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The Cult of Cool in a World of EMRs

I realized two things the other day. Things I’ve been in denial about. Things I just couldn’t bring myself to admit to anyone else in the world of healthcare IT.

I’m old, and I’m not cool.

I’ve hidden these two flaws fairly well, but a recent high-profile tech acquisition has forced me to let the cat out of the bag. I’ve never used Tumblr (or Instagram for that matter), and I can’t force myself to close my Yahoo! account. I’ve checked that email address for the last 12 years. I fondly remember when my boyfriend/husband set it up for me in an Internet café in Amsterdam. He had been demanding for some time that I rid myself of my @uga.edu address. Graduation was looming and it was time for something more adult, more cool.

My how times change. It’s people like me, apparently, that are holding Yahoo! back and what prompted it to purchase Tumblr. As I’m sure you’ve heard (especially if you’re not cool like me and listen to NPR all the time), it paid over a billion dollars to acquire the micro-blogging site in an effort to get its ads in front of Tumblr’s 100 million users – most of which are young, cool and influential amongst their peers. It’s a demographic most marketers can only dream about having dropped in their laps. Now it’s up to Yahoo! to not screw it up, as CEO Melissa Mayer so succinctly said during a recent conference call.

News of the acquisition got me wondering, are EMRs cool? I think there’s certainly a hip factor around certain parts of healthcare IT. Openness, innovation, mobile health, social networking and bow ties seem to be in right now, but I’m not sure I’d go so far as to call any one particular EMR cool. Though athenahealth and Practice Fusion jump to mind as fairly cool from a branding perspective. Epic certainly seems to have won the word-of-mouth game, so perhaps it can be lumped into the cool category as well.

Perhaps the fact that only three brands come to mind is a good thing. I hope that most companies are spending more time focused on development than branding. Surely players in this most sacred of spaces would never acquire one company over the other purely to latch onto a coolness factor? I could understand the business acumen behind the decision to acquire a start up in the “hopes of gaining an edge in growth,” which is how a recent Wall Street Journal article described the Yahoo!/Tumblr transaction. Goodness knows there’s no shortage of start ups in healthcare right now.

How do you define cool in today’s world of healthcare IT? Is it about technology, branding or some unidentifiable “je ne sais quoi?” Share your comments with me below.

John’s Editorial Note: If Jenn’s not young and cool, then the rest of us are in real trouble.

May 22, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company’s social media strategies for its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

Balancing EHR Change vs Train

I was talking with Heather Haugen from The Breakaway Group (A Xerox company) today and in our discussion she used the word “train”, but I heard the word “change”. I always love a good play on words and so it was interesting for me to consider the difference between change and train in an EHR implementation.

Every EHR implementation I’ve been apart of walks a fine line between users wanting the EHR software to change versus the need for an EHR user to change. One of the most common phrases out of a doctor’s mouth during an EHR implementation is, “Why did the EHR vendor implement that feature like this? Did they not talk to a doctor? This makes no sense.” We’ve dug in previously to the concept of EHR vendors consulting doctors during their EHR development so we won’t go into that further now. Every EHR vendor consults doctors, but no two doctors practice alike. So, it’s normal that every doctor would wonder why certain features are implemented the way they are implemented.

When faced with this issue, the doctor is faced with an important decision with two options. The first option is to work with the EHR vendor and convince them to change how their EHR works. In a large hospital EHR vendor situation, this can be almost impossible. Plus, even if that EHR vendor does like your suggested change it’s going to take months and sometimes years before that change is implemented in the EHR software, tested, and released all the way to you the end user. Yes, these changes can go faster with a SaaS EHR, but it still will likely take months before the change reaches the end user.

In some cases, you can wait for the change to be made before using that EHR feature. However, more often than not a doctor is going to have to train on how the EHR vendor has implemented the feature. This highlights to me why having great EHR training is so important. Sure, many of the things in an EHR will be intuitive, but great EHR training is still always beneficial. EHR software is too complex to just pickup and use. Plus, even if you can use the basic EHR features, good training points out the ways to optimize the EHR workflow.

