Provider App for Physicians and Nurses within a hospital

Part
01
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Part
01

Overview BSW (Baylor Scott & White) - Provider Referrals

There are several options for creating a physician referral in the Baylor Scott & White network. These options include a fax form, an online form, and via phone. Additionally, a web-based directory is available where a physician can be searched for by name, service, specialty, or facility. While there was no pre-existing flow chart or step-by-step instructions for the provider referral process available via public sources, we have compiled all relevant available information below.

methodology

An extensive search of the public domain spanning the BSW website, industry reports, and trusted media sources confirmed that a referral process flow chart was not available via public sources. However, we have provided extensive information regarding the physician referral process in terms of facility location, required forms, and referral options.

REFERRAL PROCESS

FACILITY LOCATIONS
On the Baylor Scott & White Health website directing physicians how to refer a patient, there are six geographic areas of service identified. For each geographic area, information is available for how to conduct a referral based on the type of office. Requirements for a referral range from online forms, fax forms, and phone numbers. It is important to note that the process varies for each area/office type. For example, the College Station Area utilizes all 3 types of referrals, but the Marble False Areas only includes a phone number.

PHYSICIAN REFERRALS
A physician or physician's office refers patients. A getting started page is provided for physicians unfamiliar with the referral process. To refer a patient, a physician's National Provider Identifier (NPI) and Federal Tax ID numbers are necessary, and sometimes the Unique Provider Identification number (UPIN) is still used. There is a form to fill out for new physicians who want to be included in the referral network. The form also allows current physicians to update their profiles.

There is a physician's relations team to assist the entire referral process. Here is a link that provides the contact information for the physician's relations team. The purpose of the physician's relations team is to "serve as a single point of communication for your practice when questions or issues arise."

A referring physician can use BSW's "Refer a Patient" directory to conduct a search for participating physicians based on last name, service, specialty, and facility. Once located, users have the option to submit a referral.

REFERRAL OPTIONS
When applicable, and once a physician has been located, an online form is used for creating a referral. This is only an option for the following area's office type combinations:

College Station Area: Clinic; Round Rock Area: Direct admits, Inpatient, OB/GYN, and Transfers; Temple Area: Emergency Department, Hospital, and Clinic. For example, here is the Temple online referral form.

Some geographic areas allow a physician's referral to be faxed, and there is a separate form to be filled out and faxed.

CONCLUSION

A physician who is a registered part of the referral network at Baylor Scott & White Health can refer using fax, an online form, or via phone. There is a physician's relations department available to guide physicians through the referral process.
Part
02
of nine
Part
02

Baylor Scott &White Health - Stakeholder Intelligence Part One

Myra N. Hager, Nick Reddy, and Thomas Bowen Wright are all currently major executives for Baylor Scott & White Health (BSWH). Information regarding their educational and employment histories was public information and will be depicted below, in addition to their general backgrounds, accomplishments, and mentions in the public media through articles or press releases. Information on Jacob H. Roseberry was not available through the BSWH website, or on LinkedIn. Multiple online searches were unsuccessful on finding information for Roseberry. When searching on LinkedIn for Jacob Roseberry, there were four results available for the name, none of which mentioned working for BSWH. Additionally, when going through the LinkedIn page for BSWH, there was no profile for Jacob Roseberry as an employee or related person. As a result, below you will find the requested information for Hager, Reddy, and Bowen Wright.

Myra N. Hager

EDUCATION
Myra first studied Math, Physics, Biology, and Chemistry at the Texas Academy of Math and Science (TAMS) between 2002 and 2004. After which, she attended the Red McCombs School of Business at The University of Texas at Austin from 2004 to 2007. From here she earned her BBA in Management Information Systems.

EMPLOYMENT HISTORY
Before claiming any full-time positions, Hager worked through four different internships. After earning her BBA, Hager started work as a Technology Leadership Program (TLP) Intern at Citgroup. She was an intern there from May 2006 to August 2006, and a year later became an intern at KPMG. She held this position for three additional months (May 2007 - August 2007), and by January 2008, earned a position as a contractor for the Southwest Key Program until March 2008, when she transferred to an intern program with the Innovation Team at Beijing Hualian Group until May 2008. In September 2008, Hager started her first full-time job as the Manager of Technology Enabled Transformation at KPMG. She was there until December 2015, whenever she received the position of Director of Digital Health as BSWH where she is currently working.

GENERAL BACKGROUND/SPEAKING ENGAGEMENTS
Myra is currently certified as a ScrumMaster and has a certification in ITIL Foundations v3. She is also further skilled specifically in project management, general management, and PMO, as endorsed by over 76 people on LinkedIn. There are no publicly mentioned notes of moments in which Hager has spoken at events, and she does not have any upcoming events. However, she is mentioned in an article, described below.

MEDIA MENTIONS/PRESS RELEASES
On July 26, 2017, Myra was the topic of an interview from Healthbox about her position at BSWH as Director of Digital Health. This article is a written version of a spoken podcast that involves her and another member of BSWH, where they talk about how Hager has worked to decrease costs, increase digital solutions, and present new business models to BSWH.

