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Could AI And Healthcare Chatbots Help Clinicians Communicate With Patients?

Posted on April 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.

AI-driven chatbots are becoming increasingly popular for a number of reasons, including improving technology and a need to automate some routine processes. (I’d also argue that these models are emerging because millennials and Gen Z-ers have spent their lives immersed in online-based social environments, and are far less likely to be afraid of or uncomfortable with such things.)

Given the maturation of the technology, I’m not surprised to see a number of AI-driven chatbots for healthcare emerging.  Some of these merely capture symptoms, such as the diabetes, CHF and mental health monitoring options by Sense.ly.

But other AI-based chatbots attempt to go much further. One emerging company, X2ai, is rolling out a psychology-oriented chatbot offering mental health counseling, Another, UK-based startup Babylon Health, offers a text-only mobile apps which provides medical evaluations and screenings. The app is being pilot-tested with the National Health Service, where early reports say that it’s diagnosing and triaging patients successfully.

One area I haven’t seen explored, though, is using a chatbot to help doctors handle routine communications with patients. Such an app could not only triage patients, as with the NHS example, but also respond to routine email messages.

Scheduling and administration

The reality is that while doctors and nurses are used to screening patients via telephone, they’re afraid of being swamped by tons of electronic patient messages. Many feel that if they agree to respond to patient email messages via a patient portal, they’ll spend too much time doing so. With most already time-starved, it’s not surprising that they’re worried about this.

But a combination of AI and healthcare chatbot technology could reduce their time required to engage patients. In fact, the right solution could address a few medical practice workflow issues at one time.

First, it could triage and route patient concerns to doctors and advanced practice nurses, something that’s done now by unqualified clerks or extremely busy nurses. For example, the patient would be able to tell the chatbot why they wanted to schedule a visit, with the chatbot teasing out some nuances in their situation. Then, the chatbot could kick the information over to the patient’s provider, who could, with a few clicks, forward a request to schedule either an urgent or standard consult.

Perhaps just as important, the AI technology could sit atop messages sent between provider and patient. If the patient message asked a routine question – such as when their test results would be ready – the system could bounce back a templated message stating, for instance, that test results typically take five business days to post on the patient portal. It could also send templated responses to requests for medical records, questions about doctor availability or types of insurance accepted and so on.

Diagnosis and triage

Meanwhile, if the AI concludes that the patient has a health concern to address, it could send back a link to the chatbot, which would ask pertinent questions and send the responses to the treating clinician. At that point, if things look questionable, the doctor might choose to intervene with their own email message or phone call.

Of course, providers will probably be worried about relying on a chatbot for patient triage, especially the legal consequences if the bot misses something important. But over time, if health chatbot pilots like the UK example offer good results, they may eventually be ready to give this approach a shot.

Also, patients may be uncertain about working with a chatbot at first. But if physicians stress that they’re not trying put them off, but rather, to save time so they can take their time when patients need them, I think they’ll be satisfied.

I admit that under ideal circumstances, clinicians would have more time to communicate with patients directly. But the truth is, they simply don’t, and pressuring them to take phone calls or respond to every online message from patients won’t work.

Besides, as providers work to prepare for value-based care, they’ll need not only physician extenders, but physician extender-extenders like chatbots to engage patients and keep track of their needs. So let’s give them a shot.

The Disconnect Between Where Wearables Are Needed and Where Wearables are Used

Posted on April 21, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

No one can argue that we haven’t seen an explosion of wearable devices in the healthcare space. In most cases, they’ve been a consumer purchase, but there are a few cases of them being used clinically. While we’ve seen a huge uptick in wearable use, there seems to be a massive disconnect between those who use them and those who need to use them.

This was highlighted to me recently when I heard someone say that at the recent Boston Marathon they predicted that almost every athlete running the Boston Marathon had some sort of tracking device on them to track their running. Runners love to track everything from steps to heart rate to speed and everything in between. I wish the Boston Marathon did a survey to know what devices the runners used. That would be a fascinating view into which wearables are most popular, but I digress.

When I heard this person make this observation, I quickly thought “That’s not who we need using wearables if we want to lower the cost of healthcare.”

With some exceptions, those who run the Boston Marathon are in incredible shape. They exercise a lot (maybe too much in some cases) and most of them eat quite healthy. These are the outliers and my guess is that they’re not the people that are costing our healthcare system so much money. That seems like a fair assumption to me.

Yes, the people we need using these wearables are those people sitting on the couch back at home. We need the unhealthy people tracking their health, not healthy people. While not always the case, unhealthy people don’t really want to track their health. What’s more demotivating to your healthy goals than being in a FitBit group with a marthon runner that always destroys you?

