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New EHR Certification Rules Including Self-Declaration – MACRA Monday

Posted on September 25, 2017 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 (QPP) and related topics.

Elise Sweeney Anthony and Steven Posnack recently announced on the ONC Health IT Blog two major changes to the EHR certification program. In some ways, it shows a maturity of the EHR certification program, but in other ways, it’s ONC kind of taking a more hands off approach to EHR certification.

Here are the two big changes they made:

  1. Approving more than 50% of test procedures to be self-declaration; and
  2. Exercising discretion for randomized surveillance of certified health IT products.

The first one is really fascinating since they’re making 30 out of the 55 certification criteria as “self-declaration only.” That basically means that EHR vendors will just have to claim they meet the requirements. The ONC-ACBs won’t be certifying those 30 test procedures. In many ways, it reminds me of the meaningful use self-attestation. Does that mean that ONC-ACBs will cut their costs in half? Don’t be holding your breath on that one.

Let’s just hope that most EHR vendors don’t self-certify the way eCW approached EHR certification. Although, the eCW EHR certification issues are the perfect example of why a company self certifying their EHR software or the ONC-ACB certifying the EHR software is just about the same. I haven’t seen which test procedures will be self-declared, but my guess is that it was the ones that the ONC-ACBs weren’t really doing much to test and certify anyway. Ideally, this will free up the ONC-ACBs to dive deeper into the 25 test procedures they’ll still complete so they can avoid another eCW like incident.

Some might wonder why we don’t just take the self-declared EHR certification tests altogether if there’s no one that’s going to be checking them. What those people miss is that the self-declaration still keeps the EHR vendors on the hook for properly implementing the EHR certification criteria. If it’s discovered that they claimed to be compliant but aren’t, then the government can go after the EHR vendor for false claims.

The second change has me a little more puzzled. I’m not sure why they would want to release ONC-ACBs from the requirement to randomly audit EHR certifications. Maybe they didn’t discover any issues during their random audits and so they didn’t see a need to continue them. Or maybe the ONC-ACBs said they were going to pull out as certifying bodies if the government didn’t lighten the EHR Certification load. This is all conjecture, but they could be some of the reasons why ONC decided to make this change. They did offer the following insight into their reasoning:

This exercise of enforcement discretion will permit ONC-ACBs to prioritize complaint driven, or reactive, surveillance and allow them to devote their resources to certifying health IT to the 2015 Edition.

I wonder how many complaints the ONC-ACBs have gotten about the EHR software they’ve certified. Have they just been so overwhelmed with complaints that they need more time to deal with those complaints and so audits aren’t needed? I’d be surprised if this was the case. At this point I imagine most people with EHR certification issues will be calling the whistle blower attorneys, but I could be wrong.

All in all, I don’t think these EHR certification changes are a huge deal. It’s largely a maturing of the EHR certification program and does little to help the EHR certification burden on software vendors. Maybe the ONC-ACBs will charge a little less for their certification, but that’s always been a negligible cost compared to the development costs to become a certified EHR. I’m sure the ONC-ACBs are happy with these changes though.

What do you think of these changes? Any other impacts I haven’t described above that we should consider?

What’s Involved In Getting To EHR 2.0?

Posted on September 22, 2017 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.

While the current crop of EHRs have (arguably) served a useful purpose, I think we’d all agree that there’s a ton of room for improvement. The question is, what will it take to move EHRs forward?

Certainly, we face some significant obstacles to progress.

There are environmental factors in play, such as reimbursement issues.

There’s the question of what providers will do with existing EHR infrastructure, which has cost them tens or even hundreds of millions of dollars if next-gen EHRs call for a new technical approach.

Then, of course, there’s the challenge of making the darn things usable by real, human clinicians. So far, we simply haven’t gotten anything that solves that issue yet.

That doesn’t mean people aren’t considering the issue, however. One health IT leader that’s stepped up to the plate is Dr. John Halamka, chief information officer of the Beth Israel Deaconess Medical Center and CIO and dean for technology at Harvard Medical School.