Nick Reddy

EDUCATION
Nick attended Texas A&M University from 1996 to 2000, where he earned his BBA in Management Information Systems. In 2006, he furthered his education at the Cox School of Business at Southern Methodist University, and graduated with his Executive BBA in 2008.

EMPLOYMENT HISTORY
Reddy was first employed as a consultant for Pricewaterhouse Coopers from 2000 to 2001. At some point during the year 2000, Reddy became a team leader at TXU, until 2004 whenever he obtained the position of Senior Manager of IT Strategy and Performance at KPMG. Reddy remained at KPMB until January 2012, after which he became the Chief Digital Officer and Senior Vice President of IS at BSWH.

GENERAL BACKGROUND/SPEAKING ENGAGEMENTS
Reddy mentions that he grew up in health care, as both of his parents and grandparents were doctors. He has been working in the health care industry for the past 12 years, and hosted a digital summit in June 2016. This summit included 12 tech companies (narrowed down from over 2,000) who pitched concepts to the top 70 executives of BSWH regarding ways to increase the digitization of the company. There have been mentions of this summit happening on a yearly basis, but the one from 2016 is the only one reported.

MEDIA MENTIONS/PRESS RELEASES
In 2016, Reddy was mentioned in an article listing the top 50 healthcare leaders under 40 years of age to keep watch of. This article talked about how he helped to develop a mobile app for BSWH, and how he was named CIO Magazine's "One to Watch" in 2014. Additionally, an article from the Dallas Morning News talked of Reddy and his performance for BSWH on consumerization. In May 2017, a press release about BSWH was publicized that cited Reddy as he mentioned how the company is working to make health care more convenient, integrated, and unique.

Thomas Bowen Wright

EDUCATION
Thomas Bowen Wright attended Ampleforth College from 1992 to 1997. Upon graduating, he studied Mathematics at the University of Oxford, where he obtained his Masters of Arts in 2000. From 2008 to 2009, Bowen Wright attended the Columbia Business School at Colombia University, graduating with his MBA.

EMPLOYMENT HISTORY
Bowen Wright first began work at JP Morgan Chase as an analyst in the year 2000. Up until 2002, he worked there, after which he started working for NewSight Corporation as the Executive VP until 2005. From 2006 until September 2010, Bowen Wright was a managing partner at Papillon Advisory Group, and then he moved on to become a Management Consultant at McKinsey & Company until October 2014. From November 2014 until October 2016, he was the Vice President of Strategy at Adeptus Health, after which he because the VP of Digital Innovation at BSWH.

GENERAL BACKGROUND/SPEAKING ENGAGEMENTS
Since October 2014, Bowen Wright has been a mentor to business school graduates at the Cox School of Business at SMU. Between October 9 - 13, 2017, Bowen Wright also was scheduled to speak at the Austin Startup Week in Austin, Texas. While there, he spoke about how BSWH was working to embrace consumerization and use more technology to further reach the mission of the company.

MEDIA MENTIONS/PRESS RELEASES
Bowen Wright released an article that he published through LinkedIn in early 2016 regarding the Q4 earnings of BSWH, as well as the full year results of the company. On July 13, 2017, Bowen Wright was quoted in a press release regarding BSWHs decision to utilize Kyruus, a technology purposed for managing provider profiles in the health care industry. Earlier this year, on February 4, 2018, Bowen Wright was quoted in another press release about BSWH. In this release, Bowen Wright talked about how BSWH would be using Jvion's Cognitive Machine to aid clinicians in making informed analysis and decisions for patients, with the goal or reducing patient stays in hospitals. This technology also has the power to provide performance analytics for the company.

Conclusion

Although no information was available for Jacob H. Roseberry, information on the other stakeholders was publicly available. Hager, Reddy, and Bowen Wright each provide distinct characteristics to the workforce of BSWH. Hager is especially focused on improving digital solutions of the company, Reddy works to implement these solutions, and Bowen Wright seems to be more of a public figure for the innovations that are going on within the company. BSWH as a business is focusing their efforts on increasing consumerization and digital technology within the company.
Part
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Part
03

Baylor Scott &White Health - Stakeholder Intelligence Part Two

Introduction:

Brandon T. Maenius, Jacob Scott, and Sydney Davis are all employees of Baylor Scott & White Health (BSW). We have compiled information on these stakeholders through LinkedIn, Facebook, and the company website. Information on Sydney Davis was not readily available as he does not maintain any form of social media and, unlike both Maenius and Scott, was not mentioned on the company website.

Brandon T. Maenius:

Background
Maenius was born and raised in Boerne, Texas and now resides in Flower Mound, Texas. He is married to Amber Glaeser Maenius and the pair have two children together.

Education
Maenius received his Bachelor's degree in business and management at Abilene Christian University. He did his graduate studies at Trinity University and received a Master of Science in Health/Health Administration/Management.

