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E-Patient Update: Hey Government, Train Patients Too!

Posted on February 10, 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.

Recently I got a most interesting email from the ONC and A-list healthcare educator Columbia University. In the message, it offered me a free online course taught by Columbia’s Department of Biomedical Informatics, apparently paid for by ONC funding. (Unfortunately, they aren’t giving away free toasters to students, or I definitely would have signed up. No wait, I’m sorry, I did register, but I would have done it faster for the toaster.)

The course, which is named Health Informatics For Innovation, Value and Enrichment) or HI-FIVE, is designed to serve just about anyone in healthcare, including administrators, managers, physicians, nurses, social workers an care coordinators. Subjects covered by the course include all of the usual favorites, including healthcare data analytics, population health, care coordination and interoperability, value-based care and patient-centered care.

If I seem somewhat flippant, it’s just because the marketing material seemed a little…uh…breathlessly cheery and cute given the subject. I can certainly see the benefits of offering such a course at no cost, especially for those professionals (such as social workers) unlikely to be offered a broader look at health IT issues.

On the other hand, I’d argue that there’s another group which needs this kind of training more – and that’s consumers like myself. While I might be well-informed on these subjects, due to my geeky HIT obsession, my friends and family aren’t. And while most of the professionals served by the course will get at least some exposure to these topics on the job, my mother, my sister and my best girlfriend have essentially zero chance of finding consumer-friendly information on using health IT.

Go where the need is

As those who follow this column know, I’ve previously argued hard for hospitals and medical groups to offer patients training on health IT basics, particularly on how to take advantage of their portal. But given that my advice seems to be falling on deaf ears – imagine that! – it occurs to me that a government agency like ONC should step in and help. If closing important knowledge gaps is important to our industry, why not this particular gap. Hey, go where the need is greatest.

After all, as I’ve noted time and again, we do want patients to understand consumer health IT and how to reap its benefits, as this may help them improve their health. But if you want engagement, folks, people have to understand what you’re talking about and why it matters. As things stand, my sense is that few people outside the #healthit bubble have the faintest idea of what we’re talking about (and wouldn’t really want to know either).

What would a consumer-oriented ONC course cover? Well, I’m sure the authorities can figure that out, but I’m sure education on portal use, reading medical data, telemedicine, remote monitoring, mobile apps and wearables wouldn’t come amiss. Honestly, it almost doesn’t matter how much the course would cover – the key here would be to get people interested and comfortable.

The biggest problem I can see here is getting consumers to actually show up for these courses, which will probably seem threatening to some. It may not be easy to provoke their interest, particularly if they’re technophobic generally. But there’s plenty of consumer marketing techniques that course creators could use to get the job done, particularly if you’re giving your product away. (If all else fails, the toaster giveaway might work.)

If providers don’t feel equipped to educate patients, I hope that someone does, sometime soon, preferably a neutral body like ONC rather than a self-interested vendor. It’s more than time.

Switching Out EMRs For Broad-Based HIT Platforms

Posted on February 8, 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’ve always enjoyed reading HISTalk, and today was no exception. This time, I came across a piece by a vendor-affiliated physician arguing that it’s time for providers to shift from isolated EMRs to broader, componentized health IT platforms. The piece, by Excelicare chief medical officer Toby Samo, MD, clearly serves his employer’s interests, but I still found the points he made to be worth discussing.

In his column, he notes that broad technical platforms, like those managed by Uber and Airbnb, have played a unique role in the industries they serve. And he contends that healthcare players would benefit from this approach. He envisions a kind of exchange allowing the use of multiple components by varied healthcare organizations, which could bring new relationships and possibilities.

“A platform is not just a technology,” he writes, “but also ‘a new business model that uses technology to connect people, organizations and resources in an interactive ecosystem.’”

He offers a long list of characteristics such a platform might have, including that it:

* Relies on apps and modules which can be reused to support varied projects and workflows
* Allows users to access workflows on smartphones and tablets as well as traditional PCs
* Presents the results of big data analytics processes in an accessible manner
* Includes an engine which allows clients to change workflows easily
* Lets users with proper security authorization to change templates and workflows on the fly
* Helps users identify, prioritize and address tasks
* Offers access to high-end clinical decision support tools, including artificial intelligence
* Provides a clean, easy-to-use interface validated by user experience experts

Now, the idea of shared, component-friendly platforms is not new. One example comes from the Healthcare Services Platform Consortium, which as of last August was working on a services-oriented architecture platform which will support a marketplace for interoperable healthcare applications. The HSPC offering will allow multiple providers to deliver different parts of a solution set rather than each having to develop their own complete solution. This is just one of what seem like scores of similar initiatives.

