It’s hard to call the Great Recession a good thing, but it may have been just that for healthcare. The American Recovery and Reinvestment Act of 2009 threw boatloads of federal dollars at a lot of industries, and healthcare caught $25.9 billion that was earmarked specifically to improve technology. That money was badly needed, because back then, the business of health was still painfully analog.
“Healthcare has been woefully behind the curve,” says Zeynep Sumer King, vice president, regulatory and professional affairs for the Greater New York Hospital Association. “Both patients and clinicians can see the stark contrasts. [Compare the tech you use to track] your morning run with how we track a patient’s blood pressure. The pace at which [healthcare technology] is happening is slower than in the rest of our lives.”
But it’s finally catching up.
The first focus was on electronic health records (EHR). Along with the Recovery Act money, the Affordable Care Act set “Meaningful Use” standards for EHR adoption that hospitals and physicians had to meet to qualify for financial incentives from the Centers for Medicare & Medicaid Services (CMS) — and penalties if they lagged. “That was the launch pad for implementation of EHR,” says Susan Van Meter, senior vice president, federal relations, for the Health Care Association of New York State. “These systems are now in all hospitals and enable improved patient care.” It has been a painful transition, however. Many doctors hated, and still hate, electronic record-keeping. Many patients hated, and still hate, that doctors spend so much time with their noses in their notebook computers. But it had to be done. “Good or bad, it really did propel hospitals into the 21st century,” King says. “For all the challenges on the industry, it has been successful in driving major adoption of robust technology.”
That has had a huge impact on the business of health. For one thing, technology is expensive, even with state and federal help, and consolidation has exploded in recent years in large part to help scale the cost of tech investment. As a result, the area’s biggest healthcare organizations tend to lead the way. Westchester Medical Center Health Network (WMCHealth), for instance, has launched several tech-based programs to improve the care it delivers throughout the Hudson Valley. The future, it believes, is in telehealth. Thanks to this technology, instead of patients going to healthcare, healthcare will go to patients.
The eHealth operations center at Westchester Medical Center in Valhalla.
WMCHealth’s eHealth initiative is run from a 5,500 sq ft eHealth operations center, located on the Medical Center’s Valhalla campus, which features 20 multimedia stations equipped with telehealth patient-monitoring technologies and software. This hub is staffed around the clock by physicians, nurses, and other healthcare professionals who serve, remotely, to complement care teams in network hospitals, nursing homes, physician offices, and, hopefully, private homes across the region.
WMC says that telehealth initiatives can reduce mortality by 20 percent and hospital-stay length by 26 percent. “Telemedicine changes the way we provide healthcare,” says Gary Brudnicki, senior executive vice president, CFO, and COO for WMCHealth. “It adds to the value and quality of services available to patients. You can’t think about that as only something to save money.”
Yet it does cut costs, in numerous ways. Enhanced patient safety reduces the odds of human error and the cost of more treatment. It can obviate the need for a helicopter or ambulance ride to get an evaluation or care. Technology saves money in more mundane areas as well — like inventory. “We have hundreds of thousands of products on our shelves,” Brudnicki says. “Technology helps manage these supplies, so we have the right product on the shelf when it’s needed, and that leads to cost savings.” Workflow gets a boost from technology, too. “Technology fundamentally affects the workflow of physicians and makes their job as efficient as possible,” says John Moustakakis, senior vice president and CIO for WMCHealth. “Technology makes information available across the continuum of care. In the world of population health, when you are working with hundreds of other partners, that is important so that Dr. X and Dr. Y are working together.”
Enhancing patient safety is the primary focus of high tech, Brudnicki says, but he admits there are secondary benefits: “Providing more quality, more access to information and more efficiency in delivery of care ultimately does have business implications.”
NewYork-Presbyterian/Lawrence Hospital in Bronxville is also embracing telehealth. Its Telestroke Initiative went live this past fall. It gives physicians video conferencing and data sharing to allow 24/7 coverage for acute stroke care from staff neurologists with stroke expertise. This has resulted in improved door-to-treatment times, which has been shown to improve overall patient outcomes, says Dr. Carlos Flores, director of emergency medicine at NYP/Lawrence.
NewYork-Presbyterian/Lawrence Hospital’s Telestroke Initiative allows doctors to video conference and share data, giving 24/7 coverage for acute stroke care.
Dr. Carlos Flores, director of emergency medicine, NewYork-Presbyterian/Lawrence Hospital
“This is a crucial venture in telehealth,” he says. “It allows us to do things rather quickly,” which is the most critical element in stroke care. When the staff neurologist is not there, specially trained nurses can wheel the computer and camera to the patient and transmit critical data. The neurologist can control the camera from wherever she is and consult with the bedside staff through audio hookup. “Contact is much quicker and treatments are significantly better,” Dr. Flores says. And it is only a matter of time, he believes, before telehealth brings specialty care for other diseases to community hospitals that don’t have subspecialty coverage.
Another new frontier in healthcare technology involves patient engagement. As Merin Joseph, EVP and CIO with WESTMED Practice Partners, puts it: “We have all this data, so how do we make patients take ownership of their health, to get them to be better patients?” An important tool in that quest is the patient portal, the Web application that makes a patient’s health record accessible and allows for online interactions with providers. This spring WESTMED is launching its new-and-improved Web/mobile app, called the Bridge Patient Portal. “We want to give patients an app that is no different from any other online experience — from hotels, airlines, or shopping. Healthcare should provide the same service,” Joseph says.
