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E-Patient Update: A Bad Case Of Hyperportalotus

Posted on September 30, 2016 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.

Lately, the medical profession has seen an increasing incidence of a new condition tentatively identified as “hyperportalotus” — marked by symptoms of confusion, impatience, wasted time and existential dread. Unlike many newly-identified medical problems, the cause for this condition is well understood. Patient simply have too many portals being thrust at them.

As a patient with a few chronic illnesses, I see several specialists in addition to a primary care doctor. I’ve also been seen recently at a community hospital, as well as an urgent care center run by a different health system. I have access to at least seven portals, each, as you probably guessed, completely independent of each other.

Portals in play in my medical care include two instances of Epic’s MyChart, the Allscripts FollowMyHealth product and an athenahealth portal. (As an aside, I should say that I’ve found that I like athenahealth’s product the most, but that’s a story for another day.)

Because I am who I am – an e-patient dedicated to understanding and leveraging these tools – I’m fairly comfortable working with my providers on this basis. I simply check in with the portal run by a given practice within a few days of my visit, review reports and lab results and generally orient myself to the flow of information.

Too Much Information
So, if I can easily access and switch between various portals, what’s the big deal? After all, signing up for these portals is relatively simple, and while they differ in how they are organized, their interfaces are basically the same.

The problem is (drumroll…) that most patients aren’t like me. Many are overwhelmed by their contact with the medical system and feel reluctant to dig into more information between visits. Others may not feel confident that they understand the portals and shy away reflexively.

Take the case of my 70-something father. My dad is actually pretty computer-savvy, having worked in the technology business for many years. (His career goes all the way back to the days of punch cards.) But even he seems averse to signing up for MyChart, which is used by the integrated health system that provides all of his inpatient and outpatient care.

Admittedly, my father has less contact with doctors and hospitals than I do, so his need to review medical data might be less than mine. Nonetheless, it’s a shame that the mechanics of signing up for and using a portal are intimidating to both he and my mother.

A Common Portal
All this being said, the question is what we can do about it. I have a theory, and would love to know what you think of it.

What if we launched an open source-based central industry portal to which all other portals could publish basic information?  This structure would take proprietary vendors’ interest in controlling data out of the picture. Also, with the data being by its very nature limited (as consumers never get the whole tamale) it would answer objections by providers who feel that they’re giving away the store with the patient data.

Of course, I can raise immediate and powerful objections to my own proposal, the strongest of which is probably that we would have to agree on a single shared standard for publishing this data to the central megaportal. (And we all know how that usually works out.)

On the other hand, such approach has much to recommend it, including better care coordination and hopefully, stronger patient engagement with their health. Maybe I’m crazy, but I have a feeling that this just might work. Heck, maybe my father would bother looking at his own medical information if he didn’t have to develop hyperportalotus to do it.

Fall Health IT Conference Schedule

Posted on September 29, 2016 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 usual, Healthcare Scene has a really full fall schedule of Healthcare IT Conferences (We’re doing local healthcare marketing meetups at most of them too). The sad thing is that there’s pretty much a conference every week which we’d like to attend and we have to say no to so many. That said, we’re extremely excited by all the events we’ll be attending this Fall. We can’t wait to mix and mingle with some of the smartest people in healthcare IT.

I’m particularly excited by the return of the Digital Health Conference in New York City December 2016. We’ve been working with NYeC, who organizes the conference, since the very beginning to help promote the event. It’s a great event that always brings out the New York healthcare community and others from around the country to talk about digital health and where it’s headed. They always have great keynote speakers and amazing innovations on stage. For example, I saw my first ever live streamed surgery on Google Glass at this conference.

This year they have keynotes from Robert Watcher, MD which many will know for his book “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age” and Steven Johnson who wrote “How We Got to Now” and “Where Good Ideas Come From.” I think both speakers will provide some interesting insights into healthcare. I’m particularly excited to hear Steven Johnson talk about innovations and where they come from. We can use more of that in healthcare. It will be interesting to think about how healthcare is suppressing those good ideas.

