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Forrester’s Take On Computing Trends For Next Year

Posted on December 31, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Recently, Forrester Research’s J.P. Gownder released a list of six broad tech trends he feels will dominate 2014. While they’re not healthcare-specific, I thought our readers would appreciate them, as they are relevant to the work that we do.

Mobility:  Gownder is arguing that this year coming will see a “sustained mobile mind shift.” He argues that customers and employees are beginning to expect that the data they touch will be available to them in context on any device at the exact what would’ve need. He argues that customers will actively shun businesses that lack mobile applications.

Fragmentation:  While vendors would like to see us, as consumers, stick to one vendor and operating system, Gownder argues that just the opposite will happen in 2014, with people trading off between multiple devices and thriving across operating systems. This movement, driven by the seeming infinity of new mobile devices, makes things more difficult for health IT administrators, to be certain.

Wearables:  While the wearables devices your editor has seen strike her mostly as toys, Gownder is far more enthusiastic. He argues that next year will see commercial availability of a range of once theoretical wearables — and that enterprise wearables have a particularly rich future ahead of them.

Intelligent assistants:  For me, services like Siri and Samsung’s S-Voice are entertaining, but hardly add anything to the mix when it comes to what your phone tablet or PC can do. Gownder, however, believes that intelligent assistance will rise to prominence in 2014 as they become more sophisticated, interesting and useful.

Gestural computing: Expect to see new applications and scenarios for gestural computing this year, Gownder predicts, driven by phenomena like the presence of XBox Kinect in tens of millions of homes, the emergence of Leap Motion and the emergence of a new device known as Myo from Thalmic Labs. In this case he isolates healthcare specifically as a strong use case, in which professionals manipulate and navigate medical imaging using gestures.

Stores recognize you: Here’s one I can see direct healthcare applications for; next year, Gownder predicts, will be the year in which you walk into a store and the store “recognizes you” and tailors your experience accordingly. I can see this being relevant in virtually any public-facing healthcare setting, including the ED, medical clinics and perhaps even EMT settings. Sounds very much like John’s description of a “biometrically controlled healthcare system.

So which of these trends do you think will be the most important next year? How are you adopting them, if at all, in your healthcare organization?

Defining EHR Usability Isn’t for the Timid

Posted on December 30, 2013 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Editor’s Note: A big welcome to Carl as a writer on EMR and EHR. He’s been writing guest posts across the Healthcare Scene network for many years, but we’re happy to have him now writing formally on EMR and EHR. You’ll be able to read all of Carl’s past and present posts on EMR and EHR here.

Sometimes it seems that EHRs and usability are like Earth and Mars. Their orbits get relatively close, but they’re never going to occupy the same place and time.

Of course, the two we’re occupied with aren’t cosmic equals. EHRs are specific systems, while usability is, at best, a concept with various definitions. In fact, the closer you get to a definition of usability the less focused it becomes. My late brother used to call things like that, “Far aways.” “The farther away you get the better they look.”

Indeed, most definitions of usability say it’s something that’s useful. Ugh. So, is there any way to bring some clarity to its definition, so it has greater precision?

Doing so, I think, requires not only defining what usability is, but also tackling when it’s not present what’s wrong.

Usability: A Different Definition Approach

Most definitions of usability I’ve seen push the issue off onto use or useful. That is, usability is defined as something that is useable. This isn’t far from using a word to define itself, which was a grammar school no no. It also fails to involve the user’s expectation. I would define it this way:

Usability is the ability of a system to supply a desired result with the minimum necessary information, conditions or steps.

This definition hinges on a user getting what they want expeditiously. Simply put, usability means no unneeded fuss or feathers. As I look at it, usability is to systems what parsimony is to logic. In logic, the simplest explanation that explains the occurrence is the best. Similarly, the most usable system is the one that requires the least effort to supply the correct response.

User Hostile Systems

If I left matters at this juncture, however, I wouldn’t have addressed a major related issue. When a system is user hostile, just where has it gone wrong. Each of us has experienced or heard these tales. You make a simple request and wind up in wilderness of documentation or your options are have everything but what you want.