Most doctors don’t understand why various parts of an EHR workflow can’t be easily changed. They just think change should happen easily. Ironically, the doctor then proceeds to resist any change to how they want to work.

May 21, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Three Tips For EHR Transitions

Moving a medical practice from paper to an EHR is no picnic.  Staff and physicians both may find the process difficult, and the changes they have to make to be threatening. But there are approaches you can take which can make the process easier.  Here’s a nice triad of suggestions from EHR implementation manager Amanda Guerrero:

* Make workflow changes gradual:

Too often, medical practices assume that they can implement an EHR without making major changes to their workflow.  The reality is, however, that many processes which worked fine on paper don’t work when you switch to using EHRs, Guerrero notes. So how do you go about making changes without upsetting and confusing staff and clinicians?  The idea, she says, is to make sure changes happen gradually. Giving people time to adapt to changes helps a lot with staff morale. (It doesn’t hurt to explain how the changes will benefit both staff and patients, either.)

Ask for feedback:

Bearing in mind that changes to workflow will have to be made, how do you choose which changes come first? One way, Guerrero says, is to ask the people who are using the EHR which processes are slowing things down the most.  Be sure, she recommends, to include doctors, nurses, front desk and even billing staff in collecting feedback — after all, virtually any part of the practice can be affected by the EHR.  Once you’ve figured out which areas are the most troublesome, arrange them in order of importance so you can take them on in the most effective manner.

Educate patients:

Now that Meaningful Use has pushed practices into making patient health data available to them, it’s time to encourage them to use it. That being said, patients may be overwhelmed by the amount of data being presented, especially when interpreting lab results, Guerrero suggests.  To reduce the impact of this change on patients, and avoid confusion, make sure you help them understand what they’re looking at and how it can help them improve their healthy, she says. And make sure let patients know you’re available to help answer questions.

May 20, 2013 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.

Healthcare Innovation – #HITsm Chat Highlights

Before we get to the regular #HITsm recap, John got together with a couple of other members of the #HITsm community and did a Google Plus hangout during this week’s chat. It’s a little random, but there were some good discussions about the #HITsm chat topics. We’d love to hear feedback about what we did. We’re considering doing something similar in the future, but with a little more focused discussion.

Topic One: What does #healthcare innovation mean to you? How do you define it?

Topic Two: Do you see innovation in #medicine different than in public health, if so how?

 

Topic Three: What are effective methods of globally diffusing innovative ideas/tech when it comes to getting healthcare user buy-in?

Topic Four: Can you name any examples of tech & innovations developed in U.S. that have translated elsewhere, & vice versa?

May 18, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

What flows through you into the world?

On this lovely Friday I thought I’d throw out something that I heard at TEDMED that was quite profound. One of the organizers asked the following question that had impacted his life:

What flows through you into the world?

It’s a powerful concept to consider what we’re doing of good in the world. In fact, he asked some follow up questions for those of us in healthcare.

Are you in healthcare to do good? Or just to make money? Or just to provide for your family? Or just because you have no other choice?

I remember when I first got my job in healthcare I was really empowered by the idea that maybe something I did could help save someone’s life. It’s amazing how the mundane gets in the way of that broader vision. Although, I feel pretty good about what flows through me into healthcare IT and EHR. It just can always be more. I hope you’ll join me in thinking about this idea this weekend.

May 17, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Apps Open Up a New World of Health Value

Parents, do you remember the days before smart devices? The days before you could hand your kid a tablet or phone in exchange for at least 20 minutes of uninterrupted quiet? I hope I’m not alone in the personal love/hate relationship I have with smart devices. One minute I find myself using them as a virtual babysitter just to get through a conference call at home. The next, I find myself wishing I could program them to shut off after 20 minutes so that my kids (and my husband) don’t wind up looking like the “humans” in Wall*e. (I’ve heard the Kindle Fire has this option. Anyone know if an iPad can be made to do the same?)

