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Hospitals and General Grant Have a Lot in Common

Posted on October 20, 2016 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

A few weeks ago, I was having a bad dream. Everything was turning black. It was hard to breath and moving was equally labored. It wasn’t a dream. I woke up and found myself working hard to inhale. Getting out of bed took determination.

I managed to get to our hallway and call my wife. She called 911 and DC’s paramedics soon had me on my way to Medstar’s Washington Hospital Center’s ER. They stabilized me and soon determined I wasn’t having a heart attack, but a heart block. That is, the nerve bundles that told my heart when to contract weren’t on the job.

A cardiology consult sent me to the Center’s Cardiac Electrophysiology Suite (EP Clinic), which specializes in arrhythmias. They ran an ECG, took a quick history and determined that the block wasn’t due to any meds, Lime disease, etc. Determining I needed a pacemaker, they made me next in line for the procedure.

Afterwards, my next stop was the cardiac surgery floor. Up till then, my care was by closely functioning teams. After that, while I certainly wasn’t neglected, it was clear I went from an acute problem to the mundane. And with that change in status, the hospital system’s attention to detail deteriorated.

This decline led me to a simple realization. Hospitals, at least in my experience, are much like Ulysses Grant: stalwart in crisis, but hard pressed with the mundane. That is, the more critical matters became in the Civil War, the calmer and more determined was Grant. As President, however, the mundane dogged him and defied his grasp.

Here’re the muffed, mundane things I encountered in my one overnight stay:

  • Meds. I take six meds, none exotic. Despite my wife’s and my efforts, the Center’s system could not get their names or dosages straight. Compounding that, I was told not to take my own because the hospital would supply them. It couldn’t either find all of them or get straight when I took them. I took my own.
  • Food. I’d not eaten when I came in, which was good for the procedure. After it, the EP Clinic fed me a sandwich and put in food orders. Those orders quickly turned into Nothing by Mouth, which stubbornly remained despite nurses’ efforts to alter it. Lunch finally showed up, late, as I was leaving.
  • Alarm Fatigue. At three AM, I needed help doing something trivial, but necessary. I pressed the signaling button and a nurse answered who could not hear me due to a bad mike. She turned off the alert. I clicked it on again. Apparently, the nurses have to deal with false signals and have learned to ignore them. After several rounds, I stumbled to the Nurses’ Station and got help.
  • Labs. While working up my history, the EP Clinic took blood and sent for several tests. Most came back quickly, but a few headed for parts unknown. No one could find out what happened to them.
  • Discharge. The EP Clinic gave me a set of instructions. A nurse practitioner came by and gave me a somewhat different version. When we got home, my wife called the EP Clinic about the conflict and got a third version.
  • EHR. The Hospital Center is Washington’s largest hospital. My PCP is at the George Washington University’s Medical Faculty Associates. Each is highly visible and well regarded. They have several relationships. The Center was supposed to send GW my discharge data, via FAX, to my PCP. It didn’t. I scanned them in and emailed my PCP.

In last five years, I’ve had similar experiences in two other hospitals. They do great jobs dealing with immediate and pressing problems, but their systems are often asleep doing the routine.

I’ve found two major issues at work:

  • Incomplete HIT. While these hospitals have implemented EHRs, they’ve left many functions big and small on paper or on isolated devices. This creates a hybrid system with undefined or poorly defined workflows. There simply isn’t a fully functional system, rather there are several of them. This means that when the hospital staff wants to find something, first they’ll look in a computer. Failing that, they’ll scour clipboards for the elusive fact. It’s like they have a car with a five speed transmission, but only first and second gear are automatic.
  • Isolated Actors. Outside critical functions, individuals carry out tasks not teams. That is, they often act in isolation from those before or after them. This means issues are looked at only from one perspective at a time. This sets the stage for mistakes, omissions and misunderstandings. A shared task list, a common EHR function, could end this isolation.

The Hospital Center is deservedly a well regarded. It’s heart practice is its special point of pride. However, its failure to fully implement HIE is ironic. That’s because Medstar’s National Center for Human Factors in Healthcare isn’t far from the Hospital.

