As the use of electronic health records continues to surge and people live longer, the need for better patient-data integration and sharing has become increasingly urgent.
Interoperability, in a healthcare context, means that records can be exchanged securely, effectively, and without compromising patient privacy. Yet, according to a nationwide roadmap created by the Office of the National Coordinator for Health Information Technology (ONC), “less than half of hospitals are integrating the data they receive into an individual’s record” and “only 14% of ambulatory providers shared electronic health information with providers outside of their organization.”
While progress has been made over the last few years, there is still significant work ahead to build nationwide interoperability.
To Micky Tripathi — who leads the ONC at the U.S. Department of Health and Human Services — improving, enhancing, and streamlining all aspects of interoperability throughout American healthcare is essential.
“I think all of us want the comfort and confidence that providers have the best available information to make the best decisions,” Tripathi said. “There are also many benefits to not having things done over and over again simply because one doctor doesn’t have access to the information from the other doctor.”
As Tripathi points outs, when interoperability is highly functional and efficient, it’s an advantage for patients who want proper access to their health data — or to have a sense of agency over it.
“Some patients may just want access to a portal to be
able to see the information, but they don’t really want to be more actively involved,” he said. “That’s totally fine — that’s up to the individual. But there are other patients who want to be more directly involved in their care. They want to do their own research and ask the right questions to their doctors, and they need to be given the opportunity to do that. They can’t do so if they don’t have the most up-to-date information about their own health.”
The very notion of interoperability implies optimization. Therefore, the conundrum of interoperability between
healthcare providers is that it shouldn’t be a conundrum. If the various operational structures within healthcare were more connected, data could flow more seamlessly and securely, and both patients and providers could further benefit from this.
Still, Tripathi mentions that there are many efforts underway to improve these processes. “We’re doing a tremendous amount to bring all of us to the 21st century digital healthcare system that we all want. We’ve invested roughly $40 billion federally, and there was an equal amount invested by the private sector. Then there’s been a lot of sweat equity by healthcare providers and technology developers to
get electronic health records in place.”
What about privacy — perhaps the biggest concern that patients may have when it comes to exchanging sensitive health information?
“These entities exchanging information with each other are regulated by HIPAA, and the HIPAA rules say that you don’t need consent from the patient if it’s for treatment, payment, or operations because that allows for care continuity.”
But HIPAA only provides data protection when it’s in the hands of doctors, hospitals, and health insurers.
“From a privacy perspective,” Tripathi added, “one of the biggest issues that we have with interoperability is that as we make more and more information available to patients, they’re taking data outside of the boundaries of HIPAA. Once it’s on your phone, you’re the one who’s now responsible for protecting it — and for making sure you don’t click through some user agreement with your favorite app that grants access to all of your data.” n
Most people don’t think of radiology or sonography as high-stress careers, but the statistics tell a different story. More than 60% of radiologists report suffering from burnout , according to the National Institutes of Health, citing overwork and feeling underappreciated. And a study from King’s College London found that more than 70% of surveyed sonographers were considering leaving the profession due to workplace stress2.
Meanwhile, the demand for radiology and ultrasound procedures is growing rapidly. The benefits of early diagnosis combined with the rise in chronic diseases and a need for less-invasive diagnostic procedures is boosting the radiology and ultrasound system market. For example, the Bureau of Labor Statistics predicts employment of medical sonographers to grow 10% in the next decade3, adding nearly 15,000 jobs a year, aided by record-low unemployment. But in the short term, that extra demand translates to more images to interpret, more data to input — and more stress.
With demand for radiologic scans and ultrasound exams soaring, challenges to the well-being and mental health
of the experts delivering these services is mounting:
• There is wasted time and inefficiency — for example, an analysis at a Canadian hospital showed radiologists spent about 10% of their work day communicating routine results 4 , while sonographers in a US hospital spent only 39% of their day on scanning activities — and up to 5 hours per day on non-scanning activities 5
• Increasing exam complexity combined with inter-operator variability can have a negative impact on workflows, leading to frustration and lowered confidence6.
• Outdated equipment can pose a heightened risk of repetitive
stress injuries (RSIs) and other health risks7.
• Redundant manual data entry takes up time that could be spent on more important aspects of the work — frustration with electronic medical records is frequently cited as a major cause of burnout8.
