Neal Singh explains why healthcare organizations are turning to this strategy

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A family physician offers three case studies in virtual primary care

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Burnout and professional satisfaction of healthcare workers are associated with subsequent changes in work effort over the following 24 months.

Findings of the new study highlighted the importance of addressing factors contributing to high stress among all healthcare workers for workforce retention and cost reduction.

Liselotte N. Dyrbye, M.D., M.H.P.E., and an investigative team explored the association of burnout and professional satisfaction with changes in work effort over two years in a large cohort of nonphysician healthcare workers. A link to a survey was administered to all employees at Mayo Clinic in October 2015 and 2017. The survey sample included healthcare workers who were nonphysician professionals, administrative office support workers, business professionals, clinical office support workers, service and support workers, and technicians and technologists. Among those who received the surveys, more than 26,000 completed both and were included in the analysis.

To collect work effort, administrative and payroll records were retrieved. On the survey were two items from the Maslach Burnout Inventory used to measure emotional exhaustion and depersonalization. Those with a high score on either item were considered to have symptoms of burnout.

The survey had one item assessing professional satisfaction. Respondents were asked, “Considering everything, how would you rate your overall satisfaction with Mayo Clinic as a whole at the present time?” using a five-point Likert scale — one indicated very dissatisfied; five indicated very satisfied.

Among participants, a majority were women (77.1%), 27.8% were 45-54 years old, most were employed less than five years (32.6%) or more than 15 years (30.9%), and 25.1% were nurses. At baseline, 21.9% of respondents had high emotional exhaustion, 9.2% had high depersonalization, and 23.8% had overall burnout. Of those who rated their baseline satisfaction, most were very satisfied (35%) or satisfied (51.1%) with the organization.

Only 8.2% of respondents reduced their work effort between 2015 and 2017. A majority of those who reduced their work effort were younger than 35 years old (42.2%), women (89.7%), and had less than five years of employment (42.4%). More than half of those who reduced their work effort were nurses. For those who reduced their work effort, the mean reduction was 21% and among nurses, the mean reduction was 18.7%.

Participants who had burnout in 2015 were more likely to reduce their work effort over two years than those without burnout (10.5% vs 6.7%). Higher frequencies of emotional exhaustion and depersonalization symptoms were associated with greater prevalence of reduction in work effort. Lower satisfaction with the organization was associated with higher prevalence of reduction in work effort.

Further research is needed to determine causal relationships among identified factors and how best to improve the work environment to mitigate burnout and decreased satisfaction.

Characterization of Nonphysician Health Care Workers’ Burnout and Subsequent Changes in Work Effort

Articles

Factors contributed to stress must be addressed in nonphysician healthcare workers.

Burnout and Satisfaction Affect Work Effort 

Health systems are rapidly adopting automation in their revenue cycle operations.

In fact, 78% of surveyed participants — nearly 400 chief financial officers and revenue cycle leaders at hospitals and health systems across the U.S. — said their health systems were currently using or in the process of implementing automation in their revenue cycle operations. That demonstrated a twelve-percentage point increase compared to the results of AKASA’s 2020 survey.

The findings highlighted automation in healthcare is critical for driving efficiency and cost-effectiveness in revenue cycle operations.

“The findings underscore that automation serves as a backbone for healthcare financial leaders looking to streamline complex staff workflows,” Malinka Walaliyadde, co-founder and chief executive officer of AKASA said in a 

. “The opportunity going forward for provider organizations is to expand their ambitions and scope for automation. Instead of identifying dozens of small, discrete use-cases and never getting past the first few due to high setup and maintenance costs, leaders should consider solutions that can be deployed rapidly with minimal disruption.”

The goal, he said, could drive giant leaps in efficiency.

Automation may provide flexibility and resiliency in healthcare operations while minimizing revenue cycle leaders’ organization’s cost to collect. Further, the survey findings showed 37% of organizations that were not currently using automation planned to do so this year or sometime in 2022.

Revenue cycle automation can increase revenue, decrease denials, speed up prior authorization and claims, and remove repetitive clicks that hinder daily operations. With robotic process automation, health systems can have more seamless execution of administrative actions, appointment management, billing and enrollment, and data management.

Machine learning, robotic process automation, and natural language processing can create a layered intelligent automation approach. Such a strategy allows healthcare leaders to layer different technologies, increasing the number of processes that can be automated.

Automation helps drive efficiency and is cost-effective.

