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What Do Med Students Need To Know About EMRs?

Posted on August 16, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Recently, I was asked to write an introduction to EMRs, focusing on what medical students needed to know in preparation for their future careers. This actually turned out to be a very interesting exercise, as it called for balancing history with the future, challenges with benefits and predictable future developments with some very interesting possibilities. Put another way, the exercise reminded me that any attempt to “explain” EMR technology calls for some fancy dancing.

Here’s some of the questions I tackled:

  • Do future doctors need to know more about how EMRs function today, or how they should probably function to support increasingly important patient management approaches like population health?
  • Do med students need to understand major technical discussions – such as the benefits of FHIR or how to wrangle Big Data – to perform as doctors? If so, how much detail is helpful?
  • How important is it to prepare med students to understand the role of data generated outside of traditional patient care settings, such as wearables data, remote monitoring and telemedicine consults? What do they need to know to prepare for the gradual integration of such data?
  • What skills, attitudes and practices will help physician trainees make the best use of EMRs and ancillary systems? And how should they obtain that knowledge?

These questions are thornier than they may appear at first glance, in part because there no hard-and-fast standards in place as to how doctors who’ve never run a practice on paper charts should conduct themselves. While there have been endless discussions about how to help doctors adopt an EMR for the first time, or switch from one to the other, I’m not aware of a mature set of best practices available to med students on how next-gen, health IT-assisted practices should function.

Certainly, offering med school trainees a look at the history of EMRs makes sense, as understanding the reasons early innovators developed the first systems offers some interesting insights. And introducing soon-to-be physicians to the benefits of wearable or remote monitoring data makes sense. Physicians will almost certainly improve the care they deliver by understanding EMRs then, now and their near-term evolution as data sources.

On the other hand, I’m not sure it makes sense to indoctrinate med students in today’s take on evolving topics like population health management or interoperability via FHIR. These paradigms are evolving so rapidly that pinning down a set of teachable ideas may be a disservice to these students.

Morever, telling students how to think about EMRs, or articulating what skills are needed to manage them, might actually be a bad idea. I’m optimistic enough to think that now that the initial adoption frenzy funded by HITECH is over, EMRs will become far more usable and physician-shapeable over the next few years, allowing new docs to adapt the tool to them rather than adapt to the tool.

All that being said, educating med students on EMRs and health IT ancillary tools is a great idea. I just hope that such training encourages them to keep learning well after the training is over.

Mobile EHR Access Is Maturing

Posted on August 4, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Today I read a story that surprised me, though perhaps it shouldn’t have. A clinician, writing for a publication called Diagnostic Imaging, suggests that a “mobile EHR” is emerging, a new entity which embraces mobile technology rather than treating it as an add-on. I wasn’t surprised that this was happening, but it is remarkable that it’s taken us so long to get to this point.

As Saroj Misra, DO, notes, healthcare organizations are rolling out infrastructure for clinicians to access EHR data via mobile devices, and EHR vendors are ramping up development of mobile interfaces for their systems. And physicians are responding. According to a recent Physicians Practice survey, 78% of physicians are now using mobile-accessible EHRs, and more than 85% of doctors and practices were using mobile devices to do their jobs.

As he sees it there were three big issues which previously held back the development of mobile EHRs:

  • Mobile device screens were too small, and battery life was inadequate.
  • EHR vendors hadn’t created interfaces which worked effectively with mobile devices
  • Healthcare organizations weren’t convinced that mobile EHR access protected health data sufficiently

Today, these problems have receded into the background. Screens have gotten larger, battery life has been extended, and while security is always an issue, standards for protecting mobile data are gradually emerging. Also, healthcare organizations are developing mobile device management policies which help to address BYOD issues.

In response, EHR developers are embracing mobile EHR access. There’s vendors like drchrono, which is a mobile-native EHR, but that’s not all.  Other ambulatory vendors, like athenahealth, describe themselves as a “provider of network-enabled services for electronic health records,” and MEDITECH’s Web Ambulatory app runs on a tablet.  Also, Cerner’s PowerChart Touch solution is built for the Apple iPad.