Employment History
Before working for BSW, Maenius worked at Homecare Homebase and held a number of positions including "implementation consultant, senior implementation consultant, project manager, and manager of implementation". Since joining BSW Maenius has held roles as "project leader, EHR program management; project leader, strategic incentives; senior project manager/chief of staff to IS SVP; manager, digital health; and director/manager, digital health".

Tech Endorsed
In 2016, Maenius was mentioned on the company website as a champion of the design for the mobile-device app that allowed patients to schedule video visits and access their health accounts.

Press Releases, Recent Conferences, and Prior/Upcoming Speaking
Information on Maenius's activities in this sector could not be found. We looked through his Facebook and LinkedIn and found no history of the information requested.

Jacob Scott:

Background
Background information was unavailable on Scott as he does not have that sort of information on his LinkedIn and he does not have a Facebook account.
Education
Scott attended Dallas Baptist University for both his undergraduate and graduate degree. He received his Bachelor's degree in Business Management and his Master's in Business Administration.

Employment History
Prior to BSW, Scott worked at Dallas Baptist University. He held positions as a shuttle driver, a campus security dispatch office coordinator, and a graduate adviser. He currently holds a position at BSW as project manager.

Tech Endorsed
In 2017, Scott was mentioned on the company website as a champion of the company's E-visits systems. This system connects patients with a physician assistant or nurse practitioner for prescription refills and help with minor illnesses like cold and flu.

Press Releases, Recent Conferences, and Prior/Upcoming Speaking
Similar to Maenius, information on this section of the request could not be found. We searched his LinkedIn and Facebook and could not find any information.

Sydney Davis:

After searching the company website, LinkedIn, and Facebook the only information we could find on Davis is that he received his Bachelor of Science in Healthcare Management from UAB and that he currently holds the position of project manager at BSW.

Also, he attended a conference in 2016 called ACHE Networking Event. His name was on a list of attendees compiled by the University of Alabama at Birmingham (UAB) Department of Health Services Administration.

Conclusion:

While we could not find all the information requested on Davis, we were able to compile a decent amount of information on both Maenius and Scott. Both Maenius and Scott are champions of the technology within their company.
Part
04
of nine
Part
04

Provider App for Physicians and Nurses Within a US Hospital

Epic, eClinicalWorks, Nextgen Healthcare, McKesson and Cerner are apps are currently being used for nurses/doctors at US hospitals to manage productivity and communication.

METHODOLOGY

In order to find out what apps are currently being used for nurses/doctors at US hospitals to manage productivity and communication, I started off by looking at the top competitors of the company provided, Epic. I found that their top competitors are named as: eClinicalWorks, Nextgen Healthcare, Allscripts, Athena Health, McKesson, Care Cloud, CureMD and Cerner. I have investigated each of these companies, and have discussed those that fit the criteria. Such as those that focus on productivity and communication, and those that provide a profile of physicians/nurses, offer management solution, and a directory. Some of Epic's top competitors did not make the list. For example, Allscripts is based on the NHS, which is the UK healthcare system, so it was excluded. In addition to this, CareCloud and CureMD are only focused on practices not on hospitals. Finally, I also searched through articles and pre-compiled lists for extra companies. For example, I looked through this source of top 9 medical apps for doctors. However, there were no further companies in the sources I searched through that fitted the criteria.

Below is the list of 5 companies that I found. For each I have provided an overview of the company, including financial information and location. I have also provided details on the services/products that they offer, focusing on their productivity/communication aspects. I have also noted which of the following criteria they meet and how.

FINDINGS

Epic

Epic was founded in 1979, and is based in Wisconsin. The company's annual revenue is $2.5 billion, and their founder and CEO is Judith Faulkner.

Epic offer a system to independent practices and hospitals that has the ability to keep billing and scheduling separate. Community providers can be communicated to via an integrated portal, keeping them up-to-date with their patients, submit referrals, order labs & imaging, schedule visits, and more. The integrated portal is an example of communication which the system fosters. Productivity is managed through keeping numerous tasks in one convenient place.

Epic's solution hits many areas such as increased patient engagement and patient referrals, rapid and simple sharing of patient data and heightened revenue and increased patient care.

HCI Group claim that use Epic Community Connect has resulted in a boost to communications. They state to have reached the next level of interoperability with the system. Epic's system encourages the sharing of data as well as patient data, which in turn boosts the level of patient care and productivity.


Based in Westborough, Massachusetts, eClinicalWorks generates an annual revenue of $440 million. The company was founded in 1999, and Girish Navani is the founder and CEO.

The company offers an Acute Care solution which "features a patient dashboard showing all clinical details, for Emergency Department, Operating Room, ICU, or any inpatient unit." Working as a single platform, Acute Care provides the unique documentation needs of providers, nurses and allied health professionals. Its dashboard has interactive and predictive features. It also includes many more features for increased analytics, and therefore increased productivity.

The service also connects nurses with anesthesiologists and surgeons. Acute Care connects these workers together to make documentation sharing simple and seamless, and it makes this record is visible to all authorized care providers.

