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Consumers Take Risk Trading Health Data For Health Insurance Discounts

Posted on August 28, 2015 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.

When Progressive Insurance began giving car owners the option of having their driving tracked in exchange for potential auto insurance discounts, nobody seemed to raise a fuss. After all, the program was voluntary, and nobody wants to pay more than they have to for coverage.

Do the same principles apply to healthcare? We may find out. According to a study by digital health research firm Parks Associates, at least some users are willing to make the same tradeoff. HIT Consultant reports that nearly half (42%) of digital pedometer users would be willing to share their personal data in exchange for a health insurance discount.

Consumer willingness to trade data for discounts varied by device, but didn’t fall to zero. For example, 35% of smart watch owners would trade their health data for health insurance discounts, while 26% of those with sleep-quality monitors would do so.

While the HIT Consultant story doesn’t dig into the profile of users who were prepared to sell their personal health data today — which is how I’d describe a data-for-discount scheme — I’d submit that they are, in short, pretty sharp.

Why do I say this? Because as things stand, at least, health insurers would get less than they were paying for unless the discount was paltry. (As the linked blog item notes, upstart health insurer Oscar Insurance already gives away free Misfit wearables. To date, though, it’s not clear from the write-up whether Oscar can quantify what benefit it gets from the giveaway.)

As wearables and health apps mature, however, consumers may end up compromising themselves if they give up personal health data freely. After all, if health insurance begins to look like car insurance, health plans could push up premiums every time they make a health “mistake” (such as overeating at a birthday dinner or staying up all night watching old movies). Moreoever, as such data gets absorbed into EMRs, then cross-linked with claims, health plans’ ability to punish you with actuarial tables could skyrocket.

In fact, if consumers permit health plans to keep too close a watch on them, it could give the health plans the ability to effectively engage in post-contract medical underwriting. This is an unwelcome prospect which could lead to court battles given the ACA’s ban on such activities.

Also, once health plans have the personal data, it’s not clear what they would do with it. I am not a lawyer, but it seems to me that health plans would have significant legal latitude in using freely given data, and might even be seen to sell that data in the aggregate to pharmas. Or they might pass it to their parent company’s life or auto divisions, which could potentially use the data to make coverage decisions.

Ultimately, I’d argue that unless the laws are changed to protect consumers who do so, selling personal health data to get lower insurance premiums is a very risky decision. The short-term benefit is unlikely to be enough to offset very real long-term consequences. Once you’ve compromised your privacy, you seldom get it back.

Wearables Data May Prevent Health Plan Denials

Posted on August 27, 2015 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 story begins, as many do, with a real-world experience. Our health plan just refused to pay for a sleep study for my husband, who suffers from severe sleep apnea, despite his being quite symptomatic. We’re following up with the Virginia Department of Insurance and fully expect to win the day, though we remain baffled as to how they could make such a decision. While beginning the complaint process, a thought occurred to me.

What if wearables were able to detect wakefulness and sleepiness, and my husband was being tracked 24 hours a day?  If so, assuming he was wearing one, wouldn’t it be harder for a health plan to deny him the test he needed? After all, it wouldn’t be the word of one doctor versus the word of another, it would be a raft of data plus his sleep doctor’s opinion going up against the health plan’s physician reviewer.

Now, I realize this is a big leap in several ways.

For one thing, today doctors are very skeptical about the value generated by patient-controlled smartphone apps and wearables. According to a recent survey by market research firm MedPanel, in fact, only 15% of doctors surveyed see wearables of health apps as tools patients can use to get better. Until more physicians get on board, it seems unlikely that device makers will take this market seriously and nudge it into full clinical respectability.

Also, data generated by apps and wearables is seldom organized in a form that can be accessed easily by clinicians, much less uploaded to EMRs or shared with health insurers. Tools like Apple HealthKit, which can move such data into EMRs, should address this issue over time, but at present a lack of wearable/app data interoperability is a major stumbling block to leveraging that data.

And then there’s the tech issues. In the world I’m envisioning, wearables and health apps would merge with remote monitoring technologies, with the data they generate becoming as important to doctors as it is to patients. But neither smartphone apps nor wearables are equipped for this task as things stand.

And finally, even if you have what passes for proof, sometimes health plans don’t care how right you are. (That, of course, is a story for another day!)