Health Systems Rapidly Adopting Revenue Cycle Automation

Use of analytics and the electronic health record (EHR) helps provide COVID-19 vaccine outreach to marginalized populations.

The findings demonstrated potential benefits of an analytics-based strategy to reach marginalized patients at high risk for exclusion from electronic outreach.

Jacob Stein, M.D., M.P.H., and a team of investigators from University of North Carolina at Chapel Hill used analytics to identify and contact patients who could benefit from targeted nonelectronic communication about the COVID-19 vaccine. The team used the EHR to find patients who received cancer therapy during the past year with follow-up scheduled, without an active patient portal account, no valid email on file, or who lived in a county with a more than 20% poverty rate across several census points.

Four nurses made scripted, informational telephone calls to each patient to give them education about the eligibility, safety, and logistics of the vaccination. The goal was to aid patients in making informed decisions about the vaccination, address identified barriers to the vaccination, and respond to patients’ questions or concerns.

Overall, 536 potentially marginalized UNC patients eligible for the COVID-19 vaccine were identified. Among the patients, 61% were non-Hispanic White and 32% were Black, while 14% were from counties with persistent poverty. Almost all patients were called and 67% were successfully reached and 9% receiving voicemails. Three-quarters of the Black patients were reached and 93% of patients from counties with high levels of poverty were contacted.

The mean duration of phone calls was slightly more than four minutes. Since the second day of April, 26% of contacted patients were confirmed to have received vaccination via EHR review or self-report. Another 4% scheduled a vaccination appointment at UNC.

The team’s targeted outreach helped identify and connect patients who do not regularly use electronic communication and whose community networks could have been disrupted by the isolation of the COVID-19 pandemic. Based on qualitative feedback from patients, the calls aided them in their decision to receive the vaccination. The calls also helped identify patients with unmet clinical or social needs.

“While not the intended goal of this project, and thus not consistently tracked, mitigating barriers became an integral part of this effort and may have yielded positive patient experiences and increased the ability for patients to become vaccinated,” the investigators concluded.

Use of an Analytics and Electronic Health Record-Based Approach for Targeted COVID-19 Vaccine Outreach to Marginalized Populations

Issuing phone calls to marginalized patients increases COVID-19 vaccination likelihood.

Phone Calls to Marginalized Patients Increase Likelihood of COVID-19 Vaccine

A plan has been developed to begin offering COVID-19 booster shots for all Americans beginning the week of September 20, according to public health and medical experts from the U.S. Department of Health and Human Services (HHS).

Booster shots will be available following the FDA’s independent evaluation and determination of the safety and effectiveness of a third dose of the Pfizer and Moderna mRNA vaccines. Further, the CDC’s Advisory Committee on Immunization Practices will issue booster dose recommendations based on a thorough review of the FDA’s evidence.

Come fall, those who were fully vaccinated earliest in the vaccination rollout, such as healthcare providers, nursing home residents, and senior citizens, will likely be eligible for a booster. Booster shots will also be given directly to residents of long-term care facilities as there is an increased risk that COVID-19 poses to that population.

It is also anticipated that booster shots will be needed for individuals who received the Johnson & Johnson vaccine. The team of experts expects more data on the vaccine in the next few weeks as its rollout did not begin in the U.S. until March 2021. Additional data will help experts keep the public informed with a timely plan for such booster shots.

“Our top priority remains staying ahead of the virus and protecting the American people from COVID-19 with safe, effective, and long-lasting vaccines especially in the context of a constantly changing virus and epidemiologic landscape,” experts 

. “We will continue to follow the science on a daily basis, and we are prepared to modify this plan should new data emerge that requires it.”

As the Delta variant continues to circulate, the COVID-19 vaccines authorized in the U.S. have been very effective in reducing risk of severe disease, hospitalization, and death. Available data demonstrate protection against SARS-CoV-2 infection begins to decrease over time following the initial doses of vaccination. And due to the Delta variant, experts see evidence of reduced protection against mild and moderate disease. Protection against severe disease, hospitalization, and death could diminish in the coming months.

“For that reason, we conclude that a booster shot will be needed to maximize vaccine-induced protection and prolong its durability,” experts said.

COVID-19 booster shots will become available this fall.

COVID-19 Booster Shots Will Be Available in Fall

Since COVID-19, patients have higher expectations for their physicians, according to the findings of a recent survey conducted by SymphonyRM.

