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E-Patient Update:  When Your Tech Fails, Own It!

Posted on December 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.

I am reasonably comfortable with my primary care practice which, though not exactly chi-chi – no latte machine in the lobby! — does a reasonably good job with the basics of scheduling, payment, referrals and the like.  And I also like that my PCP is part of a multispecialty group linked together by an athenahealth EMR and portal, which makes it easier to coordinate my care.

But recently, I’ve run into some technical problems with the practice portal, repeatedly and inconveniently. And rather than take action, apologize or even acknowledge the problem on an executive level, the group appears to be doing nothing whatsoever to address the issue.

The issue I’m having is that while the portal is supposed to let you schedule appointments online, my last two didn’t show up in the group’s live schedule. This may not sound like a big deal, but it is. One of the appointments was to see a neurologist for help with blinding migraines, and trying to attend the non-existent meeting was a nightmare.

Because I needed my neurologist, I scraped myself out of bed, put on an eye mask to avoid extra light exposure – migraine makes you terribly light-sensitive – and had my husband guide me to the car. But when I walked into the lobby (peeking out from under the mask to avoid crashing into things) I was told that they had nothing for me on the schedule.

Almost crying at this point, and with migraine-induced tears streaming down my cheeks, I begged them to squeeze me in, but they refused. To add insult to injury, they all but told me that it must have been my fault that the appointment booking didn’t take. There was no “I’m sorry this happened” whatsoever, nor any suggestion that their technology might be glitchy. If I hadn’t been so sick I might have gotten into a screaming match with the supercilious receptionist, but given my condition I just slinked away and went back to bed.

I’ve since learned, from a much nicer clerk at the affiliated primary care practice, that the group has been getting scores of calls from similarly aggrieved patients whose time had been wasted – and health needs unmet. “Tell the doctor, so she can tell the practice management committee,” she told me. “This is happening all the time.”

Of course, because I write about health IT, I realize that practice leaders may be struggling with issues that defy an easy fix, but I’m still disappointed with their failure to respond publicly. There are many steps they could have taken, including:

* Putting a warning on their practice website, and (if possible) the portal that the scheduling function has issues and to double-check that their appointment registered
* Disabling the scheduling function entirely until they’re reasonably certain it works
* Putting a sign in on the practice’s front desk alerting patients about the problem
* Updating the practice’s “hold” message with an advisory

And that’s just what came to mind immediately. They could do postcards, email messages, letters, robocalls…I don’t care if they drive around town with a guy who shouts the message into a megaphone. I just want expect them to take responsibility and treat my time and health with respect. Sure, tech will go south, but if it does, own it! There’s no excuse for ignoring problems like these.

Healthcare Trade Groups Join To Evaluate mHealth Apps

Posted on December 29, 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 group of leading healthcare organizations, including HIMSS, the American Medical Association, the American Heart Association and DHX Group, have come together to evaluate mHealth apps. The new organization, which calls itself Xcertia, says members came together to foster knowledge about clinical content, usability, privacy, security and evidence of efficacy for such apps.

It’s hardly surprising that that healthcare groups would want to take a stand on the issue of health app quality. According to a study published late last year by the IMS Institute for Healthcare Informatics, there are at least 165,000 mHealth apps available on the iTunes and Android stores.

But what percentage of those apps are worth using? Nobody really knows. It’s hard to tell after casual use which apps are useful and which don’t live up to their hype, which protect patient privacy and which leave data open to prying eyes, and particularly, which offer some form of clinical benefit and which just waste people’s time. And without a set of formal standards by which to judge, it’s very hard to compare one with the other in a meaningful way.

This uncertainty is holding back mHealth adoption by doctors. According to a recent survey by the AMA, physicians are interested in using apps and related tools – in fact, 85% told researches that digital health solutions can have a positive impact on patient care – they’re also reluctant to “prescribe” apps until they understand them better. (There’s also a group of doctors I’ve encountered who say that until mobile apps are FDA-approved, they won’t take them seriously, but that may be another story.)