In his Life As Healthcare CIO, Halamka lays out the changes he sees as driving the shift to EHR 2.0. Here are some of his main points:

  • Regulators are shifting their focus from prescribing certain types of EHR functionality to looking at results technology achieves. This supports the healthcare industry’s movement from a data recording focus to an outcomes focus.
  • With doctors being pulled in too many directions, it will take teams to maintain patient health, this calls for a new generation of communication and groupware tools. These tools should include workflow integration, rules-based escalation messages, and routing based on time of day, location, schedules, urgency, and licensure.
  • With value-based purchasing gradually becoming the norm, EHRs need new capabilities. These should include the ability to document care plans and variation from those plans, along with outcomes reported from patient-generated healthcare data. Eventually, this will mean the dawn of the Care Management Medical Record, which enrolls patients and protocols based on their condition then ensures that patients get recommended services.
  • EHRs must be more usable. To accomplish this, it’s helpful to think of EHRs as platforms upon which entrepreneurs can create add-on functionality, along the lines of apps that rest on top of mobile operating systems.
  • Next-gen EHRs need to become more consumer-driven, making patients an equal member of the care team. Although existing EHR models do have patient portals, they aren’t robust enough to connect patients fully with their care, and they don’t include tools helping patients navigate their care system.

As far as I can tell, Dr. Halamka has covered the majority of issues we need to address in transitioning to new EHR models. I was also interested to learn that regulatory bodies have begun to “get it” about the limitations of demanding certain functions be included in an EHR system.

I’m still left with one question, however. How does interoperability fit into this picture? Can we even get to the next generation of EHRs without answering the question of how they share data between one another? To me, it’s clear that the answer is no, we can’t leave this issue aside.

Other than that, though, I found Dr. Halamka’s analysis to be fairly comforting. Nothing he’s described is out of reach, unless, of course, vendors won’t cooperate. I think that as providers reach the conclusions he has, they’ll demand the kind of functionality he’s outlined, and vendors will have no choice but to pony up. In other words, there might actually be light at the end of the EHR tunnel.

Virtual Reality Offers New Options For Healthcare Data Analysis

Posted on September 21, 2017 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 don’t know about you, but I’ve always been interested in virtual reality. In fact, given my long-time gaming habit, I’ve been waiting with bated breath for the time when VR-enabled games become part of the consumer mainstream.

Until I read the following article, however, I hadn’t given much thought to how VR technology could be used outside of the consumer sphere. In the article, the author makes a compelling case that VR tools may be the next frontier in big data analytics.

The author’s arguments include the following:

  • VR use allows big data users to analyze data dynamically, as it allows users to “reach out and touch” the data they are studying.
  • Using an approach known as immersive data visualization, coupled with haptic or kinesthetic interfaces, users can understand data intuitively and discover patterns.
  • VR allows users to view and manipulate huge amounts of data simply by looking at them. “VR enables you to capably stack relevant data, pare it and create visual cues so that you can cross-refer instantly,” the author writes.
  • With VR tools, users can interact naturally with data. Rather than glancing at reports, or reviewing spreadsheets, they can “manipulate data streams, push windows around, press buttons and actually walk around data worlds,” the article says.
  • VR makes multi-dimensional data analysis simpler. By using their hands and hearing, you just can pin down the subject, location and significance of specific data sources.

Though these concepts have been percolating for quite a while, I haven’t found any robust use cases for VR-based big data analytics either in or outside of healthcare. (They may well exist, and if you know of one above to hear about it.)

Still, a wide range of healthcare-related VR applications are emerging, including both inpatient care and medical education. I don’t think it will be long now before smart health IT leaders like yourselves begin to apply this approach to healthcare data visualization.

Ultimately, it seems likely that some of the healthcare data technologies are in play will converge with VR applications. By combining immersive or partially-immersive VR technologies with AI and big data analytics tools, healthcare organizations will be able to transform their data-guided outcomes efforts far more easily. And future use cases abound.

Hospitals could use VR to model throughput within the ED and, by layering clinical and transactional data over traffic statistics, doing a much better job of boosting efficiency.

I imagine health insurers combining claims records and clinical performance data, then using VR to as a next-gen tool predict how value-based care contracting play out in certain markets.

