2020 FedHealth Conference Thought Leadership Compendium by Professional Services Council

THOUGHT LEADERSHIP COMPENDIUM

TABLE OF CONTENTS 1

Bridging the Gap Between Government and Industry to Address the Public Health Crisis Capgemini

Data Analytics in Government Health DLH

Data’s Role in Your Digital Transformation Dovel Technologies

Using Feedback to Drive Decisions Within Public Health Agencies ICF

The Future of Healthcare Payments: What Ten Years of Trends Can Tell Us About a COVID-19 World J.P. Morgan

Taking a Strategic Approach to Experience True Digital Transformation Leidos

COVID-19 and Supply Chain Resilience: What’s Next? LMI

Our Nation’s Health: Progress and Opportunities for Improvement MayaTech

Optimizing Medical Device Management and Security for Clinical Technicians During and Post COVID-19 Ordr

Technology Aids in the Protection of High-Risk Healthcare Recipients and Providers Parsons

Bridging the gap between government and industry to address the public health crisis The public health crisis and overnight switch to a fully remote working model this year has forced us all to re-imagine the way that businesses interact with one another. As Government and industry come together to fight the spread of COVID-19, it is crucial that we re-evaluate our existing communication processes and breakdown unnecessary siloes and inefficiencies. Government agencies have already launched innovative campaigns to identify industry-leading technologies and accelerate modernization efforts, such as NIH’s All of Us campaign and FDA’s Precision Data Challenge. While these campaigns help target pressing issues, we must also use this critical moment in the world to improve the status quo and to foster long-standing relationships between private and public sector partners. This is the only way to ensure that technology modernization needs are addressed and sustained in the future.

Bridging the Gap While Government contractors have been supporting Federal agencies for decades, Government projects are often separated from similar work in the private sector due to a variety of factors including security, speed of implementation, priorities, and funding. Security concerns withstanding, companies that serve both Federal and private sector clients have a unique obligation to serve as a collaborative intermediary between Federal agencies and the industries they regulate. At Capgemini a recently formalized ‘Bridge the Gap’ initiative between Federal Health & Technology and Life Sciences groups was designed to increase communication between public and private sector clients, bringing best practices to both groups, and delivering solutions across the commercial and Government industries. The best practices below highlight some of the lessons learned that can be leveraged to accelerate collaboration between the private and public sectors.

Understand the Interaction Between Government and Industry There is often more cross-over between Federal and commercial clients than initially assumed. For example, pharmaceutical companies submitting applications to the FDA through web-based portals can have valuable input about how to improve the webforms. By taking the time to understand pharma pain points, FDA can identify shared experiences and challenges, creating an opportunity to serve both stakeholder groups more effectively.

Acknowledge that Timelines are Different Government agencies are purposefully structured to move much slower than the private sector to accommodate for factors such as security and budget. Recognize that emerging technologies from the private sector will need to be implemented differently in Government agencies and plan additional time to support clients who must review, approve, and implement emerging technologies.

Define Your Value Add as the Intermediary Each consulting firm has a unique expertise and set of capabilities that are leveraged to support Government and industry clients. Each firm should identify the best tools that they can leverage to serve as a supportive intermediary to both Government and industry. At Capgemini, we have leveraged our customized tools and methodologies built specifically for Life Sciences clients and presented them to our Federal health clients such as FDA and VA. These tools already incorporate features that consider industry-specific regulations, such as HIPPA, which allows us to better cater to our clientsâ&#x20AC;&#x2122; needs. Breaking down the unnecessary silos that separate private and public sector clients will ensure that emerging technologies are not only made available to the Government, but also implemented at an accelerated rate. It is industryâ&#x20AC;&#x2122;s responsibility to use this pivotal moment not only to address COVID-19, but more importantly, to ensure that we are better equipped to serve our clients in the future.

Want to know more about Capgeminiâ&#x20AC;&#x2122;s Life Sciences division? Click here. For all Capgemini Government Solutions blogs, click here Author Details: Deak Jenkins, Fed Health & Technology Practice Lead deak.jenkins@capgemini-gs.com

Data Analytics in Government Health How government health programs use data analysis to evaluate results and drive improved outcomes Prepared by

Gil Tadmor

Chief Technology Officer gil.tadmor@DLHcorp.com www.DLHCorp.com

(770) 554-3545

Corporate Headquarters: 3565 Piedmont Rd NE, Building 3, Suite 700, Atlanta, GA 30305 National Capital Region Headquarters: 8757 Georgia Ave, Suite 1200, Silver Spring, MD 20910 3

Data is everywhere. By utilizing repeatable data management processes -- critical for trustworthy analytics -- the government health industry has already begun to move. By diving head first into innovation, organizations are exploring the potential of their untapped data.

Data analytics are an indispensable tool across all levels of government, and in no sector is that more apparent than health. From study design, to data modeling, provisioning and aggregation, all the way to predictive analysis and impactful real-time dashboard reporting, government health programs utilize data analytics to evaluate results and drive improved outcomes.

Core Data Management Needs The core driving data management needs haven’t changed over the years - accessibility, sharing, privacy and security. To support these needs in a scalable fashion, allowing continuous integration of the latest tools and technologies, many agencies require some level of digital transformation to establish the right framework. Increased investment in IT architectures is driving this transformation, thus providing two key advantages: flexibility – the ability to adapt to user needs and roll out new system capabilities, and scalability – support for an increasing user base, data management, and complexity. Capably providing support and accessiblity for large user bases is key for modern government health systems. Real-time complex business decisions are predicated on access to large and diverse data sets. Easy data integration, consolidation, and dissemination is vital, and new systems must enable data mashups, dashboards, and data browsing services that support distributed and mobile users with real-time access. Agencies that are successful in claiming ‘data-driven’ decision making and CQI have achieved a true enterprise-wide adoption of their data manage-

ment framework, and tool-enabled automation.

Looking Forward - What’s Next? With top-of-the-line enterprise IT architectures in place, government entities can take advantage of the rapid advancements in analytics technology. Analysis has evolved from mere data reporting and user-driven exploration -- describing what happened -to diagnostic analysis of why something happened. The imminent future lies in forecasting -- predictive analytics and optimization. Predictive and prescriptive, these analytical elements seek answers to the questions “what will happen?” and “how we can make something happen?” These advancements are already having profound effects on government health. Through advanced infrastructure, AI-fueled organizations, and intelligent interfaces, research, health data management, and technology-enabled treatment solutions are becoming easier to use, more trustworthy, and increasingly automated. With expanded flexibility and customization options available to health professionals and operational decision makers, coupled with an increased focus on security to match the threat around us, the future of government health data analytics is bright. For those we serve, that means two things: better outcomes and increased efficiency.

DATAâ&#x20AC;&#x2122;S ROLE IN YOUR DIGITAL TRANSFORMATION 5

DATA’S ROLE IN YOUR DIGITAL TRANSFORMATION

In today’s digital world, data has become the most strategic asset in an organization. The quantity of data is not in question, but rather, the most important question is how to create meaningful value out of it. Federal health agencies can find themselves with too much data. The value is derived when the data is organized, analyzed, and then utilized to proactively move missions forward and drive meaningful change. An investment in data requires creating a framework that aligns with business goals and the overall organizational strategy. The process of organizing, analyzing, and using data is happening at different speeds across the government. Health agencies are at varying levels of digital maturity as defined below with the range being: DOVEL DIGITAL MATURITY MODEL

LIMITED

ORGANIZED

DIGITIZED

CONNECTED

OPTIMIZED

Little governance, separated data silos, all technology is on premise, reactive response to issues.

Beginning stages of data integration, Cloud migration is happening, decisions are documented and shared.

Data is shared across departments building digital consensus, dashboards are used to track KPIs, data warehouse and data lakes are being used.

External partners are engaged in data strategy, predictive data products are implemented, automation is applied across departments.

Automatically detect and respond to errors, dashboards are accessible to all departments, predictive solutions are applied across departments.

The connected and optimized levels are aspirational for many federal health agencies, but they are attainable. In moving through this maturity model, there are several key steps that empower health agencies to realize the value of their data and apply it to daily decision-making. The starting point is a data strategy to support interoperability, data sharing, and analytics. ENTERPRISE DATA MANAGEMENT

DATA INTEGRATION

DATA GOVERNANCE

DATA INTELLIGENCE

ADVANCED DATA ANALYTICS

A DATA INVESTMENT MUST SOLVE A BUSINESS PROBLEM AND ALIGN WITH THE STRATEGY

DATA VISUALIZATION

BUSINESS INTELLIGENCE

DATA’S ROLE IN YOUR DIGITAL TRANSFORMATION

DATA STRATEGY – THE STARTING POINT FOR DIGITAL EVOLUTION (Includes Data Governance and Data Integration phases)

Organizations need a data strategy in place that aligns with the mission and values. It is critical to understand not only what the high-level strategic goals are but how does data help achieve these goals and what data is needed. In order to be successful, the strategy needs a strong data management approach which starts with defining data governance. DEFINE YOUR BUSINESS NEED – What do you need the data for? What value will it bring? Looking at specific business goals that need to be achieved or overarching strategy that needs support will help narrow the focus on particular sets of data. TAKE AN INVENTORY OF THE DATA YOU HAVE – Where is it housed – both internally and externally? Is it interoperable? Is data missing that is needed to accomplish your goals? This data audit is critical to ensuring you have access to the right data and are not wasting time or resources on unneeded data. CREATE A DATA GOVERNANCE MODEL – This is the collection of practices and processes which help to define how data assets are accessed within an organization. This includes the hierarchy of who can see and share the data, defining administration levels, and quality practices. CONSOLIDATE DATA SETS – Defining a plan for data integration raises questions about how the migration, consolidation, and management of the data is possible. What processes, tools, and skills are needed to collect, house, access, and analyze the data? How will new data be incorporated? DEFINE THE OUTCOMES – Identifying the KPIs, the metrics, and the outcomes needed from the data is a critical part of the data strategy. With these steps completed, organizations find themselves at the “organized” stage of digital

evolution. The massive amounts of data begin to feel more manageable as only the data most relevant to the business goals have been collected and made ready for use. With a data strategy in place, the next phase of realizing the value of the data is making it digestible. This is where data visualization comes into play.

