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E-Patient Update: A Bad Case Of Hyperportalotus

Posted on September 30, 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.

Lately, the medical profession has seen an increasing incidence of a new condition tentatively identified as “hyperportalotus” — marked by symptoms of confusion, impatience, wasted time and existential dread. Unlike many newly-identified medical problems, the cause for this condition is well understood. Patient simply have too many portals being thrust at them.

As a patient with a few chronic illnesses, I see several specialists in addition to a primary care doctor. I’ve also been seen recently at a community hospital, as well as an urgent care center run by a different health system. I have access to at least seven portals, each, as you probably guessed, completely independent of each other.

Portals in play in my medical care include two instances of Epic’s MyChart, the Allscripts FollowMyHealth product and an athenahealth portal. (As an aside, I should say that I’ve found that I like athenahealth’s product the most, but that’s a story for another day.)

Because I am who I am – an e-patient dedicated to understanding and leveraging these tools – I’m fairly comfortable working with my providers on this basis. I simply check in with the portal run by a given practice within a few days of my visit, review reports and lab results and generally orient myself to the flow of information.

Too Much Information
So, if I can easily access and switch between various portals, what’s the big deal? After all, signing up for these portals is relatively simple, and while they differ in how they are organized, their interfaces are basically the same.

The problem is (drumroll…) that most patients aren’t like me. Many are overwhelmed by their contact with the medical system and feel reluctant to dig into more information between visits. Others may not feel confident that they understand the portals and shy away reflexively.

Take the case of my 70-something father. My dad is actually pretty computer-savvy, having worked in the technology business for many years. (His career goes all the way back to the days of punch cards.) But even he seems averse to signing up for MyChart, which is used by the integrated health system that provides all of his inpatient and outpatient care.

Admittedly, my father has less contact with doctors and hospitals than I do, so his need to review medical data might be less than mine. Nonetheless, it’s a shame that the mechanics of signing up for and using a portal are intimidating to both he and my mother.

A Common Portal
All this being said, the question is what we can do about it. I have a theory, and would love to know what you think of it.

What if we launched an open source-based central industry portal to which all other portals could publish basic information?  This structure would take proprietary vendors’ interest in controlling data out of the picture. Also, with the data being by its very nature limited (as consumers never get the whole tamale) it would answer objections by providers who feel that they’re giving away the store with the patient data.

Of course, I can raise immediate and powerful objections to my own proposal, the strongest of which is probably that we would have to agree on a single shared standard for publishing this data to the central megaportal. (And we all know how that usually works out.)

On the other hand, such approach has much to recommend it, including better care coordination and hopefully, stronger patient engagement with their health. Maybe I’m crazy, but I have a feeling that this just might work. Heck, maybe my father would bother looking at his own medical information if he didn’t have to develop hyperportalotus to do it.

How To Choose Tools For Physician-Patient Engagement

Posted on September 22, 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.

To transition from fee-for-service reimbursement to value-based care, it’s pretty much a given that we have to do a better job of getting patients engaged with their physicians and overall plan of care. However, despite the array of intriguing digital health and mobile technologies we have available to get the job done, it’s still not clear exactly how to do it.

But according to one health IT exec, it all boils down to understanding how the various tools and technologies work and integrating them into your practice. Dr. Ali Hussam, CEO of outcomes data collection firm OBERD, suggests that the following tools are particularly important. I’ve listed his suggestions, and added some thoughts of my own:

  • Educational technologies: Physicians can use these tools to make sure patients are prepared to have an intelligent discussion of their health status, he notes. My take: It’s hard to argue that this makes sense; in fact, this concept is so important that I’m surprised it isn’t mentioned more often as part of the broader patient engagement picture.  
  • Electronic questionnaires: Hussam argues that since value-based care calls for quantifiable outcome measurements, it’s smart to use electronic questionnaires, which are more appealing, efficient and sophisticated than paper tools. My response to this is that while it’s a good idea, it will be important that the questionnaires be based on well-defined measures which the provider organization trusts, and these may not be easy to come by at first.
  • Wearables: Patients may already be using wearables to monitor their own health metrics, but it’s time to make better use of their presence, Hussam suggest. Physicians can step up their value by using the information to improve the quality of health discussions and intervene in response to the data if needed.  It’s hard to argue that he’s right about the potential uses of wearables. However, there’s a lot of doubt about their accuracy, so my sense is that many physicians are still reluctant to make use of them given the clinical accuracy questions which still bedeviled these devices.