We may even see a time when surgeons wear VR glasses and, when perplexed in mid-procedure, can summon big data-driven feedback on options that improve patient survival.

Of course, VR is just set of technologies, and it can’t offer answers to questions we don’t know to ask. However, I do think that by people using their intuition more effectively, VR-based data analysis may extract new and valuable insights from existing data sets. It may take a while for this to happen, but I believe that it will.

Very Little Manual Entry in EHR

Posted on September 20, 2017 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 some fascinating data on how much of a doctor’s EHR note is entered manually versus some other automated method. I honestly wouldn’t have guessed that only 18% of the doctor’s EHR note was being entered manually. Although, from the doctor’s perspective, they still see a copied section of note as something they largely entered manually since a good doctor that copies something into the note generally also reviews it to make sure that it’s accurate for the patient they’re seeing.

What’s ironic is that every doctor I know would love for their note to be 100% automated so that they didn’t have to create any clinical note. In fact, that’s kind of what I outline in the perfect EHR workflow – Video EHR. Doctors would love to just see and interact with patients and have the EHR documentation be completely automated so they could just reference it as needed. Sadly, we’re not there yet. Not even close.

Plus, the critics of this type of automation would argue that automatic note creation will take (many aptly argue that it already has taken) the life and soul out of a note. They appropriately suggest that these auto-generated EHR notes are impossible to effectively read and have ruined patient notes. What used to be an elegantly written (although often illegible) note has now become an auto-generated mess of a note which makes it hard to find the relevant findings, issues, and treatment plan.

Except for a few rare exceptions, these critics are spot on in their analysis of the EHR note. The problem with these criticisms is that it’s not the automation which is making these notes useless. It was the automation’s focus on billing which has made these notes useless. In order to satisfy higher levels of billing, the Jabba the Hutt EHR note was created and is still thriving in healthcare today. Now we’re seeing organizations doing machine learning on this ugly billing notes to try and make the notes useful for patient care.

The difference between a note designed around patient care and one designed for billing is shocking.

What we need to realize is that automated notes don’t have to mean lower quality notes. However, improved patient care has to be the goal of the automated notes and not billing if we want to achieve that vision.

It’s not clear to me if many EHR vendors can achieve both visions of a quality billing note and a note designed around patient care or if it will require a new approach to documenting patient visits to achieve both goals. I have no doubt EHR vendors are going to try to do both. The problem is that most of them already tell themselves that they have a great clinical note that improves care. That attitude is preventing changes to the note that would make them more effective clinically.

I’m all for more automation in healthcare and particularly in doctor’s note creation. Every doctor I know wants to stop being a data entry clerk and spend more time being a doctor. However, we need to rethink our approach to automated note creation so it does more than effectively bill for services. Seems obvious, but I assure you that’s a dramatic change in mindset for many EHR organizations.

Say It One More Time: EHRs Are Hard To Use

Posted on September 19, 2017 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 don’t know about you, but I was totes surprised to hear about another study pointing out that doctors have good reasons to hate their EHR. OK, not really surprised – just a bit sadder on their account – but I admit I’m awed that any single software system can be (often deservedly) hated this much and in this many ways.

This time around, the parties calling out EHR flaws were the American Medical Association and the University of Wisconsin, which just published a paper in the Annals of Family Medicine looking at how primary care physicians use their EHR.

To conduct their study, researchers focused on how 142 family physicians in southeastern Wisconsin used their Epic system. The team dug into Epic event logging records covering a three-year period, sorting out whether the activities in question involved direct patient care or administrative functions.

When they analyzed the data, the researchers found that clinicians spent 5.9 hours of an 11.4-hour workday interacting with the EHR. Clerical and administrative tasks such as documentation, order entry, billing and coding and system security accounted about 44% of EHR time and inbox management roughly another 24% percent.

As the U of W article authors see it, this analysis can help practices make better use of clinicians’ time. “EHR event logs can identify areas of EHR-related work that could be delegated,” they conclude, “thus reducing workload, improving professional satisfaction, and decreasing burnout.”