DATA VISUALIZATION – CONNECTING THE DOTS (Includes Data Visualization and Business Intelligence phases)

Now that the data strategy has been developed with governance and integration plans providing a roadmap and the outcomes having been defined, the next step is to decide the best route to get to your destination and make the results available throughout the organization. To do so, data needs to be visualized – where are the meaningful intersections that will shorten the route to decision making and insight? Organizations find data sets that flow up to data lakes are an effective way to share previously siloed data. The data lake becomes the repository for all data that is used for visualization. It is here where the data from multiple sources can be standardized. Additionally, the use of data lakes, and/or a storage repository for all data, including raw source system data, as well as the transformed, standardized data ensures that it can be digested by artificial intelligence (AI), machine learning (ML), and natural language processing (NLP) technologies. Collecting data in this way allows for the creation of dashboards with detailed insights, organized by characteristics (like geography or dates), and includes the integration of data from other sources such as social networks. For example, if a regulatory agency wanted to track adverse events that occurred as part of a medication, the agency could take a large set of public data, integrate the data on the labels of the adverse events that have been reported and start running queries creating a powerful dashboard with statistics on labeled and unlabeled adverse events within the population. With the power of visualization, the agency could break down the results by race or gender or location, etc. to provide a more useful look at the data.

DATA’S ROLE IN YOUR DIGITAL TRANSFORMATION

Visualization is a critical step but is not the end goal. This is how federal health agencies become “digitized” and “connected” – having all of their data online, accessible (by role) in one place, across the organization. Forward thinking agencies are continuing on the digital maturity journey, using data as the basis for decision making. Visualization leads into business intelligence (BI) which includes data warehouses, data marts, and Relational Database Management Systems (RDBMS), all of which are applied to build powerful dashboards. Together, these dashboards present a good view of the past – how an event happened, identifying big trends and patterns without digging too much into the why’s or what will happen later. However, business leaders today want to know what will happen in the future to drive organization-impacting decisions. The next step is applying advanced analytic tools and practices like ML, NLP, predictive analytics, and deep learning to gain insights that will drive the success of the organization’s business objectives. Taking data visualization and BI and combining them with advanced analytics techniques is what forms the basis to achieve ultimate decision intelligence.

ADVANCED DATA ANALYTICS – ACHIEVING DECISION INTELLIGENCE (Includes Advanced Analytics and Data Intelligence phases)

Building on data strategy, data visualization, and BI, the next step in becoming a data driven organization is implementing and using advanced data analytics tools that will build decision intelligence. Data intelligence, or the prescription of what to do with the insights and predictions, is the last phase of the journey. Here, health agencies are no longer making decisions on gut feelings or what the past has shown them, their data is now not only predicting what will happen in the future but also giving actions to take based on those predictions. Agencies are now making critical decisions based on solid insights and predictions, enabling faster response time, cost reductions, and more efficient processes.

Many agencies try to get to this step too quickly. For advanced analytics to be successful, organizations need to put in the work outlined above of setting up the data strategy and fine tuning the data integration, reporting, and visualization. It is only then, that advanced analytics tools can be applied and enable organizations to reach their goals by tracking trends to discover deeper insights and make predictions. These predictions are only as valuable as what an organization does next. Will health agencies know the right steps to take based on the predictions? Data intelligence, or the prescription of what to do with the insights and predictions, is the last phase of the journey. DATA IS CRITICAL FOR DIGITAL TRANSFORMATION From creating a data strategy to making the data understandable to automating and informing decisions with that data, organizations can achieve the “optimized” state of maturity where data drives every decision made. Once this is achieved, the time spent on dashboards will significantly decline as dynamic autogenerated and personalized data stories will provide the insights that are easily consumable and actionable by the majority of users. These data stories will be automatically generated with the combination of user experiences, NLP algorithms, and predictions and prescriptions. This achieved state does not signal the end. The process is cyclical, not linear and requires constant reevaluation of where data is living and what data is needed. Federal health agencies need to be cognizant of auditing the predictions to ensure optimal results and return to data governance when big changes do happen. Applying the rigor outlined here can help any organization realize the value of their data hiding in plain sight.

CONTACT INFORMATION Dovel Innovation and Technology Group (ITG) ITG@doveltech.com

Health

White Paper

icf.com

Using feedback to drive decisions within public health agencies Collecting Voice of the Customer (VoC) data for smarter resource investment By Josh DeLung, ICF Why CX matters for government § Alignment with Executive Branch priorities, such as the President’s Management Agenda § Compliance with OMB Circular A-11 (2019) Section 280 (especially for high-impact service providers)

§ Adherence to the 21st Century Integrated Digital Experience Act (IDEA)

§ Preparedness for upcoming legislation, such as the Federal Agency Customer Experience Act

§ Improvements to metrics that matter to an agency’s mission and the trust it builds with customers

§ Better understanding of the public’s health IQ and the needs of different segments

§ Cost savings through more efficient, customer-focused processes

How do you decide where to invest limited resources as a federal agency? Are audience research, information technology, infrastructure, and service improvements the right moves to make? Leaders must balance competing priorities and budgets with the public good and effective stewardship of taxpayer dollars. So how can agencies gain clarity in the decision-making process while helping citizens, health professionals, and other stakeholders get the information and services they need most? The answer is a wellstructured approach to collecting customer feedback.

Start with the voice of the customer A foundational component to improving the results your agency delivers to its customers—whether citizens within particular segments of the general public, employees of internal departments, or state and local public health agencies—is by starting a formal, consolidated VoC program: a fundamental component of improving customer experience (CX). What is a VoC program? A VoC program is a systematic way of collecting qualitative and quantitative customer feedback at multiple touchpoints along the customer journey. The purpose of collecting feedback at each touchpoint is to identify opportunities for specific improvements to the messages, interventions, services, and processes with which citizens and partners interact. You’ve probably seen VoC programs in action in your everyday life, some more successful than others. Take, for example, the ambiguous (and potentially misleading) happy and sad face kiosks at an airport, or the “How was your visit?” survey you’re asked to complete after visiting an urgent care facility. This type of customer sentiment and behavior data—which can come not just from surveys but from other sources, including call center

Using feedback to drive decisions within public health agencies

data, web analytics, online reviews, and social media—are all examples of VoC programs in action. But VoC programs only work for an organization if the qualitative and quantitative data they collect are synthesized and shared in a fashion that improves CX decision making and the delivery of services. Put simply, feedback from people who interact with an agency that’s synthesized with a strategic lens allows government agencies to better serve the population. Armed with this information, they can more efficiently and effectively disseminate data, make policy recommendations, develop guidelines, manage health information, and produce emergency content through reports, articles, campaigns, social media platforms, and other channels. Why VoC programs now? The nuts and bolts of a VoC program § Inventory of touchpoints with customers (e.g., online applications)

§ Feedback mechanisms for key touchpoints (e.g., surveys)

§ Tracking software or documentation to compile and analyze data (e.g., a COTS product)

§ Designated staff to manage program workstreams

§ Designated staff to act on insights from data

The last decade has seen a dramatic change in how the government approaches service delivery. CX gained momentum with the formation of a cross-agency customer service working group, followed by Executive Order 13571, the government’s first CX officer, and the establishment of organizations such as 18F and the U.S. Digital Service. This progress continues today under the guidance of the President’s Management Agenda, OMB Circular A-11 (2019) Section 280, the 21st Century Integrated Digital Experience Act (IDEA), and the pending Federal Agency Customer Experience Act. Today, 89% of private companies say they compete based on CX. Research has shown that customers who have a good experience are 3.5 times more likely to make additional purchases and five times more likely to recommend an organization’s services than those who don’t. These lessons can apply to the government sector as well, helping to increase trust and engagement with constituents. It’s more than just a good strategic move for government agencies to improve how citizen services are delivered—it’s now a formal requirement from the highest levels of the executive branch. Without a VoC program, an agency simply can’t begin to meet those requirements, and they’ll miss out on significant opportunities to increase trust with their customers. VoC program data also allow agencies to make more impactful investments through efficient customer journeys, faster decision making, more targeted content, and better technologies.

VoC programs at public health agencies Americans are safer when public health organizations implement VoC programs. Knowing which communications and service touchpoints work best enables agencies to move quickly to thwart problems—especially in times of crisis. There are massive national security and public health implications to knowing what’s happening on the ground. When minutes and hours matter to dispel myths, disseminate vital information, or make policy decisions, synthesized data from multiple listening posts are crucial to making the right choices.

Using feedback to drive decisions within public health agencies

Layers of VoC program measures 1. Program measures. Program-wide overall feedback that assists with tracking trends over time against program changes. 2. Journey measures. Feedback at high-priority milestones in customer journeys that helps identify pain points within specific touchpoints. 3. Tactical measures. Analytics and qualitative feedback that helps identify root cause issues with engagement tactics like conferences and web content.

There’s a lot of scrutiny on how the government spends taxpayer money— and significant consequences for failure. As such, it’s more important than ever to make sure agencies use their resources to develop the right content and services—and to deliver them through technology platforms best suited to achieve mission success and build customer trust. This is especially true for public health organizations like the Centers for Disease Control and Prevention (CDC). For example, preventing the widespread outbreak of disease is only possible if citizens trust the CDC and its content, and if citizens are made aware of that content through the channels they access in times of crisis. How are VoC program data used? There are many ways to use collected customer feedback. Teams will synthesize data in different ways to inform multiple types of outputs relevant to their department. That’s why it’s essential for agencies to do more than just collect customer feedback on their content and services; that feedback must be shared outside of silos to inform decision making at the mission-delivery level. Thankfully, the Office of Management and Budget (OMB) has worked to streamline the Paperwork Reduction Act (PRA) approval for collecting customer feedback in order to improve experiences with agency information and services. The CX MAX Community page includes tools and templates for navigating the clearance process. Digital.gov also has a simple guide to the PRA that includes tips for deciding what requires clearance. Feedback throughout the customer journey is critical to understanding a customer’s overall trust, sentiment, and future intent. This includes feedback about interactions with employees, web content, other digital systems, and even physical spaces and associated needs (such as parking at a facility). It must be shared with all relevant parties who support the journey; for example, if the person who receives feedback on the entire customer journey only manages the department responsible for the website, other issues may go unresolved. If the data are pulled into reports or dashboards that can be shared more widely, however, it’s possible that human resources, public affairs, information technology, and facilities departments could all contribute to improving the overall CX in quantifiable ways. Consider a parent who’s concerned about the health of their child. They may hit many touchpoints: Google, the CDC, their primary care provider (PCP), an urgent care center, the pharmacy, and again with their PCP. Data may be reported by providers to the county health department and, eventually, to the CDC. Throughout, there are many customers and stakeholders touching many systems and having many interactions—and all of them impact an agency’s reputation and ability to achieve its mission. In a VoC program, customer feedback inputs from interviews, surveys, live chats, transactions, and more will undergo synthesis activities such as text analysis and journey mapping to name only a couple. Finally, that synthesis will result in outputs such as improved contact center protocols, better web content, or employee enablement programs. icf.com ©Copyright 2020 ICF