This is a challenging psychological problem that I haven’t seen any wearable company address. I guess there’s too much money to be made with healthy people that want to track themselves that they don’t need to dive into the psychological impact of wearables on unhealthy people. However, that’s exactly what we’re going to need to do as wearables become more clinically relevant and can help us better understand a patient’s health.

The Personalization of Healthcare and Healthcare Chatbots

Posted on April 20, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

At HIMSS 2017, I did a plethora of videos where I was interviewing people and even more where people were interviewing me. Many of those videos are just now starting to leak out onto the internet. One of those videos where I was interviewed was with the team from Availity. They had a great team there that interviewed a bunch of the HIMSS Social Media Ambassadors including me.

I’ll admit that I was pretty tired when I did this interview at the end of the day, right before the New Media Meetup at HIMSS. However, I think the interview shares some high-level views on what’s happening in healthcare IT and important topics coming out of the conference. Check out the full video to learn the details:

I like that I talked about the personalization of healthcare and then healthcare chatbots in the same video interview. Some people might see these as opposites. How can talking with a healthcare chatbot be more personal than a human?

The answer to that question has two parts. First, a chatbot can quickly analyze a lot more information to personalize the experience than a human can do. Notice that I said personalization and not personal. There’s a subtle but important difference in those two words. Second, I didn’t clarify this in the video, but the healthcare chatbot will not fully replace the care provider. Instead, it will just replace the care provider from having to do the mundane tasks that the providers hate doing. Done correctly, the healthcare chatbot will fee up the providers to be able to focus on providing patients a more personalized and personal experience. That’s something we would all welcome in healthcare.

All of this health data we are amassing on patients is going to make both the healthcare chatbot and the human healthcare provider better able to give you a personalized experience. That’s a great thing.

Since in the video I also recommended that people follow Rasu Shrestha, MD, you may also want to check out the video interview Rasu did with Availity:

I love the idea that we go to conferences to not just learn something, but to unlearn things. Rasu is great!

A New Definition of EHR

Posted on April 19, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

That’s a pretty funny play on words by Nicholas DiNubile, MD. Well, it’s funny unless you’re the one that’s become the government tool. Dr. DiNubile also shared this picture with the above definition.

While I think that this picture is an exaggeration of reality for most doctors, what isn’t an exaggeration is administrative overheard a doctor has now is much greater than it was in the past. In most cases, the EHR hasn’t made it any better and what the EHR vendors have had to implement for meaningful use and now mACRA have generally made this worse.

Over the past couple weeks, I’ve had the good luck of spending a lot of time with my colleague Shahid Shah. Something he’s been sharing lately is that “Doing stupid faster isn’t innovation.” We see a lot of this in healthcare. Talking to one healthcare IT vendor he came to the realization that all his company does is stupid faster. It was a shocking thought for him and likely for many that read this.

As you look at your organization and where you want to take it, are you focused on true innovation or are you busy doing stupid faster? If you’re doing the former, keep fighting the good fight. If you’re doing the later, it might be time to take a step back and reconsider your path forward.

Is ICSA Labs Getting Out of the EHR Certification Business?

Posted on April 18, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. 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 got the following email that was received by ICSA customers:

Dear Valued Customer:

Your organization has received product testing and certification services as a customer of ICSA Labs, a division of MCI Communications Services, Inc., d/b/a Verizon Business Services (“ICSA Labs”).

I am writing to inform you that ICSA Labs will no longer be accepting new engagements for product testing and certification, or renewing expiring Statement(s) of Service. However, please be assured that we will continue to honor any existing, active Statements of Service that we may have with your organization, and to maintain any current certifications for the applicable term.

Thank you for your attention to this matter. If you have any questions, please contact icsalabsinfo@icsalabs.com.

Sincerely,

George Japak
ICSA Labs, Managing Director

Does this mean ICSA is withdrawing as an EHR Certifying body (ATCB)? I asked EHR certification expert, Jim Tate, which EHR certifying bodies remain if ICSA is pulling out and he said that right now Drummond, ICSA, InfoGard, and SLI are authorized to test and only Drummond, ICSA, and InfoGard are authorized to certify. You can find more details on the ONC website.

A part of me isn’t really surprised since the EHR certification business isn’t a great business. There are a limited number of clients and a limited amount of revenue available. Plus, under meaningful use, EHR certification became a commodity. That’s why CCHIT couldn’t survive. Seems like ICSA Labs is heading the same direction as CCHIT.