Along with recommending these approaches to engagement, Hussam offers some tips for implementing patient engagement technology, including:

  • Focus on patient outcome: Hussam recommends sending a patient-determined outcome as the focus of care, and explaining to patients how engagement technology can help them meet this goal. Plain and simple, this sounds like an excellent idea, as patients are more likely to succeed at meeting goals they have embraced.
  • Solicit feedback: Effective engagement tools “should offer patients a sense of individual attention and intimacy by soliciting feedback about individual patients’ entire healthcare experience,” along with offering care data. He argues, I think compellingly, that this exchange of information could help providers succeed under merit-based incentive payment programs.
  • Encourage responses to questionnaires: As Hussam noted previously, providers must collect data to succeed at outcome-based payment models. But he also notes correctly that these questionnaires and help patients achieve their desired health outcomes by tracking what’s going on with their health. No matter how you couch things, however, patients may need additional encouragement to fill out forms. Perhaps it would make sense to have med techs go through the questionnaires with patients prior to their physician encounter, at least at first.

As Hussam’s analysis suggests, engaging patients isn’t just a matter of presenting them with shiny new technologies. It’s critical to align patient use of the technologies with goals they hope to meet, and to explain how the tools can get them there.

Otherwise, both patients and providers will see little benefit from throwing engagement tools into the mix.

Yet Another Study Says EMRs Contribute to Physician Burnout

Posted on September 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 Mayo Clinic study recently concluded that – surprise, surprise – that physicians who used EMRs were less likely to be satisfied with the amount of time spent on clerical tasks. But from where I sit, while the story certainly deserves attention, it’s also worth considering how this fits into the problem of physician burnout on the whole.

First, let’s review the study itself. To conduct the study, which appeared in the Mayo Clinic Proceedings, researchers connected with 6,375 physicians in active practice, 5,389 of which (84.5%) reported using EMRs. Meanwhile, of 5,892 physicians who said that CPOE was relevant to their practice specialty, 4,858 (82.5%) said they used CPOE technology.

Researchers concluded that physicians who use EMRs and CPOE had lower satisfaction with time spent in clerical tasks and higher rates of burnout, including when the data was adjusted for age, sex, specialty, practice setting and hours worked per week. The bottom line, researchers said, was that this large national study demonstrated that satisfaction with EMRs and CPOE was generally low.

Now let’s take a look at the big picture on physician burnout. One comprehensive take comes from the American Academy of Family Physicians, whose position paper on the subject includes the following definition of burnout: “A syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feeling of cynicism (depersonalization), and a low sense of personal accomplishment.”

The AAFP paper, which points out that the phenomenon has been studied for decades, notes that 45.8% physicians are considered to be experiencing at least one symptom of burnout. According to a recent broad-based study, that there is currently a 35.2% overall burnout rate among U.S. physicians.

According to research cited by the AAFP, there’s still no definitive data on what causes physician burnout, but notes that common drivers of family physician burnout include paperwork, feeling undervalued, frustration referral networks, difficult patients, medicolegal issues, and challenges in finding work-life balance.

While I don’t want to minimize the impact that a badly-designed EMR can have a negative impact on a physician’s practice, or underplay the findings of the Mayo study cited above, I think it’s worth noting that the group doesn’t cite EMRs as a specific cause of burnout.

Clearly, physicians don’t like using EMRs for administrative work — and it even appears that they would rather use paper to handle such chores. However, let’s not kid ourselves into thinking that doctors loved documenting on paper either. Complaints about not wanting to finish their charts were common in the paper world too.