The AMA, for its part, was not as detached. In a related press release, the trade group argued that the long hours clinicians spend interacting with EHRs are due to poor system design. Honestly, I think it’s a bit of a stretch to connect the study results directly to this conclusion, but of course, the group isn’t wrong about the low levels of usability most EHRs foist on doctors.

To address EHR design flaws, the AMA says, there are eight priorities vendors should consider, including that the systems should:

  • Enhance physicians’ ability to provide high-quality care
  • Support team-based care
  • Promote care coordination
  • Offer modular, configurable products
  • Reduce cognitive workload
  • Promote data liquidity
  • Facilitate digital and mobile patient engagement
  • Integrate user input into EHR product design and post-implementation feedback

I’m not sure all of these points are as helpful as they could be. For example, there are approximately a zillion ways in which an EHR could enhance the ability to provide high-quality care, so without details, it’s a bit of a wash. I’d say the same thing about the digital/mobile patient engagement goal.

On the other hand, I like the idea of reducing cognitive workload (which, in cognitive psychology, refers to the total amount of mental effort being used in working memory). There’s certainly evidence, both within and outside medicine, which underscores the problems that can occur if professionals have too much to process. I’m confident vendors can afford design experts who can address this issue directly.

Ultimately, though, it’s not important that the AMA churns out a perfect list of usability testing criteria. In fact, they shouldn’t have to be telling vendors what they need at this point. It’s a shame EHR vendors still haven’t gotten the usability job done.

Mental Health EMRs And MIPS – MACRA Monday

Posted on September 18, 2017 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

Recently, I began researching the mental health EMR market on behalf of a client. I had expected to find it dwindling as a) the big EMR players have always insisted that an all-purpose EMR could be adapted to serve mental health providers effectively and b) more importantly because mental health professionals weren’t eligible for Meaningful Use payments, which presumably made them lousy sales targets for vendors.

However, my research concluded that there’s roughly a dozen mental health EMRs out there and kicking and that at least two large medical EMR vendors had bought into the mental health technology niche. (Allscripts bought a stake in NetSmart Technologies last year, and Cerner acquired Anasazi outright in 2012). With their investments, the two vendors effectively admitted that supporting mental health providers wasn’t as easy as they’d suggested.

Now, with MIPS imposing new demands on clinicians, mental health providers are likely to expect even more from mental health IT vendors, said Bob Ring, a consultant with Mica Information Systems.

Right now, few mental health EMRs defining themselves as “therapy specific” are CEHRT technology, which could become an issue if MDs on staff in a mental health setting want to meet MIPS requirements, Ring notes.

Under MIPS, psychiatrists must provide a wide range of mental health-specific data, some of which calls for specialty-related technology. For example, one category under the Clinical Practice Improvement Activity Performance Category calls for enhancements to an EMR to capture added data on behavioral health populations and use that data for additional decision-making.

But uncertified EMRs are likely to stay that way, Ring says. “Because these therapy-specific [EMRs] are generally priced very low, and it is expensive to go through the ONC certification process, it’s questionable whether many of them ever will be,” he concludes.

Not only that, things could get even trickier for both mental health clinicians and mental health EMR vendors in the future, if CMS follows through on its threat to hold therapists to the same standards as MDs beginning in 2019.

This could create chaos, however, according to my colleague John Lynn, who contends that putting mental health therapy EMRs under MIPS would be “a disaster.” Instead, mental health should not piggyback MU or MIPS, but instead, focus on incentives for mental health focused EHR incentives.

“The relationship between a mental health provider and a client is totally different than the relationship between a medical provider and their patient,” said John, whose first EMR implementation came when he rolled out a medical EMR in a health and counseling center. “Their methods of documentation are different. Their methods of billing are different. Their approach to care is different. We made it work, but it took a lot of duct tape and jerry rigging to fit it in.”

Healthcare Waiting Room Cartoon – Fun Friday

Posted on September 15, 2017 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.

It’s late on a Friday and so you know that means it’s time for a Fun Friday blog post. What we do in healthcare is extremely serious, but we shouldn’t take ourselves too seriously. Plus, there’s nothing like a great cartoon to point out the absurdity of some of the things we see happening in healthcare.

