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Twitter Highlights from AMIA17

Posted on November 15, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week I had the privilege of attending the 2017 American Medical Informatics Association (AMIA17) annual conference in Washington DC. I thoroughly enjoyed the experience and came away with new appreciation for the work informaticists do. Check out this blog for key AMIA17 takeaways.

One of the most enjoyable aspects of AMIA17 was the quantity and quality of the live-tweeting. My twitter feed hadn’t been that active at a healthcare conference since HIMSS17. There were no less than 20 attendees actively tweeting throughout the conference.

Below is a selection of memorable AMIA17 tweets.

I wasn’t familiar with Carol Friedman’s work, but her lovely tribute video was riveting – almost Hidden Figures-esque. Friedman not only had to overcome being a female data scientist, she was one of the few in her field to believe Natural Language Processing could be applied to healthcare. Her acceptance speech was filled with humor and funny stories.

One of the major announcements at AMIA17 was the creation of a new open access journal – called JAMIA Open. This new publication will be AMIA’s attempt to break down one of the biggest barriers to innovation – a lack of access to research papers. It will be interesting to track the progress of JAMIA Open in the months and years to come.

A very interesting concept discussed at AMIA17 was the use of EHR audit logs as way to identify areas for improvement. This included finding opportunities where retraining might be needed and where bottlenecks exist in clinical workflows. Suddenly it’s not so bad that EHRs record every action…or maybe it is if you are a bottleneck.

Genomics is very exciting. Carolyn Petersen, an Editor at Mayo Clinic, tweeted one out an interesting use case during AMIA17 – using genomic info to prevent adverse drug reactions. Amazing.

This was an extremely interesting question posed by Dr. Danny Sands. In the OpenNotes session he attended the presenters found that physicians were more honest in their documentation notes than they were with the patients they were seeing face-to-face. This makes for an intriguing scenario when patients gain access to those notes after a visit.

One of the more prolific live-tweeters at AMIA17 was Dr Wayne Liang. I enjoyed reading his tweets from sessions that I was unable to attend. This tweet stood out for me. He expertly summarized the 5 ways HealthIT systems could be improved to allow for better data analytics.

Another active live-tweeter was Pritika Dasgupta, PhD student at University of Pittsburgh Department of Biomedical Informatics. This tweet nicely summed up how sensitive the issue of decision support tools has become. Patients and clinicians both want the latest and greatest tools that will lead to the best outcomes. From that perspective, evidenced-based decision support tools can be very effective. However, medicine is more than simply a set of if/and/or statements. It is truly a craft and there is a concern that we lose something when we try to reduce patients to a set of input parameters.

It is always a special treat to listen to a Ross D Martin live performance. At AMIA17 he performed his latest creation – a theme song for #digituRN, an initiative to transform nursing through digital innovation. You can listen to the song on YouTube.

Shout out to Pritika Dasgupta, Dr Wayne Liang, Carolyn Petersen, Rebecca Goodwin, Dr Paul Fu Jr, Dr Arlene Chung, Jenn Novesky, Scott McGrath, Dr Danny Sands, Ross Martin, Alex Fair and Michael Rothman. It was fun to live-tweet with you at AMIA17.

Better Performing Practices More Efficient with IT Spending According to MGMA

Posted on October 23, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The Medical Group Management Association (MGMA) recently released its 2017 MGMA DataDive Better Performers data, a report that provided a glimpse into the health of US medical practices across four key performance categories:

  1. Operations
  2. Profitability
  3. Productivity
  4. Value

Of the 2,941 physician practices that provided their performance data for the report, only 32 were found to be “better-performing” than their peers in three of the four categories. No practice was considered better-performing on all four categories.

For a deeper dive into the report, check out this post from Anne Zieger.

The report’s most surprising results were in the Operations – Information Technology category:

  • Physician-owned practices spent more than 2x on IT Per FTE Physician than their hospital-owned practices
  • Better performing physician-owned practices spent LESS on IT than their peers
  • Better performing hospital-owned practices spent MORE on IT than their peers

At first glance these results run counter to what many would expect. How could independent physician practices be spending more than 2x hospital-owned practices on IT – especially when you consider that a hospital has many more IT systems and applications.

To help make sense of the results, we sat down with David N Gans, MSHA, FACMPE – Senior Fellow, Industry Affairs at MGMA.

Why are hospital-owned practices spending less overall on HealthIT?

Gans: The raw numbers that we received from the practices was a bit deceiving. What we found was that not all IT costs borne by the hospital are filtering down to the practices owned by that hospital. Server costs, IT department salaries, support costs and network infrastructure costs, for example, did not appear as line item costs for the practices. Only equipment and the EHR licenses used by the practice’s staff were considered IT costs. Independently owned practices, however, bear all the costs associated with IT including licensing, servers, support and ongoing maintenance. Thus, it only appears that hospital owned practices are spending less than their counterparts. It is a quirk of the way costs are allocated in a hospital setting.