Using feedback to drive decisions within public health agencies

Five steps for getting started These five steps provide the necessary direction for upstart CX teams starting a VoC program within their agency. 1. Outline your goals. Define your intended experience for each customer segment. What measures must you achieve at each touchpoint to be successful and to effectively deliver on your mission? Think about these measures at tactical, journey, and program layers. Document how you plan to use feedback and who’s responsible for acting on it. 2. Conduct a customer feedback inventory. Identify all existing methods of collecting customer feedback and at which touchpoints along the customer journey they fall. Document gaps and determine the best methodologies for getting a holistic picture of what your customers need at the tactical, journey, and program layers. 3. Establish baseline CX metrics. Use the data you currently have to set benchmarks and identify key performance indicators in need of improvement so you can measure progress over time. Good CX metrics look at customer perception (what a customer thinks or feels), customer description (what’s happening to a customer), and customer outcomes (the end results for which your agency is held accountable). 4. Design collection methods for actionable feedback. Ensure you ask customers about their overall experience using a mix of specific and open-ended questions. Offer the smallest number of rating options possible, prioritize what’s most important to your mission, and ask customers to rate the relative importance of the topics about which you ask. To avoid customer survey fatigue, limit your surveys to the number of interactions a customer has with your agency on a regular basis, and use completion rates to help gauge how often to survey your target audiences. 5. Synthesize and triage. Data collection is most valuable when it involves careful synthesis and deliberate action. It’s easier (and more justifiable) to act on insights from real customers. Engage crossfunctional teams in your data analysis and share the outputs with all teams involved with the customer touchpoints in question. Remember the final step of triaging customer feedback: letting the customer know you’ve heard them and that you’ve fixed the issue. This process involves three important parts: the customer interaction (e.g., completing a form online), the channel through which VoC data gets collected (e.g., web intercept survey tied to that form page), and the insight generated from the collection channel (e.g., whether the form is easy to find, understand, and use).

Informing content operations with a VoC program Many organizations start with a small VoC program and scale up to an agency-wide, consolidated program over time. Although it’s important to work toward a united view of an agency’s full impact on its customers, you can kick off the change with a single-use case. icf.com ©Copyright 2020 ICF

Using feedback to drive decisions within public health agencies

ICF helps agencies gather data along their customers’ journeys to uncover challenges that might impact goal achievement. We are a trusted service provider for federal CX services based on our groundbreaking work with the GSA IT Modernization Centers of Excellence for CX at USDA and HUD.

Web content is a wonderfully appropriate area to begin because it touches many segments of users across many platforms and devices. And because so many different people produce and consume web content in a variety of formats, customers may find and experience it in unique ways. A VoC program can lend deeper insights into these nuances than traditional web analytics, helping agencies target enhancements more effectively. Most web analytics tools, for example, tell you what users do—but not why they do it. Through web intercept surveys, analytics data, text analytics from search and chat interactions, synthesis of unstructured qualitative data from customer interviews, and other tactics, web teams can find ways to improve content operations and answer questions, such as: § What content is most needed?

About ICF ICF (NASDAQ:ICFI) is a global consulting and digital services company with over 7,000 full- and part-time employees, but we are not your typical consultants. At ICF, business analysts and policy specialists work together with digital strategists, data scientists and creatives. We combine unmatched industry expertise with cuttingedge engagement capabilities to help organizations solve their most complex challenges. Since 1969, public and private sector clients have worked with ICF to navigate change and shape the future. Learn more at icf.com.

For more information, contact:

Kim McCarley

Kim.McCarley@icfnext.com +1.571.459.4085

Visit us at icf.com/health

§ How well do users understand content that the agency knows is important? § Do users trust the content, and, if not, is the content or the medium the problem? § In what ways are users finding, engaging with, and sharing content? § What content is underutilized, and why? § Is content optimized for the way customers discover it? § Is content streamlined for the right devices and platforms? § What other mechanisms for service delivery do people interact with before, during, and after coming to the agency’s digital products? VoC program data help agencies see more of the full picture and feel empowered to make content and service delivery decisions faster— and better.

About the Author Josh DeLung is a senior digital strategist with more than 18 years of combined strategic communication experience. His career has focused on building and leading teams who design excellent experiences and engage people via digital touchpoints. He leads strategy for ICF’s team of experts focused on content strategy, customer experience, and digital analytics. He serves as a strategist on multiple digital government and commercial projects, including many U.S. Department of Health and Human Services (HHS) offices, as well as institutes and centers within the National Institutes of Health (NIH) and projects with the Centers for Disease Control and Prevention (CDC).

THE FUTURE OF HEALTHCARE PAYMENTS: What Ten Years of Trends Can Tell Us About a COVID-19 World

When the Trends in Healthcare Payments Annual Report was first published ten years ago, the tidal wave of consumer healthcare payment responsibility was beginning to take shape. At that time, the data from the report pointed towards growing payment responsibility for consumers and showed the beginning shift in preferences for payment options to streamlined and electronic options. The findings in this yearâ&#x20AC;&#x2122;s report confirm that consumers once again owe more for medical bills and health plan premiums, and at the same time want a more streamlined payments experience in healthcare. Yet, the industry as a whole has not embraced streamlined payment options that consumers overwhelmingly demand at scale. Instead, most payment processes in healthcare depend on manual tasks and paper-based tools across various disparate systems.

The negative experiences already caused by increasing payment responsibility and outdated payment tools are only exacerbated by the impacts of COVID-19. In todayâ&#x20AC;&#x2122;s new normal, the trends in healthcare payments stand to accelerate and will likely include widespread adoption of contactless payments, meaningful expansion of telemedicine and an overall shift to digital experiences in healthcare.

Adapting to a “New Normal” Presented by COVID-19 Before 2020, rapid tech adoption was leveraged to

The surge in telehealth usage reflects the ability for the

connect us for entertainment, like Instagram reaching

industry to react and adapt to change in the industry,

100 million active users in two years or Fortnite hitting

as well as consumers’ appetite for digital in healthcare.

100 million monthly active users in 18 months . Now,

The increased options to connect with consumers will

technology has become a vital tool that connects us for

be crucial for the future of many organizations as the

everything, proven by the rapid adoption of platforms like

pandemic continues. More than a third of consumers

Zoom, which went from 10 million to 200 million daily

have changed or plan to change spending on

meeting participants in three months .

healthcare visits due to COVID-19 with the majority

of those consumers skipping non-essential The healthcare industry is adapting to the new normal

appointments such as a well visit or recommended

presented by social distancing guidelines, stay-at-

screening4.

home orders and other efforts to slow the spread of the COVID-19 virus. In particular, provider organizations have turned towards virtual options to connect with and treat consumers for care that does not necessarily require an in-person appointment. In the first couple months of the pandemic, 16.5 million consumers started using telehealth options with 80 percent saying they would use it again3.

Mary Meeker, Our New World, April 2020

PwC’s Health Research Institute Consumer Survey, The COVID-19 pandemic is influencing consumer health behavior. Are the changes here to stay?, April 2020

How Payment Responsibility Has Increased The COVID-19 pandemic and its effects on the industry

Over the last decade, deductibles have contributed to

only magnify challenges that consumers already

both the number of consumers who owe more and the

faced due to increased payment responsibility, which

increasing amounts of those balances, representing a

has grown considerably in the last two decades. In

162 percent increase in the total burden of deductibles8.

2019, families covered a third of healthcare costs, including premiums and out-of-pocket costs,

The reality of these increases in consumer responsibility

estimated at $28,3865.

go far beyond industry payment trends and were already felt deeply by consumers before COVID-19. Many

Deductibles continue to be a main driver of increased

consumers struggle to balance their health, medical

payment responsibility for consumers. Significantly

costs and overall financial outlook. Some even put off

more consumers have health plans with a deductible

medical care or avoid it altogether due to healthcare

that must be met before most services are covered and

costs. In fact, there has been a 50 percent increase

the amounts of those deductibles have also increased

in consumers avoiding care due to the ability to pay

considerably.

since 20019.

In 2019:

It remains to be seen how record unemployment during

82 percent of covered workers have a deductible in their plan, up from 63 percent a decade ago6

health plan enrollment will shape payment responsibility

$1,655 was the average deductible for covered workers, up from $826 a decade ago7

the COVID-19 pandemic and any resulting changes in in the future. However, chances are that payment responsibility for consumers will not dramatically decrease any time soon. 5

Millman Research Report, 2019 Millman Medical Index, July 2019

Kaiser Family Foundation, 2019 benchmark KFF Employer Health Benefits Survey, September 2019

Kaiser Family Foundation, 2019 benchmark KFF Employer Health Benefits Survey, September 2019 9

Gallup, More Americans Delaying Medical Treatment Due to Cost, December 2019

The Reality of Payment Experiences in Healthcare

PAY NOW

The traditional processes associated with healthcare

However, digital payment options are not always offered

payments do little to improve an already fraught situation.

by healthcare organizations. The option to simply

Typically, consumers leave provider encounters with

receive statements electronically is only available

little understanding of possible payment responsibility or

to 23 percent of consumers, though 77 percent

payment channels available to them. When consumers

want to enroll in eStatements from providers14. The

do have a balance, they are often mailed an explanation

demand for eStatements is almost universal among

of benefits (EOB) from the health plan and a medical

younger generations as 90 percent of Millennials want

bill from the provider â&#x20AC;&#x201C; both of which the majority

eStatements15.

consumers reported being confused by10. In addition to the confusion, 91 percent of consumers are often

The lack of digital payment channels available in

surprised in some way by their medical bills11, such

healthcare is surprising considering the vast reach of

as receiving unexpected bills or balances higher

digital options in other industries. The trends repeatedly

than anticipated.

demonstrate that consumers want this in healthcare too. In particular, 85 percent of consumers want to make

For healthcare organizations, there are multiple

all of their healthcare payments in one place16.

opportunities to improve the payment experiences with options available in other in industries. For example, 84 percent of consumers pay their household bills online for things such as utilities, cable and cell phones12. In addition, a growing portion of consumers, 18 percent in 2019 compared to 12 percent in 2018, pay their monthly bills through a mobile app . 13

InstaMed Consumer Healthcare Payments Survey 2019

Change Is Needed Now to Help Consumers Adapt Healthcare organizations no longer have the luxury of

The long-term impacts of COVID-19 are predicted

waiting to see how trends in healthcare payments may

to bring additional spotlight to eradicating manual,

play out as they did a decade ago when the Trends in

paper-based, human-dependent approaches to

Healthcare Payments Annual Report was first published.

healthcare payments. Stakeholders are being

The shifts in payment responsibility have almost

conditioned to rethink ways to avoid unnecessary human

completely changed how consumers interface with

contact in all aspects of healthcare. Social distancing

healthcare organizations. Unfortunately, that experience

and a focus on contactless interactions will put even

has not always been for the better according to

more pressure on legacy approaches to healthcare

consumers. Healthcare must take the lead on reducing

payments that accelerate the shift to digital.

the friction in the current consumer experience in healthcare payments.