These are negative examples of usability. It is, however, not enough to just stamp them as such and move on. It’s also important to say exactly where usability fails. To get a handle on these issues, I divide them into three classes:

Class One: Bug. Generally, a computer or software bug is anything that caused a wrong or unexpected response. I take a narrower view. To me, a bug represents a properly designed system that’s incorrectly implemented. That is, the program code fails to carry out the system designer’s intent. For example, you click Print and the system emails your Aunt Edna.

Class Two: Design Failure. In these, the code is OK, but the requirements failed. The classic refrain for these is, “ Yes, that‘s what I asked for, but it isn’t what I wanted.” Fixing these, unlike bugs, requires correcting the requirements and conforming the code.

Class Three: Missing Requirement. Sherlock Holmes in the Silver Blaze mystery had this to say about EHR usability:

“Is there any point to which you would wish to draw my attention?”
“To the curious incident of the dog in the night-time.”
“The dog did nothing in the night-time.”
“That was the curious incident,” remarked Sherlock Holmes.

Nothing is less usable than something that doesn’t exist. It’s not a matter of getting wrong. It’s a matter of not getting it at all.

What makes this a difficult category to apply is the issue of user need. What some users think is fundamental, others may regard as a frill or not necessary at all. Usability, therefore, hinges on neither design nor programming but on policy. However, if policy deems the function important, then its omission is far more serious than the other two categories.

An example. I use a large practice associated with a local medical school. It uses Jardogs’ Followmyhealth (FMH) web portal. It conveniently combines PHR, email and scheduling. I especially like being able to email my PCP. Recently, however, I ran into a class three problem.

FMH lists my PCP and any other of my providers. My PCP suggested I see a specialist for a problem. I went to FMH to find a list of specialists and phone numbers. I got nowhere. I could remove a provider, but not find a new one. I searched FMH’s knowledge base for provider and got 40 hits, but nothing on finding one. I then went through the FMH Patient Guide again without luck. Frustrated, I left the system and went to the practice’s public web site. It had the list. I found the department and number I wanted. Once I got set up, the new provider appeared in FMH.

Wondering if I had missed something, I called support with the problem. The support rep spent several minutes, came back, and confirmed that it could not be done, which surprised him. He agreed they should at least have a link in FMH to search for providers. Whether FMH adds it, of course, is a policy question.

10,000+ Healthcare IT Professionals

Posted on December 29, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As we head to the end of the year, I’m really excited that Healthcare IT Central just reached an amazing milestone. That community just passed 10,000 active healthcare IT professional resumes (officially 10,070 as of this post). This sets Healthcare IT Central as one of the top (and possibly the #1) healthcare IT career website out there. As we head into 2014, we’re making plans to ensure that we are the #1 healthcare IT career website for those searching for healthcare IT positions and those looking for healthcare IT talent.

For those readers who might be looking to improve on their current job or are looking for a job, you can search for a health IT job. We’re adding more and more employers and more and more jobs. It’s exciting to see all the match making that happens on the site.

If you happen to be searching for a new or better job, you might check out some of the following links to popular health IT job searches:

Happy New Year to everyone! I hope each of you is able to reach your career goals in 2014.

OCR Didn’t Meet HIPAA Security Requirements

Posted on December 27, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Oops — this doesn’t sound good. According to a report from the HHS OIG, the agency’s Office for Civil Rights has failed to meet the requirements for oversight and enforcement of the HIPAA security rule.

The 26-page report spells out several problems with OCR’s enforcement of the security rule, which was expanded by the HITECH ACT of 2009 to demand regular audits of covered healthcare organizations and their business associates. The vulnerabilities found leave procedural holes which could harm OCR’s ability to do its job regarding the security rule, the OIG said.

What was OCR failing to do? Well for one thing, the report contends, OCR had not assessed the risks, established priorities or implemented controls for the audits to ensure their compliance. Another example: OCRs investigation files didn’t contain the required documentation supporting key decisions made by staff, because the staff didn’t consistently follow the offices procedures by reviewing case documentation.