Why are better performing physician-owned practices spending less on HealthIT than their peers?

Gans: The scoring system we used for this report rewards efficiency. The more efficient you are in any category, the higher you will score. Using that lens, practices that were more judicious with their IT spending achieved higher efficiency scores. What you are seeing in the report results is an associative effect – the more effective you are with IT, the more efficient your practice is considered.

Gans was quick to point out that the survey did not measure the impact of or the outcomes achieved from the implementation of HealthIT. There was also not linkage between overall IT spend and practice profitability.

Why is it important that practices strive to be efficient. Isn’t that an antiquated notion?

Gans: It’s actually more important than ever for practices to focus on being efficient. If you go back to 2001 and look at three key economic indices it becomes painfully obvious why efficiency is the key to practice survival. Just look at this chart we have compiled:

The red line is the % increase in practice operating costs per FTE Physician relative to what it was in 2001. By 2020, costs will be 116.7% of what they were in 2001. The blue line is the consumer price index. The green line is the rise in Medicare reimbursements. There is no way a physician practice can stay in the black without taking a serious look at their operational efficiency. If you do nothing, costs will eat up your practice.

Gans is hopeful that new technologies and changes to the reimbursement mechanisms will help reduce the performance gap for practices. According to Gans, Artificial Intelligence, like IBM’s Watson, could make practices exponentially more efficient. It can crunch numbers much faster than a human ever could, which would allow physicians to offer more personalized care or care via less expensive channels (ie: telehealth).

“One thing is clear,” says Todd Evenson, Chief Operating Officer at MGMA. “As we change from volume to value, the financial metrics we track in this report will have to change. We will need to de-emphasize the production-style metrics we have used in the past to more value based ones. We will also need to find a way to measure the quality of care provided by practices. This will make this report even more important and relevant in the years to come.”

Patient Generated Data, Workflow and Usability Coming Into Focus for EHR Vendors

Posted on October 16, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

At the recent Medical Group Management Association annual conference (MGMA17), I made a point of visiting as many of the EHR vendors in the exhibit hall as I could so that I could ask them two questions:

  1. What are you working on right now, given that there is a bit of a lull between ONC requirements?
  2. How do EHRs and EHR vendors need to evolve over the next 5 years?

Below are some of the best responses I received.

Steve Dart, Senior Director of Product Management at AdvancedMD believes that both EHRs and EHR companies need to fundamentally change their paradigms in order to thrive over the next five years. “EHRs should facilitate the job that needs to get done rather than serve as a documentation repository,” says Dart. “What is that job? Helping patients live healthier lives while at the same helping physicians be happier at work. We really missed the boat during the Meaningful Use (MU) gold rush. We neither helped patients be healthier nor did we make physician lives easier. In fact, as an industry we generally made things more difficult for doctors.”

AdvancedMD is charting a new path forward, instead of just fixing their user interface (UI), they are rethinking their entire approach to their EHR. The company is taking full advantage of the lull in MU requirements by using the time to bring together designers, UI experts, physicians and office managers to design a brand new EHR. Dubbed the “connect the dots” strategy, AdvancedMD is centering their next generation on clinical and administrative workflows.

“When you think about it, healthcare is really just a journey of sequential workflows,” Dart explains. “A patient starts by experiencing symptoms, then moves to research physicians online, schedules an appointment, comes in for their visit, goes to get lab tests done, comes back to discuss the results and fills a prescription. What EHR companies have done is create whole bunch of point solutions for each one of these situations. What we haven’t done well is connect these all together with technology. We siloed everything. Instead what we need to realize is that each situation is actually a complex workflow and we journey from one workflow to another as patients. What we need now, and what AdvancedMD believes, is that we should build technology that enables these workflows – make them easier and more seamless for patients and physicians. Data collection, for example, should happen on devices that both doctors and patients already use and in a way that doesn’t detract from the visit.”

To illustrate that AdvancedMD is doing more than just giving their theory lip-service, Dart showed an early design prototype of an EHR interface that provides a longitudinal view of a practice. Instead of clicking down into one patient to order labs or renew prescriptions and then clicking down into the next patient to do the same, the new interface groups all lab orders together and all the prescriptions together. One click and the physician can see all that they need to do and clicks once to push the orders ahead. The new interface is highly intuitive and functional.

Juan Molina, VP of Strategy and Business Development at CareCloud also believes that EHRs need to radically change. “EHRs need to allow doctors and their staff to do their jobs better,” says Molina. “We have to stop asking doctors to be data entry clerks and documentation specialists. They need to go back to being 100% focused on the patient and providing care. As an industry we have focused too much on checking the box. We need to move beyond that through better use of technology – especially modern cloud-based architectures.”

