RightPatient-augments-population-health-investments

How Can You Protect Your Investment in a Population Health Solution?

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RightPatient-augments-population-health-investments

Healthcare in the U.S. is going to see a paradigm shift in the next five years that will move it from a fee-for-service (FFS) payment model towards a value-based model. Simply said, those who produce better results and improve patient quality of care at lower costs will reap higher dividends. This shift will require better use of technology and significant changes to many platforms and their capabilities, including more investment in big data, analytics, and patient matching systems. These investments in population health management technologies will provide the real-time information needed to make more informed decisions.

RightPatient-augments-population-health-investments

Population health solutions play a critical role in moving healthcare from a treatment-based to a prevention-based model. These platforms enable providers to better prepare for patient-reported outcomes, provide data regarding social determinants of health and activity-based costing, and match extracted data outcomes with the right patient.

Current state of U.S. healthcare

The U.S. spends more on healthcare per capita than any other nation in the world but fails to produce better results for life expectancy and other health outcomes. Moreover, U.S. taxpayers fund more per capita on healthcare (64%) than those in other countries, including those with universal health programs.

These facts suggest that encounter-based medicine might be contributing to sub-optimal results in the U.S. and there is a need for change. That change is prompting the rise of population health management and data analytics technologies.

The population-based model is based on aggregating patient data across various health information resources, forming a comprehensive, longitudinal health record for each patient, and leveraging analytics to produce insights that clinical teams can use to improve care and lower costs. In addition to health and financial data derived from electronic health records (EHRs) and medical claims, information such as a patient’s socio-economic status, personal support network, and habitat conditions can be useful in building preventative care strategies.

For example, a patient diagnosed as prediabetes would be classified as high-risk in an encounter-based model. However, this does not take into consideration the patient’s lifestyle and behavioral patterns. Many prediabetics can avoid developing diabetes by modifying habits such as diet and exercise. Patients who smoke, abuse drugs, or have a sedentary lifestyle are much more at risk of developing the disease. Identifying these genuinely high-risk patients requires access to accurate data that is linked to the correct record. 

Challenges in moving to a population health solution

At present, a tremendous amount of patient data is available but it is not unified – it exists within different institutions and across various platforms. Thus, the available information is very difficult to match with the right patient (if not impossible in some cases) and such data has little practical value. Population health solutions need a system that can match patients with their available data and provide information on the best recommendations for preventative care, helping to improve outcomes and save resources.

Therefore, the most important variable in extracting value from a population health solution is ensuring that a patient’s captured data is matched to the correct record. Better data warehousing and mining capabilities will serve no purpose if healthcare providers lack the ability to match the output with the right patient. At present, not only do patient identification issues exist within a single healthcare institution, but these issues become even worse when patient data is exchanged across multiple systems, with error rates rising to 60%.

Failure to properly identify a patient means loss of historical medical history, social indicators, financial information, medications, allergies, pre-existing conditions, etc. – vital information that puts the patient and healthcare provider at greater risk. These data integrity failures can significantly dilute the efficacy of population health initiatives.

In fact, the transition from fee-for-service to value-based healthcare is only going to work if healthcare entities invest in patient matching technology alongside their investments in big data and analytics platforms. These investments should go hand-in-hand since patient matching errors can have such a substantial impact on data quality.

Population health management is among the top six categories in healthcare that are attracting investments from venture capital firms. Other segments include genomics and sequencing, analytics and big data, wearables and biosensing, telemedicine, and digital medical devices.

Thus, the industry is investing in technologies that will play a significant role in value-based care and population health management. However, the success of any population health initiative depends on the right patient being identified every time so that medical records and the corresponding patient data are not mixed-up. Considering the data fragmentation that exists in healthcare and lack of standards around patient identifiers, AI-based systems like RightPatient are the only way to ensure reliable identification of patients across various data platforms and maximized investment in population health management.

How Big is the Patient Mix-up Problem in the U.S.?

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Hollywood has created several films featuring a person that was wrongly informed about cancer or another fatal disease with the patient being told that they only have a few months/days left to live. Upon hearing this news, the patient goes on a spending spree and adventure only to discover in the end that things have been mixed up. This might make for a great movie but in the real world, if such a patient mix-up happens, the outcomes may be far worse. 

But just how frequently does this medical record mix-up problem happen in real life?

It seems that the problem of so-called mistaken patient identity is big enough to cause serious problems – something that is very evident from the article published in the Boston Globe, reporting 14 cases of mistaken identity. 

