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MGMA17 Day 2 – The Future of Patient Engagement Looks Bright

Posted on October 10, 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.

Day 2 at MGMA17 started very early for exhibitors when the doors to the exhibit hall opened sharply at 6:30am Pacific Time. It was clear that MGMA organizers were catering to the early-rising-east-coast contingent of attendees. Thankfully there was a warm breakfast with plenty of caffeine options available.

The early exhibit hours provided a unique opportunity to slowly browse the floor and read booth signage fully without being blocked by fellow attendees walking in the aisles…and in some cases without being blocked by company representatives in the booth itself.

As I walked around the exhibits I began to notice that the words “Patient Engagement” appeared frequently. EHR companies, revenue cycle management companies, call center providers and even HR consultants had this nebulous term emblazoned on their booth properties. I thought it would be interesting to ask a few of these companies how they interpreted patient engagement and how they saw it evolving over the next three years.

Josh Weiner, Chief Operating Officer at SolutionReach, was quick to say “Patient Engagement is more than having a portal on your EHR”. He believed that the key to engaging patients was communicating with them in an easy, convenient manner. “For SolutionReach, this means texting. Everyone knows how to text and it’s just so simple to use. A few years ago texting patients was just one-way. Doctors would send a text to a patient and that would be it. More recently companies like SolutionReach introduced the ability for healthcare providers to conduct one-to-one conversations with patients via text. We call it SR Conversations and we have over 4,000 clients using it.”

In the future, Weiner predicted that providers and patients would continue to use SMS texting as the primary means of patient engagement. The key difference is that instead of just sending text messages back and forth we would be sending mini-text-applications back and forth. He cited the example of the latest iOS upgrade which now featured the ability to send a map, a Starbucks gift card and other such applications within an SMS message. He foresaw a day when we will have the ability to send a prescription, a lab test, a referral and an appointment schedule to a patient via SMS.

At BinaryFountain, a company that makes a platform that consolidate patient feedback from multiple social media sources as well as from HCAHPS surveys and allows providers to publish positive comments made in those medium as online reviews, they define patient engagement through the lens of reputation management. Engaged patients mean they are more likely to provide a positive comment and if they provide a positive comment, they are more likely to rate the doctor/practice/hospital highly. That, in turn, leads to a better reputation which attracts patients who are more likely to be engaged in their care. In the future, the company believes that quantitative measures for patient engagement will be developed and that these measures will be used in a similar way that the 5-star rating system is used today.

West Communications is a provider of telephony solutions to a broad range of industries. In healthcare, West offers a number of patient communication tools that engage patients via phone, email, and text. They define patient engagement as the degree to which a patient is active in and adherent to their care plan. They saw a bright future for patient engagement – especially as technologies from other industries are adapted to healthcare. The West team, for example, has been working on adding AI-based intelligent IVR capabilities to their healthcare IVR solutions so that inbound calls from patients can be automatically triaged quickly based on needs.

At Stericycle Communication Solutions, Sarah Bennight, Healthcare Strategist, defined patient engagement as getting patients to be active throughout their care journey. “Patient engagement creates trust between patients and providers. It’s more than just pushing information out to patients, it’s true two-way conversations that are relevant to where the patients are in that moment. It means providing patients with useful calls to action – clicking on a button to book their next appointment, download information or connect with the right clinician.”

Bennight sees a patient engagement future that includes new forms of communication through platforms like Snapchat and iMessage. “The younger generation communicates in different ways. They’ve gone beyond voice, text, and email. Healthcare will need to adapt to these new forms of communication. We may even need to develop a healthcare nomenclature for communicating information via emoji’s and giphies.”

Finally, Varun Hippalgaonkar, Senior Vice President of Growth at HealthGrid suggested that patient engagement is the sum total of all the interactions that a patient has with their healthcare providers including face-to-face visits, phone calls, text messages, telemedicine, and emails. The key for Hippalgaonkar was not to try and engage patients across all channels, but rather to zero in on the communication modalities that each individual patient preferred.

