By: Ronda Polansky, MS, CCC-SLP, TSHA Business Management Committee Co-Chair

This four-part series will discuss the vulnerability of healthcare, insurance contracts, data collection, government contacts, and contract negotiation.

Henry David Thoreau's prophetic statement in Walden (1854), “Men have become the tools of their tools,” has come to be completely realized in the 21st century, specifically concerning human interface with information technology.

Healthcare has become a popular target for cybercriminals. In fact, according to Check Point Research (CPR), healthcare organizations experienced 1,426 attacks per week in 2022, which was a 60% increase over 2021. In many cases, cyberattacks against healthcare organizations carried a high cost to the victims, and healthcare organizations continue to have the highest data breach of any industry. According to the Cost of a Data Breach Report, the cost is averaging $10.10 million per incident.

In February 2024, Change Healthcare, a widely used clearing house, became the victim of a cyberattack. Smaller medical practices closed their doors all across the nation, and most providers went months without the ability to bill their claims. Some were forced to revert to paper claims, which some payors did not even know how to process. This crisis has uncovered a critical weakness. This clearing house was a critical infrastructure, serving more than 50% of the claims billed out in the U.S. Change’s revenues were documented as $3.4 billion in 2021. The Change Healthcare attack was “unprecedented” in terms of how widespread its impact was on practices both big and small, causing a near healthcare system collapse and bringing it to a complete halt. The hackers succeeded with their negotiations at a price of $22 million, followed immediately by a second breach/hack of the system collecting military data within two months of the first one. This was a direct threat to our country that was being explored by the White House, Health and Human Services, and the FBI. This coordination, while essential, unfortunately added to the complexity and timeline of the recovery process for the many who were affected and some who still are.

Healthcare organizations are vulnerable, with the focus of the cybercriminals influenced by a few different factors, including:

• The expanding attack surfaces resulting from the digitization of the world. In 2022, more than 90% of people in high-income countries were online, compared to 26% in low-income countries
• An expanding IT security talent yet at the same time there are IT staff shortages. The staffing shortages brought on by COVID-19 and the Great Resignation are still affecting companies today
• The volume and the value of the sensitive data available in healthcare across the board
• A large user base of interconnected medical locations across the country
• There is a high likelihood that there will be successful ransom negotiations due to the regulatory pressures of maintaining business operation, i.e., high costs of downtime creating a domino effect across both providers and suppliers
• The other target trend on healthcare is the ever-expanding dark web marketplace data that is available for purchase

Our world is increasingly more digital and increasingly more interconnected, whether it is by choice or not. There is no turning back the clock to paper files, with the advent of electronic forms, e-signatures, and accessible cloud storage. Being cybersmart is necessary and contagious. Always trust your instincts and think before you click a link, create and use strong passwords (eight-plus characters), use multifactor authentication, when possible use secure internet connections (HTTPS), update antivirus software regularly, and report anything of concern or suspicious to your IT department.

Electronic Health Records Technology Advancement or Demotion
“Technology is wonderful and seductive, but when seen as more real than the person to whom it is applied, it may also suppress curiosity; and such curiosity is essential to active thinking and quality care.” —Dr. Faith Fitzgerald

The history of medical records is thousands of years long. Medical records have existed since the beginning of the practice of medicine with a history of dating back as far as 4,000 years in some form. Some of the first medical records date back to Hippocrates in the fifth century BC and medieval physicians. Medical records, as we know them, were first developed in Paris and Berlin during the 1800s. The history of the electronic health records (HER)/electronic medical records (EMR) companies began in the 1960s. The Mayo Clinic in Rochester, Minnesota, was one of the first major health systems to adopt an EHR and move away from keeping paper medical records. At that time, EMR programs were so expensive that they were only used by the government in partnership with larger health organizations. Before the 1980s, it was rare to see a computer used at all in any private practice, let alone for storing electronic health information and HIPAA related information (5). By the 1990s, technology had advanced into most medical offices, academic inpatient, and outpatient medical facilities while being used to a limited degree for record-keeping purposes. In 2004, President George W. Bush created the Office of the National Coordinator for Health Information Technology, which outlined a plan to ensure that most Americans had electronic health records within the next 10 years (14). That vital push came through the American Recovery and Reinvestment Act 2009, spearheaded by President Barack Obama, which conceived the form of incentives to EMR users (12).

Even in 2024, the EMR has continued to grossly miss the intended mark of efficient and personalized patient care. Modern healthcare systems require physicians and other healthcare providers to spend excessive amounts of time behind a computer screen at the expense of face-to-face patient care. Most healthcare professionals got into the healthcare to serve and care for others, not for data entry. This type of workplace environment has declining appeal to potential medical school students. Now there are longer hours required to see far too many patients (up to 20 a day), with an average visit length limited to 18 minutes to be able to maintain quota with declining reimbursement, which does not allow time to establish relationships and address the complex needs and mental health issues of the patients (5).

A current literature search yields 28 articles on the effects of the EHR on healthcare. There is a common consensus of the excess of clinically irrelevant information and poor data display that led to information overload. Excessive information in a chart, well known as “note bloat,” was shown not to improve but to impair comprehension and cause cognitive overload, which led to potential errors (8,15). Studies have confirmed that the overworked healthcare staff spend nearly twice as much time documenting in EHR than they do actually interacting with patients (1). This creates a source of not only frustration but could compromise patient safety (11). The EHR software was specifically designed and intended to optimize billing, not patient care.

One of the avenues of improving our ever-changing healthcare environment would be to emphasize the importance of effective healthcare by protecting it within the Medicare Physician Fee Schedule, which in turn could support the fee schedules used for Medicaid and other commercial payors, not to mention Medicare Advantage Plans. We need to invest in our medical practices to continue to ensure better staffing and task-sharing so everyone can practice to the extent of their licenses and capabilities in providing timely quality healthcare. An ideal EMR should work in tandem to bring together the heart and art of medicine with information technology and processing.

Overworked and Undervalued
The realities of our current healthcare system, exacerbated by the pandemic, have driven many healthcare workers to burnout with many choosing to leave the healthcare workforce early. The vaccination mandate on healthcare workers split the healthcare communities in many workplace environments. Many staff work in environments that strain their physical, emotional, and psychological well-being, filling a position that once required two to three more to complete. The outcome is that patients do not get the care they need when they need it. The end result is higher healthcare costs. It will hinder our ability to be prepared for the next public health emergency and leave gaps in the healthcare continuum.

Instead of calling it burnout, maybe it should be called undervalued, misused, and overworked. Any work environment should not be just for disbursing energy but rather for getting energized, recharged, motivated, focused, and inspired. There are changes at the organizational level that are necessary to foster a supportive environment that will prioritize personal and professional growth with focused gains in areas of patient flow and a more customized healthcare delivery. The mentality of “these patients/people are living in my work environment” to “I work in the home of these people” goes a long way in how patients are perceived. In addition, resources provided for shared activities and experiences could include socialization, open group discussions, and collaborative creativity.

We should not expect to achieve high-quality care from healthcare staff who feel demoralized, unappreciated, and dissatisfied with their work lives. Together, as the workforce, we have the responsibility and the capacity to provide our healthcare workforce with all that they need to heal from this current condition and thrive in a better future.

References

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