What’s more, 23% of survey respondents said their opinion of their physician changed since the onset of the pandemic, and nearly 20% were considering changing their physician based on how they handled COVID-19. And the top reason patients lost confidence in their healthcare professional during the pandemic was infrequent communication about COVID-19.

“Our research found that, although many health systems and doctors rose to the challenge of connecting patients with the information they needed about their health and the virus, many Americans were left behind and did not receive the same level of communication and engagement,” Michael Linnert, chief executive officer of SymphonyRM, said in a 

. “These findings reveal what we at SymphonyRM have long known: People want doctors to send more consistent and actionable information about their health, such as preventive screenings and proactive health tips. The pandemic appears to have confirmed people’s expectations.”

It appeared as though organizations had difficulty communicating and connecting with patients to provide reliable information when the need was significant. Results of the survey determined only 49% of Americans received general information about COVID-19 from their physician and just 35% received communication about the vaccine.

Patients wanted to receive health-related information outside of office visits. The findings highlighted that 42% of respondents wanted general health and wellness tips and 41% wanted scheduling options for preventive screenings. Some 40% of patients wanted to know about appointment availability, while 37% were interested in updates about the COVID-19 vaccine.

And patients of all ages wanted more proactive communication. Based on the survey, 51% of patients aged 45-54 years old said they wanted better communication with their physicians and 49% of those aged 18-24 years old agreed.

Patients reported they received more communications from their favorite retail brand than engagement messages from their physician. There are plenty of data healthcare workers can leverage to interact with patients, but this is not seen as frequently in the space as it is in retail.

“Doctors and health systems can learn strategies from consumer-facing brands for engaging consumers and driving action,” Linnert said. “Those just starting out on their patient engagement journey, or even those that are further along, can look at brands like Amazon to identify tactics to which today’s healthcare consumers will respond.”

Without healthcare teams being proactive, 43% of patients missed a preventive care appointment during the past year despite 71% saying they would likely schedule such an appointment if prompted by their physician.

There are heightened expectations since COVID-19 struck. Patients want digital appointment scheduling (58%), proactive communication (57%), and virtual appointments (54%).

The survey, which was conducted online in May 2021, included responses from a broad distribution of more than 1,100 consumers in the U.S. It can be found 

Physicians must embrace the digital era of healthcare to improve the patient experience.

Patients Have Higher Expectations Since COVID-19

The use of ICD codes is a poor proxy measure for the number of skin cancers per patient, according to a recent study.

The findings supported the use of CPT codes for estimating incidence of skin cancer and as a base for using electronic health record (EHR) data to estimate numbers of skin cancers per patient.

Nimay Anand, B.A., and a team of investigators assessed whether standard diagnostic and procedural codes presented in EHRs at a single healthcare system were a valid proxy for estimating the number of overall skin cancers. They conducted a retrospective cohort study of patients seen between July 2008 and June 2018. Patients were included if they had at least one EHR-based diagnostic or procedural code for any skin cancer and at least one pathology report of a skin cancer.

The team separated their sample into three groups based on the presence of CPT codes and pathology records. The first group was composed of internal patients who had more than one CPT code and more than one pathology report of skin cancer. The second group comprised outside patients whose pathology was read at Vanderbilt University Medical Center (VUMC) and who would have more than one pathology report, more than one ICD code, but zero CPT codes relating to skin cancer. Group three contained outside patients referred to VUMC for Mohs surgery or subspecialty oncology management with more than one ICD code and more than one CPT code. Investigators focused on group one.

There were 5,688 patients in the first group with at least one CPT code and at least one confirmed skin cancer. The investigators found a strong linear correlation between the number of pathology records and the number of CPT codes (r = .87). Conversely, the total number of ICD codes was poorly correlated with the records (r = .22). For patients with records but no CPT codes, there was a very poor correlation between ICD codes and the pathology records (r = .06).

CPT codes accounted for more than 75% of the variability in the number of skin cancers and were a better measure for the total number of skin cancers per patient.

A subset of patients had a marginally stronger correlation between CPT codes and confirmed skin cancers. There was a mean difference between the number of CPT codes and the number of pathology records of -1.06.

Among 100 patients with CPT codes and no reports selected randomly for EHR review, the correlation between the number of histologically verified skin cancers from outside pathology and the number of CPT codes for unique lesions was near perfect.

Findings suggested the method was an adequate proxy for the number of skin cancer per patient.