• The exploding volume of exams can overtax even a fully staffed service, while manual billing and quality assurance and control procedures can result in duplicated effort and disrupted work.
One other potential cause of workplace stress and burnout for radiologists and sonographers is non-standardization of both equipment and protocols. Legacy software in
picture archiving and communication systems (PACS) and radiology information systems (RIS) are often left to languish with minimal upgrades from vendors, and there can be wide variation in report terminology. These disparate approaches, systems, and vocabularies contribute to a stressful work environment.
Technological solutions
There are several effective ways to combat the prevalence of workplace burnout for radiologists and sonographers. One overall change is to implement digital workflow optimization solutions. Employing artificial intelligence (AI) and other software tools may minimize steps in workflows, reduce distractions, analyze real-time volume to make workload assignments equitable, and ensure right-size staff-
ing as volume fluctuates. These solutions may also help standardize the equipment, terminology, and protocols used by sonographers, resulting in reduced variability in exam quality and standardization of reporting for radiologists.
Artificial Intelligence may reduce burnout in other ways. GE Healthcare’s Voluson SWIFT™ * is an ultrasound system that leverages artificial intelligence to simplify the workflow, increase efficiency, and improve accuracy. The system uses Sonolyst, a suite of AI tools that can automatically identify fetal anatomy, offer AI-assisted analysis of images, and help properly align views of the fetal brain. And adding cloud-based storage to PACS and RIS platforms can improve access to images and facilitate collaboration. n
Jeff Somers
For more information about the ways technology like workflow optimization solutions and AI tools will help reduce stress and burnout for radiologists and sonographers, two recent GE Healthcare Innovation Theatre events at the 2022 Radiological Society of North America offer insights and information from industry leaders: “Digital Path to Improved Ultrasound Quality, Ef�ıciency, and Work�low” and “A Glimpse into the Digital Future of Ultrasound.”
1Chetlen, Alison L et al. “Addressing Burnout in Radiologists.” Academic radiology vol. 26,4 (2019): 526-533. doi:10.1016/j.acra.2018.07.001
2Skelton E, Harrison G, Rutherford M, Ayers S, Malamateniou C. UK obstetric sonographers’ experiences of the COVID-19 pandemic: Burnout, role satisfaction and impact on clinical practice. Ultrasound. 2022;0(0).
3Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Diagnostic Medical Sonographers and Cardiovascular Technologists and Technicians, at https://www.bls.gov/ooh/healthcare/diagnostic-medical-sonographers.htm (visited November 14, 2022).
4O’ Neill SB, Vijayasarathi A, Nicolaou S, et al. Evaluating Radiology Result
Communication in the Emergency Department. Canadian Association of Radiologists Journal. 2021;72(4):846853.
5Hoffman K, Evans J, Kershner P, Haurani MJ, Satiani B. Analysis of Lost Sonographer Productivity in a University Hospital Vascular Laboratory. Journal for Vascular Ultrasound. 2015;39(2):78-80.
6Reiner, Bruce I. “Strategies for radiol-
ogy reporting and communication. Part 1: challenges and heightened expectations.” Journal of digital imaging vol. 26,4 (2013): 610-3. doi:10.1007/ s10278-013-9615-6
7Muir, Marylou & Hrynkow, Paul & Chase, Robert & Boyce, Dianne & Mclean, Daria. (2004). The Nature, Cause, and Extent of Occupational Musculoskeletal Injuries among
Sonographers. Journal of Diagnostic Medical Sonography. 20. 317-325. 10.1177/8756479304266737.
8 Christopher R. Bailey, Allison M. Bailey, Anna Sophia McKenney, and Clifford R. Weiss “Understanding and Appreciating Burnout in Radiologists.” RadioGraphics 2022 42:5, E137-E139.
*Voluson Swift is a trademark of GE Healthcare.
Healthcare technology has already advanced so much in the past few years. What is the next step? What is the next big thing?
The next big thing in healthcare is acknowledging the most signifi cant milestone in the history of medicine: patient empowerment. Not only accepting that it exists and the newest member of the medical team is the patient themselves, but further embracing the concept to implement strategies and technologies that shift the traditional point-of-care to wherever patients are. This is simply unprecedented, and while the influx of advanced technologies into care initiated the changes we experience today (from the use of health sensors and remote care solutions to at-home lab tests and AI in medical decision-making), the cultural consequences of patient empowerment are the ones that primarily impact the way healthcare is delivered.
