experiences.

Leaders are sick of hearing it. But that doesn’t make it any less true.

Current market pressures, however, compel hospitals, health systems and medical practices to reconsider their hesitancy in embracing these innovations. A combination of consumer demand and acute, unrelenting labor shortages force leaders to explore the practicality of leveraging technologies to address a myriad of operational challenges – fielding calls to answer patients’ routine questions, for example or reaching out after clinical procedures to assess patient status.

‘Perfect storm’ drives workflow automation

According to a report generated by IBM, “Digital Customer Care in the Age of AI,” 80% of routine tasks can be effectively managed by automated virtual assistants, reducing staff workload significantly. What’s more, patients are begging for better digital experiences – and are frustrated with healthcare’s lack of functionality. Late last year, Redpoint Global found that 80% of patients prefer digital channels to communicate with their healthcare providers. Studies cited by Patient Safety and Quality Healthcare (PSQH), however, report that 88% of physicians still rely upon phone calls and manual outreach.

This perfect storm is driving healthcare leaders to consider digital solutions to streamline tasks including self-scheduling, patient intake, disease management check-ins, care and medication reminders, and more. But to be successful they must ensure the technologies they adopt to provide a frictionless experience for both patients and staff.

Patients deserve frictionless, empathetic experiences

First, let’s consider the patient. As consumers, more than 80% of the population have used a virtual assistant or chatbot – to book a flight or hotel, pay bills, call for a rideshare, or make dinner reservations. Adoption has been swift because these industries have invested time and money into ensuring the technologies are easy and intuitive.

Healthcare must do the same. Without a doubt, healthcare is a complicated business. Strict privacy and security regulations must be taken into account. And accuracy is paramount because life and well-being are at stake.

Nevertheless, it is doable. Innovative leaders have discovered breakthrough technologies that accommodate the unique demands of the industry while meeting patients “where they are.” Among the key attributes of these solutions are:

1. Plain Speech. Allowing patients to use words and phrases they are comfortable with – and then translating these into the vernacular of healthcare so they are equally meaningful to clinicians. For example, when seeking information about their concerns, a patient might say, “I am peeing a lot.” A medical professional, on the other hand, would describe and document these symptoms as “frequent urination.” Digital tools that use natural language understanding close this gap so patients can more easily navigate the system, get accurate information specific to their situation and then take appropriate action like scheduling an appointment with their primary care provider.

2. Multi-channel. Enabling patients to communicate with a healthcare professional via the channel most convenient for them. Some individuals prefer email or a web chat, while others respond to text messages. In any case, they want to be able to complete the full task within that single channel rather than getting a text reminder, for instance, and then being asked to go to a patient portal to complete intake paperwork or make a phone call to confirm an appointment. 

One healthcare organization recently implemented automated outreach to follow up with patients seen in urgent care. The communication reminded them to schedule recommended appointments with their regular provider and included contact information for convenient action. The organization experienced an immediate 23% increase in appointments following urgent care encounters, reducing system leakage and driving revenue.

3. Empathetic. Injecting a healthy dose of empathy into any automated system. Healthcare, by its very nature, is highly personal and oftentimes fraught with stress. It’s critical that leaders ensure the digital experience emulates one-on-one interactions between patient and caregiver. Conversational AI, combined with natural language understanding, can build a dialog that encourages the patient to share important information that leads to precise and contextual responses. It’s equally important that automated systems feature a seamless interface with live representatives, as well. This can be triggered when the patient’s situation requires an urgent or time-sensitive response – or when the patient has encountered a frustrating obstacle and is in danger of abandoning the interaction.

Integrations, platform utility reduce staff burden

Staff, both clinical and administrative, represent half the patient-engagement equation. That makes it equally vital that digital solutions such as virtual assistants genuinely lighten workloads. Not only must they be convenient and easy for patients to use, but they must also streamline processes for employees. This can be accomplished in a number of ways.