“HealthGrid is striving to be the single communication platform for all pre-, day of and post- visit patient interactions. Our platform will provide a consistent patient experience in the communication channel or channels that patients prefer to use. We mine our own interaction data to determine the best way to interact with patients. For example, the analysis of past interactions may reveal that John Smith responds better during weekday mornings via text message and seems to prefer phone calls at night. When a hospital or a practice has the information they want to share with John, they simply put the content in our system and we handle how it will be delivered to him based on his known response patterns.”

Down the road, Hippalgaonkar saw patients interacting with AI-powered chat bots that were so sophisticated that patients would feel they were interacting with a person. These bots would work across the different communication channels providing a consistent experience no matter what modality the patient elected to use.

Hippalgaonkar summed up by saying: “In the end it’s all about motivating patients to make changes to their health or put another way, to engage in their health. We can only achieve this if we communicate with patients in a way that compels them to take action. As an industry, we need to build technologies and processes that takes things down to the individual patient level. We need to use AI, machine learning, personalization and deliver meaningful information to patients so that they are compelled to make a change.”

From these conversations, it was clear that patient engagement meant different things to different people. Yet everyone agreed healthcare needed more engagement and more involvement from patients in order to deliver on the promise of better health at lower cost. Motivating patients to become more involved is not going to be easy, but if the MGMA17 exhibit hall is representative of HealthIT overall, the future is certainly bright for patient engagement.

Full Disclosure: Solution Reach and Stericycle Communication Solutions are both sponsors of Healthcare Scene.

MACRA Preparation, Are You Ready? – MACRA Monday

Posted on October 2, 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.

I’ll admit that the timing of this week’s MACRA Monday is a bit rough for me given the tragedy that’s occurred in my town, Las Vegas. Instead of dwelling on the tragedy and the person who could do such an awful thing, it’s been amazing even in these early hours to see how many people in Las Vegas and around the world want to and are supporting the victims of this tragedy.

We heard that there was a need for blood and thought we could help. Turns out that hundreds of others had the same idea and the blood banks have their schedules full through Wednesday. We’ll go after that to replenish the blood banks that no doubt will take a while to replenish their supply.

Thanks to everyone on Facebook, Twitter, and other social media that have reached out to myself and the rest of us that live in Las Vegas. We’re in a bit of shock and it doesn’t feel real.

To keep with our tradition of MACRA Monday, I thought I could at least share this infographic from Integra Connect on how prepared specialty practices are for MACRA:

No doubt there are a lot of healthcare organizations that aren’t ready for MACRA and they are confused on how they should be ready. Hopefully, those who have read our weekly MACRA Monday posts feel better prepared than most. MACRA is upon us whether you’re ready or not. However, MACRA certainly seems much less important on this day of mourning in Las Vegas.

On this tragic day, it’s worth noting all the incredible stories I’ve heard about Las Vegas healthcare professionals that were prepared and ready for a tragedy like this. I read stories of UMC, a major Las Vegas hospital that was so full of victims that they asked to stop bringing people to UMC that didn’t have life-threatening injuries. I read of EMS people who were at home and went into the danger to help transport victims. No doubt there will be hundreds of other stories of heroism by healthcare professionals. Many that likely won’t be heard or seen, but saved people’s lives. We thank them for their preparation, care, and work that no doubt has saved hundreds of people’s lives.

A big thank you from Vegas to each of you for all of your support.

Physician Burnout Cartoon – Fun Friday

Posted on September 29, 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.

If you haven’t noticed, I love irony. That’s why this cartoon from Pediatrician and Cartoonist Dr. Maypole was perfect for a Fun Friday entry.

The sad part of this Fun Friday is that this is far too true for far too many doctors. The one good thing is that people are now recognizing it and working to address it in their workforce as Dr. Maypole suggests we do.

The Value of Collaborating with Customers in EMR Optimization

Posted on September 27, 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.

