By Joe Nicholson, DO
Nostradamus predicted that 2021 will be the Year of the Zombie Apocalypse. At least, that is the belief of some who claim the French physician-turned-mystic also foretold COVID-19. Cause for alarm?
With no disrespect to the esteemed Mr. Nostradamus, it is probably safe to say we do not need to stock up on anti-zombie gear. Whether or not he divined the COVID-19 “plague,” there is no denying that the pandemic has fundamentally changed healthcare forever.
For this reason, health information management (HIM) professionals may want to consider the following four trends that promise to materially impact healthcare in 2021 and beyond:
- Incorporating social determinants of health (SDOH)
- Mainstreaming artificial intelligence (AI) and machine learning (ML) capabilities
- Grappling with the exponential growth of telemedicine
- Facing increases in patient acuity
SDOH: Spotlight on Nontraditional Data
COVID-19 has renewed the focus on long-standing disparities within the US healthcare system. There also is a growing body of peer-reviewed evidence that factors other than clinical care can affect more than 80 percent of health outcomes. These SDOH factors include financial and food insecurity, education and home, and social environments, including access to healthcare.
Nonclinical health and wellness factors can be complex and multifaceted. There is no “silver bullet” solution. However, with a connected view into each patient’s SDOH, providers can start to address disparities and provide more patient-centric, whole-person care.
Going forward, this will require providers to use multiple sources of data to pinpoint which patients are at risk for poor outcomes and which interventions they need. Healthcare organizations will need to increase their ability to exchange SDOH information with “nontraditional” data sources, such as community food banks, shelters, and other safety net organizations.
HIM professionals will be increasingly tasked with developing strategies to securely and appropriately integrate structured, unstructured, and external data to create more holistic patient views. Layering consumer data over existing healthcare data, for example, may help capture information about education, income, transportation, and other SDOH absent in traditional healthcare data.
As a first step, HIM professionals may want to evaluate how well their organizations assign ICD-10-CM “Z” codes. The Z codes identify nonmedical SDOH that may influence patients’ health status, but their adoption has been limited. Recent guidance from the American Hospital Association attempts to clarify documentation criteria, so the use of these codes may be worth a fresh look for HIM departments in 2021.
Algorithms: Time for a Performance Check
Although ML and AI are not new trends in healthcare, 2021 may be a “refinement” year. The days of applauding the mere implementation of ML and AI tools may be behind us. Instead, we should anticipate even further acceleration of ML and AI to inform health-related algorithms to dramatically enhance their precision and performance outputs.
ML and AI tend to surface fears of job replacement among some coders and clinical documentation integrity (CDI) specialists. In reality, these tools would augment the skill sets and expertise of these professionals. As ML and AI crests the hype cycle in the years ahead, HIM professionals will need to pair their depth of knowledge with an expanded skill set in data analysis. HIM teams also will play an essential role in defining the privacy and information management practices necessary for these tools to work effectively.
HIM professionals will have to re-think how inherently biased algorithms work. Here is an example: Claims data reflects only part of any given patient population—the part that has health insurance and access to care. Consequently, algorithms using claims data to predict population risk are inherently flawed. They can never deliver an accurate risk assessment because they lack visibility into those patients without health insurance or access to care—in other words, patients at the most significant risk for poor health outcomes.
Healthcare organizations have only just touched the tip of the ML and AI iceberg. Data is rapidly becoming more valuable than gold, growing into a key resource for driving operational, financial, and clinical decisions. Still, it is not the answer to all healthcare challenges.
The worthiest use-case for data is when it supports true human-to-human engagement. In healthcare, data is important—but the human touch is indispensable.
Telemedicine: No Going Back
The power of telemedicine uncorked in 2020 cannot be recorked. The elephant in the room is how quickly the Centers for Medicare and Medicaid Services and other payers will change their telemedicine payment parameters once the COVID-19 public health emergency ends. However, there are few who debate that it will—and should—remain a paid benefit destined to continue expanding care access in 2021 and beyond.
Some services will always entail an in-person visit, of course, but a lot of primary care can happen in the virtual space. Thus, telemedicine’s ability to extend healthcare’s reach—especially into underserved communities—holds great value. Likewise, we may finally see wearables gain real traction in 2021 as a valuable care management tool, rather than just a novelty.
Capitalizing on these advantages will require data managers to be flexible and adapt quickly as rules and technologies change. Furthermore, HIM professionals will need to take a closer look at ensuring both HIPAA compliance and accurate documentation in the virtual environment—crucial factors in the reimbursement, compliance, and care delivery functions.
After the fast-paced, groundbreaking experiences of 2020, the next 12 months should provide a welcome opportunity to evaluate what went well, what did not, and how to best move forward with telemedicine and wearables.
Across the board, HIM professionals should expect to see an uptick in requests to incorporate real-time data from telehealth applications, wearables, and other external sources into a usable, secure, and compliant patient record.
Patient Acuity: Expect a Post-Pandemic Rise
Healthcare organizations may be open for care, but patients nervous about potential coronavirus exposure are still delaying preventive and acute services. Care for mental health conditions may be lagging as well, despite a growing public appreciation for the role of mental health in overall wellness.
It is very likely we will see data emerge in 2021 that reflects this preventive care crash. The mental health stresses of 2020 combined with unaddressed gaps in physical care mean more patients will present with higher-acuity physical and mental health conditions—such as late-stage cancer diagnoses combined with associated depression and anxiety disorders. HIM professionals may start to see expanded requests to shore up data sharing capabilities between historically siloed mental and physical healthcare settings.
Accurately capturing data to support higher-complexity services also will be essential in the coming months. It will be necessary to help ensure accurate reimbursement and to safeguard against potential audit findings—always important, but especially so given the revenue hits experienced in 2020. It will be interesting to see if any spikes in higher-level diagnostic and procedure coding trigger a corresponding rise in payer audits in 2021.
New Era, New Opportunities
This is an unusual and exciting time in healthcare. The pandemic has forever changed the course of care in the US. In the face of so much death and misery, we have been afforded a rare opportunity to truly change public health in this country. If we seize the momentum, we will have new opportunities in the years to come to deliver higher quality care at a more affordable price for patients everywhere.
Take a deeper dive on the tools and technologies in this article:
Joe Nicholson (Joe.Nicholson@CareAllies.com) is a board-certified physician and chief medical officer of CareAllies, a subsidiary of Cigna.Leave a comment