Mollna is most excited about the potential of real-time analytics and Artificial Intelligence (AI) at the point of care. He feels that the promise of precision medicine and true personalized care will only be possible if “massive amounts of health data is crunched and context from that data delivered to the doctor at the time when they are seeing a patient.” CareCloud is using the freedom from compliance requirements to work on new partnerships for deep analytics, AI and patient experience (read about their partnership with First Data here).

It is refreshing to hear EHR companies talk about collaboration. Over the past several years it was frustrating to see vendors attempt to build everything themselves only to end up with inferior solutions to what was readily available in other industries from other vendors. Partnership and collaboration are a welcome shift in EHR strategy.

athenahealth is actively pursuing partnerships as part of their More Disruption Please (MDP) program. “We are constantly expanding and improving our cloud-based platform to align with our vision,” says Stephanie Zaremba, Director of Government and Regulatory Affairs at athenahealth. “We want to see a healthcare industry free from administrative burden, enabled to care for diverse and disparate populations, and one that ultimately lets doctors be doctors. We believe that the current paradigm of federal regulations hinders, rather than helps, our industry from making this vision a reality. The innovation we so desperately need can’t flourish in the confines of check-the-box requirements that do not grow and evolve with technological advances. But even if we’re stuck with the regulatory status quo, in the next five years, we hope that vendors will continue to embrace their collective potential, shifting from competitors to collaborators in an effort to create a more provider-friendly, patient-facing, and connective tech landscape that captures the full continuum of care.”

The announcement of the partnership between Pulse Systems and InteliChart at MGMA17 is a prime example of this newfound collaborative spirit. For years Pulse offered a perfectly serviceable patient portal, yet they recognized that they would never pour as much time and effort into that area of their solution versus a company like InteliChart.

“We are pursuing an open-EHR strategy,” explains Chris Walls, President & CEO of Pulse Systems. “Although we provide a comprehensive solution, we recognize that clients may not want every component from our stack. They may want to keep a best-of-breed solution that they already have in place. Rather than force our clients to change, we are working to ensure we can integrate and play nice with others.”

Pulse arrived at this open approach by listening closely to clients and prospects. What they found was an under-current of a best-of-breed approach. Physician offices wanted to use different tools and applications from different vendors but the lack of integration and internal IT resources forced them to go with a single monolithic solution instead.

Through this listening exercise, Pulse also realized that it was more than an EHR vendor to its clients. Many of their clients are smaller practices which do not have ready access to technical support. Rather than deflect their client’s calls for help with mundane things like anti-virus updates, internet connection issues and printer failures, they leaned into it. They created a dedicated IT Field Support team that handles calls for routine IT issues and will even fly out to help a client if needed.

By proactively helping their clients in this manner, Pulse has found that they reduce EHR issues down the road and they engender tremendous loyalty. When you think about it Pulse is essentially applying a Population Health approach to their own clients – offering preventative maintenance to avoid more costly support calls in the future.

Most impressive is how Greenway Health is using this lull in compliance requirements. “Now that we are freed from working on ONC compliance work, we are putting focus on customer requested enhancements” says Mark Janiszewski, EVP of Product Managmeent & Corporate Development at Greenway. “Much to the delight of our customers, we can now apply resources to the enhancements that they have asked for, but that were lower in priority compared to what was needed to comply with regulations and the Meaningful Use program.”

Greenway is also using their “found time” to take a serious look at EHR usability. They recognize that there is tension between physicians and EHR makers caused by the endless clicking and confusing user interfaces. Greenway is hoping to relieve that tension by collaborating with clients to improve their system. According to Janiszewski, the company has planned a series of customer visits where a team of designers and engineers can observe how people interact with their system over a 2-3 day period.

The team has already identified several areas of improvement after observing how admin staff were copying down ID numbers from one screen onto post-it notes in order to key it in on a different screen to bypass a lengthy click-path. The team is hard at work to ensure data is transferred across the system more seamlessly.

Over the next five years, Janiszewski believes that EHR companies will have to embrace the concept of multiple care settings and multiple data sources: “EHRs will need to have a higher degree of interoperability as patients move between care settings – from acute care to rehab to home care or from acute care to elder care. EHRs will also need to solve for Patient Generated Data. We are all wearing fitness trackers and using apps to track our health. This data needs to be incorporated in a meaningful way into the EHR. “

The responses from MGMA17 demonstrates that companies are well aware of the negative feelings healthcare providers have towards EHRs. What is very encouraging is that fixing the user interface is only one of many different solutions being pursued by EHR companies. Rather than myopically focusing on the shiny object in front of them, companies like Greenway, Pulse, athenahealth, CareCloud and AdvancedMD are taking a step back and looking at healthcare with a broader perspective in order to identify opportunities for improvement. It will be interesting to circle back with them a year from now to see what progress has been made.