One of the biggest challenges I see in healthcare IT is that the knowledge on how to get value out of EHR and other health IT is not evenly distributed. One healthcare organization that figures out how to optimize their EHR system for maximum benefit doesn’t have the opportunity to share that knowledge with other organizations across the country. Plus, even an organization that has optimized their EHR solution in one specific area is still missing optimization benefits in other areas.

Sharing optimization best practices is a massive problem that needs to be solved if we’re going to finally optimize EHR and other health IT systems to benefit both healthcare organizations and patients.

While some healthcare organizations are competitive and don’t want to share best practices, I’ve found that most hospitals and health systems are happy to share their EHR and health IT practices with their peers across the country. Healthcare is so regional and most people doing the optimization work want to benefit patients regardless of other competitive pressures.

Why then don’t healthcare organizations share if in fact most of them want to share their insights and experiences? The challenge is that most professionals don’t see any easy way for them to collaborate and share with their colleagues.

I recently saw where Galen Healthcare Solutions took this problem head-on as they gathered together a focused group of MEDITECH users in a project they called Claire[IT]. Check out this webinar on Claire[IT] to learn more about how Galen Healthcare Solutions involved their users to create enginu[IT]y.

Out of this user focus group they produced a package of MEDITECH rules and best practices which could be implemented by any MEDITECH user. What makes this package special is that it wasn’t just one person’s best thinking but Galen brought together a wide variety of end users to each contribute their best practices and insights into the MEDITECH rules they created. I love that one participant in the user focus group said “I am the only one in my organization that loves MEDITECH rules. It was great to finally be part of a group of other people as passionate as me about rules.”

This is the type of collaboration we need to see happening in healthcare IT and EHR for us to receive all the benefits technology can provide. Plus, now a company like Galen Healthcare Solutions can package up this knowledge and EMR optimization best practices and share it with all of the other MEDITECH users out there. This MEDITECH EHR rules knowledge doesn’t have to be confined to one organization.

The problem is that this type of focus group is really targeted and includes a lot of minutiae that only those that are deep in these systems will appreciate. These aren’t conversations that casually happen at an event like HIMSS. However, when you put the right EHR users together it’s like magic and the sharing and collaboration happens naturally. I love that Galen Healthcare Solutions called their webinar “Operation #NerdyWork.” Talking over MEDITECH rules really is #NerdyWork, but it’s also essential work if you want to truly get the most out of your MEDITECH EHR. The same is true for all the other EHR vendors. There’s a lot of #NerdyWork required to optimize them.

Props to Galen Healthcare Solutions for showing us one way EMR end users can collaborate together to share best practices and provide everyone with a better solution than if they’d done the EMR optimization alone. Now we just need to scale up this collaboration and sharing so that every EMR in every healthcare organization is working in the most optimized way possible.

Note: Galen Healthcare Solutions is a sponsor of Healthcare Scene and the EMR Clinical Optimization Series of blog posts.

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?

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.

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?

AI Making Doctors Better Is the Right Approach

Posted on September 6, 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 summer Bertalan Meskó, MD, PhD posted 10 ways that AI (Artificial Intelligence) could make him a better doctor. Here are his 10 ways:

1) Eradicate waiting time
2) Prioritize my emails
3) Find me the information I need
4) Keep me up-to-date
5) Work when I don’t
6) Help me make hard decisions rational
7) Help patients with urgent matters reach me
8) Help me improve over time
9) Help me collaborate more
10) Do administrative work

This is a great list of ways that AI can make doctors better. No doubt there are even more ways that we’ll discover as AI continues to improve. However, I love this list because it looks at AI from the appropriate point of reference. AI is going to be something that improves the doctor, not replaces the doctor.

I know that many people have talked about how technology is going to replace the doctor. The most famous of which is Vinod Khosla. However, you have to remember that Vinod is an investor and so he needs to drum up companies with ambitious visions. I believe his statement was as much about finding companies that will push the bounds of healthcare as much as it was his prediction for the future of healthcare. However, it no doubt created a lot of fear for doctors.