Parental musings aside, I believe smart devices certainly do have their part to play when it comes to educating or even conditioning healthcare consumers, especially in the area of gamification. This point was driven home when I overheard my oldest say to my youngest as they played on the iPad, “Your health value isn’t high enough. You need to add more broccoli.”

smoothiemaster

“Smoothie Master” from TabTale was their game of choice. As the name implies, they were tasked with becoming masters of smoothie creation. I’m still not sure if this game is winnable in the traditional sense, but my seven year-old did explain to me that you could win points for adding healthy ingredients.

TabTale doesn’t seem particularly invested in promoting a healthy lifestyle, as it also has similar apps for mastering the art of making pizzas and hamburgers. But, their inclusion of a health value scoring system does make me wonder if this younger generation will grow up with an inherent sense of what behaviors will keep them healthy in real life. (The irony being that all the broccoli in the world won’t do them any good if they stay glued to the devices that are helping provide this type of education.)

Now, if I can just figure out a way to “gamify” the health value of the broccoli I fix at home so that my kids will eat it and think they have “won.” Let me know in the comments below if you’ve figured out a way to take virtual culinary successes offline and into the real world of kid-friendly cuisine.

May 16, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company’s social media strategies for its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

Geisinger Opens Doctors’ Notes To Patients

Geisinger Health System is kicking off a new program under which more than 100,000 patients will have access to their doctors’ notes. Patients will access the notes through the secure MyGeisinger online patient portal, reports Healthcare Informatics.

The initiative grows out of a pilot, funded by a $1.4 million grant from the Robert Wood Johnson Foundation. The OpenNotes project, which lasted 12 months, brought together 105 primary care doctors with more than 19,000 of their patients, in an effort to see how both patients and physicians were affected by the sharing of doctors’ notes after each encounter, according to Healthcare Informatics.

The study group included 24 Geisinger primary care docs and 8,700 patients.  The rest of the patients and doctors  were drawn from Harborview Medical Center, Seattle, Wash., and Beth Israel Deaconess Medical Center.

Results from the pilot, which were published in the October 2012 Annals of Internal Medicine, showed that patients strongly favored seeing their physician’s notes.  Also, tellingly, no doctors asked to opt out at the study’s end.

Findings showed that patients did indeed read their notes and felt more a part of the care process when they did. Roughly 11,200  patients (or about 82 percent) opened at least one note found in their EMR.

Of patients who opened at least one note, 77 to 87 percent across the three study sites said that OpenNotes made them feel more in control of their care.  Doing so also helped them adhere to their medication regimens, the magazine said. Only a few patients reported higher levels of worry, confusion or offense due to seeing the notes.

Patients liked having the notes access so much that 85 percent reported that it would influence their choice of providers in the future.

It seems that opening up a patient portal isn’t quite the pandora’s box that some thought it could be.

May 15, 2013 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.

When Patients Know More Than Doctors

With a title like that, I know I’m bound to get a visceral response from some doctors, but hear me out. As someone told me today, the thing I love about John is that you know he’s going to tell you what he really thinks. He’s not going to hold back. Hopefully that’s true. Plus, I certainly welcome other people to provide opposing viewpoints so that we can all learn together.

First I should make it clear that I’m a great patient. I have extreme respect for the doctors I work with and follow their care plans to a T. For example, as a child I took accutane. That requires you to take pills twice a day. I think there may have been 1 or 2 times I missed taking my pills in 6 months. That’s pretty good if I say so myself. Regardless, I’m quite good at following the doctors care plan for me. Over time I have developed what I call a trust but verify approach. I trust that the doctor is doing what’s best, but I do like to confirm my understanding of why it’s being done when its a complicated situation. I don’t do this for things like common coughs and colds.