What’s more, the OCR apparently hasn’t been implementing sufficient controls, including supervisory review and documentation retention, to make sure investigators follow policies and procedures for properly managing security rule investigations.

The OIG also found that OCR wasn’t complying with federal cyber security requirements for its own information systems used to process and store data on investigations. Requirements it was neglecting included getting HHS authorizations to operate the system used to oversee and enforce security rule. OCR also failed to complete privacy impact assessments, risk analyses or system security plans for two of its three systems, the OIG concluded.

All told, it seems that if the OCR is going to oversee the privacy rule properly, it had better get its own act together.

All I Got for Christmas was a New Digital Health App

Posted on December 26, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Last week, I wrote that “All I Want for Christmas is a Doctor’s Appointment.” Turns out what I got – a flu-like cold – put that need into perspective. As luck would have it, I had recently read an article by fellow Healthcarescene.com blogger Neil Versel about AskMD, a new app from the folks at Sharecare. Being a mother of two children who are both in school, and thus exposed to their fair share of colds, I thought I’d get good use out of the symptom checker, which Versel explains, enables users to “choose which symptoms they are feeling and then see which potential health issues they might have. The app then walks the user through a “consultation” in which the app will ask the user a series of questions to identify more specifically what the symptom feels like, when it started, and if there are any other symptoms accompanying it. After the “consultation,” the user can enter in any information about medications that they are taking. When users have finished entering information, AskMD generates a list of potential problems the user might have ordered by the commonality of the potential problems.”

Before rushing to try and make an appointment with my local primary care physician during Christmas break, I decided to give AskMD a whirl. Anything that could potentially save me a co-pay, crowding into a waiting room with other sick folks, and then ultimately being told by my kindly nurse practitioner that the only treatment is rest and fluids, would be beneficial. After entering in an initial main symptom, the app took me through a series of 19 questions, resulting in a list of 11 possible causes, plus a link to find physicians and prepare for my visit. The list of physicians was helpful, and I was surprised to see that Cartersville Medical Center, where I had surgery over the summer, sponsored the results. It’s promising to see small, community hospitals are recognizing the importance of digital health tools.

photo

While a nasty cold wasn’t something I had bargained for over the holiday, it’s nice to know that a digital health app can bring me some peace of mind as I decide whether to treat my symptoms at home, or ultimately go into the doctor’s office. What digital health app did this Christmas bring your way? Or perhaps a new EMR was on your wish list? Let me know what health IT tools you’ll be ringing in the new year with in the comments below.

You might be an #HITNerd If…

Posted on December 23, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

You might be an #HITNerd If…

you buy your staff HIPAA Training gift cards (coupon code: HCS40) for Christmas!

Note: Much like Jeff Foxworthy is a redneck. I’m well aware that I’m an #HITNerd. Good thing Nerds rule the world. At least that’s what I keep telling myself.

Patient Loyalty, EHR Adoption, and EMR vs. EHR

Posted on December 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


This is interesting to consider. I’m really not sure how you can measure this result. I think this will eventually be true, but I don’t think we’re there yet. In theory everyone wants their doctor to have an EMR. However, they really just want more services for themselves as patients. That’s very different from what an EMR provides today.


My we’ve come a long ways. Now we’ll see how many organizations end up switching EHR software because they rushed their EHR implementation.


I prefer EMR and I think most doctors do as well. Although, $36 billion has a way of changing things.

All I Want for Christmas is a Doctor’s Appointment

Posted on December 20, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

A friend of mine had a very timely – and telling – prayer request at church the other day. She asked the Lord to help those in need of doctor’s appointments make them in a timely manner, both in terms of receiving care soon, and getting face time with a doctor before insurance deductibles roll over or cancelled policies end. It’s a prayer I’m sure many patients have been uttering just before they pick up the phone to see when their doctor’s next available appointment is; one that is all the more urgent for those with chronic conditions.