Excelicare, for its part, offers a cloud-based platform housing a clinical data repository. The company says its platform lets providers construct a patient-specific longitudinal health record on the fly by mining existing EHRs claims repositories and other data. This certainly seems like an interesting idea.

In all candor, my instinct is that these platforms need to be created by a neutral third party – such as travel information network SABRE – rather than connecting providers via a proprietary platform created by companies like Excelicare. Admittedly, I don’t have a deep understanding of Excelicare’s technology works, or how open its platform is, but I doubt it would be viable financially if it didn’t attempt to lock providers into its proprietary technology.

On the other hand, with no one interoperability approach having gained an unbeatable lead, one never knows what’s possible. Kudos to Samo and his colleagues for making an effort to advance the conversation around data sharing and collaboration.

EMR Data Use For Medical Research Sparks Demand For Intermediaries

Posted on February 7, 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.

Over the last couple of years, it’s become increasingly common for clinical studies to draw on data gathered from EMRs — so common, in fact, that last year the FDA issued official guidance on how researchers should use such data.

Intermingling research observations and EMR-based clinical data poses different problems than provider-to-provider data exchanges. Specifically, the FDA recommends that when studies use EMR data in clinical investigations, researchers make sure that the source data are attributable, legible, contemporaneous, original and accurate, a formulation known as ALCOA by the feds.

It seems unlikely that most EMR data could meet the ALCOA standard at present. However, apparently the pharmas are working to solve this problem, according to a nice note I got from PR rep Jamie Adler-Palter of Bayleaf Communications.

For a number of reasons, clinical research has been somewhat paper-bound in the past. But that’s changing. In fact, a consortium of leading pharma companies known as TransCelerate Biopharma has been driving an initiative promoting “eSourcing,” the practice of using appropriate electronic sources of data for clinical trials.

eSourcing certainly sounds sensible, as it must speed up what has traditionally been the very long process of biopharma innovation. Also, I have to agree with my source that working with an electronic source beats paper any day (or as she notes, “paper does not have interactive features such as pop-up help.”) More importantly, I doubt pharmas will meet ALCOA objectives any other way.

According to Adler-Palter, thirteen companies have been launched to provide eSource solutions since 2014, including Clinical Research IO (presumably a Bayleaf client). I couldn’t find a neat and tidy list of these companies, as such solutions seem to overlap with other technologies. (But my sense is that this is a growing area for companies like Veeva, which offers cloud-based life science solutions.)

For its part CRIO, which has signed up 50 research sites in North America to date, offers some of the tools EMR users have come to expect. These include pre-configured templates which let researchers build in rules, alerts and calculations to prevent deviations from the standards they set.

CRIO also offers remote monitoring, allowing the monitor to view a research visit as soon as it’s finished and post virtual “sticky notes” for review by the research coordinator. Of course, remote monitoring is nothing new to readers, but my sense is that pharmas are just getting the hang of it, so this was interesting.

I’m not sure yet what the growth of this technology means for providers. But overall, anything that makes biopharma research more efficient is probably a net gain for patients, no?

E-Patient Update:  Portal Confusion Undermines Patient Relationships

Posted on February 3, 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’m not surprised that some medical practice staffers and doctors seem uncomfortable with their EMR system and portal. After all, they’re not IT experts, and smaller practices might not even have any full-time IT staffers to help. That being said, if they hope to engage patients with their healthcare, they need to do better.

I’m here to argue that training staff and doctors to help patients with portal use is not only feasible, it’s important to customer service, care quality and ultimately a practice’s ability to manage populations. If you accept the notion that patients must engage with their health, you can’t leave their data access to chance. Everyone who works with patients must know the basics of portal access, or at least be able to direct the patient immediately to someone that can help.

Start with the front line

If I have problems with accessing a practice portal, the first person I’m likely to discuss it with is someone on the front lines, either via the phone or during a visit. But front office staffers seldom seem to know Thing One about the portal, including how to access it or even where to address a complaint if I have one.  But I think practices should do at least the following:

* Train at least one front-desk staffer on how to access the portal, what to do when common problems occur and how to use the portal’s key functions. Training just one champion is probably enough for smaller practices.

* Create a notebook in which such staffers log patient complaints (and solutions if they have one). This will help the practice respond and address any technical issues that arise, as well making sure they don’t lose track of any progress they’ve made.