The problems I encountered aren’t critical, but they are troublesome and can easily lead to serious even life endangering problems. Most egregious is failure to fully implement HIT. This creates a confusing, poorly coordinated system, which may be worse than no HIT at all.

The Exciting Future of Healthcare IT #NHITWeek

Posted on September 28, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One time I went to my wife’s OB/GYN appointment and I was in shock and awe with how well the doctor remembered my wife’s past pregnancies. Literally down to the tear that occurred. The reason I was in shock was that she prefaced her memory of my wife’s medical history with “Your old chart is off in storage, but as I recall you had a…”

While year later I’m still impressed with this OB/GYN’s ability to remember her patients, I know that this is not always the case. Doctors are humans and can’t possibly remember everything that occurred with every patient. Humans have limits. In fact, doctors deserve credit that they’ve provided such amazing medical care to so many patients despite these limits.

My esteem for doctors grows even greater when I think of the challenges associated with diagnosing computer problems (Yes, I am the nerd formerly known as @techguy). It’s not easy diagnosing a computer problem and then applying the fix that will remedy the problem. In fact, you often find yourself fixing the problem without really even knowing what’s causing the problem (ie. reinstall or reboot). While fixing computers is challenging, diagnosing and treating the human body has to be at least an order and probably two or more orders of magnitude more complex.

My point is that the work doctors do is really hard and they’ve generally done great work.

While I acknowledge the history of medicine, I also can’t help but think that technology is the pathway to solving many of the challenges that make doctors lives so difficult today. It seems fitting to me that IT stands for Information Technology since the core of healthcare’s challenges revolve around information.

Here are some of the ways technology can and will help:

Quality Information
The story of my wife’s OB/GYN is the perfect illustration of this potential. Doctors who have the right information at the point of care can provide better care. That’s a simple but powerful principle that can become a reality with healthcare IT. Instead of relying on this OB/GYN’s memory, she could have had that information readily available to her in an EHR.

Certainly, we’re not perfect at this yet. EHR software can go down. EHR can perpetuate misinformation. EHRs can paint the incorrect picture for a patient. However, on the whole, I believe an EHRs data is more accessible and available when and where it’s needed. Plus, this is going to get dramatically better over time. In some cases, it already is.

Deep Understanding of Individual Health Metrics
Health sensors are just starting to come into their own. As these health sensors create more and more clinically relevant data, healthcare providers will be empowered with a much deeper understanding of the specific health metrics that matter for each unique patient. Currently, doctors are often driving in the dark. This new wave of health sensors will be like turning the lights on in places that have never seen light before. In some cases, it already is.

Latest Medical Research
Doctors do an incredible job keeping up on the latest research in their specialty, but how can they keep up with the full body of medical knowledge? Even if they study all day and all night (which they can’t do because they have to see patients), the body of medical knowledge is so complex that the human mind can’t comprehend, process, and remember it all. Technology can.

I’m not suggesting that technology will replace humans. Not for the forseeable future anyway. However, it can certainly assist, inform, and remind humans. My phone already does this for me in my personal life. Technology will do the same for doctors in their clinical life. In some cases, it already is.

Patient Empowerment
Think about how dramatic a shift it’s been from a patient chart which the patient never saw to EHR software that makes your entire record available to patients all the time. If that doesn’t empower patients, nothing will. I love reading about how many kings use to suppress their people by suppressing information. Information is power and technology can make access to your health information possible.

Related to this trend is also how patients become more empowered through communities of patients with similar conditions and challenges. The obvious example is Patients Like Me, but it’s happening all over the internet and on social media. This is true for chronic patients who want to find patients with a rare condition, but it’s also true for patients who are finding the healthcare system a challenge to navigate. There is nothing more empowering than finding someone in a similar situation that can help you find the best opportunities and solutions to your problems.

In some cases, patient empowerment is already happening today.