I have based past decisions on which new doctor to use based on their window of open appointments. Can’t see me for three weeks? Then you don’t get my business. Time is of the essence in healthcare these days. Patients want doctors’ time, and doctors don’t seem to have enough to go around. (Nor do they feel adequately compensated for it.)  Healthcare IT – patient portals, CPOE, natural-language processing systems, etc. – is certainly playing a role in helping doctors and ancillary staff get back some of that time. (Though many doctors contend entering data into EMRs is eating up a lot of that time savings.)

Some have postulated that healthcare IT, particularly digital health tools, will actually cause us to need doctors less. This counters the notion that we will soon see (if we aren’t already) a physician shortage, and an even greater lack of appointment availability thanks to the 27 million newly insured who will take advantage of their new policies in 2014. I’m not quite convinced that digital health devices and apps will cause me to go to the doctor any less. They may make the waiting in between my appointments less anxiety inducing, but I know myself too well to think I’d ever scale back on face time with my doctor. Perhaps those with chronic conditions feel differently. I’d be open to telemedicine and virtual visits, but those don’t seem to be on the radar of providers in my area.

Healthcare IT can certainly save time and improve access to care, but I don’t see how it can convince people to enter the healthcare field, which is where the true appointment availability problem seems to stem from. As a recent article at HealthcareFinanceNews.com points out, “retirement age physicians outnumber young members entering the ranks; over-worked physicians want to reduce their hours and care for fewer patients; and [there is a] general disenchantment with the state of healthcare.”

It’s a sad state of affairs when put that way. So what’s the answer? How can the healthcare industry – healthcare IT in particular –  work to ensure that prayers for timely appointment availability are no longer routine? Feel free to share your ideas in the comments below.

Save the Date: First of Its Kind Health IT Marketing and PR Conference

Posted on December 19, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare IT Marketing and PR Conference
I’m really excited to let readers know about a first of its kind event that I’m putting together called the Health IT Marketing and PR Conference. The conference is happening April 7-8, 2014 in Las Vegas, NV. I wrote a bit of the story behind the conference over on EMR and HIPAA and its shaping up to be an incredible event.

The conference is focused on helping marketing managers, PR professionals and health IT company executives refine their marketing and PR efforts. There is a lot of noise in the health IT space right now and it’s a real challenge for many HIT organizations to cut through that noise. The great part is that there are so many more tools available to us today to get our message out there. Plus, we’ll be bringing in a number of marketing and PR experts from outside healthcare to provide a well rounded view of what’s happening in the industry.

You can find out more details about the event on the conference website. Plus, you can register as a Founding Attendee for the event.

I also want to mention our four Founding Sponsors for the event. Each company supported this conference when it was just an idea and we’re glad to have their support in making this event a success.

Agency Ten22

Billian

Dodge Communications

Aria Marketing

We’ll be announcing more event details over the coming months. If you have any thoughts or feedback about the event, we’d love to hear it as well. We’re doing everything we can to make sure it’s a high quality event that sets the standard for how to conduct business in health IT.

Patient Engagement Strategies Must Start with the Patient

Posted on December 18, 2013 I Written By

The following is a guest blog post by Matt Adamson, vice president of product management for ACO and value-based health at ZeOmega

Healthcare providers are preparing to engage patients at a deeper level than ever before as they strive to achieve quality and savings metrics required of accountable care models being implemented across the country. However, a critical, lingering question remains – will patients participate? Patients have grown accustomed to seeking out healthcare information on their own, with the top five healthcare websites logging more than 78 million unique visitors monthly.[i] While this is clearly a positive sign that must be leveraged to move the needle even further, the answer could lie with the addition of the care coordinator that exists in most accountable care and medical homes.

A patient portal is seen as the most likely way that care providers will interact with patients outside of resource intensive office visits or telephone conversations, but any technology adoption must be accompanied by monumental shifts in attitudes among both physicians and patients in order to be successful. Physicians already are strapped for time and few are reimbursed for patient engagement beyond the traditional face-to-face interaction. Likewise, patients may hesitate to “bother” their doctors with questions or access their personal healthcare information online.