#SHSMD17 in 17 Tweets – Perspectives on Healthcare Marketing

Posted on October 4, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The AHA’s Society for Healthcare Strategists and Marketing Development recently held its annual conference – SHSMD17 – in Orlando Florida. For three full days, 1,500 attendees shared ideas and traded insights on the latest trends healthcare marketing trends. The 60+ concurrent sessions covered a variety of topics including:

  • Developing online support groups for patients
  • Successful blog-driven content marketing
  • Media relationships
  • Communication and preparedness during a crisis
  • Chatbots
  • Consumerism

For daily summaries of SHSMD17, check out these Day 1, Day 2 and Day 3 blogs. As well see this blog on the release of SHSMD’s Bridging Worlds 2.0 report during the conference.

If I had to pick an overall theme for SHSMD17 it would have to be “perspective”. The four keynote speakers and many of the session presenters urged the audience to break out of our boxes in order to truly “see” healthcare from multiple viewpoints – including patients, clinicians and government. Only by putting ourselves into the shoes of healthcare’s various stakeholders can we create effective marketing campaigns and hospital programs.

During the conference, there was a lot of live-tweeting and there were many conversations happening via social media with people who were not in attendance. I thought it would be fun to highlight 17 tweets from SHSMD17.

Here goes.

Fun SHSMD17 Tweets

 

CareCloud + First Data Partnership a Hopeful Sign of Things to Come

Posted on October 3, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Earlier today, CareCloud and First Data (NYSE: FDC) announced they have partnered to create Breeze, a new patient experience management platform. Built on First Data’s Clover infrastructure, Breeze’s mobile, web and kiosk based applications provide consumer-style convenience to patients while helping practices streamline workflows. Through Breeze, CareCloud customers will be able to offer patients the ability to book appointments, fill out medical forms, check-in remotely and manage payments from their phones.

“We looked outside of healthcare for inspiration on what patients want” says Juan Molina, VP of Strategy and Business Development at CareCloud. “What we found was that consumer interactions have changed from in-person transactions to online experiences. We wanted to give patients the same experience in healthcare that they are used to from the rest of the world through apps like Uber, OpenTable and Amazon.”

At a Breeze-enabled CareCloud practice, the “happy path” patient interaction would be as follows:

  • Patient is invited to Breeze by their doctor’s office through a text with a specific link
  • Patient downloads the Breeze app to their phone through that link
  • Patient books an appointment through the app
  • Prior to the appointment date, patient is reminded by the app to fill in paperwork which could include: demographic information, consent forms and insurance data (photo of insurance cards can be uploaded)
  • On the day of the appointment, patient can check in remotely
  • After the appointment, patient can manage payments through the app (credit card on file, Apple Pay, Android Pay or other options made available by the practice)

By automating parts of the appointment booking, patient intake and payment workflows, Breeze reduces the workload on front-line staff.

“From the moment that the patient walks in, they are happier, and my staff no longer has to spend time dealing with packets of registration papers. Our front office can now focus on patient care and delivering the excellent level of service that they deserve,” says Barbara Arbide, a practice manager who is using Breeze in her allergy practice in Coral Gables, FL.

The CareCloud and First Data partnership is encouraging. For many years now, EHR vendors have tried to build their own walled gardens where customers and partner companies could play nicely together. Unfortunately, a lack of useful application interfaces (APIs) and a high cost of entry for potential partners, resulted in a barren courtyard with high walls (aka a prison) for customers rather than a thriving garden.

By partnering with First Data, CareCloud is showing that it is a company willing to break from traditional EHR vendor thinking. They have opted to play in someone else’s ecosystem in order to bring more functionality to their customers at a faster pace.

First Data’s Clover platform already has hundreds of useful business apps built for it including employee scheduling tools, customer loyalty apps, inventory management systems and survey programs. By basing Breeze on Clover, CareCloud’s customers have access to this rich library of apps.

“After just two days of using Breeze,” Molina told EMRandEHR.com, “A practice in southern Georgia went and downloaded a time-and-attendance app for their system from the Clover library. This replaced a cumbersome Excel spreadsheet that they had been using. This helped the practice become more efficient and sophisticated.”

Could CareCloud have developed a time-and-attendance app on their own? I’m sure they could have. Would it have been a wise investment of their time? Probably not. Would it have been delivered in two days? Absolutely not. Although in theory CareCloud is forgoing potential revenue, their partnership with First Data allows them to focus on what truly matters – improving the clinical and practice operations side of their own platform.

What’s next for Breeze? According to Molina: “Patient expectations are only going to climb higher and higher as more and more consumer apps bring more sophistication into their lives. We have to pay attention to what’s happening outside of healthcare – how people are booking tickets online, speaking to Alexa, tracking their fitness with wearables and getting food from uberEats. Patients don’t want to be transported back to the 1980s when they come to a physician office where you have to fill out forms on a clipboard. With Breeze we have a flexible platform that can continue to grow and expand. We will be able to build new patient-centric applications faster, that help our clients with more and more of their workflows.”