The pandemic has shown that millions of patients and physicians can adopt a new technology if they need to. Now it’s time to save a decade’s worth of progress in digital health by simply adding the cultural transformation, too.
What technologies do you see lasting in healthcare? Are there any that you don’t think are beneficial?
I think all healthcare technologies are beneficial that improve the doctor-patient relationship, make healthcare globalized, are evidence-based, meet
real-life patient or clinical needs, or share data with not only medical professionals but patients, too. These are the rules of thumb we use at The Medical Futurist when we try to assess the future impact of a new technology.
To highlight a few along these lines, voice-to-text applications stand out as those would finally give patients and physicians a chance to have a normal conversation while the app would write everything down into the medical records.
Easy-to-use health sensors provide patients with data they used to have but had no interfaces to access before. With such data, they are in a
better position with their caregivers to make decisions about health or disease management.
Every healthcare provider’s goal is to improve the lives of patients. If the industry can prove the benefi ts of these technologies through clinical trials and evidence-based studies, providers will be able to use them.
Moreover, proper regulations require policymakers to be at the forefront of innovation and understand certain disruptive technologies even
before those would hit the market. The reason why it comes with more pressure than 10 years ago is that, due to global supply chains and the widespread access to technologies, patients can reach out to devices and sensors themselves before those get regulated. The #wearenotwaiting movement is the perfect example for that in which thousands of diabetes patients made DIY artificial pancreas systems as regulations were lagging behind.
This is a historical chance for regulators to bring technologies to patients as soon as possible, as well as a threat for patients to access untested medical technologies like never before. n
Dr. Bertalan Meskó, Ph.D., director of The Medical Futurist Institute, discusses his predictions for the future of healthcare technology and how we can encourage providers to implement these new technologies.PHOTO: ANDRÁS ZOLTAI
SMS-based survey tools should also be used to collect patient-reported data on health conditions and risk factors. A population health management (PHM) platform aggregates and normalizes all this data for predictive analytics.
patient care. Leading digital patient engagement technology uses aggregated data, advanced predictive analytics, augmented intelligence, and machine learning to determine the content most likely to meet specific needs. It then automatically adjusts message content and delivery based on individuals’ responses to continually personalize and improve engagement.
4Close gaps in care and keep patients healthy
Sheen, M.D., M.P.H., M.B.A. Population Health Officer, Senior Vice President, Health Catalyst
Healthcare is undergoing a historic transition to value-based care (VBC). Success requires a holistic approach that keeps care teams closely connected with patients, delivering better care at lower costs.
Digital patient engagement technology enables care providers to overcome limitations in staffing, resources, and clinic capacity to reach more patients in the community. The Pew Research Center estimates that 97% of Americans own a cell phone. Automated SMS text-based communication is a means to securely communicate with patients, provide education, coordinate care, and motivate actions for their health. Gartner reports SMS open rates as high as 98% compared to 20% for email.
There are five foundational steps to improve care with these capabilities:
1Aggregate multi-domain data
To accurately identify patients who will benefit from added support via engagement technology, combine data from many sources. For example, claims data specify patients due for an Annual Wellness Visit. HL7 Scheduling Information Unsolicited messages contain data to identify patients with upcoming scheduled appointments. Admission-Discharge-Transfer feeds alert providers that a patient needs transitional care management after hospitalization.
A robust collection of data sources, including claims, clinical, pharmacy, and social determinants of health data, provides a holistic view of populations.
Identify patient cohorts
Predictive risk stratification tools identify patients at different levels of risk. Identifying the largest cohorts who will benefit most from specific interventions will make your efforts most impactful. There are many different standardized and customized risk stratification models. Cost, predictive power, ease of implementation, and fit for your patient population are among the factors to be evaluated. Leading PHM platforms typically incorporate high-quality predictive analytics.
It is also important to understand current services, processes, workflows, and opportunities for improvement, such as:
• Clinic hours and appointment wait times
• Consistency of evidence-based practices
• Preventive care services
• Health literacy and barriers to care
Once you have risk-stratified patient cohorts, using an integrated engagement platform automates communications and workflows to reduce administrative tasks. Care teams should focus on
There are many potential applications of this technology. One major function is automating personalized digital outreach for closing guideline-based gaps in care, including missed cancer screenings and vaccinations. When care gap information is embedded within electronic health records (EHRs) and workflows, care teams act on these insights to deliver the right care more reliably and efficiently.