It makes the patient's medical record completely visible between facilities, and doctors. This speeds up the process of accessing data, and therefore enhances productivity.


Nextgen Healthcare generates $120 million annual revenue, and their President & CEO is Rusty Frant. The company's headquarters are in Horsham, Pennsylvania, and the company was founded in 1994.

NextGen Healthcare transforms hospitals by helping them to succeed in value-based care. It measurably improves patient outcomes and population health at lower costs. They assist providers in improving the healthcare of over 150 million patients. They do this through facilitating collaborative care, through information sharing and enhancing communication between healthcare professionals.

The solution also improves the revenue cycle by taking advantage of new value-based care models, to leveraging cloud technology. In addition to this, they boost productivity by and outcome patient healthcare by optimizing data and transforming it into actionable information. Finally, they solution has helped patient engagement to thrive.

McKesson

McKesson generate $154.4 billion in annual revenue. They were founded in 1833, are based in San Francisco California, and John Hammergren is the Chairman and CEO.

McKesson helps improve productivity by streamlining the registration and scheduling process for providers. It can "efficiently capture accurate patient data pre-service and at registration and scheduling, verify insurance eligibility, estimate patients’ financial responsibility, and accept point-of-service collections."

The data-driven clinical applications offered by McKesson claims to impact positively on every aspect of inpatient and outpatient care. They do this through assisting with assessment and diagnosis, assessing the appropriateness of medical and surgical interventions, providing clinical workflows, and overseeing care transitions and coordination of post-acute care.

The solution improves communications in several ways such as sharing lab and imaging results, and sharing patient data.

Cerner

Cerner is a Missouri based company, founded in 1979. They generate $6.2 billion in annual revenue, and Brent Shafer is the Chairman and CEO.

Cerner have designed a solution that improves on physician and nurse workflow by helping to save time on a number of tasks, and helps these healthcare professionals to focus on meaningful delivery of care. The solution that they have created increases productivity by streamlining administration.

The award-winning solution also focuses on improving communications by enhancing information sharing.

CONCLUSION

To sum up, I have found that Epic, eClinicalWorks, Nextgen Healthcare, McKesson and Cerner are apps are currently being used for nurses/doctors at US hospitals to manage productivity and communication.
Part
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of nine
Part
05

Pain Points - US Hospital Scheduling.

Nurses in the US face burnout and high turnover rates which are likely the result of staff shortages. These shortages reduce their "ability to move patients through the system in a timely manner." Low productivity, fatigue, poor quality performances, and more negatively impact "clinical staffing and scheduling." These issues overlap with the concerns of doctors who are dissatisfied and lack confidence in the standard scheduling systems. Further, details on these scheduling pain points and how they impact doctors and nurses are provided below.

DOCTORS SCHEDULING PAIN POINTS

Insufficient software contributes to lower productivity levels. The majority of the healthcare scheduling software that is currently available is either "limited, hard to use, or can’t be updated easily." With this being the case, mistakes occur more frequently, inefficiencies can become commonplace, and "havoc ensues." These circumstances cause doctors to lose confidence in the scheduling system. It also results in less productivity, flexibility and access to information. These pain points hinder the ability of doctors to perform at their best.

When doctors alter patient appointments according to their preferences, they are not confident that their changes will be properly added to the system. Doctors are also concerned with whether these changes will be appropriately conveyed to the "entire scheduling staff." Without confidence in the system, doctors don't have the freedom to adjust their appointments as needed. Unfortunately, medical scheduling software typically lacks the agility needed to update "often enough to incorporate these changes."

In order to avoid miscommunication, doctors opt to hand deliver their appointment changes rather than rely on scheduling software. Medical schedulers would benefit from gaining "access to key information." When this information is not readily available and a patient calls with symptoms that the scheduler is unfamiliar with, then the only option is to consult the doctor. These scenarios ultimately reduce doctor productivity. A streamlined automation system with patient data and appointment information could "hard code doctors’ preferences so that every scheduler" could access the information and save doctors time.

NURSING SCHEDULING PAIN POINTS

In a 2016 survey conducted by AMN Healthcare, 94% of nurse managers "agree that scheduling and staffing problems negatively affect overall staff morale." From this figure, 90% report that the continuation of these issues causes "them to feel underappreciated."

The most frequent staffing issue for 40% of respondents was last-minute scheduling changes. These changes included scheduling errors, day-of sick calls, specialty vacancies, and patient acuity changes. Nurse managers also reported that understaffing was a major concern at nearly 50%. Fatigue due to understaffing is a major pain point for nurses. Nurses take on extra shifts in order to address patient needs, cover for their peers, or work overtime. Despite this, insufficient staffing prevents them from being able to "adequately serve their patients." 70% of nurses are worried about the effects that staffing issues and nurse scheduling have on "patient experience and patient satisfaction." Over half the respondents were also concerned about the impact that these issues have on the quality of care.

Productivity issues may also be a result of the tools that nurse managers rely on to fulfill their duties. From those surveyed, 24% rely on paper-based tools, 23% don't use scheduling tools, and 19% use digital spreadsheets. Out of the respondents who had access to "technology-enhanced scheduling tools," 43% continued to use manual scheduling.