Validity of Using Billing Codes From Electronic Health Records to Estimate Skin Cancer Counts

Investigators compare ICD and CPT codes for estimating the incidence of skin cancer.

CPT Codes Help Estimate Incidence of Skin Cancer

 podcast, we are joined via Zoom by Duane Schielke, executive director of the Alliance for Integrated Care of New York, LLC. Schielke also serves as the executive vice president of health management initiatives at Cerebral Palsy Associations of New York State. We discuss health data, innovations, and more.

Podcasts

On this episode of Data Book, CHE speaks with Duane Schielke about health data and innovations.

Podcast: Health Data and Innovations with Duane Schielke

Sharon Carothers is the Managing Director of SensisHealth and has worked on marketing initiatives for the Truth Initiative, the Centers for Disease Control and Prevention, the Food and Drug Administration, and the Department of Health and Human Services.

Hieu Nguyen is the Jr. Account Executive at SensisHealth and has worked on campaigns for United States Department of Agriculture, the Department of Health and Human Services, and Centers for Disease Control and Prevention.

Perhaps the most brutal impact of COVID-19 is its enduring effects on certain patients. According to research published in the 

Journal of the American Medical Association

, approximately 10% of COVID-19 patients have long-term symptoms of the virus. Described as “long-haulers,” these individuals are patients who have experienced the virus’ symptoms — from fatigue to loss of smell — for more than four weeks after they’ve been diagnosed with the virus.

Researchers are just beginning to understand the 

, and it is still unclear how long these symptoms will last for some patients. With so much mystery and uncertainty surrounding the virus, medical professionals need deeper and more expansive data. Thus, some are turning to patient-reported outcome (PRO) data, which provide a more holistic picture of long-term COVID-19 symptoms.

Patient-reported outcomes are self-assessed, health condition status reports conducted by a patient without the interpretation of the patient’s response(s) by a clinician or anyone else. They allow assessment of patient-reported health status for physical, mental, and social well-being. Collecting high-quality PROs is vital to understanding the complex needs of a patient. Some of the benefits of using PROs include:

Tracking of outcomes, health, and well-being longitudinally

Supporting and improving shared decision-making

Identifying patients for registry-based research studies and clinical trials

Like in many other areas of healthcare, there have been efforts to digitize the collection of these important data. In 2018, the LA-based advertising firm Sensis helped launch the Step Up App Challenge, sponsored by the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services, to help health professionals better access patient-reported outcome data.

 called upon participants to develop a user-friendly application that simplifies the process of collecting, interpreting, aggregating, and sharing patient-reported outcomes data related to health outcomes in the ambulatory care setting, such as a medical office, a dialysis center, or a hospital outpatient department.

The winning app was PRISM — Patient Reported and Insight System from Minnesota. This application was designed to enhance the quality of clinical discussion between healthcare providers and patients, allowing for continued patient engagement beyond the clinical setting. The application builds on the successful use of paper-based PROMIS (Patient-Reported Outcomes Measurement System) measures at the HealthEast Kidney Stone Institute but enables patients to use a convenient mobile app, instead of paper.

More innovation efforts like PRISM are needed to expand the collection of health data. The ability of mobile applications to provide a safe and quick way for patients to report symptoms is especially key during pandemic times. PRO data can be better leveraged in the ongoing fight against the COVID-19 pandemic to deepen our understanding of the longevity of the long-term symptoms of the virus. As the pandemic endures, and new variants emerge, we need a more holistic and comprehensive approach to understanding this complex and often fatal virus.

More innovation efforts are needed to expand the collection of health data.

Accessing More Holistic Health Data Is Vital for Understanding COVID-19

Two out of three Americans have missed getting recommended cancer screenings during the pandemic, and more than half omitted or delayed routine care, a 

 recently found. These gaps in care likely will increase individuals’ risk for serious health issues—a scenario that could put intense pressure on specialty care access, especially in areas that were underserved prior to the pandemic.

Warnings about the impact of gaps in essential care began not long after COVID-19 emerged in the United States, when it was clear that Americans were postponing needed care out of fear of contracting the coronavirus. By June 2020, four out of 10 adults had avoided care due to COVID-19 concerns, according to a CDC survey. These numbers were even higher among unpaid caregivers, people with underlying medical conditions, Black adults, Hispanic adults, young adults, and persons with disabilities.

