I’ve come across few articles recently that really validate the notion that the success of healthcare IT is really in the eye of the beholder, or in some cases, the editorialized results of a study.

Take, for example, the following headlines:

“EHR Use Not Linked to Improved Diabetes Care Quality, Study Finds”
and
“App Improves Diabetes Management Among Teenagers, Study Finds”

I find it hard to believe that if formally connected, the second study couldn’t somehow influence the first. In other words, if a mobile health app can improve diabetes management among teenagers, shouldn’t whatever data that app is capturing transmit successfully to the teen patients’ EHRs for easy access by their doctors? And then couldn’t that doctor digest that information, picking out patterns in the patient’s behavior that is either positively or negatively impacting their diabetic condition and overall health, to better inform care protocols?

I’m taking big leaps of logic here, since the first study found that not only was there no correlation between the use of an EHR and “increased adherence to clinical guidelines for care processes and treatments,” but there was actually a “higher probability of meeting certain targets for blood pressure and A lc levels after two years” at practices without such systems. (Seems like these outcomes might be due more to end-user experience than the technology itself.)

The second study doesn’t even mention EHRs, but I wonder how many of the 20 teens participating in the study see doctors who have this type of technology, how many of those doctors know their patients are participating in the study (all I’d assume), and how many are feeding the app’s info into an EHR.

Surely if a smartphone app is helping a diabetic teenager better adhere to medication regimens, then the EHR their doctor could potentially be using would somehow tie in to better clinical outcomes. Another study to start, perhaps?

The second set of headlines that gives me pause (and kinda makes me chuckle) includes:

“Physician Use of Tablets has Nearly Doubled Since 2011”
and
“Not all Doctors and Nurses are Happy with an iPad in the Hospital Setting”

Neither headline surprises me. We all know that adoption of mobile health tools is growing, if not by leaps and bounds then at least steadily. It would make sense that providers are adopting tablets in relation to this. Every technology has its detractors, so of course not everyone is going to be happy with how an iPad works in a clinical setting, just as not every provider is going to want to install an EHR. I do wonder, though, how the same set of users mentioned in the second article would rate a different kind of tablet if given the opportunity to use one.

I find the first sentence to be kind of hard to believe: “It looks as if most doctors and nurses would rather not touch the iPad at work (or deal with any other kind of tablet computing).” If “most” doctors and nurses would rather have nothing to do with tablets at work, than how can physician use of tablets have doubled since last year?

So you see, the “success” of healthcare IT seems to depend on whose writing about it. I have a feeling the American Forest and Paper Association might be behind the very first one.

I’ve been a big fan of the “engaged patient” for about as long as I’ve known what the term meant, but until earlier this week, I hadn’t given much thought to the burden Meaningful Use requirements potentially place on providers to create these types of folks.

As I’m sure most readers know, comments on proposed Meaningful Use Stage 2 requirements were due to CMS this past Monday. Many organizations not only turned in comments, but released summaries of those comments to various media outlets as well.

Lynn Scheps, Vice President of Government Affairs at SRSsoft, has done a nice job of drawing out a few major themes from comments submitted over the 60-day period. In her most recent Meaningful Use Monday blog, she points out that:

“While increased patient engagement is recognized as an important goal, providers are expressing concern about having their incentives be dependent on actions by patients—actions over which they have no real control. For example, one proposed measure would require that 10% of patients access their information on the physician’s portal, and another that 10% of patients send a secure e-mail message to their physician.”

Now, as I’ve written (or tweeted) about before, I’ve tried to get into using a personal health record, and just found it to be too much trouble, too time consuming. If I, a fairly digitally savvy healthcare consumer (and thankfully a fairly healthy one), can’t keep up with a PHR, how likely is it that patients who don’t even have an email address will immediately jump onto their physician’s portal or send e-mail messages to their physician.

And it should probably be pointed out that those who make up the bulk of healthcare costs in America – the chronically ill and/or obese – most likely consist of patients in underserved communities, people who don’t have consistent access to the Internet. It’s a systemic problem that I could write at length about, but I’ll save that for another blog altogether.