* Every front desk staffer (and every doctor) should have a paper handout at hand which educates patients on key portal functions, as well as the name of the champion described above.  Also, the practice should provide the same information on a page of their site, allowing a staffer to simply email the link to patients if the patient is calling in with questions.

* All doctors should know about the champion(s), and be ready to offer their name and number to patients who express concerns about EMR/portal access. They should also keep the handout in their office and share it when needed.

Honestly, I don’t regard any of these steps as a big deal. In fact, I see them as little more than common sense. But I haven’t encountered a single community practice that does any of them, or even pursued their own strategies for educating patients on their portal.

Maximizing your investment

For those reading this who think these steps – or your own version – are too much trouble, think again. There’s plenty of reason to follow through on patient portal support.  After all, if nothing else, you’ve probably spent a ton of money on your EMR and portal, so why not maximize the value it offers?

Also, you don’t want to frustrate patients needlessly when a little bit of preparation and education could make such a difference. Maybe this wasn’t the case even a few years ago, but today, I’d submit, helping patients access their data is nothing more than good customer service. Given the competition every provider faces, why would you ignore a clear opportunity to foster patient loyalty?

Bear in mind that a little information goes a long way with patients like me. You don’t have to write a book to satify me – you just have to help me succeed. Just tell me what to do and I’ll be happy. So don’t miss a chance to win me over!

Practice Management Market To Hit $17.6B Within Seven Years

Posted on February 1, 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.

A new research report has concluded that the global practice management systems market should hit $17.6 billion by 2024, fueled in part by the growth of value-adds like integration with other healthcare IT solutions.

The report, by London-based Grand View Research, includes a list of what it regards as key players in this industry. These include Henry Schein MicroMD, Allscripts Healthcare Solutions, AdvantEdge Healthcare Solutions, athenahealth, MediTouch, GE Healthcare, Practice Fusion, Greenway Medical, McKesson Corp, Accumedic Computer Systems and NextGen Healthcare.

The report argues that as PM systems are integrated with external systems EMRs, CPOE and laboratory information systems, practice management tools will increase in popularity. It says that this is happening because the complexity of medical billing and payment has grown over the last several years.

This is particularly the case in North America, where fast economic development, plus the presence of advanced research centers, hospitals, universities and medical device manufacturers keep up the flow of new product development and commercialization, researchers suggest.

In addition, researchers concluded that while PM software has accounted for the larger share of the market a couple of years ago, that’s changing. They predict that the services side of the business should grow substantially as practices demand training, support and system upgrades.

The report also says that cloud-based delivery of PM technology should grow rapidly in coming years. As Grand View reminds us, most PM systems historically have been based on-premise, but the move to cloud-based solutions is the future. This trend took off in 2015, researchers said.

This report, while worthwhile, probably doesn’t tell the whole story. Along with growing demand for PM systems,I’d contend that vendor sales strategies are playing a role here. After all, integration of PM systems with EMRs is part of a successful effort by many vendors to capture this parallel market along with their initial sale.

This may or may not be good for providers. I don’t have any information on how the various integrated practice management systems compare, but my sense is that generally, they’re a bit underpowered compared with their standalone competitors.

Grand View doesn’t take a stand on the comparative benefits of these two models, but it does concede that emerging integrated practice management systems linking EMRs, e-prescribing, patient engagement and other software with billing are actually different than standalone systems, which focus solely on scheduling, billing and administration. That does leave room to consider the possibility that the two models aren’t equal.

Meanwhile, one thing the report doesn’t – and probably can’t – address is how these systems will evolve under value-based care in the US. While appointment scheduling and administration will probably be much the same, it’s not clear to me how billing will evolve in such models. But we’ll need to wait and see on that. The question of how PM systems will work under value-based care probably won’t be critically important for a few years yet.

(Side note:  You may want to check out John’s post from a few years ago on practice management systems trends. It seems that the industry goes back and forth as to whether independent PM systems serve groups better than integrated ones.)

KPMG: Population Health Taking Hold

Posted on January 31, 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.

A new KPMG survey has concluded that population health management approaches are becoming popular – and for nearly half of respondents, are already working.

According to the consulting firm, which reached out to 86 respondents working for a payer or healthcare provider, 44% said that they have a population health platform in place which is being used “efficiently and effectively.” Twenty-four percent of respondents said that they were in the process of implementing a pop health program within the next three years, while 10% said they had no plans to use such a platform. (Another 21% said that their organization didn’t need one.)