Yes, I know that many of the technologies implemented to date don’t meet this ambitious vision of what technology can accomplish in healthcare. In fact, many health technologies have actually made things worse instead of better. This is a problem that must be dealt with, but it doesn’t deter me from the major hope I have the technology can solve many of the challenges that make being a doctor so hard. It doesn’t deter me from the dream that patients will be empowered to take a more active role in their care. It doesn’t deter me from the desire to leverage technology to make our healthcare system better.

The best part of my 11 years in healthcare IT has been seeing technology make things better on a small scale (“N of 1” –@cancergeek). My hope for the next decade is to see these benefits blow up on a much larger scale.

The Waiting Room – A Patient’s First Impression

Posted on September 23, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is sponsored by Samsung Business. All thoughts and opinions are my own.

We’ve all heard about the importance of first impressions. They last a long time and happen very quickly. The same is true for a medical practice. Patients’ first impression of a medical practice is the waiting room and that impression can last a very long time. What have you done to improve your patients’ experience in the waiting room?

Instead of doing a bunch of small things in your waiting room, I suggest you focus on creating one specific WOW! factor that patients will remember. In many cases people are turning to digital signage to provide this wow factor. Combine amazing content with some amazing digital signage like a curved TV, 3D TV, or massive screen and you can quickly implement the WOW! factor in your waiting room.

These type of memorable experiences for patients in your waiting room are the fuel that feeds social media and physician rating services today. If you want patients to share their experience at your office on social media or rate you highly on the various physician rating websites, start by WOWing them in your waiting room. Almost all of your patients now arrive with a phone in their pocket which they can use while they wait to provide your practice a quality rating. Leverage that as an asset.

I’ve heard some people argue that digital signage isn’t valuable anymore in the exam room because patients all show up with their own smartphones and tablets. They argue that patients have their heads buried in their phones and so they never see the digital signage you put in the exam room. This couldn’t be further from the truth.

The reality is that most of us with smartphones have become quite habituated to what people call the second screen experience. More and more people are watching TV while playing on their smartphone. It’s normal for us to be processing what’s on a TV while keeping an eye on our smartphone at the same time. The same thing happens in the waiting room when you provide a compelling digital experience. We consume both the TV and our smartphone.

Leveraging a high-quality digital experience in your waiting room provides a better patient experience overall. What’s the worst part of a waiting room? You have to wait. What’s the solution? We all have experienced a long flight or car ride that felt like it was much shorter thanks to some sort of digital media experience. This same experience can be had by patients if you invest in the right digital signage and content. Shorter wait times lead to better physician ratings in ambulatory practices and better HCAHPS scores in hospitals.

How have you approached your waiting room? Is there something unique or interesting you’ve done that’s made the patient experience better? What kind of first impression are you making on your patients?

For more content like this, follow Samsung on Insights, Twitter, LinkedIn , YouTube and SlideShare.

Where’s the Humanity in Healthcare?

Posted on September 8, 2016 I Written By

The following is a guest blog post from Snarky Frog. Yes, that’s her real name. Ok. You got us. No, it’s not her real name, but that’s how she wants to be known online. Who are we to judge her if she loves frogs and snark that much?
Snarky Frog
There was a time when I blogged. There was a time when I wrote about living with POTS (Postural Orthostatic Tachycardia Syndrome) and EDS (Ehlers Danlos Syndrome). There was time when I wrote about having a parent who…well…if I were to explain in this piece, I would lose all credibility.

There was time when I thought people would read what I wrote. There was a time when I thought people would care about how my father died (Yes hospital in CT, I do hold you accountable for that).

There was a time when I thought people would care that when I was half conscious after fainting, a nurse took it upon herself to show me what happens to drug users – apparently folks who use drugs have no rights to sexual dignity.

I wasn’t using illegal drugs then and I don’t now. The more you read about POTS patients, the more you read about how strange our symptoms are. I still argue my symptoms don’t matter, the way I was stripped of my humanity did and still does – turns out nobody really agrees with me. Guess you can do whatever you want to drug users (I’ve since learned this again and again via EMTs and others). As it turns out, you can also pretty much do this to patients you think are faking their disease.

