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Encouraged By Political Changes, Groups Question ONC Functions

Posted on March 21, 2017 I Written By

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

Riding on an anti-regulation drive backed by the White House, groups unhappy with some actions by ONC are fighting to rein it in. President Trump has said that he would like to see two regulations killed for every new reg, and the groups seemingly see this as an opening.

One group challenging ONC activities is HealthIT Now, a coalition of providers, payers, employers and patient groups.

In a letter to HHS Secretary Tom Price, Health IT Now argues that ONC exceeded its authority last year, when it backed an oversight rule designed to boost the certification process by evaluating vendor interoperability capabilities.

The 2016 rule also holds health IT vendors accountable for technology flaws that could compromise patient safety, an approach which, HITN argues, steals a move from federal agencies such as the FDA. The group also contends that ONC has not been clear about its criteria for critiquing HIT solutions for safety problems.

Meanwhile, a group of medical societies and specialties is asking federal health officials to hold off on 2015 EHR certification requirements, which providers are expected to start using January 2018, for at least one year. The group notes that since ONC released its final 2015 Edition requirements, few vendors – in fact, just 54 of 3,700 products currently certified – have fully upgraded their systems.

Given this situation, rushing to deploy the latest certification requirements could create big problems, including a major disruption to medical practices’ business, the coalition argues.

If they’re forced to choose from the small number of systems which have upgraded their platforms, “physicians may be driven to switch vendors and utilize a system that is not suitable for their specialty or patient population,” the group said in a letter to CMS acting administrator Patrick Conway, MD, and acting ONC national coordinator Jon White, MD.

In addition to addressing certification concerns, there’s much the federal government can do to support health IT improvement, according to attendees at HIMSS17.

According to HITN, attendees would like policymakers to address interoperability, in part by reviewing Meaningful Use and the ONC Voluntary Certification programs; to focus on improving patient identification systems, and avoid imposing barriers to private market solutions; to clarify the role of the ONC in the marketplace; and to encourage the use of real-world evidence in healthcare and health IT deployment.

As I see it, these ideas veer between close-in detail and broad policy prescriptions, neither of which seem likely to have a big effect on their own.

On the one hand, while it might help to clarify ONC’s role, authority and process, the truth is that the health IT market isn’t living or dying on what it does. This is particularly the case given its revolving door leaders with too little time to do more than nudge the industry.

Meanwhile, it seems equally unlikely that the federal government will come up with generally-applicable policy prescriptions which can solve nasty problems like achieving health data interoperability and sorting out patient matching issues.

I’m not saying that government has no role in supporting the emergence of health IT solutions. In fact, I’m fairly confident that we won’t get anywhere without its assistance. However, until we have a more effective role for its involvement, government efforts aren’t likely to bear much fruit.

Paper Records Are Dead

Posted on March 14, 2017 I Written By

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

Here’s an argument that’s likely to upset some, but resonate with others. After kicking the idea around in my head, I’ve concluded that given broad cultural trends, that the healthcare industry as a whole has outgrown the use of paper records once and for all. I know that this notion is implicit in what health IT leaders do, but I wanted to state this directly nonetheless.

Let me start out by noting that I’m not coming down on the minority of practices (and the even smaller percentage of hospitals) which still run on old-fashioned paper charts. No solution is right for absolutely everyone, and particularly in the case of small, rural medical practices, paper charts may be just the ticket.

Also, there are obviously countless reasons why some physicians dislike or even hate current EMRs. I don’t have space to go into them here, but far too many, they’re hard to use, expensive, time-consuming monsters. I’m certainly not trying to suggest that doctors that have managed to cling to paper are just being contrary.

Still, for all but the most isolated and small providers, over the longer term there’s no viable argument left for shuffling paper around. Of course, the healthcare industry won’t realize most of the benefits of EMRs and digital health until they’re physician-friendly, and progress in that direction has been extremely slow, but if we can create platforms that physicians like, there will be no going back. In fact, for most their isn’t any going back even if they don’t become more physician firendly. If we’re going to address population-wide health concerns, coordinate care across communities and share health information effectively, going full-on digital is the only solution, for reasons that include the following:

