Scaling Identity Management in Healthcare

The average hospital has seen a 90% turnover of its workforce in the last five years, and 83% of RN staff. Nurses are not just protesting about their inability to deliver great care – they are leaving the healthcare field altogether. And they’re not the only ones. From the doctors to those responsible for testing and administering medication, there are shortages across the healthcare system.

Healthcare frontline caregivers identify the need to maintain electronic health and data records as a high contributor to burnout. Moreover, the lack of connection between clinical needs and data access creates a never ending quest to find the appropriate data for patient care, which also leads to workarounds.

For example, traveling nurses need to be enabled to hit the ground running in already understaffed areas. If they can’t log their work, they are more likely to use a universal login – this poses a risk but in an emergency, compliance takes a back seat to delivering care. To take a different scenario, the access needs for temporary surge staff brought in to help with testing are different from emergency care or chronic care management, but might be delivered by the same individual. Ultimately, shortages of healthcare workers combined with cumbersome technology create frustration, rather than enable care.

Technology and Healthcare Data Security

What role does technology play in improving staff shortages and ensuring access to care? Technology will not be the cure-all, but it can reduce inefficiencies, improve care, and modernize outdated processes. Still, data security and access are major burdens for healthcare organizations facing an already increasing financial burden from staff turnover. Long-term healthcare shortages and short-term crises are not new, so long-term solutions have to include workforce training and recruiting to help mitigate their impacts.

Healthcare data security remains a top concern, both for virtual care and for traditional brick and mortar hospitals, and a centralized data governance strategy is the foundation of proactive solutions. A strategic interpretation of data security capabilities might be recognizing vaccinations need to be administered by nurses and others who are not usually in that area. This would mean when healthcare workers show up to deliver care, they’d need to be able to easily log in, find patients, understand potential allergy interactions, and record their work.

Data-based decision making involves every stakeholder impacted by the data, from the patient to the lab technician and physician, to the billing department. Let’s take a look at how this impacts various aspects of the quality and efficiency of healthcare.

Patient Care

Transferring patient records requires having healthcare records in the first place. However, there is often a gap between when care is recorded, when it is delivered, and when physicians update clinical notes after hours. This gap becomes wider with staffing shortages and in emergency care situations. If you must record what care was delivered but have no way to record it, the delay can mean patients transferred from one facility to another do not have records. This can lead to duplicate tests or inaccurate patient care data.

Staffing shortages have been identified as a major concern for patient safety. The fewer nurses and staff, the more likely patients are to have poor outcomes – patient length of stay is longer when there aren’t enough people with the skills to deliver care. And, if physicians do not have access to records, they cannot independently deliver care, send orders, or have visibility into what has been done. A streamlined strategy can leverage data intelligence to identify user patterns and potential needs, while reducing technological and administrative burdens frees time for direct patient care.

Workforce Shortages and Frontline Care

As the saying goes, necessity is the mother of all invention. In a world of employee strikes or walkouts in already understaffed healthcare facilities, the absence of proper data security and access measures can lead to workarounds and degradation in the accuracy of patient records.

Healthcare had a shortage of workers before 2023, but these shortages have recently been exacerbated, and clinicians report concerns about their ability to deliver patient care safely. Heightened capacity needs, paired with increased turnover, necessitate better data security systems. In many instances, a strike may mean temporary staff caring for patients. In these situations, if those on the front lines do not have immediate access, they may use the credentials of another user within the system. This creates a security risk for patient data and a delay in care delivery.

The demand for expedited user creation and management means device security and organized governance is necessary. These workers need secure access to patient data in order to do their jobs, and an agile system for recording their work.

Administrative Burden and Cost

Secure access to relevant data is not just a healthcare problem. Nearly half of respondents to the 2023 State of Data Engineering Survey identified access control complexity as a barrier to doing their jobs. Physicians also identify administrative burden, such as manual access controls, as one of the main drivers of healthcare burnout. Yet, some reports have recommended one to two years to plan for physician hiring and onboarding. This long period accounts for credentialing, getting to know the healthcare system, and access. But in a major health event, this is impossible.

In the case of travel nursing, the identity verification and onboarding process has to occur in a concentrated period of time. Organizations need to use data to inform the usage needs and decisions, and many identify lack of access as a barrier. At the very minimum, the lack of secure data access results in care delivery delays. In some instances, lack of appropriate access to deliver care results in temporary employees like travel nurses leaving, and long-term employees being less satisfied.

No single healthcare event can cover the entire administrative cost of the team involved in delivering care. With higher turnover, this cost becomes more concentrated, rather than spread over all patient encounters throughout an employee’s tenure. Reducing the friction and total cost for each person will improve these ratios. A more organized data infrastructure is not just a way to reduce burdens and improve patient safety, it is also a smart short- and long-term financial decision for organizations.

Additionally, data access based on current policy should ideally facilitate compliance while reducing manual tasks and employee frustration. Rather than waiting on employee requests for each type of data, understanding the data needed based on attributes such as a user’s role, environment, and usage purpose can proactively reduce administrative burden and frustration. This approach, called attribute-based access control (ABAC), allows an ICU nurse who is administering vaccinations to be given access to a specific data set that is not accessible to another nurse who is responsible for recording vital signs.

Device Security

Purpose-based data management should be paired with purpose-based access control. Many individuals wear multiple hats within an organization. A nurse informaticist making staffing decisions needs different access for staffing than for bedside care, but both of those roles might be filled by the same person. The need for adaptable systems can be demonstrated by the recent increase in flu cases or COVID-19 illness in any given area. The demand for testing in both situations was high, but also not permanent. Tents for patient care or for testing were set up in many areas, or other buildings were repurposed to meet care demands. Devices in these portable care delivery areas needed different visibility into patient history than those at the bedside of a permanent care facility or hospital. Patients with a chronic condition such as diabetes benefit from ongoing monitoring, and at-home devices for testing or post-surgery follow-up also help patients recover quickly. Purpose-based access rules can personalize the data for a one-time test or ongoing monitoring.

Purpose-driven access applies to the same individual filling different roles, and the same individual giving care which requires different devices. A nurse evaluating chronic care or home based healthcare conditions might use monitoring tools to help with that work. Healthcare has a shortage of clinicians and people involved in testing, and purpose-based access control for each device can help reduce the burden. In some areas, medical devices are employed to record data. Each of these devices represents an access point with its own security needs. This can expand to protocols for communication and devices in home- and community-based care settings.

Patient & Employee Engagement

One of the most important factors for delivering great healthcare is community. Staff turnover leads to a greater sense of disconnection for everyone, reducing quality of care and patient engagement. Lack of staff sufficient for delivering safe patient care is a top concern. Higher paid temporary staff and turnover are identified as a source of dissatisfaction for nurses. They are being asked to do more work, with people who are getting paid more, and know the patients and system less. The cost of temporary staffing is drastically higher, including administrative costs.

What makes people more likely to stay? Connection. Employees connected to their communities deliver better care and are more likely to stay at a given employer. This means they have the data tools to deliver care, without forgotten passwords or lack of access. The median length of employment for healthcare workers was only five years before the current crisis. Access management helps you know WHO your employees are more quickly, and build strong bonds with them to increase their likelihood of staying.

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