There’s a lot more that gets me excited about the event. They have a session focused on SHIN-NY (The Statewide Health Information Network for New York). You might remember my previous post about the SHIN-NY getting funded as a kind of “public utility” funding model. I’m interested in learning how that’s progressed. I also noticed sessions on 3D printing and the Cancer Moonshot which should be interesting. You can check out the full conference program here.

Since Healthcare Scene is a partner with the conference, we’ve gotten them to offer our readers a 15% discount to attend the Digital Health Conference. All you need to do is use the promo code HCS to get a 15% discount off your registration. The early bird pricing for the event ends October 14, 2016, so be sure to take advantage of the lower price now.

We hope to see a lot of readers at the NYC event or at one of the other EHR and Health IT conferences we’ll be attending. There are few things we enjoy more than meeting readers in person. So, don’t be shy. Let us know if you’ll be there so we can say hi in person.

The Exciting Future of Healthcare IT #NHITWeek

Posted on September 28, 2016 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.

One time I went to my wife’s OB/GYN appointment and I was in shock and awe with how well the doctor remembered my wife’s past pregnancies. Literally down to the tear that occurred. The reason I was in shock was that she prefaced her memory of my wife’s medical history with “Your old chart is off in storage, but as I recall you had a…”

While year later I’m still impressed with this OB/GYN’s ability to remember her patients, I know that this is not always the case. Doctors are humans and can’t possibly remember everything that occurred with every patient. Humans have limits. In fact, doctors deserve credit that they’ve provided such amazing medical care to so many patients despite these limits.

My esteem for doctors grows even greater when I think of the challenges associated with diagnosing computer problems (Yes, I am the nerd formerly known as @techguy). It’s not easy diagnosing a computer problem and then applying the fix that will remedy the problem. In fact, you often find yourself fixing the problem without really even knowing what’s causing the problem (ie. reinstall or reboot). While fixing computers is challenging, diagnosing and treating the human body has to be at least an order and probably two or more orders of magnitude more complex.

My point is that the work doctors do is really hard and they’ve generally done great work.

While I acknowledge the history of medicine, I also can’t help but think that technology is the pathway to solving many of the challenges that make doctors lives so difficult today. It seems fitting to me that IT stands for Information Technology since the core of healthcare’s challenges revolve around information.

Here are some of the ways technology can and will help:

Quality Information
The story of my wife’s OB/GYN is the perfect illustration of this potential. Doctors who have the right information at the point of care can provide better care. That’s a simple but powerful principle that can become a reality with healthcare IT. Instead of relying on this OB/GYN’s memory, she could have had that information readily available to her in an EHR.

Certainly, we’re not perfect at this yet. EHR software can go down. EHR can perpetuate misinformation. EHRs can paint the incorrect picture for a patient. However, on the whole, I believe an EHRs data is more accessible and available when and where it’s needed. Plus, this is going to get dramatically better over time. In some cases, it already is.

Deep Understanding of Individual Health Metrics
Health sensors are just starting to come into their own. As these health sensors create more and more clinically relevant data, healthcare providers will be empowered with a much deeper understanding of the specific health metrics that matter for each unique patient. Currently, doctors are often driving in the dark. This new wave of health sensors will be like turning the lights on in places that have never seen light before. In some cases, it already is.

Latest Medical Research
Doctors do an incredible job keeping up on the latest research in their specialty, but how can they keep up with the full body of medical knowledge? Even if they study all day and all night (which they can’t do because they have to see patients), the body of medical knowledge is so complex that the human mind can’t comprehend, process, and remember it all. Technology can.

I’m not suggesting that technology will replace humans. Not for the forseeable future anyway. However, it can certainly assist, inform, and remind humans. My phone already does this for me in my personal life. Technology will do the same for doctors in their clinical life. In some cases, it already is.