And the truth is, as EMRs have gradually shifted from being vehicles to support billing to richer clinical documentation and support tools, it may very well have become harder to use them for routine administrative tasks. Vendors probably need to reconsider yet again the balance between clinical and administrative features, and how effective both are.

That being said, I think it’s important not to forget that physicians are facing many, many challenges, most of which began grinding away at their independence and self-respect well before EMRs became an established part of the picture.

Unfortunately, it’s likely that for some physicians, feeling forced to adopt an EMR has proven to be the straw that broke the camel’s back. And they certainly deserve a hearing. But if in the process, we allow ourselves to lose sight of the countless other problems physicians are struggling with, we are doing them a disservice. Addressing physicians’ EMR issues won’t fix everything that’s broken here.

E-Patient Update:  Keeping Data From Patients Has Consequences

Posted on September 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.

Given who I am – an analyst and editor who’s waist-deep in the health IT world – I am primed to stay on top of my health data, including physician notes, lab reports, test results and imaging studies. Not only does it help me talk to my doctors, it gives me a feeling of control which I value.

The thing is, I’m not convinced that most physicians support me in this. Time and again, I run into situations where I can’t see my own health information via a portal until a physician “approves” the data. I’ve written about this phenomenon previously, mostly to wring my hands at the foolishness of it all, but I see the need to revisit the issue.

Having given the matter more thought, I’ve come to believe that withholding such data isn’t just unfortunate, it’s harmful. Not only does it hamper patients’ efforts to manage their own care effectively, it reveals attitudes which are likely to hold back the entire process of transforming the health system.

An Example of Delayed Health Data
Take the following example, from my own care. I was treated in the emergency department for swelling and pain which I feared might be related to a blood clot in my leg. The ED staff did a battery of tests, including an MRI, which concluded that I was actually suffering from lumbar spine issues.

Given that the spinal issue was painful and disabling, I made an appointment for follow up with a spine specialist for one week after the ED visit. But despite having signed up with the hospital’s portal, I was unable to retrieve the radiologist’s report until an hour before the spine specialist visit. And without that report the specialist would not have been able to act immediately to assist me.

I don’t know why I was unable to access the records for several days after my visit, but I can’t think of a reason why it would have made sense to deprive me of information I needed urgently for continued care. My previous experience, however, suggests that I probably had to wait until a physician reviewed the records and released them for my use.

Defeating the Purpose
To my way of looking at things, holding back records defeats the purpose of having portals in the first place. Ideally, patients don’t use portals as passive record repositories; instead, they visit them regularly and review key information generated by their clinical encounters, particularly if they suffer from chronic illnesses.

It’d be a real shame if conservative attitudes about sharing unvetted tests, imaging or procedure data undercut the benefits of portals. While it’s still not entirely clear how we’re going to engage patients further in managing their health – individually or across a population – portals are emerging as one of the more effective tools we’ve got. Bottom line, patients use them, and that’s a pretty big deal.

I’m not saying that patients have never overreacted to what looked like a scary result and called their doctor a million times in a panic. (That seems to be the scenario doctors fear, from conversations I’ve had over time.) But my guess is that it’s far less common than they think.

And in their attempts to head off a minor problem, they’re discouraging patients from getting involved with their care, which is what they need patients to do as value-based care models emerge. Seems like everyone loses.

Sure, patients may struggle to understand care data and notes at first, but what we need to do is educate them on what it means. We can’t afford to keep patients ignorant just to protect turf and salve egos.

Physician Practices Lack Good Models For EMR Adoption

Posted on September 14, 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.

“All happy families are alike; each unhappy family is unhappy in its own way.”
― Leo TolstoyAnna Karenina

When hospitals roll out an EMR, they go through complex and rich information-gathering process. Health IT leaders tackle problems of scale, systems integration and feature development with support from multiple leaders in other departments. There are best practices to consider and vendor selection processes to observe, references and case studies to collect, and user group meetings they can attend to fine tune their EMR rollout and answer questions.