Now, recent data are beginning to reveal the health impact of gaps in essential care for people with chronic and complex conditions:

 found diabetes and hypertension outcomes have worsened among adults in the Salt Lake City area—particularly older adults—even as options for accessing telehealth have expanded.

Last year, more people than expected died from causes unrelated to COVID-19, and some of these deaths are likely due to disruptions in access to care or utilization, 

Rates of anxiety and depression are climbing, and experts fear this could have a 

profound impact on chronic care management

In specialties like pulmonology, otolaryngology and cardiology, patient visits 

still lag far below pre-pandemic baselines

Unless healthcare providers prepare for an eventual onslaught of patients with complex conditions and advanced illness, they could struggle to manage a sudden surge in demand. Such a scenario would put patient access, engagement and outcomes at risk.

How can healthcare leaders prepare for heightened demand while also engaging hard-to-reach populations that most need help? In the months ahead, efforts to increase access and build trust among those most vulnerable will be crucial. Here are three action steps to consider.

Partner with employers to close gaps in essential care

 say they will ramp up the move toward value-based care models over the next three years. In this environment, healthcare providers will be distinguished in part by their ability to:

Match members with the expert best suited to review their case—not just locally

Perform behind-the-scenes work ahead of the appointment—from collecting medical records to coordinating lab samples, imaging and more—to optimally support medical decision making

Engage patients directly in a thorough review of their diagnosis and treatment plan

During the pandemic, four out of 10 Black and Hispanic adults in every age group are likely to have missed or canceled health appointments, and women in these demographics are most likely to have missed a mammogram, pap smear or HPV test. Working with employers to determine which employees and dependents missed needed care and screenings during the pandemic and encourage them to come back for care is a vital step toward closing gaps in care that could put members’ lives at risk. It’s an effort that could improve health outcomes by pairing members with the right care—including specialty care—at the right time. It also helps distribute demand for specialty care more evenly and strengthens providers’ bottom line.

Teach populations most at risk how to navigate digital paths to care

. The key to a return to pre-pandemic specialty volumes is gaining patients’ trust. An 

 found that while 57% of respondents had a medical condition that required immediate attention in July 2020, 60% had not tried a virtual visit, in part because they were concerned about the quality of care or the privacy of an online visit. They also stated that they did not know enough about virtual visits and believed telehealth visits were too impersonal.

more specialty providers are engaging in telehealth visits

. Some consumers face challenges with broadband connectivity or availability of devices that support video interactions. Others aren’t sure how to set up a virtual visit with their physician or whether they have the tools to engage in a virtual encounter.

That’s why reaching out to populations most at risk and providing the tools and support needed to access virtual care—including specialty care—is so critical. One way to do so is by partnering with health plans and employers to determine which members could most benefit from virtual care to close essential gaps in care. From there, leaders should identify options for pairing members with the technology to access virtual care and providing one-to-one education on how to use it. Community service organizations—including those that meet social determinants of heath needs, from meal services to transportation—also could be a vital link in reaching individuals who could most benefit from telehealth.

. If individuals most in need of care are hesitant to seek it due to lack of trust, ensuring that they have fast access to experts who can answer their questions and provide appropriate guidance is crucial. In 2021 and beyond, the ability to close essential gaps in care demands that providers have the tools and workflows to make it easy to speed access to care—including specialty care—for those who most need it. They must also be willing to honor patients’ desire for a second opinion when life-altering diagnoses are made—a scenario that could increase in the months ahead, given the tendency to delay needed care and recommended screenings.

The chances of being misdiagnosed are especially high for people with complex medical conditions: 20% of people with serious illnesses are misdiagnosed

 found. When patients who have questions about their diagnosis are connected with a provider who specializes in their condition, the level of precision increases and is essential to providing reliable care. It is also key to ensuring speed to insight and gaining patients’ trust.

Research by The Clinic by Cleveland Clinic indicates that when patients receive a second opinion for life-altering diagnoses, such as cancer, 28% of patients who seek a second opinion receive a change in diagnosis. When treatment plans are reviewed by an expert, 72% of treatment plans are modified after analysis.

As the MGMA survey indicates, securing the trust of people most at risk for developing complex conditions during the pandemic is vital to providing the care individuals need. It also is an important step toward mitigating sudden surges in demand that could compromise timely access to care. Efforts to meet individuals where they are, educate them on the most efficient ways to seek care and provide fast access to the medical insight they need are three great places to start.

Data are revealing the health impacts of gaps in essential care for those with chronic conditions. Technology can be used to leverage a response.