There was a time when I blogged about how I couldn’t understand that a patient advocacy org promoted things one day, disagreed with them the next, then went back and forth for years. By the way, what’s still up with that? Will exercise heal me or is it IVIG I need or is it small fiber neuropathy all around? Oh… you need to study more – well hate to tell you patient group, if I need IVIG, exercise won’t save me. Though, it honestly may help.

There was a time in life when I questioned things. There was a time when I wrote. There was a time I cared. I probably still do all of those things but I do all of it less.

Nobody cared what I wrote so I stopped publicly blogging. The things I tried to get folks to care about – I was on my own with. I wrote but my writing was for me. I took my blog pieces down one by one.

By that time my writing abilities were somewhat gone after I had taken a few too many hits to the head. Things became mostly jots on google docs. My posts are now long gone into the ether and even the WayBackMachine can’t find them.

Right now I could write about not having a single doc who knows much about any of my diseases. I could write about having 3 different specialists who each understood different pieces of EDS / POTS leave their practices in the same year. I could write about fighting with hospital billing offices. I could write about how a doctor who played a role in quality affairs at an academic medical center could literally get nowhere with my insurance when he tried to get me some assistance. I could write about the discussions I have had with the insurance co regarding how much my POTS costs them (about 90-100K in 2015, likely to be more this year) and the various suggestions I’ve given them to lower those costs. I could write about how they respond with the fact that none of those suggestions, while cost saving to them, are part of my plan, and as such, are not things they can or will do.

I could write about my grief over a friend. I could write about the things I saw happen to her the one time I visited her in the hospital. I could write about how I wanted to help more but couldn’t.

I could write about system failures. I could write and I could write and I could write some more about how every single part of the system has failed me and has failed my friends. It might not all make sense but I could write. The irony is the thing that matters to me the least is the specific cost yet that’s what people care about.

I care about the fact that my friend died.

I care about my losses as a human being. I care how much of my human dignity I have lost and how much has been taken away from me since I started getting sicker. I care about the fact that I will likely lose my job (days off, their having to worry or perhaps lack of worry about my falling on the job, my requests for accommodations etc.). I care about the fact that I will never be able to do what I wanted to do with my life – PhD, fieldwork – yeah, not a chance.

I care about the fact that I will eventually get so physically injured by a fall, by EMTs, by hospital staff, or other that I will no longer be able to get out of bed. I care about the fact that I will forever wonder whether one of these things will kill me, and if so, when.

I can give you the health care cost numbers but they don’t matter to me. Ask any chronic illness patient for his or her own costs of care and you’ll find the same thing. Once you go past “typical” or “trendy” chronic illnesses, there is no care coordination, there is nobody to turn to for help, and your insurance company, well maybe they’ll pay for something and maybe they won’t. I do wonder, if I were sick and rich would I still be as sick?

One thing I do know, I’m damned tired of being sick. I’m tired of identifying myself that way and I’m tired of others doing so. I’m also tired of wondering if it’s in my head and tired of having people tell me it is. (And if it is all in my head, then please, by god, someone help me treat that.)

If creating a blog post that delineates each and every expense will help me find a doctor who can help me with whatever the heck is wrong, yes, I will write one. That said, that post would take away a part of me, the part that says humanity matters most and that’s what we should care about.

This post is part of our effort to remind us of the patient perspective by sharing patients’ stories. Thanks Snarky Frog for sharing your story with us. If you have a patient story you’d like to share, please reach out to us on our Contact Us page.

Gastroparesis – A Patient Story

Posted on September 2, 2016 I Written By

The following is a guest blog post by Melissa Adams VanHouten. You can read more about her on her Gastroparesis: Fighting for Change website and her blog.
Melissa Adams VanHouten - Gastroparesis
Since being diagnosed with gastroparesis, my life has changed in unimaginable ways – and the medical community, which did not initially recognize my complex needs, left me ill-prepared for these changes.  In February 2014, I was hospitalized with severe pain and vomiting, put through a battery of tests, diagnosed, and sent home with only a brief explanation of my illness. No one prepared me for the seriousness of this condition.  Perhaps they thought I understood, but I did not.