The reality is that some aspects of what a doctor does will be replaced by technology, but as the list above illustrates, that can be a very good thing for doctors.

AI is coming to healthcare. In some ways, it’s already here. However, the AI that’s coming today isn’t about replacing the doctor, it’s about making the doctor better. Honestly, any doctor that can’t embrace this idea is a doctor that shouldn’t have a medical license.

Should doctors be cautious in how quickly they adopt the technology and should they take the time to make sure that the AI won’t have adverse impacts on their patients? Absolutely. However, there’s a tipping point where not using AI is going to be much more damaging to patients than the risks that are likely to make headlines and scare many. Doctors need to be more driven by what’s best for their patients than fear inducing headlines.

AI will make doctors lives better in a wide variety of ways. It won’t replace the doctor but will enhance the doctor. That’s exciting!

3 CEO Perspectives on Medication Adherence – Part 3 of 3

Posted on August 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.

KNB Communications recently interviewed three leaders in healthcare technology – Propeller Health Co-founder and CEO David Van Sickle, RxAnte Founder and CEO Dr. Josh Benner, and RxREVU Founder and CEO Carm Huntress – to get their insights on medication adherence.

This is part 3 in a 3 part interview on medication adherence. Be sure to read part 1 and part 2 as well.

Q: How can technology be harnessed to collect patient-reported outcomes such as real-time symptoms and perceptions of medications?

DVS: Propeller sensors passively collect information about use of inhaled medications and transmit that information through a smartphone to Propeller. Then, the system tries to make sense of how the person is doing, to estimate their level of risk and impairment, and to report back its impression and suggestions through digital apps and interfaces.

We ask people to add details about their symptoms, tell us what they perceived to have triggered their episode, and to answer periodic questionnaires that provide other kinds of information, such as whether they are waking up at night. Altogether, this information teaches us a lot about how asthma is affecting that individual in their daily life and how they are responding to treatment.

With this combination of self-reported information and medication use data, Propeller is able to inform physicians about which of their patients need more attention, to help them better understand what might need adjustment to gain control of the symptoms, and to encourage collaborative efforts to improve its care and treatment.

JB: I think this concept has a lot of merit in managing adherence, because if we can get people to communicate with us about how they’re using their medicine and how their medicines are making them feel in real-time, then we can more actively detect and overcome those barriers to nonadherence before they become a decision to stop the medicine.

Phone calls and mobile apps alike can be used to collect information from patients, assess how the medication is working, and tailor the intervention program.  For example, we use our live pharmacist call center to collect patient-reported outcomes and potential reasons why patients may have trouble using their medications as prescribed.  Response rates to digital approaches are typically lower, but they are also less costly.

CH: This is a critical issue because most technologies today, especially electronic health record systems, aren’t really set up to store anything beyond basic patient clinical factors. We need a lot more technology today that can go beyond these basic factors.  We need to think about socioeconomic, patient-reported outcome measures, and other factors to really improve our understanding of medication adherence. How effective a medication is, what outcome it’s really delivering for certain types of patients, and really looking at technologies that are sophisticated decision support systems that capture all this at the point of care, similar to what we’re doing at RxREVU, with our prescription decision support platform, and capturing those key socioeconomic factors.

If we know the patient has a poor adherence, why is that happening and is it a side effect? Is it a socioeconomic factor? What are those patient-reported outcome measures we can capture and store and then longitudinally feed that data across a whole host of patients to better understand how those factors are affecting adherence?

At the patient level, we’re looking at really simple technologies today, Even text messaging is a great solution, especially for many low-income patients that may not have a smartphone, to engage with them and capture that information.