Will Delayed Care Ramp Up Demand for Specialists? Key Trends to Watch

Healthcare systems and nursing workforces across the United States are already suffering the effects of a nursing shortage, but data suggest the worst is yet to come.

As the baby boomer generation ages and their healthcare needs grow, and nursing colleges struggle to meet demand, both current and projected nursing shortages will only intensify. A projection reported in the 

United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit

, published in the May/June 2018 issue of the 

, says the nursing shortage will spread across the nation and reach more than 500,000 by 2030. The same analysis projected that the South and West will be hit hardest by the shortage, a prediction already borne out in states like Missouri and Florida.

2018 National Sample Survey of Registered Nurses

, the average age of a registered nurse is 50 years old. As nurses approach retirement, the healthcare sector faces a large wave of retirees over the next 15 years. More than 1 million registered nurses will leave the workforce by 2030, according to a 2019 

Low nursing school enrollment rates–due to a lack of nursing school faculty–may fail to replace the ranks of retiring nurses, leaving healthcare systems with staffing shortfalls. The American Association of Colleges of Nursing’s report on 

2019-2020 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing

 revealed that U.S. nursing schools rejected 80,407 applicants from baccalaureate and graduate nursing programs in 2019 due to shortages of faculty members, clinical sites, classroom space, and clinical preceptors. Lackluster enrollment rates may result in the failure to keep pace with the shifting demographics of the nursing workforce.

“The number of nurses leaving the workforce each year has been growing steadily from around 40,000 in 2010 to nearly 80,000 by 2020. Meanwhile, the dramatic growth in nursing school enrollment over the last 15 years has begun to level off,” said healthcare economist David Auerbach in a 2015 report published by 

An aging population and growing demand for healthcare services will only exacerbate the current nursing shortage. According to a 2017 report by the 

, the number of US residents that will be 65 or older by 2030 is projected to be 82 million. This number indicates there will be an increased need for geriatric care, with an emphasis on care for individuals with chronic diseases and comorbidities, as the population ages. 

 found that the prevalence of multimorbidity in adults aged 65 or older in the United States between the period of 2005 and 2012 was 67%.

As older nurses retire and younger nurses trickle in from baccalaureate and graduate nursing programs, whether the workforce will be able to meet the increased demands of healthcare is questionable.

The lack of staffing is already having substantial impacts on nurses across the country, as they experience more stress and burnout, report lower rates of job satisfaction, and consider leaving the profession. Nurses are stretched thin, proven by data reported by 

 that there are currently only 12 nurses per every 1000 people in the United States. Some states are experiencing more dire consequences than others.

Amid the COVID-19 pandemic and recent surge in cases driven by the delta variant, nurses in Florida are being hit hard by staff shortages, where they have the 

 for COVID-19 of any state. Nurses are experiencing burnout due to stressors associated with the 

Many organizations are offering enormous pay raises to nurses to stay afloat during shortages, some upwards of $70 per hour.

“Because there’s been a demand for nurses, we’re all getting offers from agencies from around the country, from different hospitals in South Florida and throughout Florida with offers for double, sometimes triple your salary,” Betsy Marville, nurse organizer with the 1199 SEIU United Healthcare Workers East in Florida, 

. “They are limited, but since the offers keep coming, you can stay pretty well employed.”

This can result in a mismatch between the number of available nurses and where they are most needed as the pandemic enters a dangerous new phase. In Mississippi, which has one of the nation’s lowest vaccination rates, the state medical school made plans to 

 in a parking garage as it ran out of hospital space. Meanwhile, state officials said there were 

 in the state than there were a year ago.

Despite promises of pay raises and safer conditions, many nurses are more likely to retire early rather than be subject to workplaces with high rates of infection from COVID-19, Marville said.

“Starting with their own full-time employees–instead of trying to lure temporary staff with high but short term pay–healthcare facilities need to provide better wages and benefits, including hazard pay, and to provide a level of staffing that is sufficient and safe for caregivers and patients. We also need elected leaders to who will take public health seriously and who will invest in the people who care for everyone else. Nurses are the backbone of care in hospitals, and we need to be protected, paid fairly and have a place in the decision-making that will ensure quality care and avoid crises like this. Our union is fighting for all of this on behalf of patients, caregivers and our communities.”

