Trying to fit in an appointment with the doctor, visiting the clinic, scheduling a 5-minute test while waiting in line for hours—these aspects, while still necessary in many cases, are slowly becoming practices of the past through the benefits brought about by frontier technologies. For these technologies to bring about their full spectrum of benefits, they need to be backed by industry best practices. The following best practices are responsible for bringing about a rise in value-based healthcare solutions and systems.
Health Insurance Portability and Accountability Act
(HIPAA) is an American regulatory law enacted to protect aspects like Protected Health Information (PHI) and Personally Identifiable Information (PII). HIPAA was signed into law on August 21, 1996. This is a very important part of the healthcare domain where a patient’s data cannot be accessed by someone who is not in the medical profession and even the medical team that is not assigned to the patient. The violation of HIPAA law can result in civil and criminal penalties. The following parameters are a must to adhere to the compliances stated under this act.
- Quality: Quality healthcare provides timely service and positive patient outcomes. Studies have shown that quality healthcare along with improved patient knowledge not only improve a patient's health but also help in creating extraordinary patient experiences. One of the most important qualities of healthcare management is to be always up and running, may it be the healthcare providers of the patient or the application that takes over in critical times like pandemics. The devices to upload the vital signs and symptoms are now easily available as a watch or even as a machine that works in a specific way. For example, a blood pressure monitoring machine that records the BP reading and uploads it to a system and alarms the concerned doctors in case of emergency. Here, these devices should be also HIPAA compliant.
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Compliance: Compliance generally refers to the adherence of guidelines to safeguard the information related to a patient. HIPAA is one such regulation in the US that requires the protection of PHI and PII from unauthorized personnel. The PHI data includes Health Information that has been communicated over any channel, may it be emails, applications, verbal, etc., whereas the PII data includes the attributes like name, email id, phone number, address, etc., through which a person can be identified.
The technical challenges of a healthcare domain project are storing PII and PHI data in a HIPAA compliant and secured system. This can be overcome by implementing a secured system where the data is stored in an encrypted database while at rest and is transmitted over a certified network.The actual data here should not be even accessible to the software team members working on the application and supporting it. This is called data-at-rest and they can only access the anonymized version of it. - Data Anonymization/Pseudonymization: Data Anonymization is a process to protect the data (mostly production data) with various techniques such as encrypting, masking, scrambling, etc. This process is used when we need to access production data in certain cases. Pseudonymization doesn't mask the data but creates a relation between the actual data and the scrambled one so that the data can be recovered in accidents or to maintain the look and feel of data. At times, there is a need to access the actual data. The question is: ‘why do we even need to access the actual data’? The answer being—to reproduce a scenario where the program is failing due to any kind of issues in the data itself. To access this data, we should use a tool/script to mask/replace any sensitive data while maintaining the look and feel of the attributes. This is required to comply with the rules of HIPAA/any other regulation for that matter.
- Communication: A single platform to provide multiple solutions for a patient and provider would be an ideal practice where the two parties can also communicate about the symptoms and current vital readings, and the provider can suggest immediate actions/medicines to the patient. The advantage of this platform is basically to keep the data within the application and not use third-party tools to communicate that may violate the compliance standards of HIPAA.
All these above parameters are closely linked to the five main rules of HIPAA. These five rules play a crucial role in achieving HIPAA’s goal of guaranteeing the safety of PHI and ePHI.
- Privacy Rule: provides standards to safeguard the privacy of PHI and medical records as well as standards for providing individuals with privacy rights and helping individuals understand and control how their health information is used, and request corrections to their file.
- Security Rule: covers the aspect of electronic protected health information on storage, accessibility and transmission. This rule is implemented by using appropriate physical, administrative and technical safeguards to ensure the confidentiality, integrity and security of this information.
- Enforcement Rule: deals with provisions, protocols and directives around compliance with and enforcement of standards, investigation and hearings of breaches, and fines and penalties for violation.
- Breach Notification Rule: mandates HIPAA covered entities and their business associates to send out notification to the affected stakeholders following a breach of PHI within 60 days. These notifications will be carried out in compliance with the Health Information Technology for Economic and Clinical Health Act as well as any other applicable federal or state notification law.
- Omnibus Rule: contains updates to all of the previously passed rules with an aim to further strengthen the protection of sensitive health data. It came into effect in 2013 updating certain privacy rule conditions such as making the length of PHI protection after death up to 50 years, granting more rights for individuals to access their own ePHI, etc.
Security and Compliance
Protecting a healthcare solution is based on certain fundamental safeguards as follows:
- Physical: These safeguards are policies and procedures that ensure the protected data electronic system and its housing location are safe from unauthorized access. For example, server isolation will allow access to only those users who are a part of the approved network access group.