At this point, I truly wonder why all EHRs aren’t developed primarily with mobile deployment in mind. Physicians have been engaged mobile device users since smartphones and tablets first emerged, and the need for them to manage patients on the go has only increased over time. I know desktops still have their place, but the reality is that empowering physicians to take patient data with them is overwhelmingly sensible.

My sense, after researching this post, is that ongoing security worries are probably the biggest roadblock to further mobile EHR deployment. And I understand why, of course. After all, many of the major health data breaches occur thanks to a stolen laptop “walking away” when it’s left unattended, and mobile devices may be just as vulnerable.

That being said, the benefits of giving doctors an elegant mobile EHR solution are substantial. With the right targeted security policies in place, I believe the benefits of robust mobile EHR deployment – particularly giving clinicians on-the-spot data access and getting immediate data back — far outweigh these risks. I sincerely hope the HIT software industry agrees!

New ONC Scorecard Tool Grades C-CDA Documents

Posted on August 2, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The ONC has released a new scorecard tool which helps providers and developers find and resolve interoperability problems with C-CDA documents. According to HealthDataManagement, C-CDA docs that score well are coded with appropriate structure and semantics under HL7, and so have a better chance of being parseable by different systems.

The scorecard tool, which can be found here, actually offers two different types of scores for C-CDA documents, which must be uploaded to the site to be analyzed. One score diagnoses whether the document meets the requirements of the 2015 Edition Health IT Certification for Transitions of Care, granting a pass/fail grade. The other score, which is awarded as a letter grade ranging from A+ to D, is based on a set of enhanced interoperability rules developed by HL7.

The C-CDA scorecard takes advantage of the work done to develop SMART (Substitutable Medical Apps Resusable Technologies). SMART leverages FHIR, which is intended to make it simpler for app developers to access data and for EMR vendors to develop an API for this purpose. The scorecard, which leverages open-source technology, focuses on C-CDA 2.1 documents.

The SMART C-CDA scorecard was designed to promote best practices in C-CDA implementation by helping creators figure out how well and how often they follow best practices. The idea is also to highlight improvements that can be made right away (a welcome approach in a world where improvement can be elusive and even hard to define).

As SMART backers note, existing C-CDA validation tools like the Transport Testing Tool provided by NIST and Mode-Driven Health Tools, offer a comprehensive analysis of syntactic conformance to C-CDA specs, but don’t promote higher-level best practices. The new scorecard is intended to close this gap.

In case developers and providers have HIPAA concerns, the ONC makes a point of letting users know that the scorecard tool doesn’t retain submitted C-CDA files, and actually deletes them from the server after the files have been processed. That being said, ONC leaders still suggest that submitters not include any PHI or personally-identifiable information in the scorecards they have analyzed.

Checking up on C-CDA validity is becoming increasingly important, as this format is being used far more often than one might expect. For example, according to a story appearing last year in Modern Healthcare:

  • Epic customers shared 10.2 million C-CDA documents in March 2015, including 1.3 million outside the Epic ecosystem (non-Epic EMRs, HIEs and the health systems for the Defense and Veterans Affairs Departments)
  • Cerner customers sent 7.3 million C-CDA docs that month, more than half of which were consumed by non-Cerner systems.
  • Athenahealth customers sent about 117,000 C-CDA documents directly to other doctors during the first quarter of 2015.

Critics note that it’s still not clear how useful C-CDA information is to care, nor how often these documents are shared relative to the absolute number of patient visits. Still, even if the jury is still out on their benefits, it certainly makes sense to get C-CDA docs right if they’re going to be transmitted this often.

Team Training Can Produce Great Results

Posted on July 21, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study suggests that team training of healthcare staffers can cut patient mortality and also reduce medical errors. The study, which was conducted by multiple universities and two federal agencies, also found that such training improved staff members’ learning skills and use of such skills, as well as boosting financial outcomes, clinical performance and patient satisfaction.

Participants in the research program included Rice University, the Johns Hopkins University School of Medicine, the University of Central Florida, the U.S. Department of Defense and the Michael E. DeBakey VA Medical Center. The researchers conducted a meta-analysis of 129 prior studies, which looked at programs designed to improve team-based knowledge, skills, attitudes and problem-solving interactions, as well as developing coordination, cooperation, communication and leadership skills.