We don’t need sophisticated apps yet. We’re not there at all, in terms of capturing these types of measurements. It’s really about these simple technologies that can engage a patient with a simple question, allow them to answer that through a technology like SMS, and then obviously store that information and make it available to stakeholders to evaluate and better understand adherence issues. Those are definitely some things I think about, as we start to get better at capturing patient-reported outcomes measures that directly affect adherence.

Additional Comments

JB: There’s an exciting tidal wave of interest in the topic of medication adherence across the healthcare system. Fifteen years ago, pharmaceutical companies were the only ones investing heavily in medication adherence. But this has changed dramatically, especially over the past six to seven years.

It’s changed because of new evidence that helped us better understand the consequences of non-adherence as a population health management problem. This stimulated the development of consensus-based quality measures for medication use.

Today, health plans, providers, pharmacies and pharmacy benefit management companies are increasingly being compensated based on the quality of care they deliver—and that is an incentive to improve adherence to critical medications. RxAnte’s products and services are used by all of these stakeholders—and in the years ahead, we want to facilitate unprecedented collaboration among these parties to help patients get more from medicines.

CH: In terms of adherence, we at RxREVU really take a different point of view. Many companies are focused clearly on the patient’s experience and around adherence and how they improve that. But ultimately, all these decisions start at the point of care. We are solely focused on helping the provider at the point of care make the most informed decision that’s going to drive an appropriate prescription to the patient, that they can afford, and they can adhere to.

As we look to the future, I think this is a critical piece that we need more and more technologies at the point of care supporting clinician’s decisions, because ultimately, you as the patient aren’t making the decision; your provider is. That’s sometimes missed, and providers are a key component to the decision-making. It is really is a shared decision-making and technologies that can sit alongside those patients and providers in the exam room and support those decisions are really going to be critical in the coming years.

This was part 3 in a 3 part interview on medication adherence. Be sure to read part 1 and part 2 to read the full interview.

About David Van Sickle

David Van Sickle is co-founder and CEO of Propeller Health – the leader in respiratory digital health. David received his PhD in medical anthropology. His dissertation research, funded by the National Science Foundation, examined the rising prevalence of asthma and allergy in India. He was then an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention in Atlanta, where he was assigned to the Air Pollution and Respiratory Health Branch. During this time, he provided epidemiological support to the National Asthma Control Program, and investigated the health effects of a variety of environmental exposures. In addition, he helped establish emergency illness and injury surveillance in coastal Mississippi after Hurricane Katrina. David was also named a Champion of Change by the White House for his work on innovation.

About Josh Benner

A leading voice on medication adherence, Dr. Benner’s award-winning research and numerous publications have shed new light on the problem of nonadherence and identified promising approaches to improving it.  He is the founder and CEO of RxAnte, the leading provider of predictive analytics and targeted clinical programs for improving medication use.

Before joining RxAnte, Dr. Benner was Fellow and Managing Director at the Brookings Institution’s Center for Health Care Reform, where he focused on medical technology policy.

Prior to Brookings, Dr. Benner was principal at ValueMedics Research, an analytic and consulting services firm. Following the acquisition of ValueMedics by IMS Health in 2007, he served as senior principal in health economics and outcomes research and global lead for medication adherence at IMS. Dr. Benner received his Doctor of Pharmacy degree from Drake University and his Doctor of Science in health policy and management from the Harvard University School of Public Health.

About Carm Huntress

Carm Huntress is an entrepreneur and strategic leader with over 20 years of experience in startups focused around consumer and enterprise technology. His first web development and hosting company he started while in high school was eventually acquired in 2001.  After finishing his degree in electrical engineering at Northeastern University in 2004, he went on to work for PlumVoice, an IVR and voice technology startup, where he ran their network operations.  He later was asked to run product development at My Perfect Gig, a Northbridge and Commonwealth Venture start-up.

After two years as CTO at Reef Partners, where he ran the technology for a number of portfolio companies, he became CTO at Audiogon.com, the largest high end audio site in the world.  He managed the transition of the core technology platform and team for growth.  In 2013 he moved to Denver where he founded RxREVU.