But when it comes to physician practices, particularly the smaller ones that dominate the medical landscape, the way is not as clear. Often without even a full-time IT staff member to assist them in their selection process, EMR adoption by physician groups is far less structured. Sure, physicians may check references like their hospital colleagues do, explore customer case studies and participate in software demos, but in most cases their process is far less systematic and informed than that of a hospital.

What’s more, if their EMR implementation runs into trouble, smaller medical groups may have far less support than hospital IT leaders. After all, not only are they less likely to get much help in selecting an EMR, they probably don’t have a robust network of peers who can answer questions in context. Like any small business, they make their idiosyncrasies work for them, but when they get into trouble with IT they are unhappy in their own unique way.

Standardizing Physician EMR Adoption
Of course, practice leaders who are struggling with their EMR investment can turn to the vendor that sold them the system, but that can backfire pretty easily. While the vendor is obviously the last word on how the contract is structured, they may or may not have a strong incentive to address gripes and concerns, even if they are obligated to address outright failures of the system.

If the vendor offers a fairly open support model, practices may get some help as they evolve. But if their vendor charges by the hour for support, it’s unlikely many practices be willing to pay for the time to address anything but major problems. That may cut practices off from the knowledge and context they need.

Given these concerns, I’d argue that we need to develop a generalizable, reproducible model for physician EMR adoption and rollout. As I envision it, it should include:

  1. A standardized form smaller practices can use to identify their key needs, allowing them to pick and weight their priorities from an evidence-based list of key selection criteria
  2. A frequently-updated database, maintained by a third party, which collects physician ratings on how a given vendor meets these well-articulated needs
  3. A post-implementation form, once again drawn from research evidence, helping them identify and weight their EMR’s performance based on objective criteria

The idea behind all of this is to standardize physician groups’ EMR selection and rollout, and turn what can be a groping, uneven process into an evidence-based one. Not only will this help physicians from the outset, it allows for building a knowledge base which cuts across vendors, geographies, practice sizes and technical sophistication levels. If physicians had such tools, their process of learning would become iterative and collaborative in a far more effective way.

Don’t get me wrong, I know that virtually any software selection process will address issues that don’t make it into a model like the above.  But if you offer practices a more structured way to adopt an EMR, they are more likely to be happy with their overall results. This is going to become even more and more important as small practices switch EHR software due to EHR consolidation and other factors.

In The Trenches: Primary Care Practice Saves With EMR Transition

Posted on September 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.

This is the first in an occasional series of stories I’m writing on how medical practices – particularly smaller groups – are handling their health IT challenges. If you have suggestions for future columns please feel free to write to me at anne@ziegerhealthcare.com.

It only took six months for Clem Surak to realize that his current EMR system wasn’t going to cut it. Surak, who bought Wilmington, NC-based primary care practice Health Partners in 2011 with his wife, didn’t originally come from the healthcare business, but he quickly saw that his IT platforms weren’t cost-effective.

The systems he inherited to run the practice, an Allscripts EHR sprawling across three servers and a companion practice management platform called Tiger, were “very proprietary” and tech support wasn’t easy to access. And they cost $20K per year to support two doctors.

Worse, the product wasn’t very current. “Meaningful Use had to be downloaded as a separate module,” said Surak.

Not surprisingly, Surak began looking for other options. After consulting with his local Regional Extension Center, he went with a new system from Amazing Charts (full disclosure: a former client of your editor). The new system, which went live in June 2012, offered some important benefits, including:

* Savings:  It cost Health Partners $5,400/year to license the integrated Amazing Charts EHR, a $14,600 savings over the Allscripts systems.

* Maintenance: Because the new solution is cloud-based, the practice doesn’t need to maintain the software or cope with technical breakdowns directly.

* Rollout: Implemented over the course of three months, with no slowdown or reduction in physician hours needed. “We kept our normal pace,” Surak says.

* Data transfer: To bring patient demographic data over from Allscripts to the new system, all the practice had to do was export Allscripts data into an Excel spreadsheet, then run an Amazing Charts wizard which imported it.