1. When healthcare leaders begin to evaluate workflow automation solutions, they must include front-line staff in all discussions. These are the individuals most familiar with what needs to happen and what challenges might arise. In addition, distinct workflow processes must be assessed and, in all likelihood, adjusted when technology is introduced. As healthcare learned during the adoption of patient management and electronic medical record systems (EMR), simply layering software over existing procedures rarely improves efficiency or performance (and might have the opposite effect).

2. New digital solutions must integrate with other systems of record such as customer management systems, EMRs and call center software. Just as patients would rather not log into and out of multiple systems, employees want to have comprehensive information at their fingertips. When a virtual chat converts to a phone conversation, for example, staff members need to have the record of the previous interactions immediately available. This saves patients from having to repeat themselves and allows staff to resolve issues more quickly and confidently.

For optimal organizational utility, one additional factor must be considered. Too often, health systems implement single-purpose technology to solve a discrete problem. Perhaps the gastroenterology group adopts a point solution to remind patients about screening colonoscopies, distribute intake forms and communicate preparation procedures. But a year later, the orthopedic department begins to explore vendors to automate post-discharge communications with surgical patients to reduce complications and preventable readmissions. 

Rather than purchase and maintain multiple solutions, savvy leaders are choosing platform-based technologies to support their virtual assistant and conversational AI needs. By embracing a platform approach, the organization has both the power and the flexibility to optimize its digital strategy. For example, one major East Coast health system uses an integrated platform with user-friendly tools such as drop-down fields and drag-and-drop functions that allow existing staff to manage and activate multiple virtual assistants for a range of tasks core to its mission. These automate pre-visit reminders, patient intakes, post-visit follow-up, test-result reporting and other outreach programs that were identified as priorities over time. Besides the savings realized from decreasing call center demands through automation, the organization also reduced costs by eliminating multiple-point solutions. 

Modern platforms that support multiple templatized and turnkey solutions, like patient self-scheduling or care management outreach, provide the tools an organization needs to design, develop and deploy its own digital experiences. This level of configurability enables leaders to address opportunities and solve problems across the organization while recognizing a return on investment more quickly.

Without a doubt, a digital tsunami is about the descend upon healthcare. Gartner, one of healthcare’s preeminent research and consultancy firms, updated its research report, “It’s Time for Healthcare Delivery Organizations to Adopt a Digital-First Strategy,” in January 2022. In it, analysts stated that “it’s time to flip today’s in-person-centric healthcare delivery model into one that prioritizes digital engagement, digital interactions, and the use of digital products and services.” Healthcare leaders eager to compensate for staff shortages while simultaneously improving the patient experience are moving quickly toward virtual assistants and conversational AI to deliver results. 

About Nathan Treloar

Nathan Treloar is co-founder and chief operating officer at Orbita, a leading provider of intelligent virtual assistants and workflow automation for healthcare. With extensive experience in voice technologies and conversational AI, Nate is a respected author and speaker on consumer and business trends in user experiences.

Drug diversion is an increasingly serious issue that tends to be substantially underestimated. In every instance, a potential threat to patient safety is present. This includes the risk of inadequate pain relief, exposure to infectious diseases through contaminated needles or drugs, and risks associated with unsafe care from impaired healthcare workers. Drug diversion can also pose risks to staff safety and regulatory compliance, as can be seen across all types of healthcare facilities and, across all clinical disciplines. Healthcare organizations face financial penalties, potentially in the millions, for lack of compliance with DEA regulations leading to diversion within their hospitals. Healthcare workers who divert for their own use risk addiction, overdose, death, loss of professional license, criminal prosecution, and civil malpractice suits. While the fallout of undetected drug diversion can be far-reaching and life-threatening, many drug diversion cases are undetected.

A recent report shows that about 8% of controlled substance transactions in U.S. hospitals using ControlCheck have a variance between the dispense and final disposition of the drug (i.e. administration, waste, or return). These variances could be indicative of drug diversion, yet only about half of those variances are ever investigated. Often, cases will go uninvestigated due to lack of time or priority. Inefficient auditing processes and a lack of comprehensive analytic workflows are common reasons why variances are often uninvestigated. 