Ultimately, though, new data generates new ways of doing business. I believe that when doctors fully adapt to using wearable and app data in clinical practice, it will change the dynamics of their relationship with health plans. While sleep tracking may not be available in the near future, other types of sophisticated sensor-based monitoring are just about to emerge, and their impact could be explosive.

True, there’s no guarantee that health insurers will change their ways. But my guess is that if doctors have more data to back up their requests, health plans won’t be able to tune it out completely, even if their tactics issuing denials aren’t transformed. Moreover, as wearables and apps get FDA approval, they’ll have an even harder time ignoring the data they generate.

With any luck, a greater use of up-to-the-minute patient monitoring data will benefit every stakeholder in the healthcare system, including insurers. After all, not to be cliched about it, but knowledge is power. I choose to believe that if wearables and apps data are put into play, that power will be put to good use.

Accenture: “Zombie” Digital Health Startups Won’t Die In Vain

Posted on August 24, 2015 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 been screaming for a while about how VCs are blowing their money on questionable digital health ventures. To my mind, their investment patterns suggest that the smart money really isn’t that smart. I admit that sorting out what works in digital health/mHealth/connected health is very challenging, but it’s far from impossible if you immerse yourself in the industry. And given how much difference carefully-thought out digital health tools can make, it’s exasperating to watch failing digital health startups burn through money.

That being said, maybe all of those dollars won’t be wasted. According to no less an eminence grise than Accenture, failing digital health ventures will feed the stronger ones and make their success more likely. A new report from Accenture predicts that these “zombie” startups — half of which will die within two years, it says — will provide talent and technology to their surviving rivals. (OK, I agree, the zombie image is a bit unsettling, isn’t it?)

To bring us their horror movie metaphor, Accenture analyzed the status of 900 healthcare IT startups, concluding that 51% were likely to collapse within 20 months.  The study looked at ventures cutting across social, mobile, analytics, cloud and sensors technologies, which include wearables, telehealth and remote monitoring.

While most researchers try to predict who the winners will be in a given market, Accenture had a few words to say about the zombie also-rans. And what they found was that the zombies have taken in enough cash to have done some useful things, collecting nearly $4 billion in funding between 2008 and 2013.

The investments are part of an ongoing funding trend. In fact, digital health dollars are likely to pour in over the next two years as well, with healthcare IT startups poised to take in $2.5 billion more over the next two years, Accenture estimates. Funding should focus on four segments, including engagement (25%), treatment (25%), diagnosis (21%) and infrastructure (29%), the study found.

So what use are the dying companies that will soon litter the digital health landscape? According to Accenture, more-successful firms can reap big benefits by acquiring the failing startups. For example, healthcare players can do “acqui-hiring” deals with struggling digital health startups to pick up a deep bench of qualified tech staffers. They can pick up unique technologies (the 900 firms analyzed, collectively, had 1,700 patents). And acquiring firms can harvest the startups’ technology to improve their products and services lineups.

Not only that — and this is Anne, not Accenture talking — acquiring healthcare firms get a wonderful infusion of entrepreneurial energy, regardless of whether the acquired firm was booking big bucks or not. And I speak from long experience. I’ve known the leaders of countless tech startups, and there’s very little difference between those who make a gazillion dollars and those whose ventures die. Generally speaking, anyone who makes a tech startup work for even a year or two is incredibly insightful, creative, and extremely dedicated, and they bring a kind of excitement to any company that hires them.

So, backed by the corporate wisdom of Accenture, I’ve come to praise zombies, not to bury them. While they may give their corporate lives, their visions won’t be wasted. With any luck, the next generation of digital health companies will appreciate the zombies’ hard work and initiative, even if they’re no longer with us.

Are EMRs Getting Worse Or Doctors Getting Smarter?

Posted on August 20, 2015 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 know it sounds crazy — it’s hard to imagine doctors being more annoyed with EMRs than they already are — but according to one study that’s just what’s happening.

A newly-published study by the American Medical Association and the American College of Physicians’ AmericanEHR division suggests that doctors like the current crop of EMRs less than ever.

About half of study respondents said that their EMR was having a negative impact on costs, efficiency or productivity, the groups reported. Only 22% said they were satisfied with their EMR, and a scant 12% said they were “very satisfied.”

Doctors’ happiness with their EMRs has dropped substantially since five years ago, when 39% reported being satisfied and 22% said they were very satisfied, according to a prior study by AmericanEHR.  In other words, nearly 4 out of 10 doctors surveyed seem to have been content with what they had. But conditions have clearly changed.