Nurses have to contend with inadequate staffing, scheduling challenges, "high employee dissatisfaction and managing overtime." In an attempt to combat these pain points, schedulers at the NorthCrest Medical Center located in Tennessee have developed a "crisis staffing plan." When a nursing unit is short-staffed they "offer a bonus of $100 for the day shift and $150 for nights to nurses to come into work." If the unit happens to only be short one nurse, then the nurses split the money. This has resulted in higher employee morale. Other hospitals have attempted to fix pain points by not allowing nurses to work overtime if they've declined to take a lunch break. Business analysts are also being used to address gaps in the schedule weeks in advance.

CLINICAL WORK SCHEDULERS

Most nursing homes and hospitals have a minimum of one position "dedicated to creating and maintaining employee schedules." These work schedulers help to control costs by "minimizing staffing levels and overtime, and by frequently making changes to align work hours with fluctuations in the patient census." The patient census is the number of people being cared for.

It is necessary that work schedulers follow effective practices to meet the necessary cost, legal, and "quality standards in health care." Schedulers are required to adhere to state and federal "regulations that require minimum standards for the quantity and mix of licensed staff on duty that vary by patient acuity." Individual states are also responsible for regulating staffing in order to "balance Medicaid and Medicare costs with safety standards." In cases where there is a staff shortage, the workload increases for those who are tasked with covering their shifts. Understaffing occurs because of unplanned gaps, paid time off, facility growth, staff turnover, low employment, budget management, and more. Regardless of the cause of the gap, work schedulers are responsible with "hole-filling" and finding someone to take those shifts.

TECH SOLUTIONS FOR PAIN POINTS

WakeMed Health and Hospital is using computer software in order to address their scheduling issues. This hospital manages 70 doctors and has "a lot of variability in shifts." There are night, evening, non-teaching, and teaching shifts. Not all the doctors they manage work all these shift types. By relying on scheduling technology for approximately five years, WakeMed has been able to save time. This has led to higher satisfaction among doctors which WakeMed hopes will translate into "more camaraderie, physician retention, and revenue." The main drawback to using this automated scheduling system has been the inclusion of complex schedules. These schedule types can require customization which can take longer to set up.

Despite the fact that WakeMed has successfully implemented tech solutions to address their scheduling concerns, about 80% of nurse managers are not familiar with advanced scheduling tech. These managers are unaware that "predictive analytics can accurately forecast patient demand and staffing needs up to 120 days into the future." Gaining access to this type of data would allow managers to properly prepare in advance for the number of patients they'll need to care for and the skill level of the staff they'll need with 95-97% accuracy. This vastly improves the current standard where managers end up "frantically calling nurses two hours before the start of the shift."

Healthcare establishments that have started using "predictive analytics and advanced labor management strategies" have experienced various benefits. These benefits include increased nurse satisfaction, 97% accuracy in "predicting staff needs 30 days out from the shift," 75% of "open shift hours filled more than two weeks in advance," and 4-7% (or millions of dollars) savings in labor spending.

CONCLUSION

In conclusion, staff shortages cause pain points like fatigue, burnout, overtime, low morale, and concerns about patient care for US nurses. Some of these pain points overlap with doctors who are also concerned with the accuracy of scheduling, a lack of flexibility, and decreased productivity. WakeMed Health and Hospital and NorthCrest Medical Center are examples of healthcare establishments that are addressing these scheduling issues. NorthCrest's "crisis staffing plan" offers monetary incentives to nurses who cover shifts and WakeMed's computer scheduling software has led to higher satisfaction levels among their doctors.
Part
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Part
06

Pain Points - Administrative management of profiles.

I looked at the term "administrative management of profiles" from the point of view of general administrative duties for clinicians and administrators (e.g. paperwork, staffing, workflow procedures, etc.) Reoccurring pain points seem to be centered around misalignment of priorities, technological frustrations, and the effects from employment changes in the healthcare industry.

ALIGNMENT ACROSS HEALTHCARE SYSTEMS
57% of healthcare executives say alignment with physicians is a significant pain point. This conflict arises from cultural differences between administrative concerns and physician expectations. Administrators come to situations with an "organizational advocate" perspective, while physicians consider themselves a "patient advocate." Thus, physicians desire autonomy, detest corporate practices that put the patient's needs at second place, and view cost of care as a secondary issue. Administrators, on the other hand, value collaboration, have organizational and financial issues at the forefront of their concerns, and keep long-term projects and goals in mind.

In radiology departments that need to read and produce images in a timely manner, pain points often result from inefficient workflow procedures from other departments. This misalignment between departments results the impediment of patient flow in areas such as patient transport, MRI triage, and hospital requirements that increased patient waiting times and increased "MRI throughput times."