On the flip side, the Robert Wood Johnson Foundation, in its Stage 2 comments to CMS, called for the criteria around patient engagement to be either maintained or enhanced. Its views on doubling the 10-percent threshold of patients viewing, downloading or transmitting their health information seems fairly indicative of their stance on the criteria as a whole:

“This change would provide an incentive to health professionals to adopt patient-facing platforms that have the potential to increase patient engagement and self-care.”

Needless to say, it will be interesting to see what route CMS takes when it issues a final rule sometime in August. I do hope that it errs on the side of conservative optimism, and keeps its proposed patient engagement criteria, rather than decreasing or banishing them altogether. Hopefully this can help healthcare overcome its bad habit of protracted procrastination and, with the tiniest of baby steps, help physicians get over the hump of getting themselves, and their patients, on the digital bandwagon.

A lot has already been written about whether or not EMRs lead – directly or indirectly – to higher patient satisfaction scores, but I’ve yet to find anything on those scores being included in the patient’s record itself. The idea occurred to me this past weekend, as I was on the phone with a survey firm asking patient satisfaction questions on behalf of Kaiser Permanente.

The visit in question was routine and had gone well, so my ratings were high, and the call was quick. Would the doctor who had been involved ever see my direct responses? Do doctors see these scores in aggregate, or can they look them up by individual patient? Would they feel themselves more accountable if they could see how a patient rated their last encounter while looking at that person’ EMR?

I supposed it could go either way. A healthy, highly satisfied patient’s record would display high scores and vice versa. That person’s doctor could look at these scores before the next encounter to see what could be improved upon, what to keep doing, or what to start doing with other patients of a similar condition. I wonder  if the ability to view a particular patient’s satisfaction scores wouldn’t somehow make the doctor feel even more accountable for their patient’s health – if they’d have more “skin in the game,” so to speak.

Perhaps it could have a negative effect. Low satisfaction scores could lead to an emotionally charged appointment if a doctor doesn’t fully understand why the scores were given.

After my phone call, I did wonder if other health systems send out patient satisfaction surveys electronically, making them accessible via an email or a patient’s portal. The ability to respond digitally would seem to also enable the ability to make personal comments on the scores – something I was not given the option to do on the phone call. I’ve filled out paper satisfaction surveys from other providers, but don’t recall comment boxes being included. Come to think of it, I filled out the paper survey mainly because the hospital told me I had the chance to win a prize if I did so. I wish my phone survey had offered that incentive!

Patient satisfaction scores are important, of course, especially in this day and age of accountable care. I just wonder if they’re not being given enough transparency by hospital management. If doctors could see the good and the bad on a microscopic rather than macroscopic level, would they strive to produce better outcomes?

Let me know what you’ve heard or seen lately in the comments below.

I heard an interesting statistic a few days ago during a very informative webinar – “The Future of Meaningful Use, EHRs and Accountable Care” – hosted by Greenway Medical’s Justin Barnes. He shared a huge amount of information during the hour-long presentation, but the fact that most stood out to me was that, according to Barnes, between 35 and 50 percent of EMRs will eventually be replaced after just one year of use. (Don’t quote him on the “year,” but I’m pretty sure that’s what he said.) His point being, of course, that providers need to think long and hard about what type of solution they need to fit their workflows before they spend time and money implementing an EMR.

This sentiment was echoed by Kimberly Harding of BCBS Florida in a panel at the iHT2 Summit in Atlanta. As part of a greater discussion on Meaningful Use, she made the comment that just because a healthcare IT product is certified doesn’t mean it’s the best fit for a particular facility.

My takeaway from both of these statements is that providers looking to adopt new healthcare IT tools like EMRs need to take a long, hard look at what their current needs are and what their future needs might be before they even think about demoing products.

They also need to adopt technologies that fit their workflows, not necessarily technologies that have a ton of bells and whistles. Added features won’t do anyone any good if they’re never used properly, never used at all, or used to the detriment of a physician’s productivity.