The reasons for this are unlikely to be the result of mere peevishness. After all, with EMRs being a reality of doing business today, it seems unlikely that physicians would simply revert into sulking. Actually, my own unofficial survey — of several docs I’ve actually seen as a patient — suggests that most have gone through their stages of grief and decided that EMRs aren’t unholy. (My PCP said it best: “You get used to them, then they’re not so bad.”)

Instead, I’d argue, something good is actually happening, though it may not look that way on the surface. Having adapted to the need to use EMRs, physicians are engaging with them deeply, and beginning to expect more from them than a kludgy interface slapped on a slow database can provide.

Some are actually proposing that EMRs go beyond traditional medical record paradigm, something I see as an exciting development. For example, Dr. Arlen Meyers, CEO of the Society of Physician Entrepreneurs, argues that it’s time to “unbundle and re-engineer the care processes model” by introducing new templates into EMRs. In fact, he’s a fan of rethinking the hallowed SOAP (symptoms, objective findings, assessment and plan) approach to patient notes:

Given how things are changing, it might be time to give the pink slip to SOAP. The main problems are that 1) the model does not prioritize information by levels of urgency, 2) it does not provide decision support when it comes to how one disease affects the other or how one medicine affects another, and 3) it does not add efficiencies to taking care of increasingly complex patients.

And Meyers is not the only one. In fact, a recent paper published in JAMA Internal Medicine suggests that a new format flipping the elements of the SOAP note and reordering them as APSO (assessment, plan, subjective, objective) works well in the EMR age.

According to a 2010 study detailed in the paper, APSO notes were fairly successful at the University of Colorado ambulatory clinics. The study, which looked at APSO use in 13 clinics, found that 73% of participants were “satisfied” or “very satisfied” with the new format, and 75% “preferred” or “strongly preferred” reading APSO notes.

I’m betting that physicians will only be satisfied with EMRs again when EMRs are reshaped to embrace new ways of working. Since new workflow demands are generated by using EMRs, in turn, this cycle may never end. But that’s a good thing. If physicians are engaged enough with their EMRs to propose new ways of working, it will benefit everyone.

I Have Seen The Portal, And It Is Handy

Posted on July 14, 2015 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.

After writing about EMRs/EHRs and portals for many years, I’ve finally begun using an enterprise-class portal to guide my own care. Here’s some of my impressions as an “inside” (EMR researcher) and “outside” (not employed as a provider) user of this tool. My conclusion is that it’s pretty handy, though it’s still rather difficult to leverage what I’ve learned despite being relatively sophisticated.

First, some background. I get most of my care from northern Virginia-based Inova Health System, including inpatient, primary care, imaging and specialist care. Inova has invested in a honking Epic installation which links the majority of these sites together (though I’ve been informed that its imaging facilities still aren’t hooked up to core medical record. D’oh!) After my last visit with an Inova doctor, I decided to register and use its Epic portal.

Epic’s MyChart has a robust, seemingly quite secure process for registering and accessing information, requiring the use of a long alphanumeric code along with unique personal data to establish an account. When I had trouble reading the code and couldn’t register, telephone-based tech support solved the problem quickly.  (Getting nearsighted as I move from middle- to old-aged!)

Using MyChart, I found it easy to access lab results, my drug list and an overview of health issues. In a plus for both me and the health system, it also includes access to a more organized record of charges and balances due than I’ve been able to put together in many years.

When I looked into extracting and sharing the records, I found myself connected to Lucy, an Epic PHR module. In case you’ve never heard of it (I hadn’t) here’s Epic’s description:

Lucy is a PHR that is not connected to any facility’s electronic medical record system. It stays with patients wherever they receive care and allows them to organize their medical information in one place that is readily accessible. Patients can enter health data directly into Lucy, pull in MyChart data or upload standards-compliant Continuity of Care Documents from other facilities.

As great as the possibility of integrating outside records sounds, that’s where I ran into my first snag. When I attempted to hook up with the portal for DC-based Sibley Memorial Hospital — a Johns Hopkins facility — and integrate the records from its Epic system into the Inova’s Lucy PHR, I was unable to do so since I hadn’t connected within 48 hours of a recent discharge. When I tried to remedy the situation, an employee from the hospital’s Health Information Management department gave me an unhelpful kiss-off, telling me that there was no way to issue a second security code. I was told she had to speak to her office manager; I told her access to my medical record was not up for a vote, and irritated, terminated the call.