My ordeal began in the ER with blood tests and scans.  When these tests showed nothing of concern, the doctors forced a tube down my nose and pumped my stomach in preparation for an upper endoscopy.  To this day, I have never experienced anything quite so unpleasant and terrifying.  The doctors were kind and warned me that, though necessary, the procedure would be painful.  They did their best to talk me through it, but it was not an experience I ever wish to relive.  In addition to the endoscopy, I was sent for a Gastric Emptying Study (GES) the following day.  This was not a particularly harsh test except for the fact that I was required to keep the food down despite my frequent vomiting episodes.  My situation was not improved by the radiology technician warning me repeatedly and sternly that if I vomited, we would have to repeat the test.  My week was rounded out with more scans, additional blood tests, and a few IV changes.

The good news is that, though the tests were difficult to endure, the nurses and doctors were (for the most part) kind and understanding.  They controlled my pain well, answered my questions when they could, and took reasonable steps to ensure my comfort; however, my stay was not without issues.  There were numerous occasions where I had to ask what medication I was being given and why, and there were a couple of medications that I concluded were unnecessary – such as the “standard treatment” for heartburn, which they assured me everyone who complained of stomach pain received, when I was not experiencing heartburn.  I was also woken up by the blinding overbed light several times during the night, every night, for blood pressure checks and such when I really could have used the rest.  I was discouraged from showering and walking the halls as well, as this seemed to be an inconvenience for the nurses. The biggest issue by far, though, was the coordination of care.  I lost count of how many different medical providers I spoke to, could not understand their various roles in my care, and was required to repeat my “story” every time someone new arrived.  I would have loved to have felt as if everyone working with me was “on the same page.”

Fortunately, at the end of my week’s stay, I did receive a diagnosis.  I am thankful I was diagnosed so quickly, since many in my community spend weeks, months, or even years seeking answers.  What is not quite so fortunate is that, upon my release, I was sent home with very little information regarding my condition and was told simply to follow up with a gastroenterologist in about 6 weeks.  I had no detailed diet plan, no medications to try, and no idea what to expect.

I recall the doctors giving me an overview of gastroparesis.  They told me it was “paralysis of the stomach” and impressed upon me that there was no cure.  I remember them saying I would need to make some dietary changes, and if those didn’t work, there were a few medications to try – but they came with risks and negative side effects.  I recall them telling me that in some severe cases, people would opt for surgery to implant a gastric electrical stimulator or resort to feeding tubes.  Mostly, though, I remember them saying that some would recover almost completely over time and would not experience long-term effects.  Of course, this last statement is what I believed would be the case for me.  After all, I was in good overall health.  Not a big deal.  I would follow a liquids-only diet, work my way up to soft foods and solids, just as they indicated I should, and I would be fine.

But it did not happen that way.  I went home believing I would continue to improve; instead, my condition deteriorated.  Within a couple of days, I started vomiting again and could barely keep down liquids.  The attacks of pain worsened, and I became so weak that I honestly could not lift my head up.  I told my family goodbye.  I truly believed I would die.  I could not get in quickly to see my new gastroenterologist, and I had no idea what to do.  I finally mustered up the courage to call my doctor and told him that despite the risks, I thought I should try one of the medications the hospital doctors had mentioned.  He agreed, but because of FDA restrictions and requirements associated with my particular medication, it was two horrendous weeks before I could begin taking it.  These were without a doubt the longest two weeks of my life.

Since starting the medication, I have stopped vomiting (for the most part) and can now function well enough to make it through the day, but I still cannot eat without pain.  It is clear to me now that I will likely never again be able to eat “normal” foods in “normal” amounts, and it is crystal clear to me that this is a life-altering disease from which there is perhaps no coming back.  I have experienced levels of fatigue I previously thought impossible, endured unfathomable pain, and come to realize the horrors of hunger and malnutrition.  I had no idea I would face this.  The doctors did not impress on me that this was a serious, chronic illness, and they left me in the dark as to how to cope with my illness should it not resolve itself, as I had believed it would upon leaving the hospital.