For pharmacists dealing with drug-resistant super bugs, increased responsibility for antibiotic stewardship places pressure on their department to keep track of "what antibiotics [their] organization as a whole is using, at what cost and with what outcomes." The opioid addiction epidemic is also occurring in the healthcare field, as "one in every 10 health professionals is struggling with addiction or abusing drugs that are not prescribed for them." This crisis necessitates an entire, new system of prevention in the industry; some of those steps requiring "education and training across multiple disciplines to educate staff on controlled substance diversion" and "an audit of controlled substance data in the hospital organization."

TECHNOLOGICAL FRUSTRATIONS
Issues with technology were constantly mentioned as a source of pain points for both administrators and clinicians.

For administrators and executives, the main issues centered around inefficient usage and costs of technology. A Chief Medical Officer states that administrators should manage the various interests and desires between C-Suites for new technology, and keep in mind the "maximum value for the organization as a whole." Administrators also need data governance to deal with data silos that occur in each department which often result in "difficulty in working toward a unified goal."

The final main administrative problem with technology is when administrators see badly implemented, tracked, or managed technology by failing to consider the staff that will be using it. Unused, or incomplete usage, of technology by clinicians who don't understand how to use it results in the waste of financial and data investment into the technological product.

Nurses are extremely dissatisfied with current technological issues. Their complaints revolve around being overburdened with data entry for patient and administrative documentation, technological complications in transitions of care, having to develop workarounds for insufficient or missing systems, and tech UI that "doesn't fit with workflow, cognitive processes, and other tech systems."

Radiology departments say "software can often eliminate variability, particularly in workflow management" which negatively impacts "situations that require judgment of complex results."

Physicians in general are overwhelmed with inefficient technological processes that "aggravate alarm fatigue" and fail to "automate routine and simple processes."

CHANGES IN THE HEALTHCARE INDUSTRY
With the rise of increased technological advancement and implementation, "additional staff needs to be hired, processes and procedures need to be evaluated, and enormous amounts of training is required." Even the traditional, physical forms of documentation are a pain point for administrators as "coordinating all of this paperwork requires additional staff dedicated to sorting, maintaining, filing, and accessing."

However, due to mergers and acquisitions all across the healthcare industry, and the subsequent shifting of work and downsizing of leadership in pursuit of cost efficiency, with the addition of clinician burnout and physician shortage, staffing has become a major pain point in the healthcare industry for everyone involved.

Conclusion

The major administrative pain points in US hospitals result from conflict between departmental priorities, disorganization surrounding technological advances, and staffing issues in the healthcare industry.
Part
07
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Part
07

US Hospitals - Staffing

At hospitals in the U.S., approximately 55% of employees are directly responsible for patient care or for technical occupations related to patient care. Another approximately 13% are engaged in office support functions and a further 3.5% are employed in management.

Of the individual jobs, nurses make up the largest share of hospital employees, representing nearly 30% of all hospital staffs.

Doctors, meanwhile, are underrepresented in most data related to hospital employment, since most physicians that work at hospitals are not directly employed by the hospitals themselves. However, an analysis of the statistics, as described below, suggests that doctors represent approximately 7% of the people working on hospital grounds.

Major Categories Of Hospital Employment

According to U.S. Department of Labor data from 2016, the most recent year for which statistics are available, here is the breakdown of employees at hospitals in the country by major category:

Healthcare Practitioners and Technical Occupations - 55.10%

Office and Administrative Support Occupations - 12.60%

Management Occupations - 3.55%

Building and Grounds Cleaning and Maintenance Occupations - 3.19%

Community and Social Service Occupations - 2.60%

Healthcare Support Occupations - 2.46%

Food Preparation and Serving Related Occupations - 2.34%

Business and Financial Operations Occupations - 2.14%

Computer and Mathematical Occupations - 1.32%

There are also some miscellaneous categories, collectively representing less than 5% of hospital staffs. Each of the individual category in this miscellaneous group is a negligible portion of the overall employment at the hospital and includes things like legal, media, construction and sales.

Also, as explained in greater detail below, physicians are underrepresented by the Department of Labor data on hospitals and should be considered in a separate category. For the purposes of the categories listed above, physicians would be included in the "Healthcare Practitioners and Technical Occupations" category.

However, due to the way the data are compiled, they make up a nearly negligible proportion of this group and for the purposes of this report, they have been broken out into a separate category.

Individual Professions

Of the individual professions, nurses make up the largest part of hospital staffs by a significant margin. Registered nurses (RNs) represent 29.6% of hospital employees. The next largest group is nurses assistants, which make up about 6.6% of hospital staffs.

No other individual profession represents more than 3% of hospital staffs on average.

Here is a breakdown of all the individual professions that make up at least a 2% share of hospital staffs, according to the Department of Labor data (again, as of 2016):

Registered Nurses 29.64%

Nursing Assistants 6.57%

Medical Secretaries 2.52%

Medical and Health Services Managers 2.09%

Radiologic Technologists 2.02%

Physicians Working At Hospitals

Because of the structure of the relationship between hospitals and most doctors, very few physicians are employed directly by a hospital. Most of the doctors who practice at the hospital are credentialed to work there but are not officially employed by the hospital.