Experiencing Drug Diversion Firsthand

Before next-generation diversion technology started making its way onto the main stage, I led the regional diversion program at a large integrated delivery network. Our team developed key performance indicators to assess the effectiveness of our program, implemented a Controlled Substance Diversion Prevention Committee, formalized a Diversion Response Team, and evaluated next-generation diversion technology solutions. 

Lacking next-generation drug diversion software, we used manual tracking systems and knowledge of drug dispensing processes to run reports on drug usage and dispensing patterns. Analytic reports were based on users per drug per automated dispensing cabinet and would only show a spike or abnormality in dispensing patterns but failed to account for why. These reports did not assess administration patterns or take into account common variances such as an increased number of shifts, waste patterns, an added hospice patient, or an actual case of drug diversion. 

In instances where documentation practices or controlled substance usage patterns suggested possible diversion, the pharmacy quality and audit teams were forced to compare all data points manually to determine if there was an actual risk of diversion. 

Some of these audits would simply reveal poor practice in dispensing or administration procedures, while others would reveal the need for further investigation. An audit of a possible instance of diversion would take more than four hours of chart reviews, making it virtually impossible to track every suspicious instance from start to finish effectively. Tracking documentation of all aspects of an investigation was also cumbersome and very manual without a system that allowed for multidisciplinary collaboration in one platform. 

The need arose for a more effective technology solution to help prevent, detect, and respond to diversion. I advocated for our health system to review technology incorporating artificial intelligence and prescriptive analytics to take our diversion program to the next level. Emerging next-generation technologies provided us with an opportunity to adopt a comprehensive diversion solution that provided closed-loop visibility into medication transactions, an unbiased approach to risk scoring, and supported collaborative workflows during investigations.

The Role of Technology in Diversion Detection and Prevention 

The introduction of next-generation software with closed-loop reconciliation and prescriptive analytics that we see today solved several of the issues that manual audits and standard deviation-based reports missed. Transactional level data and analytics revealed workarounds in the medication use process that put patient and staff safety at risk. Software that automates tracking controlled substances from the dispense to the final disposition of the drug in hospitals enables a diversion prevention team to better identify unaccounted-for medications and workarounds that impact patient safety and focus their time on investigating users at risk of diverting.  

Advocating for Next-Generation Diversion Technology

As diversion technology continues to evolve and national guidelines are updated, hospital leaders should lean into adopting and optimizing the use of these software solutions to protect patients and healthcare workers. As leaders, we have an obligation to protect not only the patients in our care but our fellow healthcare workers who may be suffering from addiction. Healthcare workers who divert will circumvent all processes to maintain their addiction. It ceases to become solely a logistical and economic problem and evolves into a human, empathetic issue. While technology provides data-driven analytics to identify drug diversion, diversion prevention teams have the opportunity to provide compassionate support in helping diverters receive treatment. A collaborative approach, between different departments and agencies, is necessary to identify that a person is diverting and get them to help if needed. Next-generation diversion software ultimately allows teams to collaborate across departments and create processes that yield faster, more efficient, and more accurate results.

Healthcare workers should champion the change they want to see in hospitals, and technology and software are often the tools for implementing that change. For those who work in hospitals and potentially encounter diversion, it can make a world of difference to implement a technology that can help prevent, detect, and respond to diversion. A solution that supports collaborative, multidisciplinary workflows can streamline and expedite the processes required to confirm diversion and support the hospital in taking action. Staff who frequently complete time-consuming audits lose valuable time that could be spent treating patients. They should advocate for diversion detection technology to improve the safety of patients and fellow healthcare workers. It is exciting to see where this new intersection of healthcare and technology will take us and the continued impact it will have on patients, health systems, and healthcare workers.   