I am thankful I now have a physician who is willing to listen to my concerns and partner with me in evaluating treatment options.  Though there are few treatments available for gastroparesis, my doctor seems to genuinely care and refuses to give up on me.  That means the world to a person in my circumstances.  My experience differs from many in the gastroparesis community.  Unlike me, they remain lost and confused, as I was immediately after diagnosis.  They never find that competent, compassionate doctor.  These are the people for whom I advocate.  I hope that eventually we are able to establish a healthcare system that meets the needs of all.  We need better care, better treatments, and a medical community that comprehends our needs.

This post is part of our effort to remind us of the patient perspective by sharing patients’ stories. Thanks Melissa for sharing your story with us. If you have a patient story you’d like to share, please reach out to us on our Contact Us page.

What Do Consumers Demand from Modern Healthcare?

Posted on August 26, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Consumer Demand for Modern Healthcare IT

This represents some really fascinating data and illustrates a major trend around consumer demand in healthcare. More and more patients are comfortable with some form of electronic healthcare. Over time I’m sure that this acceptance is going to grow into pure demand for these type of modern healthcare options. Are you prepared for this change?

Right now, most doctors don’t need to offer the services described above. Patients don’t generally choose their doctor using the above criteria, but over time I think that will likely change. As patients get the first glimpse of how much easier a telemedicine visit was as compared to an office visit, they’re going to want more. It’s the natural process of how these things evolve.

My fear is that many small practices are asleep at the wheel in this regard. This will likely lead to problems since their big health system competitors are going to roll this out in a broad way that could make it hard for small practices to compete if they don’t get on it early. Plus, large health system competitors will be able to do things like offer 24 hour services that a small practice just can’t reasonably offer.

At the end of the day, every small practice needs to ask themselves, what am I doing to create an amazing patient experience for those in my care. Small practices that do this will be successful and retain patients. Those that continue practicing business as usual will likely run into difficulties as consumer driven healthcare starts to take over.

Patient Self Management

Posted on August 25, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I always find stats like this interesting, but misleading. The fallacy that most people apply to a stat like this is saying that because people want something they will actually do it. In this case, just because 90% of people want to self-manage their care, that doesn’t mean that 90% of patients will actually self-manage their care.

90% of people want to stop smoking, but they don’t. 100% of people want to be more fit and healthy, but we don’t. There are a lot of things that we want, but that doesn’t mean we actually want it enough to do something about it.

The reality is that most of us don’t think about our health until we have a problem. If you ask us if we care about our health, we’d all say that we do. However, our actions tell a very different story. Our actions say that most of us don’t really care about our health. Or at least that we don’t care about it enough to give up things that are harming our health.

In many ways our health system reflects this fact. Our doctor doesn’t really worry about our overall health. Our doctor mostly treats our chief complaint. In many cases, they don’t even dig down past our chief complaint. They certainly don’t proactively look for ways our lifestyle or environment are impacting our health. Should that change?

The question I keep asking is if the doctor is the right person to address this type of change in perspective when it comes to health. Should the doctor be the one to understand our overall health and address our health risks? Should we do it ourselves? Should a health app do it for us in a way that it motivates us enough to actually care about the unhealthy choices we make?

The last option seems like the most likely option to me. Doctors aren’t trained to treat you when you’re healthy. It would take a sea change for them to switch roles. Health apps, the health sensors that inform these apps, and the baseline health knowledge are all progressing so quickly that it’s not hard to see a day when a health app could better help us understand how the choices we make influence our health.

What do you think? Is there anything that will really help us understand the health impact from the choices we make? Do patients really want to self-manage their care?

Fixing the “Not My Problem” Culture in Healthcare – #KareoChat

Posted on August 17, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It was pretty shocking to hear the news of the passing of Jess Jacobs, patient advocate and Aetna innovator. Life is certainly fragile and Jess’ passing was a reminder of that to me. While I certainly didn’t know her well, I’d had a chance to meet her a few times at HIMSS and Wen was nice enough to share a great picture of Jess having fun at the New Media Meetup which I organize. That made me smile.