Hospitals in the Midwest are facing the consequences of staff shortages, as well. In Missouri, only one county out of 114 counties reported having enough healthcare personnel to serve its community, as reported by 

 live in areas where there is an established nursing shortage.

, conducted in 2020, that surveyed about 136,000 registered nurses in Missouri found that rural areas have about 40% less nurses than metropolitan areas. A lack of employment opportunities and smaller pay in rural areas contribute to the disparity seen among different demographic areas.

The same study also revealed that 31% of all nurses in Missouri are older than 54, suggesting that the state’s workforce might take a hit as nurses approach retirement.

Many states are implementing initiatives to address and mitigate the consequences of the nursing shortages. The University of Wisconsin announced in 2013 the Nurses for Wisconsin initiative, for instance, a program that has provided $3.2 million worth of fellowships and loan forgiveness to incoming nurse faculty who plan to teach in the state after graduation.

Similarly, the University of Minnesota partnered with the Minnesota VA Health Care System in June 2013 with the intent to increase enrollment in the school’s nursing baccalaureate program. The VA provided $5.3 million towards the program to expand clinical placement sites, fund additional faculty, and support interprofessional engagement, with an emphasis on veteran care.

Some nurses are confident they’ll find relief and comfort amid the nursing shortages as more people get vaccinated and are urging their communities to do so.

“I encourage our community, especially our community in Broward County and Miami-Dade County–we need everyone to get vaccinated,” said Juana Mejia, manager of Memorial Hospital Miramar’s COVID intensive care unit. “Not only for you. We want to save you, and we want you to save us.”

Pandemic fuels burnout, stress, and thoughts of leaving the workforce.

Nurses, Hospital Systems Stretched Thin Amid Ongoing National Nursing Shortage

On this week's episode of Data Book, Chief Healthcare Executive™ spoke with Punit Soni, CEO and founder of Suki, an artificial intelligence (AI) platform that streamlines administrative work for providers as a means to reduce burnout. We discussed how this tool helps reduce burnout among healthcare professionals and how this technology can be used in a post-pandemic world. We also talked about some of the misconceptions about how AI can be used in healthcare and the role that it should serve.

Punit Soni, CEO and founder of Suki, delves into how artificial intelligence (AI) can be used to address burnout among healthcare professionals, as well as misconceptions about the purpose that this technology should serve in healthcare.

Podcast: Addressing Provider Burnout and Work Overload: What is the True Purpose of AI in Healthcare?

Wearable devices show promise for monitoring the heart rate and sleep of patients in hospitals, according to the findings of a recent systematic review.

Older patients are frailer after hospitalization and have a high chance of readmission. Low activity and poor sleep during hospital stays could lead to such instances of readmission. Continuously monitoring those items by using wearables could reduce the prevalence.

Vikas Patel, B.M.Sc., M.D., and a team of Toronto-based investigators conducted a systematic review to evaluate the validity and utility of wearable devices for monitoring hospitalized patients. They identified articles on three main concepts: wearables, monitoring, and inpatients.

Databases were searched and articles were screened by two reviewers. Eligible studies included medical or surgical patients at least 18 years old, wearable devices (watch, vest, pendant, jewelry, headset, and wristband), described an element of continuous monitoring for at least 24 hours, and described the measurement of at least one digital biomarker other than just physical activity or standard hospital telemetry for heart rate recording.

The two reviewers extracted data such as year of publication, study setting and design, number of participants, gender ratio, mean age of participants, digital biomarkers measured, average and maximum duration the wearable was worn, and patient completion rate. Additional information included the types of wearables worn — medical grade (approved or cleared by the FDA), research grade (used typically in research settings), and consumer grade (used generally by consumers), and the placement sites on the body.

Overall, 14 studies were included in the systematic review. Of them, nine different types of commercial wearables were described, and seven different health variables were assessed. The mean patient completion rate was more than 90%.

There were five studies that assessed heart rate accuracy. A wearable sensor accurately detected tachycardia with a sensitivity of 90% and specificity of 97%. In another study, Fitbit-derived heart rate values were slightly lower than those from continuous electrocardiography monitoring, but a majority were within five beats per minute.

Six studies used wearables to assess sleep. Two assessed whether wearable readings were reliable. Findings of one study demonstrated self-reported sleep correlated with the actigraphy-recorded number of awakenings. Another study’s findings revealed a moderate correlation between wearable-derived sleep duration and questionnaire-derived sleep quality.