Dig deeper into these trends and more. The full Trends in Healthcare Payments Annual Report is available online at:

www.instamed.com/trends 19

Taking a Strategic Approach to Experience True Digital Transformation Walk into some healthcare organizations and it might feel a bit like you took a step back in time. “Almost no other industry still relies on the fax machine. But at some healthcare clinics, if they didn’t have a fax machine, operations would come to a screeching halt,” said Donald J. Kosiak, Jr., MD, CMO at Leidos. The fact is rudimentary technology is still commonly operating throughout healthcare, which points to the need for digital transformation. Of course, most healthcare organizations already have spent considerable money on electronic medical records. “But those investments have not done enough and are just one piece of an overall transformation that needs

to take place,” Kosiak said. “The healthcare industry is on a trajectory we can’t sustain with the current way that organizations operate.” A report published in the Journal of the American Medical Association, in fact, showed that the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes.1 The problem is that while healthcare organizations have tried to leverage modern technology, they have not looked at the transformation from a systems approach. “They just bought solutions and plugged

Taking a Strategic Approach to Experience True Digital Transformation

“It might be because there are new regulations coming that will dictate the need for certain functionality, or because your organizational mission is to drive toward specific outcomes. That layer of self-awareness about organizational needs is what should drive technology investments.” Rod Piechowski | Vice President of Thought Advisory | HIMSS

them in,” Kosiak said. “And, they said, ‘We’ll figure it out later.’” A more strategic approach is clearly warranted. The hope is that healthcare organizations will now spend time designing what the organization of the future should look like and then wrap it with the technology that is needed. “With this approach, the technology would not bend the clinical workflow, the clinical workflow would bend the technology,” Kosiak said. According to Rod Piechowski, Vice President of Thought Advisory for HIMSS, organizational leaders need to stay away from investing in every solution billed as the latest and greatest simply because they have a fear of being left out. A mature organization

knows when and why it needs to update its technology, he said. “It might be because there are new regulations coming that will dictate the need for certain functionality, or because your organizational mission is to drive toward specific outcomes. That layer of self-awareness about organizational needs is what should drive technology investments.” To move in this direction, leaders should envision a future state and then “define the process improvements or changes required before determining what technology is required to enable the change,” according to Doug Barton, CTO of Leidos. “Leaders need to ensure that requirements precede design and implementation.”

Whipping Data Into Shape Data management is one area where this strategic approach is clearly warranted. As the healthcare industry has moved toward electronic systems during the past decade, electronic data has proliferated — but organizations have struggled to tap into its potential.

have a strong data management-governance process in place. “Being able to maintain the consistency and validity of data and to drive value out of that data is fundamental,” Barton said. “From there, organizations can share the information in a meaningful way and use the data to do more advanced analytics.”

“The challenge is that in today’s age, the industry creates terabytes and terabytes of clinical data,” Kosiak noted. “As a result, many organizations might have an overabundance of data, but they simply leave the clinicians on their own to sort through that data and try to figure out what’s best for the patient.”

Piechowski emphasized that advanced technologies such as artificial intelligence will require better and more standardized data that can be fed into artificial intelligence systems providing meaningful views of the future. Technologies that increase the liquidity of data, therefore, are apt to play a prominent role in data management efforts. For example, technologies that use Fast Healthcare Interoperability Resources (FHIR), an interoperability standard for electronic exchange of healthcare information, could help.

Mimicking how other industries use data could help healthcare organizations make its data more valuable, he said. “In the airline industry, for instance, pilots don’t get shown thousands of pieces of data elements at one time. Instead, they view a single pane of glass that says, ‘Hey, you might need to do this now because it’s important.’” To leverage data in a similar manner, organizations need to, first and foremost,

Even with stellar data, organizations will still need to proceed strategically with artificial intelligence and machine learning (AI/ML). “The last time I looked, there were thousands of algorithms publicly 21

Taking a Strategic Approach to Experience True Digital Transformation

available,” Barton said. “Before moving forward with AI/ML implementation, healthcare leaders should ask themselves how the technology can add more value, improve outcomes, reduce costs, or increase

efficiency. Without doing so, their organizations may wind up with a collection of interesting proofs of concept that are not meaningfully impacting their ability to efficiently provide quality outcomes.”

“Before moving forward with AI/ML implementation, healthcare leaders should ask themselves how the technology can add more value, improve outcomes, reduce costs, or increase efficiency. Without doing so, their organizations may wind up with a collection of interesting proofs of concept that are not meaningfully impacting their ability to efficiently provide quality outcomes.” Doug Barton | CTO | Leidos

Considering the Cloud Cloud technologies also hold significant potential for organizations seeking to experience digital transformation. Leaders, however, need to be clear on why and for what purpose their organization would contemplate moving to the cloud, said Barton. Then, they can put the appropriate measurements in place to ensure that they are achieving the objectives. When examining the cloud’s potential, leaders are apt to discover that they could benefit from the following:

Cost Savings There can certainly be cost savings, but that is not guaranteed. “You have to do the math and make sure that moving to the cloud is, in fact, more cost effective if cost efficiency is your objective,” Barton said. “But there are many other benefits of cloud adoption.”

Flexibility and Scalability "The cloud can accommodate flexibility in processing demand, he said. “Organizations don’t have to procure and install equipment if they need to scale up, and

they don’t have unused equipment sitting idle if they need to scale down.”

Staffing Advantages “The cloud can be an advantage if an organization is in an area where hiring IT resources to manage infrastructure is challenging,” Barton said. “So, these organizations no longer have to worry about recruiting local IT talent to manage infrastructure because that’s a service offered by the cloud provider.” When taking a more detailed, strategic look at the cloud’s potential, though, leaders might also discover that they can leverage the technology to accelerate innovation. “If you look at the service catalog the major cloud providers have, and the number of new services they add on a monthly basis, it’s astonishing,” Barton said. “If your organization is looking to innovate, you can do that much more rapidly because you could just bring up a service and try it out in a nonproduction environment.”

Zeroing in on Security Using advanced technologies such as AI/ML or cloud in the name of digital transformation could quickly backfire if organizations do not successfully address security issues. “We had ‘meaningful use’ as a government initiative,” Barton said. “Now, it looks

like we need to have a ‘meaningfully secure’ initiative as well. Data security is something that needs more federal attention and funding to help hospitals get on a more secure foundation.” (cont.) 22

Taking a Strategic Approach to Experience True Digital Transformation

“Sometimes, initiatives lean a little too much to the security side. While it’s easy to see why, the impact on the end user sometimes gets lost.” Donald J. Kosiak, Jr., MD | CMO | Leidos

Certainly, with digitization, healthcare organizations have become vulnerable. According to the 2019 HIMSS Cybersecurity Survey, 74% of organizations experienced a significant security incident in the past 12 months. Ransomware is especially fraught with danger. “The possibility exists that a hacker could injure or kill somebody by turning off a digitally connected infusion pump, or other medical device,” Barton said. “So, if healthcare organizations are going to put medical devices on their networks, they simply have to be secured. Otherwise, we’ve put patients at risk, and we’ve put hospital operations and the financial and reputational status of hospital systems at risk.” The challenge is to strike a balance between security and usability. “Sometimes, initiatives lean a little too much to the security side,” Kosiak said. “While it’s easy to see why, the impact on the end user sometimes gets lost.” To move forward, senior executives must start with a clear policy, a governance process, and an end-state objective of balancing risk, cost, and, to some extent, usability, he said. With such a plan in place, they will know where they are trying to get to and then can

establish a measurement plan calibrated to the cyber posture the organization has elected to achieve and sustain. A good security plan will address processes, tools, and objectives, as well as education and change management. While leaders need to take responsibility for security with in-house technologies, they also must realize that security is a shared responsibility with cloud vendors, Kosiak said. “As a result, leaders need to be crystal clear on what their part of that responsibility is and what the cloud provider’s responsibility is. Healthcare organizations can’t just assume that the cloud provider will do everything.” In the final analysis, to experience the digital transformation that will truly prompt needed industry change, healthcare organizations must stretch far beyond simply plugging in new technologies. Instead, they should take a strategic approach to technology implementation, enabling a digital transformation that allows patients to feel as if they are stepping into the future and being treated with advanced methods that enhance care and result in improved clinical and financial outcomes.

Papanicolas I, Woskie L, and Ashish K. “Health Care Spending in the United States and Other High-Income Countries.” JAMA. https://jamanetwork.com/journals/jama/article-abstract/2674671?redirect=true

For more information, visit us at: www.leidos.com/health Leidos is a Fortune 500® information technology, engineering, and science solutions and services leader working to solve the world’s toughest challenges in the defense, intelligence, homeland security, civil, and health markets. The company’s 38,000 employees support vital missions for government and commercial customers. Headquartered in Reston, Va., Leidos reported annual revenues of approximately $11.09 billion for the fiscal year ended January 3, 2020. For more information, visit www.leidos.com. ©Leidos. All Rights Reserved. The information in this document is proprietary to Leidos. It may not be used, reproduced, disclosed, or exported without the written approval of Leidos. 20-Leidos-0908-22002

COVID-19 and Supply Chain Resilience: What’s Next? The COVID-19 crisis created unprecedented shocks to supply chains. While supply chains are often invisible to customers, simultaneous challenges in supply and demand brought them to the front of news and business. COVID-19 highlighted gaps and created an opportunity to build resiliency for the future. Uncovering these gaps encourages investments to improve supply chain resilience for government and industry. Over the past several months, LMI hosted workshops and panels focused on COVID-19 impacts and next steps. This paper summarizes data collected from those events. Table 1 outlines the key takeaways. Table 1. Key Takeaways Area

Takeaway

Pre-COVID-19 supply chain

• Organizations focused on an efficient and lean supply chain without resilient design • Supply chain investments increased resilience to disruptions

Effects from COVID-19

• Poor coordination in procurement stressed supply chains • Supply and demand shocks led to equipment shortages and more

Investment areas

• Supply chain planning and strategy should be integrated into strategic planning • Relationships and partnerships are key before, during, and after events

Pre-COVID-19 Supply Chain Throughout LMI’s events, participants reflected on the capabilities of their supply chains before COVID-19 and how previous decisions focusing on efficiency affected their ability to respond to COVID-19 challenges effectively.