As all the tributes to Jess Jacobs poured in, I admit that I didn’t know a good way that I could honor her memory until I was asked to host this week’s #KareoChat. Queued off of Ted Eytan, MD’s tribute to Jess, I thought it would be valuable to talk about what he calls the “Not My Problem” culture in healthcare and how we can change it in this week’s #KareoChat Twitter chat. My only regret is that we didn’t have this conversation while Jess was alive. I’m sure that she would have really added some depth (and likely a bit of snark) to the conversation. Instead, I’ll have to hope she’s smiling down on us trying to make the lives better for patients that are suffering in our health system like she did.

KareoChat - Not My Problem Culture in Healthcare - UnicornJess

You can follow along and participate in the #KareoChat on Thursday, August 18th at 9 AM PT (Noon ET). We’ll be discussing the following 6 questions:

  1. Have you seen the “Not My Problem” culture in healthcare?  Where and what impact did it have?
  2. How can small practices avoid the “Not My Problem” culture that sometimes exists?
  3. What can a small practice do to become more patient focused?
  4. Will becoming more patient focused be good or bad for a small practice’s business? Why or why not?
  5. What can we do to better help chronic patients who are suffering like #UnicornJess suffered?
  6. Do we see the “Not My Problem” issue in health IT towards doctors?  How?

As Dr. Eytan said in his post, I don’t think the people in healthcare are the problem. Most of the healthcare providers I know care deeply about the patient and want to be more patient focused. However, our system pushes a culture that often destroys the patient experience. Hopefully, in this chat we can talk about ways we can overcome or change that culture for the better of patients so that future patients don’t have to endure the painful patient experiences that Jess Jacobs had to endure.

If you want to learn more about Jess Jacobs, many people who knew her did this #UnicornJess Twitter chat where they told a lot of stories and memories about her. Also, the family has asked that donations be made in Jess’s honor to the Walking Gallery, a cause that was important to Jess.

Full Disclosure: Kareo is an advertiser on this blog.

The World is Going Remote and Mobile – Are You?

Posted on August 5, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Anthony Guerra has a great post on his blog Health System CIO called “Cutting the Line.” If you’ve never read Anthony’s blog posts, he’s a great story teller and that post is a great example. Take a second to go and read the whole post, we’ll be here when you get back.

For those too lazy to click over to Anthony’s blog, here’s an excerpt of the full story which highlights the shift to remote and mobile that he’s been seeing happening in society:

And it isn’t just Starbucks that has gotten into the business of cutting out the personal touch (which nobody really wants anyway — think banking). A few days after my Starbucks experience, I got an email from my gym notifying members that those sitting poolside no longer had to trek to the outdoor café to grab their lunch (and that line really stinks). Now, you could order right from your lounge chair and have your salad and smoothie delivered without missing a ray of sunshine.

Oh, and as if everyone suddenly got a “go-remote” memo at once, the next day I saw this signat one of my favorite burrito places. I guess everyone realizes their customers get no pleasure from waiting on lines. What do customers want? The product, the result — so why not have it ready, or deliver it straight to them?

The world, as we know, is going remote and mobile, and it’s going there fast.

We’ve all seen this happening in one way or another. Ironically, I went into Dominos and had this very same experienced. I’d ordered it all online. I walked in, told them my name and walked out. There was a bit of a rush that they had it waiting for me while I saw two poor saps sitting there waiting for their orders. If I didn’t have kids, I could have literally done that order with a simple voice command to Alexa. Although, I haven’t enabled that feature since I don’t want my kids ordering pizza at their whim.

What’s interesting is that there are very few experiences in healthcare that are like this. A few pharmacies have made it almost this easy to pickup a refill. That’s the closest we’ve come. Shouldn’t we be able to do more?

I think the answer is that we could and we should. I think the reason we aren’t is that we’ve overburdened our doctors and practices as a whole. Between meaningful use, ICD-10, ACOs, MACRA, etc etc etc, when have practices had time to work on innovative interactions with their patients. Doctors are running as fast as they can on the treadmill that is healthcare and now we’ve asked them to become data entry clerks while running on that treadmill. It takes a pretty special doctor to find the time to start thinking of and implementing consumer centric interactions with their patients.