In late November, attendees at a recent AMA meeting moved the mHealth puck up the ice a little bit, adopting a set of proposed set best principles for mobile health design. The criteria they adopted for mobile apps and devices included that they should follow evidence-based practice guidelines, support data portability and interoperability, and have a clinical evidence base to support their use. But these guidelines are hardly specific enough to help doctors decide which apps to adopt.

So far, all Xcertia is willing to say about its plans is that it plans to develop a framework of principles that will “positively impact the trajectory of the mobile health app industry.” The guidelines should help both consumers and clinicians choose mHealth apps, the group reports.

Let’s hope those guidelines are less ho-hum than those coming out of the AMA meeting – after all, it certainly would be good if developers and providers had concrete standards upon which they could base their app efforts.

Is Lack of Security the Death Knell of Cloud Companies?

Posted on December 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.

In the eternal discussion of what’s more secure: cloud or in house, it was recently pointed out to me why many people now believe that a cloud company is more secure than anything you would implement in house. Here’s the reason: If a cloud company gets breached, they’re dead.

I think this is true. At least it’s true in healthcare. I don’t know many healthcare organizations that would select a cloud healthcare IT company that had just been breached. Not many. If you’re a healthcare cloud company and you get breached, your future is basically over as a company. There might be a few that could survive if they have enough money, if there are mitigating circumstances, etc, but that’s going to be pretty rare.

With this in mind, it’s easy to understand why a cloud based healthcare company is going to invest to ensure they don’t get breached. No startup founder or health IT company CEO wants to put their blood, sweat, and tears into a company that gets blown up because they didn’t address proper security and get breached.

What happens if a healthcare organization gets breached? If you’ve ever been there, it’s not a fun experience. It’s embarrassing. This is particularly true if your breach is large enough (500 or more individuals) to end up on the HHS Wall of Shame. I mean the HHS Breach Portal. Yes, there are often even fines associated with a breach as well. It’s not pretty and it’s not fun. However, most healthcare organizations that get breached continue practicing like usual. Sure, they likely make an investment in some more security, a proper risk assessment, etc, but the company still continues providing healthcare services like usual.

Fear isn’t always the best driver in life, but it can be a good one. Cloud healthcare companies have a healthy fear of being breached because their company’s future depends on it. That’s a powerful motivator to make sure you avoid breaches. I’m sorry to say that most healthcare organizations don’t have this same fear and motivation. Most of them still employ what I call the “Just Enough” approach to security and privacy. Note that it’s “Just Enough” to sleep at night as opposed to “Just Enough” to be secure. There’s a difference.

No doubt there are exceptions to the above on both sides of the aisle. Some cloud healthcare companies don’t do a good job securing their technology. Some healthcare organizations do a really excellent job securing their organizations. However, as a rule, I think it’s fair to say that most cloud healthcare companies are more secure than hosting something in house.

Rival Interoperability Groups Connect To Share Health Data

Posted on December 27, 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.

Two formerly competitive health data interoperability groups have agreed to work together to share data with each others’ members. CommonWell Health Alliance, which made waves when it included Cerner but not Epic in its membership, has agreed to share data with Carequality, of which Epic is a part. (Of course, Epic said that it chose not to participate in the former group, but let’s not get off track with inside baseball here!)

Anyway, CommonWell was founded in early 2013 by a group of six health IT vendors (Cerner, McKesson, Allscripts, athenahealth, Greenway Medical Technologies and RelayHealth.) Carequality, for its part, launched in January of this year, with Epic, eClinicalWorks, NextGen Healthcare and Surescripts on board.

Under the terms of the deal, the two will shake hands and play nicely together. The effort will seemingly be assisted by The Sequoia Project, the nonprofit parent under which Carequality operates.

The Sequoia Project brings plenty of experience to the table, as it operates eHealth Exchange, a national health information network. Its members include the AMA, Kaiser Permanente, CVS’s Minute Clinic, Walgreens and Surescripts, while CommonWell is largely vendor-focused.

As things stand, CommonWell runs a health data sharing network allowing for cross-vendor nationwide data exchange. Its services include patient ID management, record location and query/retrieve broker services which enable providers to locate multiple records for patient using a single query.