Patient Empowerment
Think about how dramatic a shift it’s been from a patient chart which the patient never saw to EHR software that makes your entire record available to patients all the time. If that doesn’t empower patients, nothing will. I love reading about how many kings use to suppress their people by suppressing information. Information is power and technology can make access to your health information possible.

Related to this trend is also how patients become more empowered through communities of patients with similar conditions and challenges. The obvious example is Patients Like Me, but it’s happening all over the internet and on social media. This is true for chronic patients who want to find patients with a rare condition, but it’s also true for patients who are finding the healthcare system a challenge to navigate. There is nothing more empowering than finding someone in a similar situation that can help you find the best opportunities and solutions to your problems.

In some cases, patient empowerment is already happening today.

Yes, I know that many of the technologies implemented to date don’t meet this ambitious vision of what technology can accomplish in healthcare. In fact, many health technologies have actually made things worse instead of better. This is a problem that must be dealt with, but it doesn’t deter me from the major hope I have the technology can solve many of the challenges that make being a doctor so hard. It doesn’t deter me from the dream that patients will be empowered to take a more active role in their care. It doesn’t deter me from the desire to leverage technology to make our healthcare system better.

The best part of my 11 years in healthcare IT has been seeing technology make things better on a small scale (“N of 1” –@cancergeek). My hope for the next decade is to see these benefits blow up on a much larger scale.

President’s Message for National Health IT Week #NHITWeek

Posted on September 27, 2016 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 week is National Health IT Week. I’m not sure why we need a week for it. Some of us celebrate health IT all year round. That said, at least it’s an opportunity for some people that could impact healthcare IT to take some time to think about it. A good example of this was that President Obama put out a letter for National Health IT Week (Side Note: It’s kind of funny that it’s still a “letter” and not a blog post or Tweet or Snap or something else. It’s interesting how letters keep subsisting in electronic format. Hmm…sounds a bit like healthcare.). Here’s an excerpt of what he said:

During National Health IT Week, we recommit ourselves to improving the health of our citizenry using the breakthrough technologies of our time and reaching for the next frontier of innovation…Because of our collective efforts, 97 percent of our Nation’s hospitals and three-quarters of doctors are using electronic records to care for their patients…These efforts help advance our Administration’s goal of fostering the seamless and secure flow of electronic health information when and where it is needed most. Though there is more to be done to realize a healthcare system that fits each of our needs, I am confident that if we continue working together, we can build a future of greater health and prosperity for coming generations.

While I’d like to think that this week has caused the President to spend some time thinking about healthcare IT, I’m not sure it really makes any difference. Besides the fact that some staffer or ONC itself probably did most of the work for the letter, the letter illustrates to me that the President doesn’t really understand the challenges that face healthcare IT. That’s unfortunate because it means we won’t see any real push to change things from him.

Just to be clear, I’m not saying the President should be an expert on healthcare IT and I’m certain that few people in Congress know much more about it than he does. They’re all likely in the same position the President is in with too many challenges and limited time. They can only dive in deeply on so many of them.

The thing that disturbs me about this letter is that it’s likely the same position that our government has had for health IT since pre-meaningful use. In fact, it’s likely why meaningful use was included so easily in the ARRA stimulus package. Is Health IT good? Well, electronic has been good in every other industry. So, that sounds good. Can you transfer bits and bytes of health data better than paper? Yep! So, EHR should make sharing data easier. Conclusion: Let’s keep doing more EHR and healthcare will be better and healthcare data sharing will happen.

It’s this naivety that’s gotten us where we are today.

My cause for optimism is that the people in government positions over healthcare like Andy Slavitt, Acting Director of CMS, do have a much better pulse on what’s happening in healthcare IT. They understand physician burnout. They understand overwhelming doctors with unnecessary and useless documentation. They understand data blocking and the pressures healthcare organizations face to not share health data. I’m not saying they have all the solutions. These are challenging problems, but I’m hopeful because they do understand these problems much better than most people give them credit.