I guess this is why I’m so torn by the current state of our healthcare system. There are so many opportunities to improve the experience for both patients and doctors. However, we’re all too burdened with minutia that there’s no room to innovate. The question I keep asking is when will we break free of the chains of bureaucracy and be able to implement these type of consumer focused innovations? At what point will some healthcare organizations break through the barrier and essentially make it a standard of care for which all others will have to follow? I look forward to that day.

We Self-Diagnose Our Car, Why Not Our Health?

Posted on July 29, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today my wife went out to move my car and came back to tell me that my battery was dead. This is a common thing in Las Vegas since it’s so dry it kills batteries regularly. However, I was intrigued that my wife with no training as a mechanic had diagnosed the health of my car and rendered a diagnosis. I’ll be going to check that indeed it’s the case. If jumping my car doesn’t last, then I’ll have to take the battery in where they’ll run the battery tester to confirm her diagnosis.

When I take the battery in, the mechanic won’t question my diagnosis. He won’t feel like I haven’t trained long enough to know if the battery might be the problem. He’ll run the tests to verify what I’m saying, but he’ll work collaboratively with me to fix the problem.

Why is it so different in healthcare?

In reality, it’s not that different. We’ve been self-diagnosing in healthcare for a long time. There’s a whole industry of over the counter medications that anyone can go and take to treat their health condition with no doctor involvement at all. We self diagnose and self treat with no intervention from the doctor at all. Why then do so many doctors (not all of them) balk at the idea of the patient working to understand their issue and identify their diagnosis?

I think there’s two reasons that this scares doctors. First, a minority of patients have ruined it for the rest of us. Some patients go into their doctor and are completely disrespectful. They treat the doctor as someone who should just give them whatever they want and whatever they ask for. It’s shameful and a few of these “bad apples” will no doubt make a doctor gun shy when the next patient comes in respectfully talking about their own efforts to diagnose their issues. We can’t let a few bad apples spoil the bunch.

Second, the tools we have available today have opened up so many new worlds for patients to be able to be more informed about possible health issues. This starts with Dr. Google which is literally available to us at our fingertips or even at our beck and call (ie. Siri, Alexa, Google, and Galaxy). It continues with this wave of health sensors and health apps which help us better understand our own health and possible health issues we may be experiencing. Both of these are only going to get better. Before we might diagnose a fever but with new technologies we might eventually be able to know if we have diabetes or some other more complex disease. It’s not hard to see how patients will know more than doctors about their own individual health. This is scary, because with increased information and data we can do so much more. However, with that power also comes new risks.

Going back to the car analogy. A dead battery is something pretty easy to diagnose in a car. I’ve even had enough experience with cars that I could probably diagnose an alternator problem. However, while I could diagnose the problem, I certainly am not capable of fixing the problem. Plus, it’s possible that the mechanic might replace the alternator and there are still problems or I might suggest that it’s a problem with the alternator, but they find something else which is really causing the problem because they understand how a car works better than me.

We’re going to find a very similar experience in healthcare. We may be able to eventually know that we’re a diabetic, but we’ll need the healthcare system and doctors working collaboratively with us to actually fix the problem. Plus, we may think we’re a diabetic, but once we see the doctor we’ll find out that what appeared to be diabetes was something else that had similar symptoms. That’s ok and normal. Much like we wouldn’t freak out at our mechanic for finding a different diagnosis, we shouldn’t freak out at our doctor.

The reality is that healthcare must be a collaboration between patient and doctor. Neither should feel so arrogant that they don’t listen to or disrespect the other. Patients should present the doctor with their symptoms, experiences, and findings so that the doctor has as much information about your health needs as possible. Doctors should be excited to have a patient that’s deeply interested in their health. Together they can work through the findings to help everyone understand the best path forward and why something the patient found might not be accurate or appropriate for them.

The very best doctors I know love this type of collaboration with their patients. They also hate when patients arrive in a disrespectful and arrogant way. We need to purge the later from the system so that they don’t ruin it for the rest of us and the doctors.