With this in mind, I was kind of blown away recently when someone told me about their 20 year old son who’s a diabetic. This patient and his parents had been dealing with his disease for about 15 years. As part of dealing with the disease they’d studied it and the various treatment and management options in depth. As he said, “we set a Google Alert and have read every study and discussion about the topic for 15 years.”

After moving, this diabetic patient went to see a new doctor who had just gotten out of medical school. A short discussion started and the patient quickly realized that he knew a lot more about his condition than his new doctor. What a challenging situation this must be for the new doctor.

I think most doctors are ok with this situation and have been dealing with chronic patients that know a lot about their disease for a long time. However, the availability of medical information is helping a lot of patients to be very well informed on their health issues. I wonder if a doctor use to treating well informed chronic patients has lessons we can apply to well informed general patients.

No doubt we’re in the stage of learning a new dance with a new partner. I’m not suggesting that we should change who’s leading the dance. The doctor should still be the lead for a lot of reasons. However, I am saying that the leader shouldn’t be surprised when their dance partner wants to provide some feedback on the choreography they’re doing. The leader might just find that working together they can produce even better results.

Side Note: It seems appropriate that I should use a dance analogy with the So You Think You Can Dance premiere tonight.

May 14, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

EHR Adoption Percentage, EHR Story, and Future of EHR


I always love to grab the various EHR adoption numbers. Seems like most are hovering around the 60% number now. This one says 57% EHR adoption.


Of course, this is coming from ONC’s Twitter account, but I’m always happy to read someone’s story. If you’re willing to put your name to it, I’m willing to read it and see what you have to say. Plus, he takes a realistic look at some of the benefits of an EHR in a real matter of fact way.


This is probably the most focused and well written description of the real reasons why EHR software is a disappointment today. Unfortunately, the issues described are a fundamental problem with the healthcare system and something unlikely to change in the near future.

May 12, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

EMR, HIE Use Up Sharply In U.S.

A new survey by Accenture has concluded that the number of U.S. doctors using EMRs — either in their practice or at a hospital — has climbed to over 90 percent, and that almost half are using HIEs. More than half of doctors surveyed (60%) report using an EMR in their own medical practice.

The Accenture survey reached out to 3,700 doctors in eight countries, including Australia, Canada, England, France, Germany, Singapore, Spain and the U.S.  Data showed a spike in healthcare IT usage across all of the countries surveyed.

In the U.S., doctors had the biggest increase in adoption demonstrated in the survey, up 32 percent in routine use of health IT capabilities, as opposed to an average increase of 15 percent among non-U.S. clinicians, reports HealthcareIT News.

Other standout activities were e-prescribing (65 percent using) and entering patient notes into EMRs (78 percent), a 34 percent annual increase between 2011 and 2012. Forty-five percent of physicians also use IT for basic clinical tasks such as getting alerts while seeing patients (45 percent), according to Healthcare IT News.

Healthcare IT News also caught an interesting detail around lab orders. The magazine notes that 57 percent of U.S. doctors said they regularly use electronic lab orders  (a 21 percent annual increase) the volume of physicians doing so internationally dropped 6 percent.

Globally, the number of doctors who “routinely” access clinical data on patients seen by different health organizations has climbed by 42 percent, from 33 percent of doctors in 2011 to 47 percent in 2012. Spain was the leader by a significant margin, with 69 percent of doctors routinely accessing such data.

The study also concluded that internationally, almost 60 percent of doctors customarily enter patient notes electronically either during or after consults.

On the other hand, so-called “digital doctors” are still unlikely to connect or transact electronically with outside organizations. Accenture found that only 10 percent of physicians communicate electronically to support remote consults/diagnostics, and that roughly 20 percent e-prescribe, receive notifications of patients’ interactions with other health organizations and communicate electronically with clinicians in other organizations.

May 10, 2013 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.