Hopefully this new partnership is a sign of things to come.

Is Healthcare Delivery Not ‘Sexy’ Enough for Investment?

Posted on September 1, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

On the latest #hcldr tweetchat, guest hosts Pam Ressler @pamressler and Pippa Shulman @drpippa posed an interesting question – why hasn’t the delivery of healthcare been an area of innovation? or put another way – is healthcare delivery not sexy enough to warrant investment?

Ressler and Shulman used the example of online retail giant Amazon. Among its many innovations, Amazon came up with a new way to deliver the retail experience. They found a way to deliver goods to people where and when they wanted it. Their approach to delivery was so good that it has since become the expected norm for anything purchased online.

Ressler and Shulman wanted to know why healthcare delivery wasn’t getting the attention it needed.

Shulman’s comment makes for an interesting thought exercise. Instead of just asking what it would be like if Disney ran your hospital. What if we asked what would happen if FedEx, Dominos or Amazon did. It would be fun to see uniformed “delivery agents” speed-walking through the hospital carrying meals and oxygen tanks.

Deanne Kasim @DKasim agreed with Shulman and Ressler:

Kasim’s “need it, want it” statement really struck a chord with the #hcldr community. It’s not just a case of delivering care in the way that patients want it (ie: Telehealth), we need to think about delivering it in when and where patients need it. Telehealth during regular business hours is helpful, but imagine how much more successful it would be if it were available after-hours when most people are home from work. The same with text messaging and email communication.

Kat McDavitt @katmcdavitt tweeted her frustration with this timing mismatch:

Dr. David Tom Cooke @DavidCookeMD went further and provided a great example of how appointment-booking could use an Amazon-upgrade.

Later in the chat, Dr. Cooke provided an compelling idea. Instead of trying to make healthcare delivery attractive for investment by making it “sexy” (which many believed would be very hard), why don’t we just present it as it is – a difficult and challenging problem.

I believe one of the best ways to spur investment is to have a bold pioneer show the world how successful they can be. Amazon showed the world how shopping online could be as-good-as (and now even better than) shopping in-person. FedEx showed us that next-day delivery could be done affordably and reliably. I believe it will take a healthcare pioneer to help blaze the trail for innovation in healthcare delivery.

For a time, Turntable Health in Las Vegas was one such pioneer. Zubin Damania MD, better known as @ZDoggMD, created a wholistic practice – one that made health a relationship rather than a transaction. They used technologies to engage patients in their care and they helped their patients with prevention as much as treatment.

James Legan MD, who practices in Montana, is another pioneer who projects his EHR so that patients can see what he is entering. He has also linked his EHR to a cloud-based customer-relationship-management (CRM) system so that his practice can be more efficient in the way they serve the community.

There are also practices like Access Healthcare in North Carolina and Izbicki Family Medicine in Pennsylvania that are demonstrating the benefits of direct primary care for both patients and physicians.

Hopefully there is a physician practice pioneer out there today that will become the beacon that will attract more investment in healthcare delivery. If you know of one, please email me or put their name in the comments section.

Positive Patient Experience with an EHR is Possible

Posted on August 30, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week I had a rare healthcare experience – something that I had only read about in blogs and on Twitter – a physician showed me what he was entering into him EHR while I sat beside him in the exam room! I’m not ashamed to admit that my first thought was “I can’t believe this is really happening”.

The doctor must have noticed how I quickly moved my seat closer to the large monitors because he chuckled and asked me: “How long have you been in healthcare?”. After sharing a laugh he went on to say “It’s rare that patients take a keen interest in what I’m keying into the system. It’s usually other healthcare people that want to see what’s going on. Are you a nurse or a physician?”

When I told him I was in Healthcare IT field he smiled and said “Ah that would have been my third guess.”

For the next 20 min he would type a line of notes, point to the screen and then share his reasoning with me. I asked him questions on clinical terms that I did not understand, at which point he would bring up a resource that had a definition. If he didn’t have a ready resource, he explained it as best he could and then encouraged me to look it up on a trusted site like Mayo Clinic’s.

Near the end of the appointment, the doctor asked me if I was involved with EHRs. When I asked him why, he said the most intriguing thing – “because it’s clear to me that the people who design EHRs (a) have never actually seen a patient in an exam room – it’s ridiculous how awful the screens are and (b) never thought that one day doctors would sit beside patients to let them see what they are entering.”

The latter statement has been churning through my mind ever since.

There is little doubt that the majority of EHRs are less-than-well-designed. Physicians everywhere complain about the amount of clicking required to navigate their EHRs and the number of fields they have to enter. The prevailing opinion is to improve EHRs by getting closer to physicians and actually studying how they really conduct a patient visit. This will certainly yield positive results.