Will we see much change? The jury is still out. Those at HHS only have so many levers they can pull. I do hope they can find ways to encourage without stifling innovation. I hope they focus on collecting useful data as opposed to possibly useful data. I hope they stop wasting money on EHR certification which provides no benefit and causes a lot of harm and they instead focus on a meaningful EHR interoperability certification.

Most of all, I hope they’re not afraid to focus on one thing that’s extremely valuable and doable (ie. interoperability) and set aside the 100s of other things which have questionable value. Wouldn’t we all rather have CMS do 1 thing really well as opposed to doing 100 things poorly?

Today I focused on some government health IT perspectives. Tomorrow I’ll talk about some of the other healthcare IT trends that get me excited and a few that scare me. Happy National Health IT Week!

Top 10 Reasons for Full EHR Data Migration

Posted on September 26, 2016 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.

EMR switching has become a really hot topic in healthcare IT and I predict that it’s only going to become more important. EHR vendors will continue to consolidate which will force healthcare organizations to switch EHR software. Health systems will continue to acquire healthcare organizations which will also drive EHR switching. Given these trends, it’s important to have a good answer to the question “Should we migrate our EHR data to the new EHR or not?

Galen Healthcare Solutions has put out a detailed whitepaper on EHR data migration that does a great job highlighting best practices for EHR data migration based on their decade of clinical data migration experience. Together with the whitepaper, they offer these 10 reasons a healthcare organization should migrated their EHR data:

  1. Eliminate Legacy Systems
  2. Lower Costs
  3. One System for All
  4. Maximize Productivity
  5. Strengthen Compliance
  6. Prescribe Electronically
  7. Enhance Operational Efficiency
  8. Reduce Human Error
  9. A Greener Solution
  10. Meet Quality Measures

They obviously go into a lot more detail for each of these 10 points in their Free EHR switching whitepaper, but even just looking at the list it’s pretty compelling. At the end of the day for me, the overarching reason to migrate your EHR data is number 7 on the list: Enhancing Operational Efficiency. Is there anything less efficient than limping along an old EHR system that people quickly forget how to use? It’s inefficient for the IT people, but even less efficient for the end users that want access to the clinical data.

Don’t get me wrong. I’m not saying that EHR data migration is easy work. We’d like to think that you just export the data from your old EHR and import it into your new EHR. That’s now how it works. Check out the complex process that Galen uses to do an EHR data migration:
ehr-data-migration-process
You can certainly take out some of the steps in this chart if you don’t care about the integrity of your data. Yep, that’s a reality that exists in no healthcare organization. The integrity of your health data really matters in healthcare. People’s lives are on the line.

The problem is that if the data is stuck in your old legacy EHR and not accessible, then it’s as good as gone. The ideal situation is to migrate your EHR data to your new system in a way that the integrity of the data is maintained. That’s something that takes real experience and expertise to do it right. However, when done right it you can gain all the benefits of accessible data along with the ability to sunset your old EHR application.

Have you switched EHR software? How did you approach EHR data migration? What would you have done the same or different?

Galen Healthcare Solutions is a sponsor of the Tackling EHR & EMR Transition Series of blog posts on Hospital EMR and EHR.

The Waiting Room – A Patient’s First Impression

Posted on September 23, 2016 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 post is sponsored by Samsung Business. All thoughts and opinions are my own.

We’ve all heard about the importance of first impressions. They last a long time and happen very quickly. The same is true for a medical practice. Patients’ first impression of a medical practice is the waiting room and that impression can last a very long time. What have you done to improve your patients’ experience in the waiting room?

Instead of doing a bunch of small things in your waiting room, I suggest you focus on creating one specific WOW! factor that patients will remember. In many cases people are turning to digital signage to provide this wow factor. Combine amazing content with some amazing digital signage like a curved TV, 3D TV, or massive screen and you can quickly implement the WOW! factor in your waiting room.

These type of memorable experiences for patients in your waiting room are the fuel that feeds social media and physician rating services today. If you want patients to share their experience at your office on social media or rate you highly on the various physician rating websites, start by WOWing them in your waiting room. Almost all of your patients now arrive with a phone in their pocket which they can use while they wait to provide your practice a quality rating. Leverage that as an asset.