I kept this sentiment in mind when I read the results of a recent study of 250 hospitals and healthcare systems by consulting firm KPMG. The survey found that “71% of respondents’ organizations are more than 50% finished with their EHR adoptions. Will this 71% be satisfied with their EMRs once fully installed and adopted? How many will realize their product of choice wasn’t the right call? If we apply the Greenway statistic, that could be as many as 125 facilities!

So where is the disconnect? Why are providers making poor choices with presumably the best of intentions? Why has the term “rip and replace” become so well known in healthcare? Are physicians misinformed, or not educated enough? Are they feeling so rushed by Meaningful Use deadlines that they don’t perform proper due diligence? Are vendors part of the problem? If so, shouldn’t they be part of the solution? What role do regional extension centers have to play in all this?

If you have answers, please let me know in the comments below.

Anybody catch the recent Mashable.com or CNN articles on the feedback Facebook COO Sheryl Sandberg has received because she makes it a point to leave work at 5:30 pm every day? (You can read them here and here.) In a nutshell, Sandberg has always left the office around that time – a practice she started when she first had kids, but has only felt comfortable talking about it now that she is in upper management and (presumably) somewhat immune to corporate push back. ( Don’t confuse leaving work with not working, by the way. Sandberg, like many others, checks email at all hours.)

Mashable CEO Pete Cashmore, who authored the CNN.com story, summarizes the mini-controversy that has evolved in the tech world as a result of Sandberg’s coming clean: “In a competitive industry where your work is never truly complete, has it become socially awkward to leave work at a time that used to be the standard? And are those working eight-hour days that end at 5 p.m. being quietly judged by their co-workers? Whatever happened to “work-life balance”?

Good questions, to be sure. So good, in fact, that I felt compelled to pose a similar query to a panel of current and former healthcare CIOs – all guys, by the way – at the recent Women in Technology International (WITI) / GAHIMSS event, “Women in Healthcare IT Talk.”

Piedmont Healthcare CIO Mark Pasquale was refreshingly candid in his response: “I don’t have a work-life balance.” His point being that, as a CIO overseeing a near-future EPIC ERP system go-live, his work day never really ends, especially given how connected he is via multiple mobile devices. He also pointed out that, as 85% of Piedmont’s install team is internal, Piedmont spent copious amounts of time preparing that staff for the time commitment required to travel to Epic headquarters in Madison, Wisc., for training. Pasquale kept an open door, and said many staff members came by multiple times to hash out whether committing to such an intense project was the right move for them.

From left to right: Christopher Kunney, The BAE Company; Sonny Munter, Georgia Dept. of Community Health; Mark Pasquale, Piedmont Healthcare; Praveen Chopra, Children's Healthcare of Atlanta

Fellow panelist Christopher Kunney, HIT Strategist at the BAE Company and former CIO of Piedmont, made the point that you have to be aware of what you’re signing up for when you enter healthcare’s executive ranks. Long days aren’t unusual; they are the norm. Children’s Healthcare of Atlanta CIO Praveen Chopra concurred, adding that his wife makes him limit use of his Blackberry on vacation to just one hour a day. Sonny Munter, CIO of Georgia’s Dept. of Community Health, joked that he leaves his job everyday at 4pm – but gets going around 6 in the morning. Munter added that he makes it a point to surround himself with good staff members, which also helps in balancing his work and family obligations.

From left to right: Lisa McVey, McKesson; Gretchen Tegethoff, Athens Regional Medical Center; Patty Lavely, CIO Consulting LLC; Deborah Cancilla, Grady Health System

A second panel of healthcare executives – all female – pretty much agreed with their male counterparts. Patty Lavely, founder of CIO Consulting LLC and former CIO of three different health systems, did echo Facebook’s Sandberg just a bit in her comment on the subject: “There comes a time when you have to say, ‘This [work] will be here for me tomorrow. I need to go home and have dinner with my family tonight.”

All of the panelists mentioned the need to prioritize workplace projects and challenges in a way that is suitable to the particular balance they need in their lives. They have triaged, so to speak, their commitments, priorities, deadlines, etc. to fit their schedules.