Carequality, for its part, offers a framework which supports interoperability between health data sharing network and service providers. Its members include payer networks, vendor networks, ACOs, personal health record and consumer services.

Going forward, CommonWell will allow its subscribers to share health information through directed queries with any Carequality participant.  Meanwhile, Carequality will create a version of the CommonWell record locator service and make it available to any of its providers.

Once the record-sharing agreement is fully implemented, it should have wide ranging effects. According to The Sequoia Project, CommonWell and Carequality participants cut across more than 90% of the acute EHR market, and nearly 60% of the ambulatory EHR market. Over 15,000 hospitals clinics and other healthcare providers are actively using the Carequality framework or CommonWell network.

But as with any interoperability project, the devil will be in the details. While cross-group cooperation sounds good, my guess is that it will take quite a while for both groups to roll out production versions of their new data sharing technologies.

It’s hard for me to imagine any scenario in which the two won’t engage in some internecine sniping over how to get this done. After all, people have a psychological investment in their chosen interoperability approach – so I’d be astonished if the two teams don’t have, let’s say, heated discussions over how to resolve their technical differences. After all, it’s human factors like these which always seem to slow other worthy efforts.

Still, on the whole I’d say that if it works, this deal is good for health IT. More cooperation is definitely better than less.

Slick Setups to Make Your Health Clinic’s Processes Simple

Posted on December 26, 2016 I Written By

The following is a guest blog post by Eileen O’Shanassy.

Medical technologies have come a long way since the days of manual appointment and check-in books, clip-board health information, gathering forms, and huge patient medical chart walls. Today, health clinics can enjoy far more simple and efficient processes with only a few changes to traditional methods of providing healthcare. Consider these following four easy-to-use and inexpensive technologies for your own health clinic.

Touchscreen Check-In Desks
You do not have to pay your front office staff any longer to check in patients. With this slick setup, a patient walks up to a desk that features a wide, large LCD monitor located inside the waiting room or near the receptionist’s desk. Instructions at this touchscreen check-in desk explain to the patient that they only need to tap the screen and then tap out the letters of their name using large virtual buttons to check themselves into your clinic. In some clinics that offer a variety of diagnostic and treatment services, patients also select a clinic area.

Health Information Kiosks
A lot of front office staff time is wasted every day providing patients with information that is already available on your clinic’s website or local affiliated health system’s site. With the slick setup of a health information kiosk, your front office staff can direct patients to the kiosk and return to other tasks. Beyond information about the services offered at your clinic and local healthcare systems, health information kiosks can also be set up to provide patients local news and weather conditions, health and safety tips, emergency alerts, and even details about local restaurants and businesses.

Identification Scanning Software
One of the slowest processes at a clinic with new patients is establishing a record that contains accurate personal and health information. Some healthcare systems now provide clinics with the ability to quickly access information about patients already in their medical data storage programs. This is done electronically via scanning software that can be used with a patient’s driver’s license, medical insurance card, or a special system healthcare card. This type of slick setup also makes it possible for your clinic to save important information about a patient who is entirely new to the area and share it with local specialists and their staff members in hospital and other facilities.

These are only a few examples of the types of slick setups that can make traditional processes in your health clinic simple. These and other cutting edge methods can also result in positive testimonials that attract more new patients to your clinic.

About Eileen O’Shanassy
Eileen O’Shanassy is a freelance writer and blogger based out of Flagstaff, AZ. She writes on a variety of topics and loves to research and write. She enjoys baking, biking, and kayaking. Check out her Twitter @eileenoshanassy. For more information on medical data storage and new technology check out Health Data Archiver.

The Importance of Communication in Healthcare and Thoughts on How To Do It Right

Posted on December 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.