Thirty percent of respondents said that the biggest individual obstacle to implementing a population health strategy was aggregating and standardizing information from multiple sources. Meanwhile, 10% cited stakeholder adoption as a barrier, and 10% named integrating with clinical work flows as a key issues. Meanwhile, another 34% cited “all of the above” as a significant barrier, along with enabling patient engagement, funding investments and choosing the right vendors.

Along the way, KPMG asked respondents where they stood with value-based payments. Thirty-six percent said “some of our revenue is generated by value-based payments,” and 14% said that the majority of their revenue came from value-based payments.  As for those that weren’t there yet, 26% said they were planning to enter into value-based contracts within one to three years, while just 7% said they were not planning to do so. (The remaining 17% said they don’t require value-based payments.)

All that being said, though, there’s a problem here. And that problem is that while everyone seems to think they mean the same thing when they discuss population health management, I’d submit that in many cases they aren’t on the same page. In fact, I’d argue that until we get that straight, studies like these don’t tell us a lot.

Yes, I think we all have the same broad idea in mind when the topic of PHM comes up, which is to say that we envision a system in which a health system, ACO or health insurer sets broad goals for key health metrics across a population.  And as most readers probably know, the health insurance industry has been managing a population-wide set of standards known as HEDIS (the Healthcare Effectiveness Data and Information Set) for decades. HEDIS is designed to make apples-to-apples comparisons of health plan performance possible by providing very carefully defined criteria.

On the other hand, the number of technologies, approaches and philosophies being implemented by health organizations for population health management do no such thing. While there’s probably many areas of broad consensus on what should be measured – particularly when it comes to chronic, costly conditions like diabetes and heart disease — we don’t have any shared performance standard.

So before we look at pop health stats, it might be a good idea to clarify what that means to those answering surveys like this. Otherwise, it’s GIGO.

 E-Patient Update:  The Impact Of Telehealth Confusion

Posted on January 27, 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 am a huge fan of telemedicine consults. As far as I can tell, all of the chronic conditions I currently cope with can be addressed effectively by a virtual visit unless I’m in a medical crisis.

My reasons are not unusual. Like most people, I hate having to drive to a doctor’s office if I’m already feeling yucky, particularly if it’s not necessary. And since time is money – particularly when you work for yourself like me – there’s some material benefits to telehealth too. Not only that, since I’m a tech fan who lives online, these contacts “feel” as real as face-to-face visits, so I don’t have lingering doubts that I’m not getting much for my money.

Getting a quick visit in regarding an acute medical issue (like, say, a sinus infection) has been pretty easy and relatively affordable as well. But reaching out to a new specialist – or even connecting with my existing providers — is another story. Over the last several months, I’ve encountered a number of barriers which seem to be fairly entrenched in the system.

Garbage contact info

Over the last year, I’ve been with two major health insurers (CIGNA and United Healthcare) whose databases included a list of specialists which were allegedly willing to do telehealth consults. But as it turns out, actually moving ahead with such visits has been impossible.

At one point, I decided to go all out and see if I could actually schedule a telehealth visit with one type of specialist I need. Armed with a list of providers who were supposedly up for it, I called perhaps 15 or 20 offices to see how I could schedule my first virtual visit. But I got nowhere. Most of the physicians simply never returned my calls, and in the rare cases where I got a live person, they had no idea what I was talking about.

I’m assuming that this happened because the doctors had the option to check a “telemedicine” box if they were generally interested in implementing it, and that few if any had actually gone ahead with their plans. But I’m still very annoyed with the whole thing. Sure, insurers don’t have perfect information on hand at any given moment, but isn’t in their interests to steer patients to less-expensive telehealth services if they’re available?

Coverage confusion

Another thing that astonishes me is that while I allegedly have telemedicine coverage via my current insurer (CIGNA) I can’t find anyone who has the slightest idea of how I should use it!  I have called CIGNA’s call center four or five times in an attempt to straighten this out, but none of the reps I spoke with had a clue as to which providers were covered by my policy, if any, and under what circumstances.

At some point, telemedicine coverage will be known as “coverage,” of course. There’s really no reason to segment it out into a separate category if you’re going to pay for it anyway. But at present, if CIGNA is any indication, there’s still some confusion around how and when coverage is even applicable. I can’t understand it, but I can attest to you that such foolishness is a Real Thing.