I’ve heard some people argue that digital signage isn’t valuable anymore in the exam room because patients all show up with their own smartphones and tablets. They argue that patients have their heads buried in their phones and so they never see the digital signage you put in the exam room. This couldn’t be further from the truth.

The reality is that most of us with smartphones have become quite habituated to what people call the second screen experience. More and more people are watching TV while playing on their smartphone. It’s normal for us to be processing what’s on a TV while keeping an eye on our smartphone at the same time. The same thing happens in the waiting room when you provide a compelling digital experience. We consume both the TV and our smartphone.

Leveraging a high-quality digital experience in your waiting room provides a better patient experience overall. What’s the worst part of a waiting room? You have to wait. What’s the solution? We all have experienced a long flight or car ride that felt like it was much shorter thanks to some sort of digital media experience. This same experience can be had by patients if you invest in the right digital signage and content. Shorter wait times lead to better physician ratings in ambulatory practices and better HCAHPS scores in hospitals.

How have you approached your waiting room? Is there something unique or interesting you’ve done that’s made the patient experience better? What kind of first impression are you making on your patients?

For more content like this, follow Samsung on Insights, Twitter, LinkedIn , YouTube and SlideShare.

How To Choose Tools For Physician-Patient Engagement

Posted on September 22, 2016 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.

To transition from fee-for-service reimbursement to value-based care, it’s pretty much a given that we have to do a better job of getting patients engaged with their physicians and overall plan of care. However, despite the array of intriguing digital health and mobile technologies we have available to get the job done, it’s still not clear exactly how to do it.

But according to one health IT exec, it all boils down to understanding how the various tools and technologies work and integrating them into your practice. Dr. Ali Hussam, CEO of outcomes data collection firm OBERD, suggests that the following tools are particularly important. I’ve listed his suggestions, and added some thoughts of my own:

  • Educational technologies: Physicians can use these tools to make sure patients are prepared to have an intelligent discussion of their health status, he notes. My take: It’s hard to argue that this makes sense; in fact, this concept is so important that I’m surprised it isn’t mentioned more often as part of the broader patient engagement picture.  
  • Electronic questionnaires: Hussam argues that since value-based care calls for quantifiable outcome measurements, it’s smart to use electronic questionnaires, which are more appealing, efficient and sophisticated than paper tools. My response to this is that while it’s a good idea, it will be important that the questionnaires be based on well-defined measures which the provider organization trusts, and these may not be easy to come by at first.
  • Wearables: Patients may already be using wearables to monitor their own health metrics, but it’s time to make better use of their presence, Hussam suggest. Physicians can step up their value by using the information to improve the quality of health discussions and intervene in response to the data if needed.  It’s hard to argue that he’s right about the potential uses of wearables. However, there’s a lot of doubt about their accuracy, so my sense is that many physicians are still reluctant to make use of them given the clinical accuracy questions which still bedeviled these devices.

Along with recommending these approaches to engagement, Hussam offers some tips for implementing patient engagement technology, including:

  • Focus on patient outcome: Hussam recommends sending a patient-determined outcome as the focus of care, and explaining to patients how engagement technology can help them meet this goal. Plain and simple, this sounds like an excellent idea, as patients are more likely to succeed at meeting goals they have embraced.
  • Solicit feedback: Effective engagement tools “should offer patients a sense of individual attention and intimacy by soliciting feedback about individual patients’ entire healthcare experience,” along with offering care data. He argues, I think compellingly, that this exchange of information could help providers succeed under merit-based incentive payment programs.
  • Encourage responses to questionnaires: As Hussam noted previously, providers must collect data to succeed at outcome-based payment models. But he also notes correctly that these questionnaires and help patients achieve their desired health outcomes by tracking what’s going on with their health. No matter how you couch things, however, patients may need additional encouragement to fill out forms. Perhaps it would make sense to have med techs go through the questionnaires with patients prior to their physician encounter, at least at first.