A while back I had the chance to sit down with 4 healthcare experts to talk about healthcare communication. The panel consisted of:

  • Mandi Bishop, Chief Evangelist and Co-Founder of Aloha Health
  • Jessica Johnson, Director of Operations, Health Transformation at Dartmouth-Hitchcock Population Health Management
  • Ethan Bechtel, CEO at OhMD
  • Nathan Larson, Chief Experience Officer at ImagineCare
  • John Lynn, Founder of HealthcareScene.com

We had a wide ranging conversation about the importance of communication in healthcare and how to do it more effectively. This is a topic that should be of interest to all of us. Watch the full video conversation below:

Happy Holidays! What more could you want this holiday weekend than some great discussion from amazing people?

eClinicalWorks Warns Users About Patient Safety Risks

Posted on December 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.

EMR vendor eClinicalWorks has issued a warning to users about “potential patient safety risks” in its software, a very unusual step which is almost unheard of from vendors in this market.

If there are any meaningful care problems that could occur by using the company’s software, they could have a broad impact. According to the vendor, 115,000-odd physicians use its software, 850,000 healthcare professionals and 70,000 facilities.

Unlike many such announcements by software vendors – which typically identify, say a security vulnerability or a newly-identified bug – the press announcement on the topic is rather broad. In its press release on the subject, eClinicalWorks summarizes its goals as follows:

eCW is making this announcement to ensure that all participants in the healthcare process – clinicians, pharmacies, and patients and their family members or caregivers – are aware of key patient safety risks and are focused on the roles they can play in minimizing those risks.

But there’s certainly more. In what comes across as exasperation with providers who aren’t keeping up with advisories, eCW asks its users to implement software upgrades needed to address problems with medication management, electronic prescribing and the process of ordering tests and procedures.

Specifically, eCW notes that it needs providers to install upgrades issued back in December of last year. It also pleads with doctors to upgrade their eCW to the latest version of their software, which it issued in July of 2016, as well as asking users to upgrade to the most current version of the Multum or Medispan drug databases.

In addition to making these technical requests, eCW makes several operational suggestions, including that users should read every patient safety notice, designate a patient safety officer to serve as eCW liason, and asks providers to confirm order accuracy as well as training patients to do the same. It also urges providers to follow appropriate steps for modifying medications and to take special care with custom medications.

Then, in a particularly unusual move, the press release also speaks directly to patients, advising them to be educated about their care, to know their medications and orders and to confirm that tests performed are the right ones and med orders are accurate.

It remains to be seen how effective eCW’s public awareness strategy will be. After all, if your end users are so recalcitrant that they don’t bother to keep their critical software up to date, neither pleading nor shaming them is likely to do the trick. Plus, many users don’t upgrade EHR software because there’s a cost to upgrade the software (Not sure if eCW’s upgrades are free or not).

That being said, doctors using eClinicalWorks will have virtually no excuse they can offer if a patient is harmed by software they were privately and publicly warned to update. If its customers figure this out, perhaps fear of med mal litigation will achieve eCW’s purpose after all.

Online Reputation Management: Trending Topic or Industry Shift?

Posted on December 20, 2016 I Written By

The following is a guest blog post by Erica Johansen (@thegr8chalupa).

It seems that in healthcare this year online reputation management has taken center stage in conversations as consumers have a larger voice in the healthcare purchasing experience. Reviews, in particular, provide an interesting intersection point between social media technology and healthcare service. It is no surprise that there is pervasive, and exciting, conversation around this topic across the industry at conferences and online.

During the #HITsm chat on Friday, we had an excellent conversation about the value of online reputation management by physicians and other healthcare providers, and what lessons could be learned from one managing their own reputation online. During our chat, we asked the #HITsm community (as patients) about their behavior leaving and reading reviews as a part of their care selection process, as well as the role that social technology plays today in the patient experience. There were some exceptional insights during our conversation:

1. Should providers be interested in their online reputation? Does it matter? There was a resounding “yes” among attendees that attention should be given to a practice’s online brand.

2. As a patient, have you ever read a review after being referred to, or before selecting, a new physician? Perhaps unsuprisingly, most attendees supported trends in consumer behavior by reading reviews of physicians online.

3. Have you ever written an online review for a healthcare experience? If so, was it generally positive or negative? Suprisingly, the perspective of our attendees suggested that the consumption of reviews was more common than the creation of them. Most folks just won’t review unless they felt compelled by an experience that surpassed,or fell too short, of expectations.

