Healthcare challenges that data science helps solve

Healthcare challenges

The healthcare industry is facing rapid changes.


Key challenges healthcare is facing that data science helps solve

  • Cybersecurity
  • PriceTransparency
  • Telehealth
  • Effective Payment Model
  • Patient Experience
  • Invoicing and Payment Processing
  • Big data

Big data in healthcare

Greater amounts of healthcare data is being generated, but scattered across multiple parties and systems that include patients, payers, and providers. There’s no single source of truth that providers can use to leverage the power of data science for insights to improve practices and ultimately optimize patient's experience.

When a patient moves insurance plans or healthcare providers which occurs on mass if a large company shifts plans - most medical practices rely on patients’ self-reporting to reconstruct records. Consequently, incomplete information is often transferred and it’s extremely challenging to harness the power of data to generate accurate competitive insights.

Healthcare data comes from many sources in a variety of formats. Currently, there’s no single system or technology infrastructure to retrieve, store, and analyze data from various sources at scale.

An organizations’ analytical prowess is largely dependent on;

•      A cultural appetite for data

•      A set of transactional systems that generate data to be gathered and analyzed

•      A willingness to invest in and deploy

For healthcare organizations to successfully harness the power of big data, the leadership needs to embrace data-driven decision-making, weaving it into the fabric of the organization and culture. To leverage all the patient data from a variety of sources, healthcare organizations need to design and implement a data strategy that enables data from all relevant data sources, external and internal regardless of structure.

Augmented intelligence is the idea that a computer system supplements and supports human thinking, leaving intentionality to a human actor.  

It’s crazy to think that advertising a product or service on asocial network uses some of the most advanced AI-tech in history, while healthcare professionals making life-or-death decisions have to make do with technology decades old.

AI should be applied to where it can really make a tangible difference. Healthcare is a clear and obvious one. Data enabled business models secure the future viability of an organization and data science must become a top priority.

Cybersecurity in healthcare

Although ransomware, data breaches, and other cybersecurity concerns are nothing new to the healthcare industry, the 2020 Covid-19 pandemic revealed just how vulnerable sensitive patient health information really is.

As identified in recent breach events the software supply chain forms an immense attack surface. This massive attack surface is perhaps the biggest problem in the past, present and future of cyber defense.  It’s in the compile, build, CI/CD pipeline for developers and also in custom off the shelf packaged software (COTS) that organizations procure and use. Software procurement dangers should be understood (link to doc Product lifecycle and the procurement of off the shelf software risks and benefits) It's in the auto-updates employed by modern software.  It can infect closed operating system app stores, and various trojan horse routes.

One of the hardest parts of solving this challenge is the ability to understand and detect some of the most advanced threats that exist in software, such as tampering and implant injection. We all need a control for the criminal tradecraft, and the benefits of a code first approach provides a foundation for a better defense.

The recent growth of digital health initiatives- such as tele-health doctor visits - is a major contributor to the severe increase in breached patient records. With functions continuing to move online it’s crucial to ensure protection from outside threats.

Continuing the trend, many healthcare providers still slow to respond to threats will be even more exposed as decentralized systems make them more vulnerable to attacks.

When breaches happen, not only is confidential patient information compromised, organizations face harsh penalties if found to have violated the broad regulatory compliant standard.

Many medical providers are investing in adequate safeguards to protect patient data; implementing multi-factor authentication along with strong firewalls to reduce hacker success.

Practices are also requiring their third-party patient engagement vendors to possess industry trust certification, combining safeguards from HIPPA, COBIT, HITECH, PCI…. Compliant vendors are less susceptible to hacker’s attacks.

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Consumer adoption of Telehealth from 11% during 2019 to 46% in 2020. While the future implications of COVID-19 are still uncertain, it seems that tele-health adoption will continue to grow. In fact, 76% of consumers say they are highly or moderately likely to use tele-health in the near future. However, the Telehealth sector still faces major issues like a potential digital health bubble and an uncertain regulatory future. There are challenges to making Telehealth work and data can provide the insights for providers to make the right choices.

Invoicing and Payment Processing

Collecting patient’s payments is among the top-challenges providers face. Patients are becoming increasingly responsible for more of their medical expenses. Providers who cater to patient payment preferences encourage more on-time payments.

To improve patients experience, providers must ensure billing statements are simple to understand. Offer paperless statements and a variety of payment options online via a patient portal. Utilize preferred consumer payment technologies, such as mobile and secure application to pay. Helpful reminders whether as application messaging or email help effectively communicate with patients and encourage them to pay their bills.

For many providers it can be a challenge and costly to implement in-house invoicing and payment processing systems. Beside negotiating multiple vendor terms with each processor, and the infrastructure build (for secure payment processing, and portal access) there are cost to maintain the software and technologies. Of course, any payment portal and processing system must be fully compliant, or there’s significant risk of incurring a harsh regulatory penalty.


Price Transparency

Besides troubles submitting payment due to insufficient and desired remittance options, another key reason consumer’s failing to remit their part of the payment is confusion around actual prices that stems from poor or no price transparency. Healthcare systems are now making service pricing accessible. This reduces patient confusion and unforeseen price issues. Empowering patients in this way can benefit healthcare providers in multiple ways;  from attracting more patients to aligning and improving operations, easier more efficient medical billing, and a reduction in overall costs. Practices that don’t disclose their charges, are highly unlikely to make prospective patients shortlists as fundamental pricing comparison criteria is missing. A price list, enables a better chance of making more patients consideration when they’re choosing a provider.

Patient Experience

The medical insurance landscape has experienced some significant changes in recent years. As more patients become responsible for a larger portion of their healthcare bill, they naturally demand better services from their providers.

Healthcare organizations will face tougher competition in attracting and retaining patients who demand an experience that matches the level of customer service they expect from other consumer brands.

They demand a streamlined patient experience so they can “self-service” to resolve most questions, issues, or concerns (e.g., downloading an immunization record, booking an appointment, paying their bills, or checking their account/insurance status) whenever, wherever, and however is most convenient for them.

For healthcare organizations offering a variety of services in different locations, it’s also important for every employee to have access to the most up-to-date patient information from one centralized location. Not only will it deliver a better patient experience (who wants to tell their story from the beginning every single time?) but also help avoid fatal mishaps such as drug interactions.

To create an outstanding and streamlined user experience, providers should create a patient portal that keeps all the patient interactions in one place. It also allows all employees to access each patient’s history, which is updated in real-time from one centralized record to avoid costly mistakes.

Effective Payment Model

To manage cost and improve service quality, there’s a trend toward aligning price based on patient outcomes rather than service consumption, or use.

Collectively patients and payers are demanding evolving payment models, that encourage care providers to coordinate services and promote preventive care – from bundled payments, disbursement to patient-oriented care providers, global payments, and shared savings.

When implementing new models, monitoring the processes within the existing systems can be a challenge. Data insights help drive the use case of evolving business and payment models, that require new KPI metrics to that measure performance and quantify the ROI.

If providers are not crossing the chasm themselves keeping an eye on early adopters, testing and fine-tuning new payment models is critical to understand how best to reduce cost and improve patient outcomes.

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