Organizations Focused on an Efficient and Lean Supply Chain without Resilient Design Prior to COVID-19, businesses implemented lean and efficient supply chains to reduce costs. These supply chains delivered products quickly while minimizing waste. Companies reduced excess inventory to free up capital. Modern supply chains exceled at efficiency; however, COVID-19 highlighted the danger of a too lean supply chain—losing responsiveness and the ability to pivot. In the early days of the COVID-19 response, despite working with skilled labor and financial resources, the Federal Emergency Management Agency did not have enough medical supplies to meet demand. An ingrained culture of always having quick access to disposable supplies, combined with panic buying, resulted in distribution of much of the inventory in the Strategic National Stockpile by mid-March. This, along with the expense of holding inventory, meant a lack of medical supplies as demand soared. The shortage of medical supplies, such as masks and ventilators, resulted from unprecedented demand coupled with a supply chain too lean to respond quickly.

Supply Chain Investments Increased Resilience to Disruptions

Participants rated their supply chains as moderately resilient, with an average score of 3.1. Organizations with modeling as well as business continuity plans were significantly more resilient.

LMI collected data about organizational supply chain capabilities and resilience. Participants selected their business capabilities before COVID-19 and rated their supply chain resilience during the pandemic from 1 to 5 (1 = ad hoc and Figure 1. Organizational Supply Chain Capabilities not resilient; 5 = resilient). The average resilience score for before COVID-19 respondents was 3.1. We also collected information on the capability types of each organization (Figure 1).A significant number of organizations (43 percent) had modeling and scenario planning capabilities prior to COVID-19. In addition, 29 percent reported specific supply chain disruption and business continuity plans. On average, participants with modeling and scenario planning capabilities rated themselves 3.7 (more resilient), and those with business continuity plans scored 3.5. Businesses without either of those capabilities self-assessed their resilience at 2.3. This data indicates that firms can improve their supply chain resiliency through the right investments.

Effects from COVID-19 COVID-19 massively shocked supply chains. This low probability, high-impact disruption challenged every industry. LMI captured how COVID-19 has had widespread effects and shown the need for more in-depth collaboration.

Poor Coordination in Procurement Stressed Supply Chains Serious coordination challenges arose for the procurement of medical supplies when large numbers of citizens, organizations, hospitals, and government agencies tried to procure the same medical supplies simultaneously. Requests on a massive and global scale increased demand for N95 masks by 3,500 percent and for nasal swabs by 1,755 percent over a short period of time. Despite searching for new suppliers, few were not already being utilized. Early in the crisis, each hospital handled this unprecedented demand alone, creating massive procurement problems. States collecting supplies to redistribute to hospitals in need eased this problem but increasing coordination between epidemiologists and supply chain planners can further address this issue, leading to better utilization of the limited supply of medical equipment.

Supply and Demand Shocks Led to Equipment Shortages and More With COVID-19, demand surged for many medical supplies, such as personal protective equipment and ventilators. At the same time, suppliers suffered from reduced capacity and transportation issues. Unlike most disruptions, COVID-19 shocked the supply and demand sides of supply chains simultaneously. Respondents emphasized the need to understand market responsiveness to better mitigate issues. Federal agencies strove to meet demand and rectify shortages, flying supplies via the air bridge to the United States and using the Defense Production Act. The government leveraged its experienced acquisition professionals and program managers from the Department of Defense to obtain those critical items. Organizations should continue to invest in acquisition expertise to enable quick responses to challenges in the future. In addition to buying more supplies more quickly, innovation efforts modified equipment to last longer and serve more people.

Figure 2. COVID-19 Supply Chain Effects

While medical shortages were a concern from the healthcare perspective, participants experienced other supply chain challenges as well (see Figure 2). Lack of staff availability was a prominent issue for many respondents, with 53 percent reporting that challenge. This was partly due to differing country or locality requirements and designations of what was an â&#x20AC;&#x153;essential business.â&#x20AC;? Thirty-five percent of those surveyed also faced issues dealing with change, including onboarding new suppliers and updating rules and regulations.

Investment Areas The COVID-19 disruption served as a catalyst to improve supply chain resilience and spur investment.

Supply Chain Planning and Strategy Should Be Integrated into Strategic Planning COVID-19 increased awareness and understanding of the importance of supply chains. The financial and health consequences of disruptions demonstrate that supply chain must be included in strategic planning. Businesses should design their supply chains strategically and for resilience. COVID-19 helped all organizations identify and visualize gaps and how disruptions can affect profits or service levels in an extreme way. Organizations are using COVID-19 to emphasize the value of investing in the supply chain to prevent serious downsides when large disruptions occur. How an organization weathers a disruption is a function of planning and preparation before the disruption occurs. Planning for the capacities and outcomes you want is more effective than planning for what caused the disruption. An infinite number of disruptions could occur but planning for the desired outcome and understanding the various tradeoffs in an unknown future builds supply chain resilience.

Relationships and Partnerships Are Key Before, During, and After Events The ongoing COVID-19 response would not have been possible without strong interagency relationships and robust public-private partnerships. Strong relationships mitigate the procurement coordination challenges created by disruptions. The government relies heavily on industry and is using partners to support COVID-19 relief efforts. Although the government manages these relationships with experience and expertise, an even stronger understanding of dependencies will improve the response for COVID-19 and other crises in the future. Equitable risk sharing is crucial to effective and long-lasting Figure 3. Supply Chain Investments partnerships. Respondents are using COVID-19 lessons learned to improve supply chain resilience. Figure 3 shows planned investment areas. Half are investing in proactive measures, including supply chain disruption plans and dual sourcing. Top supply chain companies are making additional investments in modeling and simulation planning to better understand how risks and mitigations may play out in the future. Investments planned for war rooms and supplier mapping indicate that respondents understand the need to develop internal and external relationships to increase supply chain resiliency.

The Need for Resilience COVID-19 showcased how supply chain leaders leveraged a combination of collaboration and innovation. While most organizations are still experiencing COVID-19’s effects, now is the time to plan for the next wave and future disruptions. Organizational resiliency takes nothing for granted, challenging notions of demand, supply, and operational normalcy. It requires a deeper examination of the supply chain, displacing wishful thinking with outright skepticism. Leaders must instill a long-term outlook, resisting tunnel vision on the next quarter’s performance. Optimization, usually in the context of maximizing profits, must be tempered with resiliency-minded investment. Technologies, like data analytics and digital thread, can reveal operational vulnerabilities, helping leaders anticipate and mitigate pain points. Too easily, such investments are deferred for near-term gains— making companies more vulnerable. Rather than seeing a zero-sum relationship between short-term optimization and long-term resiliency, organizations must capture overall operational health better. Just as cash reserves are an important barometer of a company’s capacity to weather unexpected expenses, organizations must identify and value metrics that indicate their resiliency posture. These measures may vary across and within sectors. What matters is that they, and what they connote, are valued internally and conveyed externally as appropriate. Resiliency does not diminish the value of forecasting. On the contrary, projecting an expected path and aligning operations accordingly is appropriate due diligence. However, COVID-19 revealed the fragility of those forecasts and the need to account for their variability. The world often disagrees with our best laid plans. Labor disputes close ports and factories, new trade agreements raise costs or lower access to materials, hurricane seasons cause disruptions, and the final chapters of COVID-19 are not yet written. Preparing for the future—what we expect and especially what we don’t—must begin today. LMI experts stand by to help you improve your organization’s supply chain resilience posture.

About LMI and Contact Information LMI is a consultancy dedicated to powering a future-ready, high-performing government, drawing from expertise in digital and analytic solutions, logistics, and management advisory services. We deliver integrated capabilities that incorporate emerging technologies and are tailored to customers’ unique mission needs, backed by objective research and data analysis. Founded in 1961 to help the Department of Defense resolve complex logistics management challenges, LMI continues to enable growth and transformation, enhance operational readiness and resiliency, and ensure mission success for federal civilian and defense agencies. Stuart Jones Director, Supply Chain Management sjones@lmi.org | 703.677.3845

Kerry McCarthy Sr. Consultant, Supply Chain Solutions kmccarthy@lmi.org | 703.917.7286

Our Nation’s Health: Progress and Opportunities for Improvement Arrey-Takor Ayuk-Arrey;a Shelly Kowalczyk, MSPH, CHES;b Jhilya F. Mayas, PhDc a Research

Assistant; b Senior Technical Vice President; c Senior Research Scientist, The MayaTech Corporation

Spotlight on the COVID-19 Pandemic Towards the close of 2019, the world was on the verge of experiencing the devastating consequences of a novel coronavirus outbreak we came to know as COVID-19. An outbreak that began in Wuhan, China in December 2019 , soon after surfaced in the U.S. in January 2020, quickly reached pandemic status. As of July 2020, COVID-19 had affected 227 countries and territories.1 For nearly eight months now, these countries and territories have suffered the loss of over 780,000 lives, with the U.S. accounting for nearly a quarter of those lost.1 Furthermore, Americans are suffering from economic hardship; adverse mental health conditions due to mitigation activities such as social isolation and other circumstances; hunger; housing instability; and other adversities brought on by this pandemic. To add fuel to the fire, this pandemic has illuminated the glaring gaps and system failures that have historically driven health disparities for specific racial, ethnic, income and age groups and geographic locations. We now know that those at greatest risk for severe COVID-19-associated illnesses and death are older adults and those with underlying health conditions. 2 Recent studies have also revealed the racial and ethnic disparities among those affected by COVID-19 in which persons of color are disproportionately impacted. For instance, age-adjusted COVID-19 mortality rates for Blacks, Indigenous Peoples, and Latinx are 3.6, 3.4, and 3.2 times higher, respectively, compared with rates among non-Hispanic Whites.3 The impact of the pandemic is further exacerbated by factors and conditions (i.e., social determinants of health—SDOH) that continue to unduly affect underrepresented racial and ethnic groups, leading to increased initial risk of exposure to COVID-19 such as working low wage jobs without the ability to telework; relying on public transportation that may not be able to incorporate social distancing practices; relying on food delivery service or school lunch programs that may be operating in limited capacity; being uninsured or underinsured; and being unable to access needed healthcare to treat underlying conditions.4 As government and public health partners strive to eliminate health disparities and address inequities that are preventing individuals and communities from achieving optimal health—not only during this pandemic but in moving forward—all sectors of society must address SDOH and maximize opportunities for creating change.

Overview The United States has made tremendous strides in improving our nation’s health through numerous policies, initiatives, and programs. However, health disparities remain, and for many priority areas, progress has stalled. Below are select highlights of areas in which there have been great successes, and where much work still needs to be done.