About Sandy Still, PharmD

Sandy Still is an experienced pharmacy leader with experience in health system pharmacy. Prior to joining Bluesight^Ⓡ, Sandy was the Manager of Medication Safety, Use and Policy at the Medical University of South Carolina in Charleston, SC. During her time at MUSC, she helped implement ControlCheck. Prior to MUSC, Sandy was the Inpatient Pharmacy Quality Coordinator at Kaiser Permanente Northwest (KPNW) in Portland, Oregon. She developed KPNW’s controlled substances diversion prevention committee and co-led the Bluesight RFID implementation in anesthesia automated dispensing machines. Sandy has a passion for medication safety and believes that the Bluesight solutions are key to preventing medication errors, providing insight into medication management data, and allowing more time for pharmacy staff to focus on patients.

Although the healthcare industry has shown significant resilience, the byproduct of the pandemic has amplified staff stressors across all operational and clinical roles. In a study conducted in 2022, more than one-third (34%) of the participating registered nurses (RN) stated that it was likely they would leave bedside nursing by the end of the year. Almost half (44%) cited both burnout and high-stress environments as their main reasons to retire or pursue other careers. 

As staff shortages increase, so do workloads. Forty-three percent of the nurses that responded to Hospital IQ’s recent survey echoed that sentiment. Due to technician shortages, many nurses must now complete even more tasks that fall outside of their respective roles, which reduces the time spent on patient care and increases the overall stress carried on the shoulders of these critical caregivers. Forty-five percent of respondents stated that the patient-to-nurse staffing ratios they’re experiencing are currently 5:1, which is more than double the optimal target of 2:1 and contributes to reduced quality of care and even patient safety risks. Administrative burdens and manual tasks are additional drivers of nurse burnout and frustration. Many of those interviewed expressed that most of the workflows and processes involved in their day-to-day are manual – due to a lack of technology solutions, systems, and automation.

Providing the necessary support is key to achieving high-quality patient care, staff satisfaction, and overall retention, along with increasing an organization’s bottom line. In 2023, hospital and health IT leaders should examine new approaches to provide support and truly take meaningful steps to address the challenges facing healthcare professionals. Real-time location systems (RTLS) have been proven to offer cost-effective solutions that ease operational burdens and enhance safety for both the patients and the staff. The IoT technology behind RTLS features active-radio frequency identification (RFID) badges and tags to reliably and securely offer immediate visibility into the precise location of equipment, colleagues, or patients while increasing workflow efficiencies at a time when healthcare professionals need all hands on deck and to work at the “top of their license.”

Provide A Better Experience for the Patient and Staff

Many healthcare systems are pursuing enhanced technology to bring new value to patients and ensure greater support for staff. To enhance both experiences further in 2023, healthcare organizations should leverage real-time location technologies to provide stronger communication between patients, loved ones, and staff. By utilizing RTLS alongside robust patient workflow software, automated family text messaging shares updates with patient-approved contacts in real-time as patients move throughout the phases of care. RTLS implementations have an immediate impact by automating proactive patient communications, and sharing status details, wait times, and directions. These communication options enable healthcare facilities to provide peace of mind and ensure that both patients and loved ones are well-informed. This all happens in an automated fashion with the single goal of removing the administrative burden from the frontline staff. 

Due to continued pandemic restrictions and protocols, the necessary hospital infection control rules have increasingly led to family separation when loved ones are admitted. Reduced contact can increase the stress experienced by patients and negatively impact their recovery process. This separation often creates knowledge barriers within families and leaves them in the dark when trying to fully understand the complex medical needs of their loved ones. Family text messaging can return some comfort as visitation restrictions remain ever-changing. These automated messages allow staff to focus on patient care, while still providing important and timely updates for loved ones. Organizations that have implemented this have seen an increase in trust among the patient, the medical staff providing care, and family members.

Digital wayfinding can also reduce stress and anxiety for patients and visitors as healthcare systems seek cost-effective ways to provide a better experience in 2023. On a first visit to a new facility, it is estimated that approximately 30% of patients get lost attempting to navigate a complex and unknown facility. Navigational challenges can lead to late arrivals, missed appointments, and ultimately delayed patient care. In addition to impacting the patient’s care, hospitals nationwide collectively lose ~$150 billion each year from missed appointments. 