Of course, the practice faced some challenges as well, largely around adjusting workflow and phasing out the old system:

* Running in parallel:  For the first few years after the transition to Amazing Charts, Health Partners had to keep the Allscripts system running alongside the new system.

* Practice management lag:  Amazing Charts didn’t offer a practice management module at the time Health Partners acquired the EMR. Until mid-2015, when a practice management module became available, it had to keep doing patient scheduling and accounting in the Allscripts system.

Ultimately, despite some transitional hassles, Surak is glad he made the shift to a set of systems that work effectively in tandem. Putting a new EMR and practice management system in place hasn’t just saved money, it’s helped Surak keep efficiency high, running the practice with just a couple of support staffers.

“Most offices this size would have five to seven support staffers, but we don’t have to,” he says. “And keeping overhead down is the key to remaining independent.”

Enterprise EHR Vendors Consolidating Hold On Doctors

Posted on September 9, 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.

When I stumbled across a recent study naming the EHRs most widely used by physicians, I don’t know what I expected, but I did not think big-iron enterprise vendors would top the list. I was wrong.

In fact, I should have guessed that things would play out this way for giants like Epic, though not because physicians adore them. Forces bigger than the Cerners and Epics of the world, largely the ongoing trend towards buyouts of medical groups by hospitals, have forced doctors’ hand. But more on this later.

Context on physician EHR adoption
First, some stats for context.  To compile its 2016 EHR Report, Medscape surveyed 15,285 physicians across 25 specialties. Researchers asked them to name their EHR and rate their systems on several criteria, including ease of use and value as a clinical tool.

When it came to usage, Epic came in at first place in both 2012 and 2016, but climbed six percentage points to 28% of users this year. This dovetails with other data points, such that Epic leads the hospital and health system market, according to HIT Consultant, which reported on the study.

Meanwhile, Cerner climbed from third place to second place, but it only gained one percentage point in the study, hitting 10% this year. It took the place of Allscripts, which ranked second in 2012 but has since dropped out of the small practice software market.

eClinicalWorks came in third with 7% share, followed by NextGen (5%) and MEDITECH (4%). eClinicalWorks ranked in fifth place in the 2012 study, but neither NextGen nor MEDITECH were in the top five most used vendors four years ago. This shift comes in part due to the disappearance of Centricity from the list, which came in fourth in the 2012 research.

Independents want different EHRs
I was interested to note that when the researchers surveyed independent practices with their own EHRs, usage trends took a much different turn. eClinicalWorks rated first in usage among this segment, at 12% share, followed by Practice Fusion and NextGen, sharing the second place spot with 8% each.

One particularly striking data point provided by the report was that roughly one-third of these practices reported using “other systems,” notably EMA/Modernizing Medicine (1.6%), Office Practicum (1.2%) and Aprima (0.8%).

I suppose you could read this a number of ways, but my take is that physicians aren’t thrilled by the market-leading systems and are casting about for alternatives. This squares with the results of a study released by Physicians Practice earlier this year, which reported that only a quarter of so of practices felt they were getting a return on investment from their system.

Time for a modular model
So what can we take away from these numbers?  To me, a few things seem apparent:

* While this wasn’t always the case historically, hospitals are pushing out enterprise EHRs to captive physicians, probably the only defensible thing they can do at this point given interoperability concerns. This is giving these vendors more power over doctors than they’ve had in the past.

* Physicians are not incredibly fond of even the EHRs they get to choose. I imagine they’re even less thrilled by EHRs pushed out to them by hospitals and health systems.

* Ergo, if a vendor could create an Epic- or Cerner-compatible module designed specifically – and usably — for outpatient use, they’d offer the best of two worlds. And that could steal the market out from under the eClinicalWorks and NextGens of the world.

It’s possible that one of the existing ambulatory EHR leaders could re-emerge at the top if it created such a module, I imagine. But it’s hard for even middle-aged dogs to learn new tricks. My guess is that this mantle will be taken up by a company we haven’t heard of yet.

In the mean time, it’s anybody’s guess as to whether the physician-first EHR players stand a chance of keeping their market share.