As Hussam’s analysis suggests, engaging patients isn’t just a matter of presenting them with shiny new technologies. It’s critical to align patient use of the technologies with goals they hope to meet, and to explain how the tools can get them there.

Otherwise, both patients and providers will see little benefit from throwing engagement tools into the mix.

Yet Another Study Says EMRs Contribute to Physician Burnout

Posted on September 21, 2016 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.

A Mayo Clinic study recently concluded that – surprise, surprise – that physicians who used EMRs were less likely to be satisfied with the amount of time spent on clerical tasks. But from where I sit, while the story certainly deserves attention, it’s also worth considering how this fits into the problem of physician burnout on the whole.

First, let’s review the study itself. To conduct the study, which appeared in the Mayo Clinic Proceedings, researchers connected with 6,375 physicians in active practice, 5,389 of which (84.5%) reported using EMRs. Meanwhile, of 5,892 physicians who said that CPOE was relevant to their practice specialty, 4,858 (82.5%) said they used CPOE technology.

Researchers concluded that physicians who use EMRs and CPOE had lower satisfaction with time spent in clerical tasks and higher rates of burnout, including when the data was adjusted for age, sex, specialty, practice setting and hours worked per week. The bottom line, researchers said, was that this large national study demonstrated that satisfaction with EMRs and CPOE was generally low.

Now let’s take a look at the big picture on physician burnout. One comprehensive take comes from the American Academy of Family Physicians, whose position paper on the subject includes the following definition of burnout: “A syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feeling of cynicism (depersonalization), and a low sense of personal accomplishment.”

The AAFP paper, which points out that the phenomenon has been studied for decades, notes that 45.8% physicians are considered to be experiencing at least one symptom of burnout. According to a recent broad-based study, that there is currently a 35.2% overall burnout rate among U.S. physicians.

According to research cited by the AAFP, there’s still no definitive data on what causes physician burnout, but notes that common drivers of family physician burnout include paperwork, feeling undervalued, frustration referral networks, difficult patients, medicolegal issues, and challenges in finding work-life balance.

While I don’t want to minimize the impact that a badly-designed EMR can have a negative impact on a physician’s practice, or underplay the findings of the Mayo study cited above, I think it’s worth noting that the group doesn’t cite EMRs as a specific cause of burnout.

Clearly, physicians don’t like using EMRs for administrative work — and it even appears that they would rather use paper to handle such chores. However, let’s not kid ourselves into thinking that doctors loved documenting on paper either. Complaints about not wanting to finish their charts were common in the paper world too.

And the truth is, as EMRs have gradually shifted from being vehicles to support billing to richer clinical documentation and support tools, it may very well have become harder to use them for routine administrative tasks. Vendors probably need to reconsider yet again the balance between clinical and administrative features, and how effective both are.

That being said, I think it’s important not to forget that physicians are facing many, many challenges, most of which began grinding away at their independence and self-respect well before EMRs became an established part of the picture.

Unfortunately, it’s likely that for some physicians, feeling forced to adopt an EMR has proven to be the straw that broke the camel’s back. And they certainly deserve a hearing. But if in the process, we allow ourselves to lose sight of the countless other problems physicians are struggling with, we are doing them a disservice. Addressing physicians’ EMR issues won’t fix everything that’s broken here.

E-Patient Update:  Keeping Data From Patients Has Consequences

Posted on September 20, 2016 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.

Given who I am – an analyst and editor who’s waist-deep in the health IT world – I am primed to stay on top of my health data, including physician notes, lab reports, test results and imaging studies. Not only does it help me talk to my doctors, it gives me a feeling of control which I value.

The thing is, I’m not convinced that most physicians support me in this. Time and again, I run into situations where I can’t see my own health information via a portal until a physician “approves” the data. I’ve written about this phenomenon previously, mostly to wring my hands at the foolishness of it all, but I see the need to revisit the issue.