An advanced digital wayfinding solution integrated with the larger RTLS deployment can prepare a customized route for a patient and send the link via text message. Upon arrival, the user simply opens the route in a mobile web browser, eliminating the need for a specific application, and receives turn-by-turn directions from their parking spot to the location of their appointment. The directions are provided on a private Google Maps-like interface, giving users a sense of familiarity and peace of mind. The future is exciting as the industry will see automated check-ins once a patient enters the parking garage or send notification to a pharmacy to begin mixing medications proactively for oncology patients that are in route to the infusion clinic. 

Staff Safety Is Crucial 

As tensions continue to grow within healthcare facilities, 48% of U.S. RNs reported an increase in workplace violence throughout 2022. Ask any nurse you know, and they will share horrific stories about this issue at organizations across the country every day of the year. Tens of thousands of caregivers and operational staff utilize mobile duress solutions to prevent violent threats from escalating to dangerous events. Granting easy access to subtly signal for help, duress alert buttons are located on IoT-enabled staff badges. With just the push of a button, employees gain better protection and enterprise-wide support.

Once clicked, the badge immediately sends a silent alert with the precise, real-time location of the staff member to the security team and the appropriate computer workstation, monitor, and dispatcher, as well as by email, text, and/or VoIP phone message. The first responders can see the person’s movement and respond to the most recent location, as it updates every few seconds. For enhanced location capabilities and a safer working environment, leadership should consider RTLS duress solutions that offer clinical-grade locating (CGL) which ensure room and even sub-room level accuracy.

For ease of implementation, staff duress solutions can integrate with various traditional security systems, video management systems, access control, and mass notification systems. The staff duress functionality can be a simple add-on for healthcare facilities that already leverage an automated nurse call system and desire a safer work environment in 2023. By providing the ability for staff to request assistance to their exact location should they need it, the message is reinforced that they work in a safe environment where they are valued.

Automate Workflow to Discover the Best Staffing Options 

It isn’t a secret that improving operational performance at hospitals helps to improve staff productivity, morale, care quality, and patient outcomes. Fifty-three percent of nurses in the Hospital IQ survey desired streamlined processes that ensure visibility into patient needs and overall communication. The best place to start is with the manual administrative processes bogging down already overwhelmed nurses.

Lessening nurses’ workloads is a critical aspect of combating burnout and promoting staff retention, and healthcare leaders will find that investing in healthcare professionals makes sense for the facility’s bottom line. To jointly provide the best patient care and workplace environment, staff need access to platforms that automate workflow to alleviate manual documentation, which can often be delayed or potentially inaccurate, and offer proactive communications to each other, patients, and family members. Workflow platforms that leverage RTLS data can keep tabs on key patient flow metrics and ensure staff know where all patients are in their care journey. 

Effective enterprise-wide care coordination can be greatly hindered by manual workflow systems. These manual systems waste time that could otherwise be reallocated back to patient care. Healthcare decision-makers can eliminate non-value-added tasks by providing access to an advanced workflow platform with staff display boards showing real-time facility visibility. Through this automated system, teams are on the same page with up-to-the-minute insight to continuously measure interactions, reduce bottlenecks, and consider best staffing choices. Real-time communications and enterprise visibility keep operations running smoothly with high productivity and satisfaction.

Discover the Right RTLS for a Strong ROI 

As healthcare providers are constantly considering new approaches to support staff, selecting an RTLS partner with a comprehensive suite of solutions makes it easier to expand into other use cases and departments in the future. Decision-makers should look to truly partner with a vendor who will explore the organization’s pain points and deliver a 3-to-5-year implementation plan with associated ROI projections and necessary operational resourcing. 

Invest in a partner who has nurses, former hospital administrators, epidemiologists, and clinic managers as part of their implementation and consulting offerings. These individuals have worked in the field and understand the pain points from top to bottom. ROI and overall utilization of the IoT investment is more important than ever and working with an RTLS expert who can not only provide upfront proposed value specific to your organization but follow up with executing and documenting results is what matters most. Through practical guidance, healthcare facilities can maximize real-time technologies and drive meaningful change throughout their enterprise in the new year.