4. Is there an expectation that providers (individual and/or organizational) respond to social media engagements by patients? Our attendees chimed in that maybe it isn’t so much that there is an expectation, but it could signifantly help a negative review or solidify a positive one.

5. What would a healthcare provider who is exceptional at managing their online reputation look like? Examples? Stellar examples shared illustrated folks that have harnessed the power of social media to augment their patient expierence and brand. For example:

Bonus. What lessons could be learned from managing your personal online reputation that could guide provider reputation management? This question took a different turn than I initially anticipated, however, for the better. Many insights shared included mentions to social platforms and meeting the patients where they are. There is so much opportunity for the next phase of healthcare social media as platforms begin to cater more to feature requests and uses based on consumer trends. (One great example of this is the Buy/Sell feature added to Facebook Groups.)

Additional thoughts? There were some flavorful insights shared during the chat that are worth an honorable mention. Enjoy these as “food for thought” until our next #HITsm chat!

I’d like to say a big “thank you” to all who participated in the last #HITsm chat (and are catching up after the fact)! You can view a recap of these tweets and the entire conversation here.

#HITsm will take a break for the next two weeks over the holidays, but we will resume in 2017 on Friday, January 6th with a headlining host Andy Slavitt (@ASlavitt) and the @CMSGov team (@AislingMcDL, @JessPKahn, @AndreyOstrovsky, @N_Brennan, @LisaBari, and @ThomasNOV).

MIPS Benefits and Pick Your Pace – MACRA Monday

Posted on December 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.

As promised, we’re back with another MACRA Monday looking at the MIPS Pick Your Pace options. However, before we dive into Pick Your Pace, we want to take a second to look back at the details of the MIPS incentives and penalties that are available as well. This really didn’t change in the final rule, so it’s review for those who have been following MACRA Monday since the beginning.

If you remember from last week’s MACRA Monday post, what you do in 2017 will determine your MIPS payment adjustment in 2019. Assuming you perform at the top level, you can get a full 4% positive payment adjustment to your Medicare Part B reimbursement (Note: It was pointed out to me that the MACRA program has to be budget neutral, so while they can give up to a 4% positive payment adjustment, it won’t be a 4% positive payment adjustment if enough practices aren’t penalized. With Pick Your Pace, hardly anyone will be penalized. On page 1282-1286 of the final rule it highlights this and points out that with the budget neutrality scaling, the upward adjustment is estimated to be under 1% for the base and 2.4% for exceptional performers. Thanks Lynn Scheps for the clarification!). Of course, if you don’t participate in MIPS, you’ll get a 4% penalty. That scales up to 9% in 2022. There are some exceptional performance bonuses as well, but we’ll cover that in a future MACRA Monday.

In the MACRA final rule, CMS added a number of other ways for doctors to participate in MIPS. They call the various options Pick Your Pace since the provider can choose how much they want to participate in MIPS in 2017. Here are the 3 MIPS Pick Your Pace options (and the Advanced APM for completeness’ sake):

As is laid out above, you can fully participate in MIPS for the entire year and get the largest positive payment adjustment. You can report on 90 days and receive at least a small positive payment adjustment and up to the full positive payment adjustment. Or you can just submit something to MIPS and that will have you avoid the negative MIPS payment adjustment.

The “Test Pace” option as it’s listed above needs some further clarification. Basically, if you don’t want to fully participate in MIPS, but want to avoid the negative payment adjustment you can just do 1 quality measure, 1 improvement activity, or the required advancing care information measures.

Clear enough? Basically, in 2017 they’ve made it so pretty much everyone should be able to at least do the Test Pace portion of MIPS and avoid the 4% negative payment adjustment. I don’t know of any practices where this wouldn’t be a reasonable goal. However, is that the best approach for a practice? I think not.