So, can healthcare IT folks – providers or vendors, executives or otherwise – ever be off the clock, never mind leave the office between 5 and 6? Share your stories and advice in the comments below.

I got just a glimpse yesterday of what clinicians must feel like when they log into an EMR for the first time – giddy with anticipation, hopeful that its use will ultimately lead to better patient outcomes and easier workflows for all. On the flipside, there was also frustration, impatience, and a bit of confusion.

Just before bedtime, I fired up Calorie Counter, my newest iPad app. As with any community you join, I first had to fill out a member profile, which took some time. I then had to learn through trial and error how to navigate through the program – search for, find and choose the foods I had eaten earlier that day, make adjustments for portion sizes, then log the data. The app’s drop-down menus included some of the foods I ate, but not all. “How do I add foods to the stock menu?” I wondered, thinking at the same time that this must be what doctors feel like when they can’t find what they need in an EMR.

It didn’t take long, and I’m sure now that I’ve at least done it once, future data entry will be more intuitive, and quicker. I do wonder about the rate of retention for this type of app, though. Do people stick with it for more than a few days or weeks?

I’ll have to either keep a running paper list of the foods I eat throughout the day, or bring my iPad with me wherever I go in order to log my calories. I was bummed that I couldn’t find this particular app for both the iPad and iPhone. (Those that were developed for both just didn’t seem to be as robust.) Perhaps this twinge of disappointment has been felt by doctors who have fallen in love with their new EMR, only to realize they can’t access it via their chosen mobile device.

It will take dedication on my part to keep up with daily logging of calories and activity, but I am convinced it will be worth it. After just one day, I’ve already had a nutritional wake-up call: Just seeing how much cheese I eat has made me decide to cut back before bathing-suit weather.

The beauty of the app isn’t the comprehensive list of foods already plugged in from which to choose from, but the calorie recommendations it makes based on members’ profiles (weight/height/activity level/age/gender, etc.) and the analytics that will result after I have a few days/weeks/months logged. Patterns will emerge that will give me a clearer picture of my diet – foods I should keep eating, those I should eat in moderation, and those I should avoid all together as long as I’m trying to reach a certain daily caloric intake. Not quite as important, but still similar in my mind to the aggregating power EMRs have when it comes to clinical data.

Other than keeping up with the daily log, I also have the option of joining the Calorie Counter community on Facebook, and I think there’s a brief tutorial out there I can take a look at. Depending on my time available, I may not do either – a course of action I’m sure a few doctors also opt to take with their EMRs, which I assume is ultimately detrimental to the results they’ll see with the technology.

In addition to trying to get a bit healthier, I’m overcoming my resistance to change (as if I really want to eat less cheese!), which as my colleague John pointed out in a recent post at EMRandHIPAA.com, is “the number one reason doctors aren’t adopting EHR software.”

But change is usually good, and as John also points out, “resistance to change is going to be the reason why EHR adoption will become the norm.” I’ll let you click over to his post to find out why. In the meantime, I’m going to try and resist the bagel with cream cheese that seems to be calling my name from the kitchen.

I’ve been writing about and commenting on the plight of healthcare IT students for a few months now, and the recent HIT job fair I spoke at gave me a great chance to talk one-on-one with folks finishing up their course work and getting ready to enter the job market. One – Helen Murphy, who is currently Director of Sonographic Education at Worldwide International Emergency Medical Services in Atlanta – was nice enough to share her experience with me first-hand.

What educational program are you in right now?
I have recently completed the Health Information Technology (HIT) Workforce Development Program Trainer Role being offered through the Atlanta Technical College.  Atlanta Tech is one of the Community College Consortia designated to educate HIT professionals.

What prompted you to enter a healthcare IT curriculum?
I understand the value of Healthcare information technology, and the benefit EHRs will bring with regards to patient safety, workflow efficiency and return on investment.  The opportunity to use my healthcare education along with my training experience was a perfect combination to me. Educating and/or training have been a part of all of my work experience, and this program is an opportunity to be a part of a profession that is in its infancy.

What did you find to be the most challenging in your studies?
My background is healthcare-based, so understanding some of the IT areas are challenging to a degree.