About Scott Hondros

Scott Hondros is the Vice President of Professional Services at CenTrak, which offers locating, sensing, and security solutions for the healthcare industry. CenTrak has helped more than 2,000 healthcare organizations around the world build safer, more efficient enterprises. For more information: visit www.centrak.com 

In 2022, the Center for Medicare and Medicaid Services (CMS) established health equity as a pillar of its future work. Program integrity staff from every state Medicaid program, and federal program staff working on Medicare, must consider the roles of both program integrity and analytics when combatting fraud, waste, and abuse (FWA)in the healthcare system.

CMS defines health equity as “the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.”

Experts in the field have growing concerned over the potential for implicit bias when investigating FWA cases to negatively impact specific populations of healthcare recipients and providers. However, designers of program integrity analytics must make use of a different kind of data bias in order to be effective. It is essential to distinguish between unintentional, implicit bias through attribute selection and intentional algorithmic bias through sampling methodology. 

Health outcomes and Medicaid program integrity

Health outcomes are a function of the quality of care. CMS has been focusing heavily on quality of care for the last decade. Healthcare providers willing to commit fraud often do so at the expense of quality care. Such a singular focus on financial gain indicates a view of patients as a financial transaction, where what can be billed (legally or not) takes precedence over the care delivered. Simply put, providers that commit fraud are willing to jeopardize patient care, contrary to the CMS goals for health equity. Therefore, program integrity staff in both Medicaid and Medicare have a responsibility to weed out these bad providers.

Program integrity is a balancing act. Too much effort in one direction can create provider abrasion (e.g., the perception that it is difficult to work with the healthcare program). Provider abrasion can exacerbate access to care issues Medicaid faces leading to inadequate provider networks. Understandably, Medicaid and Medicare agencies attempt to reduce that abrasion. However, this does more than just risk increased poor health outcomes; it raises a genuine and tangible threat to patient safety. The goal is to combat FWA throughout the healthcare system successfully.

Health equity must consider patient safety in cases of FWA

The worst healthcare outcome a patient can face is death or direct harm. Patient safety can be affected in two ways: (1) receiving unnecessary treatments and (2) not receiving necessary treatments and services. Consider the fraud case of Scott Charmoli, DDS, for a grave example of unnecessary treatment. For years, Charmoli schemed to defraud dental insurance companies by billing for unnecessary crowns, even breaking patients’ teeth intentionally to justify the procedures.

Not receiving necessary services, which clearly qualifies as a driver of health inequity, can result in patient deaths, such as in the case of Mikayla Norman. Mikayla, a 14-year-old with cerebral palsy, weighed only 28 pounds at the time of her death. Providers billed for home and community-based services to care for her but did not provide adequate care. These tragedies are way too common when bad providers are allowed to continue practicing unchecked.

Medicaid agencies may be reluctant to fully employ their program integrity capabilities, fearing provider abrasion may create access to care concerns. This mindset is counterproductive and skirts Medicaid and Medicare’s responsibilities for health equity. This is especially true for patients at higher risk of harm and abuse, like those covered under federal Medicaid waivers designed to allow those patients to remain in the community. Generally, these are patients with a skilled nursing level of care, such as senior citizens, medically fragile patients like Mikayla Norman, and patients diagnosed as intellectually and developmentally disabled (IDD).

A failure to effectively pursue healthcare program integrity is an admission that these types of patients won’t receive the enhanced program oversight that health equity requires. Not aggressively pursuing FWA may be an invitation for providers that CMS already identifies as high risk for fraud (i.e., home health, transportation, etc.) to commit the types of fraud that put patients at risk of harm and abuse, as well as leading to poorer health outcomes.

Health equity and analytics: Why bias is not always a bad thing.