To conduct their analysis, researchers looked at the impact of team training programs among 23,018 participants. The studies being analyzed looked at how team training affected quality of care, customer service, patient satisfaction and other relevant variables. Participants in the team trainings included clinicians, allied health staffers, support staffers and healthcare students. The trainings were conducted at facilities ranging from small clinics to large hospitals in the U.S. and abroad.

Researchers found that team training can reduce patient mortality by 15%, and reduce medical errors by 19%. The training program also boosted employees’ learning of new skills by 31% and on-the-job use of such skills by 25%. In addition, the training improved financial outcomes of healthcare organizations by 15%. And team training was associated with a 34% improvement in clinical performance and 15% growth in patient satisfaction, researchers said.

While this study didn’t address health IT teams, it’s easy to see how such cross-disciplinary efforts might help IT staffers succeed.

As Rick Krohn of HealthDataManagement aptly puts it, health IT teams often cope with “a spaghetti bowl of boutique applications, systems and external linkages,” which creates major stresses and leaves little time for outreach. In other words, as things stand, keeping rank and file HIT staffers from burning out is a challenge – and keeping them aware of end user needs is a daunting task.

But if health IT managers have at least sporadic team meetings with outside departments that depend on them – including clinical, financial and operational units – a big uptick in learning, sharing and coordination may be possible. As the study underscores, people have to be taught how to work with their partners in the organization, no matter how professional everyone is. Fostering a cooperative exchange between health IT front-liners and users can make that happen.

Artificial Intelligence Can Improve Healthcare

Posted on July 20, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

In recent times, there has been a lot of discussion of artificial intelligence in public forums, some generated by thought leaders like Bill Gates and Stephen Hawking. Late last year Hawking actually argued that artificial intelligence “could spell the end of the human race.”

But most scientists and researchers don’t seem to be as worried as Gates and Hawking. They contend that while machines and software may do an increasingly better job of imitating human intelligence, there’s no foreseeable way in which they could become a self-conscious threat to humanity.

In fact, it seems far more likely that AI will work to serve human needs, including healthcare improvement. Here’s five examples of how AI could help bring us smarter medicine (courtesy of Fast Company):

  1. Diagnosing disease:

Want to improve diagnostic accuracy? Companies like Enlitic may help. Enlitic is studying massive numbers of medical images to help radiologists pick up small details like tiny fractures and tumors.

  1. Medication management

Here’s a twist on traditional med management strategies. The AiCure app is leveraging a smartphone webcam, in tandem with AI technology, to learn whether patients are adhering to their prescription regimen.

  1. Virtual clinicians

Though it may sound daring, a few healthcare leaders are considering giving no-humans-involved health advice a try. Some are turning to startup Sense.ly, which offers a virtual nurse, Molly. The Sense.ly interface uses machine learning to help care for chronically-ill patients between doctor’s visits.

  1. Drug creation:

AI may soon speed up the development of pharmaceutical drugs. Vendors in this field include Atomwise, whose technology leverages supercomputers to dig up therapies for database of molecular structures, and Berg Health, which studies data on why some people survive diseases.

  1. Precision medicine:

Working as part of a broader effort seeking targeted diagnoses and treatments for individuals, startup Deep Genomics is wrangling huge data sets of genetic information in an effort to find mutations and linkages to disease.

In addition to all of these clinically-oriented efforts, which seem quite promising in and of themselves, it seems clear that there are endless ways in which computing firepower, big data and AI could come together to help healthcare business operations.

Just to name the first applications that popped into my head, consider the impact AI could have on patient scheduling, particularly in high-volume hostile environments. What about using such technology to do a better job of predicting what approaches work best for collecting patient balances, and even to execute those efforts is sophisticated way?

And of course, there are countless other ways in which AI could help providers leverage clinical data in real time. Sure, EMR vendors are already rolling out technology attempting to help hospitals target emergent conditions (such as sepsis), but what if AI logic could go beyond condition-specific modules to proactively predicting a much broader range of problems?

The truth is, I don’t claim to have a specific expertise in AI, so my guesses on what applications makes sense are no better than any other observer’s. On the other hand, though, if anyone reading this has cool stories to tell about what they’re doing with AI technology I’d love to hear them.