Public Health Milestones at a Glance Our health and overall quality of life are measured by more than just the absence of injury, illness and disease. They are predicated upon factors and conditions that impact access to care and services, our ability to secure employment, housing, healthy foods, and formal education, among many other determinants. As government and public health partners strive to eliminate health disparities and address inequities that prevent individuals and communities from achieving optimal health, all sectors of society must address SDOH and maximize opportunities for inspiring change. The Healthy People Initiative was initially launched in 1979 to identify goals and objectives for improving the nation’s health; establish benchmarks for monitoring progress towards those goals; and guide individuals, communities, and stakeholders toward coordinated action. Healthy People 2020 (HP2020) launched in 2010 and underscored the importance of SDOH and put forth measurable objectives in the areas of economic stability, education, health and healthcare, neighborhood and the built environment, and social and community context.5 While there is much work to be done to improve the conditions in which our vulnerable populations live, learn, work and play, some progress has been made. Health Insurance Coverage. HP2020’s Midcourse Review reported progress on several Leading Health Indicators (LHI). One LHI, Access to Health Services – measured as the

proportion of the population with insurance coverage, those with a usual primary care provider, and those with a source of ongoing care – has shown improvement between 2008 and 2014.6 The Patient Protection and Affordable Care Act (ACA), enacted in 2011 and fully implemented in 2014, expanded access to Medicaid in participating states and contributed substantially to increased health care coverage access.7 An estimated 20 million people reportedly gained health insurance coverage following the enactment of the ACA, resulting in 9 in 10 Americans having insurance coverage.8 The 2018 National Healthcare Quality and Disparities Report also showed improvements between 2000-2017 in the areas of insurance coverage, having a source of ongoing care, and routine medical appointments.9 Health Communications and Health Information Technology. Several HP2020 technology targets were met, including those specific to persons using the Internet and mobile devices to keep track of personal health information, using the Internet to communicate with healthcare providers, and office-based medical practices using electronic health records.10 Progress was also made in the proportion of people reporting their healthcare provider always listened carefully to them, explained things so they could understand, showed respect for what they had to say, and spent enough time with them.10 These objectives are of particular importance when considering the impact of the patient-provider relationship on patient health outcomes.

Progress in Many Areas has Stalled While progress made to date in many areas of public health deserves recognition, missed targets and substantial disparities due to race, gender, education, income, geographic location, and other SDOH variables persist. 27

Maternal and Child Health. The United States is in the midst of an extraordinary maternal mortality crisis. Rates of maternal deaths have increased dramatically since 2000, in stark contrast to reductions observed globally over the past several decades. HP2020 set a national goal of reducing the maternal mortality rate to 11.4 deaths per 100,000 live births. However, CDC’s Pregnancy Mortality Surveillance System reported the U.S. maternal mortality rate in 2016 was 16.9 deaths, more than double the rate of 7.2 deaths reported in 1987, when the surveillance system first was implemented.11 Furthermore, significant racial/ethnic disparities exist within these data, with non-Hispanic Black and American Indian/Alaska Native (AI/AN) women experiencing mortality rates 3-4x that of non-Hispanic white women. Several factors contribute to the overall maternal mortality rates and the observed racial/ethnic disparities, including quality of care experienced, and implicit racial biases within the health care system.12 Moreover, access to maternity care is a significant contributing factor. According to a 2018 report by the March of Dimes, an overwhelming 53% of U.S. counties do not have a hospital offering obstetric services, leaving more than 5 million women as residents of maternity care deserts. 13 While maternal health outcomes require urgent mitigation, the U.S. infant mortality rate has been steadily declining over the last decade. In 2012, the infant mortality rate fell to 5.98 deaths per 1,000 live births, marking the achievement of HP2020’s goal of 6.0 deaths.14 In 2018, the rate further declined to 5.66.15 While these overall declines are encouraging, there are substantial racial/ethnic disparities present among babies after birth. Babies born to non-Hispanic Black or American Indian/Alaska Natives mothers are generally twice as likely to die within their first year of life compared to babies born to nonHispanic white or Asian mothers. In 2017, the U.S. infant mortality rates (deaths per 1,000 live births) were:14 • 10.97 among Blacks/African Americans • 9.21 among American Indian/Alaska Natives • 7.64 among Native Hawaiian or other Pacific Islanders • 5.10 among Hispanics • 4.67 among non-Hispanic whites • 3.78 among Asians These disparities among infants are attributable to many of the same factors that are associated with the disparities observed in maternal mortality rates, particularly the quality of care received and exposure to stress resulting from implicit and explicit racial discrimination.16 Sexually Transmitted Diseases (STDs). Our nation is experiencing record-number cases of chlamydia, gonorrhea, and syphilis, with nearly 2.5 million combined reported cases in 2018. HP2020 objectives for reducing STD incidence have not been met, and the data continue to suggest a worsening trend. Despite decades of awareness and prevention efforts focused in promoting safer sexual practices, these recent increases reflect a need to reinvigorate preventive approaches and highlight the consequences of infection. In 2018, the rate of reported chlamydia infections was 2.9% higher than the rate in 2017 and 19.1% higher than the rate reported in 2011.17 17 One of HP2020’s objectives was to reduce the proportion of females aged 15 to 24 years with chlamydia infections attending family planning clinics to 7.2%; however, in 2018, the rate was 9.8%, a 1.8% increase

from 2015.17 HP2020 identified a goal of reducing the number of new gonorrhea cases among individuals aged 15-44. As of 2018, progress towards these goals were not met, as the rate of reported gonorrhea infections in males nearly doubled since 2008, and increased by nearly 30% among females.17 HP2020 objectives included 1) a reduction of domestic transmission of primary and secondary syphilis and 2) a reduction in the rate of congenital syphilis. In 2018, the rates of reported primary and secondary syphilis infections were more than twice the HP2020 target; the rate of congenital syphilis cases was more than three-times the target.17 While the rates of chlamydia, gonorrhea and syphilis infections have increased across all racial/ethnic groups, rates are persistently higher among many racial/ethnic minority populations.18 Health Care Access in Rural Communities. Rural residents often face barriers (e.g., limited access to healthcare coverage, and low provider density) that impede their ability to obtain appropriate care. In 2014, 20% of rural individuals without a usual source of healthcare cited a financial or insurance reason for not having a source of care.19 Moreover, among those unable to get or delayed getting needed medical care, dental care, or prescription medications, 64% cited financial or insurance reasons.19 HP2020 included a goal of reaching 100% insurance coverage for all persons under the age of 65. In 2018, 88.9% of people under age 65 years reported having some form of health insurance coverage, slightly lower than the proportion in 2017 (89.3%).20 Among rural residents, only 85.9% had health insurance coverage in 2018, compared to 89.6% of residents in large metropolitan statistical areas (MSAs).20 In addition, a greater proportion of rural residents reported not receiving or delaying necessary medical care compared with residents of large MSAs (14.2% and 11.1%, respectively), a factor that can worsen health outcomes for individuals and communities.20 Childhood Immunizations. The ACA greatly improved access to and utilization of preventive services; however, a few areas of need remain. One area of particular concern is the rise in non-medical vaccine exemptions observed across the nation. In 2019, the CDC reported the vaccine exemption rate among children in kindergarten for the 2018-2019 school year was 2.5%.21 The 2018-2019 vaccine exemption rate was 0.2 percentage points higher than the exemption rate from 2017 to 2018 and 0.6 percentage points higher than the exemption rate from 2015-2016.22 The increase in exemption rates, while numerically small, may reflect a growing trend that will further delay reaching the target coverage rates and increase the incidence of vaccine-preventable diseases. Measles was declared eliminated in the Unites States in 2000. However, between January and late April 2019, 704 cases of measles were reported, 663 of which were associated with outbreaks in 12 states and New York City. 23 The number of cases reported during that four-month period was the single greatest count for a single year since 1994 (993 cases), and exceeded those reported for all of 2018 (375 cases).24 HIV Prevention. A notable area of progress has been the steady reduction of new HIV diagnoses; reflected in a 7% decline between 2014 and 2018.25 Sustained awareness and prevention activities have been successful in reducing new infections, including the introduction of preexposure prophylaxis (PrEP). From 2012 to 2016, the number of PrEP 28

users increased from 8,768 to 77,120, an average 73% increase year over year.26 While the increase has been substantial, there is still a sizeable unmet need. In 2018, only 18.1% of the estimate 1.2 million individuals for whom PrEP was indicated were prescribed medication. 27 Moreover, significant racial/ethnic disparities exist among PrEP users. In 2016, the majority (68.7%) of PrEP users were white, 11.2% were Black, and 13.1% were Hispanic; however, whites accounted for just 26.3% of those for whom PrEP is indicated.28 This disparity in access to and utilization of PrEP is reflective of the disparity in overall HIV diagnoses, with Blacks/African Americans accounting for 42% of new diagnoses, but only 13% of the national population.25

The launch of HP2030 highlights the need to implement policies and programs built upon successes of the past and learned from efforts that have failed. We should avoid the temptation to “start from scratch” and lose the experiences gained along the way. A clear roadmap to a healthier future must be more than any standalone plan. Our collective actions must integrate the best of multiple initiatives currently underway including: the HHS Strategic Plan (FY 2018-2022), the STI Federal Action Plan, the National Adult Immunization Plan, Ending the HIV Epidemic: A Plan for America, and the National Infrastructure for Mitigating the Impact of COVID-19 within Racial and Ethnic Minority Communities.

The Uphill Public Health Battle Ahead

As a long-standing stakeholder in helping to advance U.S. public health outcomes, MayaTech is deeply committed to our nation’s health – with a keen eye on addressing SDOH and reducing systemic barriers that result in health disparities and inequities. Tackling the coming weeks, months, and years will require dynamic partnerships among all sectors to ensure that Federal public health initiatives are effective, efficient, and reach the communities most in need.

As the country and the world are only beginning to wrangle the COVID-19 pandemic, we are rapidly losing ground on numerous other health indicators – many of which have been trending favorably in recent years. Systemic inequalities persist – and are increasingly being exposed – as we witness devastating consequences on the health of marginalized populations in every geographic region of our nation. Furthermore, even in advance of final reports, we have missed the mark on many HP2020 goals, and in some areas the outcomes have worsened. The factors that prevent so many individuals from reaching optimal health – and the persistence of those disparities – have long been identified and characterized. It is not new or unpredictable. The time for hypothesizing why dramatic health disparities persist has long past – NOW is the time to act through systemic changes, re-education, dramatic policy shifts, targeted deployments of demonstrated effective best practices, and emerging strategies that reach and reflect the most marginalized populations.

MayaTech has witnessed substantial improvements to the health and lives of many. Perhaps even more exciting is the great potential that exists to do more, do better, and win bigger. National health priorities, natural disasters, emergent diseases, and social injustices will continue to underscore the absolute need for highly coordinated and systemically responsive strategies to ensure a future in which every person can attain and maintain optimal health and wellbeing, regardless of geography, race or ethnicity, education, gender, sexuality, or socioeconomic status. That goal is well within our reach – a sustained national public policy commitment can catalyze this reality.