While some states have shown concern about how artificial intelligence (AI) and machine learning (ML) are applied in program integrity, as it relates to fraud, waste and abuse, the concern is that providers serving protected classes will be disproportionately targeted. This perceived risk could discourage providers from treating those populations, reducing access to care.

This implicit bias can happen when algorithms unintentionally include attributes that correlate with a particular demographic. Consider an algorithm that detects cosmetic surgeries fraudulently billed under insurance as medically necessary. Without careful consideration, this could inadvertently target women undergoing reconstructive surgery after a cancer-based mastectomy. Ideally, AI and ML platforms have built-in tools to help detect and resolve analytics bias and model monitoring to ensure bias is not introduced over time.

By nature, the goal of fraud analytics aims to seek out rare occurrences; only a small percentage of providers commit fraud. Algorithms are designed to be highly accurate and will naturally skew toward the more common behavior – the 99% or so of providers who don’t commit fraud. To account for this, data scientists use intentional bias selection techniques to emphasize the fraud examples while minimizing the impact of the bulk of the data. However, the analytics must focus on the behaviors of bad providers without regard to groupings such as age, race, gender, etc.

Program integrity data analysts must be aware of historical biases that are potentially harmful. Where historical data on fraud convictions and fraud cases is used to train unsupervised models, there is a risk that these training data sets contain bias because of how humans previously unwittingly determined which cases to investigate and prosecute. Care should be taken to examine and vet these data sets fully.

About John Maynard 

John Maynard is a fraud and risk solutions specialist for analytics provider SAS. An expert in fraud and risk, specializing in healthcare and government, John served in government for more than 25 years and has a broad background in federal, state, and local programs. A former auditor, John has experience with healthcare providers, banking, insurance, and financial services in the private sector. 

About Tom Wriggins

With over 30 years of healthcare experience, Tom Wriggins brings practitioner-level expertise to his role as a Principal Industry Advisor with SAS. Tom combines extensive clinical experience with data and analytics knowledge to help government healthcare entities crack down on fraud and improper payments. He has led multidisciplinary teams that have delivered large and complex data solutions for government health agencies, as well as created fraud and abuse investigative training programs 

What You Should Know:

– ECRI, the nation’s largest non-profit patient safety organization, names communications gaps with recalls of home-use medical devices as the nation’s most pressing health technology safety issue for 2023.

– ECRI’s Top 10 Health Technology Hazards for 2023 list identifies the potential sources of danger that will warrant the greatest attention for the coming year and offers practical recommendations for reducing risks. 

Top 10 Health Technology Hazards for 2023

For 2023, ECRI’s report includes a series of challenges to industry, urging manufacturers to pursue device or process improvements that could mitigate—or even eliminate—some of the hazards included on the list. With healthcare facilities understaffed and healthcare workers overstressed, it’s more important than ever that technologies be designed in ways that ensure their safe use.

The 10 topics on ECRI’s 2023 hazards list are listed below in rank order:

1. Gaps in Recalls for At-Home Medical Devices cause patient confusion and harm

Accurate and understandable information about medical device recalls often does not reach patients using those devices in the home; this information gap is growing every year as healthcare moves into the home setting.

2. Growing Number of Defective Single-Use Medical Devices puts patients at risk

An unacceptably high number of defective single-use medical devices continue to be present in the supply chain. Single-use medical devices—which include products that are used once and then discarded, as well as those that get consumed during use—play a role in virtually every patient encounter. As a result, defective products can have a broad, negative impact on patient care, causing delays and increasing costs—and most concerningly, contributing to patient harm or death in some circumstances.

3. Inappropriate Use of Automated Dispensing Cabinet Overrides can result in medication errors

Automated dispensing cabinets (ADCs) are used to provide controlled access to medications near the point of care. These cabinets typically incorporate locked or lidded pockets, drawers, or other drug storage options. During routine use, practitioners enter their credentials at the ADC and select patient specific medications that have been reviewed and verified by a pharmacist.