  • Millennial and Gen Y patients won’t settle for less. These consumers are growing up in a world which has gone almost completely digital, and telling them that, for example they have to get in line to get copies of a paper record would not go down well with them.
  • Healthcare organizations will never be able to scale up services effectively, or engage with patients sufficiently, without using EMRs and digital health tools. If you doubt this, consider the financial services industry, which was sharing information with consumers decades before providers began to do so. If you can’t imagine a non-digital relationship with your bank at this point, or picture how banks could do their jobs without web-based information sharing, you’ve made my point for me.
  • Without digital healthcare, it may be impossible for hospitals, health systems, medical practices and other healthcare stakeholders to manage population health needs. Yes, public health organizations have conducted research on community health trends using paper charts, and done some effective interventions, but nothing on the scale of what providers hope (and need) to achieve. Paper records simply don’t support community-based behavioral change nearly as well.
  • Even small healthcare operations – like a two-doctor practice – will ultimately need to go digital to meet quality demands effectively. Though some have tried valiantly, largely by auditing paper charts, it’s unlikely that they’d ever build patient engagement, track trends and see that predictable needs are met (like diabetic eye exams) as effectively without EMRs and digital health data.

Of course, as noted above, the countervailing argument to all of this is the first few generations of EMRs have done more to burden clinicians than help them achieve their goals, sometimes by a very large margin. That seems to be largely because most have been designed — and sadly, continue to be designed — more to support billing processes than improve care. But if EMRs are redesigned to support patient care first and foremost, things will change drastically. Someday our grandchildren, carrying their lifetime medical history in a chip on their fingernail, will wonder how providers ever managed during our barbaric age.

 

Physicians Ask New HHS Head For Health IT Help

Posted on February 28, 2017 I Written By

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

The American Academy of Family Practitioners has written to new HHS Secretary Tom Price with a list of areas in which health IT could use a helping hand.  In its letter, the group outlines issues with physician use of health IT that the new leadership could tackle.

According to the AAFP, the top issues policymakers need to tackle include:

  • Lack of healthcare data access undercuts care: Without interoperability, it will be hard for doctors to ensure continuity of care, care coordination and a learning and accountable health system, the group says. It names the Direct protocols as an example of progress on this front.
  • HIT functions are too business-oriented: According to the AAFP, the healthcare industry has spent too much time focused on automating the business of healthcare, particularly documentation. The letter argues that it’s time to flip the focus from business functions to delivery of appropriate care.
  • HIT reduces physician satisfaction: The group argues that current health IT solutions are “extinguishing the joy of practice” for physicians and contributing to physician burnout and frustration.
  • EHR certification standards are undercutting clinicians: The AAFP contends that existing standards for EHR certification are causing problems physicians, as they don’t do much to push vendors to meet user demands or improve their technology.

This is certainly a reasonable summary of issues in physician HIT adoption. And they deserve to be addressed Unfortunately, it’s not likely that that the AAFP will get much satisfaction from HHS, CMS or any other government entity. I’ve reluctantly come to the conclusion that agencies like ONC aren’t going to get much more done.

I do have hope that current waves of technology will allow health IT issues to self-heal to some extent. In particular, as healthcare technology becomes more decentralized, connected and mobile, providers won’t have to manage clumsy, ugly EMR interfaces on the desktop. In part due to some chats with vendors, I’ve become convinced that next-gen HIT solutions will present data via lightweight clients (perhaps even lighter than existing apps) which create an EMR-on-the-fly. One example of a company working on this approach is Praxify which Healthcare Scene recently saw at HIMSS. This lightweight client approach could make existing concerns about HIT usability and architecture obsolete.

However, I’m realistic enough to know that no matter how nifty emerging HIT approaches are, we still have to get from here to there. And as long as clinicians remain something of an afterthought when EMRs are designed – something which despite vendor denials, remains a big issue – we’re likely to keep struggling with today’s HIT issues. Let’s hope the revolution comes before we’ve exhausted our issues fighting current health IT demons.

The Healthcare AI Future, From Google’s DeepMind

Posted on February 22, 2017 I Written By

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

While much of its promise is still emerging, it’s hard to argue that AI has arrived in the health IT world. As I’ve written in a previous article, AI can already be used to mine EMR data in a sophisticated way, at least if you understand its limitations. It also seems poised to help providers predict the incidence and progress of diseases like congestive heart failure. And of course, there are scores of companies working on other AI-based healthcare projects. It’s all heady stuff.

Given AI’s potential, I was excited – though not surprised – to see that world-spanning Google has a dog in this fight. Google, which acquired British AI firm DeepMind Technologies a few years ago, is working on its own AI-based healthcare solutions. And while there’s no assurance that DeepMind knows things that its competitors don’t, its status as part of the world’s biggest data collector certainly comes with some advantages.