But what if we designed an EHR that was meant to be displayed on a big screen? One that had screens that the patients would see as the doctor entered his or her notes? I believe that designing for this type of usage would result in a more significant improvement in usability and have a more positive impact on patient experience than building EHRs based on better observation of physician workflow.

Consider the phenomenon of open kitchens in the restaurant industry. For diners, being able to watch the kitchen staff prepare meals helps to pass the time while waiting for your order. It also allows the diner to see how talented the chefs are – because they can see them working. For staff, an open kitchen often means that the restaurant has put a lot of thought into optimizing food prep workflow. After all, no one would choose a layout that had staff constantly bumping into each other in full view of diners.

If a company designed an EHR that could be shared with patients, they would not only improve the interface for physicians, but they would also provide a means for that physician to improve the overall patient experience.

I hope that more physicians adopt the practice of sharing their EHR screens with patients during a visit. Doing so will immediately improve patient experience and will push vendors to improve their solutions at a far greater pace.

Everything Old is New Again at Lenovo #HIThinkTank Event

Posted on June 28, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week in Durham NC, 35 healthcare innovators gathered at the Lenovo offices to discuss three trendy topics: Value-base care, connected health and virtual care. Dubbed the Health Innovation Think Tank #HIThinkTank, it was the first summit-style event hosted by Lenovo Health.

#HIThinkTank was designed to be an opportunity for audience members to learn about the latest innovations from leading academics, technology companies and healthcare organizations. I went into the event expecting to hear about the latest in artificial intelligence, big data, predictive analytics and genomic medicine. It did not turn out to be that kind of event…and it was all the better for it.

I would say that the overall theme of #HIThinkTank was innovation through the application of old ideas in new ways. In other words, everything old is new again in healthcare.

The day started with Rasu Shrestha MD, Chief Innovation Officer at UMPC Enterprises, emphatically stating that we are “in a time of tremendous opportunity in healthcare” and that it was “time for us to move from ‘doing digital’ to truly ‘being digital’”. Shrestha went on to explain that our challenge now was to reimagine clinical processes/workflows in light of modern technologies and methodologies. Like the re-engineering wave that swept through manufacturing in the 1980s, Shrestha believes it’s time to engage all stakeholders and collaborate on reworking healthcare.

Shrestha was followed by Juliet Silver of Perficient who gave us all a dose of reality by telling her personal healthcare story. The day Silver’s husband was diagnosed with cancer was the day she became an advocate – “Google searching and academic research quickly became my constant companions as we struggled to make sense of his disease.” Silver made specific mention of how she had to manually obtain paper copies of her husband’s medical records in order to share them with members of his care team and what a difference that made in his care. She hinted that patients may be the key to truly solving healthcare’s interoperability problem as they are the one stakeholder with the most to lose/gain.

After Silver, several speakers made their case for a return to a more community-based approach to healthcare – one that harkens back to the days of early pioneers when physicians, nurses and members of the community worked together to keep each other healthy.

Holly Miller MD of MedAllies presented the results of a local implementation of CMS’s Comprehensive Primary Care Plus (CPC+) program – a program that stressed simple post-discharge follow-up as a way to reduce readmissions and keep overall healthcare spending to a minimum. Miller specifically mentioned how community doctors do this all the time.

This was echoed by Marty Fattig, CEO of Nemaha County Hospital, a 16-bed facility 60 miles south of Omaha NE. Fattig spoke at length about the successful EHR, HIE data sharing and population health initiatives by his staff. Particularly noteworthy was his repeated statement: “We may not have the financial or technical resources of the large networks, but we get stuff done because we are all driven to improve the health of our community peers. It makes a big difference that we see our patients at church, at the grocery store and at the post office.” Ironically this old fashioned community approach to delivering healthcare is now the goal of many healthcare organizations.

In the afternoon Steve Aylward of Change Healthcare and Dr Sylvan Waller led the discussion on virtual care by first reminding the audience that over 90% of virtual visits still happen via the phone. Video consults is the fastest growing area of virtual care, but it has a long way to go to catch up to the telephone. Dr Waller said it best “In 30 years #telehealth will finally become the overnight success everyone expects it to be”. Both Aylward and Waller stressed that we cannot lose sight of these “older technologies” that work for patients when we think about innovation.

For me, what drove home this theme of old-is-new-again was the afternoon tour of the Lenovo model data center. This new highly efficient and “green” room prominently featured Lenovo’s latest innovation – direct water-cooled servers. The new NeXtScale WCT server series boasts high pressure water lines that physically run through the server and draw heat directly away from the quad CPUs. Back in the early 90’s I remember getting a tour of an IBM facility (not far from Lenovo’s facility in Durham) that still had a functioning 308X mainframe that featured…you guessed it…water cooling technology.