Department Of Defense (DOD) EHR Delayed By “Aggressive Schedule”

Posted on September 7, 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 Department of Defense has announced that it will be delaying the deployment of its massive EHR project, citing issues identified in testing and an “aggressive schedule” as reasons for the decision. If the DoD and its vendors are right, the deployment delay will be a negligible few months, though one setback to an effort of this kind usually to leads to another.

On the plus side, military officials said, they’ve made significant progress with developing user-approved workflows, interfaces and technical integration of its legacy system to date. But they’re not ready to engage in the concurrent system configuration, cybersecurity risk management, contractor and government testing yet.

The deployment has been in the works for little over a year. Last summer, the DoD Healthcare System Modernization Program awarded the $4.3 billion contract to upgrade its existing Military Health System EHR to a group including Cerner and defense contracting firm Leidos. The Cerner/Leidos team won out against some tough competition, including a partnership including Allscripts, HP and Computer Sciences Corp. and an Epic/IBM bid.

The ten-year project is about as large and complex an integration effort as you’re likely to see even by Cerner standards. The effort will connect healthcare systems located at Army hospitals, on Naval vessels, in battlefield clinics across the globe. MHS GENESIS will bring all of this data — on active-duty members, reservists, and civilian contractors — into a single open, interoperable platform. The new platform should serve 9.5 million military beneficiaries in roughly 1,000 locations.

The project is upgrading the DoD from AHLTA (Armed Forces Health Longitudinal Technology Application), which has been in place since 2004. AHLTA has many flaws, though none that would surprise a health IT expert. (For example, when patients are referred to non DoD providers, the data is not captured and integrated into the system.)

Ultimately, it won’t matter very much whether the DoD manages to kick off its project on time. The larger question, here, is whether over the course of a 10-year integration effort, the project becomes, as Forbes columnist Loren Thompson puts it, “obsolete before it’s even built” and incapable of the data sharing that fueled its conception. Of course, any systems integration with a long timeline faces that risk, but not all industries are changing as quickly as healthcare.

The truth is, this is arguably an awkward time for any large entity to be making big interoperability plans. I’d argue that while there are more initiatives than ever aimed at the problem, they’ve effectively made things worse rather than better. After all, the unfortunate truth is that the more people compete over interoperability standards, the less possible data sharing becomes.

A Circular Chat On Healthcare Interoperability

Posted on September 6, 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.

About a week ago, a press release on health data interoperability came into my inbox. I read it over and shook my head. Then I pinged a health tech buddy for some help. This guy has seen it all, and I felt pretty confident that he would know whether there was any real news there.

And this is how our chat went.

—-

“So you got another interoperability pitch from one of those groups. Is this the one that Cerner kicked off to spite Epic?” he asked me.

“No, this is the one that Epic and its buddies kicked off to spite Cerner,” I told him. “You know, health data exchange that can work for anyone that gets involved.”

“Do you mean a set of technical specs? Maybe that one that everyone seems to think is the next big hope for application-based data sharing? The one ONC seems to like.” he observed. “Or at least it did during the DeSalvo administration.”

“No, I mean the group working on a common technical approach to sharing health data securely,” I said. “You know, the one that lets doctors send data straight to another provider without digging into an EMR.”

“You mean that technology that supports underground currency trading? That one seems a little bit too raw to support health data trading,” he said.

“Maybe so. But I was talking about data-sharing standards adopted by an industry group trying to get everyone together under one roof,” I said. “It’s led by vendors but it claims to be serving the entire health IT world. Like a charity, though not very much.”

“Oh, I get it. You must be talking about the industry group that throws that humungous trade show each year.” he told me. “A friend wore through two pairs of wingtips on the trade show floor last year. And he hardly left his booth!”

“Actually, I was talking about a different industry group. You know, one that a few top vendors have created to promote their approach to interoperability.” I said. “Big footprint. Big hopes. Big claims about the future.”

“Oh yeah. You’re talking about that group Epic created to steal a move from Cerner.” he said.

“Um, sure. That must have been it,” I told him. “I’m sure that’s what I meant.”

