Office 365 for Healthcare Professionals

Healthcare is a complex industry with ever more regulations, increasing costs, lower margins, longer innovation cycles, and decreasing quality of care. United States healthcare spending reached $3.2 trillion in 2015, accounting for 17.8 percent of the GDP. By the year 2021, it is projected to reach $4.8 trillion, accounting for one-fifth of the U.S. economy, according to the Center for Medicare and Medicaid Service (12/06/2016). Despite this spending, the United States ranks behind most developed countries in various measures of health outcomes, such as affordability, accessibility, life expectancy, and healthcare costs per capita. Healthcare has become the top concern for Americans, even surpassing the economy, and rightly so. Wasteful practices play a major part in this problem, costing $750 billion dollars annually. A significant portion of these wasteful practices are the result of interoperability issues, which entail data-sharing challenges and communication gaps between different providers, hospitals, and payers. The information that is captured and tracked traditionally tends to stay only within a singular organization.

Office 365 is a Software as a Service (SaaS) offering from Microsoft. It comes in various licensing models and has specific licenses for small and medium businesses as well as for education-domain customers. This chapter will not focus on the various licensing options of Office 365, but rather will focus on things to remember while configuring Office 365. Office 365 offers a variety of services such as email, shared calendar, document management, team collaboration, mobile access, instant messaging, online meetings, and presence, which are mainly focused around improving the productivity of an organization. We will review some of these services and showcase how to configure them and what to keep in mind when configuring them for a healthcare environment.

We live in a highly connected and complex world today. Digital technology as a change agent has enabled us to innovate faster and more cost-effectively to accomplish new goals and achieve new efficiencies. Innovations are no longer region- or country-centric; they are based on data and information from across the world. Innovation is dependent on data, and maintaining and managing that data securely is the responsibility of every citizen and organization. Connected devices and services have provided organizations with valuable data, creating new opportunities to personalize service and drive new business models. This growth is being driven by an ever-increasing number of sources, and the data being generated now is more complex than ever. In many cases, this data-collection process evolved over years across multiple IT systems with variable levels of security and compliance. The amount of electronic data being created by organizations is growing exponentially.

Did you know that the telemedicine concept was invented in the 1960s by NASA? Yes, to monitor astronauts’ health from Earth at NASA centers, NASA sent several test flights using animals attached to medical monitoring systems, which sent the animals’ biometric data to scientists on Earth via a telemetric link. The focus on the possible limitations of the human body forced NASA to take a technologically focused approach to telemedicine. In situations where a quick return to Earth was not possible, the ability to not only monitor biometric data, but also engage at least rudimentary guided medical treatment by non-physicians, was critical. The same concept applied to remote rural areas where medical help was not available to those who needed it urgently. As we say, necessity is the mother of all invention, and from this necessity was born telehealth. The US military started using telemedicine in the 1980s to combat several natural disasters and conflicts. The American Telemedicine Association (ATA) describes telemedicine as the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.

A tumor board review (TBR) is a treatment planning approach in which many doctors who are experts in different medical specialties, and often are from different hospitals, review and discuss the medical condition and treatment options of a patient. In many countries, the tumor board review is an important phase in the multidisciplinary oncological care pathway. In cancer treatment, a tumor board review may include a medical oncologist (who provides cancer treatment with drugs), a surgical oncologist (who provides cancer treatment with surgery), and a radiation oncologist (who provides cancer treatment with radiation). It is also called a multidisciplinary opinion. A tumor board is a regularly scheduled (typically weekly) meeting where cancer cases are discussed in a comprehensive manner. There is typically a pathologist present to review biopsy and surgical specimens, with the microscopic pictures projected on a large screen, as well as a radiologist to review pertinent scans. The tumor board functions as a comprehensive second opinion and allows specialists to have input on how cancer cases should be treated, thereby creating a type of community standard. The recommendations are not binding but are very helpful in tough cases. Some tumor boards are limited to one kind of cancer. Most commonly, these are for breast and lung cancer because of the frequency of cases. Others are general tumor boards where cases requiring complicated treatment decisions are reviewed.