All in all, I walked away from #HIThinkTank feeling encouraged about the future of healthcare. It was refreshing to be at an innovation event and hear about actual successful implementations rather than pie-in-the-sky promises. The event reaffirmed my belief that technology alone is insufficient to fix healthcare. Those of us in HealthIT need to do more than just create cool products, we need to help clients re-engineer their internal processes to better utilize those products to improve community health.

As Dr Shrestha said – It’s time for us to stop doing digital and truly be digital.

#HIMSS17 Mix Tape

Posted on January 24, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.


On February 19th 2017, the annual HIMSS conference (#HIMSS17) will be held in Orlando FL. It will once again be the largest gathering of Healthcare IT folks in North America with over 45,000 people expected.

Every year I look forward to HIMSS. It is the best place to see what is happening in the industry, hear the challenges that lay ahead and see what the smart minds in #healthIT are investing in. Although the sessions, keynotes and exhibit hall are all amazing, the best part of the conference is meeting people face to face – especially at the meetups and spontaneous get-togethers. I love catching up with friends that I haven’t seen in a year and meeting new ones for the first time.

For the past couple of years, I have used HIMSS as an opportunity to compile a soundtrack for healthcare – a Mix Tape that can be enjoyed during the conference (see last year’s Mix Tape here). This annual HIMSS Mix Tape is a fun way to reflect on where we have been and where we are going. As with prior years, I asked friends and colleagues on social media for the song they believe best represents healthcare. I also asked them to explain their selection.

Below are the songs chosen for the #HIMSS17 Mix Tape. What would your selection be? Let us know in the comments.

Enjoy.

You’ll be back – Hamilton. Chosen by Regina Holliday @ReginaHolliday.

Because that song could be the words of any doctor who wants his patient compliant and silent and any government that denies care. Hence we must have revolution.

Shine – Camouflage. Chosen by Nick Van Terheyden @drnic1.

After many potential choices ranging from the deep and dark Wadruna by Helvegen through “America” by Young the Giant that celebrates the immigration to the uplifting dance song that captured what seemed to transpire for the year was “Don’t Stop the Madness” by DJ Hush and featuring Fatman Scoop (what an awesome name) I settled on Shine. That captured the spirit of what I need this year: This is the world where we have to live / there’s so much that we have to give / so try to Shine Shine Shine within your mind / Shine from the Inside / if you Shine Shine Shine within your mind.

Can’t you hear me knockin – Rolling Stones. Chosen by Linda Sotsky @EMRAnswers.

In my own life, I started my Mothers  fight for data 17 years ago. As collective patients, caregivers and advocates we are STILL  knockin and screamin “give me my damned data” Can’t you hear us knockin?

Faith – George Michael. Chosen by Rasu Shrestha MD @RasuShrestha.

My HIMSS17 playlist is inspired by some of the best singers we said goodbye to in the last 12 months – an acknowledgement that, even as we continue to push the envelope in healthcare in so many ways, life is fragile, beautiful and melodious in every one of our ups and downs. Other finalists: When Doves Cry (Prince), Rebel Rebel (David Bowie) and The Heat is On (Glenn Frey)

We’re not Gonna Take It – Twisted Sister. Chosen by Mandi Bishop @MandiBPro.

The disenfranchised, the chronically or severely ill, the caregivers, and the underserved communities will rise up and be heard in the face of healthcare weaponization. We will not remain silent. We will not take it.

Sit Still Look Pretty – Daya. Chosen by Geeta Nayer MD @gnayyar

I chose this to represent the HIT chicks movement in health tech. Increasingly women are coming to the table and taking senior leadership roles in health tech which we so very much need as women remain the primary healthcare decision maker in the home with “doctor mom” being the go to for any and every illness first! Spouses rely on their wife to be the care takers when parents get older and when kids are sick and need to run to the pediatrician etc. Also, HIMSS for the first time is giving the women in tech awards which itself is a big statement.

Bring on the Rain – Jo Dee Messina and Tim McGraw. Chosen by John Lynn @techguy

We’ve got challenges all around us in healthcare, but I say “Tomorrow’s Another day, and I’m thirsty anyway, so Bring on the Rain.”  Things will get better in healthcare because so many amazing people work in healthcare and battle through the rain.