Any deviation from safe ADC use practices could lead to the selection and removal of the wrong medication type, strength, or dose—errors that could lead to severe harm. For this reason, ADCs should be configured to require pharmacist approval prior to allowing access to a drug; the cabinet’s override feature should be used only for its intended purpose (when even a short delay would put the patient at risk); and use of the override feature should be routinely tracked and monitored.

4. Undetected Venous Needle Dislodgement or access-bloodline separation during hemodialysis can lead to death

Potentially life-threatening hazards can occur during hemodialysis, including the venous needle becoming dislodged at the vascular access point or the central venous catheter becoming separated from the bloodline used for treatment. Either event can very quickly lead to a massive loss of blood, and thus severe injury or death. Often, such events cannot be detected by a hemodialysis machine’s venous pressure monitor—and so will not produce an alarm.

5. Failure to Manage Cybersecurity Risks Associated with Cloud-Based Clinical Systems can result in care disruptions

Accessing a clinical service such as an electronic health record (EHR) or a radiology system through the cloud can offer significant benefits compared with more traditional systems. This deployment model does not, however, eliminate a healthcare delivery organization’s security considerations. It only changes them.

Organizations that do not both understand and plan for these differences will be at increased risk of a security event that could significantly disrupt patient care. Disruption of a cloud based service in a healthcare environment could lead to loss of availability or integrity of that service, with the potential to cause lengthy delays in care and adverse patient outcomes. Potential breaches of patients’ protected health information (PHI) are an additional concern.

6. Inflatable Pressure Infusers can deliver fatal air emboli from IV solution bags

Inflatable pressure infusers (IPIs) are simple, mechanical devices that compress an IV solution bag to allow pressure-assisted infusions. In certain circumstances, using an IPI to administer fluids creates an increased risk of infusing air from the IV bag into the patient—specifically, if (1) the air is not purged from the bag before use and (2) the bag is allowed to be compressed completely flat by the IPI during use.

ECRI recommends avoiding the use of IPIs for continuous infusion through vascular sheaths and catheters that terminate in the left heart. Even small amounts of air introduced in this location can be fatal.

7. Confusion Surrounding Ventilator Cleaning and Disinfection Requirements can lead to cross-contamination

Lack of clarity about the cleaning and disinfecting steps to be taken between patients can lead to ineffective reprocessing of ventilator components. This in turn increases the risk of cross contamination, an otherwise preventable occurrence that can lead to the spread of infectious disease.

8. Common Misconceptions About Electrosurgery can lead to serious burns

Electrosurgical units (ESUs) use concentrated electrical currents to cut and coagulate patient tissue at the site of application. These workhorses of the OR have been in use for decades. Nevertheless, misconceptions about their use persist, and the systems can—and sometimes do—cause unintended burns if operators do not fully understand the risks.

An incomplete understanding of the risks associated with any of the components involved in the electrosurgical circuit can lead to patient or clinician burns or other injuries.

9. Overuse of Cardiac Telemetry can lead to clinician cognitive overload and missed critical events

Overuse of cardiac telemetry monitoring—specifically, its use on noncardiac patients—can lead to alarm fatigue, clinician cognitive overload, and ultimately unrecognized critical events.

To minimize the risk, healthcare providers should establish clear criteria defining when telemetry monitoring should be used, as well as when it should be discontinued. In practice, this means verifying that telemetry is being prescribed appropriately (i.e., to monitor the right patient populations) and regularly assessing each patient’s need for continued telemetry monitoring.

10. Underreporting Device-Related Issues may risk recurrence

Reporting medical-device-related problems is crucial for keeping patients and staff safe. Unfortunately, problems aren’t always reported through appropriate channels, if at all. Healthcare organizations need to identify and eliminate barriers to reporting. Most importantly, they must make the reporting process as easy as possible in order to minimize disruptions to patient care tasks. Other measures include building a culture of safety (to encourage reporting), educating staff about how to identify device-related hazards, providing feedback to keep staff informed about the status of a report, and promoting the “wins”—that is, instances in which a report prevented significant harm or led to meaningful improvements.