Having given the matter more thought, I’ve come to believe that withholding such data isn’t just unfortunate, it’s harmful. Not only does it hamper patients’ efforts to manage their own care effectively, it reveals attitudes which are likely to hold back the entire process of transforming the health system.

An Example of Delayed Health Data
Take the following example, from my own care. I was treated in the emergency department for swelling and pain which I feared might be related to a blood clot in my leg. The ED staff did a battery of tests, including an MRI, which concluded that I was actually suffering from lumbar spine issues.

Given that the spinal issue was painful and disabling, I made an appointment for follow up with a spine specialist for one week after the ED visit. But despite having signed up with the hospital’s portal, I was unable to retrieve the radiologist’s report until an hour before the spine specialist visit. And without that report the specialist would not have been able to act immediately to assist me.

I don’t know why I was unable to access the records for several days after my visit, but I can’t think of a reason why it would have made sense to deprive me of information I needed urgently for continued care. My previous experience, however, suggests that I probably had to wait until a physician reviewed the records and released them for my use.

Defeating the Purpose
To my way of looking at things, holding back records defeats the purpose of having portals in the first place. Ideally, patients don’t use portals as passive record repositories; instead, they visit them regularly and review key information generated by their clinical encounters, particularly if they suffer from chronic illnesses.

It’d be a real shame if conservative attitudes about sharing unvetted tests, imaging or procedure data undercut the benefits of portals. While it’s still not entirely clear how we’re going to engage patients further in managing their health – individually or across a population – portals are emerging as one of the more effective tools we’ve got. Bottom line, patients use them, and that’s a pretty big deal.

I’m not saying that patients have never overreacted to what looked like a scary result and called their doctor a million times in a panic. (That seems to be the scenario doctors fear, from conversations I’ve had over time.) But my guess is that it’s far less common than they think.

And in their attempts to head off a minor problem, they’re discouraging patients from getting involved with their care, which is what they need patients to do as value-based care models emerge. Seems like everyone loses.

Sure, patients may struggle to understand care data and notes at first, but what we need to do is educate them on what it means. We can’t afford to keep patients ignorant just to protect turf and salve egos.

Details for 3 MIPS Performance Categories – MACRA Monday

Posted on September 19, 2016 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 post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Last week we got a bit side tracked on MACRA Monday as we covered the news about modifications to the MACRA timeline. That seems to be a welcome change. As we mentioned at the end of our post on the MIPS performance categories and MIPS composite score, now we’re going to start diving into the details of those performance categories starting with: Quality Performance, Resource Use (Cost), and the new Clinical Practice Improvement Activities Category.

Quality Performance Category
This category is a replacement for PQRS, but is a reduction from 9 to only 6 measures. Plus, there is no longer a domain requirement. MIPS also expands the program to include close to 300 measures. To combat this explosion of options, they’ll also be offering specialty specific measure sets so that each specialty can more easily identify the measures that might be best for their specialty.

The Quality Performance category makes up 50% of the MIPS composite score.

Resource Use (Cost) Category
The resource use category is also often called the cost category and is a replacement of the value based modifier. The great part of the resource use category is that there is no data submission required to report your work in this category. Instead, this MIPS category will be calculated based on your Medicare claims. MACRA will add 40+ episodic specific measures so providers have more options to participate in this category.

The Resource Use (Cost) category makes up 10% of the MIPS composite score.

Clinical Practice Improvement Activities Category
The CPIA (Clinical Practice Improvement Activies) category that is the new category created as part of MACRA. It will include 90+ activities to choose from and you must participate in a minimum of one activity. Small practices (ie. 15 or fewer professionals) can participate in 2 activities and receive full credit for CPIA. Practices participating as a Patient Centered Medical Home (PCMH) also receive full credit for this category. Participation in an APM gives you 50% credit.

The Clinical Practice Improvement Activities category makes up 15% of the MIPS Composite Score.

That’s the general overview for these three MIPS performance categories. We’ll cover the Advancing Care Information category next week since it’s a bit more complicated.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.