Study: Doctors Made More Note-Taking Errors With EHRs Than Paper

Posted on July 19, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study appearing in the Journal of the American Medical Informatics Association has concluded that a sample group of physicians made more data entry errors with a new EHR than in comparable paper records, according to a HealthcareITNews item.

Researchers studied progress notes created at a Michigan hospital, Beaumont Hospital of Royal Oak, Michigan, between August 2011 and July 2013. They looked at 500 notes created during that period, some of which were prepared before the EHR implementation in 2012 and some after. The charts contained five specific diagnoses which always include physical findings, including permanent atrial fibrillation, aortic stenosis, intubation, lower limb amputation and cerebrovascular accident with hemiparesis.

Upon analysis, they found that rates of inaccurate documentation were 24.4% with the EHR, versus 4.4% with paper records. Residents had fewer inaccuracies (5.3% vs. 17.3%) and omissions (16.8% vs. 33.9%) than attending physicians.

While this is no reason to throw the EHR baby out with the bathwater – after all, the physicians in question were learning a system for the first time – it’s still a troubling set of statistics. They are even more troubling given that EHR documentation errors can sometimes create patient safety problems of their own, especially in fast-moving care settings like the emergency department.

“There are new categories of patient safety errors” taking place in EDs that didn’t exist before EHR use became commonplace, according to Raj Ratwani, scientific director for MedStar Health’s National Center for Human Factors in Healthcare in Washington, D.C., who spoke with Kaiser Health News. For example, EHRs that only allow doctors to edit records for one patient at a time can make it harder to track ED patients, according to MedStar physician Zach Hettinger.

Without a doubt, the healthcare industry can’t afford to have its IT infrastructure creating new categories of safety errors or even making mistake-ridden documentation more common. Not only does this defeat the key goals for putting EHRs in place (improving care quality and efficiency), it could lead to a net increase in safety problems.

But as peanut-gallery observers like myself have been shouting for ages, the answer to the problem is fairly straightforward. EHR user interaction design has to be improved dramatically, and soon. This isn’t exactly a secret, but it seems that the issue is still treated largely as an academic discussion rather than one of immediate practical importance for providers.

I’m not sure why we haven’t made more progress on the user experience front in EHR design – or rather, which of the reasons can actually be addressed in our lifetime – but something’s gotta give.

Physicians Still Struggle To Find EHR Value

Posted on July 18, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study by Physicians Practice magazine suggests that medical groups still aren’t getting what they want out of their EHRs, with nearly one-fifth reporting that they’re still struggling with an EHR-related drop in productivity and others still trying to optimize their system.

Physicians Practice surveyed 1,568 physicians, advanced practice providers across the U.S. as part of its 2016 Technology Survey. Nearly a third of respondents (31.9%) were in solo practice, and 34% in 2 to 5 physician practices, with percentages largely dropping as practice sizes grew larger.

Specialties represented included pediatrics (17.5%), family medicine (16.2%), OB/GYN (15.2%), psychiatry (12%), internal medicine (10.6%), surgery (2.9%), general practice (2.7%) and “other” at 22.9% (led by ophthalmology). As to business models, 63.3% of practices were independently-owned, 27.9% were part of an integrated delivery network and the remaining 8.8% were “other,” led by federally-qualified health centers.

Here’s some interesting data points from the survey, with my take:

