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1. Each team member will find an article from the library or organizational source that discusses
one of the patient engagement digital impact areas mentioned in the chapter text (patient
portals, telemedicine, remote monitoring, etc.).2. Based on the source that you find, comment on how effective you believe this type of patient
engagement would be. 3. Would you want this type of digital engagement used on you or a family member during their
treatment or care?4. Make sure to include a reference list.
CHAPTER 3: The Digital Age: Changing
the Landscape of Healthcare Finance
After completing this chapter, you should be able to
1. Understand what drives changes to health information technology.
2. Identify types of high-tech and high-touch digital approaches.
3. Identify the digital impact areas for patient engagement.
4. Define digital media.
5. Understand the difference between EMR and EHR.
6. Recognize how to effectively manage population health.
This chapter explores major digital age influences that are impacting healthcare finance.
HIGH-TECH AND HIGH-TOUCH APPROACHES
Healthcare systems are using high-tech and high-touch approaches to reach patients where they
are and with what they need in an attempt to meet the challenges of patient engagement. Digital
platforms, including mobile apps and social networks, are changing customer interactions and
We characterize the current state of online technology as Web 2.0, which goes beyond simply
letting people access information on the Internet (as was the case in the early days of the
Internet). The current state is now characterized by greater user interactivity and collaboration,
more pervasive network connectivity, and enhanced communication channels.1
Social media, such as Facebook and Twitter, are the outgrowth of Web 2.0. The challenge to a
healthcare organization’s marketing staff is to determine how to harness social media to reach
customers and turn social media content into business value.
Central to understanding the changes that are now occurring due to the variety of digital impacts
and changes in health information technology is the concept of patient engagement. Technology
and patient engagement go hand-in-hand. An overarching objective of the healthcare digital age
is to make patient engagement more meaningful and effective.
The Engaged Patient
A truly engaged patient is one who is an active partner in his or her own health care. It stands to
reason that primary care would be the specialty wherein this concept can most effectively be
operationalized. Patients who are punctual with their annual checkup and those with chronic
diseases like diabetes who are adhering to their regimens would be considered engaged patients.
Jacqueline Fellows assembled a comprehensive list of digital impact areas under the rubric of
“Patient Engagement Investments” and examined them by setting (e.g., hospital, physician
organization) and by net patient revenue.2 Among the areas that attracted the most interest were
patient portals, patient access to medical records, telemedicine, remote monitoring, and
telehealth to track patient health status.
The major factors driving the growth of the telehealth market appear to be the rise in aging and
chronically ill population and the shortage of physicians in some areas of the country. However,
there are reimbursement issues that must be overcome, which also encompass telemedicine.
Mobile technology has the potential to help healthcare providers manage risk, encourage healthy
behaviors, and engage with consumers. Garmin (producers of GPS programs), along with
various partners, has launched new products including a wide range of “wearables” to help
people reach their health and wellness goals. In one example, OffTheScale (OTS) has entered
into partnership with Garmin and its innovative healthcare platform that fights against obesity
and other chronic diseases. OTS provides a Garmin wearable device that measures steps taken
and combines it with user data to calculate distance walked and calories burned.3
Leaders in performance technology such as Garmin also produce remote monitoring devices for
patients with other conditions such as diabetes and heart failure. These types of mobile
technology have the true potential to improve wellness and to lower healthcare costs.4 It is
essential, however, that the devices and systems that are flooding the market (including apps) be
properly studied or vetted through clinical trials.
Recognizing the importance of social media is a first step in bringing a hospital, for example,
into the digital world. Social media can help a hospital manage the patient experience, connect
with community members and potential patients before they arrive, and manage their care
transactions after they leave. Providing an alternative mode of communication can help make
patient interactions more comfortable and less clinical. The intersection of health care and social
media is unavoidable. Social networks, blogs, discussion forums, and other social and digital
media highlight these alternative modes of communication.
Digital media may be defined as any type of information stored in a computer or mobile device,
including data, voice, and video.5 A common misconception related to social media is that it
requires the creation of additional content. Any content that is being used for print media
(newsletters, information packets, marketing materials, or other promotional items) can be
repurposed for digital media. An effective social media strategy is integral to managing a
healthcare organization’s reputation.
What Do the Data Show?