Measure progress and deliver additional care
Dashboards and additional analytics allow organizations to measure progress and understand what is happening. As further needs are identified, such as coordination of care during or after a health challenge, additional personalized care plans can be automatically communicated to the right patients at the right time.
The transition to more accountable and higher-value care is complex. Success requires a holistic approach to transforming care that includes clinical leadership, care delivery redesign, quality improvement, operational excellence, patient engagement, aligned payment models, and additional innovations. Data aggregation, advanced analytics, augmented intelligence, machine learning, and personalized automated outreach keep care teams closely connected with patients, delivering better care at lower costs. n
To learn how you can start transforming care today, visit healthcatalyst.com/offerings/population-health
Wearable technology is one of the fastestgrowing markets in the world, estimated to be worth $52.14 billion in 2021.
João Bocas, a wearable tech expert, called wearables “the healthcare delivery of the future.”
“Wearables are an excellent vehicle to acquire data, and data is fundamental in terms of treating people,” Bocas said, adding that wearables can be used to monitor and diagnose patients.
The nonprofit GCF Global Learning describes wearable technology as devices worn throughout the day. Examples include smartwatches like the Apple Watch and fitness trackers like Fitbit. These devices aim to collect data and help wearers make more informed choices as they go about their day.
User comprehension of and engagement with that data is crucial for behavioral change.
“Wearables on their own, they’re not the miracle,” Bocas said. “The miracle is a combination of change of behavior and the wearables to assist.”
Wearables, he added, “require a very strong element of human intervention. The human being needs to be quite engaged and intrinsically find the motivation to use wearables to benefit from them.” Without the user knowing how to activate a feature and interpret its data, the wearable is useless for its intended purpose.
Other barriers that have been studied and need to be overcome for wearables to be helpful include: absent patient motivation, a lack of perceived value, human error (such as failing to charge a device or use a device), and concerns over patient data privacy and security.
Experts like Bocas are optimistic about the future of wearables — but they say those devices will be a lot more advanced than those you’re used to seeing on the wrist.
“They will be with us 24/7,” Bocas said. “Because of testing capabilities, wearables will be unrecognizable.”
As our healthcare system continues to plan for “post-COVID” strategies in patient care, a wide range of stakeholders are leading discussions about the future role of telehealth services.
Throughout the public health emergency (PHE), patients, healthcare providers, and the public at-large have seen the significant benefits that telehealth delivers in providing safe and convenient access to high-quality healthcare services. This was made possible due to flexibilities put in place allowing temporary access to telehealth under the PHE. Looking to the future, Congress and the Administration must now take steps in healthcare policy to ensure that access to telehealth remains in place beyond the PHE and continues to bring these benefits to patients across the United States.
The American Telemedicine Association (ATA) is currently asking Congress for a two-year extension of these flexibilities and waivers while continuing to advocate for permanent access to virtual care services in both the Medicare program and the commercial market.
In further efforts to support the permanency of telehealth, ATA introduced a platform of principles designed to guide policy decisions related to tech-
nology-enabled care in the years ahead. With a primary focus on ensuring patient choice, access, and satisfaction, the ATA policy principles also call for the essential levels of autonomy for healthcare providers in decisions related to care delivery and patient management, broad coverage and reimbursement for telehealth services, and the opportunity for patients to access care across state lines. Policy decisions at the state and federal levels should also allow non-physician members of care teams to offer telehealth services.
Prioritizing the patient perspective
To ensure the patient perspective is front and center in policy decisions, the ATA’s affiliated trade organization, ATA Action, launched a new Patient Voices for Telehealth Coalition (PVTC). This initiative invites organizations representing diverse patient communities to provide perspectives on federal and state policies related to virtual care and participate in the development of new policies that can support the advancement of telehealth. Through the PVTC, more leaders in patient advocacy can play a
central role in shaping a future of healthcare that provides all Americans with safe, quality care where and when they need it.
The COVID-19 pandemic brought with it an unprecedented level of both challenge and innovation in the delivery of healthcare services. It also significantly reinforced the benefits that telehealth can provide to patients, caregivers, clinicians, and society. As we plan for a post-COVID strategy in healthcare, the ATA policy principles represent both essential and achievable goals to guide many policy decisions, by keeping a focus on the benefits to patients and healthcare providers and creating strategies that will offer the highest levels of quality and security in service delivery. n
Kyle Zebley Senior Vice President of Public Policy, American Telemedicine AssociationTelehealth has proven to be a boon to older Americans, especially those with limited mobility. However, such services often aren’t developed with seniors in mind, leaving a gap in care that’s driving a new movement.