  • Almost 40% of EHR users are struggling to get value out of their system: When asked what their most pressing technology problem was, 20.3% said it was optimizing use of their EHR, 18.9% a drop in productivity due to their EHR, and 12.9% a lack of interoperability between EHRs. Both EHR implementation and costs to implement and use technologies came in at 8%.
  • EHR rollouts are maturing, but many practices are lagging: About 59% of respondents had a fully-implemented EHR in place, with 14.5% using a system provided by a hospital or corporate parent. But 16.8% didn’t have an EHR, and 9.5% had selected an EHR (or a corporate parent had done so for them) but hadn’t fully implemented or optimized yet.
  • Many practices that skip EHRs don’t think they’re worth the trouble and expense: Almost 41% of respondents who don’t have a system in place said that they don’t believe it would improve patient care, 24.4% said that such systems are too expensive. A small but meaningful subset of the non-users (6.6%) said they’d “heard too many horror stories.”
  • Medical group EHR implementations are fairly slow, with more than one-quarter limping on for over a year: More than a third (37.2%) of practices reported that full implementation and training took up to six months, 21.2% said it took more than six months and less than a year, 12.8% said more than a year but less than 18 months, and 15.7% at more than 18 months.
  • Most practices haven’t seen a penny of return on their EHR investment: While just about one-quarter of respondents (25.7%) reported that they’d gotten ROI from their system, almost three-quarters (74.3%) said they had not.
  • Loyalty to EHR vendors is lukewarm at best: When asked how they felt about their EHR vendor, 39.7% said they were satisfied and would recommend them, but felt other vendors would be just as good. Just over 16% said they were very satisfied. Meanwhile, more than 17% were either dissatisfied and regretted their purchase or ready to switch to another system.
  • The big EHR switchout isn’t just for hospitals: While 62.1% of respondents said that the EHR they had in place was their first, 27.1% were on their second system, and 10.8% their third or more.

If you want to learn more, I recommend the report highly (click here to get it). But it doesn’t take a weatherman to see which way these winds are blowing. Clearly, many practices still need a hand in getting something worthwhile from their EHR, and I hope they get it.

Smartphone Strategy May Cause Health Data Interoperability Problems

Posted on July 13, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Tonight I was out at my local electronics store looking over the latest in Samsung gear. While chatting with the salesman behind the Samsung counter, I picked up a wireless charging pad and asked what it cost. “Don’t bother,” he said. “That won’t work with your phone,” which happens to be a none-too-old Galaxy Note Edge.

New batteries? Same problem. I strongly suspect that the lovely VR gear, headset and smart watch on display suffer from the same limitations. And heaven knows that these devices wouldn’t work with products produced by other Android-compatible manufacturers.

Now, I am no communications industry expert. So I won’t hold forth on whether Samsung’s decision to create a network of proprietary devices is a smart strategy or not. Intuitively, my guess is that the giant manufacturer is making a mistake in trying to lock in customers this way, but I don’t have data upon which to base that claim.

But when it comes to health IT, it’s clearer to me how things might play out. And I’d argue that Samsung’s emerging strategy should generate concern among providers.

Interconnecting proprietary tech is far from new. In fact, Apple long ago won the battle to force its users onto its proprietary platform, and AFAIK, the computing and media giant has never back down from the stance, including where its telecommunications gear was concerned. But at least until recently, we’ve had interoperable Android phones and tablets to work with, which ran on a freely-available operating system that played nicely with other devices running the system.

But with the device maker moving away from “works on Android” to “works on Samsung Android devices,” the chain of interoperability is broken. This could lead to shifts in the telecommunications industry which don’t bode well for healthcare users.

On the surface, we are only looking at relatively petty IT concerns for HIT leaders, such as seeing to it that the Samsung user gets a Samsung charging pad. Like enterprises in other industries, health leaders will adapt to this inconvenience. But the problems don’t stop there.

If telecommunications manufacturers follow Samsung’s lead, and decide to add proprietary quirks to their devices, providers may pay the price. Depending on how these newly-proprietary devices are configured, and how they must be supported, it could become much harder to dig data out of them on an ongoing basis. That’s the last thing we need right now.

Not only that, what happens if proprietary differences between Android phones and tablets make it harder for them to communicate with medical devices, a tantalizing possibility which is just beginning to present itself? While we don’t yet know how devices such as infusion pumps to interoperate with mobile devices, nor the latter two with desktops, wearables and servers, we don’t want to close off options.

Bottom line, I may be crying wolf too soon, but these developments alarm me. I’d hate to see additional walls go up between various data sources, particularly before we even know what we can do with them.

We Still Need More Female Leaders In Health Tech

Posted on July 12, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Despite the looming presence of Epic’s Judy Faulkner, women are still underrepresented in the boardrooms of health tech companies. This point was underscored a recent article in Healthegy News, which offered a bracing reminder of the need for better gender balance in the industry, especially at the top.

As the article points out, women are grossly underrepresented within digital health, arguably the least traditional niche within the business, running only 6% of these ventures. I don’t know what the stats are for health IT at large but I can’t imagine the ratio is any better (and it may be worse).