According to the New Scientist, DeepMind has begun working with the Royal Free London NHS Foundation Trust, which oversees three hospitals. DeepMind has announced a five-year agreement with the trust, in which it will give it access to patient data. The Google-owned tech firm is using that data to develop and roll out its healthcare app, which is called Streams.

Streams is designed to help providers kick out alerts about a patient’s condition to the cellphone used by the doctor or nurse working with them, in the form of a news notification. At the outset, Streams will be used to find patients at risk of kidney problems, but over the term of the five-year agreement, the developers are likely to add other functions to the app, such as patient care coordination and detection of blood poisoning.

Streams will deliver its news to iPhones via push notifications, reminders or alerts. At present, given its focus on acute kidney injury, it will focus on processing information from key metrics like blood tests, patient observations and histories, then shoot a notice about any anomalies it finds to a clinician.

This is all part of an ongoing success story for DeepMind, which made quite a splash in 2016. For example, last year its AlphaGo program actually beat the world champion at Go, a 2,500-year-old strategy game invented in China which is still played today. DeepMind also achieved what it terms “the world’s most life-like speech synthesis” by creating raw waveforms. And that’s just a couple of examples of its prowess.

Oh, and did I mention – in an achievement that puts it in the “super-smart kid you love to hate” category – that DeepMind has seen three papers appear in prestigious journal Nature in less than two years? It’s nothing you wouldn’t expect from the brilliant minds at Google, which can afford the world’s biggest talents. But it’s still a bit intimidating.

In any event, if you haven’t heard of the company yet (and I admit I hadn’t) I’m confident you will soon. While the DeepMind team isn’t the only group of geniuses working on AI in healthcare, it can’t help but benefit immensely from being part of Google, which has not only unimaginable data sources but world-beating computing power at hand. If it can be done, they’re going to do it.

Denmark’s Health System Suffering Familiar EMR Woes

Posted on February 21, 2017 I Written By

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

If you’re trying to navigate the US healthcare system – or worse, trying to pay for your care — Denmark’s alternative may sound pretty sweet. The Danish health system, which is funded through income taxes, offers free care to all Danish residents and EU citizens, as well as free emergency treatment to visitors from all other countries. And the Danes manage to deliver high-quality healthcare while keeping costs at 10.5% of its GDP (as opposed the US, which spends nearly 18% of the GDP on healthcare).

That being said, when it comes to health IT, Denmark is going through some struggles which should be familiar to us all. Starting in 2014, the Danish government began modernizing its healthcare system, an effort which includes developing both new hospitals and a modern health IT infrastructure. One of the linchpins of its efforts is a focus on directing care to fewer, more specialized hospitals – cutting beds by 20% and hopefully reducing average lengths of hospital stays from five to three days – supported by its HIT expansion.

You probably won’t be surprised to learn, meanwhile, that Epic has inserted itself into this effort, winning a $1B project to put its systems in place across 20 hospitals with 44,000 concurrent users. Unfortunately for the Danes, who are starting with a few hospitals in one of the country’s five regions, the effort has run into some early snags. Apparently, the Epic installs at these initial test hospitals aren’t going according to plan.

According to one publication, initial hospital go-lives in May and June of last year have seen  major problems, including errors that have put patients at risk, as well as creating erroneous test reports, results and prescriptions. The Epic systems were also having trouble communicating with the Danish health card, which stores patient information on a magnetic stripe.

The questionable rollout has since caused some controversy. As of August 2016, the local doctors’ union was demanding that a planned deployment in Copenhagen, at Denmark’s busiest hospital, be put off until authorities had figured out what was going wrong at the other two.

At first, I was surprised to hear about about Denmark’s IT woes, as I’d blithely assumed that a government-run health system would have a “central planning” advantage in EMR implementations. But as it turns out, that’s clearly not the case. It seems some frustrations are universal.

I got some insight into this yesterday, when I took a call from an earnest Danish journalist who was trying to understand what the heck was going on with Epic. “Things are going badly here,” she said. “There are lots of complaints from the first two hospitals. And the systems can’t talk to each other.”