When do you anticipate graduating?
I have completed the course and I am now studying to take the competency exam.

How is your program helping you with system training? Apprenticeships/internships/co-ops, etc.?
Atlanta Tech has initiated a six week program/internship where students who have completed the curriculum will have the opportunity to work with Pristine Technology Solutions – an Atlanta-based technology company that focuses on EHR application sales, implementation, training, support and understanding the steps to help providers reach the goals of Meaningful Use.

How has your school helped you in looking for a job?
The school has had one job fair that I attended prior to me completing my curriculum.  The internship that I am currently in made us aware of the Technology Association of Georgia Health IT Job Fair where I met you, and where the students from the Atlanta Technical College program were able to see what companies are looking for in a health IT workforce graduate. This is helping me to understand how to align my education and experience with the needs of the employers to create a tailored perspective that will show the immediate value I can provide for them in health information technology.

What do you anticipate your chances of finding employment to be right after graduation?
I anticipate employment in the very near future because the Atlanta Tech program has provided us with an internship that gives us direction in the job search.

Do you get the feeling it’s a competitive field?
I do not think there are enough trained HIT workforce individuals. Employers in some cases at this point are not completely sure what they need in potential employees, and until the field of healthcare IT has developed further, there will be a continued need for HIT trained professionals.

What are you doing to stand out from the pack?
I am developing a presence on Twitter, upgrading my LinkedIn Profile, and starting a blog about my process of becoming a health information technology professional.  I am also gaining as much knowledge and experience as possible through the internship that is being provided by Atlanta Technical College. I also understand the importance of training, and am building a strategy that will allow me to understand the needs of the providers so that I can learn to create targeted engagement methods to meet their individual needs.

Do you have any other tips for those seeking employment in HIT?
Of course, updating your professional profile to highlight your HIT experience and education is critical. Attend job fairs where a job seeker can become aware of the types of positions that are available and how they would best qualify for those positions.  It is also crucial that the job seeker understand the HITECH Act and be able to speak knowledgeably about Meaningful Use.

In my attempts to prepare for a panel discussion during last week’s TAG Health-sponsored HIT Job Fair, I corresponded with a number of you, dear readers, on how you and your colleagues have or are currently using social media in your job hunt. Thanks to everyone who shared their experiences, tips and tricks with me. I was able to relay some of it to the eager job seekers in the audience – many of whom were only vaguely aware of the potential social media can play in helping candidates: manage their personal brand and digital footprint; educate themselves on a particular niche as they transition from one industry into another; and of course, find job openings.

McKesson and Children's Healthcare of Atlanta were just a few of the employers at TAG Health's recent job fair.

The following is a list of resources that I didn’t have time to share during the job fair. Many of them come directly from the fingertips of EMRandEHR.com readers.

* Social Networking for Career Success – great book – no matter what industry you’re in – by Miriam Salpeter of Keppie Careers. You can follow her on Twitter and learn more at her website, KeppieCareers.com, which also includes a guide to Google+ in the books section.

* NWHIT.org – a website devoted to Health IT Workforce Development in the Northwestern States, part of the Community College Consortia to Educate Health IT Professionals Program. It includes some great advice blogs by Health IT Talent Specialist Yvette Herrera-Greer, as well as a session from Matthew Youngquist of Career Horizons on using LinkedIn as an effective tool for job seekers in the Health IT sector. You can also join the organization’s group on LinkedIn – just search for NW Healthcare IT Workforce.

* the @HIMSSJobMine Twitter account is a great national resource, as is the @TAG_Health account if you’re in Georgia.

* Twitter hashtags you may want to consider paying attention to include #HealthIT, #Jobs, or the name of the company, technology or position you’re interested in, such as #CIO, #Allscripts, #Epic, #EHR, etc.

* Pinterest – yep, you read that right. I’d say it’s a little too early to tell whether it will be a valuable resource for folks in healthcare IT, but the recent Forbes article I came across on the subject is worth a look, especially if you’re already a fan of the new social media sight. (Side Note: You can Find Healthcare Scene and EHR Screenshots on Pinterest also)

* CareerEnlightenment.com – a website devoted to helping people use social media to get jobs. Blogger Joshua Waldman is also the author of Job Searching with Social Media for Dummies.