Another snag came when I tried to respond to information I’d found in my chart summary. When I noted that one of my tests fell outside the standard range provided by the lab, I called the medical group to ask why I’d been told all tests were normal. After a long wait, I was put on the line with a physician who knew nothing about my case and promptly brushed off my concerns. I appreciate that the group found somebody to talk to me, but if I wasn’t a persistent lady, I’d be reluctant to speak up in the future given this level of disinterest.

All told, using the portal is a big step up from my previous experiences interacting with my providers, and I know it will be empowering for someone like myself. That being said, it seems clear that even in this day and age, even a sophisticated integrated health system isn’t geared to respond to the questions patients may have about their data.

For one thing, even if the Lucy portal delivers as promised, it’s clear that integrating data from varied institutions isn’t a task for the faint of heart. HIM departments still seem to house many staffers who are trained to be clerks, not supporters of digital health. That will have to change.

Also, hospitals and medical practices must train employees to enthusiastically, cheerfully support patients who want to leverage their health record data. They may also want to create a central call center, staffed by clinicians, to engage with patients who are raising questions related to their health data. Otherwise, it seems unlikely that they’ll bother to use it.

Providers Still Have Hope For HIEs

Posted on July 10, 2015 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.

Sometimes, interoperability alone doesn’t cut it.  Increasingly, providers are expecting HIEs to go beyond linking up different organizations to delivering “actionable” data, according to a new report from NORC at the University of Chicago. The intriguing follow-on to the researchers’ conclusions is that HIEs aren’t obsolete, though their obsolescence seemed all but certain in the past.

The study, which was written up by Healthcare Informatics, conducted a series of site visits and 37 discussions with providers in Iowa, Mississippi, New Hampshire, Vermont, Utah and Wyoming. The researchers, who conducted their study in early 2014, hoped to understand how providers looked at HIEs generally and their state HIE program specifically. (The research was funded by ONC.)

One major lesson for the health IT types reading this article is that providers want data sharing models to reflect new care realities.  With Meaningful Use requirements and changes in payment models bearing down on providers, and triggering changes in how care is delivered, health IT-enabled data exchange needs to support new models of care.

According to the study, providers are intent on having HIEs deliver admission, discharge, and transfer alerts, interstate data exchange and data services that assist in coordinating care. While I don’t have comprehensive HIE services research to hand, maybe you do, readers. Are HIEs typically meeting these criteria? I doubt it, though I could be wrong.

That being said, providers seem to be willing to pay for HIE services if the vendor can meet their more stringent criteria.  While this may be tough to swallow for existing HIE technology sellers, it’s good news for the HIE model generally, as getting providers to pay for any form of community data exchange has been somewhat difficult historically.

Some of the biggest challenges in managing HIE connectivity identified by the study include getting good support from both HIE and EMR vendors, as well as a lack of internal staff qualified to manage data exchange, competing priorities and problems managing multiple funding streams. But vendors can work to overcome at least some of these problems.

As I noted previously, hospitals in particular have had many beliefs which have discouraged them from participating in HIEs. As one HIE leader quoted in my previous post noted, many have assumed that HIE connection costs would be in the same range as EMR adoption expenses; they’re been afraid that HIEs would not put strong enough data security in place to meet HIPAA obligations; and they assumed that HIE participation wasn’t that important.

Today, given the growing importance of sophisticated data management has come to the forefront, and most providers know that they need to have the big picture widespread data sharing can provide. Without the comprehensive data set cutting across the patient care environment — something few organizations are integrated enough to develop on their own — they’re unlikely to mount a successful population health management initiative or control costs sufficiently. So it’s interesting to see providers see a future for HIEs.

Some Methods For Improving EMR Alerts

Posted on June 25, 2015 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 Journal of the American Medical Informatics Association has made some points that may turn out to be helpful in designing those pesky but helpful alerts for clinicians.

Making alerts useful and appropriate is no small matter. As we reported on a couple of years ago, even then EMR alert fatigue has become a major source of possible medical errors. In fact, a Pediatrics study published around that time found that clinicians were ignoring or overriding many alerts in an effort to stay focused.

Despite warnings from researchers and important industry voices like The Joint Commission, little has changed since then. But the issue can’t be ignored forever, as it’s a car crash waiting to happen.

The JAMIA study may offer some help, however. While it focuses on making drug-drug interaction warnings more usable, the principles it offers can serve as a model for designing other alerts as well.