I told her not to be surprised by all of this, given how complex Epic rollouts can be. I also warned that given the high cost of Epic software and support, it would not be astonishing if the project ended up over budget. I then predicted that without pulling Epic-trained (and perhaps Epic certified) experts into the project, things might get worse before they get better. “Just hire a boatload of American Epic consultants and you’ll be fine,” I told her, perhaps a bit insensitively. “Maybe.”

When I said that, she was clearly taken aback. Even from thousands of miles away, I could tell she was unhappy. “I was hoping you had a solution,” she finally said. “I wish,” I replied. And I had to laugh so I wouldn’t cry.

Switching Out EMRs For Broad-Based HIT Platforms

Posted on February 8, 2017 I Written By

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

I’ve always enjoyed reading HISTalk, and today was no exception. This time, I came across a piece by a vendor-affiliated physician arguing that it’s time for providers to shift from isolated EMRs to broader, componentized health IT platforms. The piece, by Excelicare chief medical officer Toby Samo, MD, clearly serves his employer’s interests, but I still found the points he made to be worth discussing.

In his column, he notes that broad technical platforms, like those managed by Uber and Airbnb, have played a unique role in the industries they serve. And he contends that healthcare players would benefit from this approach. He envisions a kind of exchange allowing the use of multiple components by varied healthcare organizations, which could bring new relationships and possibilities.

“A platform is not just a technology,” he writes, “but also ‘a new business model that uses technology to connect people, organizations and resources in an interactive ecosystem.’”

He offers a long list of characteristics such a platform might have, including that it:

* Relies on apps and modules which can be reused to support varied projects and workflows
* Allows users to access workflows on smartphones and tablets as well as traditional PCs
* Presents the results of big data analytics processes in an accessible manner
* Includes an engine which allows clients to change workflows easily
* Lets users with proper security authorization to change templates and workflows on the fly
* Helps users identify, prioritize and address tasks
* Offers access to high-end clinical decision support tools, including artificial intelligence
* Provides a clean, easy-to-use interface validated by user experience experts

Now, the idea of shared, component-friendly platforms is not new. One example comes from the Healthcare Services Platform Consortium, which as of last August was working on a services-oriented architecture platform which will support a marketplace for interoperable healthcare applications. The HSPC offering will allow multiple providers to deliver different parts of a solution set rather than each having to develop their own complete solution. This is just one of what seem like scores of similar initiatives.

Excelicare, for its part, offers a cloud-based platform housing a clinical data repository. The company says its platform lets providers construct a patient-specific longitudinal health record on the fly by mining existing EHRs claims repositories and other data. This certainly seems like an interesting idea.

In all candor, my instinct is that these platforms need to be created by a neutral third party – such as travel information network SABRE – rather than connecting providers via a proprietary platform created by companies like Excelicare. Admittedly, I don’t have a deep understanding of Excelicare’s technology works, or how open its platform is, but I doubt it would be viable financially if it didn’t attempt to lock providers into its proprietary technology.

On the other hand, with no one interoperability approach having gained an unbeatable lead, one never knows what’s possible. Kudos to Samo and his colleagues for making an effort to advance the conversation around data sharing and collaboration.

EMR Data Use For Medical Research Sparks Demand For Intermediaries

Posted on February 7, 2017 I Written By

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

Over the last couple of years, it’s become increasingly common for clinical studies to draw on data gathered from EMRs — so common, in fact, that last year the FDA issued official guidance on how researchers should use such data.

Intermingling research observations and EMR-based clinical data poses different problems than provider-to-provider data exchanges. Specifically, the FDA recommends that when studies use EMR data in clinical investigations, researchers make sure that the source data are attributable, legible, contemporaneous, original and accurate, a formulation known as ALCOA by the feds.

It seems unlikely that most EMR data could meet the ALCOA standard at present. However, apparently the pharmas are working to solve this problem, according to a nice note I got from PR rep Jamie Adler-Palter of Bayleaf Communications.

For a number of reasons, clinical research has been somewhat paper-bound in the past. But that’s changing. In fact, a consortium of leading pharma companies known as TransCelerate Biopharma has been driving an initiative promoting “eSourcing,” the practice of using appropriate electronic sources of data for clinical trials.

eSourcing certainly sounds sensible, as it must speed up what has traditionally been the very long process of biopharma innovation. Also, I have to agree with my source that working with an electronic source beats paper any day (or as she notes, “paper does not have interactive features such as pop-up help.”) More importantly, I doubt pharmas will meet ALCOA objectives any other way.