Launch fears

The other problem I’ve encountered is that while medical practices may have the technical capability to deploy telemedicine, they seem afraid to do so. I’ve asked many of my doctors (and their staff) what it will take for them to begin offering virtual visits, and I’ve gotten a mix of confusion and concern. None, even for example the fairly large and seemingly well-funded PCP office I visit, appears to be anywhere close to rolling out such services.

I can’t prove it, but my sense is that two things are going on here. First, I sense that practice leaders don’t feel ready to take on the technical challenges involved in supporting virtual visits. Though my guess is that security is the only real issue — which can be addressed by using the right vendor — they seem quite timid about even experimenting with this approach. Second, I am pretty sure they’re not sure how to handle billing, or alternatively, what to charge if they don’t bill insurance.

I admit their concerns are reality-based. But I’d argue that the benefits of offering telehealth far outweigh these concerns. Apparently, my doctors don’t agree just yet.

Ultimately, I think we’d all agree that telemedicine uptake will grow by leaps and bounds over the next several years. But it seems we’ll have to deal with a lot of administrivia before that can happen.

External Incentives Key Factor In HIT Adoption By Small PCPs

Posted on January 25, 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.

A new study appearing in The American Journal of Managed Care concludes that one of the key factors influencing health IT adoption by small primary care practices is the availability of external incentives.

To conduct the study, researchers surveyed 566 primary care groups with eight or fewer physicians on board. Their key assumption, based on previous studies, was that PCPs were more likely to adopt HIT if they had both external incentives to change and sufficient internal capabilities to move ahead with such plans.

Researchers did several years’ worth of research, including one survey period between 2007 and 2010 and a second from 2012 to 2013. The proportion of practices reporting that they used only paper records fell by half from one time period to the other, from 66.8% to 32.3%. Meanwhile, the practices adopted higher levels of non-EMR health technology.

The mean health IT summary index – which tracks the number of positive responses to 18 questions on usage of health IT components – grew from 4.7 to 7.3. In other words, practices implemented an average of 2.6 additional health IT functions between the two periods.

Utilization rates for specific health IT technologies grew across 16 of the 18 specific technologies listed. For example, while just 25% of practices reported using e-prescribing tech during the first period of the study, 70% reported doing so during the study’s second wave. Another tech category showing dramatic growth was the proportion of practices letting patients view their medical record, which climbed from one percent to 19% by the second wave of research.

Researchers also took a look at the impact factors like practice size, ownership and external incentives had on the likelihood of health IT use. As expected, practices owned by hospitals instead of doctors had higher mean health IT scores across both waves of the survey. Also, practices with 3 to 8 physicians onboard had higher scores than those were one or two doctors.

In addition, external incentives were another significant factor predicting PCP technology use. Researchers found that greater health IT adoption was associated with pay-for-performance programs, participation in public reporting of clinical quality data and a greater proportion of revenue from Medicare. (Researchers assumed that the latter meant they had greater exposure to CMS’s EHR Incentive Program.)

Along the way, the researchers found areas in which PCPs could improve their use of health IT, such as the use of email of online medical records to connect with patients. Only one-fifth of practices were doing so at the time of the second wave of surveys.

I would have liked to learn more about the “internal capabilies” primary care practices would need, other than having access to hospital dollars, to get the most of health IT tools. I’d assume that elements such as having a decent budget, some internal IT expertise and management support or important, but I’m just speculating. This does give us some interesting lessons on what future adoption on new technology in healthcare will look like and require.

Diagnosis And Treatment Of “Epic Finger”

Posted on January 20, 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.

The following is a summary of an “academic” paper written by Andrew P. Ross, M.D., an emergency physician practicing in Savannah, GA. In the paper, Dr. Ross vents about the state of physician EMR issues and repetitive EMR clicking (in quite witty fashion!). Rather than try and elaborate on what he’s said so well, I leave you with his thoughts.

At long last, medical science has identified a subtle but dangerous condition which could harm generations of clinicians. A paper appearing in the Annals of Emergency Medicine this month has described and listed treatment options for “Epic finger,” an occupational injury similar to black lung, phossy jaw and miner’s nystagmus.

Article author Andrew Ross, MD, describes Epic finger, otherwise known as “Ross’s finger” or “the furious finger of clerical rage,” as a progressive repetitive use injury. Symptoms of Epic finger can include chronic-appearing tender and raised deformities, which may be followed by crepitus and locking of the finger. The joint may become enlarged and erythematous, resembling “a boa constrictor after it has eaten a small woodland mammal.”