After decades of gradual progress in becoming an accepted alternative to in-person doctor visits, the COVID-19 pandemic catapulted telehealth into the mainstream. Among the biggest users of telehealth during that time? People older than 65, according to data from the Centers for Disease Control and Prevention.
In 2020 alone, Medicare visits conducted through telehealth platforms increased 63-fold, jumping to nearly 53 million from 840,000 in 2019.
“The pandemic put extraordinary strain on our healthcare system, but it also accelerated the adoption of telehealth — notably among older adults who were the least likely to engage in remote care beforehand,” said Zia Agha, M.D., chief medical officer of West Health.
As a result, telehealth is now woven into our country’s healthcare infrastructure. When done right, it benefits patients, providers, and payers alike. Recent research shows telehealth enables faster physician referrals, fewer hospitalizations and ER visits, lower costs, reduced travel, and improved mental health for caregivers.
Optimizing for senior health
Yet, serious pain points endure among seniors who use remote care, Agha noted, citing patient
Zia Agha, M.D. Chief Medical Officer, West Health Institute
That is why West Health Institute assembled the Collaborative for Telehealth & Aging, a group of experts with diverse, interrelated specialties, such as telemedicine, geriatrics, health system administration, and patient advocacy.
Best practices for telehealth and aging
As the healthcare industry drives toward a more seamless and automated future, common business rules are critical to success.
For years, healthcare has been regarded as lagging behind other parts of the economy in automation, interoperability, and the consumer experience. That is changing. The industry is making meaningful progress toward a seamless experience for health plans, providers, and consumers.
Wardlow, Ph.D. Senior Director of Clinical Research and Telehealth, West Health Institutesurveys. Telehealth, typically conducted via a computer or mobile device, often isn’t amenable to patients with cognitive issues like dementia or physical challenges like hearing loss. Some older patients also struggle with low technical literacy.
“It has become clear over these past few years that telehealth isn’t optimized for older adults,” said Liane Wardlow, Ph.D., senior director of Clinical Research and Telehealth at West Health. “The healthcare industry must come together to ensure remote care is designed in a way that’s effective, safe, and efficient for all — including seniors, who are the biggest consumers of healthcare and, oftentimes, the most vulnerable patients.”
Through an iterative process that kicked off just over a year ago, the group recently issued the first-ever best practices for telehealth and aging. In the coming months, it also will launch a Center for Excellence through which telehealth providers can pledge to adopt those best practices.
“At the core of our work is the belief that telehealth must remain a vital tool for older people who may be homebound, lack transportation, have mobility challenges, or live in rural areas where specialists are difficult to access,” Agha said.
The Collaborative landed on three guiding principles, calling for telehealth to be person-centered, equitable and accessible, and integrated and coordinated with patients’ broader care plans. The group also calls for telehealth-specific training for providers.
Wardlow’s hope is that the principles will be widely embraced among telehealth providers, elevating the standard of care for older patients today and tomorrow. n
Learn more at westhealth.org/telehealth
Kelly Quigley, Director of Communications, West Health•
CAQH CORE — a collaboration of providers, health plans, vendors, government agencies, and standard-setting bodies — develops protocols, known as operating rules, to enable predictable, consistent, and secure data sharing. By streamlining how information is exchanged, the industry has improved the experience for health plans, providers, and patients alike.
In May 2022, CAQH CORE unveiled new and updated rules that focus on:
• Connectivity
Updating key security requirements and ensuring that emerging standards can be exchanged in a uniform manner.
• Infrastructure
Increasing the amount of time per week and per month that systems are available.
• Eligibility and benefits
Reflecting emerging industry needs related to telemedicine, value-based payments, and prior authorizations.
Establishing workflows for the electronic exchange of attachments that accompany healthcare claims and prior authorizations.
Over time, these guidelines will result in less time spent by providers on administrative functions and allow more time for patient care.
Erin Weber, Vice President, Committee on Operating Rules for Information Exchange (CORE), Council for Affordable Quality Healthcare (CAQH)