It is estimated that between 70% and 75% of Internet users in the United States seek healthcare
information on line.6 According to a 2014 study, nearly 95% of hospitals had a Facebook page,
and just over 50% had a Twitter account.7 For all the good that may come from patients and
healthcare consumers use of social media, there are also risks and challenges. For example, it can
be difficult to control the quality of information that appears on patient social networks. In
addition, patient privacy and security of health-related information are major concerns.
The types of resources needed to grow a healthcare organization’s digital brand are technological
and human resources-related. In addition, with the locus of responsibility for social media
typically residing in a marketing and/or communications department in a healthcare organization,
full-time employee staff costs dedicated to electronic media should result in additional budgetary
expenses. These staff expenses are in addition to the cost of establishing and maintaining a
website (purchasing a domain name, hosting fees, etc.). A website is a collection of related Web
pages, images, videos, or other digital assets that are addressed with a common domain name or
internet protocol (IP) address in an IP-based network.8 That said, in today’s competitive
environment, it isn’t enough just to have a Web presence. Instead, healthcare organizations need
to have online visibility.
CHANGES IN HEALTH INFORMATION TECHNOLOGY
The changes that are occurring in health information technology are driven by health informatics,
or the application of information technology to healthcare delivery. These changes include the
More open, cloud-based systems that facilitate data sharing
Mobile devices and sensors that enable increased participation by patients
Adoption of digital or electronic health records
Still another major technology change involves data mining. Electronic records are increasingly
being mined and analyzed to uncover new medical knowledge, promote evidence-based
treatments, and determine the clinical and cost-effectiveness of care.9 (For additional
information on data mining, see the chapter entitled, “Understanding the Impact of Data
Analytics and Big Data.”)
EMRs and EHRs
At the center of the health information technology evolution is the electronic health record
(EHR). A distinction has been made between the electronic medical record (EMR) and the EHR.
The EMR is essentially the digital version of the traditional paper chart, the electronic record of a
particular physician’s office. The EHR ideally represents the total health status of the patient
across all providers.10
Incorporating EMRs and EHRs into clinical practice will require large investments in new
technology, in addition to changes in existing systems and processes. These barriers tend to slow
EHR adoption rates. Moreover, in some instances, this technology may serve as a
distraction during care delivery. On the other hand, the hope is that EHRs will realize their
potential to improve quality, reduce medical errors, and lower administrative costs.
Interoperability, or the ability of two or more information systems to “talk” to each other
(exchange data), is the key to the future success of EHRs as is the effectiveness of health
information exchanges (HIEs). These exchanges are a key component of health informatics
through which information from various electronic record systems is shared according to
nationally recognized standards.
POPULATION HEALTH AND THE DIGITAL AGE: CROSSING AT THE
Population health is now center stage in healthcare delivery, and it is transforming the industry.
This represents an industry-wide shift in focus; while health care used to be transactional and
focused on the individual, population health emphasizes outcomes—not just of a single patient,
but of an entire population.
This concept is being operationalized through the advent of Accountable Care Organizations
(ACOs) and their rapid growth and maturation. ACOs are groups of hospitals, doctors, and other
healthcare providers who come together voluntarily to provide coordinated, high-quality care to
their (primarily) Medicare patients. At the time of this writing, there are approximately 750
ACOs in operation, covering 23.5 million lives.11
To fully appreciate the challenge, one must understand what the essence of population health is.
First, the provider has to define the population. Then, the care that the population is receiving
must be determined. Next, identify what gaps exist when comparing the care that the population
is receiving with the care that the population requires. Finally, the delivery system should be able
to address the care gaps.12 Improving the health of populations is one element of the wellregarded Institute For Healthcare Improvement’s “Triple Aim,” the other two being improving
the patient experience and reducing the per-capita cost of health care.13 Taken together, the three
elements describe an approach to optimizing health system performance.
Assessing Information Technology Capabilities
In order to effectively engage in population health management, healthcare organizations will
have to assess their information technology (IT) capabilities and address the gaps therein.
Glaser14 maintains that efficient data sharing among multiple providers will be key; hospitals
working with other organizations such as provider groups, post-acute providers, and social
services. That data will have to be combined to formulate a complete picture of the patient in
order to determine care planning, predict utilization patterns, and assess risk.
These imperatives go beyond the functionality of EHRs and envision real-time population health
management solutions that are intended to work in tandem with that certified technology. Most
assuredly, the use of big data analytics will be part of the enabling platform, as well as cloudbased applications and telemedicine.