This first healthcare cartoon is a sad look at the waiting room, but with a subtle joke about how long health reform takes as well.

I’ll leave the health reform stuff to other people. However, the waiting room issues are something that technology can help alleviate.

This next cartoon says Healthcare, but I think it applies to a lot of healthcare IT as well:

Happy Friday everyone! Have a great weekend!

EHR Medical Malpractice Risk

Posted on September 14, 2017 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 an article by Gabriel Perna, he highlighted 5 ways the EHR has become a medical malpractice risk:

You should read the whole article to see more details on each of the 5 risks, but here’s the summary list:

  1. Copy and Paste
  2. Use of Templates
  3. Alert Fatigue
  4. Clinical Decision Support Alerts
  5. Missing Information

As the article notes, EHRs aren’t currently involved in most medical malpractice cases today, but there’s a huge potential for that to change. Gabriel hightlights some ones that are worth considering, but I thought it was interesting that his list includes using the EHR incorrectly or the EHR failing you in some way. His list doesn’t include people who choose not to use one.

Certainly, it’s not the case today that using an EHR is considered medical malpractice, but will it get there?

I believe that it will. I think that the EHR and the associated smart systems that will be bolted onto the EHR will become the standard of care that’s required of doctors that are seeing patients. I see this as similar to a doctor negligently failing to order the appropriate tests for a patient and therefore delaying diagnosis. I think we could see the same thing happen with a doctor who doesn’t use the EHR and related tools and therefore doesn’t identify the correct diagnosis when they could have if they’d used the technology.

No doubt malpractice related to the use or non-use of technology like EHR software is just getting started. That’s why there aren’t many EHR related malpractice cases yet, but I have little doubt they’re coming.

What are you doing in your practice to minimize your EHR medical malpractice risk?

How Does Age Impact Patient Satisfaction?

Posted on September 13, 2017 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.

The following is a guest blog post by Jim Higgins, Founder & CEO at Solutionreach. You can follow him on twitter: @higgs77

If you walked into the average medical practice on any given day, you would see patients ranging in age from 1 to 101. Understanding and adapting to the needs of such a diverse group of patients is challenging. Many offices are struggling with this, and patient dissatisfaction is at an all-time high.

In the Patient-Provider Relationship Study, recently commissioned by Solutionreach, researchers found that one in three patients are likely to switch practices within the next couple of years.

The question is why. What is happening to patient loyalty? And more importantly—what can medical offices do to stem the tide?

In addition to studying patient switching preferences, the study also examined the dynamics of generational satisfaction and preferences, posing the following questions:

  • What impact does age have on patient satisfaction and retention?
  • What role does it play in patient loyalty?
  • Which services create satisfaction for the different generations?

A Closer Look at How Age Impacts Patient Satisfaction

To better understand how age impacts patient retention, it is important to take a closer look at the results from each of the key age groups.

  1. Millennials—Satisfaction levels among the youngest cohort were dismal. Millennials are the least satisfied with all aspects of the practice, including the doctor, office team, and practice logistics. In fact, a stunning 81 percent say that they are not completely satisfied with their medical office. Unsurprisingly, millennials are also extremely likely to switch practices in the upcoming years. Nearly half—46 percent—of millennials say they will probably move on to a new medical practice in the next couple of years.
  2. Gen X—The satisfaction levels of Gen Xers lies somewhere between millennials and boomers. The numbers are still concerning, however. Two out of three Gen Xers are not satisfied with their medical office. Around 35 percent say they will probably change practices in the near future.
  3. Baby Boomers—While millennials are three times more likely to switch providers than boomers, there are still a significant number of unhappy patients in this demographic. Nearly 60 percent of boomers are not completely satisfied with their medical office and one in five will switch practices in the near future.

Regardless Of Age—Technology Boosts Patient Satisfaction

It’s easy to assume that everyone who moves on to a new practice does so because they move or change insurance providers. The truth is a growing number are switching for other reasons.

Why are they so dissatisfied?

Picture the average patient in your mind. What characteristics about them have changed over the past few decades?

The biggest thing is that we have become unbelievably attached to technology—it’s rare to find any of us without either a phone, tablet, or computer. We use technology for virtually everything.