Three articles gave insight into wearables’ accuracy at measuring the respiratory rate of patients. In one, it was reported there was a strong correlation between wearable and manual respiratory rate readings.

Investigators found evidence to support the use of Fitbit, ViSi Mobile, and the HealthPatch to measure heart rate because both were validated against intermittent and continuous reference standards. Many devices were not validated in inpatient settings, and readings from most that were validated in such settings had wide limits of agreement.

The team suggested future research to determine the accuracy of the digital biomarkers of hospitalized patients and to learn if wearables improve the health outcomes of hospitalized patients.

Evaluating the Validity and Utility of Wearable Technology for Continuously Monitoring Patients in a Hospital Setting: Systematic Review

A systematic review reveals wearable devices can measure biomarkers of patients in hospitals.

Wearable Devices Show Promise for Heart Rate, Sleep of Hospitalized Patients

Jay Eisenstock is a seasoned consultant, speaker, contract negotiator and management professional with more than 30 years of recognized experience in healthcare and technology.

 became effective on January 1, 2021, with the intent of allowing consumers to shop and compare prices across hospitals. The rule requires hospitals to publicly display their standard charges for at least 300 procedures including their negotiated rates with health plans and the discounted price the hospital is willing to accept from a patient if paid directly.

The idea is noble. The execution is complicated.

Much has been written about how hospitals have employed techniques preventing consumers from effectively locating pricing information such as intentionally 

 from showing pages with price lists, burying the pages so deep into their websites that consumers simply give up trying to locate the information, and even misdirecting consumers to other irrelevant pricing data.

Our existing medical culture neither endorses nor supports price shopping. As much as patients are (rightly) concerned about the cost of their healthcare, especially their out-of-pocket expenses, there are other compelling factors that affect their treatment choices. When a doctor recommends a specific procedure and facility, most people will follow that advice. In addition, a lower cost facility may not be in the network of the patient’s health plan, or the recommended physician may not have privileges at that facility.

Seeking healthcare is unlike shopping for other consumer goods and services. That said, one similarity is the shifting nature of published prices. Auto dealerships notoriously advertise they will sell you a car at their invoice price. But car invoices are often massaged. The same can be said for prices published to comply with the transparency rule. The published prices may not truly reflect the total costs associated with a given procedure. To be fair medical services, especially hospital-based procedures, can have many variables and therefore be difficult to price ahead of the services being performed.

That’s not to say price transparency can’t be an important tool for consumers. Pricing of healthcare services has long been a black box consisting of negotiated rates, hospital specific charges for health plans and patients, and various other fees. A typical hospital bill is undecipherable to most consumers. With the prevalence of high-deductible health plans, consumers desire to be more cost savvy. Any cost basis can at least help consumers understand what they could expect to pay and provide guidance should they wish to have a financial discussion with their hospital. As pricing discrepancies amongst hospitals become exposed, increased competition may become a reality.

Our existing medical culture neither endorses nor supports price shopping. 

The Opaqueness of Price Transparency

Google is dismantling its health division as its vice president, David Feinberg, M.D., leaves to become the chief executive officer and president of electronic health records (EHRs) company Cerner in October.

Google Health was formed in 2018 to organize Google’s health efforts. It developed technology solutions to enable care teams to deliver better, faster, and more connected care. The team worked on products and features to empower people to be healthier with the information, assistance, and connections to act on their health.

 Google Health was downsizing and moving employees to Fitbit as part of a reorganization strategy. More than 130 employees within the division were moved, leaving about 570 employees on the health team.

During Feinberg’s tenure with Google Health, the division helped build contact tracing software for the COVID-19 pandemic. But the software has not performed as well as was expected. Feinberg also worked with Google’s YouTube to ensure it provided more accurate information for physicians and other care givers. Over the past year, the division expanded Care Studio, built with Ascension, to help physicians better navigate EHRs.

The projects and teams that comprise Google Health will spread across different parts of Google. The clinician team building a tool for physicians to more easily search health records, will report to Feinberg’s boss, Jeff Dean, the head of Google’s research division. The health-AI group working on projects like medical imaging will report to Yossi Matias, vice president of search and AI.

“Google deeply believes in the power of technology to improve health and wellness and we have increased our health investments across the company,” a Google spokesperson told 

 “This has included developing projects within Google Health, launching and expanding health-related features on Search, Maps, and YouTube that reach billions of people, and welcoming Fitbit.”

Google Health will spread across different divisions of Google.

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