The bigger question I would ask is should EHR certification continue at all?

MACRA Stats – MACRA Monday

Posted on April 17, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. 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 part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

I love a good stat. I realize that you can make stats tell you whatever you want. However, if you look at them with a critical eye, you can learn something about both the organization producing the stat and the population that the stat represents.

It’s no surprise that I found these MACRA stats shared by David Chou to be of great interest and a perfect MACRA Monday discussion.

The stat that stands out to me is the 51% of physicians who reported that they weren’t getting paid on a performance basis or that their compensation had a very small performance based piece to it. For those of us following the cutting edge of what’s happening in the world of healthcare, it’s sometimes important to remember that while the shift to value based reimbursement is happening, it still has a long ways to go.

I found David Chou’s tweet with these stats interesting when he said “Most physicians prefer the old model of payment vs MACRA.” I would look at these stats a bit differently than David.

I would suggest that these stats say that doctors prefer reimbursement models they understand and ones that pay them well. This is proven out in the stat that 71% of physicians surveyed would participate in value-based payment models if offered financial incentives to do so. It’s not really a shocking insight that doctors are happy to shift models if there are financial incentives to do so.

The challenge is that most doctors don’t think that a value based reimbursement model is going to pay them more for the work they do. They’re probably right. This explains why nearly 8 in 10 physicians surveyed prefer fee-for-service or salary for their compensation. If a new model came along that would pay them more than their current fee for service model, then they’d happily switch models.

Sometimes we make things too complicated. Physicians just want to be paid well for the work they do. Sounds like all of us no? The concern for most physicians is that these models are unlikely to pay them more. In fact, it’s quite possible they’ll pay them less or at least pay them the same for more work.

I haven’t seen any plan or projections to pay doctors more. In fact, the rhetoric in society is that we pay too much for healthcare (which is true). As a society, we all agree that we should be paying less for healthcare. However, as a healthcare provider or healthcare organization the idea of paying less for healthcare translates to getting paid less. Who’s going to take the hit when it comes to getting paid less? Providers? Hospitals? Pharma? Med device companies? Health IT Companies?

Could value based reimbursement models theoretically cost less and pay all of these stakeholders the same amount of money because patients were healthier? Works great in theory, but looking at the past history of these programs tells another story. So, it’s no wonder that most doctors would happily stay in the fee-for-service reimbursement world they know vs moving to value based reimbursement models.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Patient Access to Health Information is a Right

Posted on April 14, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. 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 was browsing some old notes I’d taken to interesting resources and ideas. I came across some videos that ONC had created around the rights of patients when it comes to accessing health information.

Here’s a look at the first video:

The video is 3 minutes long and the information could have been shared in 30 seconds, but some of the points it shares are really good. For example, that it’s your right to be able to access your health information. Also, they make the point that you still have the right to get access to your health information even if you haven’t paid your bill.

It’s always amazing to me how many misconceptions there are out there when it comes to access to health information. We see HIPAA and other rules used as a reason to not provide patients their health information a lot and it’s often wrong.

The great thing is that over the 11 years I’ve been blogging, we’ve seen a real sea change in people’s perspectives on how and when you should have access to your patient record. That said, we still have a ways to go. Technology should make that record available to you whenever and wherever you want in near real time fashion. We see that in some organizations, but not enough.

These videos will never go viral, but they are a good information source for those patients who aren’t sure about their rights when it comes to access to their health information.

The Physician – Patient Disconnect

Posted on April 13, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’ve been in healthcare for a while, then you know that there’s often a disconnect between patients and healthcare professionals. However, this divide was illustrated pretty sharply in some research that Conduent (previously known as Xerox) put out about the relationship.

Plus, to add to this disconnect, there was an even bigger divide between patients from different ages. In fact, they’re a very heterogeneous group. However, so many healthcare organizations treat them the same.

For a good illustration of these differences, take a second to look at this infographic:

Provider-Backed Health Data Interoperability Organization Launches

Posted on April 12, 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.

In 1988, some members of the cable television industry got together to form CableLabs, a non-proft innovation center and R&D lab. Since then, the non-profit has been a driving force in bringing cable operators together, developing technologies and specifications for services as well as offering testing and certification facilities.

Among its accomplishments is the development of DOCSIS (Data-over-Cable Service Interface Specification), a standard used worldwide to provide Internet access via a cable modem. If your cable modem is DOCSIS compliant, it can be used on any modern cable network.

If you’re thinking this approach might work well in healthcare, you’re not the only one. In fact, a group of powerful healthcare providers as just launched a health data sharing-focused organization with a similar approach.