This is the area in which medical practices are struggling to keep up. Solutionreach’s study found that this is the exact category in which patients are least satisfied with their medical office. This is true regardless of age. Millennials, Gen Xers, and baby boomers all want more technology.

The biggest gap between what patients want and what medical practices offer is around texting. Texting has been the most used form of communication for over a decade now, but according to the survey less than 30 percent of practices offer any texting options. Today, every office should be able to:

  • Send a text—94 percent of millennials and 87 percent of Gen Xers want to receive texts from your office. But it’s not just the “youngsters.” Two out of three baby boomers also want you to text them.
  • Receive a text—While some offices have started sending out reminder texts, far fewer actually have the ability to have a patient initiate text messaging through the office number. Eighty-seven percent of millennials and seventy-nine percent of Gen Xers say that they want to be able to text their doctor. Once again, boomers are also on board—58 percent say they want to send a text to their medical practice.

Today’s patient lives are completely intertwined with technology. Medical practices will need to adapt to using technology in new ways to connect with patients or risk losing one in three patients in the coming two years.

Solutionreach is a proud sponsor of Healthcare Scene. As the leading provider of patient relationship management solutions, Solutionreach is dedicated to helping practices improve the patient experience while saving time for providers and staff. Learn more about the Patient-Provider relationship survey here.

Challenging Physicians’ Digital Health Fears

Posted on September 12, 2017 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.

Like you, I thought I’d read everything about the reasons some doctors struggle with adopting digital health. Then, the following article showed up on my radar. While it covers some familiar ground, it’s a fairly nuanced take on physician objections to integrating digital health into their practice.

The article, “Top 10 Reasons Doctors Fear Digital Health,” comes from Brennan Spiegel, MD, MSHS, a gastroenterologist and co-creator of the MyGiHealth app.  Given his digital health involvement, he obviously has a dog in the fight, but to my mind, that doesn’t detract from the value of what he had to say.

All ten of his observations make sense, but in the interests of brevity I’ll pick out a few that I found particularly interesting. Below, I’ve summarized some of the concerns expressed by his colleagues, then shared a condensed version of his responses:

“Use digital health devices in my practice? How the world will I have time to check all the data?”

His response:  We need to train a new type of specialist called a “digitalist” who will monitor, interpret and act upon remote patient data. They will reside in an e-coordination facility and remotely track data from biosensors, portals, apps and social media. (EDITOR’S NOTE: To see how an e-coordination center works today, check out this piece on the Mercy Virtual Hospital.) Their job will be to combine the data with clinical parameters and knowledge about the patient’s medical history then act on what they’ve learned.

* “What is my legal liability here? What if remote data show that somebody is doing poorly, but nobody checks it? What if the patient dies when there was clear evidence something bad was going to happen?”

His response: Until you have a digitalist watching your back, you cannot take responsibility – including legal responsibility – for monitoring, interpreting and acting upon the data. As I see it, that will be the digitalist’s responsibility.

* “Digital devices are cool, but most people quit using them before long. How could digital health make any difference if our patients refuse to use the stuff?

His response: To make inroads with chronic illnesses like diabetes, heart failure or obesity, we need to change behavior. One way to achieve this comes from Joseph Kvedar at Partners HealthCare. Dr. Kvedar’s team not only personalizes its apps but hyper-personalizes them. By integrating everything from the time of day, step counts, local weather and levels of depression or anxiety, these apps can send pinpoint messages to patients at the right time and place. This approach may work to foster behavioral change.

* “How will digital health improve the value of care? Can it both improve outcomes and lower costs? Until it can prove that it can, insurance won’t pay for it.”

Proving that digital health solutions provide economic value to health systems is the toughest and yet most important obstacle to taking digital health into the mainstream. As more and more digital health solutions roll off the assembly line, we need to see them subjected to formal health-economic analysis as with any other medical innovation.

I don’t know about you, but I found this to be an intriguing discussion, especially the notion of a “digitalist” responsible for remote data management and response. I look forward to talking to Dr. Spiegel someday (perhaps at the Connected Health show!) and getting more of his insights.