2020 Was the Ultimate Agility Competition. Here’s How Staying Nimble Will Get You Through 2021.

Colin Banas, M.D., M.H.A.12

If your healthcare organization is like most, you probably put a lot of time and effort into your 2020 technology roadmap. Then the pandemic hit, and all your careful planning went right out the window.

So how can you plan effectively for 2021? Your IT team will need to remain nimble in the face of unpredictable demands and shrinking budgets, and several crucial digital tools can help.

Turn to Telehealth 2.0

When the pandemic hit, the need to receive medical care without physically entering a doctor’s office or hospital suddenly became paramount. In the last week of March 2020, as patients followed advice to stay at home and providers took precautions to prevent transmission of the novel coronavirus, telehealth visits increased 154% compared with the same period in 2019, according to the Centers for Disease Control and Prevention.

For years before the pandemic, employers and health plans viewed videoconferencing as one way to reduce the cost of physician visits. Convenience was another goal of “telehealth 1.0,” but this often came at the cost of the patient-physician relationship.

Perhaps because telehealth 1.0 was not extremely popular with or widely adopted by physicians, many providers reacted to the pandemic by turning to consumer video chat solutions that were never designed for telehealth in the first place. These “telehealth 0.0” systems were a step backward, readily available and easy to use, but they lacked key privacy features and didn’t fit into clinical workflows. For better or worse, rapid adoption of these consumer solutions was aided by CMS changing its payment policies to reimburse telehealth visits for a wider range of care, and HHS temporarily loosening HIPAA enforcement penalties, opening the door for videoconferencing that wasn’t built on secure platforms.

Fortunately, new systems emerged that were built specifically to extend physician practices or hospitals beyond the walls of the facility and into the patient’s home. As these “telehealth 2.0” systems become better known, they are starting to displace earlier solutions that met certain patient needs but did not support a collaborative, team-based approach to care or reinforce patient-physician relationships. In this newer telehealth approach, the focus is not on the care provider as a cost to be reduced, but on the care provider as a professional whose value can be extended through digital tools.

As you plan for 2021, telehealth 2.0 solutions that are designed to more effectively support your physicians in caring for their patients should be at the top of your list. The ability to host a video visit is just table stakes. Seek out systems that put a premium on care collaboration and satisfy the need for securely sharing clinical information and facilitating conversations with other members of the care team and the patient. Lower healthcare costs should still be a goal, but the path should be through telehealth platforms that support care collaboration to meet the complex needs of patients with chronic and acute conditions.

You will also want to retire any telehealth 0.0 solutions that you implemented during the crazy early days of the pandemic. With so much patient information being exchanged and cyberattacks on the rise, strict security protocols will be more important than ever to keep protected health information (PHI) private. Consumer video chat apps have come under scrutiny for questionable encryption practices, and HHS will likely reinstate penalties for security breaches in 2021, so prepare now for a telehealth platform that can meet the rigors of the healthcare environment.

Add Value to Existing Systems

While much has changed due to the pandemic, some things remain the same. Your EHR will continue to be the cornerstone of your technology ecosystem, but because COVID-19 hit hospital budgets hard, your 2021 roadmap may be limited by serious financial constraints.

Both factors point to the need for digital tools that integrate seamlessly with your EHR and add functionality. You have three choices. You could wait for your EHR vendor to offer the applications you need (it may be a long wait as EHR vendor resources are increasingly stretched). You could switch EHR partners (a painful, time-consuming, often expensive prospect). Or you could be nimble and seek innovative applications that expand and complement your EHR’s capabilities with advanced integrations.  

For example, medication reconciliation at admission, discharge, or transfer—a major patient safety goal of The Joint Commission—is one area where hospitals have successfully used new solutions to supplement the power of their EHRs by eliminating information gaps and cleaning up fragmented, poorly formatted medication data.

Here’s how one health system used medication history technology in new ways to protect staff and patients through social distancing:

When the pandemic hit Michigan, Covenant Medical Center automated its medication reconciliation process for patients arriving in the emergency department. Prior to COVID-19, pharmacy technicians conducted face-to-face medication reviews with patients. The risk of virus transmission and the need to preserve personal protective equipment (PPE) compelled Covenant to rely on MedHx from DrFirst to gather comprehensive medication history data. A patented AI process cleaned the data and filled in essential prescription instructions, or sigs, to import a more complete medication history into the patient record and help reduce the risk of adverse drug events.

Covenant reported 93% accuracy in translating free-text elements into the hospital’s standard terminology and putting the data into appropriate fields so clinicians could make informed decisions about a patient’s care. The hospital saw a 14% gain in patient throughput and, compared to the 25- to 30-minute face-to-face process, Covenant reported “significant time savings” with the digital medication reconciliation approach.  

The potential to increase medication adherence is another area where digital solutions can add value to patient care. For example:

• When physicians have clear visibility into medication history, they can engage in meaningful dialogue with patients about the prescriptions they are taking or not taking and identify duplicative medications.
• When hospitals and health systems have accurate, complete medication history converted into the EHR’s preferred terminology in patient records, they can use this information to understand “adherence scores” to try to break the cycle of non-adherence and readmissions.

Create a Consumer Experience

As consumers become used to advances in technology in nearly every aspect of their lives, they are expecting the same level of user experience from healthcare. Some may wonder if that’s possible given the healthcare industry’s reputation for slow adoption of new technology. Yet we saw in 2020 that healthcare can move quickly. Faced with a global health crisis, hospital CIOs found ways to cut through bureaucratic barriers and reach consensus quickly, adopting digital tools that supported a shift to new ways of delivering care.

In the “new post-pandemic normal,” the healthcare organizations that come out ahead will be those that continue to act decisively and stay agile to deliver the consumer-quality experiences patients have come to expect, such as:

• Price transparency: Using e-prescribing tools that show patients’ specific insurance benefits and prescription co-pays in workflow, providers and patients can see in advance what medications will cost, in the same way that e-commerce websites make shipping costs available prior to placing an order. With this information in hand at the time of prescribing, providers can search for alternatives, if needed, to ensure a prescription is affordable and less likely to be abandoned by the patient at the pharmacy due to unexpected costs.
• Automatic notifications: Platforms integrated with e-prescribing can automatically engage patients after discharge to help improve medication adherence. For example, automated post-discharge prescription refill reminders with links to educational information about prescribed medications can reinforce providers’ prescribing decisions and address patients’ potential questions.
• Digital front door: More than simply a point of entry into your healthcare organization, a robust “digital front door” should give patients a meaningful, connected experience over time. For example, patients are becoming accustomed to scheduling, canceling, or changing appointments online in the same way they make a restaurant reservation. Beyond convenience, digital check-ins can limit in-person exposure and reduce administrative tasks for your staff.

The past year seriously tested hospital IT teams and the systems they rely on to connect caregivers with patients and with the clinical information that is so vital to high-quality patient care. Moving forward, it will be more important than ever to fill in your system gaps with digital tools that are proven to address care collaboration, medication management, price transparency and other challenges that will continue to confront healthcare organizations long after the pandemic.

Colin Banas, M.D., M.H.A., is Chief Medical Officer of DrFirst, and former Internal Medicine Hospitalist and former Chief Medical Information Officer for VCU Health System in Richmond, Virginia.