Nurse scheduling is about finding an optimal way to assign nurses to shifts and maintain the correct nurse-to-patient ratio at any given point in time at the hospital or facility. The nurse scheduling problem has been studied since at least 1969 and is a very complex problem that can be solved via algorithms. This chapter, however, will focus on solving this problem by putting the scheduling decisions in the hands of nurses and will not focus on solving it via any computer algorithms. Staffing and scheduling is not only a tiresome process but also requires nurse managers to have the right tools to predict the demand for nurses for any given shift hour. The primary responsibility of any nurse manager and chief nursing officer is to allocate the resources needed to deliver high-quality care at the right time to the right patient. Patients have different needs at various stages of their hospital stay. Maintaining a staffing ratio is a good starting point for any nurse manager but is not enough to provide high-value care to all admitted patients. Patients may range from needing minimal care on the day of their discharge to needing a dedicated nurse around the clock after a complication puts them in the ICU. The nurse manager needs new tools for creating staffing models and doing nurse scheduling and should have a way to pass on the responsibility to nurses for their own schedules. Nurse scheduling and ensuring each shift is staffed appropriately is one of the main reasons for job dissatisfaction among nurse managers. No matter how carefully the nurse manager defines the schedule criteria, there may always be holes in the schedule as it is dependent on a human element.

As we know, sharing vital patient information in a timely manner can improve decision making at the point of care and help providers avoid readmissions and medication errors, improve diagnoses, and decrease duplicate testing. Electronic health-information exchange allows nurses, physicians, pharmacists, other healthcare providers, and patients to appropriately access and securely share a patient’s vital medical information electronically to improve the speed, quality, safety, and cost of patient care. Most Americans’ medical information is stored on paper despite the widespread availability of secure electronic data transfer. Patient data is in filing cabinets at various medical offices or in boxes and folders in patients’ homes. Often, a patient carries their records from appointment to appointment, or information is shared between providers via mail, fax, or CDs. Patient and provider direct interaction is absolutely needed, but having electronic access to patients’ health history is extremely beneficial for doctors and nurses for accurate diagnosis and speedy recovery. Electronic data transfer helps standardize patient data across multiple electronic health record (EHR) systems, thus improving the interoperability between multiple providers.

Healthcare and nursing are both currently riding a steeply cresting wave of change and innovation. It is difficult to point to any one event as the impetus to the change and innovation that has struck the healthcare industry in just the last few years. The book Nine Shift states that between 2000 and 2020, 75 percent of how we live our daily lives (work, life, and education) in the twenty-first century will change. Since we spend about 12 hours every day doing essential tasks such as eating and sleeping, for the rest of the 12 hours in a day, 75 percent, or 9 hours, will be spent doing things totally differently than we did just a few years ago. The last major shift was from 1900 to 1920, when we moved from an agrarian farming way of life to being industrialized, and now we are moving from an industrialized to a knowledge society. These predictions are already beginning to see fruition in many aspects of our lives, including healthcare and education.

Patient readmission, as defined by Medicare, is when a patient is admitted to a hospital within 30 days of being discharged from an earlier hospitalization, regardless of in which hospital the patient was originally hospitalized. Under the Hospital Readmission Reduction Program (HRRP), hospitals with readmission rates that exceed the national average are penalized by a reduction in payments across all their Medicare admissions—not just those which resulted in readmissions. There is no doubt that compared to the 1990s readmission rates have significantly come down in recent years. As a result of Medicare’s readmissions reduction program, hospitals are working hard to bring the readmission rate down. Avoidable readmissions are a strong indicator of a fragmented healthcare system that too often leaves discharged patients confused about how to care for themselves at home and unable to follow instructions or get the necessary follow-up care. Medicare reports spending $17.8 billion a year on patients whose return trips to the hospital could have been avoided. Readmissions are costly for a provider that doesn’t have enough resources to spare, not to mention the 2 percent readmissions penalty stipulated by the Affordable Care Act.