If I were advising a practice today, I’d suggest they shoot for full MIPS participation in 2017. Assuming they do well, they’ll get the full 4% payment increase and even could qualify for bonus payments. If they fall a little short, then they should still easily qualify for the MIPS partial year option which will provide them a small positive payment adjustment. If they experience a disaster with their MIPS participation, then they will still avoid any penalties.

Why is this my suggested route? MACRA and MIPS aren’t going anywhere. Sure, they might go through various iterations and subtle changes, but the move to this kind of reporting is here to stay and even a Trump presidency isn’t likely going to change this. Plus, you don’t want to be behind the 8 ball in 2018 when the full MIPS requirements will be upon us (Remember my post about thinking about MACRA like med school). You don’t want to get so far behind that you can’t catch up. If that’s still not enough, many people believe that the commercial payers are going to follow suit. Those that have participated in MACRA will be better prepared when they do.

Those are the details on MIPS pick your pace. We may take next week off from MACRA Monday for the holidays, but the next week we’ll be diving into more of the details of MIPS and other changes to the MIPS Performance Categories.

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

E-Patient Update: The Smart Medication Management Portal

Posted on December 16, 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.

As I work to stay on top of my mix of chronic conditions, one thing that stands out to me is that providers expect me to do most of my own medication tracking and management. What I mean by this is that their relationship to my med regimen is fairly static, with important pieces of the puzzle shared between multiple providers. Ultimately, there’s little coordination between prescribers unless I make it happen.

I’ve actually had to warn doctors about interactions between my medications, even when those interactions are fairly well-known and just a Google search away online. And in other cases, specialists have only asked about medications relevant to their treatment plan and gotten impatient when I tried to provide the entire list of prescriptions.

Sure, my primary care provider has collected the complete list of my meds, and even gets a updates when I’ve been prescribed a new drug elsewhere. But given the complexity of my medical needs, I would prefer to talk with her about how all of the various medications are working for me and why I need them, something that rarely if ever fits into our short meeting time.

Regardless of who’s responsible, this is a huge problem. Patients like me are being sent with some general drug information, a pat on the back, and if we experience side effects or are taking meds incorrectly we may not even know it.

So at this point you’re thinking, “Okay, genius, what would YOU do differently?” And that’s a fair question. So here’s what I’d like to see happen when doctors prescribe medications.

First, let’s skip over the issue of what it might take to integrate medication records across all providers’s HIT systems. Instead, let’s create a portal — aggregating all the medication records for all the pharmacies in a given ZIP Code — and allow anyone with a valid provider number and password to log in and review it.  The same site could run basic analytics examining interactions between drugs from all providers. (By the way, I’m familiar with Surescripts, which is addressing some of these gaps, but I’m envisioning a non-proprietary shared resource.)

Rather than serving as strictly a database, the site would include a rules engine which runs predictive analyses on what a patient’s next steps should be, given their entire regimen, then generate recommendations specific to that patient. If any of these were particularly important, the recommendations could be pushed to the provider (or if administrative, to staff members) by email or text.

These recommendations, which could range from reminding the patient to refill a critical drug to warning the clinician if an outside prescription interacts with their existing regimen. Smart analytics tools might even be able to predict whether a patient is doing well or poorly by what drugs have been added to their regimen, given the drug family and dosage.

Of course, these functions should ultimately be integrated into the physicians’ EMRs, but at first, hospitals and clinics could start by creating an interface to the portal and linking it to their EMR. Eventually, if this approach worked, one would hope that EMR vendors would start to integrate such capabilities into their platform.

Now I imagine there could be holes in these ideas and I realize how challenging it is to get disparate health systems and providers to work together. But what I do know is that patients like myself get far too little guidance on how to manage meds effectively, when to complain about problems and how to best advocate for ourselves when doctors whip out the prescription pad. And while I don’t think my overworked PCP can solve the problem on her own, I believe it may be possible to improve med management outcomes using smart automation.

Bottom line, I doubt anything will change here unless we create an HIT solution to the problem. After all, given how little time they have already, I don’t see clinicians spending a lot more time on meds. Until then, I’m stuck relying on obsessive research via Dr. Google, brief chats with my frantic retail pharmacist and instincts honed over time. So wish me luck!