According to Adler-Palter, thirteen companies have been launched to provide eSource solutions since 2014, including Clinical Research IO (presumably a Bayleaf client). I couldn’t find a neat and tidy list of these companies, as such solutions seem to overlap with other technologies. (But my sense is that this is a growing area for companies like Veeva, which offers cloud-based life science solutions.)

For its part CRIO, which has signed up 50 research sites in North America to date, offers some of the tools EMR users have come to expect. These include pre-configured templates which let researchers build in rules, alerts and calculations to prevent deviations from the standards they set.

CRIO also offers remote monitoring, allowing the monitor to view a research visit as soon as it’s finished and post virtual “sticky notes” for review by the research coordinator. Of course, remote monitoring is nothing new to readers, but my sense is that pharmas are just getting the hang of it, so this was interesting.

I’m not sure yet what the growth of this technology means for providers. But overall, anything that makes biopharma research more efficient is probably a net gain for patients, no?

External Incentives Key Factor In HIT Adoption By Small PCPs

Posted on January 25, 2017 I Written By

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

A new study appearing in The American Journal of Managed Care concludes that one of the key factors influencing health IT adoption by small primary care practices is the availability of external incentives.

To conduct the study, researchers surveyed 566 primary care groups with eight or fewer physicians on board. Their key assumption, based on previous studies, was that PCPs were more likely to adopt HIT if they had both external incentives to change and sufficient internal capabilities to move ahead with such plans.

Researchers did several years’ worth of research, including one survey period between 2007 and 2010 and a second from 2012 to 2013. The proportion of practices reporting that they used only paper records fell by half from one time period to the other, from 66.8% to 32.3%. Meanwhile, the practices adopted higher levels of non-EMR health technology.

The mean health IT summary index – which tracks the number of positive responses to 18 questions on usage of health IT components – grew from 4.7 to 7.3. In other words, practices implemented an average of 2.6 additional health IT functions between the two periods.

Utilization rates for specific health IT technologies grew across 16 of the 18 specific technologies listed. For example, while just 25% of practices reported using e-prescribing tech during the first period of the study, 70% reported doing so during the study’s second wave. Another tech category showing dramatic growth was the proportion of practices letting patients view their medical record, which climbed from one percent to 19% by the second wave of research.

Researchers also took a look at the impact factors like practice size, ownership and external incentives had on the likelihood of health IT use. As expected, practices owned by hospitals instead of doctors had higher mean health IT scores across both waves of the survey. Also, practices with 3 to 8 physicians onboard had higher scores than those were one or two doctors.

In addition, external incentives were another significant factor predicting PCP technology use. Researchers found that greater health IT adoption was associated with pay-for-performance programs, participation in public reporting of clinical quality data and a greater proportion of revenue from Medicare. (Researchers assumed that the latter meant they had greater exposure to CMS’s EHR Incentive Program.)

Along the way, the researchers found areas in which PCPs could improve their use of health IT, such as the use of email of online medical records to connect with patients. Only one-fifth of practices were doing so at the time of the second wave of surveys.

I would have liked to learn more about the “internal capabilies” primary care practices would need, other than having access to hospital dollars, to get the most of health IT tools. I’d assume that elements such as having a decent budget, some internal IT expertise and management support or important, but I’m just speculating. This does give us some interesting lessons on what future adoption on new technology in healthcare will look like and require.

The Digital Health Biography: There’s A New Record In Town

Posted on January 18, 2017 I Written By

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

Few of us would argue that using EMRs is not a soul-sucking ordeal for many clinicians. But is there any alternative in sight? Maybe so, according to Robert Graboyes and Dr. Darcy Nikol Bryan, who are touting a new model they’ve named a “digital health biography.”

In a new article published in Real Clear Health, Graboyes, an economist who writes on technology, and Bryan, an OB/GYN, argue that DHBs will be no less than “an essential component of 21st century healthcare.” They then go on to describe the DHB, which has several intriguing features.

Since y’all know what doctors dislike (hate?) about EMRs, I probably don’t need to list the details the pair shares on why they generate such strong feelings. But as they rightly note, EMRs may take away from patient-physician communication, may be unattractively designed and often disrupt physician workflow.

Not only that, they remind us that third parties like insurance companies and healthcare administrators seem to get far more benefits from EMR content than clinicians do. Over time, data analytics efforts may identify factors that improve care, which eventually benefits clinicians, but on a transactional level it’s hard to dispute that many physicians get nothing but aggravation from their systems.