For instance, in the Department of Labor statistics, physicians and surgeons make up a total of 1.8% of the workforce at hospitals.

That total of doctors would imply a ratio of nurses to physicians of 16:1 in U.S. hospitals, using the DOL stat on the number of nurses employed at hospitals. However, a separate set of statistics compiled by Statista suggest a ratio of closer to 4.2 to 1. (Specifically, the ratios implied by the Statista data are between 4.14:1 and 4.22:1, depending on the type of hospital.)

This ratio is generally supported by overall data on the number of nurses and physicians in the overall population. According to stats compiled by the Kaiser Family Foundation, there are approximately 4.15 million nurses in the U.S. (as of October 2017) and about 951,000 doctors. This would imply a ratio of nurses to physicians of 4.36 to 1, in line with the totals suggested by the Statista data.

If a ratio of 4.2 to 1 is applied to the Department of Labor data on hospitals, that would suggest that doctors make up about 7.1% of the people working on hospital grounds, even if they are not directly employed by the hospital.

This stat is derived by taking the proportion of nurses in the DOL data (29.6%) and applying the 4.2-to-1 ratio. This leads to proportion of doctors of just below 7.1%.

Variance Among Hospitals

It should also be noted that ratios of the different hospital workers varies between hospital type and likely among individual hospitals. For instance, the Statista data source indicated that the ratio of employees to occupied patient beds was substantantially lower at hospitals that were part of a multi-hospital system (MHS) ownership structure than at non-MHS hospitals. Meanwhile, some of the individual ratios were slightly different.

For example, the data indicate that the nurses made up a lower percentage of overall staff at non-MHS hospitals than at MHS hospitals.

The stats show a ratio of non-therepeutic employees to registered nurses at MHS hospitals was approximately 2:1. At non-MHS hospitals, this ratio was closer to 2.5:1, indicating that nurses made up a smaller percentage of the overall employee base. This stands to reason since one of the advantages of a MHS hospital is that the office and other support staffs (like human resources, etc.) can be shared across multiple hospitals. This efficiency would lead to a higher percentage of hospital staff dedicated to direct patient care.

Organizational Structure And General Employment

The Department of Labor data suggest that 5.9 million people are employed at hospitals in the U.S. As noted above, this under-reports the number of physicians working at the hospital but technically employed by a private practice or other organization.

A separate Department of Labor report, derived from a separate data set, suggest that the total population employed at hospitals (as opposed to employed by hospitals) would be just over 7 million.

In terms of organizational structure, the data suggest that approximately 45% of employees are engaged in support functions, with about 13% part of the office staff and another 3.5% part of management. The majority of employees, as well as the physicians working at the hospital, are engaged in direct patient care.

Conclusion

A majority of employees at hospitals are engaged in direct patient care, with nurses making up about 30% of the total. Doctors are underrepresented in the data due to the organizational structure. However, an analysis suggests they make up about 7% of the staff on hand at a hospital, though a majority are not directly employed by the hospital itself.

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Part
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App usage data for nurses and doctors in the US

A review of the available data suggests that doctors and nurses would be willing to use mobile productivity or communications apps during their shifts. Data show that mobile technology is already being widely used within the healthcare field, though studies of communication in the space suggest that there is room for more efficient use of these tools.

There does appear to be an untapped market for apps targeting the medical community. Many of the apps currently available are focused on patients, and the apps that are aimed at medical professionals tend to facilitate career-building efforts or feature scheduling tools rather than being used to create a more efficient workplace. Moreover, it appears that medical professionals have turned to other general communications apps in order to fill the hole left by a lack of products specifically designed for them, leading to concerns about the security of data.

Current Use And Impact Of Mobile Apps

An article on MedTech Engine detailed the use of general messaging app WhatsApp by NHS doctors. In some cases, the use of WhatsApp has become critical to the communication of these medical professionals, the article reports. The general implication of the reporting is that there currently exists no widely-used chat alternative dedicated for the medical space, leading to some concerns about utilizing general messaging technology due to worries about the security of patients’ data.

The article also notes the development of app Forward, an example of a messaging app on the market.

There are signs that mobile technology has made significant penetration into the healthcare workplace. A 2013 Epocrates study indicated that 80% of U.S. healthcare professionals used a smartphone at work. The same report showed a 50% use of tablets. Since this study is now four years old, it can be assumed that this level of penetration has increased in the intervening time.

Meanwhile, a separate set of statistics indicate that mobile technology can be highly useful in streamlining communications among healthcare professionals.

A study published in 2016 studied the use of iPhones in the workplace by Australian nurses. No particular apps were specified in the study results, but the data showed that the nurses found the phones useful for communications purposes. The use between the nurses often centered on general communications. Specifically, the study found the following:

The nurses reported that the main reasons for making contact with other nurses was centered on changing shifts, social agendas, and checks related to patients."

In terms of using the iPhones to communicate with doctors, the study found that the nurses commonly used the device to check on medications and for IV fluid orders.