—-

OK, I made most of this up. You’ve got me. But it is a pretty accurate representation of how most conversations go when I try to figure out who has a chance of actually making interoperability happen. (Of course, I added some snark for laughs, but not much, believe it or not.)

Does this exchange sound familiar to anyone else?

And if it does, is it any wonder we don’t have interoperability in healthcare?

Time To Build EHRs That Address Human Complexity

Posted on September 1, 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.

As things stand in our world, caring for patients generally falls into two broad categories: treating the body and its innumerable mysteries, and caring for practicalities of the patient’s mental and social health. The two are interrelated, of course, but often they’re treated independently, as if each existed in a separate world.

But we know that this is a false dichotomy. People don’t go from being patients at one point and human beings later, and treating them that way can fail or even cause them harm. At every point, they’re people living in a complex world which may overwhelm their capacity for getting good healthcare. Their values, social networks, resources (or lack thereof), education and mental health status are just a few of the many dimensions that influence a patient’s overall functioning in the world.

This isn’t a new idea. As Frances Peabody noted in a 1927 lecture to Harvard Medical School students, “the secret of the care of the patient is in caring for the patient,” by understanding how a patient’s personal and emotional circumstances influence their health status. It’s a concept that needs revisiting, particularly given that the automation of care seems likely to further alienate doctors from patients.

Given how seldom physicians have a chance to address patients’ life circumstances, and how important it is that medicine returns to this approach, it was good to see the The Journal of the American Medical Association weigh in on the issue.

In the Viewpoint piece, entitled “Evolutionary Pressures on the Electronic Health Record: Caring for Complexity,” the authors contend that next-generation EHRs will need to do much more to help physicians address an increasingly complex patient mix.  They suggest that rising patient complexity – due to issues such as co-occurring chronic and rare diseases, organ transplantation and artificial devices – are changing the practice of medicine. Meanwhile, they point out, patients’ personal experience of illness and the social context in which they live are still important considerations.

But EHRs aren’t developing the capacity to meet these needs, they note:

The evolution of EHRs has not kept pace with technology widely used to track, synthesize, and visualize information in many other domains of modern life. While clinicians can calculate a patient’s likelihood of future myocardial infarction, risk of osteoporotic fracture, and odds of developing certain cancers, most systems do not integrate these tools in a way that supports tailored treatment decisions based on an individual’s unique characteristics.

Existing EHRs aren’t designed to help physicians use predictive analytics to deliver preventative care or services to targeted individuals either, they note. Nor are they helping clinicians to learn from past cases in a systematic manner, the piece says:

When a 55-year-old woman of Asian heritage presents to her physician with asthma and new-onset moderate hypertension, it would be helpful for an EHR system to find a personalized cohort of patients (based on key similarities or by using population data weighted by specific patient characteristics) to suggest a course of action based on how those patients responded to certain antihypertensive medication classes, thus providing practice-based evidence when randomized trial evidence is lacking.

The JAMA authors also take EHR vendors to task for doing nothing to capture social and behavioral data (otherwise known as “social determinants of health”)  which could have a big impact on health outcomes and treatment responses:

In this world of patient portals and electronic tablets, it should be possible to collect from individuals key information about their environment and unique stressors – at home or in the workplace – in the medical record. What is the story of the individual?  The most sophisticated computerized algorithms, if limited to medical data, may underestimate a patient’s risk (eg, through ignorance about neighborhood dangers contributing to sedentary behavior and poor nutrition) or recommend suboptimal treatment (eg, escalating asthma medications for symptoms triggered by second-hand smoke).

If EHRs evolve successfully to embrace such factors – and move away from their origins in billing support – physicians may spend much less time with them in the future. In fact, the authors speak lovingly of a future in which “deimplementing the EHR” becomes a trend, and care no longer revolves around a computer. This may not happen anytime soon.

Still, perhaps we can speak of “rehumanizing the EHR” with information that address the whole, complex person. A rehumanized EHR that Francis Perkins would use, were he alive today, is something physicians should demand.