REFERENCES. 1. COVID-19 Dashboard by the Center for Systems Science and Engineering at Johns Hopkins University. ArcGIS. Johns Hopkins University. 2. Razzaghi H, Wang Y, Lu H, et al. Estimated County-Level Prevalence of Selected Underlying Medical Conditions Associated with Increased Risk for Severe COVID-19 Illness — United States, 2018. MMWR. 2020;69:945–950. 3. APM Research Lab. The Color of Coronavirus: Covid-19 Deaths By Race and Ethnicity in the U.S. Online. 4. Moore JT, Ricaldi JN, Rose CE, et al. Disparities in Incidence of COVID-19 Among Underrepresented Racial/Ethnic Groups in Counties Identified as Hotspots During June 5– 18, 2020 — 22 States, February–June 2020. MMWR. 2020;69:1122–1126. 5. HHS, Office of Disease Prevention and Health Promotion. Healthy People Initiative; 6. Healthy People 2020 Midcourse Review. Access to Health Services; 7. Patient Protection and Affordable Care Act (ACA); 8. The White House. Fact Sheet: Healthcare Accomplishments, March 22, 2016; 9. AHRQ. 2018 National Healthcare Quality and Disparities Report; 6. Healthy People 2020 Midcourse Review. Health Communications and Health Information Technology; 10. Healthy People 2020 Midcourse Review. Health Communications and Health Information Technology. 11. HHS, Centers for Disease Control and Prevention. Trends in Pregnancy-Related Mortality in the United States: 1987-2016; 12. Howell EA. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clin Obstet Gynecol. 2018;61(2):387-399; 13. March of Dimes. 2018. Nowhere to Go: Maternity Care Deserts Across the U.S; 14. Ely DM, Driscoll AK. Infant Mortality in the United States, 2017: Data From the Period Linked Birth/Infant Death File. National Vital Statistics Reports. 2019;68(10):1-20; 15. Xu JQ, Murphy SL, Kochanek KD, et al. Mortality in the United States, 2018. NCHS Data Brief, no 355; 16. Smith IZ, Bentley-Edwards KL, El-Amin S, Darity W. Fighting at Birth: Eradicating the Black-White Infant Mortality Gap. 2018; 17. CDC, Division of STD Prevention. Sexually Transmitted Disease Surveillance 2018; 18. CDC, Division of STD Prevention. Sexually Transmitted Disease Surveillance 2018. STDs in Racial and Ethnic Minorities; 19. AHRQ. National Healthcare Quality and Disparities Report Chartbook on Rural Health Care. October 2017; 20. CDC. Age-adjusted percent distributions of type of health insurance coverage for persons under age 65 and for persons aged 65 and over, by selected characteristics: United States, 2018. National Health Interview Survey. 2018; 21. Seither R, Loretan C, Driver K, et al. Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2018–19 School Year. MMWR. 2019;68(41):905-912; 22. Seither R, Calhoun K, Street EJ, et al. Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year. MMWR. 2017;66(40):1073-1080; 23. Patel M, Lee AD, Redd SB, et al. Increase in Measles Cases — United States, January 1–April 26, 2019. MMWR. 2019;68(17):402-404; 24. CDC. Annual Reported Cases of Notifiable Diseases and Rates per 100,000, excluding U.S. Territories – United States, 2018. 25. CDC. HIV in the United States and Dependent Areas; 26. Gilead Sciences, Inc., Emory University Center for AIDS Research. AIDSVu. Mapping PrEP: First Ever Data on PrEP Users Across the U.S.; 27. Harris NS, Johnson AS, Huang Y-LA, et al. Vital Signs: Status of Human Immunodeficiency Virus Testing, Viral Suppression, and HIV Preexposure Prophylaxis — United States, 2013–2018. MMWR. 2019;68(48):1117-1123; 28. Huang YA, Zhu W, Smith DK, et al. HIV Preexposure Prophylaxis, by Race and Ethnicity — United States, 2014–2016. MMWR. 2018;67(41):1147-1150.

The MayaTech Corporation addresses existing and emerging public health challenges through direct engagement with agencies, governments, communities, and individuals. We provide a portfolio of research, training, evaluation, capacity-building, and other strategic support services - all aimed at reaching/impacting the most vulnerable populations, amplifying best practices, and innovating the practice of public health. MayaTech’s recent work has included support of Federal projects aimed at: increasing capacity for HIV and viral hepatitis service provision; improving regional-level adult immunization rates; assessing feasibility of state and local implementation of pandemic flu mitigation recommendations; increasing young-adult HPV vaccination rates in the South; identifying barriers to HPV vaccination in rural communities; and building workforce capacity among minority behavioral health providers and trainees. © 2020 The MayaTech Corporation

Federal Healthcare providers of all sizes naturally need to get the most out of their limited clinical resources and devices. From Secure Supply Chain teams making strategic procurement decisions to the daily asset management needs of Federal Healthcare Technology Managers and Biomedical Engineers, efficiency is always paramount. However, the pressure to fully leverage all available resources has become even more magnified due to the unprecedented pressures created by COVID-19. When clinical resources are stretched to capacity, the ability to continually track and fully utilize medical devices is directly linked to an organizationâ&#x20AC;&#x2122;s ability to deliver care. Additionally, COVID-19 has brought other changes to the environment with moves to more telemedicine visits, home health, a decline in the number of patients doing elective procedures, patients postponing care, and availability of the clinical engineering staff due to COVID issues. These changes have made understanding how medical equipment is being and not being used crucial to driving efficiencies and safety in patient care for our VA veterans and other Federal Healthcare clients. Ordr helps federal healthcare teams address these challenges by providing a fully automated and up to the minute view of all of an organizationâ&#x20AC;&#x2122;s devices. Clinical engineering teams can see exactly what devices are in their environment, where they are located, how they are being utilized, and who is using them. In this paper we show how these capabilities can be applied to clinical environments in general, and then take a more detailed look at how these concepts can apply specifically to the challenges of COVID-19.

DEVICE MANAGEMENT AND SECURITY BEST PRACTICES IN CLINICAL ENVIRONMENTS In order to get the most out of their medical devices, federal healthcare teams need to know what devices are available, where they are, what risks they bring and how they are being used. This can be a challenge when it comes to clinical devices which are often moved around within healthcare facilities as needs change, and likewise may not support traditional endpoint management agents and security tools that other IT systems do. Here are the best practices for device management and security in clinical environments:

Know What Is Available

Clinical engineering teams need to know and classify all medical devices, ensuring that they have an up to the minute and accurate inventory of the devices at their disposal. This includes virtually any type of connected medical device from patient monitors, to high-value imaging devices and lab equipment. This also means staff can know when devices go missing or are taken offline so that they can take corrective action. This visibility should be provided in real-time for any new connected device

and integrated with configuration management database (CMDB) and Computerized Maintenance Management Systems (CMMS) solutions to trigger the proper workflow. Inventory Management is continuous in healthcare and incorporating real time information about devices into CMDB and CMMS systems is paramount.

Know Where Devices Are

Clinicians and medical devices are naturally on the move as they respond to patient needs throughout the day. As a result, staff often need to scramble and search for important devices, leading to lost productivity and delays in care. A GE healthcare report found that medical devices were frequently unaccounted for, with only some assets recorded centrally â&#x20AC;&#x201C; and rarely tracked in real-time. Nurses typically spend more than 20 minutes per shift simply looking for needed equipment. This oftentimes

leads to staff hiding or hoarding crucial patient care devices like Infusion Pumps, which further complicates identifying where devices are and understanding how they are used.

Know How Devices Are Being Used The more valuable a device is, the more important it is to make sure the device is fully utilized while minimizing bottlenecks. Clinical engineering and procurements teams then have the data they need to

make highly informed decisions, for example, ensuring all devices are being fully utilized before acquiring additional devices. By tracking utilization trends, staff can know when it makes the most sense to buy vs rent devices, when devices are likely to need service, and when to end-of-life devices. Understanding device utilization can also be important for schedule appropriate timing for device maintenance.

Know What Risks Devices Are Bringing Medical devices pose a unique challenge to fed healthcare organizations because they may not always be designed with security in mind, but because of cost reasons, will exist in the environment for a long

time. The traditional IT lifecycle for computer systems, which is generally three to five years, is much different than the lifecycle for medical systems that may run for decades. As a result, clinical engineering teams need to understand the risks that they bring â&#x20AC;&#x201C; vulnerabilities, manufacturer recalls and FDA recalls â&#x20AC;&#x201C; and manage them appropriately. Managing this risk is a continuous process as operating systems and software versions become obsolete and new vulnerabilities and exploits are

created against these systems. Additionally, managing FDA recalls is continuous as this information is updated and published.

ORDR PLATFORM FOR MEDICAL DEVICE MANAGEMENT AND SECURITY Ordr puts clinical teams in control by automatically discovering and classifying all connected devices in federal health environments down to the specific model of device and detailed attributes such as the current version of software, vulnerabilities detected and the location of the device. This discovery is performed in real-time, is continuous, utilizes a passive approach and does not impact sensitive medical equipment or the performance and availability of the networks these devices are connected to.

Next, the platform uses artificial intelligence to profile every device and how it is behaving. This includes not only mapping and baselining device communications and risks, but also visually mapping it to the organization’s network topology. This allows Ordr to deliver deep understanding of device insights – from identifying normal versus malicious behaviors (that may indicate a security attack in progress) to understanding device utilization. Ordr also provides a view into vulnerability information and can provide context around Common Vulnerabilities and Exposures as well as FDA recall notification information for these systems. This information can assist not only clinical teams but the organization’s extended security and networking teams, but also gives them a platform to work together to ensure availability and safety of patient care from these devices. Finally, based on the rich context of the device, how it is behaving, and its risk profile, Ordr can automate appropriate actions. These include the automated creation and enforcement of policies or alerting and triggering a specific security or operations workflow. Figure 1 provides the Ordr framework for visibility and security of all unmanaged devices – IoT, IoMT and OT.

AI PLATFORM FOR VISIBILITY AND SECURITY OF ALL UNMANAGED DEVICES

THE ORDR PLATFORM ALLOWS CLINICAL TEAMS TO DELIVER THE FOLLOWING USE CASES: Real-time Visibility and Classification Challenges such as COVID-19 can quickly and unexpectedly stretch clinical environments to their maximum capacity. In these cases, nimble and accurate visibility and classification of devices becomes not just an issue of efficiency, but a determining factor in the ability to deliver patient care. Ordr provides high fidelity visibility and classification of all unmanaged devices in the network, wired or wireless, without impacting device operations. Although this document is targeted to clinical engineering teams, the ability for Ordr to provide comprehensive security for all devices in the healthcare organization – IoT, IoMT and OT – ensures that the Ordr platform value can be extended to security and network teams as well.