ADDITIONAL TRENDS AND COMPLEXITIES: OTHER DELIVERY SYSTEMS
The trends and complexities related to population health and the digital age involve other
delivery systems. Most notably among them are urgent care, retail medicine clinics, and
Urgent Care Medicine
The growth and development of urgent care medicine has not been unexpected. For many
patients, there are long waits in the emergency room for nonemergent care, and there has been a
concomitant shortage of primary care physicians in parts of the country. Since 2008, the number
of urgent care facilities has increased from 8,000 to 9,300.15
Further evidence of the continuing maturation of this type of care is that many centers are now
seeking accreditation. Urgent care centers offer imaging and other services not found in retail
outlets. However, the challenge therein lies in the ability of the centers to share clinical data with
a patient’s primary care physician in a timely manner for continuity of care purposes.
Retail Medicine Clinics
Retail medicine clinics may be found in drugstores, grocery chains, and even airports. They are
typically small clinics staffed by Nurse Practitioners. Retail health clinics, by definition, are
clinics in which the consumer pays the provider directly at the point of sale.16 Hospital systems
are increasingly opening satellite care centers in retail locations, either partnering with chains
like Walmart on in-store centers or going it alone. Many consumers of retail medicine are
uninsured individuals looking for a fixed cost-of-care. There are also regulatory concerns and
questions about quality of care.
Behavioral health presents a myriad of unique challenges in the digital age. The nature of
behavioral health care (mental health care) makes the application of current health IT
challenging. The use of EHRs in behavioral health is limited because of strict privacy concerns,
which cause persistent barriers to information sharing.17 Thus, few behavioral health
organizations have formal linkages or agreements to securely share their information. A recent
survey found that while 97% of U.S. hospitals and 74% of physicians have implemented
interoperable EHRs, only 30% of behavioral health providers have implemented these
Within the heathcare finance world, it is important to recognize the impact and consequences of
the Digital Age. To be successful today, managers must work toward fully recognizing and
understanding these significant trends.
What Is Needed?
Your healthcare organization’s online visibility.
Where Is It Found?
Websites, blogs, discussion forums, Facebook, Twitter, and/or LinkedIn.
How Is It Used?
The particular online visibility sources will vary depending upon your organization’s media
Electronic Health Record (EHR)
Electronic Medical Record (EMR)
Health Information Technology
Accountable Care Organization
Health Information Exchange
1. “Web 2.0,” WhatIs.com, http://whatis.techtarget.com/definition/Web-20-or-Web-2,
accessed January 5, 2016.
2. J. Fellows, “Meeting the Challenge of Patient Engagement,” Health Leaders, 18, no 6 (2015):
3. OffTheScale, www.prnewswire.com/news-releases/groundbreaking-healthcareplatform-offthescale-partners-with-Garmin-300136825.html, accessed September 2,
2015, and http://site.garmin.com/en-US/wellness, accessed September 19, 2016.
5. Society for Healthcare Strategy & Market Development, A Hospital Leadership Guide to
Digital & Social Media Engagement (Chicago: American Hospital Association, 2015).
6. J. Glaser, “Five Reasons to ‘Like’ Patients Use of Social Media,” H&HN, April 11,
8. C. B. Thielst, Social Media in Healthcare: Connect, Communicate, Collaborate (Chicago:
Health Administration Press, 2010).
9. M. L. Braunstein, Contemporary Health Informatics (Chicago: American Health Information
Management Association, 2014).
11. J. Glaser, “All Roads Lead to Population Health Management,” H&HN, June 13,
12. M. Zeis, “Toward Population Health,” Health Leaders, 16, no 8 (2013): 24–28.
13. Institute for Healthcare
Improvement, http://www.ihi.org/engage/tripleaim/pages/default.aspx, accessed June
14. J. Glaser (Op.Cit), June 19, 2016.
15. American Academy of Urgent Care Medicine, “Future of Urgent Care,”
aaucm.org/about/future/default.aspx, accessed June 18, 2016.
16. “How Retail Medicine Lost its Way,” Managed Healthcare Executive, June 17, 2015,
17. P. A. Ranallo, A. M. Kilbourne, A. S. Whatley, and H. A. Pincus, “Behavioral Health
Information Technology: From Chaos to Clarity,” Health Affairs, 35, no 6 (2016): 1106–1113.
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