For what it’s worth, the strategies I’m about to present came from a DDI Clinical Decision Support conference attended by experts from ONC, health IT vendors, academia and healthcare organizations.

While the experts offered several recommendations applying specifically to DDI alerts, their suggestions for presenting such alerts seem to apply to a wide range of notifications available across virtually all EMRs. These suggestions include:

  • Consistent use of color and visual cues: Like road signs, alerts should come in a limited and predictable variety of colors and styles, and use only color and symbols for which the meaning is clear to all clinicians.
  • Consistent use of terminology and brevity: Alerts should be consistently phrased and use the same terms across platforms. They should also be presented concisely, with minimal text, allowing for larger font sizes to improve readability.
  • Avoid interruptions wherever possible:  Rather than freezing clinician workflow over actions already taken, save interruptive alerts that require action to proceed for the most serious situation. The system should proactively guide decisions to safer alernatives, taking away the need for interruption.

The research also offers input on where and when to display alerts.

Where to display alert information:  The most critical information should be displayed on the alert’s top-level screen, with links to evidence — rather than long text — to back up the alert justification.

When to display alerts: The group concluded that alerts should be displayed at the point when a decision is being made, rather than jumping on the physician later.

The paper offers a great deal of additional information, and if you’re at all involved in addressing alerting issues or designing the alerts I strongly suggest you review the entire paper.

But even the excerpts above offer a lot to consider. If most alerts met these usability and presentation standards, they might offer more value to clinicians and greater safety to patients.

Doctors, Not Patients, May Be Holding Back mHealth Adoption

Posted on June 24, 2015 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.

Clearly, mHealth technology has achieved impressive momentum among a certain breed of health-conscious, self-monitoring consumer. Still, aside from wearable health bands, few mHealth technologies or apps have achieved a critical level of adoption.

The reason for this, according to a new survey, may lie in doctors’ attitudes toward these tools. According to the study, by market research firm MedPanel, only 15% of physicians are suggesting wearables or health apps as approaches for growing healthier.

It’s not that the tools themselves aren’t useful. According to a separate study by Research Now summarized by HealthData Management, 86% of 500 medical professionals said mHealth apps gave them a better understanding of a patient’s medical condition, and 76% said that they felt that apps were helping patients manage chronic illnesses. Also, HDM reported that 46% believed that apps could make patient transitions from hospital to home care simpler.

While doctors could do more to promote the use of mHealth technology — and patients might benefit if they did — the onus is not completely on doctors. MedPanel president Jason LaBonte told HDM that vendors are positioning wearables and apps as “a fad” by seeing them as solely consumer-driven markets. (Not only does this turn doctors off, it also makes it less likely that consumers would think of asking their doctor about mHealth tool usage, I’d submit.)

But doctors aren’t just concerned about mHealth’s image. They also aren’t satisfied with current products, though that would change rapidly if there were a way to integrate mobile health data into EMR platforms directly. Sure, platforms like HealthKit exist, but it seems like doctors want something more immediate and simple.

Doctors also told MedPanel that mHealth devices need to be easier to use and generate data that has greater use in clinical practice.  Moreover, physicians wanted to see these products generate data that could help them meet practice manager and payer requirements, something that few if any of the current roster of mHealth tools can do (to my knowledge).

When it comes to physician awareness of specific products, only a few seem to have stood out from the crowd. MedPanel found that while 82% of doctors surveyed were aware of the Apple Watch, even more were familiar with Fitbit.

Meanwhile, the Microsoft Band scored highest of all wearables for satisfaction with ease of use and generating useful data. Given the fluid state of physicians’ loyalties in this area, Microsoft may not be able to maintain its lead, but it is interesting that it won out this time over usability champ Apple.

Is Meaningful Use For Mental Health Providers On The Way?

Posted on June 10, 2015 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.

If you look at the policy statements issued by ONC, it sounds as though the organization is a big fan of putting behavioral health IT on the same footing as other aspects of care. As the agency itself points out, 46% of Americans will have a mental health disorder over the course of their lifetime, and 26% of Americans aged 18 and older live with a mental health disorder in any given year, which makes it imperative to address such issues systematically.