- Technical: These safeguards regulate the flow and visibility of data across the application’s infrastructure. This includes ensuring access to only those individuals with relevant access, recording and monitoring access to the system via audit controls, and preventing the alteration, destruction and tampering of sensitive data.There are certain tools available in the market that facilitate the implementation of these best practices and safeguards for healthcare applications. One of them is Amazon Web Services (AWS). AWS is a cloud platform that is HIPAA compliant.
- Administrative: These safeguards cover the training sessions and procedures for employees handling the system based on their access to PHI. This must be enforced through annual security awareness training sessions based on the policies set out by an organization’s Privacy Officer.
The above image is a pictographic recap of the various safeguards.
Predictive Analytics
Technologies like Predictive Analytics help to track healthcare dynamics at all levels right from an individual patient to a whole system thereby reducing human error. Predictive Analytics helps not only to pinpoint patterns like identifying high-risk patients, managing optimal staffing and resource allocation, anticipating equipment failures, and so on, but also reduces healthcare waste right from pathological waste to pharmaceutical waste and from cytotoxic waste to non-hazard waste.
According to Statista (an online platform specialized in market and consumer data) findings for the year 2022, 92 percent of surveyed healthcare executives in Singapore reported that they have implemented or are currently implementing predictive analytics in their healthcare organizations, the highest adoption rate of any county survey. China was second on the list, with an acceptance rate of 79 percent, followed by Brazil and the US with 66 percent. Providing quick high-quality, data-driven evidence-based healthcare is all about establishing patient trust and Predictive Analytics is one of main ways of achieving this aspect. As they say: “Better data leads to better care.”
For example, when reading a patient’s BP data, a physician may need significant time to analyse that same data gathered over months or years. Scalable models can read through that data, analyse it, and produce actions to be taken by the patient’s care team much more quickly.
This image represents the use of models to produce an expected user action—‘Reduce TW & Increase UF Time’, this action is determined based on weight and BP data fed to the model.
This will save the physician the time they would have otherwise spent studying the patient’s history, it also reduces potential human errors using established and tested algorithms to arrive at an effective conclusion.
Metrics
Measuring healthcare quality is of utmost importance. Metrics in the healthcare domain help to optimize and transform healthcare processes and outcome variables. Metrics provide better budget management, optimized healthcare standards, improved treatment plans, enhanced accountability, improved protection of sensitive data and so on.
A quality dashboard that shows and tracks metrics like satisfaction scores, adverse conditions and events, patient complaints and so on helps to identify areas for quality improvement.
Here we see the visualization of AM/PM BP data over a time period—providing easy reading/study of the same for healthcare providers and patients alike.
A physician can use this to quickly and easily read through the patient’s BP history, expediting their response to a patient’s needs. Additionally, it reduces the need for paperwork that can otherwise be misplaced and/or lead to the unwanted exposure of sensitive data.
Timely Communication
With an estimated 80 percent of medical errors resulting from miscommunication among healthcare teams, organizations can significantly improve outcomes with better communication.
Timely communication is vital to the healthcare industry—whether it is a patient trying to reach their doctor or a doctor waiting to be notified of a patient’s new symptoms. Sharing this type of information with all relevant parties will maximize the healthcare outcomes an institution can deliver to their patients. This can be achieved via in-app messages, phone/video calling, SMS notifications, etc.
Herewe see Grace Carter reaching out to her fellow physician to ensure the patient, Alexia, is attended to based on newly reported symptoms.
By leveraging the services provided by Amazon Chime, we can provide real-time communication between healthcare providers and patients—In-App and PSTN calls can be made easily via this solution. In-app messaging is also enabled through the same communications service to allow convenient and logged conversations between all parties concerned.
Both the patients and their healthcare provider/s could be away from their systems or have no internet access when a critical notification/alert comes their way. To close this gap, we must ensure that these users have access to both SMS as well as In-App notifications to enable rapid response to updates that need immediate action.
Conclusion
All the above best practices bring about a plethora of benefits, including the following:
- Leads to optimum clinical outcomes.
- Improves evidence-based medical knowledge.
- Reduces public health risks through early recognition both in the case of individual patients and in events that impact vast groups of people like outbreaks.
- Supports the time-sensitive nature of healthcare work in real-time.
- Leads to streamlining of dynamics related to inputs/history, dissemination/implementation, and monitoring/outcomes.
Researchers estimate that in one year, $25 to $45 billion is spent on unnecessary hospital readmissions and avoidable complications. Missed appointments cost the US healthcare system more than $150 billion a year. By implementing a whole gamut of healthcare best practices, all these (negative) statistics can be minimized to a great extent.
“Best Practices” is the best medicine—the superlative adjective ‘best’ reflects the essence of the word ‘quality’—quality patient care, quality clinical data, quality patient outcomes, and so on.