Cautionary Tale – Dylan LeBlanc. Chosen by Steve Sisko @ShimCode

A cautionary tale is a story with a moral message warning of the consequences of certain actions, inactions, or character flaws. Healthcare players – CMS, other government agencies, large vendor companies, special interest groups and others – seem to be stuck in a continual cycle of Dictate, Demand, Deviate and Destroy. Half-baked programs, ‘standards,’ reimbursement schemes, “quality measures,” and other mandates are dictated to providers, health plans and others on the receiving end.  Then revisions, waivers and deviations are made over the course of a year or two before they’re eventually destroyed. When will we learn from these cautionary tales? Don’t offer up help that you know that I won’t be needin’ / Cause I do it to myself, like I never get tired of bleedin’

You Can’t Always Get What You Want – Rolling Stones. Chosen by Don Lee @dflee30

Too often in healthcare we only want to look at solutions that solve for 100% of the possibilities, have proven ROI and that are already being used by our peers. That severely limits the possibilities for improvement. There’s no such thing as a sure thing. So, for 2017 I hope we can break this cycle and focus on incremental improvements. Take some shots. Be willing to fail. Think: “what can I do today that won’t require a huge budget and 1000 meetings, but might make something 5, 10 or 20% better?”.5% better today is better than “we might possibly be able to be 100% better 36-48 months from now”. So, “you can’t always get what you want, but if you try, sometime you find, you get what you need”

Livin’ On The Edge – Aerosmith. Chosen by Matt Fisher @Matt_R_Fisher

The whole healthcare industry is balancing on a razor’s edge in many respects. What will happen with the ACA, can EMRs meet their promise and what will value based cared do? All of these unanswered questions mean that these lyrics hold true: Tell me what you think about our situation / Complication, aggravation / Is getting to you

One Step Away – Casting Crowns. Chosen by Jennifer Dennard @JennDennard

While it’s a praise song at its core, its title makes me think of how close the healthcare industry is to interoperability. And yet there are still a few “small” hurdles we need to overcome. (Plus, my daughter is singing this song in her school talent show, so I have developed quite a soft spot for it!)

Record Year – Eric Church. Chosen by Joe Lavelle @Resultant

In hope that all my #HealthIT / #PatientAdvocate / #SoMe / #ThoughtLeader colleagues ignore and overcome the nonsense of the current political climate to keep making HUGE progress on the most important healthcare initiatives like Telemedicine, Interoperability, a National Patient ID,  Care Coordination, alternate payment models like Direct Primary Care, and more.  Let’s all have a Record Year in 2017!

Fight Song – Rachel Platten. Chosen by Max Stroud @MMaxwellStroud

This goes out to all the people in HealthIT that are working diligently for their vision of the future of healthcare.   In a year of major political shifts and possible policy changes, it will be important to maintain focus on our passions and continuing to move toward innovation and improvement of HealthIT.   This goes out to patient advocates from #epatients to the walking gallery, To the folks living the #startupgrind because of thier passion for a better tomorrow, and to the #HealthITChicks working towards gender parity. Like a small boat / On the ocean / Sending big waves / Into motion / Like how a single word / Can make a heart open / I might only have one match / But I can make an explosion”

Crosseyed and Painless – Talking Heads. Chosen by David Harlow @healthblawg.

There was a line/ There was a formula. But we are now in a post-factual environment. Facts all come with points of view/ Facts don’t do what I want them to/ Facts just twist the truth around. We need to focus on achievable goals, on implementing solutions that make sense independent of regulatory engines that have driven so much of health IT over the past eight years.

What Do You Mean – Justin Bieber. Chosen by Lygeia Ricciardi @Lygeia

There’s a lot of talk in health IT that you can’t take it at face value. For example, everyone says they support interoperability, and yet… we’re not there yet. Also, there’s a lot of talk about patient engagement, but is it really about involving patients in their care… or just getting them to better “comply”? Finally, is Trump really going to get rid of Obamacare, or just rebrand it? What *do* you mean?

Addicted to Love – Raymond Penfield. Chosen by Charles Webster MD @wareFLO

Raymond Penfield was 94 when he recorded Addicted to Love and became an Youtube sensation. He made it to 98. Here is his obituary. BTW he was a graduate from the University of Illinois as was I! I hope I have as much energy and spirit and health into my 90s!

Video Killed the Radio Star – Buggles. Chosen by Joe Babaian @JoeBabaian

Why? Because times are changing and status quo is being cast aside.

Truckin’ – Grateful Dead. Chosen by Brian Ahier @ahier

Because this ♫♪♪♪♫♪? ♫♪ What a long strange trip it’s been ♫♪♪♪♫♪?

Under Pressure – David Bowie and Queen. Chosen by Colin Hung @Colin_Hung

Healthcare in the US and around the world has never been under more pressure than it has now. Patients are expecting more (as they should!), governments are trying to regulate everything from drug prices to reimbursements, employers are looking to curb healthcare costs and there is tremendous pressure on the healthIT industry to work together. To me, this song is the perfect collaboration – an example of what happens when two amazing artists come together. We need more of this type of collaboration in healthcare. Plus there is one verse that is very applicable to 2017: And love dares you to care for / The people on the (People on streets) edge of the night / And loves (People on streets) dares you to change our way of / Caring about ourselves

For a full #HIMSS17 Mix Tape Playlist on Spotify, click here or play the embedded player below.