Patients with Epic finger may experience severe psychiatric and comorbid conditions. Physical complications may include the inability to hail a cab with one’s finger extended, play a musical instrument or hold a pen due to intractable pain.  Meanwhile, job performance may suffer due to the inability to conduct standard tests such as the digital rectal exam and percussion of the abdomen, leading in turn to depression, unhappiness and increased physician burnout.

Dr. Ross notes that plain film imaging may show findings consistent with osteoarthritic changes of the joint space, and that blood work may show a mild leukocytosis and increased nonspecific markers of inflammation. Ultimately, however, this elusive yet disabling condition must be identified by the treating professional.

To treat Epic finger, Dr. Ross recommends anti-inflammatory medication, aluminum finger splinting and massage, as well as “an unwavering faith in the decency of humanity.”  But ultimately, to reverse this condition more is called for, including a sabbatical “in some magnificent locale with terrible wi-fi and a manageable patient load.”

Having identified the syndrome, Dr. Ross calls for recognition of this condition in the ICD-10 manual. Such recognition would help clinicians win acceptance of such a sabbatical by employers and obtain health and disability insurance coverage for treatment, he notes. In his view, the code for Epic finger would fit well in between “sucked into jet engine, subsequent encounter,” “burn due to water skis on fire” and “dependence on enabling machines and devices, not elsewhere classified.”

Meanwhile, hospitals can do their part by training patients to recognize when their healthcare providers are suffering from Epic finger. Patients can “provide appropriate and timely warnings to hospital administrators through critical Press Ganey patient satisfaction scorecards.”

Unfortunately, the prognosis for patients with Epic finger can be poor if it remains untreated. However, if the condition is recognized promptly, treated early, and bundled with time spent in actual patient care, the author believes that this condition can be reversed and perhaps even cured.

To accomplish this result, clinicians need to stand up for themselves, he suggests: “We as a profession need to recognize this condition as an occult manifestation of our own professional malaise,” he writes. “We must heal ourselves to heal others.”

A Look At The Role Of EMRs In Personalized Medicine

Posted on January 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.

NPR recently published an interesting piece on how some researchers are developing ways to leverage day-to-day medical information as a means of personalizing medical care. This is obviously an important approach – whether or not you take the full-on big data approach drug researchers are – and I found the case studies it cited to be quite interesting.

In one instance cited by the article, researchers at Kaiser Permanente have begun pulling together a dashboard, driven by condition types, which both pulls together past data and provides real-life context.

“Patients are always saying, don’t just give me the averages, tell me what happened to others who look like me and made the same treatment decisions I did,” said Dr. Tracy Lieu, head of Kaiser’s research division, who spoke to NPR. “And tell me not only did they live or die, but tell me what their quality of life was about.”

Dr. Lieu and her fellow researchers can search a database on a term like “pancreatic cancer” and pull up data not only from an individual patient, but also broad information on other patients who were diagnosed with the condition. According to NPR, the search function also lets them sort data by cancer type, stage, patient age and treatment options, which helps researchers like Lieu spot trends and compare outcomes.

Kaiser has also supplemented the traditional clinical data with the results of a nine-question survey, which patients routinely fill out, looking at their perception of their health and emotional status. As the article notes, the ideal situation would be if patients were comfortable filling out longer surveys on a routine basis, but the information Kaiser already collects offers at least some context on how patients reacted to specific treatments, which might help future patients know what to expect from their care.

Another approach cited in the article has been implemented by Geisinger Health System, which is adding genetic data to EMRs. Geisinger has already compiled 50,000 genetic scans, and has set a current goal of 125,000 scans.

According to Dr. David Ledbetter, Geisinger’s chief scientific officer, the project has implications for current patients. “Even though this is primarily a research project, we’re identifying genomic variants that are actually important to people’s health and healthcare today,” he told the broadcaster.

Geisinger is using a form of genetic testing known as exome sequencing, which currently costs a few thousand dollars per patient. But prices for such tests are falling so quickly that they could hit the $300 level this year, which would make it more likely that patients would be willing to pay for their own tests to research their genetic proclivities, which in turn would help enrich databases like Geisinger’s.

“We think as the cost comes down it will be possible to sequence all of the genes of individual patients, store that information in the electronic medical record, and it will guide and individualize and optimize patient care,” Ledbetter told NPR.

As the story points out, we might be getting ahead of ourselves if we all got analyses of our genetic information, as doctors don’t know how to interpret many of the results. But it’s good to see institutions like these getting prepared, and making use of what information they do have in the mean time.