And as writer Kirti Patel notes, it’s probably not a coincidence that only 6% of venture capitalists are female. Patel cites stats suggesting that VC teams with women on them are twice as likely to invest in management teams that include women, and three times more likely to invest in companies with female CEOs.

Of course, Faulkner isn’t the only woman to hold a powerful position in the health IT world. Female influencers and leaders in U.S. healthcare industry range from Nancy Ham, CEO of Medicity to Carla Kriwet, CEO of Patient Care and Monitoring Solutions at Phillips to AHIMA CEO Lynne Thomas Gordon. Other standouts include Deborah DiSanzo, General Manager of IBM Watson Health and of course Karen DeSalvo, Acting Assistant Secretary for Health at ONC. But numbers-wise, women with top roles in health IT are still in the minority.

To be fair, the lack of women in the health IT boardroom reflects the larger technology industry. Research suggests that only 25% of professional computing physicians in the 2015 U.S. workforce were held by women, and that just 17% of Fortune 500 CIO positions were held by women that year. This dovetails with other trends, such as the fact that only 15% of 2014 computer science bachelor’s degree recipients at major research universities were women.

Still, even given these statistics, I’d argue that we all know incredible women in health IT who might be capable of far more, including top leadership roles, if they had the opportunity. And while I’m not suggesting that conscious discrimination is going on, gender bias pops up in ways that people don’t always recognize.

The problem is so pervasive, in part, because it extends beyond technical positions to healthcare as a whole. According to statistics from a couple of years ago, women made up 80% of the healthcare workforce, but just 40% of the leadership roles in the industry.

Health IT faces too many challenges to pass over anyone who might have good solutions to offer. Health IT organizations should do everything they can to be sure that unseen gender bias in preventing them from moving the industry forward.

E-Patient Update: Video Visits Need EMR Support

Posted on July 11, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

From what I’ve read, many providers would like to deliver telemedicine consults through their EMR platform. This makes sense, as doing so would probably include the ability to document such visits in the same way as face-to-face encounters. It would also make it far easier to merge notes from telehealth visits into existing records of traditional care.

Unfortunately, there’s little reason to believe that this will be possible anytime soon. If nothing else, vendors won’t face too much pressure from providers until the health insurers routinely pay for such care. Or one could argue that until providers are living on value-based care models, they have little incentive to aggressively push care to lower-cost channels like telemedicine. Either way, EMR vendors aren’t likely to focus on this issue in the near term.

But I’d argue that providers have strong reasons to add EMR support to their telemedicine efforts. If they don’t take the bull by the horns now, and train patients to see video visits as legitimate and worthwhile, they are unlikely to leverage telehealth fully when it becomes central to the delivery of care. And that means, in part, that providers must document video consults and integrate that data into their EMR anyway they can. After all, patients are already beginning to understand that it data doesn’t appear in their electronic record, it probably isn’t important to their health.

It seems to me that the lagging EMR support for telemedicine visits springs in part from how they grew up. Just the other day, I had a video visit with a primary care doc working for one of the major direct-to-consumer telehealth services. And his comments gave me some insight into how this issue has evolved.

As sometimes happens, I ended up straying from discussion of my health needs to comment on HIT issues with the visit, notably to complain about the fact that I had to reenter my long list of daily meds every time I sought help from that service. He agreed that it was a problem, but also pointed out that the service’s founders have assumed that their users would almost exclusively be seeking one-off urgent care. In fact, he noted, none of the data collected during the visit is formatted in a way that can be digested easily by an EMR, another result of the assumption that clients would not need a longitudinal record of their telemedical care.

Admittedly, this service is in a different business than hospital or ambulatory care providers with a substantial brick-and-mortar presence. But my guess is that the assumptions upon which the direct-to-consumer businesses were founded are still shared by some traditional providers.

As a patient, I urge providers to give serious thought to better documenting telehealth today, rather than waiting for the vendors to get their act together on that front. If your clinicians are managing relationships by a video visits today, they will be soon. And when that happens I want a coherent record of my digital care to be available. Letting all that data fall through the cracks just doesn’t make sense.