Care coordinators could serve as the bridge that connects physicians and patients, bringing them together at a clinical connection point. Relatively new in the healthcare system, care coordinators generally are nurses with care management experience who can help put conditions and diagnoses into the appropriate clinical context while speaking with patients on their level. The patient portal would provide another avenue for patients to communicate with the care coordinator, who would serve as the liaison to the physician when appropriate.

Meaningful Use Drives Push for Patient Engagement

Patient engagement will be a critical consideration in achieving Stage 2 Meaningful Use. Now extended through 2016, Stage 2 includes objectives to improve patient care through better clinical decision support, care coordination and patient engagement. Patient engagement metrics will require that more than 5% of a practice’s patients send secure messages to the provider and more than 5% of the patients access their health information online.[ii]

The Medicare Shared Savings Programs (MSSP) and the Partnership for Patients community-based care transitions program both have measures related directly to demonstrating an enhanced communication experience between patients and physicians that can lead to recognition and additional revenue for practices and hospitals. The NCQA Patient-Centered Medical Home certification also includes elements related to patient engagement. One of the critical certification factors requires contact with at least 50% of patients to develop and document self-management plans and goals.[iii]

Beyond regulations and certifications, patient engagement is also being shown to help meet the cost savings aspects of accountable care. Patients who are more engaged have fewer hospital stays, adhere more often to prescribed medical treatments, recover faster and are more satisfied with their care.[iv]

Engaged patients are also more successful at managing chronic illness than those who are not. More than 40% of Americans are living with at least one chronic disease, which overall cause seven in 10 deaths each year in the United States, according to the Centers for Disease Control and Prevention.

Getting Patients Involved in Their Own Health

As clinicians work more closely with patients who are trying to manage chronic illness, it is important to note that the time patients spend with physicians, nurses and other care providers represents a very small percentage of the overall time spent managing conditions or treatments. The patient and other caregivers are largely responsible for adhering to care plans and making the necessary lifestyle changes to accommodate chronic conditions. Patients who are educated about their conditions and engaged in the process will more likely succeed in keeping their chronic conditions in check.

So using a patient portal or similar technology would seem a rational, logical way for patients to learn more about their conditions and interact with care providers in a secure, HIPAA-compliant environment. Unfortunately, it isn’t as easy as that. With all of the rules, metrics and evidence that are mandated for the clinician community, there are no such rules in place that require compliance for patients.

A portal would allow patients to contact their doctor any time, day or night, to ask a question or relate treatment information. But few doctors are trained for or desire that type of high-touch interaction, especially since reimbursement for that type of interaction is rare. The United States also is facing a rather serious primary care shortage in many areas, one that will be exacerbated as up to 30 million uninsured obtain coverage under the Affordable Care Act. So what’s the best use of physician time – diagnosing and treating an increasing number of patients or answering questions by secure email?

Patient portals and other technologies that Meaningful Use is bringing into common usage will not move the needle toward smarter health choices on their own. The technology has to be helpful and interesting for patients, providing them with an easy way to connect with care providers when they need help and to get updates and reminders when needed.

This is why the idea of using care coordinators in the role of engaging patients when not in the physician office or receiving direct care is gaining traction. The goal of care coordinators would be to guide patients and help them to navigate the healthcare system so that they stay on track with their treatments between physician visits. Care coordinators would have a direct link to a patient’s physicians, bringing them in only when needed.

Secure messaging and emails could provide an easy way for patients to submit questions or take action when they are ready to do so. Platforms that can connect and share the nursing care plans between the care coordinator, caregivers and the patient could be highly effective, especially if there are issues resulting from chronic or acute conditions. This seamless connection would allow the care coordinator to pass along educational content and become part of a two-way mechanism for tracking medications in a manner that allows patients to update and print the list.

From there, embedding incentive management and gaming features into the portal would provide a reason for the patient to keep coming back to continue the engagement.

Technology platforms built to enable the connection between the patient and the care coordinator could be the missing pieces of the puzzle that would allow patients to become more involved in their health and allow the promise of patient engagement to become a reality.