So what makes the DHB model different? Here’s how the authors lay it out:

* Patients own the DHB and data it contains
* Each patient should have only one DHB
* Patient DHBs should incorporate data from all providers, including PCPs, specialists, nurse practitioners, EDs, pharmacists and therapists
* The DHB should incorporate data from wearable telemetry devices like FitBits, insulin pumps and heart monitors
* The DHB should include data entered by patients, including family history, recollections of childhood illness, fears and feelings
* DHB data entry should use natural language rather than structured queries whenever possible
* The DHB should leverage machine learning to extract and organize output specific to specific providers or the patient
* In the DHB model, input and output software are separated into different categories, with vendors competing for both ends separately on functionality and aesthetics
* Common protocols should minimize the difficulty and cost of shifting from one input or output vendor to the other
* The government should not mandate or subsidize any specific vendors or data requirements
* DHB usage should be voluntary, forcing systems to keep proving their worth or risk being dumpted
* Clinical applications shouldn’t be subservient to reimbursement considerations

To summarize, the DHB model calls for a single, patient-controlled, universal record incorporating all available patient health data, including both provider and patient inputs. It differ significantly from existing EMR models in some ways, particularly if it separated data input from output and cut vendors out of the database business.

As described, this model would eliminate the need for separate institutions to own and maintain their own EMRs, which would of course stand existing health IT structures completely on their head. Instead of dumping information into systems owned by providers, the patient would own and control the DHB, perhaps on a server maintained by an independent intermediary.

Unfortunately, it’s hard to imagine a scenario in which providers would be willing to give up control to this great an extent, even if this model was more effective. Still, the article makes some provocative suggestions which are worth discussing. Do you think this approach is viable?

E-Patient Update:  When Your Tech Fails, Own It!

Posted on December 30, 2016 I Written By

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

I am reasonably comfortable with my primary care practice which, though not exactly chi-chi – no latte machine in the lobby! — does a reasonably good job with the basics of scheduling, payment, referrals and the like.  And I also like that my PCP is part of a multispecialty group linked together by an athenahealth EMR and portal, which makes it easier to coordinate my care.

But recently, I’ve run into some technical problems with the practice portal, repeatedly and inconveniently. And rather than take action, apologize or even acknowledge the problem on an executive level, the group appears to be doing nothing whatsoever to address the issue.

The issue I’m having is that while the portal is supposed to let you schedule appointments online, my last two didn’t show up in the group’s live schedule. This may not sound like a big deal, but it is. One of the appointments was to see a neurologist for help with blinding migraines, and trying to attend the non-existent meeting was a nightmare.

Because I needed my neurologist, I scraped myself out of bed, put on an eye mask to avoid extra light exposure – migraine makes you terribly light-sensitive – and had my husband guide me to the car. But when I walked into the lobby (peeking out from under the mask to avoid crashing into things) I was told that they had nothing for me on the schedule.

Almost crying at this point, and with migraine-induced tears streaming down my cheeks, I begged them to squeeze me in, but they refused. To add insult to injury, they all but told me that it must have been my fault that the appointment booking didn’t take. There was no “I’m sorry this happened” whatsoever, nor any suggestion that their technology might be glitchy. If I hadn’t been so sick I might have gotten into a screaming match with the supercilious receptionist, but given my condition I just slinked away and went back to bed.

I’ve since learned, from a much nicer clerk at the affiliated primary care practice, that the group has been getting scores of calls from similarly aggrieved patients whose time had been wasted – and health needs unmet. “Tell the doctor, so she can tell the practice management committee,” she told me. “This is happening all the time.”

Of course, because I write about health IT, I realize that practice leaders may be struggling with issues that defy an easy fix, but I’m still disappointed with their failure to respond publicly. There are many steps they could have taken, including:

* Putting a warning on their practice website, and (if possible) the portal that the scheduling function has issues and to double-check that their appointment registered
* Disabling the scheduling function entirely until they’re reasonably certain it works
* Putting a sign in on the practice’s front desk alerting patients about the problem
* Updating the practice’s “hold” message with an advisory

And that’s just what came to mind immediately. They could do postcards, email messages, letters, robocalls…I don’t care if they drive around town with a guy who shouts the message into a megaphone. I just want expect them to take responsibility and treat my time and health with respect. Sure, tech will go south, but if it does, own it! There’s no excuse for ignoring problems like these.