Current Mobile Technology Marketplace For Healthcare Professionals

While the use of mobile technology in the healthcare workplace is widespread and there are indications that it could be useful, there are data suggesting that the health professional market is underserved by mobile apps.

A report published in Research2Guidance stated that while mobile health apps produce 3 million free downloads and 300,000 paid downloads, these are generally used for patients and other groups. The study showed that only 15% of the mobile health apps were targeted toward healthcare professionals.

There are some current apps aimed at the healthcare professional market. Here is a summary of two of the more prominent entries:

Doximity - This free, LinkedIn-like social networking app for doctors can be used for communication. However, it is not conceived as a daily communication app for doctors. It claims to reach 70% of all U.S. doctors, or more than 800,000 medical professionals.

NurseGrid - Primarily conceived as a scheduling and communications platform for nurses, this app reports that it has 470,000 users. This would equate to an 11% market penetration, using a Kaiser Family Foundation estimate of the U.S. nurse population of a little over 4.15 million.

Reimbursement Question

No data was found directly answering the question of whether doctors or nurses would require compensation or reimbursement to use particular apps. However, a general overview of the available research indicates that additional compensation would likely not be necessary, given the overall ubiquity of mobile technology generally and the popularity of voluntarily downloaded apps like Doximity and NurseGrid.

However, those services are both free and are primarily of benefit to the individual doctor or nurse. An app that required payment and would primarily be used for the benefit of the healthcare organization, through building a more efficient workplace, might require expenses to be paid by the healthcare organization.

Use Of Personal Phones

There are some potential barriers to the widespread implementation of mobile technology for healthcare professionals being rolled out on personal phones. These include cultural concerns about using seemingly personal devices in a workplace setting. Also, security concerns about patient data could cause some pushback against the use of medical professionals' personal phones.

The 2016 study of Australian nurses found that there were some psychological barriers to use of iPhones in a workplace setting. The nurses involved in the study reported that they were concerned that using the device would be seen as unprofessional. They also feared they would be perceived as rude if they took a call or text while at a patient's bedside.

Meanwhile, a theme of the MedTech Engine report on doctors' use of WhatsApp focused on the security concerns of using the app for communicating sensitive patient data. A similar concern could be applied to the use of a personal phone for storage or sending such data, even if the app itself were deemed secure.

Conclusion

Data suggest there there is widespread use of mobile technology in healthcare, with at least 80% penetration of healthcare professionals for smartphone use at work. However, the market for medical professionals seems underserved with only 15% of current mobile health apps targeting this market. Meanwhile, there are studies indicating that the additional use of targeted mobile technology in the healthcare workplace would be effective in improving efficiency. However, such a technology, especially if rolled out on personal phones, would face some headwinds, primarily dealing with cultural assumptions about the use of personal devices at work and with the security of patient data.
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Epic Software - Capabilities

OVERVIEW
A core function of Electronic Health Records (EHR) is to provide authorized healthcare professionals, across different organizations, access to patient records to be able to provide them with the best health care. According to this source, an essential feature of EHR systems is interoperability. Interoperability refers to the ability of two systems to communicate, that is, send, receive and interpret information. In this research, we provide information of Epic software’s interoperability using its Care Everywhere program and how it achieves communication across systems.

Please find below a deep dive into this request.

EPIC’S INTEROPERABILITY
From their website, Epic claims that they have the largest interoperability network. They say they shared records of 66,049,110 patients in January 2018. Using a communication system known as MyChart, Epic users are able to message doctors, schedule in-person and e-visits, take surveys, and get involved in their health management. Their technology can also loop in community providers so they can remain up to date with their patients.
They have a MyChart FAQ that users can visit to get quick answers of how to use this interface. The page mentions a feature of MyChart known as Lucy. Lucy helps manage patient records and is the communication system that enables patients view, enter, send and request their charts. The FAQ also helps users decide on a suitable browser to use if they are assessing Lucy on desktop.
There are mobile versions of this application. There is Epic Haiku for iPhone users and Epic Rover for Android. In 2017, they also started giving developers the opportunity to build applications off their Fast Healthcare Interoperability Resources framework. Other Epic software are Bedside, Canto, EpicCare Link, and PlanLink.
EPIC’s COMMUNICATION ‘WEAKNESSES’

Despite Epic’s large customer base and the range of applications it uses to make life easier for its users. This source says 72% of Epic users said they will be unwilling to encourage friends and family to use the service. The reason, as shown by this source, is that Epic does not allow free use of its software which makes it fall short of Meaningful Use Regulations. All patients must continue to use health care organizations that subscribe to Care Everywhere system for physicians to be access their charts. This makes users feel trapped. Epic holds 25.8% of total EHR market share. Although this is the largest share, about 74.2% of the market cannot access their system.
CONCLUSION
Under the umbrella of its Care Everywhere program, Epic runs many subsystems using various applications to make the health care of its users collaborative. In January 2018 alone, the system shared the charts of almost 70 million users. Epic has versions of its software available on desktop which can be assessed through its site, they also have mobile versions of their app on iPhone and Android.

Sources
Sources