Asset Inventory and Management The Ordr and CMMS integration can address the following use cases: Discover Med Devices NOT in the CMMS solution: This can be a concern for clinical engineering teams, and allows these teams to identify systems that are not being procured through standard channels 3rd Party Managed Equipment: With operational costs being impacted moving forward, there are lots of 3rd party equipment that is being managed or leased. Ordr helps clinical engineering teams track these devices and how they are being utilized Legacy Operating Systems: Healthcare organizations purchase medical equipment and have it running in their environments far beyond the traditional 3 – 5-year IT lifecycle. Ordr can help identify the vulnerable systems running legacy operating systems.

Medical Devices Offline: Ordr can track assets that HAVE NOT connected in 30 days, 60 days to open up a new investigation into where these devices are. Ramp-up and Ramp-down of Medical Devices: During the COVID-19 pandemic Ordr has seen new trends and behavior as Health Delivery Organizations have ramped up new treatment facilities, created dedicated care areas, built testing centers, and added additional Intensive Care Unit beds. In some cases, Ordr had detected up to one thousand new medical devices

a week. As the impact and treatment of COVID-19 changes, knowing the details around the location, utilization, and trending information will be key in ramping down to new clinical demands.

Track Device Location It is not enough to just know what devices are in your network. During a pandemic, the ability to locate devices or bring them back into compliance after deployments in field hospitals is important. The Ordr location data has helped reduce detective work for clinical engineering teams, potentially saving 20mins per shift per employee.

Manage Vulnerabilities and Recalls Ordr delivers comprehensive view into risks for every device. In addition to the initial device visibility and classification during deep packet inspection, the device context is also enriched with threat intelligence, vulnerability data, FDA/device manufacturer alerts, and a risk score is provided. This allows clinical engineering teams to prioritize the management of vulnerabilities and recalls on the right medical devices. More importantly, clinical engineering can quickly reduce their window of risks by triggering the right automate actions to address the vulnerabilities and recalls such as putting a medical device into a quarantine VLAN until it is ready to be patched.

Integrate with Existing IT Infrastructure to Enhance ROI of Existing Tool Investments Ordr offers the most comprehensive integrations, extending IoT, OT, and IoMT device context to NGFWs, NACs, WLAN controllers, ITSM, SIEM, Vulnerability Management, CMDB and CMMS solutions in the market. For clinical engineering teams, the Ordr platform can integrate with CMDB and CMMS solutions to automate tasks, and enhance the asset inventory process. For example, Ordr can trigger the appropriate alert or workflow in CMMS systems when a new medical device is discovered in the network, or a new high severity vulnerability is discovered on a new medical device. This reduces time and costs with the IT staffs from manual processes of tracking devices, and allows them to focus more on patient care.

SOLUTIONS 38

Technology Aids In The Protection Of High-Risk Healthcare Recipients And Providers. To protect patients, residence, and health workers, healthcare providers and senior living centers are taking extra measures to protect those at high risk of COVID-19. One of these measures is to screen entry into hospitals, senior centers, and other treatment centers. Given the high risks associated with these facilities, it is imperative that access is based on a risk assessment as it relates to any pathogen with distinctive symptoms. Currently, the general state of access control technology is comprised of an individual with a digital thermometer and a clipboard, taking the potential entrants’ temperature and asking risk assessment questions. This laborintensive process exposes the screener to potential COVID-19 risks and is subject to human errors in recording temperature measurements and data retention.

Innovative technology is allowing the screening process to become automated using touchless kiosks with badge printers and cloud based hosted platforms. Kiosk technologies can eliminate or minimize the need for manned entry points thereby allowing the redeployment of resources and minimizing the risk of exposure to the screener and facility. A badge printer provides physical proof at the facility that an individual meets the access risk threat level. Finally, a cloud- based hosted platform provides questionnaire screening that both prevents at risk individuals from entering the facility and expedites entry for those individuals meeting the access risk threat level.

Kiosk Technology Kiosks, which measure body temperature and have the capability to question potential entrants, are replacing the need to have an attendant at every entry point. Touchless kiosk technology is deployed to prevent potential disease transition through surface contact. Kiosks require no physical contact and eliminate both the potential for disease transfer and the need for sanitizing between individuals. Without touchless kiosks, the reverse effect is created: a bottleneck where all individuals are subject to interacting in the same place. Kiosks are deployed with an array of cameras and thermographic imaging devises to measure core body temperature. A common misconception is that skin temperature is the same as core body temperature. As the individual approaches the kiosk, a camera detects the individual and messages the individual to approach or step back to allow the thermographic imaging to be completed. The imaging takes between one and three seconds. For accurate and repeatable core body temperature measurements, the temperature resolution and integration of the sensor matters. Contactless medical thermometers may use sensors which are as low as 16 temperature pixels. Obtaining the core body temperature requires data from specific regions of the face. If the administrator does not target the correct area, the measurement may miss elevated febrile skin. Taking a temperature reading from the correct location on a face is critical to ensuring reliability. Less technologically advanced kiosks use inexpensive, low resolution sensors to perform core body measurements. DetectWise

Figure 1: Moving from handheld devices to automated core body temperature thermographic kiosk sensors.

Elenium Sensor Array (100k temperature pixels) XVGA Higher resolution sensors are able to detect more temperature points on a human face to an area of interest like a human tear duct in an area 2-3mm² in size from 0.5 meters away.

Chino Corp., Japan Thermopile Array (2.2k temperature pixels) 48x47 pixels Low cost sensors rated for technically -/+ 0.5 accuracy will not have the capability to return values specific enough to a location on a human face, resulting in high false negative rate.

An accurate technology solution must be able to detect specific regions of interest on a human face. Parsons’ advanced DetectWise kiosk integrates a thermographic image with a high-resolution visual image to accurately locate facial regions of interest like an individual’s tear duct or the area where supraorbital blood vessels are closest to the individual’s external skin surface. This ensures that the core body temperature assessment can differentiate between surface skin temperatures and true core temperature.

Figure 2: Comparison – High Resolution vs. Low Resolution Sensors

In order to provide accuracy to the 0.1 degree C every time, the DetectWise kiosk continually measures surrounding ambient

Figure 3: Detection of specific Facial Regions is Key to an Accurate Solution

Forehead

1-to-1 Framing

Temples

Tear Ducts

High-Res Full-Face Imaging

Illustration of Supraorbital Blood Vessels

DetectWise Solutions | Parsons

temperature while actively and algorithmically reducing temperature drift, which increases the accuracy of the sensor temperature. The level of monitoring provided by DetectWise assures that drift is always within the 0.1 degree C limit which eliminates the need for periodic manual calibrations required by lower end kiosks. To replace the human screener, the kiosk must be able to present all questions in multiple languages and allow a response input. While a touch screen kiosk can meet this simple requirement, it also exposes the possibility of contamination of the touch screen and COVID-19 transmission via surface transfers. To help prevent surface transfer, we have deployed touchless question response mechanisms. This can take the form of voice recognition or a screen cursor which tracks the user’s head and eye movement. Noise cancelling technologies are used with voice recognition to provide a better analysis of a user’s input. Cursor control, which follows the individual’s head and eye movement, has been found to be a preferred entry mechanism for entry points with mid to high levels of background noise. These technologies’ yes and no questions are composed to allow binary responses to collect risk assessments associated with contacts, any COVID-19 testing, other symptoms, and travel as examples. This prevents screeners from interfacing with people entering a facility. Those entering the facility can answer questions without physical interaction with a kiosk. An additional function that a human screener performs is the exclusion of individuals who are determined to have an elevated risk profile, through either core body temperature or the answers to the questionnaire. The kiosk screening relies on the integrity of the person entering with additional technical implementations to perform remote elevated risk identification. The implementation of a remote alert sent to a station near an entry point allows human intervention in the event of an elevated risk assessment. The kiosk can utilize a printed “PASS” sticker with a time and date which must always be worn by any individual entering the facility. Barcodes can be printed on the badge for validation within the facility. Finally, the kiosk and associated cloud application can be interfaced to door controls and access controls to block entry in the event of an elevated risk assessment. Our DetectWise kiosk meets the stringent requirements to replace or diminish the need for human screeners while keeping our most critical population protected. DetectWise was developed to meet the demands of a COVID environment and is in use today.

If the answers are within the risk tolerance the web application, it will provide a QR code with a unique user identifier, date and time stamp. When the individual arrives at their facility the QR code is scanned by the kiosk which will use the unique idenfication to determine the user and marry their core temperature data with the questionnaire that has been filled out on the web. All communication to and from and the DetectWiseTM database web application is encrypted at all times. If the core temperature is within the acceptable limits and the questionnaire was answer within a specified elapsed time a message is returned to the kiosk to display a welcome message and print a badge, if that option is exercised.

Figure 4: Sample health Questionnaire/QRC Check-in

If the questionnaire is answered in a manner that would elevate the risk assessment beyond an acceptable threshold or value, a message is displayed to the user that they should NOT come into the facility and provides a configurable direction to call a supervisor and / or COVID hotline. Similarly, if the questions are low risk but the individual arrives at the facility and registers a core body temperature above the threshold the kiosk will report this to the application and the application will respond with a command to display a message blocking entry. In addition to the advantages of entry streamlining and remote detection, the web application technology also provides a means to collect and store data in a secure environment. When a new registration is entered, the applications creates two file storages, a unique identification under which the temperature and questionnaire information is stored and a file which include personal data about the registrant. These two files are bifurcated thereby preventing the storage of potentially PHI. Reports can be run regarding statistics for entry as a global population.

Online Cloud Based Hosted Platform While a kiosk at entry points can help reassign human resource and protect staff from exposure, it is this process of scanning people at a location which poses a potential bottle neck during high traffic periods and does not catch potential risk elevated individuals before they arrive at the facility. Parsons DetectWiseTM Cloud Based Hosted Platform provides a technological solution to entry flow rate and prescreening before arrival in addition to an on premises Kiosk. Using a secure web-app individuals who regularly enter the facility; employees, mobile residence, contractors, etc.; can be registered with the DetectWiseTM system. The individual can then log in remotely and answer the risk assessment questionnaire, provided by their place of employment or the facility they would like to visit, using a computer, tablet or smart phone. Parsons | DetectWise Solutions

Contact us WILLIAM KRULL / Vice President Direct: + 1 404.824.7968 william.krull@parsons.com GUS NASSAR / Director of Product Development, Digital Solutions Direct: +1 734.309.2153 gus.nassar@parsons.com

4401 Wilson Blvd. Suite 1110 Arlington, VA 22203 www.pscouncil.org