The portal enables patients to find their medical records, view lab results, schedule appointments, access urgent-care wait times, message with providers, access patient education, pay bills and more on both iOS and Android devices. As with other businesses, WESTMED hopes the portal reduces its call-center expenses. “Each call costs us to answer the phone,” Joseph says. “You may not get the right outcome in the first call, so you leave a message; there’s back and forth and lots of wasted time playing phone tag.” She hopes an efficient portal will improve customer satisfaction, which has financial implications, as well, because CMS payments are tied to patient-satisfaction scores.
Along with making all this accumulated data more available, technology allows it to be analyzed more efficiently. Quest Diagnostics, the lab-testing service that says it provides testing for one in three American adults each year, is adding data analytics to its long list of services. “In many industries, real-time access to data is commonplace, like when you can access your bank records online,” says Harvey Kaufman, senior medical director, medical affairs for Quest, which is based in Madison, NJ. “But what do you do if you have two banks? Most of healthcare is fragmented, with patients seeing different doctors, filling prescriptions from different pharmacies and using a multitude of other healthcare services. Physicians don’t have real-time access to clinical, quality, and other data stored in different systems for their patients.” Quest has developed what it calls Data Diagnostics technology, which helps physicians access data in real time while with the patient, so he or she can deliver care aligned with quality standards and other metrics that are increasingly used to reimburse providers. “For instance, if the patient is overdue for a diabetes test based on her age, Data Diagnostics tells the doctor while with the patient, so he or she can order the right test at the right time,” Kaufman says.
Harvey Kaufman, senior medical director, medical affairs, Quest Diagnostics
Technology has even changed the teaching of healthcare. Mary Jane D. O’Connell, PhD, Esq, associate dean for academic affairs in the Fordham School of Professional and Continuing Studies, says her school has reached out to C-suite leaders in healthcare in the Lower Hudson Valley to learn what they are looking for in new employees. “The consistent feedback is that they are sitting on a huge body of information and are in dire need of people to help them extrapolate from those data to better move their own institutions and serve their patients,” she says. The skills they are looking for include data analysis, statistics, and, above all, critical thinking. “MBA-level training is valuable but not necessary,” she says. “They are looking for entry-level and middle-management hires, and we are looking to incorporate those skills into our programs.” To that end, the school has added non-credit workshops, continuing-education and certification programs in healthcare administration and policy to its curriculum. She is quite bullish on the future of employment in healthcare. “We are moving students into rewarding and productive jobs with long-term employment opportunities,” she says.
Dr. H. Michael Dreher, The Elizabeth Bell LeVaca Dean of the School of Nursing & Healthcare Professions at The College of New Rochelle, agrees. The healthcare job market is forecast to grow 20 percent between 2014 and 2024, he says, and “Nursing has a projected 19 percent growth rate through 2022, which will provide my grads a lot of jobs.”
Those jobs now require basic to intermediate IT skills. “The increasing levels of technology required in the daily work of RNs has caused many to upgrade their skills to stay practicing,” he says. The school has adopted a tech-based learning platform to promote digital fluency among its students. “We are one of a few schools in the US fully adapted to this platform,” he says. “It’s a new paradigm in learning for both faculty and students. I am a firm believer that digital is where healthcare education is going.”
He’s probably right, since that’s where the business of healthcare is going, as well.
As helpful as electronic health records (EHR) are, they still pose considerable problems. One of the biggest is that there are many different EHR systems, and they often don’t play well together. This issue, called interoperability, is a national challenge. Though the Centers for Medicare & Medicaid Services has provided incentives to address the problem scheduled for 2018, New York State got proactive with a program whose acronym is pronounced “shiny.”
The Statewide Health Information Network for New York, or SHIN-NY, is a set of regulations that establish how the state’s eight regional networks collect, store, and protect patient information. This allows a doctor in Yonkers collaborate with a doctor in Buffalo about a patient’s record, helping them make informed decisions faster while avoiding unnecessary tests and reducing costs of care.
“New York State has been at the forefront of facilitating the exchange of electronic health information,” says Susan Van Meter, senior vice president, federal relations, for the Health Care Association of New York State.
According to a report issued by IBM on the major security threats to businesses worldwide in 2015, healthcare is now the most-cyberattacked industry, replacing financial services. Five of the eight largest healthcare security breaches since the beginning of 2010 took place during the first six months of 2015. More than 100 million healthcare records were compromised in 2015.
This year will likely be even worse, with cyber-thieves holding patient records for ransom, according to the credit-reporting firm Experian. “Personal medical information remains one of the most valuable types of data for attackers to steal,” notes the company’s fourth annual data-breach forecast.
“There is an amazing amount of ID theft with medical records,” says Gary Sastow, a partner with the legal firm Brown, Gruttadaro, Gaujean, Prato & Sastow, PLLC, in White Plains, who specializes in healthcare law. He knows of a few “relatively minor breaches” in Westchester County healthcare providers. “I know one where their email was hacked, but it didn’t go into their medical-records system,” he says.
Provider organizations need appropriate safeguards, including firewalls and password protection and awareness of the regulations dealing with security and remediation. “That can be very costly, both in dollars and in business reputation,” Sastow says. “It’s not good for business when you discover your provider had its medical records hacked.”
David Levine is a contributing writer to Westchester Magazine and 914INC. He wrote about niche businesses in the Q4 2016 issue of 914INC.