Have additional resources and tips to add? Please share yours in the comments below.

During my recent visit to my daughter’s pediatrician, I was pleasantly surprised to see a computer up and humming along in a corner of the exam room. The last time we had been in, some six months before, that same piece of equipment sat shrink-wrapped (as it had been for a few months even before that), waiting for an eager clinician to tear open its plastic casing and put its digital capabilities to good use.

I had been dreading this particular appointment – our first with the one pediatrician left at the practice. Our usual doctor had left a few month earlier for parts unknown, so I wasn’t sure who – or what – to expect. The advice nurse who made my last minute “work-in” appointment was kind enough to make sure I understood that due to the second doctor’s departure, we would likely wait an extremely long time.

Our wait, which ended up being no longer than usual, gave me time to do a bit of snooping around the new computer. No keys or mouse were touched, but I did notice that NextGen was the practice’s EMR of choice. Yes, the nurse did have her back turned to us as she asked me questions about the reason for our visit and entered responses into the EMR. When I asked her if she liked the new system, she gave a rather noncommittal response in close approximation to “some days I do, some days I don’t.”

I’m guessing she may have bigger issues to deal with, such as assisting the patients of a double-, sometimes triple-booked pediatrician. The single-doc situation made me wonder how much training the practice’s staff had time for before and during go-live. I could certainly believe that follow-up training will take a backseat until a second pediatrician is brought into the fold and everyone gets back to a somewhat normal workload.

So how do small practices in similar situations do it? How do they find time for EMR training when overscheduled? Do vendors often step in and help with extra resources? How long do practices go before hiring additional staff? (That’s an off-topic question, I know, but one I’d still like an answer to.) I’d like to think that in the long run, the new EMR would of course help make everyone more efficient, and us patient parents more satisfied. Let me know what you find out in the comments below.

I try to avoid navel-gazing, which to me means commenting on someone else’s commentary – a practice all too commonly relied upon in the healthcare IT blogosphere. How many blogs, articles and rebuttals have been generated, after all, as a result of the Health Affairs/Mostashari back-and-forth in the past few days? Quite a few, and yours truly happily participated in the fringe commentary. So as you can see, sometimes a topic already covered by someone else just begs for a second opinion, which I’ll happily give if the context is right.

Yesterday I came across two pieces of online content that I couldn’t help but draw correlations between. The first, a blog written by Dr. Rick Weinhaus entitled “Humans Have Limited Working Memory,” tells the tale of our poor ability to retain information, made all too obvious by a common EHR design feature – the utilization of a row of clickable tabs at the top of a dashboard to designate the different categories of data that make up the patient visit.

Dr. Rick laments that since humans are capable of only retaining four to five unrelated elements in working memory, the row of one-click tabs, though logical, doesn’t work very well. In fact, it drives him “crazy.”

I certainly believe in our limited capacity for remembering unrelated things at any given time, and I’m sure other working parents will agree. Our capacity for keeping everything straight is finite – the more kids, colleagues, coworkers, patients, tabs, bells and whistles you add, the more likely you are to forget something, leave something behind, or, if you’re like me, leave your car door wide open in a parking lot while grocery shopping with two kids in tow. But I digress.

The second piece of content revolves around the results of a survey put out by CDW Healthcare on what clinicians find frustrating about implementing new health IT systems. Surprise, surprise, “too many passwords to memorize” came in at the top, emphasizing what Dr. Rick pointed out in his unrelated blog post.

So what’s a clinician to do? Especially those that work in multiple facilities on different EHRs? Are you like me, scribbling down usernames and passwords on a master paper document, which just screams “privacy breach waiting to happen?” How are vendors helping to address these issues – single sign-ons? Better, overall design? Whose doing it the right way when it comes to designing an EHR, or as Dr. Rick says, designing one “based on what humans are good at — using our visual system to make sense of the world?”

Please let me know in the comments below.