But as things stand, behavioral health IT initiatives aren’t likely to go far. True, ONC has encouraged behavioral health stakeholders on integrating their data with primary care data, stressed the value of using EMRs for consent management, supported the development of behavioral health clinical quality measures and even offered vendor guidelines on creating certified EMR tech for providers ineligible for Meaningful Use. But ONC hasn’t actually suggested that these folks deserve to be integrated into the MU program. And not too surprisingly, given their ineligibility for incentive checks, few mental health providers have invested in EMRs.

However, a couple of House lawmakers who seem pretty committed to changing the status quo are on the case. Last week, Reps. Tim Murphy (R-Pa.) and Eddie Bernice Johnson (D-Texas) have reintroduced a bill which would include a new set of behavioral health and substance abuse providers on the list of those eligible for Meaningful Use incentives.

The bill, “Helping Families in Mental Health Crisis Act,” would make clinical psychologists and licensed social workers eligible to get MU payments. What’s more, it would make mental health treatment facilities, psychiatric hospitals and substance abuse mistreatment facilities eligible for incentives.

Supporters like the Behavioral Health IT Coalition say such an expansion could provide many benefits, including integration of psych and mental health in primary care, improved ability of hospital EDs to triage patients and reduction of adverse drug-to-drug interactions and needless duplicative tests. Also, with interoperable healthcare data on the national agenda, one would think that bringing a very large and important sector into the digital fold would be an obvious move.

So as I see it, making it possible for behavioral health and other medical providers can share data is simply a no-brainer.  But that can’t happen until these providers implement EMRs. And as previous experience has demonstrated, that’s not going to happen until some version of Meaningful Use incentives are available to them.

I imagine that the bill has faltered largely over the cost of implementing it. While I haven’t seen an estimate of what it would cost to expand eligibility to these new parties, I admit it’s likely to be very substantial. But right now the U.S. health system is bearing the cost of poorly coordinated care administered to about one-quarter of all U.S. adults over age 18. That’s got to be worse.

Industry Tries To Steamroll Physician Complaints About EMR Impact On Patient Face Time

Posted on June 9, 2015 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.

Some doctors — and a goodly number of consumers, too — argue that the use of EMRs inevitably impairs the relationship between doctors and patients. After all, it’s just common sense that forcing a doctor to glue herself to the keyboard during an encounter undercuts that doctor’s ability to assess the patient, critics say.

Of course, EMR vendors don’t necessarily agree. And some researchers don’t share that view either. But having reviewed some comments by a firm studying physician EMR use, and the argument an EMR vendor made that screen-itis doesn’t worry docs, it seems to me that the “lack of face time” complaint remains an important one.

Consider how some analysts are approaching the issue. While admitting that one-third to one-half of the time doctors spend with patients is spent using an EMR, and that physicians have been complaining about this extensively over the past several years, doctors are at least using these systems more efficiently, reports James Avallone, Director of Physician Research, who spoke with EHRIntelligence.com.

What’s important is that doctors are getting adjusted to using EMRs, Avallone suggests:

Whether [time spent with EMRs] is too much or too little, it’s difficult for us to say from our perspective…It’s certainly something that physicians are getting used to as it becomes more ingrained in their day-to-day behaviors. They’ve had more time to streamline workflow and that’s something that we’re seeing in terms of how these devices are being used at the point of care.

Another attempt to minimize the impact of EMRs on patient encounters comes from ambulatory EMR vendor NueMD. In a recent blog post, the editor quoted a study suggesting that other issues were far more important to doctors:

According to a 2013 study published in Health Affairs, only 25.8 percent of physicians reported that EHRs were threatening the doctor-patient relationship. Administrative burdens like the ICD-10 transition and HIPAA compliance regulations, on the other hand, were noted by more than 41 percent of those surveyed.

It’s certainly true that doctors worry about HIPAA and ICD-10 compliance, and that they could threaten the patient relationship, but only to the extent that they affect the practice overall. Meanwhile, if one in four respondents to the Health Affairs study said that EMRs were a threat to patient relationships, that should be taken quite seriously.

Of course, both of the entities quoted in this story are entitled to their perspective. And yes, there are clearly benefits to physician use of EMRs, especially once they become adjusted to the interface and workflow.

But if this quick sample of opinions is any indication, the healthcare industry as a whole seems to be blowing past physicians’ (and patients’) well-grounded concerns about the role EMR documentation plays in patient visits.

Someday, a new form factor for EMRs will arise — maybe augmented or virtual reality encounters, for example — which will alleviate the eyes-on-the-screen problem. Until then, I’d submit, it’s best to tackle the issue head on, not brush it off.