Reports indicate that medical errors due to patient mix-ups are a recurrent problem. Consequently, a wrong person may be operated on, the wrong leg may be amputated, the wrong organ may be removed, etc. In fact, CNN reported that in 6.5 years, in Colorado alone, more than 25 cases of surgery on the wrong patient have been reported, apart from more than 100 instances of the wrong body parts being operated on.

It would be challenging to estimate the true total number of patient mix-ups simply because the vast majority of them go unreported until something untoward happens. Even in cases where complications do occur, most medical organizations would not be eager to publicize them. 

Today, it is widely accepted that medical errors are the third largest killer in the U.S.; that is, far more people die of medical errors compared to diseases like pneumonia or emphysema. It is now estimated that more than 700 patients are dying each day due to medical mistakes in U.S. hospitals. This figure clearly indicates that medical errors often occur even though a fraction of them will have fatal outcomes. It also tells us that cases of patient mix-ups may be shockingly high and indeed underreported.

Though several thousand cases of mistaken patient identity have been recorded, it remains the most misunderstood health risk, something that hospitals barely report, and an outcome that patients do not expect to happen.

The U.S. healthcare system is extremely complex, making it challenging for a single solution to resolve this issue. There have been lots of efforts to implement a unique identity number for each patient (a national identifier) but political roadblocks have proven difficult to navigate. The chances are bleak that any such national system would be created, as patients remain profoundly worried about the privacy of their data.

At present, perhaps the best option is that each hospital finds its own way to solve this problem by developing some internal system to make sure that patient mix-ups don’t happen. Or, a better idea is to leave this task to the professional organizations that specialize in the business of improving patient identification. The RightPatient® Smart App is a perfect example of an innovative solution that is powered by deep learning and artificial intelligence to turn any device like a tablet or smartphone into a powerful tool to completely eliminate the problem of mistaken patient identity.

Technological solutions are often meant to augment human efforts, not to replace them. Here are some of the ways to avoid patient mix-ups:

  • Always confirm two unique patient identifiers within the EHR (Electronic Health Record), like patient name and identity number.  Though this is a standard practice, many mistakes still occur due to similar first or last names. Thus, an app like RightPatient can help to eliminate the chances of such an error.
  • Two identifications should be used for all critical processes.
  • There must be a system to alert staff if two patients have a similar first or last name.
  • Avoid placing patients with similar names in the same room.

Although patient misidentification and medical record mix-ups continue to plague the U.S. healthcare system, there is hope to address this serious issue with solutions like RightPatient. Now, we just need healthcare providers to make this a priority and take action. 

How Opioid Abuse Exposes Hospitals

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Whenever I’m talking to a healthcare provider about RightPatient, the topic of “frequent flyers” inevitably arises. For those who might not be aware, frequent fliers are patients that use different aliases to obtain healthcare services. It’s estimated that between 2-10% of patients arriving at the emergency department (ED) provide some kind of false or misleading information about themselves. Typically, these patients are lying about their identity to obtain prescription medications, and most of these are for opioids.

Since these patients lie about their identity or demographic information, hospitals often end up writing off a considerable amount of money for their services – up to $3 million annually on average. Aside from these financial losses, frequent fliers also pose other risks to providers that are associated with patient safety and quality of care. Why? Because they also frequently lie about prescription drug use or addiction.

What’s worse is that this behavior is not limited to frequent fliers. Any patient can lie about their addiction. Many of these patients lie about their addiction to opioids, specifically. As we all know by now, the U.S. has a serious problem with opioid addiction, a crisis that killed over 33,000 Americans last year. This crisis has no rules or boundaries, and does not seem to select for a particular demographic. Anyone is susceptible to getting hooked on opioids because they are so addictive.

The opioid epidemic has far-reaching consequences that extend beyond the health of the patient; however, in the ED, this is the primary concern of a clinical team. Considering the circumstances, this question seems relevant – “how can healthcare providers ensure high quality of care when patients lie about their identity and/or drug use?”

RightPatient can play an important role in helping to answer this question. Our AI platform can accurately recognize the patient and offer key clinical insights by detecting patterns in the patient’s appearance over time. Clinicians won’t need to rely on the words lies coming out of a patient’s mouth, patients with no ID, or expensive tests. RightPatient automatically knows who the patient is and whether or not they are at risk of opioid abuse.

ED nurses who suspect a patient of abusing opioids will typically search the patient’s belongings to make sure they aren’t prescribed something that could cause an adverse event or even kill them. Unfortunately, the human eye, clinical intuition, and patient reliability have many shortcomings. Luckily, RightPatient can augment clinical diagnostics with cognitive vision to help fight the opioid epidemic and save a lot of lives and money in the process.