The Center for Medical Interoperability, which will be housed in a 16,000-square-foot location in Nashville, is a membership-based organization offering a testing and certification lab for devices and systems. The organization has been in the works since 2011, when the Gary and Mary West Health Institute began looking at standards-based approaches to medical device interoperability.

The Center brings together a group of top US healthcare systems – including HCA Healthcare, Vanderbilt University and Community Health Systems — to tackle interoperability issues collaboratively.  Taken together, the board of directors represent more than 50 percent of the healthcare industry’s purchasing power, said Kerry McDermott, vice president of public policy and communications for the Center.

According to Health Data Management, the group will initially focus on acute care setting within a hospital, such as the ICU. In the ICU, patients are “surrounded by dozens of medical devices – each of which knows something valuable about the patient  — but we don’t have a streamlined way to aggregate all that data and make it useful for clinicians,” said McDermott, who spoke with HDM.

Broadly speaking, the Center’s goal is to let providers share health information as seamlessly as ATMs pass banking data across their network. To achieve that goal, its leaders hope to serve as a force for collaboration and consensus between healthcare organizations.

The project’s initial $10M in funding, which came from the Gary and Mary West Foundation, will be used to develop, test and certify devices and software. The goal will be to develop vendor-neutral approaches that support health data sharing between and within health systems. Other goals include supporting real-time one-to-many communications, plug-and-play device and system integration and the use of standards, HDM reports.

It will also host a lab known as the Transformation Learning Center, which will help clinicians explore the impact of emerging technologies. Clinicians will develop use cases for new technologies there, as well as capturing clinical requirements for their projects. They’ll also participate in evaluating new technologies on their safety, usefulness, and ability to satisfy patients and care teams.

As part of its efforts, the Center is taking a close look at the FHIR API.  Still, while FHIR has great potential, it’s not mature yet, McDermott told the magazine.

A Tool For Evaluating E-Health Applications

Posted on April 11, 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.

In recent years, developers have released a staggering number of mobile health applications, with nearly 150,000 available as of 2015. And the demand for such apps is rising, with the mHealth services market projected to reach $26 billion globally this year, according to analyst firm Research 2 Guidance.

Unfortunately, given the sheer volume of apps available, it’s tricky to separate the good from the bad. We haven’t even agreed on common standards by which to evaluate such apps, and neither regulatory agencies nor professional associations have taken a firm position on the subject.

For example, while we have seen groups like the American Medical Association endorse the use of mobile health applications, their acceptance came with several caveats. While the organization conceded that such apps might be OK, it noted that such approval applies only if the industry develops an evidence base demonstrating that the apps are accurate, effective, safe and secure. And other than broad practice guidelines, the trade group didn’t get into the details of how its members could evaluate app quality.

However, at least one researcher has made an attempt at developing standards which identify the best e-Health software apps and computer programs. Assistant professor Amit Baumel, PhD, of the Feinstein Institute for Medical Research, has recently led a team that created a tool to evaluate the quality and therapeutic potential of such applications.

To do his research, a write-up of which was published in the Journal of Medical Internet Research, Baumel developed an app-rating tool named Enlight. Rather than using automated analytics, Enlight was designed as a manual scale to be filled out by trained raters.

To create the foundation for Enlight, researchers reviewed existing literature to decide which criteria were relevant to determine app quality. The team identified a total of 476 criteria from 99 sources to build the tool. Later, the researchers tested Enlight on 42 mobile apps and 42 web-based programs targeting modifiable behaviors related to medical illness or mental health.

Once tested, researchers rolled out the tool. Enlight asked participants to score 11 different aspects of app quality, including usability, visual design, therapeutic persuasiveness and privacy. When they evaluated the responses, they found that Enlighten raters reached substantially similar results when rating a given app. They also found that all of the eHealth apps rated “fair” or above received the same range of scores for user engagement and content – which suggests that consumer app users have more consistent expectations than we might have expected.

That being said, Baumel’s team noted that even if raters like the content and found the design to be engaging, that didn’t necessarily mean that the app would change people’s behaviors. The researchers concluded that patients need not only a persuasive app design, but also qualities that support a therapeutic alliance.

In the future, the research team plans to research which aspects of app quality do a better job at predicting user behaviors. They’re also testing the feasibility of rolling out an Enlight-based recommendation system for clinicians and end users. If they do succeed, they’ll be addressing a real need. We can’t continue to integrate patient-generated app data until we can sort great apps from useless, inaccurate products.